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0030 BROOKSHIRE ROAD
3d �,eoo,S'�'f5'�� i�'�f. ,� _ i :� U ��t��sff�� ��, �����5 `, C M ii E I l oFIHE TOWN OF BARNSTABLE ti 94u-ifdin . Application Ref: 200903892 9 . BABNSTABLE, * Issue Date: 10/13/09 Permit 9 MASS. o. Applicant: DONALD,KEITH Permit Number: B 20091957 Proposed Use: SINGLE FAMILY HOME Expiration Date: 04/12/10 Location 30 BROOKSHIRE ROAD Zoning District SF Permit Type: DECKIPORCH RESIDENTIAL Map Parcel 328056 Permit Fee$ 60.00 Contractor ONALD,KEITH Village HYANNIS App Fee$ 50.00 Lice um . Est Construction Cost$ 3,000 Remarks APP VED P NS MUST BE RETAINED ON JOB AND DECK 8'X14'OFF BACK OF HOUSE THIS RD UST BE KEPT POSTED UNTIL FINAL IN PE N HAS BEEN MADE. WHERE A C ICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: HSBC BANK, USA ILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 30 BROOKSHIRE ROAD NSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: PR Buildin it ued By: d THIS PERMIT CONVEYS NO'RIGHT TO OCCUP NY RE ALLY O ALK OR ANY PART THEREO ,'EITHER TEMPORARILY.OR PERMANENTLY. ENCROACH,EMENTS ON PUBLIC PROPERTY;NO SPEC ICA Y PERMI UNDER THE BUILDING CODE,MUST BE APPROVED BY,THE JURISDICTION. STREET ORALLY GRADES-AS WELL AS DEPTH,A D'LO ATI OF PUBL[ EWERS MAY BE OBTAINED.FRONI THE DEPARTMENT PUBLIC WORKS-,. THE ISSUANCE OF THIS PERMIT-DOES NOT RELEA T APPL NT FROM THE CONDITIONS OF ANYAPPLICABLE SUBDIVISIOMRESTRICTIONS. MINIMUM OF FOUR CALL fNSPECTIIJNS REQUI R ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPE D AT THE TH T LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INS TION 0 BE COMPLET RIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRU AL EMBERS(READY. LATH). 5.INSULATION. 6.FINAL INSPECTION B RE OCCUPA WHERE APPLICABLE, .E ARATE PERMIT RE RE FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT P EED UNTIL THE ECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL E OME ULL AND ID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PE T IS I UED NOT ABOVE. PERSONS CONT ING TH UN GISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). , .0 �:, t Un.: BUILDING INSPECTIO ROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health _s_�_ ., �. ..,�,- �� L� B ���� ���� � �o. � � � ' Co � ' �q .� (�� , . . d TOWN OF tBARNSTABLE , ; BUILDING PERMIT PARCEL ID 328 056 GEOBASE ID 24434 ADDRESS 30 BROOKSHIRE ROAD PHONE j HYANNIS ZIP - j LOT 30 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY "PERMIT 76723 DESCRIPTION FRONTPORCH & STEPS PERMIT TYPE BADDD TITLE BUILDING PERMIT ADD 'DECK CONTRACTORS: PROPERTY OWNER Department of ARCHITECTS: Regulatory Services TOTAL FEES: $30.00 BOND $.00 �tHE CONSTRUCTION COSTS $300.00 434 RESID ADD/ALT/CONV 1 PRIVATE 0� • BARNSTABLE, MASS. i6gq. '0?FD BUILDIPT D ISION 1 Y DATE ISSUED 05/19/2004 EXPIRATION DATE '" TOWN OFj BARNSTABL'E r` - BUILDING PERMIT "r � =� `b' " PARCEL ,ID`32$ 056 GEOBASE ID 24434 ADDRESS 34 8ROOKSHIRE ROAD PHONE, HYANNIS -zIP �a LOT. 30 `FLOCK,> LOaSZE DBA ;. I�EVELOPMEt4T - 1STRICT .HY y PERMIT' 76?�Z3 ' DESCRIPTION FROM, &x`S'1TEPS %J PERMIT TYPE BADDD` TITLE BUILDING PERMIT ADD DECK' w,,.,P.- ...,•as .x ......:Y: --t.r.wm_ w..,...M "v-,.Y. a,. ..a n. .Y, ... .. CONTRACTORS: rPROPERTY OWNER.. ARCHITECTS:' Department of Regulatory Services I, TOTAL FEES: BOND $.00 t �tME CONSTRUCTION COSTS x $300:UO 434 RESID ADD/ALT/CONV ii PRIVATE_ d . . _ • , BARNSTABLE, _ • I MASS. 039. A, BUILDI DII71SION 4 BY l DATE ISSUED 06/19/,2004 EXPIRATIO /'DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM.THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS, MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS FROM STREET. , BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS i 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE;PLAN REVIEW APPROVAL Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A) WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. I � .,_ .-. .:t�r.A.�:X�1.ice .? ,�4. .•...,... .... .... ... �..�.._ ...... _ ._....,.. .. .. w.. .... ..,.,....... $ BUILDING I a . -P El., MIT I I A I I II -- I I I I I I :+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.•_ Map Parcel d Applicationct # Health Division `Date Issued ` 0` 3'O �:. Conservation Division ' .Application Fee �. Planning,Dept: '.' Permit Fee '�Q Date Defnitive Plan Approved by Planning Board `! Historic _ OKH,. — Preservation/Hyannis lz:Proiect.Street Address cVillage-,_ / : �4Addres� s ` Telephoneas Q_er_mit_Request, G Square feet: 1 st floor: existing. ., proposed 2nd floor: existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuatiori� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family :0 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 0 Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new L Number of Bedrooms.- existing —new +11 Total Room Count (not including baths): existing new _First Floor Room Count v Heat Type and Fuel: ❑ Gas 0 Oil ❑ Electric ❑ Other Central Air: 0 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size_Pool: ❑ existing 0 new size _ Barn: ❑ex�' g ❑ rev siz„�_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ro Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use ap r" APPLICANT INFORMATION (BUILDER OR HOMEOWNER) e-T)N e- i'� IV /(' Telephone Number License # Od a Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE";_` tDATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED R k MAP/PARCEL NO. tit ADDRESS VILLAGE +i OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING g DATE CLOSED OUT 5 ` ASSOCIATION PLAN NO. V ' The Comrrtonwealth of Massachusetts .De arfinent of industrial Accidents kvP . Office of Xnvesdgations 600 Washington Street Boston, 1f4 02111 i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers Applicant Information )�� Please Print Legibly Name (Susi.nesslOrganization/Individual): �0h,,X�/,¢v_K G 4 Cit /State/Zi 44 Y P• Are you: an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . employees (full and/or part time).* have hired the stab-contractors 2V I am a•sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors bavc g, ❑ Demolition ees and have workers'loy working for me in any capacity. emp $ 9. ❑ Building addition comp• insurance. [No workers' comp,insurance 5. We are a corporation and its 10.[]Electrical repairs or additions. required.] 3.❑ I am a homeowner doing all work officers have exercised their I I_❑Plumbing repairs or additions CTL myself. [No workers' comp. right , 1(4), and we 1v1en 12.❑ Roof repairs in urance required]t :c. I52, §1(4), and we have no 13.❑ Other employees. [No workers' coap.insurance required_] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t FlomcownerC who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit anew a$idavitindicating such. tContmctors dut check this box must attached an additional sheet showing the name of the sub-contraetors and state whether or not those entities have employers. lfthc sub-contractors have employccs,they must providb their workers'comp.policy number. X am an employer that is providing iporkers'cc,mpertsatian insurance for my employees. BeloiV is the policy and job life information. Insurance Company Name: Policy#or Self-ins. Lie,M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (shopving 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 rri_mirial 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 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 bIA for insurance coverage verification. X do hereby ce under thepains•a d enalttes afperjury that the infarmatlon provided al�ave is,true and correct Date: Phone# 3 �� Official use only. Do not write in thin area, to 6e completed by city or town official City or Town: Pern it/License 4 lsstiing Authority(circle one): 1.Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other 7 Contact Person: Phone #l: ' information and Inst �uctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees: Pursuant to this statute, an em defined ployee is dened as "...every person in the service of another under any contract of hire, express or imphce orator 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 appiirtenani 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)Tithhold 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 produ ed-acceptable evidence of compliance with the insurance coverage required." 'Neither the commonwealth nor any of its political subdivisions shall Additionally,MGL chapter 152, §25G(7) states 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 all out the workers' compensation affidavit completely, by checEag the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s), address(cs) and phone numbers) along with their certificatc(s)of insucc. Limited Liability Companics'(LLC) or Limited Liability Partnerships (LLP)with no employees other than the ra.n members or partners, arc not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. B e 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, nat the Department of Industrial Accidents, Should you have any questions regarding tlic law or if you are roquired to obtain a workers' compensation policy,please call the Department at the nurrlbcr lasted below. Self-insured companies should cntcr thee•sclf-insuranco license number on the a ropriato 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 Offiec of Investigations has to contact you regarding the applicant Please be sure to fl1 in the permit/liccnsc number which will be used as a reference number. In addition, an applicant that must submit multiple permit/licensc applications in any given year, need only submit onG affidavit indicating current policy information(if Accessary) and under"lob Site Address" the applicant should write"all locations in (city or A copy of the affidavit that has been Officially cially stamped or marked by the city or town may bo provided to the applicant as proof that a valid affidavit is on file foz future permits or licenses. Anew affidavit must be filled out each year.Whoro a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Lc. a dog license or-permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would hIc to thank you in advance for your cooperation and should you have any questions, please do not hesitato to give us a call The Department's address, tclephone•and fax number: Thtr Cbmmo wc,-4th of Massarh=tts Dtrpaftm=t of I.adustr O Arcid(-,zits Office, of liwe'stgatwus 600 Wasl i gtan Strt t;t Boston, MA 02111 Tci; # 617-727-49O.0 ext 4Q6 4r 1-$77-MASSAFE Fax# 617-727-7749 Revised 11-22.06 www.ma.SS..gov/dia Zimbra: cherylekeith@comcast.net http;//sz0003.wc.maii.comcast.nett2imbra/mail -A carfri- .O p A%} loc Ah -41P 1•W^^ '�'+e^um'.�.y�'(�'.•' °�.y'..-:Y.e",� -? � - ��,r.�nu. � — O'�'•.-'--s-vc+�i� y,�... - 4 ��he>�e�u certt�v�tha�t�us�rnortaclne:�insr�Qctiort:_ u�zs��xcrrQr,� 2 of 3 8/19/2009 12:17 PM �opYHer�y Town of .Barnstable Regulatory Services r SS, Thomas F, Geiler, Director �p 16:59. wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.m i.us Office: 508-862-4038 Fax: 508-790-6230 ' Property Owner Must Complete and. Sign. This Section If Using A Builder 7, Lj,a , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: RD, (Address of job) Signature of Owner ate i Y?01U,,9L-Q L- C- a4 `6' Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. I Town of Barnstable y��of THE rp �� Regulatory Services Thomas F. Geiler, Director w BAR]VSrABLE, MA 0Sp19.. BuiZdiug Division ,m PrFo min Tom Perry,Building COrnrnissi0ner 200 Main Street, Hyannis., MA 02601 -ArwtY.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 _ HOAJEOWNrR LICENSE EXEMPTION Please Print DATE: JOB LOCATION: street village number "HOMEOWNER": home phone N work phone# name CURRENT MAILING ADDRESS: state zip code city/town The current exemption for"home^ owners"was extended to include olvner-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. DEI+INITION 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-fanvly 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 he Building Off,cial, that he/she shall be "homeowner shall submit to the Building Official on.a form acceptable to t 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, certifies that he/she understands the Town of Barnstable Building Department The undersigned "homeowner" minimum inspection procedures and requirements and that he/she will comply with said procedures and du 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. ROMEOWNER'S EXE1vIP1'ION nerperfotrningwork for which a building permit is required shall be exempt from the provisions The Code states that: "Any homeow of this section (Section 1 o.9.1,.1-Licensing of construction Supervisors);provided that if the ho�ncowncr engages a persons)for hire to do such work, that such HornCOIVncr shall act as supervisor," Many homeowners who use this exemption aie unaware that they are assuming the responsibilities of supervisor(sec Appendix Q, Rules &Acgulay bo for Licensing Coe this exemption Supervisors;Section 2.15) This lack cf 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 Huth e licensed Supervisor. The homeowner acting as supervisor is ultimatclyresponsib)e. 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 forrr✓ccrtification for use in your community. Town of Barnstable Geographic Information System February 20,2009 s F t jt r 328039 irr #12 tr #28 i 4 , - - y328038 #11 0f x ar > 328056 - 329063 #27 , 328037 — r 910 ! j j r. 3 }t 32$05 #31 . : } 328052 K4 t 6 #26 �lY i 32803L 3 Feet —_ - DISCLAIMERS This map is for planning purposes only. It is not adequate for legal Map:328 - Parcel:056 ? ' Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner.HSBC BANK,USA- Total Assessed Value:$239200 T�"L. .1''=100'may'not meet established map accuracy standards. The parcel lines on this map - e Abutters` ,�b.,.E are only graphic representations of Assessor's tax parcels. They are not true property Co-owner DONACD L& ACieage;0.1 Z acres on the ma i io physical features p E ROAD ' n accurate relahonsh s -i � 0 BROOKSHIR . bqundaries and do not represent c p.•...P Y Locat On.3 _ such as building locations. Buffer r • 30ard of Building Regulations and Standards og/,uaeC� Construction Supervisor License License: CS 22393 Birthdaie; .:1:p/1/1954 Ezplratwn 10/�/2009 Tr# 6094 ,� `�� Res,tnct►o�n: QO DONALD A KEITH- PO BOX 1108 5 DENNISPORT,MA 02639 �L @bmmissioner V ✓a" Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 dome Improvement,Contractor Registration Registration: 114141 Type: Individual ,¢ di Expiration: 8/8/2011 Tr# 289096 DON KEITH I DONALD KEITH 154 CAPT CHASE RDo - DENNISPORT, MA 02639 Update Address and return card.Mark reason for change. Address C1 Renewal Employment Lost Card IS-CA1 Co 50M-04104-G101216 �lze Varrvmaouural!/z o�,. uc/zuael/a Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration14141 - 10 Park Plaza-Suite 5170 Expiration 88/2011 Tr# 289096 Boston,MA 02116 Type):Individual 1 DON KEITH i s DONALD KEITH' 154 CAPT CHASE;RD DENNISPORT, MA�Q2639 � Undersecretary Not valid wi out signature 6 c"A ` 7 -144 40, , v �\ J axs 441 �a r - hie t e .. • e V� l vId l ' Loll H6 ly � Li }: � a TOWN OF BARNSTABLEBUILDING PERMIT APPLICATION... Map— Parcel ��� '.Application # Health Division Date Issued Conservation Division 'Application Fee Planning Dept: � I � °. ;Permit Fee' �- Date Definitive,Plan Approved by Planning Board Historic - 0KH Preservation / Hyannis Project Street Address l5/Q^0 k SWI C: RD Village i7 y191�/11/�S Owner ALA 6_NAU.D Address 1�/ /ff 4A U Pp e/f D1 Telephone Permit Request -IN&UL FMM IW A f- S&2 T FW IC 'ad A ►r u1i NASS -ra SLAU PlEld F&ORIN A d681iNIFTS 3 SEP Roomy ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1106 Construction Type j Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting,,currientation. i Dwelling Type: Single Family •�❑ Two Family ❑ Multi-Family(# units ) " Age of Existing Structure Historic House: 0 Yes ❑ No On Old King''ighwagn 0)�§J§ ❑ No CD Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other " CJ.1 -r a Basement Finished Area(sq.ft.) Basement Unfinished Area (sq. ft Number of Baths: Full: existing` new Half: existing e ' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded 0 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 'Do Na 1)j3EN )qu D Telephone Number Address /A/ CLIM SEKLU D ED License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO WP V &f FS SIGNATURE Am&& DATE 00 FOR OFFICIAL USE ONLY a `.APPLICATION# 31 DATE ISSUED MAP/PARCEL NO. t t ADDRESS VILLAGE - OWNER DATE OF INSPECTION: f FOUNDATION FRAME t r INSULATION 4 4� FIREPLACE ELECTRICAL: ROUGH FINAL L PLUMBING: ROUGH 'FINAL ti GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ry 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 i� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information AA� r� Please Print LeLribly =)qI� Name(Business/Organization/Individual): E/V P UP Address: IL I eUM&R09d D City/State/Zip: aw e I MA. 01^, Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the stab-contractors 6. ❑New construction 2.0 I am a sole proprietor or partder- listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g.'0 Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers'-comp.-insurance comp. insurance. required.] 5. 0 We are a corporation and its '10.❑Electrical repairs or additions 3.10 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other, comp.insurance required.] *Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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.M Expiration Date: Job Site Address: � �C�/C.� A ® City/State/Zip:A/g/AkYZ 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 tip 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 cer#under the pains and penalties of perjury that the information provideeed-above is true and correct. Si mature: Date: �J _ Phone#: Official use.only. Do not write in this area,to be completed by city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Y r- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tiustee 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-contiactor(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 ro carte line. City or Town Officials that the affidavit is co lete'and printed legibly. The Department has provided a space at the bottom Please be sure mp p of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit.that has been officially stamped or marked by the`city` or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth o£Massachusetts - Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia EI�ERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: n�NA �ENR Site Address: 30 print Town: Applicant Phone: Applicant Signature: &nd Date of Application: ,S/ 'fog .. NEW CONSTRUCTION: choose ONE of the followin two*o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FANIILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab QOption 1: Basement Fenestration exposed Wall Floor Perimeter U-factor floors R Value R-Value R-Value wall R Value '�UE HSPF SEER R-Value and Depth National Appliance-Energy 3 5 R-3 8 R-19 R=19 R-10 R-10, Conscrvatioh Act(NAECA)of ft.• 1997 as amended,minimums or eater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at jap•//www.tnrrgycodes.goy/rescheck/ ADDZTiGONS:OR ALTERA'TZONS.TO EXISTING BUILDIlVGS.O'V'ER S.YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_a) D SF 100 x 4. 6 — /30 1 = 1 y/Z% of glazing (b) Glazing area equals /8q.bSF b a If glazing i_s<-40%.u9e the chart below. If glazing is > 40 % rocee.•d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter ❑ Fenestration Exposed floors Wall Floor Basement Wall R-Value U-factor_ R-Value R-Value R-value R-Value and Depth .39 R-3 7 a R-13 . R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not corn pressed over exterior walls, and including any access openings). ' SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form found in Appendix 120T 1 �t r Town of Barnstable a Regulatory Services BAMSTABLE Thomas F.Geiler,Director '� a`�� Building Division Tfo MAC 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: /'!4 Y j q dp� /� ��y JOB LOCATION: _ Il Uo K-S 9��J/ I f v�✓ number ^ street village "HOMEOWNER": oPi D RtM9U8 �)-LTY24,20y 9 _sUso name / } home phone# n work phone ifV CURRENT MAILING ADDRESS:J C 91 N D 1/- ko w,cll IVA- O/FS-0 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, 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. Thotau " 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 helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC V �,ME � Town of Barnstable Regulatory Services MMSTABM AB&Kass. Thomas F. Geiler,Director M 039. ;o `�� 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 L , as Owntto bject property hereby authorize act on my behalf, in all matters relative to work authorized by this b ' permit application for. (Add s of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:FO RM S:O W N ERPE RM IS S ION t t r FX -TSTIN 29'11 8'9 5'1 � 16'1 4' 4'9 F 45 8'4 3'4 a m 00 Lo 8'37 4'9 0 04 `-- 00 0 8'3 4'9 N KITCHEN UP 90 20'8 x 23'6 N fn 11'11 ih rn 11'9 r- U P M co 6' 6'3 2'4 2'11 6'5 6' 12'3 - 5'3 12'5 29'11 OVER ALL FOOT PRINT OF DWELLING @ 30 BROOKSHIRE RD.HYANNIS LIVING AREA 722 sq ft ( +� V i 21' 6'10 11 '0"4 . T 1"4 O eo CEILING FANAN LIGHT 0 KITCHE co 1 20'4 x 8' Open Door-way 0 Brookshire Rd. Kitchen Renovations 271116 15'8"4 217116 KIT21HEN 1 sq 83 ft Stand p Shower MASTER BATHROOM FIRST FLOOR Jacuzzi Tub 220v Exhaust Fan o O r Toilet GFI 110v Sink Toile 110v GI LIVIING AKEA 99 sq ft a 32'1 8'9 2'10 6'4 142 6'4—7 2'5 3' 3'4 5'4 8'10 1 2'6 m LINE N 6' - LJ 2T.'T R WASH R \ ` 11'1 g' oCN co rn M � 111 13'8 0oco_ N Cfl � 00 GUEST B R M MASTER BEDROOM CO DOUBLE DRESSER AND 4'E`' (h M ch DOUBLE DRESSER AND 4'BY � FOLD DOORS FOR CLOSET FOLD DOORS FOR CLOSET 11'7 6'4 142 E-3!2'1 P 30 BROOKSHIRE SECOND FLOOR LIVING AREA 585 sq ft 29'10 8'10 21' 4'1 4'9 117'4 3'3114 o o oa o000 8'4 °O co 00I KITCHEN 04 BATHROOM -s 20'6 0 N O N d N N UP Cn N 11'9 rn M 11'10 LIVING ROOM BEE ROOM/ OR OFFICE U P ch io ri 6'1 6'3 2'4 2'11 6'5 5'10 12'4 5'3 12'3 29'10 30 BROOKSHIRE RD. HYANNIS FIRST FLOOR LAYOUT LIVING AREA 720 sq ft I 29'10 10'��6'4 � 13'6 3' 3'4 5'4 8'2 6' sMoWE;vlUa BATHR OM M 9) ~ MASTER BEDROOM iOILEI' '+tiASHER ORYER 9'6 04 CM rn 9'6 6' M 13' c� co 00 io Co N GUEST BEDROOM 6b-- N 1 SO DOUBLE DRESSER AND 4'E cy) c7 DOUBLE DRESSER AND 4'BY SO M FOLD DOORS FOR CLOSET FOLD DOORS FOR CLOSET ch 10' 64 13'6 29'10 UP 30 BROOKSHIRE SECOND FLOOR LIVING AREA 544 sq ft s 29'11 BASEAOT AREA UP N N N N BULKHEAD 29'11 LIVING AREA 722 Sq ft TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION X /)0 Applicati 0 Map Parcel Z Date Issued �3:Health'Division C,-I Conservation Division <Apo,licatio'n Fee +1 Planning Dept: Permit Fee: Date Definitive'Plan Ap proved by Planning Board Historic 70KH Preservation Hyannis _Project Street Address 30 6 VW Village Owner Address So 8yiod I'ts I IC ccl� L Telephone Permit Request C,/ zeal alert e4,-,4- S bare feet: 1 st floor: existing proposed .2nd floor: existing —proposed ofg?newer Z6ning District Ar Flood Plain Groundwater.Overlay proposed T' fj Project Valuati6 0_0 Construction Type Lot Size Grandfathered: L]Yes L11 No If yes, attach suppo suppo ing downenkition. Cn Dwelling Type: Single Family Two Family LJ Multi-Family(# units) Age of Existing Structure Historic House: LJ Yes Alo On Old King's Highway: 0 Yes LJ No Basement Type: �Full LJ Crawl LJ Walkout LJ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) OOA�'q Number of Baths: Full: existing new Half: existing —new Number of Bedrooms: existing —new Total Room Count (not including baths): existing (0 new First Floor Room Count Heat Type and Fuel: V(Gas Ll Oil Ll Electric U Other Central Air: LJ Yes WNo Fireplaces: Existing—New Existing wood/coal stove: L3 Yes L3 No Detached garage: LJ existing Linew size—Pool: LJ existing Dnew size Barn: Llexisting Unew size Attached garage: U existing Unew size —Shed: El existing 0 new size Other: Zoning Board of Appeals Authorization LJ Appeal # Recorded J Commercial Ll Yes V bi kNo If yes, site plan review # Current Use W_ ce Proposed Use bsZ OW APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A-D k\ Telephone Number Address 30 q )1aY'V--Y-cJ 51 Licensek 05 Iq C13) e' 4J �l'°'tAe) / Mid" CO-3 4 Home Improvement Contractor# 5_i 3 14-T M-1 Worker's Compensation # Vwc1P0)Q&t*30 1 ?4p,x— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE —DATE r" � S FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r�} FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` S DATE CLOSED OUT r ` ASSOCIATION PLAN NO. _ r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly . Name(Business/Organization/Individual): n Address: q a-1'VAv_0/ 6 01'. City/State/Zip: A. ,j-stan 04 a3A-a.- Phone.#: 7e�1 9cfS -2/&/1) Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction .2 I am a sole proprietor or partner- listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor.me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its '10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their It.F1 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors.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. Lie.M 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby,c d th ins and penalties of perjury that the information provided above is true and correct Si ature: Date: 1/ Phone#:_ 2CI �(� �(� Official use only. Do not write in this area, to be completed by city or town offwiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: A `Ya Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute, an employee is defined as"...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,of 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." .L •. MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),-address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 of licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable Geographic Information System February 20,2009 � y - ''y 328039 ' An 912 32800 29 t 329061 #28 :: O ItMF. W 328038 #11 O f 328056 r! 30' 329063 #27 "y ` r.Y ?yr x 328037 #10 !34 057 �t31 328062 #26 43 Feet 5 a as DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:328 Parcel:056 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:HSBC BANK,USA Total Assessed Value:$239200 1"=100'may not meet established map accuracy standards. The parcel lines on this map c � �_-� are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: /oRENAUD,DONALD L& Acreage:0.17 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:30 BROOKSHIRE ROAD - such as building locations. Buffer %/. r^ ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: rb Site Address: 3D , print Town: Intl-: Applicant Phone: cab/0 Applicant Signature: �_ Date of Application: NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Option l: Basement P Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER R-Value R-Value and Depth National Appliance Energy .35 R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987 as amended,minimums or eater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2) REScheck-Web which can be accessed at http://www.energ cy odes.gov/rescheck/ ADDITIONS FOR ALTERATIONS.TO EXISTING BIJILDIIVGS.OVER 5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_a) 77'2 SF 100 x tp4e _ 7 _ % of glazing (b) Glazing area equals SF b a If glazing is.:5 40%.use the chart below. If glazing is> 40 % roceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Fenestration Ceiling and .Wall Floor Basement Wall Slab Perimeter U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). ' SUNROOM-An addition or alteration to an existing building/dwelling'unit where the total Fglazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P)' f T► rati Town of Barnstable Regulatory Services . MUtNUi►uss�Bl'E$ Thomas F.Geiler,Director Eo.lg6A�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize R&N,+ e�rw� to act on my behalf, in all matters relative to work authorized by this building permit application for. 10 (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION r �oF tt+e t . Town of Barnstable 0 Regulatory Services Thomas F.Geiler,Director tMtAM 059. Building Division Tom Perry,Building Commissioner 200 Main,S4eet, _Hyannis,MA 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: cityhown 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 HOMEONWER' 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 buildinl?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_be/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 4 , 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 C ✓axe �iam�nzonueall/ a�./�aaoccc�tuael�6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR, RegistrationJ29593 I' Expiratlo g 012009 TrJt 259994 31 Type ndividual I ` tµ .Robert C.Doran Robert Doranr . 304 Harvard St. 4 6 it l '""•t.._i-='' whit man,mA 02382 Administrator Nlastiachusetts- Depm'tment of Puhlic S.ttch- gourd of Building Rc ulations and St�lnd,u ds Construction Supervisor License License: CS 49319 Restricted to: 00 ,•m' ROBERT C DORAN 304 HARVARD ST 4 '" WHITMAN, MA 02382 2 A Expiration: 6/28/2010 ('ummisiuncr Tr#: 28951 ,r P6 �+ ' B. DORAN CONTRACTING Lic. *CSO49319 ESTIMATE Reg( *129593 781-985-261 O WORK PERFORMED AT: } 30 rooku6i;Y eol j�✓�. Gv�ni S �''�' DATE YOUR WORK ORDER NO. OUR BID NO. DESCRIPTION OF WORK PERFORMED a• ?;���^ //qs // A —O dt-!/ V111" �Jr��V '7vroC Gvrh q� �" ' 511 cat . All Material is guaranteed to be as specified,and the above work was performed in accordance with the drawings and specifications provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of Dollars($ ). This is a ❑Partial ❑Full invoice due and payable by: Month Day Year in accordance with our ❑ Agreement ❑ Proposal No. Dated Month Day Year a t ..... _. L , • 1 ....,....__ .._ .......... _...._ .,a.,�_.�. ..� .... , vf -_, , 401*0 L__._..— ...i.— i -.w� •. j I I 1 I y a , t , I ' , I 1 f �,— _.; E ..µ _ 18 , T , a " u II , I 1 1 r �...<_. .i......._ ,.._....., ...f ... I .._3. .+-•�. I � h... .� q,w.,.:—.:I4 S , 44 a , + I I I , y I _ : f r '� ' I !� � 1 s .�: ;:, I v. '. 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HIC Registration Complaints License Type License# 114141 Restriction Name DONALD KEIT City, State, Zip DENNISPORT, MA, 02639 Expiration Date 8/8/2009 Status Expired COMPLAINT DATE HEARING DECISION STATUS DISPOSITION j NO RECEIVED DATE EFFECTIVE I!2005 248 H 2/8/2005 Closed 11/21/2006 Reprimand and Fine 5/7/2007 2005-583-H 11/17/2005 Pending 2008-272 4/8/2008 Pending Back To Search ©2009 Commonwealth of Massachusetts http://db.state.ma.us/homeimprovement/licdetails.asp?txtSearchLN=14103 9/1/2009 -St-1 O F'A S 12! MCHELEIX 780 CMR. STATE BOARD OF BUILDING REGULATIONS AND STA1vDA D kL5b. clue;_0 E NIASSACHUSE17S STATE BUILDING CODE _ S 30 'No.34774 1 U STRUCTURAL A WC Guide to Wood Construction in High-Wind Areas:1101nph Wind Zone RFct�rtia`o_a�� Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)t 4AL 1i U ChecK 1.1 SCOPE _ Compliance Wind Speed(3-sec.gust) r. Wind Exposure Category 110 mph 1.2 APPLICABILITY }3 Number of Stones(a roof which exceeds 8 in 12 slope shall be considered a story] Roof Pitch Zstories s 2 stories (Fig 2) 2 Mean Root'Height . . •�C2 s 12.12 ' (Fig 2) Building Width,W �ft s 33' Building Length,L (Fig 3)(Fig 3) ft s 80' Building Aspect Ratio(L/W) - _ft S 80' Nominal Heightof Tallest Opening' _ (Fig 4) . . . . . . /,Z3 ;L s 3.1 /t S 1.3 FRAMING (Fig 4) 6'g„CONNECTIONS -•�+•- General compliance with framing connections (Table 2) . . . . 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete Concrete Masonry . . . . . . . . . .. . . . ANCHORAGE'TO FOUNDATION''' _ 5/4"Anchor Bolts imbedded or W Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general .... . .. .. : ... . . . Bolt Spacing from end/joint of plate , '" (Table 4) . . .• . .. ¢��� (Fig 5)(Fig 1 f-in. f Bolt Embedment-concrete . ... . . . .... '- in. s 6"-12" shl- a..�.Fm w47e Bolt Embedment-mason Masonry ... ... ...... .. .. (Fig 5)5)...... . .. .. . . . . . . . .. .. Z in. 2! 7" y Plate Washer . . . . ... .. .. in: i 15 3.1 FLOORS (Fig 5) • .. . . . . ... a 3"x 3"x iA.. Floor framing member spans checked .. ' Maximum Floor Opening;Dimertsion (per 780 CMR 55.00) . . .... . . .. .. .. . Full Height Wall'SNds at Floor Openings leas than(2'ifrom Exterior Wall(Fig 6) L (' ft s.l 2' _ Maximum Floor.Joist,Setbacks _ Suppornng Loatlbadring Walls or ShearwalI -(Fig 7) • Maximum CantilevetW'Floor loi is ft s d Supporting Loadbearing Walls or Shoaiwall . (Fig 8) Floor Bracing at,Enctwalls .. •, . . . _ft s d Floor Stieathin T (Fig 9) g YPe (per 780 CMR 55,00) . .. . . Floor Sheathing Thickness : Floor SheatRmg Fnsteriing . . ... .. •• . (per 780 CMR.55.00) • •••. ...: . in. ••••• •. (Table 2)-ad nails at in edge lL��iri'field 4.1 WALLS Wall°Height Load*rkng walls Non-Loadbesrr '' • (Fig 10 and Table 5) � g rig-walls ft s 10' Wall Stud S in • ('Fig 10 and Table S) . .. .... _ ....... . .. .... r;r P _8 .. .. .. . . ft s 20' Wall Sto • ' • (Fig:10 and Table 5 '�r� ry Offsets . ) •. . ... . +�in.s 24"o.c. 4.2 EXTERIOR WALES' (Figs ) . `..-. .. . . . .. .. ... . ft id _ Wood Studs Loadbearing walls ... .. ....... Non ,ring walls . . ... .,,• .. . ... (Table 5) Lowbea ... .. . . .. ..2x ft o m Gable,Ehd Wall Hracmg' (Table 5) 2x �l ft"'1 in. _ Full'Hetght End Sti,ds ........ . .., WSP Attic.Floor Ler►gh (Fig-10) . ... .... . . . .... ... .... . .... . (Fig-11) .... . .YpSum CethJla Length ttf WSP:..I a.rs it_ .., =ft i W13 _. r,rocc cq 6 ft o c (Fig 1 1) r• ` —i c v.y'w _ ui I x .I ceiling lurriu8 strips (gt 16"spacing min. with 2 x 4 bloclung (4 4 ft.spacing in end' joist or truss bays Double Top Plate ft Splice Length . . . Splice Connection(no.of 16d common nails)- (Fig )3 and Table 6)abl . . OiR.StM sow/ �� o Ji.i 780 CM'R - Seventh Edition ¢ /l 12 28/U7 �Effrctty 1 I/U81 °F "gssgc^y 780 CMR: STATE BOARD OF BUILDING .REGULATIOhS .�,tiD ST.' 'V /�JD 0 6MICHELE \y�;'' .. �` D•ARDS 30 &�pl�-St�l�2E cuDlLo ;. APPENDICES Ay ff/,S) No.34774 Loadbearing Wall Connections ° S7RUCTURAL iz Lateral(no.of 16d common nails) . (Tables 7 Non-Loadbearin Wall Connections ) 2 GIS7E g n — Lateral '( o.of 16d common nails) . - (Table 8) . . Load Bearing Wall Openings(record largest opening but check all openings for compliance t. Table 9 Header Spans . . . . . ... . . . .. . . ) :. . . . (Table 9) Sill Plate Spans . . _iE ft__0_in. s Full Height Studs(no.of studs) (Table 9) ' �ft in: s Von-Load Bearing Wall Openings(record largest opening but check all openings for corn lianc�T Header Spans ..... able 9) (Table 9} Sip Plate Spans.. Z_ft in. s 12' Full Height Studs(no of studs) (Table 9) — (Table 9) �ft�in.., 12" Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously' — Minimum Building Dimension,W Nominal Height of Tallest Opening' . . . . t Sheathing Type . 6.5,. Edge Nail Spacing . . (note 4) .. � Field Nail Spacing, . . . . . (Table 10 or note 4 if less) .. . ,. • �� � . i6d . . . . . . (Table 10) Shear Connection(nn or o.of 16d co rnmon nails)(Table 10) I Percent Full-Height Sheathing . 5%Additional Sheathing for Wall with.Op nine >06•g•• Maximum Building Dimension,L g ( sign Concepts) Norrunal Height of Tallest Opening' . . ;. . , t Sheathing Type . . . . u �P�s 6.8" Edge Nail Spacing . . . . . . . , (note 4) � Field Nail Spacing (Table I I or note 4 if less) (Table 11).. . . . . . . —in. Shear Connection(no.of 16d common nails)(Table 11) t Percent Full-Height Sheathing 5%Additional Sheathing for Wall with Openine >16'8" D Wall Cladding ,. B ( esign Concepts}. Rated for Wind Speed? . . .. . . 5.1 ROOFS Roof framing member spans checked? (For Rafters Huse AWC S T Roof Overhang Pan Too],see BBRS Website) Truss or Rafier,Connections at Load bearing Walls(Figure 19) • . ...G1 ft s smaller of.2'or U 1 ProprietaryConnectors Uplift . . Lateral . .. . . . . (Table 12) l U l.� M (Table 12) 2 t Shear. .'. L. Ridge Strap Connection,if collar.ti (Table l 2) S Gable Rake Out o used 4i5_ t a looker .. Page 2I(Table 13). Q . Tm2 — LS r /z l L tY`C Truss or Rafter:Connecgona at Non- (Figure 20) • •. . ft s smaller of 2'or U2 Laadbeanng Walls -- ProprietatyConnectors- Uphft .. . . (Table 14).. .. .Lateral(no of 16d.eorronon nails) .. U lb. Roof Sheathm T (Table 14). L= lb. g' hl' (per 790 CMR 58.00 and .. Roof 5heathrng Thickness s. l l� ./ ) . ... Roof Sheath igl amening .... . . ... ........... in.:2.7/I "WSP `Itxes. (Table 2) d " (,� . . Vt (Q.tj This checklist shalt be met to its entirety, excluding the specific exception noted in 2,to comply with the UW:heerrients of 780 CMR 3301.2;1.1 Item I.-If the checklist i;.metin its entirety then the following metal straps and hold dc►wns:are riot cegutred.per the WFCM 110 mph Guide: a. Steei Straps per;FgM,S b. 20 Gage Straps P Figure 11 c UpE►ft.S`t! pot:Figure 14.,. d: All Strttps per Fgure l.7 e' Comer Stud Llob Downs 2. penir►aerghtof er Figurel8aad FExceptiO gurc 18b upft.shall be "e4t+rementsshown tn_Tablea 10 Permitted:when 5%is added to the percent fun_heiii h,shenthinit ;• a. From Tables 10and l l and location of a II sheathing and Building Aspe a minimum 2 in.nominal ct Ratioess .determinePercent2 dada Sheathing and Nail Spacing requirements Full-Hcighl 12/28/07 (Effectivc 1/1/08) 780 CMR- Seventh Edition ,• r '1055 GENERAL NOTES AND MATERIAL SPECIFICATIONS' ` FOUNDATIONS 1. All workmanship to conform to the requirements of the Massachusetts State'Building Code; latest edition' 2. For site location.and grading information,see Site Plan,by others.' R 3. Assumed net allowable soil bearing capacity,q=3000 psf, for a medium sand/gravel composition.,Other soils encountered, contact the Engineer of Record. 4. Concrete: Minimum 28 day strength, fc=3000 psi,3/4"aggregate,designed per American Concrete Institute Code, latest issue,maximum slump=4". a.) ,Anchor bolts ASTM A307 galvanized, min. 5/8"diameter, 12" long,,w/2-1/2"hook spaced._"o/c,or in concrete piers w: l Simpson ABU-series base:SPACED 2'o/c for slab-on-grade construction(i.e.Garage,Basement,etc.). RTA\e1g4 FRAMING 1. All workmanship to conform to the requirements of the Massachusetts State Building Code, latest edition. 2. Structural Design Loads Dead Loads:Actual Weight of Building Components Live Loads: Snow Load =30 psf(plus drift)with applicable reduction _ ATTIC Storage=20 psf Living Floor=40 psf ' Sleeping Floor=30 psf - Decks and Balconies=60 psf Wind Load :"Criteria used for 110 MPH Exposure B.unless noted otherwise 3.' Structural Steel: (as required) a. ASTM A572 Grade 50;shop paint with rust inhibitive paint.Thru-Bolts: ASTM'A307, 1/2"diameter: punched holes: 9/16"diameter. h. Welds: Shop weld cap and base plates to columns; shop weld bearing plates to beams; use E70xx electrodes. Alternatively, field weld by certified welders. c. Deflection Criteria: L/360 total load deflection. 4. Timber Framing a. All new timber framing: Spruce-Pine-Fir No. 2 with Fb=1000psi, E=1,300,000 psi,or better. h. Pressure treated timber(P.T.):Southern Pine with Fb=1300 psi,E=1,600,000 psi,or better. c. Laminated Veneer Lumber: All L.V.L. shall be 1.9E L.V.L. with Fb=2925 psi, E=1,900 ksi, F'v=285 psi, Fc_per=750 psi. Fc_par=3035 psi. Parallam(PSL):All PSL shall be min. 1.9E ES with Fb=2900 psi, E=1,900 ksi, Fv=285 psi. Fc_per-750'psi. Fc_par--2900 psi. Note that Microllam and Parallam may be used interchangeably. 1. Deflection Criteria: L/480 Live Load,L/360 Total Load 5. 2. Optional: Provide shop drawing submittal of engineered lumber systems for approval prior to materials purchasing.. Metal Connectors: As manufactured by Simpson.Strong-Tie Co.shall be handled and installed per manufacturer requirements,with all nail holes filled,with the size nail as speci fled-by.mfgr,or herein. , a. Rafter to Ridge Beam Simpson LSSU-series,or Simpson Straps over top of plywood,.spaced 16"6/c: Rafter to.Ridge Plate: C611a ties thin. 1 x6@ 48"o/c at top or Simpson Straps over top of plywood spaced 16"oic b. Rafter ends to top plate: Simpson H2.5A c. Band Joist: Simpson'straps.at48"o/c: CS-14R-50.5"centered at band.)olst, 6. Bolts: Bolts in wood framing shall be standard machine bolts unless noted otherwise. Bolt holes:in wood shall be 152" larger than bolt diameter. Bolt heads'and nuts shall bear on standard malleable iron washers,or square plate washers. All nuts shall be retightened at completion of job. 7. B o ki k a. Blocking shall be solid blocking,2x minimum,and full depth of member. b.Stud Walls:provide:blocking ai 8'=0:"o/c,maximum height. Comers to be blocked at 48"o/c Wills plywood edge nailing to this blocking for the first 48"of these building corners. c.Nailing Schedule Solid Blocking to Bearing 2-8d toenails ea:side Blocking Between:Studs 2=10d toenails ea.end,or 2-16d end-nails ea.End zH of d. New Framing Provide 2x.:blocking for 2 joist/rafter bays and spaced 48"o/c in joist and.rafter plane at all edg s plywood edges to this blocking 8. Nailing Schedule: 0� MICHELE CUDILO P� All Walling shall be in:ac cord ance with Appendix 120.Q,unless noted herein specifically. i? sF� Multiple Studs 16d;@ 12"staggered No.34774 a. All nails shall.be common wire nails. STRUCTURAL b. Sub-bore where;nails tend to split wood. o <u 9. Headers less than 4-0",•use.2-2x6;all others per MA State Building Code Table 5502.5(1)and MICHELE CUDIL P.E. f C n&AUMa: -St` uc.turcf: EnQtna�'. �� r of on ane, en ervi N, MOteOehYM pt%� �DSt Eft c�� Drawn By: MC Date: d�j�� �0 Drawing Scale: AS NOTED Rev. 0' ,S K— q/Ut <' '_`" File Project No.: le Nome: Pr ` {f ✓ MqS �� a � s ,: 1 71 : y v ) I r , a t to d • 0 sT 2qz t fi : _ t ' c 11/)) 7- Cu a .. too , n < / 2 < y I .. t '` .t; , p (Llla R e d w U GrrtB� x p sc�l6Le � � • eell e C-UT 3�4x7'�4NL� 11 p s ._.: Sr1' s\YAI �ue i cw-vuq r�9Z f - F �/l� ofsP W r - J{� LCOV / . (T ter, 4� ��3 �LV� , S 3 /`�XS�� , SAT, -� `ADD 1 I )� 14-'XS`1z,'bV-L, grrsn ► (2))3/¢x 5 �Z �iTG . f�bP- , X p 2" N OF:M.4 1 `T' ?x S MICHELE cuo�o STAIg4 ° N0. 34774 STFtiJCTUR:�L ��tc • .nPJ.'�.1. ;E. .. .. - - 29'10 r �-- g'10 21 �— 4'1 4'9 11'7."4 313114 I D -rDJif eft p pmo Z Cam, o O µ14 ZX (� V --T- i :: op— ADD 1-* -cc) Ii j I 8 4 L Vil, v oo KITCHEN (V LATM57-L Pose" �P /P►l �P�D�e , ; I. Ln N '• / N I � � I uPs g�T FL TT 11'9 _ 11,10 -- � • - LIVING ROOM BE ROOM/ OR OFFICE up - r� Cfl CD LVL ' I . ---- - 6'1. ---- 6'3 2'4 2'1.1 .`6'S— 5'10 - 12'4 _I ,. 5'3 12'3 . r - ----- 29'10 - 30 BROOKSHIRE RD. HYANNIS FIRST FLOOR LAYOUT LIVING AREA c o C, DEL r 720 sq ft IVa4," srRUCrU � / 29'11 p S(M P�sort { a-A CO 'Ole 7D , l,( tll .. r1 GV�I{�l - G�I Y. 1 J// V�1 `1�7( it BASEMIU AREA -0 OF � N N N BULKHEAD y Rom- , , { • . F 29'11 --- — LIVING AREA ., 722 sq ft � 1M OF rA `� �O k l MEL' G�, r c) N0.34774 STRUCTURAL 9rG's-TO", ,a ioNAL Dl � OF M„q Dt !!�ww bd V LT t Ir _ - .—_. _ + } 0 d ST2g7— Iled VIOI- jAi 6t r a ; : la wo t v OP -CAt4 cs 1 41 G 7ti14 4r. i M6_, ve JA\ To or 52 At Cie Ti • 610$LA;� ; Z- Zx�D Scs16Le 7j�4 �•� - s srt� sr�9Z w SFr : .ii LV, ; @ jAT `ADO @ �)1314- xs'/z`(.�V� L JX VT (2)l3I¢x I OFMg po-0 1 FT MICHELE ` qG: _ t4o z CUDlLO ' �1 G - ° P6c. 34774 ISl.L`-fp"' LC STRUCTURALIm crsTc�` PA. grcrir— M Gy a $ ti.. i t►1 w r f AA mom 30 Brookshire Road, Hyannis 7/31/2009 ir 30 Brookshire Road, Hyannis 7/31/2009 J W D h _ a r w Y - :ta " aY r'r I 30 Brookshire Road, Hyannis 7/31/2009 JR 30 Brookshire Road, y �H annis 7/31/2009 t n ^ V lint .•r �'a 30 Brookshire Road, Hyannis 7/31/2009 ra s 30 Brookshire Road, Hyannis 7/31/2009 iiticFnryt 30 Brookshire Road, Hyannis 7/31/2009 "fF7' 30 Brookshire Road, Hyannis 7/31/2009 t c • a. A 30 Brookshire Road, Hyannis 7/31/2009 er s- 4 30 Brookshire Road, Hyannis 7/31/2009 - _ 7-3I - off !vti - �� � .�. � �� t /1��. `oFt"E'Owti� Town of Barnstable : BARNSTABLE,_ .._ -.-. - - Regulatory Services MASS. 059. Building Division prFO MAy s 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection F 1Z__ LQ Location O fJ"y -S S ar- Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 10 9 -oM ER. Pci r- &_7 44- u kj2 r c A -t---i Please call: 50 -862- 038 for re-inspection. Inspected by Date �� !� i t v i Y�rt. .,.. .'.;...'..r• ,..•w-v'r F': r +a.e.,f� : - ,t: +. �'-�•••..4.,...>.b.j,. '2Y,'��.:�ry:5"rat+a+•°`9t".N""m°-h.g('...:.+.r,K ... t,i ,;�,_}.r. ... ^�Y.. *JVQ';,;•,+5�,y^�„r `oFIHE,or� Town of B arnstable o� BARNSTABLE. : Regulatory Services MASS. „a,q. ,0r Building Division - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection v gi�u arc ..... Location t Permit Number Owner Q , �- -I A V„ja Builder One noticeto remain on job.site, one notice on file,in Building'Department. The following items need correcting: rr- SCC)P W0 K/G b ff=r--c-- 5 FRO t� Pe R-V-'f T' -00 7 0 0 � o LAJ D4 N 4T 1 SAT V t-i4' -- Please'call: 508862-4038 for re-inspection.P��! Inspected by Dated ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .Map `� Parcel a —TQt��P�' �+�. � Permit# am 73� ARNSTABLE Health Division - I Date Issued 6 Conservation Division 17 I , Y ( � AFC ((: 29 Application Fee o Tax Collector Permit Fee Treasurer Y Planning Dept. APPUCANTMUST OBTAIN A SEW ER CONNECTION PMOT FROM THE Date Definitive Plan Approved by Planning Board LN4INB INC DIVISION PHIOB TO COMMOTION. Historic-OKH Preservation/Hyannis Project Street Address 1-1) r,,P, CAI Village Owner �, 1 �0 L 1�eM��s Address a ) Telephone c (1 -- 7 .1 1 Permit Request D e.C -,A L ® ,j i h �t JZ S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ��C/� a Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. r5 Dwelling Type: Single Family ❑ Two Family Cl Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes Cl No Basement Type: ,El Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑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: ZoningBoard of Appeals Authorization ❑ Appeal# Recorded❑ pP pP Commercial ❑Yes ❑No If yes, site plan review# - -Current Use Proposed Use BUILDER INFORMATION Name Polo 4bmalS Telephone Number Address License#H-)(hle 0(,1)n er Home Improvement Contractor# Worker's Compensation# i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO go,r 5��6 4� 1s1 yo D SIGNATURES — DATE r ` FOR OFFICIAL USE ONLY PERMIT NO: t , DAJ'E ISSUED MAP/PARCEL NO. _ . ADDRESS• VILLAGE OWNER DATE OF INSPECTION: I ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL " s ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 0 FINAL BUILDING �l 8 ' s •DATE CLOSED OUT 0 1 tv ry ASSOCIATION PLAN NO. x• V w tts 4 •The rCorrctnan�vea�th of 1Vluss achuse ,Department of Industriat Accidents` t - •QR16eIf�� ��' • 600'Washington,Street _ ' Boston;Mass. .02111 - ensati�on.bnsurance Affidavit-General Businesses Workers,.C m ,r,t•r•���� gale: ,a. ,-•�",ter •• ..�` • address: Y ' t ��h .. .' state• zt _ -. - . _-• •. ork site locatlozi fu11 address sines e• []Retail[]RestaurantBai/EatYng F�stablishmeat 'w �R . (i'ncluding REel-Esta e, Autos etc.)' an P ty , yvorking in ca aci .. 'lo'ees full fgl ' art time: []0}her ' ` Y' %%%�%%/%. am an® lo with this job.. t �%%%%%%////% � c�mveusation for my ems y » X providing vkecs' ,i, ti.,• :t ; .wti„ :'`.. ':��.. ,.,,:, s-, ''•' . .. �,�rloyer . .. .;� .r.. yt "'rt ,,+. 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'� a: .' •• : �% fiisu'r�nca=b'+ vera a as required under Section 25A of MGL 152 can lead to the imposition of crimfnsl pena�tles of a fine to$1,50D,n t1 or Fai]ur,to secure co g enalties#n the form of a STOP WORK ORDBR and a fino of 100.00 a day against ma I understand that ti one years'imprbonment as well as ctvilp • - copy e f this sit ent maybe forwarded to the Office of Investigation of the DTAfor coverage verification ereb certi,y u der the pains and enalties b f'perjury that the inf°ormadon provided above is frue and cord IF F I doh Y Date , Signature Phone# ���-7 2- •� , , print name y official use only de not write in this area to be completed by city or town afficW ' permit/license# (]BulldingDeparttnent ❑Licening Board city or town: ❑Selectmen's Office [}•cheekif immediate response is requtred []HeallhDepartmeaf , ]Other. Phone#; contact person: (revnedStpt?S>o3) — ' information and Instructions- eral Laws ch�pter 152 section 25 requires au employers to provide workers' eomp�atioia for:their. Massachusetts Geri ' ' person in the service of another undor any contract employees, ,As quoted'from the `law"., an employe is.defined as every of hire,•expres's or irx�Ql�ed; oral or written, .An�npioyer is defined as an individual, entity,association, corporation or other legal entity, or arty iwo or mare of the foregoing engaged'rn a�omt enterprise,and including the legal representatives of a deceased,employer, or the-receiver or rtrme Is association or other legal entity, employing tmployees. 'Howevei.the owner of a trustee of an individual,p •a px dwel g house having not'in=than three apartments,and-who resides therein, or the.occupant of the dwelling house of another wlio•empl°3'S persons to do mainkenance, construction or repair work m such dwelling house.6r on the grounds or ant thereto shall not because 9f such:eznployment bedeemed to be arm employer ,., building.apP ;.. f . " MGL chapter-152 section 25 also"states fhat'every state or ibcal hcen5lhnge commonwealth toy applicant tit who has nce dr l of a license or pen' to operate a business or to construct building not produced acceptable'evficlence'of.compliance with the insurance coverage retlufired•' Additionally;neither'tbe' coinmonwealtb•nor.any.of its political subdivisions shall enter into any coutract for the performance of public work untg' of eompliaride with t�e insurance requirements of this chapter have betn presented to the contracting acceptable evidence authority: , ' ..,. , _..... .. '• - Appllcants .. , . Please m *cr vrkers''eoiVensafiw affidavit completely,by checldng the box that applies to your situation..Please supply company name, address and phone numbers along with a certificate of.insurance as all affidavits may be submitted to the Department'of industrial•�,ccidents-for confiTmation of insurance coverage. Also'be sure to sign and date the affadayit. e�idavit should be returned to the city or town that the application for the permit or license is being requested, not the pepartment 6t 1:adustrial Accidents•. Should you have any questions regardirie the'`°la ;or if you are taro a•workers'•cornpensatimpplicy please call thepepaT[ment at the ntupber 1 s#A.below. requir toy ob ' City or Towns . please b e sure that the affidavit is cbmplete,andprinted legibly. The Department has.provided ding theme a epp licant• p are f the affidavit for you to fill out in'the event the Office of Investigations has to contact you regar be sure to filtin the pet/licemise number which w�l tie used as a reference number. The.affidayits maybe returnedtq, ari an ements have b een made, • the Department b , or FAX unless other g The Office of Investigations wo u1d like to thank cooperation and should you have airy questions, you.in advance for you cooperatio , Please do nothesitate to give us a•caTl.••• •• ' ' ' VWWWOM The Aepartmentis address,telephone and:fax number. . ' The Commonwealth Of Massachusetts Department-of Industrial Accidents . Bt�ce Di lHSfeB��etta . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 . _, +E► Town of Barnstable oY °�y o� Regulatory Services asratn,$ Thomas F.Geller,Director � 16$9• Building Division j0r6D MA'S k Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 pffice: 508-862-4038 Permit no. Date AFMAVff CTORLAW SUpgaROVEMINT CONTRA P NMNT TO EMffr AP11LICATION convers MGL c.142A requires that the"reconstruction`altionerations,n addition tooany pre�existting oow3,eroccupied ion, •improvement,removal,demolition,o biding containing at Least one but not more than four dwelling units or to structures which are adjacent to such residence or building b e done by registered contractors,with certain exceptions,along other requirements, • 1 Estim4ted Cost 0(). 00 Type of Work:__ A of ddress .�---G Owner's Name• Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑lob Under S 1,000 Building not owner-occupied 14 Owner pulling own permit Notice is hereby given that: OWNED PULLING THEIR OWN l?ERMIT OIlYIPROYEMENT WORKDR DEALING WIT11 GO NOT MOE CONTRACTORS FOR APPLICABLE R oy ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUND UNDER MGL c.142A. SIG JUR NED UNDERPENALTMS OF PERY Thereby applY for&permit as the agent of th 11 e owner: Contractor Name Registrationl�Io. pat OR Owners Name ppIKE r Town of Barnstable Regulatory 'g y Services • a sAuasrrASM : Thomas F.Geller,Director MASS 3639• .•� Building Division ArED hAAr p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.mams Office: 508-862-4038 - Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: Q e JOB LOCATION: S 6 e ` nUmber` stre .. I f village "HOMEOWNER": I / O� CY1 � A AW 0� .. , naT home phone# work phone# CURRENT MAU-ING 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. Sign re 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-fromthe provisions - . of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such. work,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly 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 fomi/certification for use in your community. Q:forms:homeexempt eck o-,F o rod Ccs �i i r- Cl uL ui f. i f { t x 39 2'8 0 5 MAP 2 MAP ;t 0 g O A 3 28 0 6 MAP ----------- 0 D 7 AP c:\conservation.dgn 5/14/2004 4:07:18 PM