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Home My WebLink About0186 MAPLE STREET UPC 12534 No.22sOR �PoS1{ON�� HASTINGS MN 0 14UA;Pq, - sY KI oor Rpovv�- Pp - u o Y� — Owner- I I I �� C' 'I � d?� � II � �b ' — �� - J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 33 Map Parcel. Application # (0 Health-bivisio' n Date Issued .- "' atidh'Conservation Division ;,Application Fee Planning Dept.- . .Per M"'it Fee; Date Definitive.Plan Approved by Planning Board Historic -' OKH Preservation Hyanhis Project Street Address /94, Qe-g ale, 3-6y e e'Z Village 'Wes� in 5+ct-67 if Owner /yo1 114,111- _F"_-tZ&Ir Address Telephone 14 2 - -to 99 Permit Rbquest Or 6C 16 10 Ate S -,de e ze pht 5 -7:,6 e Alek Y_L2 ir OQ P-J M (,n to 5 10 fid a& Square feet: 1 st floor: existing proposed .2nd floor: existing Total new prop —proposed Z6hing District Flood Plain Groundwater.Overlay #r'rp'ject Valuation Construction Type L0 Size Grandfathered: El Yes L1 No If'yes, attach supporting documentation. Dwelling Type: Single Family Ll Two Family Q Multi-Family (# units) Age of Existing Structure Historic House: U Yes Q No On Old King's Highway: Q Yes L3 No Basement Type: QFuII U Crawl Ll Walkout Ell 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: Q Gas Q Oil El Electric Q Other Central Air: Q Yes Q No Fireplaces: Existing New Existing wood/coal stove: Q Yes Ell No Detached garage: Q existing LJ new size_Pool: Q existing Q new size Barn: Q exis ing U r@w size_ C= C=3 Attached garage: Q existing Linew size —Shed: El existing Ll new size Other: 2 < Zoning Board of Appeals Authorization U Appeal # Recorded Q o Commercial Ll Yes Ll No If yes, site plan review# Cur-rent Use Proposed Use rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name qn6er+ A Telephone Number Address Q00J WOA4 License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO W SIGNATURE . DATE h0 Lo i F FOR OFFICIAL USE ONLY '- .APPLICATION# DATE ISSUED ` MAP/PARCEL N0: F' s? ADDRESS VILLAGE OWNER DATE OF INSPECTION: S yf FOUNDATION o.7 mil) 7Z°7,7�wit f- `_,.FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL M __ FINAL BUILDING ®R 4Zo! a DATE CLOSED OUT ', ASSOCIATION PLAN NO. `' i r Town of Barnstable Regulatory Services WRNSTA1. Thomas F. Geller, Director 1 6Y9 Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnst2ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW * Z©O F O Z 6 3 s Owner: /34c-r4-c-R Map/Parcel: 13 Z Project Address /e;6 lWAfte Sr- 40,b Builder: polo is r The following items were noted on reviewing: /ll& /U' �� l�osrs �7fI¢�t � T Co. ,vaRE--r& Sot-m /woes 'Lill# ' AN ffPP�o o� CoN��-rope . Ro J—zs m s7/2 I3 n�r�ac�rs 4oNN�--too .. �tiCou.�E A- �cc R-/2 �c�4->y� C�I P- • z x /O -/-I D/1,Q. .[� K -ie.,-rstc- C'� rr�cz c nr ►u-u.S r B E �� Th Tv SE--C-- u gG CU S?Eft- ►'1�-�}-k (Yk,u s1PA-G/NCT:. y �� M fi'bc� OF7WO501 F1�CJa Y ,*t4.t/fxC4f i. Rmzloy?+ X0/G 7a ZE-e—r. Reviewed by.-- Date: Q:Forms:Plnrvw TJie Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insnrance Affidavit: Builders/Contractors/Electricians/Plumbers A_pvlicant Information Please Print LeLyiblY Name (Business/Orgmization/Individual): l Q ` CoAS+f U_(*a^ • Address: ,��y( Wnna 11�de,1 - City/State/Zip: E• 61V� k YVA Phone-#: 016 �� Lit Q 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 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2. I am a'sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling These sub-contractors have g, ❑Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'.comp.-insurance Gomp• insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12J] Roof repairs insurance required.]t c. 152, §1(4), and we have no 13.9'Other.5u4 DtGC employees. [No workers' comp,insurance required_] *Any applicant that check;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. tContractors that check this box Trout attached an additional sheet shovring the name of the sub-confractors and state whcthcr or not those entities have ernployees. If the sub�onbwtors have employees,they must provi&their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob 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 crimirial penalties of a fine tip to S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the WA for insurance coverage verification. Ido hereby ce,ii±fy ounder the ains•andpenalties ofperjury that the information provided above is true and correct Date: 1 — Phone#• a j&'%00 '1 tV Z— Official use only. Do not write in this area, to be completed by city or town offtciaC City or Town: Per>rt t/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Information and husttuctious 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 statics 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 pro duced•acceptable evidence of compliance with the insurance coverage required." AdditionaDy,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 complimce RZth 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 numbers) along with their certificates)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 Towp 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 onC affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.wherc 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 burn leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,tclephone•and fax number: The Commonwealth of Massachusetts Departmmt of Industrial Accidents : Office of Iz►vestigatio-as 600 Wass ngton Street Boston, MA 02111 TO. # 617-727-490.0 ext 4.06 or 1-$77-NiASSAFE Fax# 617-727-7749 Revised 11-22-06 www-.ma4s.gov/dia Town of Barnstable Regulatory Services ELAMSTAlS1 E Thomas F.Geiler,Director �'OTE16,39. A 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 I, / 11,IAMa as Owner of the subject property herebyauthorizeLj��r- �pl�Irs/ �Ggr� 7 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 / !q&g �GLYLew Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS DWNERPERMISSION Town of Barnstable Regulatory Services BARN6rABM ; Thomas F.Geiler,Director 'bMAS& ,� Building Division AjFp�.tA 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: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the 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 procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC I 1 " Board of Building— g RegulatiOns��' ' r ? e, _ I �,.Sfand�rds � HOME IMPROVEMENT G.ONTRqjbTOR. 9 do _ .Re ist ; '10 3635 Explra loam=7-9/4010 ` [s TYPein vidual ROBERT G. IA Tr# 270590 DO kSl_ Robert ladonisi _ J 7 Hillwood Way E.Sandwich, ". MA 02537 ��-�• ' Admi nistrator. . �'' +`:�-..,�""-`---`-'•'ice' __`. .. , ., _. p , Board of Building Re ulatio ay Construction su" li ns and Stan ' gar,r � i CS rvlYson License: Bards t n 28811J Exptr tlo'n;-' =5r Re's_ti !.'� �Q�2010 Tr* 24105 ! _ ROSERT G IADONISIY '~ t E SAND OOD WAY License or re befo gistratio ;_ Board of a eXPiratiou d Valid'for individul One ABuilding Re ate. If found use only urn to. Boston sh6urton Place Rm 1301 and Standards Ma.02108 j j r' Not vali / without signature `ofzHEr y Barnstable Old Kings Highway Historic District Committee 200 Main Street, Hyannis,MA 02601;TEL: 508-862-4787 Fax 508-862-4784 p MASS o A�. �p 1639. �60 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 470,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; L. Building construction: New Addition ❑ Alteration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial 9Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, dorms' 4. Sign : ❑ New Sign ❑,Existing Sign ❑ Repainting Existing Sign_, 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole` . ❑ Retaining wall ❑ tennis court Other 6. Pool ❑ swimming' ❑ Other man-made pool -� -� r— !> r7l Type or Print Legibly: Date: L Address //of proposed work: // House# %?(a ; Street: Village rNs� �rltsfctLa�e_4ssessors Map Lot# a?3 Description of Proposed Work: Give particulars of work to be done: d a © 'X 12 e 1A "V'-6 c — nvessra ✓� -� v'e��-�� Weed /� r1la - f� fa��✓�� Ot�.��y �LZ. -/ CY P -K t ��11 r � ��m 4 - �l"1`' P 7'�. 1' Agent or Contractor(print): Telephone#: Address: Contractor/Agent'signature: NOTE All applications must be signed bythe current owner Owner(print): y�t4A u_-�le-r . Telephone#: Owners mailing address: ,6 f Owner's signature: D2 �p For committee use only. This Certificate is hereby APPRO E C E P V Date �<«.0 Members signatures APR 2 3 2009L[ . TOWN OF BARNSTABLE HISTORIC'PRESERVATION ny Condit ns o ova . n•+rn�n_r.,,,,,•+ni rr: ,.W,*-A,.,,.anva Al—A--Inc-u r.... .------: . ___.A,a__ Y • �, Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 Copies Foundation Type: (Max. 18"exposed)(material-brick/cement, other) Siding Type material: Color: e Chimney Material: Color: Roof Material: (make&.style) Color: Trim material Color: Roof Pitch: (7/12 minimum) Window: (make/model) material color Size(s): Door style and make: material Color: Garage Door, Style Size Material Color Shutter. Type/Material: Color: Gutter Type/Material: Colo : Decks: material =,j'` Size /D X Color: . kw—ya yd (1 it Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: ` olor: Fence Type(max 6' ) Style " material: $ o� 2 nn Retaining wall: Material: ' 00 E C l5 V yla0--A Lighting, freestanding on building �Qy ,� PR 2 3 Please provide samples of paint colors and manufacturers brochure o dows do A$LE fences,lamp posts etc HISTORIC PRESERVATION ADDITIONAL INFORMATION: /V h . 1 Signed: (plan preparer) 1Wzj "A 1y/�� print name Ae2tg1'Ll, Tez 7—Zlfi' tel.no. 3'1 h- &Z- Location of application: Street no. Street _ � Village�,(,zes I�� 2 �. rbo. �= P U Coto Cb� . Em o iQ �V 3 � rN t _ 1 1 J � • kgg I f n� _ m ats— raUV 7� 4 r rb � ;Q �' � � "-_ram • e�� o p fo n t . .00 c x A o ro F L� 5 P n � o �� o A vJ f rb AVN � k s �► � y I o -?z —�ss � x -o r o S n "�. 1'N N �3 I co P is 1 f E . . 1 I N 61 o 1 O � � e I L - - - ♦.. s .. n¢ A �b� q �. o � -Q ca 05 r• �' o � � � O � � y �GI hs, Q \\\\b\♦\\\ �] a \\\1\\\\♦\\♦ �� v1 V d b�i��\tt\\t1t �\I —1 \ ♦b♦b w\t\\1\b ��...III 1\\b1\tl\t ♦\b\1\ r� . 2 : ill ♦\\\l\\lt\\t\t\tt\\ � Q r - :< O f(D 3 m n ' D `1,1111111111�/�// Z �AO y'6i t!,; �!• try � � y O � yFq 53 b a � Q'11l N7.L,�M go . ,VDOrg, he . y y 60 � �b o o Zb cn p �' b �,• � � � � �j � `� �, � � moo$, b � � •. , o� , 1 r .f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel D Permit# 71 3 7o-" Health Division . fl_lsac& ilo q 6360 elli _:: ' Date Issued �O�1o�Qoo3 Conservation Division �� 6 �� Application Fee o� Tax Collector f Permit Fee 3,S Treasurer /� .SEPTIC SYSTEIj MUST PE 1115TALLED IN Planning Dept. WITH TITLE 5LI„a Date Definitive Plan Approved by Planning Board EIVIRONMENTAL Co,,-� TOWNREGUL�41Cv`► Historic-OKH Preservation/Hyannis -Project Street Address �/8!0 ✓ ��P vex r f Village Owner z6aWN y T a-r-L 5e Address ArlAple q. Telephone ( "D 8")— 3l0 . 2 S 9 9 lZe Permit Request t)e- rt-Oun M4=bZ8 �f' �d L$� -e Lol 14afz Z Square feet: 1 st floor: existing DZ proposed Z/ 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size 0 , Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Ur"' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes ❑ No On Old King's/Highway: ®'Yes El No Basement Type: @full @Crawl ❑Walkout O Other a 4x�a�' X3 4 na uJ/, 113 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing l new o Half: existing new Number of Bedrooms: existing_ new _0 Total Room Count(not including baths): existing �' new I First Floor Room Count G Heat Type and Fuel: 01/Gas 0 Oil Cl Electric ❑Other Central Air: 0 Yes O No Fireplaces: Existing New Existing wood/coal stove: ❑Yes EdTo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing 0 new size Shed:®existing � / ew size Q l� Other: 9Xl6 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name /D j,! "`1',%' ':,Telephone Number Address ddavle License# � L� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �. SIGNATURE .!? DATE L) < ' FOR OFFICIAL USE ONLY 4 PERMIT NO. DATE ISSUED - ^ MAP/PARCEL NO. ' I - ADDRESS" VILLAGE OWNER DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH; FINAL* FINAL BUILDING DATE CLOSED OUT r .ASSOCIATION PLAN NO. a1.1 a �OViHE,p Town of Barnstable y�P Regulatory Services BARN WIX, ' Thomas F.Geiler,Director MAM 9$ 1B?9• �� Building Division ArED lAPy A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax:. 508-790-6230 Permit no. Date • AFFIDAVIT HOME WROVEMENT 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. r!l'Ql4 ;W 77D Jlc° �p Type.of Work: Me V ° fi Estimated Cost 15'& . Address of Work: Owner's Name: M f,!nQ /lam TZ,42 Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law gob 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 Au T, .e Owner's Name The Commonwea-lth of Massachusetts Department of Industrial Accidents =_- = Office ot/asest/91900s 600 Washington Street Boston,Mass. 02111 `y Workers' Com ensation Insurance Affidavit naffie y fir.,.T rr� i�r iiii i !4 - location_ hone# City ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one works in ca achy / / /%% %%%%%%�%%%%%///%/%/%/////%�%///�/,. rovidin workers'an compensation for my employees wor king on this job.lam :......:::..:..•:....,::,,,.}•:.•:%i<;;>;:::},>.{:}:.Y}:;;::%; em 1 g ... ..... .... ........::::::::::.:::.v::L}}i:;+SY:::::::.v:.....................' nv::::nv:v:::::;::.vrw:::•::nv::::::.n..,..........•v:•n ....:..................................... ............................................ ................................::w::::::•.:v:::.. t............. .vv::w:::w::?^:;•}}:4:::::v:.v........... ..........v., .........\,:•':t,n vv:�i}}}}:t• ..... ...... ....... :........ ....................v..,v:.v::::......................:::.... x:n:v.:v:.w:rJ:::n,:•v.vv:::,}:>):•J.:::r:J. .......... ................ ................ ........,...t. ............................. ............... :•::•:::::.v:::nv:,v:•::::.}......:}}};w::::::::.w::...... ...............:... .... ..::vv:•r.}•:•}:i'ti'•}Q`}}}Y:}:�:•: v:::::w::•vp::•}:•i}:v.w..•.v::•v .......}.v.v v;:.n. :v:;..... .....:.?:{.}::?•i:::;•....::::.:.v::}}:::%.}:.::::i4}:;.}:;•i:�:?!;?•i}::;%?•:,.;... }h c r >h': ::::.......n:.:.:.::::::..::..::v..:::..::n....::w:;!;v::;:w:}::}}:.v:•}.v:i:}::..:}:•}:?^ii:•:::�:::::::.::::w.:v. rti.•;' .............. .........:............................:...:..........................:........................ ............. �licv ZY ill�lIIl'3 I am a sole proprietor,general contractor, omeowner circle one and have hired the-contractors listed below who have the followlnrkers' compensationolces: % :.... }...a. w;g... ..: :;::•:...............:.:...........r......:::.::...................,.....:.::. ........ ..:...... ..vt .v...x... .......... ........... ... .. ...::.-:::v:•::•:::::•::::n::•:::::.v};{h:�:^:{.;:w:.}}}:4:^}:•:3;:.y:n:v:::.;'+:w:•n..:.- .............r......v....}..............:....t...... .......... ................ ......::::.v.......... .... ...:•..v,••.v:::::::.v., r.:v.............:i?;•w�.tL}rn?vxv:-rn....:xy.:.:[i:>�.v�?{.}'?.G}::::j•}: .. .::: ...........................: ..v ... :....n....,..... .........0}}•h:4':;{.}v:y'•:t:':J}''nvnv:••.{i:`�.:•i'{.C:,�•%:�$, ....n..........................:....... ..... ... ... .:..n......... ... ::::.,•:::::.v::v::w:::::;...r....... !....... .. .... r}:?v.v::h:.Cv...r..v.... ,+.}:.{v}:•}S:v:•:;:;:•,: rt•}Y?nw:v................';v:•.v:•:J'• ?w::;; tv.v :: y}�}�,,-- .Y:• ��yg�y' ........................:.�.................... ..............:•,•:......:.:.�::::::.�::::::;•}:•}}:•.:.}}:%:;:::::.:•ST .............::...:,•:...::•:• :a:.J.rr.:::::.•r}}:;:.:::.t};t,?.tf..t}wfi i;}:<. :J..t........... ...,.. ..t...... }... ...w,. f..,......... ::.: ....Y...:...... :• ............. ..•rt....•..:.J.v....v}. •::•... ...::::.v:.v:::::::::::n::v:v:•:•::::vv::.v:.v•:::{.}}:^}}:•i:{4:+:•:�wnv::.v. v.J n::},t••.v:•. :•::::::::::x.r. ,:..:.r:••...}v}:r.. :.:.P::. •.:v.v.::::w::::.v...r......................r.... {... ....................:....................:.::................::Wnv. .........n....•,..w.y... :.. ... ♦ ........vn:n, ., ;:ti�ik iV;}i}}:ifnjti:% ... ..... .T .v r... ................................:.:..:::.v v:v.v:::.v::v.v: ..:.,v}:•i}Y.vn, {r?: .}•.�.v:•:?i'•f?ii::•}:t•}::•}?^}}.'::{. .......v.....:v............•.:...,••. ..,.....r..... ................:•.v.........................:.vr•:•..vt. ..,.v ....vY:::: ,•r.-r.•,•Y�•.•.•.,. ~�MIw .... ,...:••.v..,... ...tt.. y.,,.}:::,+.• y}•y.}{Y`Yy: :.v v•rev:•v.••;:w.v:::w:•::::n•. v.}`:•::::•:::n}:-0' w:?:.w v::: J..:...........,•.v:::::•:v.. r.....;}}..;}...�n ..v:: ............::::::{•:t.:i{4:v` 'Y' ....... .................:.....' ..........nv:........v:v.•:4i}'-i}}}}::i}::.::,::•:.v.,:w::::::::::::•:::::::::.>i^:%{:i':}:tv:t�%:i4:;%i%;:?}:i�%::: . ........ .........::....... ..... ...........w:::::::.:::.v::::.v:::.v•'::::::::....................:....w:w::v::::;:.v.v:n:•r::::::.v::::::::xn: Y. .................. ..................... ...v:::.}}).tw.....rev......... r.v::::.4.L:;:}.}.;::nyvr.•.,..v.n:.r..v:-. 'v'F.ti+•ice:��t�%:4:;i.'�: ttC••i'v'�. t:%:%::•:?:%:;:}}}:•:'%:i:•;}:3:%:::::%?:'.}.::;:;;:}:?;%::�%�:.:•:�:`;;:%;%}:>i%%:•i}+:�}%%%i%'%%:•%:�%'%}G}ii%:•}i:4}:i:•:Y;:':'%%:;}i%%:?S i}i:v:•:i}:r G:•:�::•}:y:•r:•.}v: .:::nvn..:.:::::.. ................... ....................:::. .....y..:.•.:v:::n:.}w:+•}'::.-::..:n::v:::::w.::::t•;}::ti:.%+??V:•}:ti?:•x v..v.vrx:..;...••x::tv::.•• .......::::.:v:::::::::::::::::t:::::' t..........t... ..........................v::v.t............v...... ,... :,v:• ::nvv{}vC::.v{::::?.:... .. ............. ................. ...........,.........:.................... .....n.......•........., n... {.........}:n•:::::..•., v.v............1^.;vn4:v`:i•.:?•}:iv: ......:.......:..:..........:..�:::•:::•:::..v:v:::•.:.v.::::v::.:::•::::v:v:•..................................... vxvt ti•:;ttti•:t•:.}::•}:•}yw.}} savaaraix.......... ....... �' ......................................... ..............................::::::rev::::::n....•:::::•:::v::::::.............,.................... v.....4vv\:4:::y:x..::v.v; .. ................:.:................. ..................................................:... ..................................... ...J.::v.r::::::rv::.:.................... ,t• �C3 •+''nit:�: :...............:.:•...............::•................. .... ,,�• ... ............. .............::•::::•.�::::. ..::;•}r.:•.,:•:::::.-:::•::::::::r::.:::::::::::::.-::::::::.::......:'•.... �.. t.?:..mod•.......... ........ ......... .......... ..v..... ...................... ...............:......... .m::x.:S}}}:.. nv.v:.^}':.i.:::::r:`v'v. ....):•}.v.:•:1v.•t:�•n ... ...... .......................................:....................................w::.v w::::':...... ....,..: ..n.....• r:.v::::}:x}'•}}rev}:�•.;4n%Y'::,:.t.•.. .... ..... ............. ................. .................................. .. ..:rH:i}:iv:•v+ .r.....;},:.ti•:•}�:yv�+tvlt.v'}�.^!!;>:4:j. ................................... .v .........v............r...........:•. ...... ::...........n........r. oli {�:::..........v:n......::.v::.-::.tiv::::::::? .....: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Hoe rep to SI,S00.00 and/or one yam,imprisonment as weft as civil penalties in the form of a SLOP WORK ORDER and a one 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 do hereby certify under the pains and penalties of perjury that the information provided above is trap and correct ignature Date Print name /Y/►/4 ill/� v7vi� Phone# !L official use only do not write in this area to be completed by city or town official city or town: peradttlicense If ❑Building Department ❑Licensing Board ❑Selectmen's Office hxlc if immediate response is required ❑Health Department contact pemon: phone#; ❑Other_ Uvvi"d 9/95 PJla Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct,buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. ' Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be Y Department of Industrial Accidents for confirmation of innumce coverage. Also be sure to sign and �. submitted to the _ 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 on policy,please call the Department at the number listed below. are required to obtain a workers' compensati 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 peinutllicense number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavestlgatloos 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 Town of Barnstable pFIKE Regulatory Services Thomas F.Geiler,Director BARMABIZ M"M Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 )ffice: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: - JOB LOCATION:. Jr2 number street / village "H MEOWNER": ,414A1,y d —37u 36.E-22 9 y name home p one q work phone# CURRENT MAILING ADDRESS: city/town state -zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 procedures and requirements and that he/she will comply with said procedures and requirements. Signs 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 ladle 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 responnbilities,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 formleertification for use in your community. Application to ® r1IDnaYftDrtc�LS'trTC . 4I;t<[> t ;°.BLE ICY- Map Cg 2-073 MAY 2 g Al;j q: 3�n the Town of Barnstable ,�„ �, ; it: 2 9 U3 MAR -5 CERTIFICATE OF APPROPRIATENESS kppl cation is hereby made,with four complete sets,for the issuance of a Certificate of Appropriateness under Section i of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described.below and on plans, iroWngs,or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: New Addition Alteration Indicate type of building: House ❑ Garage ❑ Commercial ❑ Other - 2, Exterior Painting: L� 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole 210ther`Sl TYPE OR PRINT LEGIBLY: DATE ' ADDRESS OF PROPOSED WORK ASSESSOR'S MAP NO. OWNER _ iU� nv I ;Fzz /`1^ ASSESSOR'S LOT NO. HOME ADDRESS ./8�v � :�� •S'�r� �sf��>^1� �p1� TELEPHONE NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any Public street or way. (Attach additional sheet if necessary.) � s2rcrc✓ ��ie�a �/ C'u��^a�. R D I5Q,x /9 07 f it AT Zx)-fo r� AGENT OR CONTRACTOR /��uta�6� TELEPHONE NO. ADDRESS IYZP ��a�1� Sp`r�,o J///��7� i�•��S W j10 DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of ro/osedsign '3; /O�X/�'S�Na�lQbj�ove� 6y iSoG^lG 4,c.uessioh42 �'rav�t >/122a s ovc i4/6l` s;4�e o l�ou . a igG lam' % yea " L-, nos GLL'-� 5462 d^c�oG�Lt��'Xz� ' U o� �L5 u s ► ca�. e�. /� xiz a d vat o� lzozcse �c�jdG'�n ?"a s wfl�^oov►n �u 10 srde hey>ncl �e4�^ 1124 o AdGLS P,✓ ea�ov� sfi i2� 5>�� o COL� �a/2Q� %�e Ike e LLB ,"-'4o cva dow. Mak, �'ho�� Signed a daoU CDIoN y�� Owner- ontractor-Agent For Committee Use Only -t^ This Certificate is hereby Date'' d lDe led e Members' Signatur f 1 . UI r KeySpan Enagy Delivery Energy Dt;if:Cry 127 WhilCs Palh South Yarmouth,MaS`; Nsetts 02664 October 8,2003 Re: 211 Maple Street, (shed)W. Barnstable Norma Butler 186 Maple Street W. Bamstable, MA 02668 To Whom It May Concern: This letter is to confirm that there is no natural gas service to the above referenced property. It you have any questions, please call 508-760-7530. Sincerely, Steve Jacobson Field Supervisor lU/uu/ZUU3 'IN 6! 1 V NAB h.: Y ;}. l¢JUUZ/UUZ N .,, EL TR/C October 8,2003 Norma Butler 186 Maple Street Barnstable,MA 02668 ke:211 Maple Street,Barnstable Dear Ms.Butler: The purpose of this letter is to confirm that,according to our account records,NSTAR Electric does not provide electric service to a shed at the address referenced above. Please feel free to call me at 781-441-3365 ifyou.have any questions. Sincerely, .-woo Nancy L.Plen Mid-Account Executive I .a I CERTIFY mX T THIS SURVEY AND PLAN WERE MADE WEST BARNSTABLE "till i°ln„ IN ACCORD INCE WITH THE PROCEDURAL AND TECHNICAL `,o OF�AJ',p--i, STANDARDS Fv THE PRACTICE OF LAND SURVEYING IN � � .p 4v o : 9� T MMPAULA. 1NWEALTH OF MASSACHUSE7 � ' PAUL A AERITXEW, P.L.S. bAlE � L00010 US 'P n�Y 0' ASSESSORS O�ti so 0 LOT 46 C� 0' b S6Bke;,s �' """"'%%-%•• LOCUS MAP PLAN REF 292175 q �/ PROPOSED ZQNINC: RF"' '�� e ADDITIONS `?O�` ASSESSORS MAP 132 4'...... / /ry /3 6.1. G ASSESSORS SHED LOT 23 t O AREA 29800E S'F. � PLOT. PLAN OF LAND E o � MILL LOCATED AT 3JS 5� ' POND #186 MAPLE STREET WEST BARNSTABLE, MA. _ PREPARED FOR.' 14 AS.5-ESSORS NORMA BUTLER LOT 24 MAY 07,, 2003 YANKEE SURVEY CONSULTANTS 5 GRAPHIC SCALE UNIT 1, 40 INDUSTRY ROAD 30 so in P. 0.' BOX 265 MARSTONS MILLS, MASS. 02648 TEL• 428-0055 FAX .420-5553 ( IN FEET ) 1 inch = 30 M J# 53402 A e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _ Application# Health Division Conservation Division Permit# Tax Collector j Date Issued / J l 7 Treasurer Application-Fee _,� Planning Dept. Permit Feed, Date Definitive Plan Approved vved by Planning Board 0� b O) — s Histold - reservation/Hyannis U' ' ,r Project Street Address le S� Village WQ..�,+ l)ar(LSA Owner u\U( mtk kAVe r Address \i Telephone Permit Request O J� Ck- �2 \ 1 SUvk G+n S �LG �b)J _ o S Square feet:l st floor.existing.I proposed l� 2nd floor:existing proposed Total new J — Zoning District Flood Plain IIL E Groundwater Overlay Project Valuat�•ion 5(1t) Construction Type LoVize a.��, IT 0 i`'' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 21 Dwelling Type:.Single,Family Two Family ❑ Multi-Family(#units) s Age of Existing StruNre Historic House: Cl Yes Cflo On Old King's Highway: ❑Yes Alo Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other in _';0 q. o�. S 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: ,2r Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes Vift Fireplaces: Existing New Existing wood/coal stove: ❑Yes dNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing Cl new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Ao If yes, site plan review# Current Use Proposed Use 1 _ _ BUILDER INFORMATION Name Pob(Lf ni • 1 Q14 Telephone Number 5-0 '-//U 2- Address `1 kA'k l 1 UJ Do J Vp 0j A License# I 3 6.2 SC.L n J W vl(VLk . 0 2-S' Home Improvement Contractor# 0 7� 1 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SQr0 c.e SIGNATURE DATE Z �-2 O i. FOR OFFICIAL USE ONLY, PERMIT NO. DATE ISSUED { - MAP/PARCEL NO. ' ADDRESS. VILLAGE OWNER DATE OF INSPECTION�Ala7 FOUNDATION ©� FRAME ` 07 INSULATION FIREPLACE f � ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL - 1 GAS: ROUGH FINAL FINAL BUILDING -6Z 3 O DATE CLOSED OUT ' ASSOCIATION PLAN NO. - � I i I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I -Permit # I MAScheck Software Version 2.01 I I I I ' I Checked by/Date I I I CITY: Sandwich STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 12-21-2006 DATE OF PLANS: 10/06 TITLE: Butler addition- 3 Season unheated porch PROJECT INFORMATION: 186 Maple Street W. Barnstable, MA COMPANY INFORMATION: I.B.I Construction Co. COMPLIANCE: PASSES Required UA = 87 Your Home = 87 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------ ------------------------------------------ CEILINGS 156 30.0 30.0 3 WALLS: Wood Frame, 16" •O.C. 500 13.0 13.0 1 29 GLAZING: Windows or Doors 140 0.400 56 FLOORS: Over Outside Air' 156 40.0 40.0 4 ------------------------------------------------- ----------------------------- 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 1 5% Af the design load as specified in Sections 780CMR 1310 a d 9 Builder/Designer Date O I DUCT CONSTRUCTION: ( ] J All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating and/or cooling input to each•zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. ' I [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I � [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I , Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I i [ ) I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.) : I I PIPE SIZES (in.) I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 I 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- 0 I MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Butler addition- 3 Season unheated porch DATE: 12-21-2006 Bldg. [ Dept. l Use I I I CEILINGS: [ ] I 1. R730 + R-30 I Comments/Location I I WALLS: ( l I 1. Wood Frame, 16" O.C., R-13 + R-13 I Comments/Location I � I WINDOWS AND GLASS DOORS: [ ) I 1. U-value: 0.4 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I FLOORS: [ J I 1. Over Outside Air, R-40 I Comments/Location I I AIR LEAKAGE: ( ) I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to -the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ 1 I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly ! I marked on the building plans or specifications. _ I I DUCT INSULATION: [ ) I Ducts shall be insulated per Table J4.4.7.1. I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ,• www.mass.gov/dia Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPUcant Information Please Print Le ibl Name(Business/Organization/Individual): CU w Address:_ City/State/Zip: vi•�.. Phone.#: (P Q Z Are you an employer? Check the appropriate bog: .Type of project(required):. 4. I am a general contractor and I 1.❑ I am a employer with � ❑ 6. New construction . . employees(full and/or part-time)-* have hired the sub-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 Working for me in any capacity. employees and have workers' 9 ❑Building addition comp.insurance.$' [No workers comp.insurance 10. Electrical repairs or additions required.] 5. We are a corporation and its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself.[No workers' comp. - right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers' 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 anew affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p s•and penalties of perjury that the information provided above is true and correct. Si ature: Date: ?Z 6 6 :hone' #: 02, 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): J.Board'of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other. Contact Person: Phone#: i intormapon anct 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law-or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information-(if necessary)and under"Job Site Address"the applicant should write"all locations in - (city' or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves-etc.)said persons 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 lnclustrial Accidents Office of Investigations 600 Washington Street Boston=.MA Q2111 Tel. #617-n7-4500 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mas.s.gov/dia i /TME lvrrll VA J..0alJAOL"LYA%7 Regulatory Services snuvsrss . ; Thomas F.Geiler,Director Ass. i6g Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ace: 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 Rzth other requirements. Type of Work: U✓1 Lc)n" Estimated Cost 2 2E S� Address of Work: �1�(P S �-�7 Owner's Name:,A J/7 e"I�A Date of Application: Z- 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: 0VnRS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTYFUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the a ent of the er, /112-ij � &3 to ontractor Signature Registration No. OR Date Owner's Signature Q:wpf les.for=,.homea.ffiday Rw 060606 °F,►W�° Town'of Barnstable ti Regulatory Services anMsUBM, ` Thomas F. Geiler,Director asnas. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder E-4 7"4 z�--R , as Owner of the subject property hereby authorize ImLL24 I�P 20 4I l S ,, to act on my behalf, in all matters relative to work authorized b7 this building permit application for: (A dress of Job) Sign tore of Owner Date , Print Name Q:F0RNIS:0WNERPERNUSSI0N "i BOARD OF 13U.IL©IN.G REGULATIONS ' License: CONSTRUZ`TION SUPERVPSOR f :, . 028811 Number:;CS. Bert dae 70511Q1'1957 ' Tr..no: 221.03 ,A fr. ;0511:01`098 FC�S �_ .. _ ROBERT G IAl70tIS{4 .4% 4 7 M6LLWpO.p WAY`; E SANDW.ICH, MA 02537 Commissloner • �r �� . I I t Board of Building Regulations and Standards j HOME IMP OVEMENT.CONTRACTOR I Registra€ion?-\103635 " Exptrati`on�-O�008 i•Vitlual 1 ROBERT G:IADO.IS:_ - Robert ladonisi 7 Hillwo8'd Way i E.Sandwich,MA 02537 `'- i' Deputy.Atlministrator • i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i,,f��&41' Map f�� Parcel . f a �BLE Permit# Health Division fo f 0q Wtio b 6a9 Date Issued -_4wq /y) MMllss r FEB �Vi.1 Conservation Division Z��Oq VTR— 2l_ Application 04 Fee 1` Tax Collector 0 �F /d Permit Fee Treasurer ,NST�ICSYSTEMMUSTSE Planning Dept. �TOH T,T�E COMPLIANCE � Date Definitive Plan Approved by Planning Board ENWRONMENTAL COD AND Historic OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address /1?42 �lp �r�P Village - e�'f Owner 101192A Address IRI, Telephone D " — Permit Reqw t d14�la J Square feet: 1 st floor: existing- to zY proposed 0 2nd floor: existing proposed Total new D Zoning District a)t� Flood Plain Groundwater Overlay_i P Project Valuation CqW ,d'd Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Rr Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: O'les ❑No On Old King's Highway: Q-1es ❑No Basement Type: @'dull O'Crawl ❑Walkout ❑Other � . pair r'kraW l Basement Finished Area(sq.ft.) 42 Basement Unfinished Area(sq.ft) fl,.z 41 6,atke_a s Le SO Number of Baths: Full: existing / new Half:existing new Number of Bedrooms: existing Z new Total Room Count(not including baths): existing 5 new First Floor Room Count ., Heat Type and Fuel: CYGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑'No Fireplaces: Existing y New Existing wood/coal stove: ❑Yes (moo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:l(existing ❑new size' Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use c BUILDER INFORMATION Name�1as�� !k(tN4l IV Telephone Number Address j W r� License# lS) D 2 3 Home Improvement Contractor# Z0 3 �3 Worker's Compensation# AILI ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ( l�tC C,t�ASI� �StS` PISSwi�� SIGNATU DATE i 1 s FOR OFFICIAL USE ONLY 'PERMIT NO. DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER o DATE OF INSPECTION: FOUNDATION FRAME i C y INSULATION FIREPLACE' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROU%i� UZ O FINAL r, FINAL BUILDING N AC ,n NSI... ,,_ o 22 DATE CLOSED OUT Jy c,") Fn co ASSOCIATION PLAN NO.W 5 The Commonwealth of Massachusetts Department of Industrial Accidents 600'Washington Street Boston,Mass. 02111 ` Workers' Com ensation Insurance davit " i Warne: iA J'�"�•l rf R location: f� Q city � Q' S /a nhone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worlds in ca amity I am an em 1 ravidin workers' co ensation for mp e 1 es working on this job. g :r.�::-•+�::+}}'.,;..%?,K,:}::.,}}+Y., .,}%.?%4:c}}:4%+{yf;2::L•• :5.?c•:c?:?:»i'Y`::.iR)?:?'.:;3?,+,:,3w:>)YL:;Y;.,}ky:;;'?';._.:'•:,4:;? ❑ n n ..xv.:•. ••, •:.A.}{..L..::vh... .::4whv\vi;�Y l..;.., ;{ v,•i 44 -<5''••• {• },'':"''%? .... .. .... ..r....r a,a.. ... ... ...\ ......,..,....,..,5::..fi•::;'i.+ :...:::.....,....:r•.:LF::+Yr..... ..:,... :.,...:w•}:%•:ay;;:......r, ,t::..::t•.,,•.:•.,,}r}i•}••.. .a4v':•K� •:.:??.}>• a+.T.. :,u... •::h•:::�•Y•:•,•:::::::• :..x. :,r...:..r:::+•:..:.}:t•.•:::::•r: vF::�$f::.r.:..5.).. .�•::•.. 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I do here.h under the and perjury that the information provided above is trw.and correct signature Date a eelA S Phone# /-501 �� "Ylow = Print name V C � ofHdal we only do not write in this area to be completed by city or town oMdal city or town: permit/license# ❑Building Deparbnent ❑Licensing Board ❑checkif immediate response is required ❑selectinews Office _ ❑HealthDeparlmeut contact person: phone#; ❑Other, (mewl9195 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer.is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or*renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe 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. Ell 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 maybe ' or confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial Accidents f . . � 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 obtairf a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sore 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/Ircense number which will be used as a reference number. The affidavits may be retnmed'io 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. /10 The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesugatlons 600'Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 . �.�ZVE'O'y�j. Town of Barnstable Regulatory Services sWsxaara. = Thomas F.Geller,Director y MASS. $ �P i639. ,,0 Building Division rfD MAC Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME LAPROVEMENT 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: Owner's Name:__ Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I h reby apply for a permit as the agent of the owner: ate Contractor Name Registration No. - � O at 0 's ame �pFSNElo�� Town of Barnstable Regulatory Services �BAMSMAM rABL&g Thomas F.Geiler,Director �ptE.6 9.MA'Sa Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I. �/� /.�,cl,�,L1_n , as-Owner of the subject property hereby authotize to act on my behalf,. in all matters relative to work authorized by this building permit application for: e % �f (Address of Job) Signature of er Date e,'fMA? Print Name Q:F0RMS:0VMERPERMMSI0N • (! :.�F.�..�.�_ I �/ae 1°oanvma�u,�`��-A�xa�. .%�aaoac�ivaef�. � ` ( BOARD OF;BtJILD;II�;G,REGUIIAJTI:O�N9. ' License: CONSTR61,6riON SUPERVISOR... Numb�G�$; 028812 Bi;F. 11956 k:n _" L4'•"004 Tr.no: 17244`- 0 tf; i JOSEPH J BAKU. PO B07P1243/91N DENNISPORT, M;' Administrator' Board of..Building Regulations and Standards HOME I QYEMENT CONTRACTOR U1 e -Erat ...�fQ Ex'_ir,�i,on,=:: 04' JOSEPH J.BAKUNA • Joseph Bakunas 9 Newcombtr.Box 1243 V Dennisport,'MA 02639 i P-AR ,,�� C-JI Et Application to �' 91 ttC�IlrYC 1 A� "@d'p AMiDnal WO Mi-0triftQF BLE M MAY 2 9 AM !1: P 9the Town of Barnstable 2D03 BAR -5 AM 11' 29 - CERTIFICATE OF APPROPRIATENESS pplication is hereby made,with four complete sets,for the issuance of a Certificate of Appropriateness under Section of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described.below and on plans, rawings,or photographs accompanying this application for. :HECK CATEGORIES THAT APPLY: Exterior building construction: New 0Additiob ErAlteration indicate type of builLing: House ❑ Garage ❑ Commercial Other Exterior Painting: II'� Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Rep—Alo�rting ExisOng Sign Structure:- ❑ Fence ❑ Wall ❑ Flagpole L✓TOther��o( TYPE OR PRINT LEGIBLY: DATE_, , 0DRESS OF PROPOSED WORK /1° 2&4 ? Spree 7' ASSESSOR'S MAP NO. /3,Z )WNER Xf-h P4-9ZA Y &t�y ASSESSOR'S LOT NO. D2 •TOME ADDRESS /81 kid aLezj ai"d, zrn^ 5 )8 TELEPHONE NO. =ULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any Subiic street or way. (Attach additional sheet if necessary.) 624 �� c a, a^avt I� e � l� � • i kGENT OR CONTRACTOR 6unev- TELEPHONE NO. 3loa-ZR�� ADDRESS IY6 )*,a PZ� S'9`rx�,o_�, /�1�sf :ia-ztns I�r_ole DESCRIPTION OF PROPOSED WORK: Give particulars of work tp be done, including materials to be used. Please Include locations of proposed signs. / N/l 2/%�!� �➢� �D a s177� O�c' ��lo l�/' �'/� S�, L1Jes �at�'a,SY�a��e. C°D..c57�v�.c�zZ Soar.b'Do vv�(z'X;C�3 o0 �Gjou�e, Cow sir d ee-k &I)e l) -fo 7G4e pea a- di- &""d �S'Cu.�r�a''t^DDvh eewd1iyj�j b ��e2hcD A o 5 eL. �>us P,fQ? G � � / aooip /Vz 5Lied me&,d "k �k ti6,4 o� G�ox l,4h.d u e2"0s _ Ke lame uw/ Cb(,u. 6'tu-u wt,;Adozo, �1,�,,t�� +ho�2 Signed �Do U CdL'°r y�of Owner- ntractor-Agent For Committee Use Only This Certificate is hereby Date a Approve enied AAA embers' Signatures: f Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATIONS SIDING TYPE�,�iLl f io COLOR CHIMNEY TYPE vAn COLOR ROOF MATERIAL-...&.2 iliZl i7 COLOR /lj/ale 1 d 5,° D / rc6 e yB q� PITCH WINDOWS ' _l a5 (�'' COLOR L &4-te SzzE ✓fir Jr ' ` �d 3`c.) ----T _ TRIM COLOR // ` )) OLORS / DOORS�/1�S 4.t2lYl� DZ^ �d/iIA_,Lt, 1 t�C SHUTTERS /Ud4 COLORS GUTTERS dLgMl-, Ld 20 COLORS GU 4G y,e DECKS /,;7 LDS'l MATERIALS C' GARAGE DOORS /U COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS_ FENCE A e COLOR NOTES: Fill out completely, including measurements and materials/colors to he used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape i Norma Butler SOSSS22999 02/05/04 11:97A P.001 r 01/27/1995 18:41 915087906230 PAGE 01 Town of Barnstable—Historic Preservation Divi.4ion Old King's Hlghway Historic District Committee } law, MAS= trn.a PostdM Fax Note 7671 gads 2 v�0 MEMORANDUM.. T° M(3. t'l C `'""' b a-� t I l c0.1owl. co. TO; Building Commissioner P"O"°° P11Ofe 0 Fmc• rl — fog� FROM: L DATE:. SUBJECT: MODIFICATION TO PRIOR APPROVED PLAN A minor modification to a prior approved plan has been approved by the OKH Committee for the applicant(s) named below. The modification is briefly summarized and I have attached backup material for your records. Applicant(s): Address of Proposed Work: IE Al Assessor's Map & Parcel Number: Minor Modification: SI;�l�1^n;iG2� Z.►�� ilLd�-.�1��-��1� � -��i� I�tsJi_.�t� ��' ��G" .. Dom' 4A1Ae7 ?0 u91111 , t e lr�;�` dot I Ile / 6 ,, a 'I7/ Jeffrefy Wilson, Chair Date Tovyih of Barnstable Old King's Highway Historic District Committee ' L r Norma Butler 186 Maple Street ` West Barnstable, MA 480 Map 132, Parcel 023 17 i; REAR ELEVATION showing approved deck and proposed new door and three windows Scale: 1/81, - 1' i I cs N A OF SFAA ��blELA. `g Gy om �• A.sSMS b LOT 9 Q a NI �' IYIIII �$ ~py II IIIIIIII/III v ® � NarNeiNovlsv �; '. \��` II/IIIIIIIIIIIII IrIIIIIIIIIIINONI • IIII/IIIIIIIrIINIIIH IfIIII� IIIIIIIII III/IN� �IIIIII/II ,r. III=II�� IINIII� IOI77011eI110I001 ' II001IIIIIIIIIII� .� NesNseoNeN IvuNlNose�' ;`sv=. ' eloseeeos gg��p��py� Ieeleil PR(L8�—ifa7�ED INeeeel Ieleeel� _ . p�yy-9pr��pp�olle �I dfX/�8/H Vlt►a7 l ��o ASS i LOT le SHED AREA , PLOT PLAN OF LAND LWA= AT -""86 MAPLE STREET PREPA&W FOR NORMA BUTLER . Y O7, 2003 GRAPHIC SCALE m nET Engineering Dept. (3rd floor) Map oG Parcel 60-9wa .Permit# / 7-?S -9 House#. _ f C_V_ Date Issued Cj � 4a38j� Fee ,,0fZ5-,C.Z. G•CcinseFu-a ' oor - 0-2.00) De oard, 19 BARNSTABLE. MASS p. TOWN OF BARNSTABLE .Fo + t Building Permit Application Project Stre Ad r f 6. Village C 15WA q SIGyP,/5 C y� Owner "`'I /2r 1�� G�/e4' rrP 161 G tA1 I Address /R �� i Telephone Permit Request Q S /-q- I First Floor square feet Second Floor square feet Construction Type 1�1 S Estimated Project Cost $ �d Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 6 O Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl alkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing l New Half: Existing New No.of Bedrooms: Existing �'� New Total Room Count(not including baths): Existing 3 New First Floor Room Count Heat Type and Fuel: gas ❑Oil ❑Electric . ❑Other Central Air ❑Yes 6'9o- Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use �9 Builder Information Name C/ W/ l��ll��f /`/ Telephone Number �� 7 Address License# 0 (3 Q Home Improvement Contractor# 0 G S� 2 Worker's Compensation# _ /moo r'`P E NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO /5�.de"' ,5e .S��o �9Col SIGNATUR DATE 9 �� 9 J9 BUILDING PER DENIED FOR THE FOLLOWING REASON(S) r j FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' r ADDRESS F - VILLAGE OWNER t ► 'Fp DATE OF INSPECTION: FOUNDATION FRAME 1 y III INSULATION I ` FIREPLACE 'All ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH F L GAS: ROUGH FINAL FINAL BUILDING cv- J/ DATE CLOSED OUT ASSOCIATION PLAN NO. Hill g +sus t. ,,.� � LY'* HOMEIMPROVEMENT'CONTRACTOR ;• :��`t �l�Aegistiatoe�1�00053 � �`�� " ha s,�F1s1+4:1t/?'8 ,..v'�','s,t�0., tr "�✓"�};I,; ' i �yPe .INDIVIDUAL�s ��. + n satt•P'�"s ytu� y's �� i*4��,.h�,1. • z �fzP�rlon �06/08/9�8;�, ��t�;Y� �wTF ' " -- s ItICTOR J IIIINIKAINEN .��-r � ,: ;�� . rville MA�y02632 �%A�� face, ' r!�(Q1r'1••Q� _ ::±iY�?'"•�p^F�"��G.�y'.b�A-'r�,,�tS�',.'••xx• �" :y..r • r L' a � .}�st "� `� "Tama•-:, - "ff�ff fa�t •tx�x t�'Tzr��.�`� �v F�.tr's w�,'iz�' y1 ��'."'.I„ gk..,�,a`;at�,ty} ,��•�� xv�w"ci'Ya ��'..Ca�. ��.��,_'3•,r. l I i 4 ' Department of Industrial Accidents - • OII/ceof/ZWest/921/ons ty,`_ i i w •- tin '• = 600 11 uxltitr,ton Street X.` Burton.A1ass. 02111 ' Workers' Compensation Insurance Afridavit 71_...� ,�.�T. Annitc. nt m rmation//�� Please�PRIIVT'le�tbl_v,�,�/I •_ name*Cit • v �' ay�� L71 L L nhone I am a homeowner performing all work myself. ,gym a sole proprietor and have no one working in any capacity �__.�f.:••�-..-=s-.....-t..--7-1.-?-:-,Llf-...rA.�.n...,V.R_:••-..s.-277?�!`-..'7�-a..ru. - - --. .•.._.. __ �_�,�_�""""'^':"""."'*"""_-s'- I am an eniplover providing workers' compensation for my employees working on this job. nn v i � Iclrc� cih phone#• incurince co notice# 1 am a sole proprietor. general contractor, or homeownex(circle one) and have hired the contractors listed below who have the following workers compensation polices: comlinnv na e- ldre cir nhone#• ins urance c nelicv# . — - - u�nc r�ss-e-,-r::�c�-.c-.•,-5.:.__ -v�-.Ra.: -Ica,�i►+.ori�s+._.,. ..,.Zc�v-a..--+.+�"w,,o,,-�e-:�.i enm anv name: iddre c- rit nhone#: incur•tnce co nolicv# .`Attach additional'shect if necessa' ;s."v,-^I""••t��"a<�eas i :•�.:.�. ir. -"4`:+ �� 7_L;-, .�__ ;•=� A; Failure to secure coverage as required under Section 3A of 51GL 1152 can lead to the imposition of criminal penalties of a fine up to S1S00.00 andiur one scars'imprisonment a!i well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. Ionderstand that a copy of this statement may be forwarded to the Ounce of investigations of the DIA for coverage verification. ' 1 do herebi•cc •tin er tit pains and p tattles ojpeduq that the information provided above is true and correct. St:nature anatu. Date *� Phone �2> u ^/Y� �jQ /l�Crr Print name a�O '0Mcial use unly do not write in this area to be completed by cih or town official city or town: permit/lieense q riBuilding Department C3Ucensing Board check if immediate response is required OSelectmen's Office C311ealth Department contact person: phone#. 1••IUther lRvi.cd P*PJAI information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* compensation for employees. As quoted tom the "law-. an crnphtme is defined as every person in the service of another under an\ contract of hire, express or implied. oral or written. An eiytp/urer is defined as an individual_ partnership, association. corporation or other legal entity. or any two or r. the foregoing engaged in a joint enterprise, and including the le-al representatives of a deceased employer, or the receiver or tntstee of an individual , partnership, association or other legal entity, employing employees. Howeve: oxvner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwcllintg, house of another who employs persons to do maintenance, construction or repair work on such dwelling: or on the arounds or building appurtenant thereto shall not because of such employment be'deemed to be an empic MGL chapter 152 section 25 also states that every state or local licensing ngene}•sliall withhold the issuance of 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 charm: been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to;your situation an supplying company names. address and phone numbers 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. Tile affidavit should be returned to the city or town that,th; 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 requi: to obtain a workers' compensation policy, please call the Department at the number listed below. Cln' or ,roivns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottotr. the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the perm it/license number which will be used as a reference number. The affidavits may be resume,- 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 questi please do not hesitate to give us a call. .. .... ate.!>`• .. :a... ' 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 fax N: (617) 727-7749 °�"� . • of Barnstable _ The Town ental Services • 1 Environmental • r"�'g Department of Health Safety and ]Building Division to 367 Main Street,Hyannis MA 02601 Ralph Crossen Building Commissioner Office: 508-790-6227 Fes: 508-790-6230 For once use only Permit no._---- Date AFFIDAVIT HOME UAPROVEMENr CONTRACTOR LAW SUppIMMENT TO PERMIT APPLICATION onsttnction, alterations, renovation, repair, moderaiz2tioa, wires that the "rec re-existing MGL c. 14ZA requires removal, demolition, or constraction of as addition dwelling anus or to conversion. improvement, at least one but not more than containing be done by registered contractors, with owner occupied building . structures which are adjacent to such residence or building with other requirements' �� certain exceptions,along /' 0i Pr 2 C- Est.Cost CO Type of Work:/� PS�I�c T Address of Work: Owner's Name 6 (Q Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling Own permit I WITH UNREGISTERED Notice is hereby Ui�GbaTV= OWN pERNIIT OR DEALING W DO NOT HAVE OWNERS RS FOR APPLICABLE HOME IIVIPROVETFD UNDER MGL c.142A CONTRALTO TION PROGRAM OR GUARANTY ACCESS TO THE ARBITRA SIGNED UNDER PENALTIES OF PER=Y i for a permit as the agent of the owner: Q C S� I he by a PP y� � n ) gegistra�tion No. Contractor Name Date OR. Owner's Name I - ,�a I CEY THAT THIS SURVEY AND PLAN WERE MADE W BARNSTABLE &OF ,ir��i IN ACCOIQDANCE WITH THE PROCEDURAL AND TECHNICAL a, PAULA 57:91VDADS FOR THE PRACTICE OF LAND SURVEYING IN s Myy �' T j(MONWEALTH OF MASSACHUSETTCal S PA Al /1!I'RITHEW, P.LS. AT LOCUS �9 ASSESSORS �4�' Y° t� � � LOT 48 9 �1 � R 0 0 ss of �•9i tia Bst6.. 5's�' 000 ell Y .."..."."...1. �. o "....""" """"." µ LOCUS MAP 0oloolo ............". PLAN REF 292175 . PROPOSED .......^ ...,, ADDITION �o• ZONING: "RF" ! ��X �` ASSESSORS MAP 132 Nto ASSESSORS SHED LOT 23 ��. �� O b AREA 298001- S F. n PLOT PLAN OF LAND b MILL LOCATED AT � POND . 315��; #186 MAPLE STREET WEST BARNSTABLE MA. PREPARED FOR: j;M NORMA BUTLER ysEssoRs ��`oT 24 - MA Y O7, 2003 YANKEE SUR VEY CONSULTANTS GRAPHIC SCALE UNIT 1, .40 INDUSTRY ROAD 15 30 so 12O P- . 0. BOX 265 MARSTONS MILLS, MASS. 02648' ( 1N FE> ' ) TEL., 428-0055 FAX420-5553 1 inch = 30 M N� J# 53402 AS 1 I 'CERTIFY THAT THIS SURVEY AND PLAN WERE MADE WEST BARNSTABLE \��u�►►►urr�� IN ACCORDANCE 07TH THE PROCEDURAL AND TECHNICAL ,QF. qs''4,'. STANDAR .D FOR THE PRACTICE OF LAND SURVEYING`IN �o G T MMf7NWEALTH OF MASSACHUS 4? PUI fi .-may N� a' z5aooco MERITHEW, P.L S-- A E 'fit �= I°O R`°o ..= LOCUS 'p - ' AV ��,y ti� ACb %ES' ORSw-T 46 4 10 -------------------- LOCUS MAP y �0' ,,,,,,..des10000000 ,,,,.,,,, rel 00 PLAN RE'F 292/75° :;,;,,;; �`�- PROPOSED _ 30, ZONING: »RL,» . ,00 0.- ,, I "s',;;,, ADDITION �` ASSESSORS MAP 132 ,,,,,I ASSESSORSN. 6p _ a T 23 o b ' `SHED t� O cv AREA ''9800f S F. '� N I 2%5'� PLOT PLAN -OF LAND _ MILL LOCATED AT I P , ' ."'- POND f-186 MAPLE STREET WEST BARNSTABLE, MA. t PREPARED FOR 14 AS.=SORS NORMA BUTLER LOT 24 MAY 07, 2003 YANKEE SURVEY CONSULTANTS GRAPHIC SCALE UNIT 1, 40 INDUSTRY ROAD o 15 30 so 120 P. 0. BOX 265 MARSTONS MILLS, MASS. 02648 TEL-. 428—0055 FAX 420—5553 IN FEW ), � Jf 53/, i inch 30. M r I r•�E?:mac•= _.... 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