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Town of Barnstable *Permit#Expires 6 13
uhs z 7 issue S�
°4 te
Regulatory Services Fee 210,3y
i AAFMICA111 R
-ASS' Richard V.Scali,Interim Director
6 p1 (MPRIEMS� l- IJ
Building Division
Tom Perry,CBO,Building Commissioner MAR 0 6 2017
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us TOWN OF 8 A R N S I A®LE
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address
0 Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address IOZOX1,a Il/'
Contractor's Name Telephone Number����
Home Improvement Contractor License#(if applicable) ����/�-/ Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
C.eck one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's'Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Z��
Re-roof(hurricane nailed not stripping. Going over existing layers of roof)
❑ (h )(
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
re ed.
SIGNATURE: n /
T:\IEVIN MBuilding Changes\EXPRESS PER1vnT1MUSS.d6c
Revised 061313
f
BARNSTABL&� Town of Barnstable
Regulatory Services
Richard V.Scali,Interim Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must .
Complete and Sign This Section
If Using A Builder
I bC1,0V17 c, /I77 //el ,as Owner of the subject property
hereby authorize 1*770-7�' G to act on my behalf,
in all matters relative to work authorized by this building permit application for.
le- f1ice--74
(Address of Job)
Signature of Owner Date
Print game
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
TAKEVIN_ IT\EMuilding Chmges�E}PRESS PERM 2RESS.doc
Revised 061313
T7ie Comincyrivealdt s�,fMassadiuseffs
Deep araffimt of lrudushid Acciderrts
O re o,f lrnvestigations
600 Washiziglou Street
_ Baston,ALA 02111
wnnn mmmgorldia
'"rarkers' Campensafrrtn Inmrance Affidavit:Buildeis/Contrac6ursJEIecfricians/Plumbers
Ap0ican#Infmrm36an Please Print Le ably
Name(susmessKhzauizaian&&vsdnaW Gt / ��r�-�r o—i
Address:
Cityltatel y �� �2 s 3/PhoneAre you an employer?Check the appropriate bom ' T r
am a general contractor and I Yl�of project,lect(required)-
I.El I am a employer with I❑ g 6. ❑New construction
employees(full andlor part-time)-* have lured the sub contactors
2. I am a sole proprietor or partner- listed on the attached sheet. I. ❑Remodeling
These sub-contractors have
ship and have no employees 8. ❑Demolition
w g fnrmaina employees and haCeworlcers'
nri any 1t3`- 9. ❑Building addition
[ND Wpdo;rs' Camp.insurance comp-fns can t-0
required-] 5. ❑ We are a corporation and its lO:❑Electrical repairs or additions
3.❑ I am a homeoumer doing all work officers have eesercised their 1 L❑Flumbing repairs or additions
mysdf[No woikers'gip- right of exemption per MGL 13.❑Roofrepairs
insurance required.]q c.152,§1(4k andwe have no
employees.[No workers' l3-❑'Other
comp.insurance required.]
•ARyapptic ff3stcheckssboxr1—st also fill out the sectionbelowshotaingthenwoAeecompeasatinu policy infororaaaL
fi I3nmeoaragrs who subaait dtis affida� iadmcating they are doing s11 woaY sad hiie outside coatiactnrs mast submit a new affidnit indica�-sack
fCanunctostbztcheckthis box must sttac_hed=additi®s1 shed sbouingthenmneofthesub-coat zcarssndsfafewhether.ornotflmseentitieslice
employees.Ifthesnb-contmctacshave employees,theynustpmvidetheir worken'comp.policy number_
I ant.an etttpIayer tltrrt isprm-zdutg�t�orkers'cotripertsrdtan inszirartce,fvr rit}�enrplv}�ees. �etoty is tJtg poiiry�rub joh a'rte
ft formatfan
Insurance Company Name:
'Policy ifl or Self-ins.Ile-i&'L. Expiration Date:
Job Sita Address: City/State/zip:
Attach a copy ofthe workers'compensationpolicydedaration page(shouviug the poPicy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a
fine up to$O,OQ.OG and.for one-yearimprisonmerd as well as civil penalties is the farm of a STOP WORK ORDERand a fine
o€up to$250-00 a day against the violator. Be advised that a copy ofthiis statement maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification-
Ida hereby ce*t nt. the pcurts artdpaiabies a pei jkgr dltatthe irtforuwfioi}proii d abm g is trus mid correct
Sitter _ Bate ? /7
Phan ik
O,,ifrd use only Da not arrtte in t[tis 1rrea to be crrtnpieted by rfty ar toirn o f1 ciat
City or'Fomm: Permit/Licease;g
Issuing Authority(circle one):
L Board of Health 2.Building Departruent 3.biylFown Clerk 4 Electrical Inspector S.Plurnbmg Inspector
6.Other
Contact Person: Phone#-
----- -- - - - 6
ormatza)a and Inst'nCtioJELs
hfas&ar Cats Ge)]L.e Laws chapter 152 reposes all eE13PIoyers to provide wormers'compensation far their empIoyees-
Pur saautto this sfatofe,an mlPrvpre is&med as-�_.evmy person.in the service of another under any contract of birey
express or iMplied,oral or wriifem"
An employer is defined as`pan individual,partnership,associate an,corporation or other legal entity,or any two or more
of the foregoing engaged is a Joint enterprise,and including the legal representatives of a.deceased employer,or the
rec er eiv or trustee of an individual,partnership,association or other legal entity,employmg 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 mabtmaace,construction or repair work on such dweIling house
or oa the grounds or building appurinaa tthereto shall ndt because of such employment be deemed to be an employer-"
MGL-chapter 152,§25C(6)also s A s t3iat"every sty or kcal licenses agency shall wifhhold Hie issuance or
renewal of a license or permit to operate a business or to construct buildags m the commonwealth for any
applicant who has not produced acceptable evidence of complianr-with the insurance covexage reg A—ed."
Additionally,MGL chaptrr.152,§25C(7)stains'Neither the cowanvecalthnor wry ofits political subdivisions shall.
enter into any contract for the.performance ofpublic wont unfit acceptable evidence of compliance with the insurance,
requsemea fs of this chapter have been presented to the contracting aufhodty_"
Applicants
Please fill obt the w0r3cess'compensation affidavit completely,by checI ang the boxes that apply to your siinaiion and,if
necessary,supply sub-contractor(s)name(s), address(es)and phone uumber(s).along with their certificates)of
„care ce. 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,apolicy is required. Be advisedtiattiis affidayitmaybe submitted to the DepaL-finent of Industrial
Accidents for conf rmation of msm-ance coverage- Also be sure to sign and date ithe aifdayit The affidaQit should
be-retrrrned to the city or to'Rm iat the application for the permit or license is being requested,not the Department of
Lndasftjal,Accidents. Shouldyou have any questions regarding the law or ifyon are required to obtain a workers'
compensation policy,please call the Department at t3ie number listed below- Self-insln-ed companies should entr-r their
self-insurance license amber on the appmpr ate-line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly- The Department has provided a space at tiler bottom
of the affidavit for you to fill out in the event the Office of Investigations has to coinact you regarding the applicant
Please be sure to fill in the peamitllicense number which will be used as a reference number. In addition,an applicant
that must submiL multiplepen =license applitstions in any givenyear,need only sabmit one affidavit indicating corrz t
policy infomation Cif necessary)and under"lob Site Address"tie applicant should Ovate"all locations in (may or
town)„A copy of tie-affidavit that has been officially stamped or madced by the city or town may be provided to file
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 penDit not related to any business or commercial venhrre
tier_ a dog license orpermiit to burn leaves eta.)said person is NOT required to complete this affidavit
I
The Office of Investigations would as to thank you in advance for your cooperation and should you have any,questions,
please do not hesitate to give us a call-
The Dep artinmf s.address,telephone and fax number-
• -
Department of 1adustial Awid-entz-,
��4��b�gtan S[zeel;
Bos1ou MA(2111
Tf,,1,4 617 -4 cxt 406 car 14M-MASS
Fax#617 727 774
Revised4-24-07 WW 7.Tna �-gcgldi&
aaooaa;;uaeu� Ueparlment or Public Safety:,'.
Board of Building Regulations and Standards
License: CS-069765
Construction Supervisor
Construction Supervisor
Restricted to: MATTHEW P GAGNON
Unrestricted-Buildings of any use. 11 OLD COUNTY WAY
less than 35,000 cubic feet(991 cubic Meters)ofontain EAST SANDWICH MA 02537
enclosed space.
/�� �� Expiration:
C ommissio er 02/28/2019
Failure to possess a current edition of the Massachusetts
��State Building Code is cause for revocation of this license.
DPS Licensing information visit' WWW.MASS.GOV/DPS
r
-License or registration vand'for mdividul.use only
before the expiratio- d`ate. If found return-fo: I /�` (92. ipaznmzoozirrea a�
/ .,.
Office of Consumer Affairs and'Business Regulation Office of Consumer Affairs&Business Re`gula�on
10,EarkP1aza,-Suite 5170 I `� v' ME IMPROVE" ENT CONTRACTOR
Boston,l4IA:02111b egistration: 4921 Type:
P xpiration. A11 .20-7 . DBA
•1,` 111 .... 1
`,MATT GAGNON _..
R00 G t
i +
! MATT GAGNON ?'`; ,�
Not valid ou �gnature •r �z ! .11'OLD COUNTY WA
' •E.SANDWICH,MA 02537
d Undersecretary
lr
� 1
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
AS& Posted Until'Final Inspection Has Been,Made.' Permit
Where a Certificate of occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-16-2857 Applicant Name: MILLER,WAYNE&BARBARA Approvals
Date Issued: 10/13/2016 Current Use: Structure
Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 04/13/2017 Foundation:
Location: 208 MAPLE STREET,WEST BARNSTABLE I Map/Lot: 132-024 -� Zoning District: RF Sheathing:
Owner on Record: MILLER,WAYNE&BARBARA Contractor Name: Framing: 1
Address: PO BOX 711 ; Contractor License:\ 2
- Est. Project Cost: $0.00
WEST BARNSTABLE, MA 02668 J, Chimney:
Description: 10x12 shed t Permit Fee: $35.00
t Insulation:
l J Fee Paid: $35.00
Project Review Req: 10x12 shed ;
Date: �'� 10/13/2016 Final:
Plumbing/Gas
Rough Plumbing:
{ \Building Official
y Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
r Rough Gas:
All work authorized by this permit shall conform to the approved application and the*approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zornng by-laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
I ---- -- �/ Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:!
1.Foundation or Footing F -°�F� 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
{- _r
h
Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
MASSBAJSTA � ' Building Division �, �
cM: a
b a` Tom Perry,Building Commissioner o.
200 Main Street, Hyannis,MA 02601 ;'' ?V)
rti
www.town.barnstable.ma.us O d -� -1
CD �
Office: 508-862-4038 Fax: 508-790-623b�
—a
q
PERMIT# FEE: $
SHED REGISTRATION
RESIDENTIAL ONLY
200 square feet or less
Location of shed(address)N Village
774
Property owner's name Telephone number
�n x i -\3 a�
Size of Shed Map/Parcel#
'a-7 &1- a�
Si aturU Date
Hyannis Main Street Waterfront Historic District? U
Old King's Highway Historic District Commission jurisdiction?
If over 120 square feet,you must file with Old King's Highway
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE
ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION
FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN
Q-forms-shedreg
REV:110413
t •—y
NOW" . , D Bend
. Parcels
Town Boundary
132046 —Railroad Tracts
9176 13 Buildings
132006 132023 — Painted Lines
8195 #1a6 Parking Lots
Paved
132036001 ;,unpaved
8,57 Driveways
/ Paved
132005 Unpaved
R211 Roads�
'` 0 Paved Roads
Unpaved Roads
r�::•`' —Streams
-Marsh
` 13 Water Bodies
132 4'
aI 41 �f
132024
0203
7 P�4
1
132025
8 230
t'L 'J'r
Map printed on: 9/27/2o16 This map is for Illustration purposes only.It is not Parcel lines shown on this map ere only graphic Town of Bamstable GIS Unit
adequate for legal boundary determination or representations of Assessor's tax pa reels.They are
Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi
O 83 167 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624
reflect current condltions,and may contain such as building locations.
Approx.Scale:I inch= 83 feet 0 cartographic errors or omissions. gis@town.barastable.ma.us
PROPERTY,
• • • i • v , ;. Legend
t{ Parcels
Town Boundary
132046 r —Railroad Tracks
x w G 176 * Butidings
132006 u 1?2028 Painted ones
?�145 �31 A6 Parking lots
13EQ36Q01 "* pand
57 4 Driveway*
= j 41 Pevcd
Roads
' ®eddy
9 oared rtoam
�R arch
x ed Rsaas
Water Bodies
a:
13204a
N
132025 ft a
#230 ���`• �
y :r
13t0fi y. �
6 232
Mapprintedon: 9/27/2oi6 Thiamapis for Illustration purposes only.Itisnot pamlllnwebo«uantidsmaymoniygraphk
•• ndegoate for kplboundntydetaminntionor reprosenn •ctionsofAsstssoestaxyanvi& heyate Town oYBatnatab1e0I3UMt
Feet regulatory ioteryteatton.This mapdoesnotrepresent not true propertyboundariesauddonotmTregent 367MWn9htet.Hywdt,MA02601
O 89 16Y an"41tcgroand"^W.It maybe gsuonnacd=may not eoeurate athtil—3ps to pbyo-tmlobj-u on the map 50"62'4624
*t0eacumatamdbioas,ondmaycontain suehasbuildinglocationa.
Approx.Scale:.1.inch 83 feet cartographic errors orondW on. gis@town.batnstable.m2.us
a �
Town of Barnstable
z Old King's Highway Historic District Committee
200 Main'Street,Hyabbh,Massachusetts 02601
i (508) 862-4787 Fax(508) 862-4784
CERTIFICATE OF EXEMTTION
Application is hereby made,with'four(4ycomplete sets,.for..the issuance of a Certificate of Exemption under Section o and 7 of Chapter
470,Acts andResolves of Massachusetts,1973,as amended,for proposed work-as described below and on plans,drawings,or photographs
accompanying this application: r -�
Date \ '' �.6 Address of Proposed work, Assessor's Map.and lot# I� ( 0 0z
House#.. Street Village:
This application s,for an exemption,of the proposed construction:on the grounds that work:
❑ Will not be visible from anyway or public place
. .Is within:a.category declared exempt`by the Old Kings:Iiighway Regional His strict Commission
Other
Description of Proposed Work:
i
i
i
Agent or.contractor(please:print): A g- ® _ Tel.no.
Address
Owner(please.print): Tel o.
Owners mailing address: C-)
Signed,Owner/Contractor/Agent
i
For Co.inmiittee Use Only This Certificate.is hereby Approve&Denied Date:
�. Committee.Members•Signatures:
APp
of earnstar le
Tow King s H,gh"aY I
Old Committee ;
Any conditions,of approval:
C.(Documents and Settmgsldeco111kU.ca1 SettingsMemporary InternetFileslOLKIIOKH EzemptiomForm•07.doe
' � = � -
M.
11` a7
.........
A
e
APP OV2D
uQuiveft CapeA OCT 12 2016
Town of P;•r:able
Perfect for seasonal storage of beach gear.fishing equipment.bikes and Old Kin
g'°6.x8h.::y $2,680 10'x10'.........$3,900
more!Our most popular design features a steep 10/12 pitch with 6'5"walls Com�6,XiQ.......
.....$2.880 10'x12'..........$4,200
on front and bade creating ample storage room for the included 48"deep 8'x8'............$2,880 10'x14...........$4,940
loft.Sheds 12'and less come with(1)door and(1)window on the front 8'x10'...........$3,300 10'x16...........$5,560
wall.Sheds over 12'come standard with(2)windows. 8'x12'...........$4.340 10'xl2* .........$5,160
8'x14'...........$4,340 12'x12'.......... $5,160
8'x16'...........$4,740 12*xI4...........$5,780
12'xI6...........$6,600
..............Plus Tax
Pictured buildings may contain options and upgrades that affect costs of sheds and small buildings.
Please inquire for more information.Pricing is subject to change without notice.
A.10'xl6'Quivett Cape:B.10'xl4'Quivett Cape:C.10'x14'Quivett Cape:D.12'04'Quivett Cape:E:8'x12'Quivett Cape
s PINEHARBOR.COM ) Buildings Beyond Your 4-pectntiou
• • s • to tp ra �; t " , Legend
WIG
� —Town Boundary
5's'<D46 1 . —RailroadTradcs
V 176 ;" J Buildings
932D23 Painted Lines
`135 Parking Lots
Paved
"t.b'.��g� �Ats- -.K ...,• `� .. Unpaved
' [ �•.� Driveways
PZved
i3' g5y gyp. p. 1y Unpaved.
4241 r, r,i -',• Roads •
.... - - • Pared Roads
•' �'s ,• �• Unpaved Roads
_-••:f:: �' 4'. .Y 'C Streams
Marsh
-'Water Bodies
'i3ZQg4�r:��
3P,. x l
132s25 �£ .. �i • "
r 230
Map printed on: 9/27/2016 This mop is foriUustmtionparposes onty.Itis not Paxoel linesebo.tn on this map amo
•- a degoateforlesotboandatydetetminationor t ab87hey Town ofFu7lstable GIS Unit
Fee[ Iega 17ia relation.This ma does no[ not rse P-Per ybo (ssor'sanddonotreheyaee
hs'P P Itpresent aot traeptapertyboundaries and do aottepresent 367Mtin Sntet,HpennIS,MAoz6ot
O 83 167 an onahe•6aomdomoq:Itmnybcaeucxalludxmq not atantetdationshipo topb�siulobjecto oa tbe>roP 50"62=4624
mfleeteacrrnteonditionr,and mgyeontnin sncbasb—IM gtootioas.
Approx.Sedle:l inch 8$ feet carlogtnpiticeraots oromsssioas.
gis@towabamstable"ma us
APPROVED
OCT 12 2016
Town of Barnstable
Old King's Highway
Committee
I
Mckechnie, Robert
From: Mckechnie, Robert
Sent: Monday, October 03, 2016 2:24 PM
To: 'Wayne Miller'
Subject: RE: shed permit
Good Afternoon,
It appears that your shed wasn't sign off by OKH. Mary Lou has informed me that she needs a picture, drawing or
brochure to show her what it looks like. If it is being installed by one of the shed companies she may have the brochure
on hand if you tell us which model/name it is. I believe that is all I will need.
Thank you,
Robert McKechnie
Local Inspector
Building Department
Town of Barnstable
200 Main Street
Hyannis, MA 02601
508-862-4033
From: Wayne Miller [ma i Ito:wamdocOverizon.net]
Sent: Monday, October 03, 2016 10:43 AM
To: Mckechnie, Robert
Subject: Re: shed permit
Attached is the plot plan with the setback for the shed noted. The 15'line from side lot has been surveyed and marked by DownCape
Engineering.The shed will be a few feet inside of that line. Let me know if you have any other questions.
Thanks
Wayne Miller
On 10/03/16, Mckechnie, Robert<robert.McKechnie(cDtown.barnstable.ma.us></robert.wrote:
Good Morning,
The following information is required before the shed permit can be issued:
1.) The setback of the shed from the property line has to be noted/shown on the information that was submitted.
You can email a sketch showing this information. The minimum setback is 15'.
Thank you
i
Robert McKechnie
Local Inspector
Building Department
Town of Barnstable
200 Main Street
Hyannis, MA 02601
508-862-4033
Z
Application to
®I� ►iTCg'� ig �lp �REgtattRYItDriti�tTirt QCATTCITCt1ttEE
In the Town of Barnstable
CERTIFICATE OF APPROPRIATENESS
lication is hereby made, with four complete sets, for the issuance of a Certificate of AppropriatQness under Section
Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed.work as described.below and on (ins,9
vings, or photographs accompanying this application for. w
rr 5J-�
ECK CATEGORIES THAT APPLY: <�
N �
O-
:xterior building construction: ❑ New Addition Alteration -
ndicate type of building: House Garage ❑ Commercial ❑ Other n
:xterior Painting: ❑ ��
>igns or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign iv ()
•)tructure: ❑ Fence ❑ Wail ❑ Flagpole ❑ Other
PE OR PRINT LEGIBLY: DATE 5�L 2-f 63
)RESS OF PROPOSED WORK_a0 d ,(&o u. Olt I4Ia,ASSESSOR'S MAP NO. _
NER ASSESSOR'S LOT NO.
VIE ADDRESS a-o S. Dk..G.Qc_ TELEPHONE NO. W-362772-�fYU
L NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any
lic street or way. (Attach additional sheet if necessary.)
-NT OR CONTRACTOR LTELEPHONE NO. 'D8- 36 2-2�,Fz1
)RESS 20 C � X G 6 fi
3CRIPTION OF PROPOSED WORK: Give particulars f work to be done, including materials to be used. Please
ids locations of proposed signs. go ��
Signed
Owner-Contractor-Agent
Committee Use Only
This Certificate is hereby Date I
Appr nied
Cc mittee Members' Signatures:
s
DESCRIPTION
1.New steps to north side porch off main entry similar material to main porch entry.
2. Rebuild stoop and steps at right front door similar to others
3. Extend south end walkway to rear door as per plan
4. Replace screen porch with double hung windows similar to others.
5. Change rear garage panel to 6 clad metal door#3068 and awaning window to #2820
Anderson
5
Town of Barnstable
Old King's Highway Historic District Committee
SPEC SHEET
)UNDATION
:DING TYPE COLOR
(IMNEY TYPE COLOR
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iUTTERS COLORS
JTTERS i COLORS
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AR.AGE DOORS COLORS
KYLIGHTS SIZE COLORS
IGNS COLORS
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)TES: Fill out completely, including measurements and materials/colors to be used. Four copies of this
form are required for submittal of an application, along with Four copies of the plot plan, landscape
plan and elevation plans, when applicable.
AUG-11-2003 12:28 FALMOUTH LUMBER _ 5084570549 P.51i93
670 TEATTCKET HIGHWAY
EAST FA LMOUTH,MA 0253ir
• FAX- 508457-0649
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MERA�O KF
•
. . • . . . . . . • • o
670 Teaticket Highway
E.Fo!mouth, MA 02536
Phone;(508)548.61W
Tom Brown 1-800649 7a55
Outslcie 5aies Monoger Fox:(508)457-0649
HUG-11-2003 12:29 rRLMOUTH LUMBER 5084573649 P.02iO3
1 C.' ode p 2ND FLOOR SUPPORT BEAM
m
Ti-Se"TM)6.05sarlWN" 1 o'":"`. 51/4" X 14" 2.0E ParallamS PSL
Paa@2 enpi eVorsicn:5.12 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN
CONTROLS FOR THE APPLICATION AND LOADS LISTED
Load Group: Primary Load Group
1 23' 0.00" ^
Max. vertical Reaction Total (ibS) 4164 4164
Max. Vertical Reaction Live (lbs) 21E0 2160
Required k3easi.ng Length in 1.87(W)
Max. Unbraced Length (in) 32
Loading on all spans, LDF = 1.00 , Lead t Floor
ocsiyn Sh.eax (.1bs) 365a -365S
Max Shear (lbs) 410E -4106
Member Reaction (ibs) 4106 4106
Support Reaction (lbs) 4164 ni61
Moment (Ft-LbS) 24294
Live Deflection. (in) 0.549
Total Deflection 0.n) 1.059
Loading on all. span.=., LDP 0.90 , Dead Only
Oes.ign Shear. (lbs) 1760 -17P,o
Max Shear (lbs) 1976 -1975
Member Reaction (lbs) i976 1976
Support Reactic;r, (lbs) 2004 2004
Moment (Ft-Lbs) 11691.
PROJECT INFQ ATION. O�RATQR.INFQR_M#T10N-
LEN CURRAN / GARAGE THOMAS BROWN
208 MAPLE ST. FALMOUTH LUMBER
WEST BARNSTABLE,NdA 670 TEATICKET HWY.
EAST FALMOUTH,MA 02536
Phone:1-508-548.6808
Fax : 1-508.467.0649
TOM BROWN@FALMOUTH LUMBER,COM
Cnpyrlpht a; 2007. Uy TT.115 7018t. a Nayerhaeuaer Uuaimc.5
FMre llem�i is a regiatered trademark of Trun Joint.
r
RUG-11-2003 12:29 FALMOUTH LUMBER 5084570649 P.03/03
ie 2ND FLOOR SUPPORT BEAM
TJ-Bm(YM 5.0890061"H=`�',t:""�"h""'ea 51/4" x 14" 2.0E Parallam@ PSL
Paer.1gel 8(1112003 tngftVeteia 1.5.12E THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN
Page t Engine Vereien'1.5.12
CONTROLS FOR.THE APPLICATION AND LOADS LISTED
I�
d Y4-
Product DiagFarn is Conceptual.
LOADS:
Analysis is for a Drop Beam Member. Tributary load Width:12'
Primary Load Group-Residential-Sleeping Areas(psf):16.0 Live at 100%duration,12.0 Dead
SUPPORTS:
input Bearing Vertical Reactions(Ibs) Detail Other
Width Length Live/Dead/UpliftlTotal
1 Stud wall 3.50" 3.50" 2160 1 2004/0/4164 L1:Blocking 1 Ply 1 114"1.3E TimberStrandg LSL-
2 Stud wall 3.50" 3,50" 21601200410/4164 L1:Blocking 1 Ply 1 14'1.3E TimberStrand®LSL
-See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s), L1:Blocking
DESIGN CONTROLS:
Maximum Design Control Control Location
Shear(Ibs) 4106 -3658 14210 Passed(26%) Rt.end Span 1 under Floor loading
Moment(Ft-Lbs) 24294 24294 40743 Passed(60%) MID Span 1 under Floor loading
Live Load Defl(in) 0.549 0.789 Passed(U517) MID Span 1 under Floor loading
Total Load Dell(in) 1.058 1,183 Passed(U268) MID Span 1 under Floor loading
-Deflection Criteria:STANDARD(LL L/360,TL:1./240).
-Breeing(Lu):All compression edges(top and bottom)must be breced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of
lateral bracing is required to achieve member stability.
ADRITIONAL NOTES'
-IMPORTANTI The analysis,presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will
be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads,
and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate.
-Not all products are readily available, Check with your supplier or TJ technical representative for product availability.
-THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS.
-Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above.
Operator NoUes:
ATTIC SPACE ONLY
PROJE_GT INFORMATION: OPERATOaINFORfiAATION:
LEN CURRAN 1 GARAGE THOMAS BROWN
208 MAPLE ST. FALMOUTH LUMBER
WEST BARNSTABLE,MA 670 TEATICKET HWY.
EAST FALMOUTH,MA 02536
Phone: 1.508.548.6868
Fax c 1.508A57.0649
TOM BROWN®FALMOUTH LUMBER.COM
Copyright 01 ;!0:12 1iy Trk's JcieL, a weycrnaeunar 6ua1nP89
r'Arellamrc le a regletcrad tra,unork or True J7iet.
TOTAL P.03
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map A . Parcel Permit# 6 7 3�
- T01`�:9i OF B��:RNSTABLE
Health Division o Date Issued 0/1 D3
Conservation Division
Y Ion cGr�" '4 A,"i 9: 57Application Fee r �
Tax Collector �39/•53--o4q
Treasurer LILT S10N`S TALLED IN COMIPLIANC-
WITH TITLE 5
Planning Dept. ENVIRONMENTAL CODE AN[
Date Definitive Plan Approved by PI nnin Board TOWN REGULPTION
D 01-�l ���Preservation/Hyannis � &Cfroorr,s on 1 ar�
Historic-OKH Q� -bs y P
e�yree✓i hAr
i
Project Street Address _ 40 9- 2Lu� sTi�
Village ,6oe2�� 4/&
Owner TaA� Address e'o P 21 J1,
Telephone SDR-.fib 2 - 29,k 0
Permit Request
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation AL_)Q Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family ,31 Two Family ❑ Multi-Family(#units)
Age of Existing Structure / PS3 Historic House: CRYes O No On Old King's Highway: ❑Yes ❑No
Basement Type: ®Full W Crawl Cl Walkout ❑Other
Basement Finished Area(sq.ft.) _M 4 Basement Unfinished Area(sq.ft) _
Number of Baths: Full: existing 3 new 5 Half:existing - new /
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new�� First Floor Room Count /5`
Heat Type and Fuel: XGas _40il ❑ Electric ❑Other
Central Air: ❑Yes ❑ No Fireplaces: Existing t New Existing wood/coal stove: ❑Yes RLNo
Detached garage:❑existing a new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing new size �hed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization O Appeal# Recorded❑
Commercial ❑Yes WNo If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE /5��
FOR OFFICIAL USE ONLY
PERMIT NO.
�J DATE ISSUED
MAP[PARCEL NO.
3 ADDRESS VILLAGE
OWNER
DATE OF INSPECTION: �o�rlo-3�AJ- BFoi> IO)salo3
41l�04 � k�
FOUNDATION __ �Soao Tua�es Rc9tB Dkfico5�
FRAME A, 7// ®�bhi
INSULATION ,y A/ S G J'//6 dAi -
FIREPLACE i
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL '
s
GAS: ROUGH ? ' FINAL
FINAL BUILDING ® �,; h —���
DATE CLOSEDOUT
ASSOCIATION PLAN NO: i
The Commonwealth of Massachusetts
-- =-- Department of Industrial Accidents
- Office af10Yestlgations
-- y 600 Washington Street
Mass. 02111
- � Boston, '
Workers' Compensation Insurance davit
name:
location: _Z
hone#
am a homeowner Performing all work myself.
I am a sole r'etor and have no one worlQn in ca ac�tp
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ha?Y•;;•rr`:•:F!"' ia''",Y'h)�"a••i:4tr: •,.+::t
'%#nS S#;fi S F.<:v:}%h•r.a:•L?E.`•L fb sa�Y n} :)�t >rk»# ;k;,<::::to.. 'Y'a:•:.:•:t?YJ:,J... :...,r:..,.
ties of a ane up to 51,500.00�mdlor
F to secore coverage as required under Section 25A of MGL ISZ canlead to the itnposidiL foe ofe Sl oo a day against me. Iund d that a
one years'imprisonmeai as Ken as dvfi penalties in the form of a STOP WORK ORDER and
one of this statement
be fornarded to the OMce of Investigations of the DIA for coverage verlscatlon.
cop
under the pains and penalties of perjury that the information provided above is OUP and correct
I do hereby certi
Date
Signature
Phone#
Print name
oiflcial u9e only do no in this area to be completed by city or town official ❑fig Departnsent
peradt/license# 0I+iceming 13cartl
city or town: osdecbnen's Office
0 checkifimmediafe response isrequired ❑HealthDepar'huMt
" ❑Other
phone#;
contact person:
Ucy;sad 9/95 PU)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 rewires 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
dw, ing 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 mi s rance 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.
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 piix t license number which will be used as a reference number. The affidavits may be retariWo
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
gMce of Investigations
600 Washington Street
Boston,Ma. 02111
fan#: (617) 727-7749
nhone#: (617) 727-4900 ext. 406, 409 or 375
�ofV4E, ti Town of Barnstable
Regulatory Services
aAaxszAe . ' Thomas F.Geiler,Director -
NAM
9$ i619. �'� g
Buildin Division
prfD MP'�A
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which,are adjacent to
such residence or building be done by registered contractors,with certain exceptions, along with other
requirements.
Type.of Work: f 47 Estimated Cost /&0 �-
Address of Work: �— S41 �/�� `/., l llZlo Gib
Owner's Name, a -v1
Date of Application: U 3
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under$1,000
E]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. t
OR
Date Owners Name .
Town of Barnstable
' OFTME l�
' Regulatory Services
BMM,,BLF� ; Thomas F.Geiler,Director
MASS,
v� i6s9• .m� Building Division
Tom Perry,Building Commissioner
i 200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:.
number IVstreet village
"HOMEOWNEI2,9,- Z fM-.362 - � 9A o Gi�-,X�_�(013
name home phone# Jwork phone#
CURRENT MAILING ADDRESS:
GtJ dLG
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
requ' ements
..
—Sf
gnature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
Permit Number
REScheck Compliance Certificate Checked By/Date
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release 1
Data filename: C:\Program Files\Check\REScheck\#3680.rck
TITLE:New Custom Additions/Alterations
CITY: West Barnstable
STATE:Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE:Other(Non-Electric Resistance)
DATE:07/02/03
DATE OF PLANS:04-04-2003
PROJECT INFORMATION:
208 Maple Street
West Barnstable,Ma. 02668
COMPANY INFORMATION:
Len Curran
P.O.Box 19
West Barnstable,Ma. 02668
NOTES:
MaCheck by Cape Cod Insulation INC.
#3680
COMPLIANCE:Passes
Maximum UA=209
Your Home UA=206
A.4%Better'Than Code(UA)
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 494 38.0 0.0 15
Ceiling 2:Cathedral Ceiling(no attic) 112 30.0 0.0 4
Wall 1: Wood Frame, 16"o.c. 1218 13.0 0.0 77
Window 1: Wood Frame:Double Pane with Low-E 158 0.340 54
Door 1: Solid 40 0.280 11
Door 2: Solid 20 0.160 3
Door 3:Glass 20 0.220 4
Door 4:Glass 40 0.310 12
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 516 19.0 0.0 24
Floor 2:All-Wood Joist/Truss:Over Outside Air 72 30.0 0.0 2
Boiler 1: Other(Except Gas-Fired Steam), 85.7 AFUE
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 Massachusetts
Energy Code requirements in REScheckVersion 3.5 Release 1 (formerly MECchec�and to comply with the mandatory
requirements listed in the REScheckInspection Checklist.
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
54
REScheck Inspection Checklist
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release 1
DATE:07/02/03
TITLE:New Custom Additions/Alterations
Bldg.
Dept.
Use
Ceilings:
[ ] 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation
Comments:
[ ] 2. Ceiling 2:Cathedral Ceiling(no attic),R-30.0 cavity insulation
Comments:
Above-Grade Walls:
[ ] 1. Wall 1:Wood Frame, 16"o.c.,R-13.0 cavity insulation
Comments:
Windows:
[ ] 1. Window 1: Wood Frame:Double Pane with Low-E,U-factor:0.340
For windows without labeled U-factors;describe features:
#Panes Frame Type Thermal Break?[ ]Yes[ ]No
Comments:
Doors:
[ ] 1. Door 1:Solid,U-factor:0.280
Comments:
[ ] 2. Door 2: Solid,U-factor:0.160
Comments:
[ ] 3. Door 3: Glass,U-factor: 0.220
Comments:
[ ] 4. Door 4:Glass,U-factor:0.310
Comments:
Floors:
[ ] 1. Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-19.0 cavity insulation
Comments:
[ ] 2. Floor 2:All-Wood Joist/Truss:Over Outside Air,R-30.0 cavity insulation
Comments:
Heating and Cooling Equipment:
[ ] 1. Boiler 1: Other(Except Gas-Fired Steam),85.7 AFUE or higher
Make and Model Number
Air Leakage:
J 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 cfin (0.944
Us)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:
[ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
I
Materials Identification:
[ ] I Materials and equipment must be identified so that compliance can be determined.
[ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
[ ] I Insulation R-values,glazing U-factors,and heating equipment efficiency must be clearly marked on
the building plans or specifications.
I
Duct Insulation:
[ ] I Ducts shall be insulated per Table J4.4.7.1.
Duct Construction:
[ J I 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.
[ ] I The HVAC system must provide a means for balancing air and water systems.
I
Temperature Controls:
[ ] I 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.
I
Heating and Cooling Equipment Sizing:
[ ] I 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.
I
Circulating Hot Water Systems:
[ ] I Insulate circulating hot water pipes to the levels in Table 1.
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 non-depletable sources. Pool pumps require a time clock.
I
Heating and Cooling Piping Insulation:
[ J I HVAC piping conveying fluids above 120 T or chilled fluids below 55 T must be insulated to the
levels in Table 2.
i
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2"
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
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5 .
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD (Building Department Use Only)
- RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE,
New Buildings,Additions $50.00 0z)
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
3�d square feet x$96/sq.foot= 32-0 x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
585 square feet x$64/sq.foot= ��q 1 x.0031=
o
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft. x.0031= A,//7, Z8.
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00_ -
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit: _.
square feet x$96/sq.foot _ x.0031=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck Z x$30.00= (DD 0
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable)
Permit Fee39
projcost
r Application,to 2001
GO 1'iit t bwttp 314anal 3hi-suTit Mi5trift Continittt?E
In the Town of Barnstable
. CERTIFICATE OF APPROPRIATENESS��;jTi�, CLE',K
�AF��. S.
Application is hereby made, with four complete sets, for the issuance of a Certificate'�o�fi/�'ppprbppiat�nes under Sect ran
6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as descnb&d beiow anf�on plans,
drawings, or photographs accompanying this application for:
CHECK CATEGORIES THAT APPLY: -
1. Exterior building construction: ❑ New Addition Alteration
Indicate type of building: El House n rage ❑ Commercial ❑ Other
2. Exterior Painting: ❑ - c;
3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign `i
4:-Structure: 0 Fence Q Wall ❑ Flagpole ❑ Other -
TYPE OR PRINT LEGIBLY: DATE 4117/U P.
ADDRESS OF PROPOSED WORK 201 ►v - �
W, ASSESSOR'S MAP h�0. cf �
-77—
OWNER ASSESSOR'S LOT NO.
HUMS ADDRESS No rto 0 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.)
AGENT OR CONTRACTOR _Ste. roC-,,Lc __TELEPHONE NO. 61 -7 `l29 96,l3
ADDRESS
DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please
include locations of proposed signs.
0VfL, l f>l2ch1 LH26E'i` )C9AIILA)CM. $ M, A- �evo�►�I �givv 3(9rf , nIE-1c)
Ul iv�G[.tJ /UD 5a t E-/25 AT- kc-6 P � ?�E-C,k�
[Z00F bUG) P(loiT
Signed
Owner-Contractor-Agent
For Committee Use Only
his Certificate is hereby Date5--'3- 6 f
DI IE 0 V enied
APR 18 2001 ommitteP mbers' SigIF
TOWN OF BARNSTA LELi
-�
,_ Qtzf �GHWAY
I I'J.ryl t'� f'.4 i 6
_ .. _ 2 00 A
�� Torun of Barnstable
6 ;-0 Old King's Highway Historic District Committee
y SPEC SHEET
FOUNDATION CO Vl C i-e /e_
61-54tkq/e s ors C,cL 6 4 eeas)— /-D C&wa_��f
SIDING TYPE_W ( P,1 ,e Clap b0Cu'd COLOR _ (Se 0= (,a_t.1 la y iG ►�Gov/ 'c2
cc /vv
CHIMNEY TYPE Pik COLOR
ROOF MATERIAL 1'1 V 1u�� �n� (� COLOR S!/GZ iL Gl�C C�AF )
PITCH I ( �!'YtC1 fCl�1 G Elyt q4 JormeV l-On T" 3//Z
V JGod,_4cL'ble-h utt-i� 1
WINDOWS aCCW e,6tf COLOR SIZE 360 e
S be I c
I v� t __'
TRIM COLOR -Lsh-lcf�y We reekc.11ce��u�.l'
Se.E? eleoez2ft' t S - EK%Sftl.ct htt-C
DOORS COTaORS_�
SHUTTERS COLORS
GUTTERS kma. 'x �Y-i S- 1!j COLORS_ 012i 4 o�- !'eeyj
pECxs des. IZ x 22 �, f�, cUoo raAxERIALs tLZcq dFc,kFL►o,
GARAGE DOORS^ x-7� I v15[�C COLORS--- � a' UQ ��c' 1
y
SKYLIGHTS SIZE K'�j.G a COLORS 1p�ror.�2 �Q
SIGNS
Vim_ COLORS_ ^- O APR 1$ 2001
FENCE COLOR
1SOT8s Sill out completoly, including al.a.ueameata and matariala/eelero to be uood. Sour copra of thie
fa7em arm roquirod !or oubmittwl of an applioation, along with Your eaviaa at the plot plum, l*nd.ac&po
plan and elevation Plana, whoa applicable.
SpEC3Hx
Revised 11/9B
J
`\�
VIP ilk
�E
0
.r
N
V) y
W E7i isT�vG � +�Y �ss�°'�SQ2S T
DWElc/�vG �
1 �
co ���/C � �'°'vt•Oo
v �uG �� ""D •
ksts3.�
I certify that this Dwellln is
ocated in Flood Hazard Zone C �out-
ide the 500 year flood) as identified
:y the Department of Housing and Urban
,evelopment (HUD) .
ate p6c, zoy zoos = CERTIFIED PLOT PLAN-
:X . LOCATION
l SCALE -/c�? ... DATE -�� ?o Z000
Reg`. and :S..unvaor PLAN REFERENCE
[ certify to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING
that there are no visible encroachments SHOWN HEREON , EITHER WAS IN COMPLIANCE
jr easements except as shown and that this WITH THE LOCAL APPLICABLE ZONING BYLAWS
plan was, prepared .under m immediate IN EFFECT WHEN CONSTRUCTED (WITH
y RESPECT TO HORIZONTAL DIMENSIONAL
3Upervision, REQUIREMENTS ONLY),OR EXEMPT FROM
VIOLATION ENFORCEMENT ACTION UNDER M.O.L.
TITLE VII , CHAPTER 40A,.SECTION 7,UNLES3
"-'u"✓4,q E. .T�. 4e A,9rA�A A• C-IZ."Al — /O&T OTHERWISE NOTED OR SHOWN HEREON.
DEC-02-20M 06:25 P.02
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Ar
Assessor's office(1st Floor): To
Assessor's map and lot number 1 �/ ) w *THE
Conservation(4th Floor).
Board of Health(3rd floor):
Sewage Permit number sARSu t
Engineering Department(3rd floor): oo�oa3o'`���
House number
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.K and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
'BUILDI-NG INSPECTOR
APPLICATION FOR PERMIT TO a—PAIR ,
TYPE OF'CONSTRUCTION �LQ��✓ �i S Y rcln�01/� ���a/ — �014^L�- �r'lyti✓� (�o r 4�S I �-Ipct t!�`P
19 13 v
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location o {200 ,-& �. iP). ?MV-►15 ynbb k
Proposed Use v �N�L-� 4 �`i/✓1 L
Zoning District "?iF Fire District � �<
Name of Owner k�,r ✓ino, 1 Address ")0% VV\a 61w,
Name of Builder Gn LO-VQ,` e., Address U 4.v� er'D�`I ¢ d c�. . b1u4✓\A US .
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior
Heating Plumbing
Fireplace Approximate Cost 590a cC
Area "de
Diagram of Lot and Building with Dimensions Fee
a�
5�r��-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding the above construction.
Name
Construction Siipervisor's License 0
A tc,-11- i 6 LI 7 L 1
PHILLIPS, NORMA
7 No 36242 Permit For
REPAIRS
t!
Single family dwelling
Location, 208 Maple Street
West Barnstable
Owner Norma Phillips
lt�-Type of Construction Wood
,Plot Lot "
Permit Granted October 19 191 93
•
Date of Inspection:
Frame 19 1
Insulation 19
Fireplace ' 19 i =
Date Completed 3� �3 19
•
i .
s�
N
DEPARTMENT OF PUBLIC SAFETY °[
i O O N
1010 COMMONWEALTH AVE.
a Q
l i BOSTON,MA 02215 r ocia
0
l LICENSE
I CONSTR. SUPERVISOR
i EFFECTIVE DATE '
W C � H C to O
0S2T82
�10/3111992 r I -j
,BRIAN A FIORENCE ti '�a a'� -� W b '
�46 'R�
;HYANNISfISHER CIA: 2601
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY I; t
OF THE COMMISSIONER
STAMPED-OR-SIGNATURE
SIGNATURE OF LICE EE '�; � - �
•i �/��� �/� s>�.ov�-�pMMISSIONER _kA _ "'--. -_. ..._
�La�y,r-:.,r.•n-.� �s cnt:z:s `� ._:s' _ems.,.
a
i '
}
TO ALL�®r
BUSINESS OWNERS
DATE:!
Fill in ple se: � .
APPLICANT'S' �}� YOUR NAME: ���� f'�N . Cvv'eet rs
BUSINESS YOUR HOME ADDRESS:,D i t B.v-.sa.t4441
TELEPHONE Telephone Number Home iWP-4_4-i ffa
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES N
Have you been given approval from the.building division? YES®NO
ADDRESS OF BUSINESS MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures,
listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall)or if you get the business certificate.first
you MUST go to the following office to make sure you have all the required pprmits'and license;..
GO TO 200 Main St.-(corner of Yarmouth Rd.-& Main Street) and'you will.find the following offices:
1. BUILDING COMMISSIONE 'S OFFICE
This individual has-been in or d of any permit requirements that pertain to this type of business.
A oozed Si natur
COMMENTS: �1� � c �� 2 szL7 f e cj
2. BOARD OF HEALTH
This individual 12en inf of the quirements that pertain to this type of business.
Author' ed nature**
COMMENTS:
3. CO SUMER AFFAIRS (LICENSING AUTHORITY)
This individual r 6 been i fp med e n ing requirements,that pertain to this type of business.
Authorize Signature**
COMMENTS: 116 -s C-
dl t 0LCC0 OAJ Ly .
Business certificates (cost $30.00 for 4 y ars). A business certificate OALY REGISTERS YOUR NAME in the town (which you must
do by M.G.L. -it does not give you permission to operate'-you must get that through completion of the processes from the various
departments involved.
**SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY.
. f
of,HE, - The Town of Barnstable
BARNSTABLE. Department of Health Safety and Environmental Services
9 MASS. 0
QED M Building Division
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
Inspection Correction Notice
Type of Inspection f u hdu�/ a I
1
Location -O' N a. t- S I— Permit Number 7 0 3-7
Owner Builder
One notice to remain on job site, one notice on file'in Building Department.
The following items need correcting:
eFw%s e ` d -gym
�0
Please call: 508-862-4038 for re-inspection.
Inspected by
- Date /Ol/ )631
J
Town of Barnstable.,.:, :
200 Main Street,Hyannis,Massachusetts 02601
BARNST"M �E1 6 JUL13
039.
Growth Management Department Thomas A. Broadrick, AICP
367 Main Street,Hyannis,Massachusetts 02601 Director of Planning,Zoning
Phone(508)862-4785 Fax(508)862-4725,www.tow..n-barnstab�s &Historic Preservation
July 12, 2006
Leonard and Patricia Curran
208 Maple Street
West Barnstable, MA
Reference: Site Plan Review (029-06) Maple Street Inn
208 Maple Street, West Barnstable—Map 132, Parcel 024
Proposal: To operate a 3 room bed and breakfast.
Dear Mr. and Mrs. Curran:
Please be advised that the Building Commissioner,Tom Perry, has found that the revised site
plan dated May 17, 2006 is approvable with the following conditions:
• Approval is based upon plan entitled: "Site Plan of Land,#208 Maple Street, West
Barnstable, MA" and prepared for Leonard E. Jr. and Patricia A. Curran by Down Cape
Engineering, Inc. of Yarmouthport, MA and dated May 17, 2006 and I't and 2°d floor
plans by AKRO Associates Architects dated 6/1/01 indicating guest area usage and access
and egress areas. Compliance with these plans is necessary.
• A bed and breakfast conditional use Special Permit will need to be obtained from the Q
Zoning Board of Appeals.
• Trash will need to be stored out of public view.
• All licenses and permits, including but not limited to signage, will need to be obtained.
If you have any questions or require further assistance, my direct telephone number is 508-862-
4679.
Sincerel , 1
Ellen M. Swiniarski
Site Plan Review Coordinator
ga�c
CC: SPR File
Zoning Board of Appeals File
m rry, wilding Commissioner
i, TOWN OF BARNSTABLE q b -7
� t seaasTeaL = o
MAM
6 MASSACHUSETTS 12�
Solid Fuel Stove Permit
/j � A 6411
DATE OF APPLICATION ...........n..q//�1....... ........... Z............... G PERMIT ...........................................................
NAME (owner) ........ 4...r/'l2� �f7a..c S'........................... NAME (Installer) ..... "� ?f 1.� .........C�2 .4. gggee�
........................................... ......... ................... ........
ADDRESS ..........�Z.Q.I��......f .. �G?5� .... (lJ.. � •''SADDRESS ®�Dsc /O � .Jp�iv,c�i....../z/�-
�adIOA,)7'.............................................................. CHIMNEY.: NEW ........................ EXISTING ..6�.....
STOVE TYPE ........................... . .
Manufacturer ..G3.V. ................................................................. CHIMNEY: Masonry ....v...................................................................................
..................
Mass. Approval ............................................................................................................... CHIMNEY: Metal ........ .tv ..............................
... ................................
This is to certify that the above installer has permission to•install a solid fuel burning appliance at the listed
7
address in accordance with an application on file with the 70.16 /1 44�"l ent,
and subject.to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
IssuedBy: ...............................................Title ........1� .............. Date .��.........................
Permit to install expires 60 days after issue date
Stove .z ��..5........... ....................... /iq.cJT"
StoveClearance .................1 ............. /.. 5................. �. ...A�.............. ....... .......... .:...../^o cl ..........°2../.........:...............:..
Floor /. l.nT�—L....... AO-/
...............................................................................................................................................................................................................
Smoke Pipe �4'... Z e s SeG L / ........... So��.r�.................................................................................................
...................................................................................
SmokePipe Clearance ...........................4 ........... ...................................................................................................................................................................................................
Chimney ............................... J.............................................................................................................................................................................................................................................
Smoke Detector .........................
Y.. ................................................................................................................
...............................................................
.........................................................
The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au-
thority•of permit dated ..................................................... has'been made in accordance with provisions of the Commonwealth
of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................
Installer
INSTALLATION APPROVED ...rl.?��......./2...... -3 By... ....�� .......................................... Titlej�;�/94
date
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT
'w
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map / 3,.2_� Parcel Permit#
�Iealth Division 9z. ��� Date Issued
Conservation Division FeeQ�p
Tax Collector
Treasurer 7 zolkad SEPTIC SYSTEM MU T Sc
INSTALLED IN COMPLIANCE
Planning Dept. WITH TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND
Historic-OKH Preservation/Hyannis TORN REGULAT1()1,9S,
Project Street Address p?D :? - 1177�
Village G�
o RM.'1 Pfa f u-f PS
Owner Address o2 y k 2Ls7�
Telephone
Permit Request ;t I
Square feet: 1st floor: existing /f';�r proposed /9/S 2nd floor: existing /�7s" proposed 64-aDy Total new er°
Valuation\i Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size 3, 0 1. Grandfatliered: ❑Yes 83 No If yes, attach supporting documentation.
Dwelling Type: Single Family 'W Two Family ❑ Multi-Family(#units)
Age of Existing Structure 4,PJ. Historic House: ®Yes ❑No On Old King's Highway: ,Wes ❑No
Basement Type: 2kFull J&Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) 4 oti Basemqpt Unfinished Area(sq.ft) / E7J
Number of Baths: Full: existing � �'�v` jew Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing /a new /0 First Floor Room Count /10
Heat Type and Fuel: ❑Gas R Oil ❑ Electric ❑Other
Central Air: ❑Yes J4 No Fireplaces: Existing New Existing wood/coal stove: d Yes ❑ No
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 O No If yes, site plan review#
Current Use Proposed Use eSd'
. � l
BUILDER INFORMATION
Name Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE �'�/
FOR OFFICIAL USE ONLY
.. �PERMIT NO. `
DATE ISSUED
MAP/PARCEL NO. - '
r
ADDRESS "`�' I VILLAGE
c 'Q�
OWNER
ir
` e
DATE OF INSPECTION:' l o/��ldr
FOUNDATION I r !
—i -
FRAME a O`1-- -rp _
INSULATION
FIREPLACE
ELECTRICAL: ROUGH ti FINAL
PLUMBING: ROUGH ,
.- FINAL
GAS: ROUGH r t !7�' - FINAL
FINAL BUILDING' l C- z r o
DATE CLOSED OUT
r
ASSOCIATION PLAN NO.
FEE VALUE WORKSHEET
LIVING SPACE
(2000 sq ft or greater) square feet x$115/sq. foot=
(less than_000 sq ft)
1913 square feet x$96/sq. foot=
i '
(affordable housing) square feet x$57/sq.foot=
(40B or low income)
GARAGE(UNFINISHED) square feet x$25/sq.foot=
7/��' _
PORCH �f S square feet x$20/sq. foot= /
•, square feet x$15/sq.foot=
DECK G.•3 39,.
ALTERATIONS/RENOVATIONS
OF EXISTING SPACE . .. . . . . cost=. . . . ... . . . . . . . . . .
Total Project Fee Value
a
Office Use Only
Permit Fee U
I
projcosc
NWP`°FTHE,°��� The Town of Barnstable
BAfl!1STABLE.
Department of Health Safety and Environmental Services
7 MASS. 0a
t6}9• �0
' p�FOIMA 0. Building Division
367 Main Street, Hyannis, MA 02601
Office: 508-862-4038
Fax: 508-790-6230
PLAN REVIEW
Owner: kbIR AYE Map/Parcel'"1a — n P 4
;--'•'Proje Address: ,� 1 An S�. Builder: '"
The following items were noted on reviewing:
1-4
a
i
Reviewed by:
Date: 713 l /o-1
q:building:forms:review
. . ° The Town .of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Elbert Ulshoeffer, Building Commissioner
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction.alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done.by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: 444412L2
Estimated Cost '
Address of Work: o?o ,��r
Owner's Name:
Date of Application: 7�2v�o
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
QJob Under$1,000
❑Building not owner-occupied
ROwner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WI WORK DO TERED OT HAVE
.
CONTRACTORS FOR APPLICABLE HOME IMP
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.
Contractor Name Registration No.
Date
OR
Date O ner's Name
q:forms:Affidav
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of/llyeSUg8U0/IS
_ t 600 Washington Street
- Boston,Mass. 02111
Workers Com ensation Insurance Affidavit
name L E O N A 011D G LIle
location: Z ° 6 )V 4 eL E T'
ci /.J �j 4,61 /R14- hone# Sa -
I am a homeowner performing all work myself.
❑ I am a sole rietor and have no one workin in anv ca acity
❑ I am an employer providing workers' compensation for my employees_working on this job. .;:.
cum an name':
a .
hone#:
insurance co. ACV#
❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers' compensation polices:
com an names
address.
;` h. _. one#
nsnc•nitceca•�' �
c an :name: .:.. •.: -... ...:.: .
,..
address:
#
insurance:co.. ..
tilicv
Fai>nre to secure coverage as required under Section 25A of MGL 152 can lead to the innposition of criminal penalties of a fine up to$1400.00 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"statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is trw.and correct
Sigma Date
Print name L fn V A- a k-r4 A, Phone# —
official us:onlydo not write in this area to be completed by city or town officialperndt/Ilcense# ❑Building Departmentcity or to ❑I.icenaing Board❑check response 1,required ❑Selectmen's Office❑Health Departmentcontact p
phone#; ❑Other
(mvaed 9/95 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,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 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.
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 p6iiii license number which will be used as a reference number. The affidavits may be retuned 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:
i The Commonwealth Of Massachusetts
Department of Industrial Accidents
Me of luyestigauOns
600 Washington Street
r Boston, Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
i
• BABNSIABI.l+ •
Regulatory Services �'
o,,,X Thomas F. Geller, Director.
Building Division
Elbert Ulshoeffer, Building Commissioner
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-7 90-6=:
HOMEOWNER LICENSE EXEMPTION
-7� Please Print
DATE. / A/
JOB LOCATION:
_ o
a r street
. village
"HOMEOWNER': �D = 3 6 L
came home phone ti work phone K
• CURRENT MAILING ADDRESS: D � C� �'nZ44i
dry/town state rip 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.
DEFINMbN 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 compiv
with ,he State Building Code Section 127.0 Construction Control.
HOMEOWNER'S PITON
The Code states thai "Any homeowner performing work for which a building permit is required shall be exempt from the
provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a
person(s)for hire to do such work.that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see
Appendix Q.Rules&Regulations for Licensing construction Supervisors.Section 2.15) This lack of awareness often results in
serious problems.particularly when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the
unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities.many communities require.as part of the permit
application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community
Q:FORMS:EYE.MM
Brewster Town Hall 5088968089 p. 1
i
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J (effective 3/1/98)
Applicant Name: 2. C Site Address: MAQ_ 13 A 4Dt a►i
Applicant Address: CityfTown: W jp�_
Use Group:
1Q _ Date of Application:
Applicant Phone: 50 Y— —B 7 Applicant Signature:
,
Compliance Path(check one): '
l - •
}g ❑ Prescriptive Package(Limited to I-or 2-family wood.frame buildings heated with fossil fuels only)
Package(A through ICK from Table J5 2.1b): Heating Degree Days(HDDO)from Table J5.2.1a:
Y
(For items d.through i.,fill in all values that apply from Table 15.2.1b:)
a. Gross Wail Area sq.ft f. Wall R-value R-
b. Glazing Area' sq.ft. g. Floor R-value
R-e. Glazing%(too x b+al % h. Basement wall R-
d. Glazing U-value U- i. Slab Perimeter R-
e. Ceiling R-value R- j. Heating AFUE
❑ Component Performance:"Manual Trade-Oir(Limited to wood or metal framed buildings only)
0
Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 0 Zone 14 _•
Attach Trade-OffWorkheet from Appendix J,(and HVAC Trade-Off Worksheet, if applicable]
❑ MiScheek,Sottware
Attach Compliance Report and Inspection Checklist printouts.
❑ Systems Analysis OR ❑ Renewable Energy Sources
Attach Mass Registered Architect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a.Gross Wall+Ceiling Area S _sq.tt. b.Glazing Area' 60 sq.ft. c.Glazing%(too x b+a) IliVo
❑ ADDMON with Glazing%(a)up to 40%may use 780 CMR Table J 1.1.2.3.1 below:
MAXIMUM U-value MINIMUM R-Values
Feaestratloa___ __ � Cei!!n` .. Watt Flow J,Bmwent%11 S1a6 Perimeter,Depth
0.39 07 R13 R19 I R-10 R10,4it
❑ "SUNROOM"addition(greater than 40%glazing-to-wall and ceiling gross area)
Attach"Consumer Information Form"from 780 CMR Appendix B.
Officini's Name. Official's Signature:
Application Approved 0 Denied 0 Date of ApprovaUDeoial:
Reasons)for Denial: (provide additional details as needed on back side)
'Giazing Area may be either Rough Opening or Unit dirnensiom. Betts 0&12M
f
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r All
intc
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SGD:
surement: the U-factor. The lower the figure the
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tification.. a guarantee of performance U .
- The American Architectural Manufacturers Association (AAMA) and the
The Canadian A440 Standard - National Wood Window and Door Association (NWWDA) are two national
for maximum quality organizations recognized for setting the performance standards .of
Windows meeting A440 standards are accredited windows and doors. Manufacturers join their programs voluntarily to ensure DO'
by the Canadian Center for Construction that their products meet stringent standards of quality.
Materials (CCCM) and/or the Canadian To attain this recognized certification, Bonneville products must meet strict
Windows and Doors Manufacturers Association requirements of structural performance(wind pressure),air infiltration and
(CWDMA), of which Bonneville Windows and
water penetration. 1
Doors is a member. J D
All Bonneville products are submitted to a series 4 + f , r
of tests executed by independant laboratories. yN PI�EV I LL W�N� �s. �i UrUU MCS ,
rT H UPS ESN SiU.R �S 0"�IbE O,F
•�'•` ♦' .�`: .,y+r f L Cn U-Fact
Bonneville Windows and Doors ;. 3
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Performance Data
All windows and doors in this document are listed in our performance chart. Each American test is cocled and falls
into one of four categories: Product Type, Performance Class, Performance Crade and Maximum Size Tested.
For more information, contact our quote department.
U . S . A . CANADA
y ll LINE
Tested CAN/CSA-A440.M98 FORCE PRODUCT LINE 101/I.S.2-97 Dimensions AIR WATER WIND ENTR
CASEMENT C-C45 32"x 70" A3 66 C4 F2
AWNING AP(POB)-C35 48"x 461/4" A3 B6 C4 F2
DOUBLE HUNG PLATINUM SERIES •Test 1 H-LC25 56 1/4"x 113" A2 B2 C2 F2
DOUBLE HUNG PLATINUM SERIES •Test 2 H-LC30 50"x 84" A2 B2 C2 F2
_ SINGLE HUNG GOLD SERIES H-R30 45 1/2"x 72 7/8" A3 B5 C3 F2
DOUBLE HUNG GOLD SERIES H-R25 45 1/2"x 72 7/8" A3 B4 C3 F2
DOUBLE HUNG BRONZE SERIES H-R35 44"x 60" A2 B3 C3 F2
WOOD SASH SLIDER HS-LC30 69"x 54" A2 B2 C3 F2
ARCHITECTURAL F-HC40 79"x 79" B7 C5
GLIDING PATIO DOOR(B-50) SGD-LC25 99 3/4"x 86" A3 B4 C2 F1
1i FRENCH DOOR(FR-50) HGD-LC20 70 3/8"x 82 1/2" Meet CAN/CGSB-82.5-M88
1!'i
•This product has been tested by Canadian A440 M98 standard.
> Product Type Performance Class Performance Grade
The Canadian A"O standard
f� \ AP: AWNING WINDOWS R: RESIDENTIAL Products are designated by the design pres- IS Similar With different codes.
C: CASEMENT WINDOWS LC: LIGHT COMMERCIAL sure for which they have been tested in A: Air tightness(Al to A3)*
F: FIXED WINDOWS C: COMMERCIAL Pounds per square foot.The structural test B: Watertightness(81 to B7)*
pressure for all products is 1.5 times the C: Wind load resistance and blowout(Cl to CS)*
H: HUNG WINDOWS(single,double,triple) HC: HEAVY COMMERCIAL design pressure.Each product performance F: Forced entry(F1 to F2)*
HGD: HINGED GLASS DOOR AW:ARCHITECTURAL class shall have a minimum performance
grade as follows: "Lowest number equals minimum rating
HS: HORIZONTAL SLIDING WINDOWS Highest number equals maximum rating
• SGD: SLIDING GLASS DOORS R: 15 psf(720 Pa)
LC: 25 psf(1200 Pa)
C: 30 psf(1440 Pa)
C Example for product designation HC:40 psf(1920 Pa)
HS-LC 25 48 x 76 AW:40 psf(1920 Pa)
LMaximum Size Tested In addition,the product may be tested to
4Vidht x Height optional performance grades higher than the
Performance Grade minimun grade in increments of 5 psf(240 Pa)
Performance Class
Product Type
Energy Data NATURAL ALUMINUM CLAD
U . S . A . Res Unit NR Unit Res Unit NR Unit Air infiltration Res Unit NR Unit Res Unit NR Unit Air infiltr.
'U-Factor -U'Factor 'R-Value -R-Value per CFM/Scl -U-Factor 'U-Factor -R-Value 'R-Value per CFM/
Ind the Clear glass/thermal edge spacer 0.46 0.47 2.17 2.13 0.01 0.47 0.47 2.13 2.13 0.01
CASEMENT low E argon gas/thermal edge spacer 0.32 0.31 3.13 3.23 0.01 0.32 0.31 3.13 3.23 0.01
Low-E argon gas/thermal edge spacer(SOL) 0.33 0.32 3.03 3.13 0.01 0.34 0.33 2.94 3.03 0.01
ational Clear glass/thermal edge spacer 0.46 0.47 2.17 2.13 0.06 0.47 0.48 2.13 2.08 0.06
lyds Of AWNING Low-E argon gas/thermal edge spacer 0.32 0.30 3.13 3.33 0.06 0.33 0.31 3.03 3.23 0.06
Low-E argon gas/thermal edge spacer(SOL) 0.33 0.33 3.03 3.03 0.06 0.34 0.34 2.94 2.94 0.06
ensure Clear glass/thetmaledge spacer 0.45 0.46 2.22 2.17 0.18 0.33 0.32 3.03 3.13 0.18
DOUBLE HUNG PLATINUM SERIES Law-E argon gas/thermal edge spacer 0.31 0.30 3.23 3.33 0.16 0.32 0.31 3.13 3.23 0.18
Low-E argon gas/thermal edge spacer(sot) 0.33 0.32 3.03 3.13 0.18 0.34 0.33 2.94 3.03 0.18
Clear glass/thermal edge spacer 0.46 0.47 2.17 2.13 0.08 0.47 0.47 2.13 2.13 0.07E
SINGLE HUNG GOLD SERIES LowE argon gas/thermal edge spacer 0.32 0.31 3.13 3.23 0.08 0.33 0.31 3.03 3.23 0.07E
et strict LowE argon gas/thermal edge spacer(sal 0.34 0.33 2.94 3.03 0.08 0.35 0.34 2.86 2.94 0.07E
on and Clear glass/thermal edge spacer 0.45 0.46 2.22 2.17 0.23 0.32 0.32 3.13 3.13 0.23
DOUBLE HUNG GOLD SERIES LowE argon gas/thermal edge spacer 0.31 0.30 3.23 3.33 0.23 0.32 0.31 3.13 3.23 0.23
Lo%.E argon gas/thermal edge spacer(SOL) 0.33 0.32 3.03 3.13 0.23 0.33 0.33 3.03 3.03 0.23
Clear glass/thermal edge spacer 0.50 0.50 2.00 2.00 0.19 0.51 0.51 1.96 1.96 0.19
DOUBLE HUNG BRONZE SERIES LowE argon gas/thermal edge spacer 0.32 0.31 3.13 3.23 0.19 0.33 0.31 3.03 3.23 0.19
Low E argon gas/thermal edge spacer(sot) 0.34 0.33 2.94 3.03 0.19 0.35 0.34 2.86 2.94 0.19
Clear glass/thermal edge spacer 0.49 0.50 2.04 2.00 0.09 0.51 0.51 1.96 1.96 0.09
WOOD SASH SLIDER Largongas/thermal edge spacer 0.32 0.31 3.13 3.23 0.09 0.34 0.32 2.94 3.13 0.09
Low E argon gas/thermal edge spacer(set) 0.34 0.33 2.94 3.03 0.09 0.36 0.34 2.78 2.94 0.09
Clear glass/thermal edge spacer 0.48 0.48 2.08 2.08 0.04 0.48 0.48 2.08 2.08 0.04
j' ARCHITECTURAL LowE argon
gas/
the,mal edge spaoer 0.30 0.29 3.33 3.45 0.04 0.31 0.30 3.23 3.33 0.04
S Lo%.E argon gas/thermal edge spacer(Sot) 0.32 0.32 3.13 3.13 0.04 0.33 0.33 3.03 3.03 0.04
Clear glass/thermal edge spacer 0.48 0.48 2.08 2.08 0.04 0.48 0.48 2.08 2.08 0.04
IRREGULAR SHAPES LowE argon gas/thermal edge spacer 0.30 0.29 3.33 3.45 0.04 0.31 0.30 3.23 3.33 0.04
Low-E argon gas/thermal edge spacer(sot) 0.32 0.32 3.13 3.13 0.04 0.33 0.33 3.03 3.03 0.04
ear glass/thermal edge spacer 0.47 0.47 2.13 2.13 0.16 0.48 0.46 2.08 2.08 0.21
GLIDING PATIO DOOR(8-50) LowEClargongas/thermal edge spacer 0.30 0.30 3.33 3.33 0.16 0.31 0.31 3.23 3.23 0.21
Low-E argon gas/thermal edge spacer(Soq 0.32 0.32 3.13 3.13 0.16 0.33 0.33 3.03 3.03 0.21
Clear glass/thermal edge spacer 0.45 0.45 2.22 2.22 0.16 0.48 0.48 2.08 2.08 0.16
FRENCH DOOR(FR-50) Low-Eargongas/thermal edge space, 0.32 0.32 3.13 3.13 0.16 0.34 0.34 2.94 2.94 0.16
Low-E argon gas/thermal edge spacer(SOL) 0.34 0.34 2.94 2.94 0.16 0.36 0.36 2.78 2.78 0.16
U-Factor=Btu/h-ft2-F R-Value=l/U-Value
Bonneville Windows and Do
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