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YjL ID
The Printing Company
508-771-8800
INSTANT PRINTING & SIGNS
300 BARNSTABLE RD.•HYANNIS,MA 02601 •FAX 771-1278
Town of Barnstable _ _ Building
Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
• BARNSCABM • Posted UntilTinal Inspection Has Been Made. •
�e�'n11�
t6S4 �� c m
Fo iAa+" Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-20-1050 Applicant Name: Douglas Mullen Approvals
Date issued: 06/18/2020 Current Use: Structure
Permit Type: Building-Demolition-Accessory Expiration Date: 12/18/2020 Foundation:
Location: 183 OST.-W.BARN. RD,OSTERVILLE Map/Lot: 120-003-002� Zoning District: RC Sheathing:
Owner on Record: GRESH,JOYCE M Contractor Name*"-,DOUGLAS W MULLEN Framing: 1
Address: 181 W BARNSTABLE RD Contractor License: 081995 2 .
.OSTERVILLE, MA 02655 Est. Project Cost: $4,000.00 Chimney:
Description: Demolish accessory structure labeled "cottage" on site plan. This Permit Fee: $50.00
f Insulation:
permit application coincides with another application we.submitted Fee Paid- $50.00
last week. Final: 6
s _ _ Date: 6/18/2020
Project Review Req:
Plumbing/Gas
Rough Plumbing:
�- --�- - _ :.Building Official Final Plumbing:
_ g
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withir`six months after issuance.
All work authorized by this permit shall conform to the approved application and the-approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoriing by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: r Service: t
1.Foundation or Footing
Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
�"a Town of Barnstable Building
enan ta.
Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
ieM `� Posted Until Final Inspection Has Been Made. Permit
r ' Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-20-1035 Applicant Name: Douglas Mullen Approvals
Date Issued: 06/18/2020 Current Use: Structure
Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/18/2020 Foundation:
Location: 183 OST.-W.BARN. RD,OSTERVILLE Map/Lot: 120-003-002 Zoning District: RC Sheathing:
Owner on Record: GRESH,JOYCE M Contractor Name: DDOUGLAS W MULLEN Framing: 1(mb/Alko �—
Address: 181 W BARNSTABLE RD Contractor License: 081995 2
OSTERVILLE, MA 02655 Est. Proj ct Cost: $ 150,000.00 Chimney:
Description: Demolish section of garage, pour foundation and build new kitchen Permit Fee: $815.00
addition Insulation:
Fee Paid; $815.00 .
Date: 6/18/2020 Final:
Adding a bedroom on second floor of the addition. Mandatory
Smoke/CO alarm upgrade. RMCK. Plumbing/Gas
Rough Plumbing:
Project Review Req: _ \Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withinx months after issuance.
All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for.public inspection for the entire duration of the Final Gas:
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contra ting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). j
� Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
IME T Town of Barnstable
JE�OPM Planning& Development Department �O� e 4
u
Barnstable Historical Commission Z �X.�'3
* BARNSPABLE. * 200 Main Street,Hyannis,Massachusetts 02601 5
9� lf/gS ���' (508)862-4787 Fax(508)862-4784 0.
'OtF1 39. A erin.logan@town.barnstable.ma.us NOF9ARwst°
Commission Members N
Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk C)
George Jessop,ALA Elizabeth Mumford Cheryl Powell Frances Parks Jack Kay,Alternate �,
c
r- 3>
DECISION
Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Properties,
Section 112-3 F
Applicant/Property Owner: Gresh,Joyce �4 �p�NG DEPT.
Subject Property: 183 Osterville-West Barnstable Road,Ost i
Assessor's Map/Parcel: 120/003/002
Hearing Date: June 2,2020 JUN 2 4 2020
Pursuant to the Barnstable Historical Commission receiving your notice of interPYWAMRSTAgLgvertised
and noticed public hearing was held on June 2, 2020 to determine whether the significant structure identified as a
single family home on this property is a preferably preserved significant building and whether demolition delay
would be imposed for the partial demolition on the parcel addressed as 183 Osterville West Barnstable Road,
Osterville.
After review and consideration of public testimony,application and record file,the Commission by a unanimous vote
in favor, found that in accordance with Chapter 112F the partial demolition of the single family structure is not a
preferably preserved significant building.
In accordance with Chapter 112-3 F, the Commission determined, by unanimous vote in favor, that the partial
demolition of the single family structure would not be detrimental to the historical, cultural or architectural heritage
or resources of the Town.Noting the roof height of the approved addition will be reduced by six inches.
This decision applies only to the demolition described in the notice of intent submitted on May 4, 2020. No future
demolition shall be permitted without application and approval from the Barnstable Historical Commission.
Nancy CIR,Chair Date
cc: Brian Florence,Building Commissioner
Ann Quirk,Town Clerk
Planning&Development Department-Elizabeth Jenkins,Director;Paul Wackrow,Senior Planner;
Erin Logan,Administrative Assistant-200 Main Street,Hyannis,MA 02601
(0hG.+tF" "f
��
�y y
EIEG�'1�` Hyannis,::April�20th 2020
To the Town of Barnstable Building Department
We would like to inform the electrical power feeding.the detached building at
183 Ostervi Ile—West Barnstable.road,Osterviile MA has been disconnected.
The building is ready to be torn down.
Sincerely,
Wellington R Soares Electrician Inc.
I
r
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 1,40 Parcel 00�_ WL Permit# 40
Health Division 9�' ZC� ��Z/ Date Issued
Conservation Division 1�' Fee *
Tax CollectorC%
Treasurer
G SEPTIC SYSTEM MUST BE
Planning Dept. INSTALLED IN COMPLIANCE
Date Definitive Plan Approved by Planning Board WITH TITLE 5
ENVIRONMENTAL CODE AND
Historic-OKH Preservation/Hyannis TOWN REGULATIONS
Project Street Address 0 3 OSA Q 10<<6 Nia( IOU �Ci �k�� J k l U
Village _ h(a4abb,
Owner I(IRY, .Grxs k Address 1�3 Ww(J AV Q NQCM1,0bt-o- 'Rd
Telephone
Permit Requests i 1", 46 11 S c Vk r, f-'e!i el ko
029 X,2_D
Square feet: 1 st floor: existing 73 �'-t'proposed 95 2nd floor: existing proposed Total new
Estimated Project Cost Zoning District Flood Plain _� Groundwater Overlay
Construction Type f Q
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure 40 + 4t4 t-5 Historic House:: ❑Yes PfNo On Old King's Highway: /❑Yes No (�
Basement Type: ❑ Full ElCrawl ❑Walkout Other &eA o na�®,-, 1:�t.,[A-9805-s+ ( _ f-a w 64
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 73 !S4-
Number of Baths: Full: existing new Half:existing fl new
Number of Bedrooms: existing new
- Total Room Count(not including baths): existing 77 new First Floor Room Count S
Heat Type and Fuel: *Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes 9No Fireplaces: Existing ID New _ Existing wood/coal stove: ❑Yes ANo
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 ��s i de Ace Proposed Use
OW ,$ r/UILDER INFORMATION
Name ce lTc— vv Telephone Number
Address 104 &,6 License#
Home Improvement Contractor#
Worker's Compensation# ff `
ALL C N TRUCTION EBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SLA
SIGNATURE DATE
r FOR OFFICIAL USE ONLY
PEAMIT-NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS ~ VILLAGE
OWNER
` DATE OF INSPECT EP4:r
FOUNDATION CJ C= �'' ��� V �%' �1�� ra r e
'r
FRAME
INSULATION ~
- t
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL '
ti— ' •,, - .-
GAS: ROUGH `-s : _ FINAL
FINAL BUILDING ; --� �s :'• a _
DATE CLOSED OUT N r
ASSOCIATION PLAN NO
!
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code Permit #
MAScheck Software Version 2.01
Checked by/Date
l
CITY: Barnstable
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 9-14-1999
COMPLIANCE: PASSES
Required UA = 151
Your Home = 147
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value U
----------------------------------------------------------------------------
CEILINGS 1040 38.0 0.0 3
WALLS: Wood. Frame, 16" O.C. 525 19.0 0..0 3
GLAZING: Windows or Doors 163 0.390 6
FLOORS: Over Unconditioned Space 774 38.0 0:0 2
----------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to:_meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in, the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
Sections 780CMR 1310 and J4.4.
Builder/Designer Date
XAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
-. MAScheck-Software Version 2 .01
DATE: 9-14-1999
Bldg.
Dept.
Use
CEILINGS:
[ ] 1. R-38
Comments/Location
WALLS:
[ ] 1. Wood Frame, 16" O.C. , R-19
Comments/Location
WINDOWS AND GLASS DOORS:
[ ] 1. U-value: 0.39
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
FLOORS:
[ ] � 1. Over Unconditioned Space, R-38
Comments/Location
I AIR LEAKAGE:
[ ] Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. 'Type IC rated, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
• gasketed to prevent air leakage into the unconditioned space.
2. Type. IC rated, in accordance with Standard ASTM E 283, with no
more than 2.0 cfm (0.944 L/s) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled.
VAPOR RETARDER:
[ ] Required on the warm-in-winter side of all non-vented framed
ceilings, walls, and floors.
i
� i MATERIALS IDENTIFICATION:
[ ] Materials and equipment must be identified so that compliance can
- =-- � be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values and glazing U-values must be clearly
marked on the building plans or specifications.
DUCT INSULATION:
[ ] Ducts shall be insulated per Table J4.4.7 . 1.
DUCT' CONSTRUCTION:
[ ] All accessible joints, seams, and connections of supply and return
ductwork located outside conditioned space, including stud bays or
joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the
manufacturer' s installation instructions. Mesh tape may be
omitted where gaps are less than 1/8 inch. Duct tape is not
permitted. The HVAC system must provide ameans for balancing
air and water systems.
TEMPERATURE CONTROLS:
[ ] Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
[ ] Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in Sections 780CMR 1310 and J4.4.
[ ] SWIMMING POOLS:
All -heated swimming pools must have an on/off heater switch and
require a cover unless over 20% of the heating energy is from
non-depletable sources. Pool pumps require a time clock.
[ ] HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F must be insulated to the following levels (in. ) :
PIPE SIZES (in. )
HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4"
Low pressure/temp. 201-250 1.0 1.5 1.5 2 .0
"Low temperature 120-200 0.5 1.0 1.0 1.5
Steam condensate any 1.0 1.0 1.5 2 .0
I
COOLING SYSTEMS:
Chilled water or 40-55 0.5 0.5 0.75 1.0
__refrigerant below 40 1.0 1.0 1.5 1.5
[ ] CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in. ) :
PIPE SIZES (in. )
NON-CIRCULATING CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F) : RUNOUTS 0-1" 0-1.25" 1.5-2 .0" 2 .0+"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
----NOTES TO FIELD (Building Department Use Only)-------------------------
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iHElp,,�O� The Town of Barnstable.•
.� BARNSTA`E.g Department of Health Safety and Environmental Services
t63P �0
Building Division
• 367 Main Street,Hyannis,MA 02601
,
Office: 508-790-6227 Ralph Crossen ,
Fax: 508-790-6230 Q Building Commissioner
Inspection Correction Notice
Type of Inspection
A "�
YP P
Location Permit Numberh_•
".I
Owner Builder "' `..w•
One notice to remain on jobsite, one notice on file in Building Department:
The following items need correcting:
oT\
Please call: .-508-862-4038 for re-inspection.
Inspected by
Date
THE
TOWN OF BARNSTABLE
33ARNSTABLE,
MAOIL
1639-
ON BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ............6......vn..,e:.........
......... ...........................
TYPE OF CONSTRUCTION ................. Vn. 4
...... ........�.eo:........19.2z
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby apElies for a permit according to the following information:
Location ...... ........... a.A/ ::-n
ProposedUse ........ ....................................................................................................... ...................
Zoning District ................................................i.........................Fire District ...
Name of ...53.0,.44.7.&Address ... ......ed................
Name of Builder ................41 jV..12.4.j✓.. .......................Address ...............................././..............
.....................................
L
Nameof Architect .................................!......................... ......Address ............ .......................
GeNumber of Rooms .........................(.r....................................Foundation ................ ........ ............
Exterior .....
.............................Roofing ................R'r, 4
Floors .....................ea_x.. . ..........................Interior ............5�9 At..t;.. e. .................................
Heating .................4.7.............4.1.)............................................Plumbing .................../....R.
...............................................
0_0
Fireplace .................0.4..e......................................................Approximatt- Cost ........... ==.................
Difinitive Plan Approved by Planning Board ------19 9
Diagram of Lot and Building with Dimensions
2 6 r
.Y ;.
b011J _pa, , f
I �S
be
Pat
I r
e_,-aA-
-W'0T' GSE D
X AND RA N,E t;H
0 OPP40'VIDING :FOR
ANITARY WATER:S.LjPPL -SEVYA-GE D.15PO ALDINAGE-IS HEi
TOWN -OF 13ARN'STA
W.Ai RD O-F ;.H EALTM
A LiCENSEI) W5TALLER
70 M)T,
AND INSTALL SYS MO-ST OBTAIN SEWA
TEM. GE
1 heVeffyf'y6'-gr9dt"';e8 tie
ules, and Regulation's of the Town of Barnstable regarding the above
construction.
Y, Ce ss TOI6 Is Name .j.....
.IT
Barboza, Antone & S. "C-tells j
14591 one story,
No ...............:. Permit for ....................................
single family dwelling
Location ........183 West Barnstable Rd.
Osterville
.......................................................................
Antone & S. Estelle Barboza
Owner .................................................................. '
Type of Construction frame
... .. .......
Plot ............................ Lot ................................
°+ Permit Granted December 7 ....19 71
i
Date of Inspection ...Tir.061 .....19 7A,
Date Completed 19
PERMIT REFUSED
................................................................ 19 Y
............................................................................... 1 '
................................................... ......... ........... 4
............................................................................... f
Approved ...................................... 19 s
..................................... .. ....................................
THE
TOWN OF BARNSTABLE
BARNSTABLE,
am 0i, BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...........-3 ......... .e......................................................
TYPE OF CONSTRUCTION ......... ............. 4,kcx 4� 4:1.1.7......... 4..........D......................
......0an/.t.....'Ir...............19..7.1
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
,
Location 2_3....W.W.,
r......... ........
Proposed Use ..... za_.Jare......... ....... .....................................
Zoning District ......R ..........%.........................................Fire District
Name of Owner kh.-B.or.r.hoo-.Address ........
Nameof Builder ...............................0. ...........Address .....=77n-=.................................................................
Nameof Architect .............................................. ...................Address ....... ............................................................................
Number of Rooms ......:T...........................................................Foundation .... ..........................
Exterior ..... o. e...kn..........................................................Roofing ....... ........ ......................
Floors ........ ...................................................Interior ........
Heating 4',A.a. ......... ...... ...... Plumbing
..............................................................................
.....Fireplace ......v............. ..........................................................Approximate Cost ..........I. . ................. ...... ...
Difinitive Plan Approved by Planning Board ---------------------------19-------- I
Diagram of Lot and. Building with Dimensions 'A7'0 a. 7S
G(y'r'C', Wow YN -,V1 0
be 7e daWhA�'T THE-PROPOSED METHOD OF PROVIDING FOR
Y-n a�+evy"C. SQd SANITARY WATER SUPPLY, SEWAGE DISPOSAL
AND DRAINAGE IS HEREBY APPROVE-D
V)e w c� e- Wu-,W 9 60f
ti e,Uj 4�a-re' TOWN OF BARNSTABLE,
BOARD OF HEALTH
_2
'�_'y1pr1 N w c-'r-0-14
Cb .10 5 110
7
L
doors to C_ 0
6
V-51 rr 6 nt a_I e_
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ./......
Barboza, Antone & S. Estelle
3 11974 _
r No ....14407............. Permit for .......gara.ge
... ...................
............................................................................... .: {
Location 183 West Barnstable Road
......
...................................
.Osterville
............................................................................... 'y
Owner Antone & S. Estelle Barboza
.................................... ...frame..... ( "`
Type of Construction
................................................................................ \�
Plot .......................... Lot ................................ V
Permit Granted October 7 �1
................................19
Date of Inspection ....................... ............19 :,4
L��S �I ,7
Date Completed /
PERMIT REFUSE® f
� .
.......................................................... I „
I ..................... .....................................................
..................... ................ ......... .............. 1
Approved
1 � .•
...............................................................................
..................... .........................................................
I
___ The Commonwealth of Massachusetts
��- . a - _ =. ' Department of Industrial Accidents
4 = - t OIII6C 0f/OBeSI/g8995S . , ,
600 Washington Street
I 'Boston,Mass. 02111
. -- Workers' Compensation Insurance Affidavit '
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❑ I am a homeowner performing all work myself. . . . .
❑ I am a sole r rietor and have no one worM in achy
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❑ I am an employer providing workers' compensation for my employees.working,on this job.::. ::: :. ::
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Fafinre to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine.up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. -
I do hereby ce=underains Mpenalti ojperjury that the information provided above is t(r�u,a and coned ,
Si ture . 1�—✓ - � Date "C-`J Q q _
_.
0 U .
Print name G(Mk Phone 503 `ton -1 we -
official use only do not write in this area to be completed by city or town official � -
ciIm
ty or town permit/llcense# ❑Bufiding Department
- ❑Licensing Board
❑checkif immediate response is requited ❑Selectmen's Office
. ❑Health Department
contact person: phone#t; ❑Other
0avued 9195 P]!)
i .
-- - I
Information and Instructions r
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a . .
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Departnient of Industrial Accidents. Should you have any questions regarding the"law"or if you
are required to obtain`a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided'a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the 0iiattlicense number which will be used as a reference number. The affidavits may be rehviaed to
the Department by mail or.FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
_Department of Industrial Accidents
oftla of Imlesdoadons
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 eat. 406, 409 or 375
°U IME
The Town of Barnstable
BAMSr"M •
1`16AS9.. ,0$ Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
✓ AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of 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.
f1r�0
Type of Work: 1k(c Q t (3 Estimated Cost ��VW
✓Address of Work: 0 3 V S�• UU • (� �
Owner's Name: Ck lJ
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under$1,000
uilding 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.
-NIL
Date n 's Name
q:forms:Affidav
� 1
I
2-4
WCURAppomki
'` 4 Tjb1a.1S2.1b(eoatianerQ
• "iptire Packages for One and TwoaFamillr RnfdmtVi BoUdbw Meow with Food Fade
MAXIMUM MAIM[ lM
Wall Floor Baaem� Blab
�) R.vdura R vaiva` Rrvabd WiU FIB smimum wa=&-?
paw:ikmw I I I I R.valua` 1-valor?
9701 to 6500 Heating Degree Dada'
Q 120% 0.40 38 13 1 19 10 6 Normal
R 12%' OM 30 19 19 10 6 Normal
s 129li G50 38 13 19 10 6 M AM
T 15% 0.36 38 13 23 WA WA Normal
U 15% a" 38 19 19 10 6 Normal
ii 13'A" -0." �s t3 2'+ WA WA AEZ1E
w 13% am 30 19 19 10 6 15 AFiJE
x IV/. an n 13 23 WA WA Normal
Y I 129A 0.42 38 19 25 WA WA Normal
t 18% 0.42 38 13 19 10 6 90 AFUE
AA IrA 030 30 19 19 10 - 6 AF[JE
1. ADDRESS OF PROPERTY:
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING:
4. %GLAZING AREA(#3 DIVIDED BY#2):
S. SELECT PACKAGE(Q—AA-see chart above):
V '
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
t
BUILDING INSPECTOR APPROVAL:
YES: NO:
I
q-forms-080303a
780 CMR Appendix J ._.
j•
Footnotes to Table J5.11b:
' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,. skylights, and
basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall
area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement.
For example,3 ftr of decorative glass may be excluded from a building design with 300 ft of glazing area.
=After January 1; 1999, glazing U-values must'be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
whole units: center-of-glass U-values cannot be used.
' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full T
insulation. thickness-over the exterior walls without compression, R-30 insulation may be substituted for R-3 8
insulation:and R-38 insulation may be substituted for R-49 insulation. Ceiling R values represent the sum of cavity
' insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between
•v,.,,the conditioned spar:and the ventilated portion of the roof.
:f i�•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-flame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-flame construction.
s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlsspaces,basements,
or garages).Floois over outside air must meet the ceiling requirements..
The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must
meet the same R-value requirement as'above-grade walls. Windows and sliding glass doors of conditioned
basements must be included with.the other�-glazingrr: Basement doors must meet the door U-value requirement
described in Note b. sV'
"Me R-value mquirements•are for unheated slabs.Add an additional R-2 for heated slabs.
• If the building utilizes electric msistaaceTheating,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 J51.1a
NOTES:
-a)Glazing areas and U values are maximum\acceptable levels. Insulation R-values are minimum acceptable levels,
�R=value requirements are for insulation only and do not include structural components.
b)Opaque doors in the build gr envelope must have a U-value no greater than 035.,Door 0-values must be tested
and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value
in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with you windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 035). .
c) If a ceiling,wall,floor;basement wall,slab-edge,or crawl space wall component includes two or more areas with
different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(035 for doors).
' a
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- - - - - - - - - - - - I SILL ANCHOR STRAPS 4' O.G. MIN > i
12'-0'
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FOUNDATION PLAN
To'd -ittioi
'CA �
AS/ZOJ 3-1 Q ,
-N
ASS I07' ..J-..0 y N
l`{ A.5%LOT 2
NONCONFORM1/VG.
r 111E ,VlRT DRIVE CROSSES
OVER ASSESSORS LOT 2
TO ACCESS BUMPS RIVER ROAD.
LOT DI.AIENSIONS TAKEN FROM
PAPS 1 AN .INSTRUV NT SURVEY
L9 RECOMMENDED.
R,CS`. ZONE: 'WC" j'hL3 WRTGAGE INSPECTION plan is Fo' nOOD ZONE.- "C"
T0W7 ,... . ' � _- REGISTRY OWNER' .l7AWD 11 RWe_,_,2ZA_ — — — — -.-
DEED REF: Sz3s�3.'1�5— — — --BUYER:
7
DATE: ._10VL9, 9 ., PLAN REF: _ __ __ =°`:W- —q4ALE:1"= 40
I HEREBY CERTIFY TO (Y�17IlI1Yr���R�UT{TG � _CD.�C1 DIALDING PAUL,`/� � yA.NKEE SURVEY
/� a
SHOWN ON THIS PLAN IS LOCATFI) ON THE CROOK AS �� ,4, `rr^, (3�
0NSULIAN S
SHOWN AND THAT ITS POSITION DOES _ — CONFORA4 MER)THRA; 'toB (SUITE 1)
ITO THE: 70NING LAW SETBACK; -1.1-iE No. 32-48 i
TOWN O(` --.--L3Afl!N5:T. l� !'_... . .. Avn THAT Gg�;'�r:,,; �`� ,• INDUSTRY ROAD
MAR.STONS MILD, DMA. 0264Ef
IT DOES_ NOT_ LIE WITHIN, THE SPECIAL FLOOD HAZARD rr
AREA AS SHOWN ON THE H,U F). MAP DATED_ ;'�.' Z 9_�__ �� 7 EC.,: 428—0055
Cc t -P tel r 0500,91 0016 D F'Ak 420-5553
THIS PLAN NOT MADE FROM AN INSTRUMENT
- - --- - I3�5�1� DEN--------
PAU[.2. MERI-CH�:'W t I-S _ IIFiVk,`r�N�C1T TO NF [�tiEl) FOk FENCES. E.7-C.
r
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print. - ,
DATE /
JOB LOCATION /?3
A� v t cil"i�1. d `�LOCATION
Number Street address Section of town
"HOMEOWNER" IoZ
Nake Home phone Work phone
PRESENT MAILING ADDRESS
City town State Zip code
The current exemption for "homeowners" was extended to include owner-occuni
dwellings of six units 'or less and to allow such homeowners to engage an in
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to r:
side, on which there is, or is intended to be, a one or two family dwelling
attached or detached structures accessory to such use and/or farm structure!
A person who constructs more than one home in a two-year period shall not bE
considered a homeowner. Such "homeowner" shall submit to the Building Offi:
on a form acceptable to the Building Official, that he/she shall be resnons=
for all such work performed under the building permit. (Section 109. 1. 1)
he undersigned "homeowner" assumes responsibility for compliance with the J.
uilding Code and other applicable codes, by-laws, rules and regulations.
he undersigned "homeowner certifies that he/she understands the Town of
arnstable Building Department minimum inspection procedures and requirement
nd that he/she will comply wit said pr cedures and requirements.
OMEOWNER'S SIGNATURE
PROVAL 'OF - BUILDING OFFICIAL
rote: Three. family ' dwellings 35 , 000 cubic feet, or larger, will be required
°0 comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION "
The code state that: "Any Home Owner performing work for which,....a=•buildin
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that
Home Owner engages a person (s) for hire to do such work, that such Home 0-
shall act as supervisor. " ;•
Many Home Owners who use this exemption are, unaware that they are assuminc
the responsibilities of a supervisor, (see Appendix 0, Rules and Regulatio:
for . l censing Construction� tupervisors, Section 2. 15) . This lack of awarE
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this, case our Board cannot proceed against the
iniicensed:person as it- would-,with licensed Supervisor.. , The. Home Owner ac
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware -of his/tier responsibilities ,
,7c-uaunities require, as part of the permit application, that the Home Owne.
-.rtify that he/she understands the responsibilities of a supervisor. On
.ast page of this issue is a. form currently used by several towns. You Asa:
care to amend and adopt such a form/certification for use in your communyt_
r .
w-�r:i'*+n3 tl� rgz+.l?waYlr.gr' i7r ' '' �yy�:'�X #i�. f. " k yrRfts} ,+}• .as ;�t Kt; T ,:. {�;sA{�.%s.i+� r+x�+ ax 'd �r� 4. s�s'i�►i�JyF`
°F THE A
. .W°. ' The Town of Barnstable
WANsenBU& i
M� � Department of Health Safety and Environmental Services
ArEo ,�s Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
PLAN REVIEW
Owner: fc�\f r{' G—)�� ��1 '�. Map/Parcel:
Project Address: (� V� /� (: uA l er: 0� 1�
S
The following items were noted on reviewing:
YC
n - 3
Lon
• - J
Please call 508 862-4038 for re-inspection.
e UL
I•nspectedby:
Date:
q:building:forms:review