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o : S M E A D No.53LOR UPC 12543 smead.com • Made In USA Slb7AINABLE fCRE51Rr WIIIATIVE cart�dRD.rEourdno ` wwwj4fOF mmp. 1�� - DPI TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4y Map Parcel V _ Application d o Health Division Date Issued 1 Z Conservation Division Application Fe 0 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis �Project`Stree_Addr�es ZOO �1nyrC1� i Address W 1>4�►'� . rJLt��� �� 2 ep e ,-j c)b) Permit Request--- _(r w%4 re-C .Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay i?roject,Valuationm A? 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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count ZVI Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other .y Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 YesO No J Detached gjrage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑anew size_ Attached gar%age: ❑ existing ❑ new size _Shed: ❑ existing.❑ new size _ Other: ~n Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ I Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use ` , i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name jTelephone�N6;, e,. Address'- Z 3c), Cti✓vt H ✓vt5 Wk Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ell `"`DATE-1(- -,% 7U1 FOR OFFICIAL USE ONLY - st APPLICATION# ' DATE ISSOED j. MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: S s,_tEOVNDATION: .P FRAME INSULATION �' t; f FIREPLACE ELECTRICAL: ROUGH - FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING /) R �' �`�! DATE CLOSED OUT ASSOCIATION PLAN NO. r , r T6 Wiz- o ariuta Ze.. - -regulatory Eeryzces r . • r ittvlJvrltrr - Mox ag F. Guar,Director . ..Building I�iyinon r-omes Perry,•CBOJ-BmZdiugCammi.c- Ono 's ' 2QD Maisa Eftit, ffYa�,MA a260I` �.Eo•s�n.ba.ris-tabl�.m�r,Ls - � . D$i= 508-8624038 .Pax: 508-79D-6M, PLAN W Owner- C' Map/Pa�ul: `�3. O d— PToicct Address a3©. Nu � �; Buiiaer- �t—n2 The faIlowii g ita v were noted:on re-yiewzng: �77"VAJ C57 ore 7 of ROiew'ed by:. _ vJj�.c:eaj trcvracc�urw�c� - 600 Washington Street Boston,MA 02111 " • f www.mass.gov/din Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricia.ns/Plumbers _Applicant Information (� D Please Print Legibly . 'Name(Businesslorgmdzation/Individual): AyV Jte,.i F CI G�✓�( Address:- U y -141'3 City/State/Zip: Phone.#: Are you an employer? Check.the appropriate'box: : :Type of project(required);. 4. I am a general contractor and I 1.❑ I am a employer with-� ❑ ' 6. New construction . - employees (full and/oipnrt-time).*. . have hired the stab-contractors 2.❑ I am a'sole proprietor or partner- listed•on the-attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have •g• ❑Demolition .workingfor me in an ca aci employees and have workers' Y P t5'• 9. ❑Building addition [No workers' comp,insurance Comp.insurance.$ ed.] 5. ❑.We are a corporation and its 10_0 Electrical repairs or additions _. am a homeowner•doing all work officers have exercised their 1 L❑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] - *Any 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. xContractors 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-contmactors have emr loyces,they must providt 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 certM under the prcins and penalties of perjury that the information provided above is true and correct. Date:Phone U 1 2G1 L I J Official use only. Do not write in this area, to be completed by.city.or town offuial. City or Town: Permit/License# Issuing Authority.(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts General Laws chapter152 iequires.all employers to provide workers' coin msation.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:" ti An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregourg engaged in a joint enterprise,and including tine legal representatives of.a deceased employer,or.the.. _..,-._:..._ ...... .... _ ..._ . receiver or trustee-of an indivi partnership, association or o legalentity,employing employees. owever e 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.msurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract fori the performance of public work until-acceptable evidence of cemplimice with the instance requirements of this chapter have been presented'to the contracting a&hority." Applicants . Please fill out'the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contiactor(s)name(s),addresses) 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 pemiit/license applications in any.given year,need only submit one affidavit indicating cu rent policy information(if necessary)and under"Job Site Address"the applicant should write"al-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 fo any business or commercial venture (Le. a dog license or permit to bum 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 As a call The Department's address,.telephone-and fax number: 1be Comm.oewWth of MassnhusQM Dgpartua mt of Thdus4ial A rcidmits Offt.c of Wesfagaf oas 600 Wasl�gtm S _ Boston, MA€12111 Td.##617-727-4900 ext 406 Or 1-M-MA&Wls Fax##61 -727-774 Revised 11-22-06 �aagav/din ' To of Barnstable Regulatory Services RnRNsznsi.E. : Thomas F.Geiler,Director. 1639. ..Building Division:. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.iown.barnstable.ma.us Office: 508-862-4038 Fax: 508=790-6230 :. HOMEOWNER LICENSE EXEMPTION 1 Please Print �.DATE: I\. Z�'j 2G\Z 4613 LOCATION: 2 04 V✓LV 7�`. lr�• G, number street. village «HOMEOWNER": AW re✓� R. C(A Cy��� ��5�''I2fi� S w„► e , _ �- name home phone# work phone#. CURRENT MAILING ADDRESS: �{3 w A �2(01D 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 j Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned."homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum' spection procedures and requirements and that he/she will comply with said procedures and requirem �. Si r omeowner 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 persons)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 4, 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 severaltowns. You may caret amend and adopt such a fom-/certification for use in your community. Q:forms:homeexempt ::. Town of Barnstable Regulatory Services r. . . MASS. Thomas F.Geiler,Director 163y. �0 '0c Building Division Tom Perry,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 as er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by wilding perinit- /alah of job) **Pool fences ane responsibility f the applicant. Pools are not to be filled ore fence is inst d and all finalinspections are pecepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS 6/2012 J � . Al h I - u3d 36.0 LOT 1 41,605t SQ. FT. #98-426 CLARK �� + 35.5P.CRES i 2 \ [ 230 CHURCH ST., W.EkARNSTAELE a SCALE 1 = 20' 1/12/02 TWIN 12" LOCUST a 7 +35.3 \L2" CEDAi / \ i a� 2 35.0 + 45.a a 42. +3 .4 / GARDEN\� 3 CRAVf� 135.3 OR, \ * 34.7a / 8" HOLL 6.1 \ 9 J� + 36. 35.8 3 4 p EXIST. DWELL. TOP FNON m 44.8', �7 4 8" HOLL • RRIG. CONTROL 804 dr 9 - v iT 4.4 1` } 35 +34.1 4. t 4 '+ 44.3 -iC•43. 'i ,r r 4.34.5 \ 45.8 Cf'q`OR MENTALS RT ' -pRpppSCD fi(�f7�[lp[�'. " 41. t 8'P/(� + 44.0 4 �h�.� +38.2 34.8 �\ 46.012" GEO R .�3.6 9 4.8\ sa` �•:.` .\\ 16"OAiI + .5 M � 2.3 � �� r qw 1. 43 '35.4 S'j, a�� �.A>o 2.0 I.N. Fes, moo' \ + 0.5 36.6 •\ + 1. .. +,3 , M \ 9.8 SM®KE DETECTORS O.K. av .. :PUeli- PLAN .. . y � !!<��TI4 • LE UILDINC;DEFT; T - - _ (ip / . c �/t,c. /�j r'roN.lo..p cN * °Fst,r:ram, Town of Barnstable Permit#A Regulatory Services Frrs monthsjrom issue date j Y 9� 16 9. `0� Thomas F. Geiler,Director ATFD MA't A J 'ERM IT Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 0.✓ I -• 5 Z O 1 J www.town.barnstable.ma.us Office: 508- i�18in 0E BARNSTABLE Fax: 508-790-6230 WRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number I Property Address L 2)C> C LI '�'�Ut _ L J' jc,/vt .Lj� !%\ [''Residential Value of Work 0a % Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Zan C i,., A ci L 6 Contractor's Name Telephone Number(,�q) Home Improvement Contractor License#(if applicable) Construction Supervisor's•License#(if applicable) ❑Workman's Compensation Insurance X-PR :SS PERMIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q r z �u ❑ I have Worker's Compensation Insurance TOWA! OF QARNSTigsL Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) 0IlZRe-side J.�' Wi1'N40 ` tk-VV' (\ ► It�1" � k� of doors _*[Replacement Windows/doors/slid rs. U-Value (maximum .44)#of windows_ 'Where required: Issuance of this permit does not exempt compliance with other to cep r ment regulations,i.e.Historic,Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission. copy of the Home Improvement Contractors License& Construction Supervisors License is equir I SIGNATURE: QAWPFILESTORMSIbuilding permit forms\EXPRESS.doc Revised 090809 The Commonwealth ofMassachusetis Department of Industrial Accidents IT-) Office of Investigations 600 Washington Street Boston, MA 02111 svw.mass.gov/din w Workers' Compensation Insurance Affidavit: Builders/Confractors/Electricians/Plumbers Applicant Information p Please Print Lepibly Name (Business/Organi2ationAndividual): Address: Z30 City/State/Zip: ^5` �'�, Phones U� ) `3•��--�z fi Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with ' 4. ❑ 1 am a general contractor and I 6 ❑New constriction have hired.the sub-contractors employees (full and/or part-time).* 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑employees and have workers' Demolition working for me in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.x quired.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions _Roof.repairs........... . .. _. .-...._.,_ ..... .....-__-. ..__�xnyself,..[No yvork�Ts.._co�np,... ...right of exemption per MGL 12. -_. ..---._... �.....-.. _..._..-r-.._._...__....... .-.... ❑ insurance required.] re u t c. 152, §1(4), and we have no q ] employees. [No workers' 13.❑ Other comp. insurance required.] *Any 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 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 isproviding workers'compensation insrrance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date. Job Site Address: City/State/Gip: 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 ender 1h pains and penalties ofperjrtry that the information provided above is true and correct Sibnahire.. Date: 1 (U Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Totivn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other 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-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 _T members or artners are not re lured to c workers corn ensation insurance If an LLC or LT P 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 maybe 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 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 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 wwtiv.mass.gov/dia I Town of Barnstable o regulatory Services ' 'Thomas F.Geiler,Director snxrrsrnar.e, Mass. " 1639. ,�� Building Division Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790-6230 HOMEOWNER LICENSE EXEMPTION. Please Print DATE: S '�i 110 Le JOB LOCATION: Z 3 o L ��fG� " 11 ���� � number street village "HOMEOWNER": ' / \V�fCi/� L'�' SUr�i 17'�GtZ�'S name �,3, ( home p one#1 work phone At CURRENT MAILING ADDRESS: `'� G�t'�/L V` VA 0 2(oto if city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelli.nps 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 pen-nit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimu inspection procedures and requirements and that he/she will comply with said procedures and requir ents. gn 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 resuhs 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\homcexempL.DOC t� �F(HE Tpk Town of Barnstable Regulatory Services saxxsrnsLF, Thomas F. Geiler,Director v Mnss �' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub)ect property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application f or: (Address of Job) signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the.reverse side. Q:FOR1vIS:0 WNERPERM 1SS10N A A 10 27 . _ U 0f YHE r0 112010 o arnstabJ3arnstable Old Mugs Highway Historic District Committee f g ��a,�T wn.ng,sHighwaY 200 Main Street, Hyannis, MA 02601;.TEL: 508-862-4787 Fax 508-.862-4784 omminee 'f° APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4) complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 4 70,Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition gAlteration 2. Type of Buildine: Q House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. ExtenorPainting, roof ❑ new roof Q color/material change, of trim, siding, window, door reVIALe. 4. Sign ❑ New Si tik0H^ —1�--= Sign ❑ Existing Sign Repainting Existing Sign 6 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole gp ❑ Retaining wall ❑ tennis court ❑ Other 6. Pool ❑ swimming ❑ Other man-made pool Type or Print Legibly: Date: 2 t 0 1 Address of proposed work: House # Z� Street: owa ll S t. Villa e 0- aa,�n -kble g S Assessors Map Lot# 1530Z� Description of Proposed Work: Give particulars of work to be done: A Lt.- wy,, t- d o� �tl�tn�A.ct V`P"J t^01 �-G (�c�a� In�ha�ot hs.�'y�ll (?-te�r.LAL re v�J ��c�lrti �✓�✓r t.L �,.,i�✓t�p"'S.___L�d�!✓S.r�t �t r/t� Se�n.�t Agent or Contractor(print), Vo,,Ae6..i er Telephone #: (5atl 3 7_S1 Address: 2-3 Q S�_ �- ��M Gb4 >M� r/L(p 6 Contractor/Agent' signature: NOTE All applications inust be signed by the current owner Owner(print): . d✓e_j Telephone#: Owners mailing address: •(j SO 'A) 236 Cti-%q ► W, �jjG��}�1,4 Ar CIL Owner's signature: 2�+ rn For committee se only. This Certificate is hereby APPROVED/DENIED D LS a Date 1� Members sig JUL 2 2 2010 �.. rkin TOWN OF BARNSTABLE Any conditions of ap royal: HISTORIC PRESERVATION 2 ` \)3kNADZ iZ-i%Z Q.•I GMD-Groupsl0id Kings High waylOKH New App IOKH Cert.4pproprint en ess o7.doc 1 Town of Barnstable Old Kings Highivay Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submiA Copies Foundation Type: (Max. 18" exposed) (material -brick/cement, other) Siding Type S�'►' material: (OolA"- L✓L., Color: trJe.%ti� Chimney Material: Color: Roof Material: (make & style) Color: Trim material �F"re_ Color: (�✓��tG Roof Pitch: (7/12 minimum) Window: (make/model)p'%164*,S,/n L'i� material Lc-J' color t^-I,% 4, Size(s): ✓-( h t,c �e z t t�1✓f C✓G�✓��./ti � W\V�d( S ��—��Z_. Door style and make: material Color: Garage Door, Style Size aterial Color P� Shutter Type/Material: K`J AIP Color: Gutter Type/Material: pUG 11 Color.- Town of s V'19hwaY Decks: material S- Lold Kiiommittee Color: Skylight, type/make/model/.- material Color: Size: Sign size: Type/Materials: Color: Fence Type (max 6') Style . material: Color: Retaining wall: Material: Lighting, freestanding on building illuminating sign Please provide samples of paint colors and manufacture [Rurof 191e[)f Wj n ors, garage door, fences, lamp posts etc ADDITIONAL INFORMATION: TOWN OF BARNSTABLE Signed: (plan preparer) print name tel. no. Location of application: Street no. Street Village twET � Town of Barnstable o� Building Department - 200 Main Street t BARNSTABIE� t H ya n n i s, MA 02601 9�A b� A,�� (508) 862-4038 rFo n�� Certificate of Occupancy Application Number: 61615. CO Number: 20080264 Parcel ID: 153021 CO Issue Date: 03103/09 Location: 230 CHURCH STREET Zoning Classification: RESIDENCE F DISTRICT Proposed Use: SINGLE FAMILY HOME Village: WEST BARNSTABLE Gen Contractor: PROPERTY OWNER Permit Type: RC00 CERTIFICATE OF.000UPANCY RES Comments: 3 0 op Building Department Signature Date Signed i Department of Health, Safety _ and Environmental.Services IME * 11MINSrABM MAM BUILDING DIVISION BY 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. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 4, -� f 2 p � 2 � 2 cL p 7 1 HEAT114G INS13ECTION AP OVALS ENGINEERING DEPARTMENT �6fPcr:�to7lS CG�u/! 2 �� O ALTH '0' . I � OTHER: FY" DW-1 SITE PLAN REVIEW APPROVAL j - WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE 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. s. I I I I Q I I I I I I I I I I . I i I . f _ , I . I oFr►,F Tgyy Town of Barnstable *Permit# Pi Regulatory Servicesr r S tens-rssue date j • a.ArmSTABLE, I Fe i 9$A ,elq �o� Thomas F. Geiler, Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 �VV/ www.town.barnstab le.ma.us Office: 508-862-4039 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax: 508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Number CjS0�I Property Address Z So ��✓;Zlii 5�' (/j ,- -16e,lvv�S R.L VVI y \ ['Residential Value of Work 60-00<. CIV Minimum fee of$35.00 for work under$6000.00 Owner's Name & Address S w- G. Contractor's Name VY Q �Ov► t om` Telephone Number ,wej Home Improvement Contractor License#(if applicable) ' Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ❑Check one: S V)F—RMIT I am a sole proprietor ❑ lam the Homeowner �,� ❑ I have Worker's Compensation Insurance Insurance Company Name 13ARNSTABLE Workman's Comp. Policy# 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 ❑Re-roof(hurricane nailed)(not stripping, Going over existing layers of roof) dRe=side P TV✓L, ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum .35)#of windows *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: QAWPFILESIFORMSIbuilding permit formslEXPRESS.doc Revised 072110 a► t! I ?Ire Commonwealth of Massachusetts Department of Indrtstrial Accidenrts r- Office of Investigations 600 Washington Street Boston,MA 02111 wivm mass.gov/dia Wa ers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applie.cmt Information Please Print Legibly Name (Emaess/0rganizatiozgndividua0: AytA -eC Address: Z 30 C h rc V7 S�-. City/StatP./Zi_p: GJ-��.tinS]"��4 t m✓� o2G Phone# Are you axemployer?Check the appropriate box.: Type of project(required): 1.❑ I am.aemployer with 4. ❑ I am a general contractor and I eis;<ploye�s(full and/or part-time). * have hired the sub-contractors 6- New construction 2-❑ I ana,asole proprietor orpartuer- listed on the attached sheet_ 7. ❑Remodeling sltii aid have no employees Theme sub-contractors have P Pla� 10 and have workers' $. ❑Demolition ,working for me in arty capacity. e 1 9. ❑Building addition [No cv�rrkers'comp.insurance comp_insurance.. egq� uind_] 5. ❑ We are.a corporation.and its 10.❑Electrical repairs or additions 3. Jam a.homeowner doing all work officers have exercised their 11..❑Plumbing repairs or additions myself[No workeas'comp. right of exemption per MGL 12.❑Roof repairs ins,usame required.]I c. 152, §1(4),and we have no f employees.[No workers' 13-2f0ther �St i,n l t.A camp.insurance required.] 'Any applicant dut checks box#1:nutst also fill out the section below showing their workers'compensation policy information. t Homeowners wbo smbviit this affidsvit indicating they are doing all wed and then hire outside contractors must submit a new affidavit indicating suc1L tcontractors that:check this box meat attached an sdditional.sheet showing the mime of the sub-c cntractors and stare whether or not those entities bave employees. If the sub.sontcactots have employees,they must provide their workers'comp.policy number. I am art eutp4er that is pros4ding ttwrkers'colrtpensn on nrsurarice for itty employees. Belosv is the policy and job site inIforma1 om Insurance Company?lame: 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 imprisomment,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 earth rrder iepaicts and penalties of perjury front fine infortraation provided above is bite and correct Si Date: T" 2" LO Phone#: �6) C) 2 Official itse only. Do not write in this area,to be completed by city or town official _ City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building:Department 3.City/Fou'n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - 6 i orgts Town of Barnstable � r Regulatory Services " iB^Ma�' Thomas F. Geiler, Director bJ9• `0� iDrB,r Building Division Tom Perry, Building Commissioner \ 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 98-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 Zl 26\(Q JOB LOCATION: 1 530Z I 23� C�v,•z�r S�, VJ . � �� number D 6d sgreet village "HOMEOWNER". A I Vldtj ^C���'C �T.��C,Z_+C) name 1>-O- AUK home phone# work phone# CURRENT MAILNGADDRESS: 11-tJ city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced es and r quirements and that he/she will comply with said procedures and requirements. natu 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 be/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 formsTXPRESS.doc Revised 072110 cF IME r, • sntwsTneLE, 9� 39. A Town of Barnstable Regulatory Services Thomas F. Geiler, 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 as Owner of the sub)ect property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form qn the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V Application # V zl�Zy Health Division FEB 1 7 RENte Issued,ued. Conservation Division n/�� Applic tion F : 4 By Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Z 30 C�v. to - Village,, W PSG _tArYnS *40Lf ,Owners bCm)H LJ A- E-1,P4.OVC C Address T30 04�0 L4 S� -Telephones 017+6 L �o� 3C-3- -\130 y Lt(l Permit•Request VVAJ t Y\-,cVL1-_0 4-e 4ru-I�✓t� �✓e��1 -�-v � ^ Yr4C iK✓1 4i7A Lt Square-.feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay vProje'ct Valuation-1-5 U 00 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 0 No On Old King's Highway: ❑Yes ❑ No Basement Type: 0 Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric 0 Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 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 0 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name - Telephone Number 5 �' 2 3o C�,, v� Sf Address_�. License # (A)' ��"'��°���' �n Home Improvement Contractor# Email, a�L�c►r�� CMn��i - «w� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE- Z 1 '4- 1 FOR OFFICIAL USE ONLY APPLICATION # r' DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER r' DATE OF INSPECTION: F. FOUNDATION Y FRAME INSULATION FIREPLACE ELECTRICAL; ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL r FINAL BUILDING 1 DATECLOSED_OUT s4 ASSOCIATION PLAN NO. .The Commormealth of Massadiuseas Departrnerrt of Industrial Accidents Office oflm-estigations 600 Washington Street � t Boston,MA 02111 wmv.rtrass gov1dra 'Workers' Compensation Insurance Affidavit:Builders!Contractors/EIectricians/Plumbers Applicant Information �P Please Print 1,egibIv .Name(susmessPOiganizationudividnal): tdd,1- ,_J —1ln•�k Address: Z3o CkAVJ-Z 5 - City/Stitch p_l.' �ay 07-bl,6 Phone: Are you an employer"Check the appropx-iate_bom. -j Type of project(required),1.El am a employer Aith 4. El am a generalcontractor and I employees(full andloryart-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 wodting for sue in any capacity. employees and have workers' [No vv orloers'comp.insurance comp.imurance,t 9. ❑Building addition. „ r ed. 5. ❑ W-a are a corporation and its 10.El Electrical repairs or additions 43 I am a homeotivner doing all work officers have exercised their 11.❑Plumbing repairs or additions my-self[No workers'comp_ right of exemption per MGL 12.❑Roof repairs insuranceregaired.]i c. 152,§1(4),and we have no employees.[No workers' 131:1 Other comp.insurance required.]' ;Any applican:ch tat checks box is1 om ut st also fill o the section below shoteing they v;o&ere compensatinapchU information_ HomeOWneM Who submit this affidarit indicating they are doing all wa l and then hire outside contrYctors mint submit a new affidavit indicating Sn rli -'Contractors that rhort this bout must attached atr additional sheet showing the rune of the sub-cantrzcto-rs said state whether or not those eu hies have employees. Ifthe sub-contractors have employees,theymastprmade tL,eir workers'-comp.policy number. I ant an eirtployer tliat isprowdddirrg it,orke.rs'conrpensatiorr iusnraace for my eniploj-ees. Below is tfie policy and job site information Insurance Company Name: Policy#or Self-ins.Lic.fi 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 NfGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and.ror one-yearimzprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe RmNarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby cer;=s and rattles o petfury drat the information pmridid above is true and correct Sitmature: Date ' Phone;F Official cial use only. Do not write in this.area,to be calnpteterl by city ortown ojJi!ciat City or Town: Perm itUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/ .own Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ` Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for then employees. Pmsaantto this sty,an errpLoye-e-is defined as."-.every person in the service of another under any contract of hoe, express or miplied,oral or wHfma." An vnproyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged ina joint enterprise,and including the legal representatives of a deceased employes,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 - dwelIing 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 shaIl not because of such employment be deemed to be an employer." I MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a Ecease or permit to operate a business or to construct buildings in the commonwealth for ray applicant who has not produced acceptable evidence of compliance with the insnrance_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 ofpublic work until acceptable evidence of compliance with the ius rran cd. requirements of this chapter have been presented to the contracting airthodty." Applicants Please f1i 1 out the worlcers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their cert fcate(s) of cn: n fn race. 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 maybe submittr--d 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 1ad„triaT 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 s elf-insurance license n>rmber on the appropriate lime. City or Town OiFicials 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/licrose number which will be used as a reference number. In addition,an applicant that must submit multiple permit/licanse 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 II (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 permitnot related to any business or commercial venture (Le. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Jnvestigafions 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 Cammonwealth-of Massachusetts ` Department C&InduStda1 AccideD.ts Office of lvestintio= 1500 Washington lit BQstou,MA f)�11I T(�L 4 617 727-4900 ext 4-06 Qr 1-977 MASSAFB Fax#617-727-7749 Revised 4-24-07 WWW as,5-gQvfdia AWC Guide to T-Yood Construction irz High end k-errs:IIO mph T- nd Zorie Massachusetts Checklist f6 r COrap:Irane (7ao muz s301.2.1.1)` C1 check 1.i .SCOPE � � � - . Compliance WindSpeed(3-sec. gust)........................................................................... --•._....110 mph Wind Exposure Category__.._..__.......__. . --- _ --•-----..__..,_-•••------••-••------------ Wind Exposure Category................En rneetin R uin�For Entire Project •,•-•C 12 APPLICABILITY Number of Stories(a roof which exceeds a in 12 slope shall be*considered a story) stories s 2 stories RoofPitch __...__ _ - - —_---•----••----•--•-•_..._17(Fig 2) -----•- :................:.- -- <12:12 MeanRoof Height'.............-----•------•---...._...-----••---...:-•-->--(Fig 2)................................................._ft -<'33' Building Width,W_----------_............................... ...... :_(Fig 3)...___._._._.._._:.._. Building Length,L --,--•---------.__-_...--•-.........._:...___.._. Fi 3 — Building Aspect Ratio(L/W) -•---__.....---•--_.__.._..------........ F 4 — Nominal Height of Tallest OpeningZ ...... .............____._.._..._. --....._ (Fig 4)....____._:_..__.___.:_,_..._:' < ..... _6B` 1.3 FRAMING CONNECTIONS General compliance with framing cflnnectians._....._,___._.__.(fable 2).........._........ . 2.1 FOUNDATiON Foundation Walls meeting requirements of 78D CMR 5404.1 Concrete........................:............. :... ......_.._...:... ..............................._• . CancreteMasonry------------------_------------------------------------------- ••---•-•-• -=-- 22 ANCHORAGE TO FOUNDATIONIA 5/8'Anchor Boits<imbedded or 5/8"Proprietary MechanicA-Anchors as an'altemative in concrete only BoltSpacing-general..................................._._:.(Table4)..----,---_,--_-...----•_--_..._..------------ in. Bolt Spacing from endpoint of plate...........-___------------(Fig.5)----------._--_:-----_-:------__- in._<6"-12'. Bolt Embedment-concrete--__....._.............-.............(Fig 5) - __._......:.------•---:---•- in.>_7" Bot(Embedment-masonry.......................................(Fig 5) ------------------------------- in_>_15' PI to Washer......,..............................---.......... ...........(Fig 5)------------------------------------- -'-3-x 3`x%' 3,1 FLOORS Floor•framing member spans checked':-----_ -_____---__--_•-_,_,(per 780 CMR Chapter 55)_._,------•----••---•_ --_-- Maximum Floor Opening'DimensiDn-.....................- ---(Fig 6)............._..._.._- -......... ............. ft<12' _ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)-.*............. MbOdmum.Floor Joist Setbacks Suppoffing Loadbearing Wails or Shearwall...._..........(Fig 7).............-.................................. . ft s d Maximum Cantilevered Floor Joists T Suppargng Loadbearing Wa[ls'or Sheankall..............-(Fig 8)....................................._............ . ft s d FioorBmcing at Endwalls...................................................(Fi9 9)-••-=----------•---------• --.-_.._..._. — Floor Sheathing Type '........ _--------- --- ------- _------------------- (per 780 CMR.Chapter 55)................................ Floor Sheathing Thickness _:_______________________;___.._...._:-----(per 780 CMR Chapter 55)_.................._... in. Floor Sheathing Fastening_..........................................:..(fable 2)__d nails at in edge I' in field 4.1 WALLS Wall Height ; Loadbearing wa[Is.�.._.-- ___--- __-•-- - (Fig 10 and Table 5 < 101 Mort-Laadbearing vralfs.,......................._. _____.__,(Fig 10 and Table 5)_.._..._._. ......... fi's20' Wall Stud Spacing :-------_----------- (Fig 10 and Table 5) Wall Story Offsets- _._...._._...........:..(Figs 7&8)_-___..._.._,._.__.------._..._:... ft c d 42 L TERI O1;Zw lriIALLS' Wood Stids LoadbearingvMls:..._......__....................................(Tabled) =- -----------------2x -_ff_in. Non 1_aadbearing•walls..........................................._..(Table 5)__-_•,-_,__.........._....---�_-_ft in. Gable End Wall Bracing' ; Full HeightEndwall Studs-------------_.___.--------•--..._...(Fig 1D)..._ .....-......... ---._...._. WSP•Abc Floor LPngfft._..-•-------.::._.._._.:_...:-_---_-,(Fi911)_. ----_........_..............._ ft'W/3. Gypsum Ceiling Length(if WSP not used)....................(Fig i 1)..,__..__---•-,_,-----•:---•_,_„-•,_ft>_0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.r-_(Fig 11)........:......................-......__.. r or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing Double Tap PlatE in end joist or truss bays Splice Length -_----._.,_:._...._----_........... _(Fig 13 and Table 6) ...................... ft Splice Connection (no.of 16d common nails).._..........( -able 6).._._�.._...................... 4 TVC Guide to HVood C'onstructiou in High Wigd Areas: 110 Frzplr Knd Zone MassAchusetts Checklist for Compliance (7-90 CLWR530l.-l.1), Loadbearing Wall Connections `- Lateral(no.of 16d common nails)_._..........................._(Tables 7)........—..._................ _......._....-_-_-. . Nan-Loadbearing Wall Connections Lateral(no-of 16d common nails)_.._ _.__.__.._.... (Table B)_.__.....__.......................................< Load Bearing Wall-Ope'nings(record largest opening but check all openings for complance to Table 9) Header Spans - •---------------------------- ..........(Table 9)..__._:..._..---_. ft in._ 11` SinPlate Spans ' ...............:.......—...........................(Table ........................ ft_in. Full Height Studs (no.of studs)....._...._.....................(Table 9).--.--.-._.--.-------------_-.--_. ----- -.-. Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans ..-•••..............._...._....(Table 9)--------------------------------_ft_in.!9 12' Sill Plate Spans........................— -.....- -- --.-..(Table 9) ------ - _�.._..._ft in. 912' Full Height Studs(no.of studs)._'. -_---_-•--(Table 9)---------------------------------------------- ._.- Exterior Wall Sheathing to Resist Uplift and Shear Simuftaneausly4 Minimum Bilrlding Dimension, W Nominal Height of Tallest Dpening2 ...............................;_........-.--------......._--------..__.-_5&,Er .Sheathing Type.............--------------•---•-.------.(note 4)_--_-•-•--•-•-----•------••-------......._..... -Edge Nail Spacing—............. .__....---------+-(Table 10 or note 4 if less)---------------------- in. Feld Nail Spacing.........................-...............(Table 10)..............-•------------------_...__.. in. Shear Connection(no.of 16d common nails)(Table 10):......................._._.__....___..._._.._._.._.__ Percent Full-Height Sheathing...................:...(Table ib).................................._.___-_..__._..._% - 5%Additional Sheathing for Wall with Opening>Vr(Design Concepts)------------------- Maximum Building Dimension, L Nominal Height of Tallest Opening?...._............. . ........................... .......___.._5 6'B' SheathingType..............................................(note 4)•----•--------•--------------------•----------•-' Edge Nail Spacing----•--------------------_.....--___-.{Table 11 or note 4 if less)----.__-...-•----.... fn. Field Nai(Spacing.-------------•----•------•-.---.---:-.(Table 11)--------•---................--....._......... in. Shear Connection(no.of 16d common nails)(Table 11.).......................—..................... ___._ Percent Full-Height Sheathing........_____._.._.(Table 11)---------------------------_.-----------_- _% .. 5%Additional Sheathing for Wall with Opening>6'B'(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?---------------------------_-_....................... ..._..................--------------------.-------- 6.1 ROOFS Roof framing member spans checked?................------(For Rafters use AWC Span Tool,see B.BRS Website) Roof Overhang ...................................................(Figure 19)._--:-------_ft 5 smaller of 2'or 1A Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................._ =----(Table 12)------------•------•----_--•-------U- Ptf Lateral.............................—-----•------.(Table 12)_-------------------------------------L= Plf Shear......_......------......-.....-------------(Table 12).................................. Fridge Strap Connections,if collar ties not used per page 21... (Table 13)...................._.......T= plf Gable Rake Outlookei ........................:............._.(Figure 20) ............. ft s smaller of 2'of L12 Truss or Rafter Connections at Non-l-Da_dbearing Walls Proprietary Connectors Uplift—------------__............. (Table 14) ------- U= lb. Lateral(no-of 16d common nails)__.(fable 14).......................................L= . lb. Roof Sheathing Type (per 78D.CMR Chapters 58 and 59)....... Roof Sheathing :........:.._--------._.__..____ _in.>_7f16`!�►5P Roof Sheathing Fastening--.................__.._._._..._._...._.(fable 2)_......................................... __--._.. Notes: 1. -This This dieckrrsf shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 78o CMR.53D1.2.1.1 Item 1. if the checklist is met in its entirety then the following metal straps and hold downs are.not raq uri ed per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 . b. 20 Gage Straps per Figure 11 c Uprdt Straps per Figure 14 d_ Ail Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 Sa and Figure 1Bb - Exception:Opening heights of up to 8 ft_shall be permitted when 5%is added to the percent full-height sheathing requirefrients shown in Tables 10 and 11. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal Ncimess pressure treated#24rzida. AfYC Gi de to Wood C-orrrfruction irr High 14,indAreas_ I10 nzph lrxrdZone Massachusett§ Cheei►list for Compliance (780 c TAR S30t 2.1:1)' 4. a From Tables 10 and 11 and location of wall sheathing and Buldmg Aspect Ratio,determine Perr-60t Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: {. Panels shall be installed with strength axis parallel to studs. I All horizontal joints shall occur over and be nailed to framing. I'c{_ On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first fioor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered k 3 inches on center per figures below:Vertical and Horizontal"Nailing for Panel Attachment 5. .Glazing protection: a)new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte.28 or north of-Rte.6) b)vertical addition—not required unless there is extensive renovation to the first fioor c)replacernent windows—needs energy conservation compliance only(chap 93) S.Wood Frame Construction Manual(VJFCM)for 110 MPH,Exposure B.may be obtained from the American Wood Council (AWC)website. ' N9r ENTHMEDGERES-MO1 Fr}AMRtG MEW hIA&S • 'ATSha . 11 - II 'I • 11 1t tl t • 1 tt JI-I it tLt a t t oititi ;i0 - 1 iJf �[L Lt t rc tl l { 1 rt r fl • -tL- 11f-��r- f+ ..�A 1 tL4tL PATiH�hT 7s PxhlS — PR " HEL l PANEEDCE QQUKEU111-MGESPACM DEAL ' Sea DeWil on Next Page Vertical and Hotiz_on{al NaTng Detail . for Panel Attachment Vertical and Horizontal Nailing j for Panel Afiachmant . = Town of Barnstable Regulatory Services 9 V�$; Richard P.Sca14 Director Building Division Tom rerry,Building Commissioner 200 Main Street;Hy=ds,MA 02601 www.townb arnstable_ma_us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing A Builder as Owner of the subject property hereby authorizeVZ to act on my behA in all matters relative to work a o&-ed by building permit applicatioa for. (Address of job) Pool fences d alarms are the responsibilityof e applicant Pools are not to b d or utilized before fence is installed and all final ' inspections.are perormed and accepted_ S;pat,*e of Owner Signatzue of Applicant Prim Name Print Name Date . QF0RIa:0WNEUERIMsI0re00rs 'down of Barnstable Regulatory Services �TI-M r Richard V.ScaA Director t BEaIdmg Divisi0li sJAI8r--.gip Tom Ferry,Building Commissioner rMAMMa� 200 Main Steer; Hyannis,MA 02601 www town-barnstable.ma-us Office: 50 8-862-403 8 Fag: 50 8-790-623 0 HOMEOwrat r ZC NM EXEN=09 plc �'DA�•, 2�2 nnmbcr' sit valap 506 3 — �2�� 5�� 3� - ll �-e-o names - bomaphonc# wo*ph=# . 7 • CURRENT MAILINGADDRES9: city/town sidin zip cods The current exemption for"homeowners"was extended to include owner-occupied dwcUines of six units or less and to alloy homeowners to engage an individual for hire who does notpossess a license,provided thatthe owner acts as supervisor. DEFDIMON OF]IM owNER. P erson(s)who owns a parcel of land on which helshe 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 contacts more than one . home in a two-year period shall not be considered.a homeowner. Sash`hbmeownei"shall sulimitto the Building Official on a form acceptable to the Balding Official,that he/she shall be responsible for Q such work performed under the balding permit (Section 109.1.1) The undersigned`,`homeowner"assumes responsibility for compliance wi h&c State Building Code and ofher applicable codes, bylaws,roles and regulations_ - r The rmdersigmed`Lomeo'Ym "certifies that he/she understands the Town ofBazustable Building Departzmcnt mmimmn inspection pace and re • eme that he/she will comply wifh said procedures and regairemems. S ah o ilomcowna Appraval ofBmtd-mgOfficial Note: Three-family dwellings mnfainb 35,000 cubic feet or larger willbe regniredto comply with the Star Balding Code Section f27.0 Consructon CG'ontroL HOMF,OWNEX'S EXMOIION The Code states that. "Any homeowner performing work for which a buiT�permit is required shall be exempt from the provisions of this section(Section log-U-Licensing of constrnction Supervisors);provided that if the homeowner engages a person:(s)for hire to do such work,that such Homeowner shall act as sup ervisor." Many homeowners who use$its exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction SQpervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case•,our Board cannot proud against the unlicensed person as it would with a Iiiaensed Supervisor_ The homeowner acting as Supervisor is IIItim.ately responsible. To ensure that the homeowner is My aware of his/her responsibilities,many communities require,as part of 12Le permit application,that the homeowner certify that helshe understands the re�ponsItiities of a Supervisor. On$ie last page of this issue is a form currently used by sayeral towns. You may care t amend and adopt such a form/cerfffiCation for use in your cammuuify. - Q�wPFII�S1FORt„tc�t„n��pemzitfa�sll�FBFSS.doo Revised 061313 Zoo G►{v2u�1 St= F,t�rZrJ�fA- , . Asa ,�• � . �� OF ss9 2ya Cy 12 RICHARD J. �� Q DEMPS 12 o EY " STRUCTURAL y o No.291730 ��. 2nc FI. iQ 2x8 Joist /STEa i /ONAL 3-1/2" Dta. Lally _4 9) 2 10'e x e • 16". o.c. on 30"x30'x113' 2x6 Wel 24'-0" '-10" Did. Lally Column. on 30"x30"xlb Gono. NO. rRI (� 8aeler 1/4 1-O LE A U l5 LJ U �� � �• .��>• �o pP�1 7 REC D r_ 12 - Q 10 Existing 1/2" PIyWOO betwe(Aboven (2) 2xlO" 2nd FI. 2x8 Joist `t 11'-O LL c I G let fl. `n ,1_ Existing Wall to be remove truotural Column C Ad • between Kitchen / eating area jq (3) (2) 2x10's below w it,-// 4) 2x1 'e 2x1 • 16" 0.0. mot• 2x6 Wal -4 on 90"x30 x16' COn Ftg. 22'-0" O�ctton LECsENDa U-NLE66 OTNERWI6E NOTED 8ca1•r 1/4 . 1- EXI8TING� M"TMG (TO BE REMOvED)- ----- PROP08EPS l� *'>6 S-►4J a-4 r7 S'- 6A- [�N S CA(sL� THE DEMPSEY GROUP, INC. JOB ' 8 Beaumonts Pond Drive SHEETNO. `may �( of 'y i FOXBORO, MA 02035 CALCULATED BY DATE (508) 543-5499 Fax (508) 543-0289 CHECKED BY DATE SCALE .............:..............:..............:.............:.............:.............. ..... ...... ..... ..... ..............:.............:. .... ....:......I.....rYl_ ....................................... ..... ..... ...... ..... ..... 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I .... ....:..... .._:.... ...:.... ............. ...................._........ .....<................. ....... ....... .... ...... ..... ...... ..... ..... ...... ..... . ....; .............:...�._o..� .r�n,� .................................. Fug► �J .. <........................................ Z...................... ...... ._........... s ..........:.. ............. :............_:......... ......._ - 1 . L......:.:.......D.: �..... �........ �o..,S......................:..... ,......o..�... 1..�..1.. a..... ...... ... �..... _o....... o, 20 :............e.............;.............;..............:.........�.......:. :............:......... P �-; �: ��> > ............... .. .................... ......a......S....M_......1... .............;....u.f.�.................. .......................................r..........._;............_.............:..........._..........................:....................... ..... ..... ..... ..... ...... ..... ...... ,2.� ...:... ...:.... ........................................ . ............................e...........................................,............... . '. ...... ,.-...... ...... .............'............_.......................................................................................... ..... ..... ... .... .... ..... .... .• P7 . ....._:.... l n�...5P_�.[.G(�l ate... :.............:..............:.............:.............;..............:..........................;...........;........................ ...:......... ....:..... ........... ....:.... .. ..... ...... ppnnllR iM.,�Sinnl.CMgc17�IS.t iw�nnAl m®isw Double 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam1F1301 BC CALL®2.0 Design Report-US 1 span I No cantilevers J 0/12 slope Friday,April 02, 2010 02:06 Build 276 File Name: BC CALC Project Job Name: Description: BM#1 -2ND FLOOR-REPLACING EX. WALL Address: 230 CHURCH STREET Specifier: City, State, Zip: BARNSTABLE, MA Designer: RICK DEMPSEY Customer: Company: THE DEMPSEY GROUP, INC. Code reports: ESR-1040 Misc: STRUCTURAL RENOVATIONS w��*�� .' SS yynn 4.:i9`.:4rTs 1 tt�,�;N .., ,,c }v'� ?cr"r f.�e.',yr n� lfi. a J�7-yy r r k, iri Niy r< -'r � ,.. ? }h/;:.,.. b; '!*:,�f : .,.'�e4...t f a.'. F+7: ..�.. ,� .i:� Xr, 13-09-00 BO,3-1/2" B1,3-1/2" LL 2,722 Ibs LL 2,722 Ibs DL 1,854 Ibs DL 1,854 Ibs Total Horizontal Product Length=13-09-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref.' Start End 100% 90% 115% 133% 125% Trib. 1 AT+WALL+2ND Unf. Lin. (plf) Left 00-00-00 13-09-00 396 258 n/a Controls Summary value %Allowable Duration Case Span Disclosure Pos. Moment 14,701 ft-Ibs 69.1% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 3,724 Ibs 47.2% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U333(0.479") 72.0% 1 1 output as evidence of suitability for Live Load Defl. U560(0.285") 64.3% 1 1 particular application.Output here based Max Defl. 0.479" 47.9% 1 1 on building code-accepted design Span/Depth 0.47 Na 1 properties and analysis methods. P P Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dlm.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 4,577 Ibs 51.5% 49.8% Spruce-Pine-Fir or ask questions,please call B1 Post 3-1/2"x 3-1/2" 4,577 Ibs 51.5% 49.8% Spruce-Pine-Fir (800)232-0788 before installation. BC CALCS,BC FRAMERS,AJS-, Notes ALLJOISTS,BC RIM BOARD"" BCIS, Design meets Code minimum U240 Total load deflection criteria. BOISE GLULAM S SIMPLE FRAMING 9 ( ) SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum (U360) Live load deflection criteria. PLUS@,VERSA-RIMS, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRANDS,VERSA-STUD®are trademarks of Boise Wood Products, Connection Diagram L.L.C. �{ b d a c e a minimum= 1-1/2" c=8-7/8" b minimum=4" d=24-' e minimum= 1" Member has no side loads: Connectors are: SIDS 11/4 x 3-1/2 Page 1 of 1 Title: 230 CHURCH STREET-BARNSTABLE,I Job#10005 Dsgnr: RJD Date: 2:23AM, 2 APR 10 Description:STRUCTURAL RENOVATIONS Scope: Rev: S80002 Timber Column Design Rev: w0606547,Ver5.8.0,t-Dec-2003 Page 1 (c)1983-2003 ENERCALC Engineering Software 10005.ecw Calculations Description 4X4 POST @ 2ND FLOOR General Information Code Ref:2001 NDS,2003 IBC,2003 NFPA 5000.Base allowables are user defined. Wood Section 3-2x4 Total Column Height 7.25 ft Rectangular Column Load Duration Factor 1.00 Column Depth 3.50 in Fc 500.00 psi Width 4.50 in Fb 500.00 psi Sawn E-Elastic Modulus 1,000 ksi Spruce-Pine-Fir,No.2 Unbraced length for"y-y"axis sideways deflection 7.25 ft Unbraced length for"x-x"axis sideways deflection 0.00 ft Lu XX for Bending 0.00 ft Loads Dead Load Live Load Short Term Load Axial Load 1,854.00ibs 2,722.00lbs 0:00 Ibs Eccentricity 0.000in Summary Column OK Using : 3-2x4, Width=4.50in, Depth= 3.50in, Total Column Ht= 7.25ft DL+LL DL+LL+ST DL+ST fc:Compression 290.54 psi 290.54 psi 117.71 psi Fc:Allowable 340.37 psi 340.37 psi 340.37 psi fbx :Flexural 0.00 psi 0.00 psi 0.00 psi F'bx:Allowable 500.00 psi 500.00 psi 500.00 psi Interaction Value 0.8536 0.8536 0.3468 Stress Details ' Fc:X-X 500.00 psi For Bending Stress Cates... Fc:Y-Y 340.37 psi Max k•Lu/d 50.00 Fc:Allowable 340.37 psi Le:Bending 0.00 ft F'c:Allow•Load Dur Factor 340.37 psi (Lu xx•NDS Table 3.3.3 factor) Fbx 500.00 psi Rb:(Le d/b"2)^.5 1.000 F'bx•Load Duration Factor 500.00 psi Min.Allow k•Lu/d 11.00 Cf:Bending 1.000 For Axial Stress Calcs... Cf:Axial 1.000 Axial X-X k Lu/d 0.00 Axial Y-Y k Lu/d 24.86 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION C. Map 55 Parcel Permit# l/)`15— Health Division 6 �,.S � L Date Issued Conservation Division Z� Z bZ Fee o (� Tax Collector '' Z (7 C� Treasurer Planning Dept. .. , . . ,. . ,... ... . , .• .._. Gt .. ._ Date Definitive Plan Approved by Planning Board v - r Historic-OKH Preservation/Hyannis -Dt—MOTOR REQUIREMENT'S Project Street Address 23° ,�C h ,S'�KI E VV B E D R O O M WILL.-TRIGGER A I`A v�es�' B ,u � CTO P; Village �, 5 F�bl� In t�e— -.. . 14 Owner �yk&- ��h,.k e �f�LAI`�ddr�s ��G �� �, ,We- Telephone 3�5-q2�5 tLEC T RICIAN TAKE OUT THE APPRDMIATE i !di Permit Request 'tp = _ ^ Square feet- 1 st floor: existing 1000proposed 41" 2nd floor: existing eTZu proposed 40o Total new bav Valuation 4� Ova Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. TZ� 4 C Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 32- Historic House: ❑Yes ff'&o On Old King's Ftrg:way: ❑'Ies 90 No Basement Type: &full ❑Crawl 21`�Valkout ❑Other NI co C -ts7-1 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) co w Number of Baths: Full: existing Z- new —Z Half: existing new Number of Bedrooms: existing 2 new Z Total Room Count(not including baths): existing new 2 First Floor Room Count `{ Heat Type and Fuel: ❑Gas O(Oil ❑ Electric ❑Other Central Air: ❑Yes RrNo Fireplaces: Existing New 6 Existing wood/coal stove: ❑Yes YNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:dexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Nam 46 wdE� At.f/^^ Telephone Number,__�db_ Address .° • 'bOX OH-S License# BA�rJ 51143 L� ^^U4 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 5ho 10Z t FOR-OFFICIAL_USE ONLY dll PERMIT NO. i DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ; DATE OF INSPECTION: a FOUNDATION Ja i _ a FRAME -47 a 2 e INSULATION.. Al FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH 'RENAL GAS: . ROUGH -FINAL'S FINAL BUILDING.-ACIAl 5 3 �4/ 0 ,/ h V y sit ' .. DATE CLO$ED OUT a -� ) ASSOCIATION PLAN NO. RESIDENTIAL BUILDING PERMIT FEES— APPLICATION FEE L. New Buildings,Additions $50.00 Alterations/Renovations $25.00 - Building Permit Amendment $25.00 - I i 1 FEE VALUE WORKSHEET , NEW LIVING SPACE YOO = 23� •06 square feet x$96/sq.foot= x.0031 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x W/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.I , >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 ' >150 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= ' STAND ALONE PERMITS Open Porch x$30.00= (der) Deck x$30.00= (number) `FireplacefChimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee proicosc I',.ril.�t.'�, j�YjWj'r4YnF-K'9�"'�i/yyr l3'"yYS4M.,'k; ::pi;"6`Sl�+�1.•-+.:."nu.,;.a'•K."'1.�•:ww.:.w.-.... . .r.., y .a.�:.:.'. . `.i,nwrsry-njyia.HriyrFtn• Y--- .*�•xn' t-Y7� INE� � Town.'of Barnstable It BARNSTABLE. Regulatory Services e MASS. t639. a.1 Building Division prFO MAC 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 { Inspection Correction Notice z; Type of Inspection Location r'T' I-u?q Permit Number k p. Owner Builder One notice to.remain on.job site, one notice on file in Building Department. + The following items need correcting: # G t Please call: 508-862-4038 for re-inspect•oC Inspected by Date 2 / 0 1 t Application to e ,^=Y '�^ . , ®Yb �Z•ing'� �ig�jkoap �.egionaY �i�toric �i�tr" e o s'� In the Town of Barnstable BARNSTAC3LE, MASS, CERTIFICATE OF APPROPRIATE E7 99 10 Ar' 9: 33 Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ZAddition ❑ Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE 2 12 SI oZ ADDRESS OF PROPOSED WORK�� 2 3� G�`'rc� Si - ASSESSOR'S MAP NO. OWNER f�,ndfe� Elea�ar C�c.rk ASSESSOR'S LOT NO. OZ� HOME ADDRESS Z250 C1nur1., TELEPHONE NO. 375-927S �� Box `lW3 t.�•$�,MS + �^ OZ e FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR TELEPHONE NO. 3 1-5_q 2 25 ADDRESS SA DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. _ \ 1 J- aN �a a� n� aJ0\1hc4, "Fa OA- 1& %A- ^k Z 30 C t "Ve 6\ Signed GK�--- A P Owner-Contractor-Agent � CIF For Committee Use Only- J !.�1� his Certificate is hereby Date 3-2 7'oL— Approved/Denie IL MAR 05 2002 Committee M m. be s' Signatures: TOWN OF BARNSTA113LE (LLD IIING'S,HIGH_ AY j_ . 4 Town of Barnstable Old King's Highway Historic District Committee 2 SPEC SHEET FOUNDATION TC vred C0%^Cv4+_q SIDING TYPE S�`�" \�P.S COLOR CHIMNEY TYPE ^c4 COLOR ROOF MATERIAL `'�'�"�k COLOR PITCH i2 V0^�r In WINDOWS Fxk%�n'A . COLOR SIZE TRIM COLOR DOORS ^S�`^'"+ ,1��r''r` �'` �d� COLORS SHUTTERS 2�IS�IK COLORS GUTTERS e 1,CIS COLORS DECKS MATERIALS GARAGE DOORS �^ COLORS SKYLIGHTS dv� SIZE COLORS SIGNS A-,, AFFI 10VED COLORS o llII I > ENCE d f �'S COLOR MAR 0 5 L� 0TES: Fn.t lately, including measurements and materials/colors to be used. Four copies of this TOW,, OF BARNSYHa3 aguired for submittal of an application, along with Four copies of the plot plan, landscape (LLD KING'S ,ydn aanN Lation plans, when applicable. WAY SPECSHT Revised 11/98 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mj � Parcel r e", I Permit# (o Health Division Date Issued Conservation Division +\ r7 16 o Application Fee Tax Collector �l �� � Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis 6V Project Street Address s"o CVt v, cam . Village UJ, 3 5 AW Owner >'' nArf„i Address rVAvv-t AS w � Telephone ZZ+S Permit Request TO r e r>�A Le k S-h&A& �v-e P IA w c�i 1 �Ot cJ n Square feet: 1st floor: existing 000 proposed 00 2nd floor: existing proposed Total new9BO Zoning District Flood Plain Groundwater Overlay Project Valuation 4, Soo 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 32 3,c,rs Historic House: ❑Yes Roffo On Old King's Highway: ❑Yes ❑No Basement Type: I"Full ❑Crawl &*alkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 1 Z— Half:existing new iNumber of Bedrooms: existing 2 new Total Room Count(not including baths): existing new Z First Floor Room Count y Heat Type and Fuel: ❑Gas YOil ❑ Electric ❑Other Central Air: ❑Yes IrNo Fireplaces: Existing Z New e3 Existing wood/coal stove: ❑Yes C21rNo 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 BUILDER INFORMATION Name fC'vJ G�ti�� Telephone Number Address Z 3d CLt v fr w 5�, License# Dw fyy LALL �h'a�nS �4, "�'� A Home Improvement Contractor# G2(o4� Worker's Compensation# NSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOTURE DATE lL aZ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - - MAP/PARCEL NO. ADDRESS VILLAGE OWNERt`p DATE OF INSPECTION: ,.. FOUNDATION ` FRAME Ze '? INSULATION FIREPLACE 944 wl or- o f-d a. /2 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL- GAS: ROUGH FINAL FINAL BUILDING /`i Al c`f i 6 DATE CLOSED OUT , 41 ASSOCIATION PLAN NO. °FZME rqs, Town of Barnstable Regulatory Services inaxszasze, Thomas F.Geiler,Director 116 . 9 1pp�y(a , Building Division Tom Perry,Building Commissioner " 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �f p1A u2 CIA 1 w►", Estimated Cost� Address of Work: 23 d CLi hrz in 0 Owner's Name: AmAv-ery ' P- - C(,4 Date of Application:_ O'L I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR D to Owners Name Q:forms:homeaffidav f The Commonwealth of Massachusetts r.. ...... Department of Industrial Accidents Office ofMosti9adons . 600 Washington Street Boston,Mass. 02111 `3 Workers' COm ensation Insurance Affidavit _ e location: 23 C) CkA Jrz h '�• city W ecA- VM d2iolo —Phone# ❑ 'I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one working c ach i%%/n a y %%////%%///%%/%%/%%//%%%/%%%//%%%/%%��%%///%/%%%%%/% %///%/%%O%%%%%%%%%%%/%%%%///%/%%%%%%%/G%�%%%%�/%%�/�////���%%��//%%%/ orkers' com ensation for my employees worlang on this job. din w P :..:.... .t..:......... ,.:.:.::.: \., 1 er_ rove .................,-x.........:.::..:.... .K:.K:.t.::::?::$!::$_i}}Y:.."+,2}:$:2><_$$>$:::x::n,.:x4.:: am an e g ......................n.......,. ..........,... . ,.......... rr.....t.:..:....:..::.,-.,..;:;.::-:: .:.::::.<ii:{!•.�`:.::::L.:.Y::.:...,, ............ r...r......,...:n..:...............r....r:.n................... ....................{n...n...............x.• .......{................. v:•.v:•:::::.Fv::•t}':::::: ...}::m..........}:..:..:.. /..•..,v}:':}:::: .n. v....... ........... ...,...... ...........v.....::::::.v:n......:::::.. .. ...... ...........:v.,:w:::::...,.........t::•:v;::::;, ,..{•i;{.:?•)}:+•}i}):v?i:;•i}:::::vi::::.v:::::•:r4 ...r.v.................. ..........r.......t..... ........ ...r........... .........n....•.........n...r.:...... ..........n:.................n......, :.:.v:::::4}:r. ..... v: ..........r.........n•...........r.............r.n....................:..... ......... .....}.....n• ....Fi.......n...• ... ...r.n.......}:.v:::::r: t ...v... n........ n.............. ..r........n .......t..... r.... ,... .. ..v............:..........:t....}:•r.+:•.{':•:•:%{:^:ji}$:v:•2>:!;tyv;: .r. r......... ........... .........v...... ........... ... ....,.n .:•:v......... ...v..:n.......+•:vv.w.,v.:v.,.m:::::...........,.x:::w.v•• v.}:%{4:C4}:n.... ...... ...... ........ .r. ....r.. v. ....v ..{............. ..t ..n ,.•:{4:?}}YG:•}}i}S::).}}Y{::{{:{:}$!•}?.??4}}:R:.x:4,}}v:} ..........l......:.... .n:•... ...n...n.n ....., r.....v......2 x.......• ...Nv..•:••v:-.v::• ...... }.v...... n......• ........ .......r. v...:..... .v... ..vv...... ........n.................. •:.v::::.v:::::::?:•}::w::vv:4}}i}}}i':....t t..nvt.:.}v::::::•• :.....x:.n.... .,.......v4.........:::w::::-.:r......v..... r....^. ........ ........n• ........... ........... •.4::nv;,•.:.................,v2{L$$$�:v:v:A:•}?}:•}:{.i`:?2v.:::n.......{v!:{;: .........+.:.....:....., n...... ..F.vw:::::.v: ....... ...L...............:. .........................:•:r::•::::::::::v::::v:.v}:{•}:v'n:::.}':::::ri::::::n...;................,........:•v:nv•:4Y4}::}}:{:''$$:i .com X. n ................�....:............::................}...................:::•:}}::;:•i:.:Y:..,•:•:r.:... .,•:::::::::::F....... .w:::::t•:•:••:::.:::r::.}'.:::..�{G;::::::::n.:.:}:•.}�::.}:.>:.?.{{..:.:i:?: ......................:.v:::::•..........,.:::}..........:::..v:......,.•:.•:.v�:•:.............,..... r.......:......:•:�:•:.::}:Y:r,:.}})i}:•:.... .}r•}:.!-:::).v::::.:.?,•r..r .}..}...r :........r..::...................,....t..r......::................,:.....t...... .....,.....:.:........ ....... .:. .r. .... ........... .. ......r... .........}... .......... .... r... ....,...n.Y::•.v:.•+:.:;;=;ry:.;,•; 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'' �:::::.:... :.:>:r}:):.}.::..r.......,. ::}?.isy:2•`•..:-:.,:+:..+•Y?:?:.:........:`:;::+:{. ........::�:.:...4..:�::............t•:::4.r ......tk,.}.{•.t,-:•:.<••:•::�$$<$:}:}i:+:;>}•::;•i:•.�.)..........::::::.�.>:;•::!;::2:`•{:;}%:+??::i:o:.:;{.?:•Y):•}Y;•;. �11f�. :li�ur�ure:;cup>;<:<:><>{$�<:i:.::•:•:..--:•::n.:::::>;�::}::��:<:•.}}i<:.:.i:.::;<{:.r..Y:•:?.:::::::.:::::•.�::n•::.... Failure to secure covers;e is required under Section 25A of MGL 152 can]cad to the imposition of criminal penalties of a Sue up to S1,500.00 md/or one years'imprisonment well civil Penalties the form of a STOP wORK ORDER and a Sue of sloo.00 a_day against me. I understand that a• copy of this statementmay be forwarded to the Office of Investigations of the DIA for coverage veri>ication. - I do)iereby'c fyun thepains-and-penalties-of-perjury-tho�the-information-proxiderl above issrue aisd correct .✓ Date " Si@pature /� Phone# 2+5 Print name Ayi-,Afe J ofScial use only do not write in this area to be completed by city or town official permit/license -OBuilding Department city or town: ❑Licensing Board ❑Selectrnen's OMce ❑checkif immediate response is required ❑Health Department contact person: phone#; ❑Other___ (�eviaed 9/95 Plfa 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. r An employer is defined as an individual, partnership, association, corporation or other legal entity, or py 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 ancf 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 not the Department of Industrial Accidents. Should you have any questions regarding the"law",of ifyQu being requested, ep .__. .. . ._.... ... are required,to obtaia�a workers' c' .eeajatioapolicy,please cMl the Department at the number IiWd below:. City or.Towns ` nted legibly. The Department has provided a space at the bottom f tie o please be sure that the affidavit is complete and pri 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 ui the.permrtTlicense number which willbe.used as a reference:riuniliei. Tlie affidavits znay�ie'r the Department o'r`FAX unless other arrangements Have been made: 7. The Office of Investigations would like to thank you in advance rfor you cooperation and should you have any�uesttons, . please do not hesitate to giye us a call. r The Department's address,telephone and fax number: TheCommonwealth Of Massachusetts 4 Department of Industrial Accidents QMce of Inyestlgallons ' 600 Washington Street Boston, Ma. 02111 fax 9: (617) 727.7749 ` .' phone #: (617) 727-4900 eat. 406, 409 or 375 i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations S25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVINGSPACE x.0031= `�N'S square feet x$96/sq.foot= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.1t , >120 sf-500 sf ` $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$961sq.foot= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= 2S � (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 25 ' proicost f _ _• The Commonwealth of Massachusetts i = _ Department o .Industrial Accidents � = � , _� ; ' 011fceollm�asffOs�foas - -� 606 Washington Street _ . 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":+}'w'"'.;l•:.;'.t$•z?:::....•:^+^dn?..:"-5:-.: .w:G♦:-.. :t•,.?. -rywv,.<4nJ.<•.G `t)♦},•'M�`..)t.... ...W.. ......-:.YC+{J:9}�PY?C;:;vr>.......+v.,.t•>.. ... 'T•;�,Y.Z'\,•"-?iYG::-.,,.:�rT• ,•,• Rc?•`.?^:-x``C?.��?'.�°°°'Z\w..,.:.,L�4.`?,-°.^.:4yr`:?`:3'.iScX•.:L•?w�:b�`„F�O°P,�?�:,>.;?Lif3._ .... ..�j'....... � }A4:''�2?3'4}. �._,,.-. .ii�.X�G''" Faihs w s«ins as weed cedar 8eetln�2SA of MGL LSt eaalsi bs tb da�ai pmal2tea of a Qaa ap to Sf W&N sod/or aar yeas'lmpetsomont as wA as ctra Penalties.ta tba form Ora SrOPwORK OBDES anti a ol=1t10.00•dsq a;atmd ma. I mtdtast�d that• copy of tbla statsmsatmay be forwarded to the OIDoe of Iareatlpttaos o[thaDTAtot. l[! los< I do herby ic thefflaw P ofPQ1w9 thm*tbriirforts:aeioa Prenadadabvw zt. ilia rrat Si�atiae p /� _ PdIIt otiidal Use only do not writa in this arcs to be c=pleted by c:Uy or in eflWA city or town: pssshit/lioesar N (]B�dlat Aep � ❑LW=siat Board ❑dbsckif Immediate reponse to regmred use eccuas OM= ❑HeaMDep"=0" contact person: pbsoa q; C3�'� @eero Bros P1N _ Information and Instructions ' Io to rovide workers' compensanon for th it Massachusetts General Laws chapter 152 section 25 require all'emp Y� P emplovees. As quoted from the."law",an employee is defined as every person in the service of another under anv cn=i:_-= of Hire, -express or implied, oral or written. An emplover is defined as as individual. partnership, association, corporation or other legal entire•,,or any two or more of the-foregoing engaged in a joint enterprise, and including the legai reprtsentatives of a decrzsed employer, art he etc.-:s•e: trustee of an individual•,partnership, association or other legal entity, employing emploYecs- However the owns of a dwelling house having not more than'thr•ee apartments and who resides theme,artbe occupant of the dwelling house of another who employs persons to-do frmaiatcnan=, Comsencticu or repair wmk oa such dwelling house or as the gttnm�.cr 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 renewai 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 immrance coverage required. Addhio�lY'nezthcrthie canaanaweahih nor any of its political subdivisions shA enfler into any caatraet for the performance of public wort unIIl of hiaace wide the insurance re4nir�bf this chapter have been presented to the cO=a R" - acceptable evidence comp authority. ' Applicants Please fili in lire wor;cers'camp affidavit completely,by clseckin the.box that applies to you siat and mpplvmg company names,address and phone numbers along with a�Gma-of msm= a as all affidavits may b e submitted to the Department of Industrial Accid=far. cf�'t�en gF• Also be sere to sign and date the affidavit: 'The affidavit should be.renamed to tine city arto�vntbzttbc application for the permit or iic�se is being requested,not the Departauat of Industrial Accidents- Sbould you ha any gaesd=regarding the"law"or if you . are required to obtain a worer ks' ccmpeaszddm p oiicy,please call,the Department at the number listed below. . City or Towns Please be sure thatthe affidavit is lete sad. Iy. Mw D arancotbas provided a space at the bottom of the comp Printed 1 aff davit for you to fill out in the evcatthe Office of has to catitact pan regarding the appIicaat. Please be sure to fill inhe pcmzrtllicease=mber which will be used as a refereax n�uber. 11w affidavits maybe rcammea to the Deparmzeat by maid or FAX ualass other have beenmada. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitata to give us a call. . The Department's address,telephone and faxmzmbes: The Commonwealth Of Massachusetts Department of Industrial Accidents OtflCe of totitestloatloas 600 Washington street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 exL.406, 409 or 375 q. The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: 2 30 C(`^,t�^ F, 1,,� ' 6"SRN SfikR L_?_ Owner's Name: kv\dr r,_) 'mow"L� Date of Application--- I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR • orms:Affidav :rev-122001 i �� �� ����� e � �/ ���, `��,° �� s� ' l TabLJi2.tb(eesmaawd) . Pmeriptive Psekaga for 0"wad Two F&o'W ReaidmtW BWMhW Humd with Fad Faab MAXIMUM Qlaaag Gk=g Ceiling Wall Floor sttsmea.. Stab H�Coolu►g Arm'(0/6) U-value= R value' R valuo' R vahns Wall Pt3>meta Etfici Parkaae 9701 to 6500 H Degesa Daw Q 12-1. 0.40 38 13 19 10 6 Normal R 12% M2 30 19 19 10 6 Normal 9 121,110 0.50 38 13 19 10. 6 is AFUE T 15% 0.36. 38 13 25 WA Wf Normal U 15% 0.46. 38. 19 19 10 6 Normal v 130/. 0." 38 13 25 WA I WA ss AFEIE W 15% 0:52 30 19 19 10 6 85 AFUE X 18% 038 13 23 WA WA Normal Y 19% t].j4q2 38 19 25 WA WA Normal t 18% 38 t3 19 10 6 90 AFUE AA 18% M50 30 19 19 1 10 6 90AFUB I. 'ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: l Z rfJ 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 DETE UMING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a I 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 will area. expressed as.a percentage. Up to.1%of the total glazing area may be excluded from the U-value requirement. For example.3 fr'of decorative glass may be excluded from a building design with 300 fl of glazing area. Z 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.JI.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 R49 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 crawispaces,basements, or Garages).Floors over outside air must meet the ceiling requirements. 'Tl:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mcct the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned br.,ements must be included with the other glazing. Basement doors must meet the door U-value requirement d-scribed in Note b. -The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or 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.la. 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(Le.,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 er 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). J .V r: The Town• of Barnstable BARNSTABI.E • 90 MASS' �° Regulatory Services OATS 39• 0 Thomas F. Geiler, Director . Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 . ce: 508=862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 3 C0 02 JOB LOCATION: number street village "HOMEOWNER": ytd'!'Pt.J 04�%f4 .3T5— ClZ}-cJ (SUb) zs5 name home phone# work phone# . CURRENT MAILING ADDRESS: 0 ' X CtLA3 vv A G2c�(e6 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellines 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,an 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 buildin permit (Section 109.1..1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Dep tment minimum inspection procedures and requirements and that he/she will comply with said . 'pr=uresre ents. • gnature 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:FORMS:EXEMPM TOWN OF BARNSTABLE BUILDING PERMIT'APPLICATION . Y. Map Parcel 02� � - Permit#Health Division Date Issued 2-1?—9c LJ Conservation Division 1Z_R Fee -' AO /Tax CollectsI Lima. treasure (o ,Gl <Rla�ieg-Bep#. . roved by Planning Board I"."Kistoric-OKH Project Street Address Z 3o C14 0,/_CLI S� Village Ownera Address A Telephone 3 a 25 Permit Request - Re��h ex%s h�� t d a t'ti► 5 A vv e k co�ov , c�z 1c et.\S�v�o� �r�C4 STt'Q �,� Shy pkALa ro4�e%A c,»�C�OW S\ S ! OrLQ" �O•� /JGr� cs S`�ric�; ReVIC", Cb""94 /ALIV tisp►^,��. Square feet: 1st floor: existing proposed / 2nd floor: existing proposed Total new ` Estimated Project Cost 6� 5yo Zoning District Flood Plain Groundwater Overlay Construction Type U3 ors& ��VV4_ tot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ r Multi-Family(#units) Age of Existing Structure 30 �f Historic House: 0 Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: I1Full O Crawl ❑Walkout . ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new Half: existing r new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas d—O it ❑Electric 0 Other Central Air: ❑Yes CENo Fireplaces: Existing 2- New Existing wood/coal stove: ❑Yes ErNo Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new:size Attached garage:.ECexisting ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes 5Ao If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Ow A C Telephone Number Address License# Home Improvement Contractor# Worker's Compensation#/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO( SIGNATURE DATE _±/30/,,�11 FOR OFFICIAL USE ONLY _• " `PERMIT NO. DATE ISSUED ' MAP/PARCEL NO.' .., ADDRESS . VILLAGE OWNER e DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ! - ASSOCIATION•PLAN NO. 1 _ The Commonwealth of Massachusetts --�=— `— Department of Industrial Accidents Office of/asesuffat/oos 4 600 Washington Street -= Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: 1 oldf ev) Ck4 location: 23 0 CW M LI ti Z�S S Wl�tSS �In�llS G2(o'-��t) hone# �' I am a homeowner performing all work myself~ ❑ I am a sole pravrietor and have no one worlds in"a ca acity din workers' compensation for my employees working on this job.am an employer ::; am ..::.......::.:::.. nv n dre .>; .... xx «><' `: >> h CI �%< �asuran ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workersco Pcusstlo n k°h...c..e..s..::: :;.;::;;:.;::> :>>::........... ..; :: : :: :�txm anv n ---ii:?:.j:i iiiii:6i:?vii:i iiii::isi;:i s;:s;:is;y;::4;v:.:::s}:+i> ............... :::.:::..:;:.._::::::::::::.:.:.?............... hone.#. .....:::::.........................::::::::::.::.:................ ................ ............................................................................................................................................................................................................. ................................................................................................................... .:::::::..............:::::::::::::::.....................::::::::::............::.::..............::::::....::::.. .........n.,. addre :.:?::.;>:.;::: :.;;.;:.;;�.::.::.;::;:.;>::;:•>;;:.; ::.;:.;::;;•;:.::.;::.;:.::.;::;;��;::.;;;:<•;.;;:.;:.;�.;:;.::.;::::::•:::::::::::........ n ::::::.:::...................... :......................::::.::•::::..::. :::::::.. ::..........:::::::: ::::. :.::.._:::.......:.:::.. ........... ............. ..........::.:. li 0 i�arance c �. Fxx ailure to seenre coverage as repaired under Section 25A of MtZ 152 can lead to the imposition of criminal penalties of a Sae up to 3146,00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 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 1 do hereby c under the pants and penalties of pedury that the information provided above is&w.and coned r/�ture Date 1�C/1-?,IPrint name C\d�r ec 12 CA ceY k� Phone# offidal use only do not write in this area to be completed by city or town official city or town. petadt/licwe# O Department Idcensing Board ❑checkif Immediate response is required ❑Selectmen's Office _ ❑Health Department contact person• phone#; ❑Other. oeysud 9/95 PJA) . o�TMe The Town of Barnstable . BARMABM • MAM ��� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 509-790-6230 Permit no. Date4 * AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. A Type of Work: � l��- � �5�� lhrv-4 �g"Y SAP Estimated Cost ±L Sc'0 Address of Work: 250 Owner's Name: v Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 C]Building not owner-occupied pOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORSOTH ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGABLE HOME IMPROVEMENT WORK DO NOT Lc. 142A. ACCESS TO SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. �0 3cJ a� �v-e R. Own RDtoer's Name q:forms:Affidav r The Town of Barnstable { "E'Or'a► Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 r� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Paint DATE: -�� JOB LOCATION: 23 0 C number sloes vage "HOMEOWNER �C�v1 Av eL,) 1�. Ur"Ll 3 �-5�`�2}S ZSS- l SoS name home phone# work phone# CURRENT MAILING ADDRESS: "P-U, _Z d X 5 12 \AA sou Ac, XM ►A GZ(o k city/town state cep code The current exemption for"ham"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 auras as Sr�eNISOr. DEFINITION OFHOMEOWNI:R 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 O>ficial on a form acceptable to the Building Official,that he/she shall be - �nnsHe f or all such work performed under the braiding pennit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and reqIjirements. A,Jr, KA___ gnanue of Homeowner Approval of Building Official Note: Thtee-fmmily dwellings containing 35,000 cubic feet or larger will be required to comply with the State Budding Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing wort for whirl►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 cmmption 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, particnhariy 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 easume that the homeowner is fully aware of his/her to 4V r abilities,many amities require,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form cuaeudy used by severai towns. You may care to amend and adopt such a formicertification for use in your community. r` Application to 1 9 9 9 1 9 9 Old Kings Y Regional Highway R ional 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 DATE Zq 1) ADDRESS OF PROPOSED WORK Z'5y CL4"-LI^ C �. ASSESSORS MAP NO. S� OWNER 1�,- C(ro-( ASSESSORS LOT NO. Q� HOME ADDRESS 230 C C; TEL. NO. 3}S"92� 5 AGENT OR CONTRACTOR ADDRESS 5 a.w-e TEL, NO. 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. V.`I'�� vain „--,dc-_j SJkS 901tVV7QVkA% f � s rck, �\c,f 1�� ext5 �� ✓m C'&N"4�A, ,s,b\e 4/1S r Jy�- p��rtHl' �cLtR� bv\\cLl C** -ep 1 h Shove N LrI � Q^� SIGNED_ 7," Space below line for Committee use. Owner-Contractor-Agent deceived by H.D.G. The Cep tifleate is hereby D p IJ 1 T Dae 7 — 7 1� J The categories of work entitled to exemption are listed on Disapproved ❑ the back of this form. li r Town of Barnstable Old I{ing's Highway Historic District Committee SPEC SHEET FOUNDATION ��`�A Cov\CV'P SIDING TYPE '^� S COLOR CHIMNEY TYPE COLOR ROOF MATERIAL A�� COLOR ��►y 9 PITCH WINDOWS COLOR SIZE TRIM COLOR DOORS COLORS SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS SKYLIGHTS ' SIZE COLORS Lj FENCE COLOR 4^ � NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 .I, s b t( z_, r .__,� _ ,�•. Q� S , I 1 . .-.. O LqA I� • . is'�! ' ,I \s a 1 I j r #r I -57 t• r'. .. - � Imo.� .. WILlmy- EE_. .. 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