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0037 CHARLES STREET
��� �h��/� cS ,. ,� Town of Barnstable Building Posf This Card�u ,r�d��,;�s Visible From theStreet ApprovediPlans Must be Retained on 1gb and,ttiis Card IVlusf be Kept gPosted Un�tllFinal Inspect on Has�Been Made q a x � ` 163p s eye■y■��• Where a Cer Pt�ficatejofrOccupan�cyisRegred,suchBu�ldmg shall Notbe Occupied until a Final Ins^pect�o�n has been made Permit No. B-18-3536 Applicant Name: DREAM HOME IMPROVEMENT LLC. Approvals Date Issued: 11/08/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 05/08/2019 Foundation: Location: 37 CHARLES STREET,HYANNIS Map/Lot 309-089 Zoning District: RB Sheathing: Owner on Record: PEREiRA, FLAVIO C Con'tractor`Name ALEXEY LEBEDEV Framing: 1 Address: PO BOX 532Contractor License CS-108208 2 HYANNIS, MA 02601 AEstrojCost: $8,165.00 Chimney: Description: build 5'x7'deck with overhang roof in front of entry door,F Permit Fee: $183.28 Insulation: Project Review Req: # Fee Paid $ 183.28 Date , 11/8/2018 Final: S - Plumbing/Gas h - Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six`months aftersissuance. N 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 zon ng by Taws 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. d Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building acid Fire Officials ate"provided on t'is permit. Service: Minimum of Five Call Inspections Required for All Construction Work:( `` a Rough:1.Foundation or Footing i " " 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 priorto 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: 11 Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Ox� Applicadon Number........ -/. _-... : , � . Ket38. � Permit Fee..�.�!.. .c.. ..............Other Fee........................ 163 TotalFee Paid..................................................................... Permit Approval by... .. ....... ..............oa.....1./.�� TOWN OF BA.RNSTABLE ' BUILDING PERMIT .P�. _ .................................. ..................»...................... MV... APPLICATION Section I— Owner's Information and Project Location Project Address J'�- 0,U Pt2 LIrS �� Village 1��(//lJ Owners Name Deibb►C- E QLIF S G,U A Owners Legal Address �:) �RLES �i City State Zip C` 60� Owners Cell# E-mail Ci me P,-k5e-nCZ(0 Wm 6"�.n Section.2—Use of Structure Use Grroup ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description g,lt4ry door T Ad nedqtm1-2/9/201 S -------------- Application Number............................................. Section 5—Detail Cost of Proposed Construction Square Footage of Project S . . Age of Structure Dig Safe Number # Of Bedrooms Existing 2) Total# Of Bedrooms(proposed) A)O0e- 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6-Project Specifics ❑ Wiring ❑ Oil Tank Storage F� Smoke Detectors Plumbing ElGas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage ❑ municipal ❑ On Site � Disposal P Historic District ❑ Hyannis Historic District ❑ Old Kings I-lighway Debris Disposal Facility: ' o,-RrnOc Ti-f -TPAV9 F-FP- ST. I am using a crane ❑ Yes [!(No Section 7—Flood Zone Flood Zone Designation Within or adjacent ? ❑ L�to a wetland,coastal bank. Yes No J d, Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last=Anted-n2019 Application Number........................................... Section 9—.Construction Supervisor Name JL LYC L/ �QbFDEV Telephone Number Address 6o 6 2,4A)_IL t N AyE City I-CY Y W i 3 State P74 Tap o26-® License Number /.OS-2DS' License Type C's Expiration Date 112 9V/ Contractors Email dr a09 hJ1 C-L@ n a, 1- CoM Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CUR the Massachusetts State Building Coqprq understand the construction inspection procedures,specific inspections and documentation requiredNby7 =CMRown of Barnstable.Attach a copy of your license. Signature Date /0/0.411l Section-10—Home Improvement Contractor . Name JJ-EXEV � 0 E r- V Telephone Number 20e 5661 Address SO �iQnVjLL?eV gvF_ City fbeRVA)L3 State zip 024� l Registration Number Expiration Date J/2-4 �g I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Buil ' Code. I understand the construction inspection procedures,specific inspections and documentation required y 780 the Town ofBaunstable.Attach a copy of your H.I.C... L7 Signature Date t®�2'4`/ Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date "P"C.ANT SIGNATURE Signature Date J % Print Name 4LLK5 Telephone Number 36-S9 E-mail permit to: AERM H! .4-0- @ T Itmnnio Section 12—Department Sign-Offs Health Department © Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvab Section 13—Owner's Authorization L , 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: (Address of job) Signature of Owner date j a r Print Name Last mdated:219=18 Board of Building.Regulations and Standards ('xn+tructiiin S��licr�i+ir License: CS-108208 ALEXEY.LEBEDEV 60 FRANKLIN AVENUE PNc Hyannis MA 02661 n5l.,,�j . Expiration Commissioner 11/27/2018 Office of-Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvemeht_�Comtractor Registration Type: LLC w Registration: 176777 DREAM HOME IMPROVEMENT LLC.: r Expiration: 09/24/2019 60 FRANKLIN AVE' HYANNIS, MA 02601 46. -r e� SCA 1 0 20M•0547 Update Address and return card. •�� (Yil/.il/%i{IYIL//�/���iJ;i:31.GPfi(/-i/��i.. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR r�°-�- Registration valid for Individual use only TYPE:LLC before the expiration date. If found return to: Reglstr ion x Ir i Office of Consumer Affairs and Business Regulation � t176Z77 ,1'09/24/2019 10 Park Plaza-Suite 5170 i " Boston,MA 02116 DREAM HOME IMPROVEMENT LLC, ALEXEY LEBEDEVIf � 60 FRANKLIN AVE. HYANNIS,MA 0261 - �� ^ Undersecretary Not valid without signature l The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/organization/Individual):Alexey Lebedev/Dream Home Improvement LLC Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 phone#:774-208-3589 Ar;yan employer?Check the appropriate box: Type of project(required): 1. m a employer with P, employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.r_J1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LEJ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5C]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[—] repairs re airs These sub-contractors have employees and have workers'comp.insurance: 6.�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill cot 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 thepolicy and job site information. Insurance Company Name: C- Policy#or Self-ins.Lic. Expiration Date: 3 f 005' r Job Site Address: 3 e� I City/State/Zip: g PV 02 f Attach a copy of the workers' compensation policy declaration page(showing the policy numbe•and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u �painanities of perjury that the information provided above is true and correct. Signature: Date: �1 2 /9 Phone#:774- - 89 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town:- Permit/License#` Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: l ® DATE(MMIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 03/27/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Eastern Insurance Group n/CNIv Ext: (508)997-6061 A/XC,No: (508)990-2731 439 State Rd. E-MAIL apaiva@southeasternins.com I ADDRESS: P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURERA: Arbella Mutual Ins Co 17000 INSURED INSURERB: AEIC Dream Home Improvements LLC INSURERC: 60 Franklin Ave INSURER D: INSURER E: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-19 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER M Y EFF MIDD MM/DDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 952005317803 03/08/2018 03/08/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 x POLICY ❑PRO ❑ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $. $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT Y/N UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE1,000,000 E.L.EACH ACCIDENT B OFFICER/MEMBER EXCLUDED? ElNIA WCC50050156792018A 03/08/2018 03/08/2019 $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD Dream Home Improvement L.I.C. 60 Franklin Ave, Hyannis, MA,02601 Email: iohn.dreamhillc@mail.com DRE11,114 Dome 508-332-8119 John Collinson Project Manager Improvement LLG. 774-208-3589 Alexey LebedevOwner/Contractor www.drearrihomeimprovement.com HIC#: 176777 CS#: CS-108208 Contract , DATE: 9 6 18 PHONE: 508-776-3413 NAME: Debbie Merlesena EMAIL: dmerlesena@comcast.net MAIL ADDRESS: 37 Charles St. Hyannis, Ma. JOB ADDRESS: _37 Charles St. Hyannis, Ma. Dream Home Improvement hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Front Entry Way: Build front covered entry way on house. The structure will be 7 feet wide and 5 feet deep. The entry platform will be 7 feet by 7 feet with 2 steps. The structure will be a pressure treated base with kiln dried posts and roof system. Columns will be wrapped in Azeks. All trim will be Azeks. There will be an Azeks T&G ceiling inside. All trim will be screwed with bungs. The decking will be slate gray Azeks decking with blind screw fasteners. Install light in ceiling Total cost for project will be $8,165.00 Deposit $4,080.00 Balance upon completion $4,085.00 All labor,materials,disposal and permit fees are included in a price.All additional extra work will be charged 70$/h plus materials Make All Checks payable to "Alexey Lebede' Compliance with Laws:Contractor agrees that it is properly licensed and insured under Massachusetts General Laws Chapter 142A and that it will perform the services contracted for herein in compliance with applicable building codes, laws, statutes and ordinances. Parties' Understanding of This Agreement: by signing this agreement,the undersigned Parties acknowledge they have had the opportunity to ask any questions concerning its terms; have read, understand and agree that its terms are fair and reasonable; and agree to be bound by the terms in their entirety. This agreement is effective as of the date it is executed by all the undersigned. Contractor Customer Date MRned JC/2S / All labor,materials,disposal and permit fees are included in a price.All additional extra work will be charged 70$/h plus materials r {i _�Ia M �� Y .y r�F .(� . 'F;. , ��� �t r�' q � y � ♦ µ l+s .. 'Vf` ffl.��. ry1. !,. +,J " t. .,y, f 1•i* "�. �� ,"`' ' �f#y'e ''f,for s wo '17WON 7,,,-,�.f'.a .,;:3,^':' .,. .✓_:. �a`a r `+f { R� f` It"w r, . ,. ,. w C dr >a4 ; j y " r u 4 a. k f � o70 70 PTl M rTi eol OD 2 c o c� tp 6 + rj a5 n� rn cn t7 SCALE �� + ��. 57 ' CRAQLf-.5 �)J- RL(aAdoI'St 4,o2- 0( �. 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'rrr a 5rec�atltRb od zane with an:effectii e date c l a d ttze�o�at�o of t ie d�teffIng ats p*rw to the local �o�iny by-laws rr� effect at the fire of Scale 1 � cos?struct�on..W..rtGr repent ¢hvrtaQfmarnal sQtt »stets Date orfs exempt fro v�latfon pvrcees?#action r� erV!lC. ,4'l�:44:.,sect tlel+lo: . �kse � + rJct dfirptoxthaaate oh! rRn rrasi�ctQr?t sutvQy is necQssary to ctet'�rmtr7e R� �,. <�` _ n x�C l�usegf for r¢ct�rQrng rpases or jar; ' ko .". ..,:......#.t�,.s....:...::f ::.::...... :.; ......... ...:.,...:..,.. .. .....acc�r...'.�t.........r?'t .: :.i�.�a�1 r. ....:.JJjp�e r� •; rrr(rirrrictR4 t t tS ak!,..IWOT :..T:H .#S:DIGIT:&BOt�ty" Y:SWVE?e'.RT*tf3 l5:FUR:MORTGAC,f.PLIR 36 .5 C► tY..: ' oLoL L cMM. Y� lac. . .. ..... ........... ................. ... ....... .... POST OMIC-EBOX 350: it-*I �lAROCK;UX-d2W 0-.!&4U6=�86'. ' `•F:78�-8Xr4833 E:Cf7l:ONlfA3sURSdEX®QikAtI.COM Application number—, . ......... .. ...... .. ... ...................... ML '5...............I........ ..Ifee ......6 ......"..A.... OCT 24 2018 Building Inspectors Initials............ ........... It FOWA) 0� 8AHNS-1ABLEIale Issued................... ................. ... ... .... . ..... Map/Parcel.... D4 bel............................... ..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATBERIZATION PROPERTY INFORMATION Address of Project: 37 C�a-.,/eA 5q H &-p7 r?, 'y 0 NUMBER , STREET VILLAGE Owner's Name: D e- bb,- e- de-4o cAx Phone Number 50 2 2 7 4 3 Email Address:M,-v-Ine n 4 locom CaA •Lit Cell Phone Number Project cost $ 1 0 0 0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK El Siding Windows (no header change) # ED Insulation/Weatherization D Doors (no header change) # Commercial Doors require an inspector's review Vloof(not applying more than I layer of shingles) Construction Debris will be going to Ya/Jyt e,&A, CONTRACTOR'S INFORMATION Contractor's name km em &&r Vc, V Home Improvement Contractors Registration(if applicable) # 3 Z-o 2 (attach copy) Construction Supervisor's License 0 6[0 Z (attach copy) Email of Contractor(0)(tv c'Mo4or-evrt Phone number 5-09-,7261- Z9'0 0 ALL PROPERTIES THAT hAVE STWUC71JRFS&ER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ....................................................I T *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent t Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer`# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowners Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PPLICANT9S SIGNATURE Signature - Date �� l All permit applications are bject to a uilding official's approval prior to issuance. {�. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Naive(Business/Organization/Individual):&yyi e Address: 97 S e-cL �A City/State/Zip: t't pl h n I 0 Phone#: S7-0 - 7;1 ' 2 9 O y Are you an employer?Check the appropriate box: Type of project(required): L5 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. 7. ❑Remodeling ship and have no employees These sub-contractors have g,, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.msurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.D.R6f 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. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurEpce coverage verification. I do hereby certify d thP.. tind a aloes of perjury that the information provided above is trueand correct Signature: Yd - Date: Phone#: �W' 7 7`— 2 (2 U Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: r4 Information and Instructions f Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees., Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 bet eturned to the-city or-town-that=the=application-for=the=permit=or-license=is=being=requested not-the=Department of Industrial Accidents..-Should you-have-any-questions-regarding-the--law or-if you-are-required to-obtain-a workers' --- " --— - compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said 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 1-877-1 ASSAFI Fax##617-727-7749 Revised 4-24-07 www.mass.gov/dia I R E,- C 10 66 CORE ' j Y Toe Roofers 67 SEA STREET APT#A4, HYANNIS MA 02601 August 9,2018 DEBBIE MERLESENA 37 CHARLES STREET EM: merlesena@comcast.net HYANNIS,MA Tel: 508-776-3413 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles (One Layer) from the Entire House and Old White Cedar Shingles and Corner Boards from Both Two Story Dormer Walls Only. Supply and Install ALL NEW ALUMINUM AND LEAD FLASHINGS ON THE WALL AREAS WHERE WHITE CEDAR SHINGLES GET REMOVED ONLY,WATER PROOF THOSE AREAS WITH TYPAR SYNTHETIC WALL PAPER AND 9" GRACE ICE AND WATER Supply and Install ALL NEW AZEK CORNER BOARDS ON BOTH DORMERS (4 IN TOTAL) Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION,CLASS A FIRE RATED, COPPER/CERAMIC STONES for a FULL I YEAR WARRANTY AGAINST ALGAE CONTAMINENT,'240 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY, CATEGORY III HURRICANE STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR•i' Supply and Install 8"WHITE ALUMINU " CK'S VENTED DRIP EDGE on All of the Eaves. Supply and Install CERTAINTEED WINTCER-GUARD(Ice& Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves& Valleys Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S "ROOF RUNNER" SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT H RIDGE VENT on the Entire Ridge. Supply and Install ALUMINUM& NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. TOTAL INVES ENT ------------- $99000.00 Oe ®s� V-e.C21 v ed 4 Sfl o. op &4 COREY CORE ' " The Roofers OPTIONAL ADDITIONAL WORK: I RE-ROOFING THE SHED WILL BE ADD:,,TIONAIL--------------------$500.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing,Missing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Mate,rials Plus Labor at the Rate of$ 60.00 per Hour. REMOVAL AND DISPOSAL OF EACH ADDITIONAL LAYER OF SHINGLES WILL BE CHARGED AT THE RATE OF$75.00 PESQ. PAYMENT SCHEDULE: A Deposit of One, Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Scheduled for Completion Within 90 Days of Acceptance and I Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. Please Jake Checks Payable to: COREY & COREY COREY & COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warranties the Shingles up to a CATEGORY III 1114AICANE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: ACCE TED BY: SU 1 Y: DEB ESENA 4AFAIRY HOMEOWNER C Y & Coj�y C Y & COREY HIC # 183202 CSSL# 106102 ).s Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improveme% Contractor Registration Type: Individual ARMEN SAFARYAN ' Registration: 2 F Expiration: 09/13 09/13/2019 67 SEA ST APT A4 a HYANNIS, MA 02601 Update Address and return card. SCA 1 0 20M-05/17 Te �smrreoieurett�l�o ��ss¢���eC�i - Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE-Individual before the expiration date. If found return to: \ Office of Consumer Affairs and Busine Regulation Registiation._ Expiration e9 E20 09113/2019 10 Park Plaza-Suite 517 Boston,MA 02116 ARMEN SAFARK DB/A COREY,'AI ID tR ARMEN SAFA YA_ � �" T 67 SEA ST APT�A4; i HYANNIS,MA 026Qi Undersecretary Not valid without sYgnyure Massachusetts Department of Public.Safety Board of Building Regulations and Standards -License: CSSL-106102 Construction Supervisor Specialty ARMEN SAFARYAN 67 SEA STREET APT A4,,, HYANNIS MA 02601 'Commissioner Expiration: 10/02/2020 . i 0 AC V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/13/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Eastern Insurance Group PHONE. _ (508)997-6061 ac No: (508)990-2731 AIc.439 State Rd. EMAIL a aiva easteminsuranoo.com ADDRESS: p P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B Armen Safaryan INSURER C: DBA:Corey and Corey INSURER D: 67 Sea Street Unit A4 INSURER E: Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 2018-2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL=1 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD POLICY NUMBER MM/DD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any oneperson) $ 5,000 A 952004644104 09/18/2018 09/18/2019 PERSONAL aADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ NIA 952004644104 09/18/2018 09/18/2019 E.L.EACH ACCIDENT $ (Mandatory in If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD Town of Barnstable SHE Regulatory Services f F Tp� Richard V. Scab,Director • Building Division MASS. Paul Roma,Building Commissioner i639. �0 �'DTfo a 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us' Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: 0 2- O Name: ! ) D R V�(V A M S Q U 1 7'4C1 MOU PA Phone#: 506 • 360 Z �/ Address: 3 L t Village: N rJ i Name of Business: �— A i�u Lo o S C L (V e 2S Type of Business: C Le N Map/Lot: —& INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the ' activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. , • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant; Date: CQ V 4_l o Homeoc,doc ev.06/20/16 YOU WISH TO OPEN A BUSINESS? i~ For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clei k's Office, 1 st FI., 367 Main St., Hyannis,MA 02601 (Town Hall)and get the Business Certificate that is required by law. DATE:0 2,0 _ 11 Fill in please: s� i _;n Syr APPLICANT'S YOUR NAME/S: V BUSINESS YOUR HOME ADDRESS:. _3 C niob MA 0 ,2 Gol am TELEPHONE # Home Telephone Number ,0 rat ,'ice ' NAME OF CORPORATION:' NAME OF NEW BLISINESS` TYPE OF BUSINESS r l rz:✓1 P Y. IS THIS A'HOME�OCCUPATION? YFS NO.: ADDRESS OF BUSINESS h MAP/PARCEL NUMBER 6 ,{Assessing);. When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'JR OFFICE w\ MUST COMPLY WITH HOME O`-,# �`TION This individual has been i or e f any perm' irements that pertain to this type of business. RULES AND REGULATIONS, FAILURE TO Authorized Signature - - COMPLY MAY RESULT IN FINES_ COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: �WE F, Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee snxxsTnsrs, v� MASS, 16yg Richard V.Scali,Director �� X Pat pr� A Building DivisionSS PE Tom Perry,CBO,Building Commissioner 4p 200 Main Street,Hyannis,MA 02601 OCT 212015 www.town.barnstable.ma.us TO VVN OF ' Office: 508-862-4038 BAR/V 08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL - %j LE c� Not Valid without Red X-Press Imprint Map/parcel Number ,36 [ Property Address Al IV,�S ��/1 t� O��o Residential Value of Work 5 -&7 C2 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P74 fq t✓'/`O y-->Cc R cz-/A Contractor's Name Telephone Number 5000-�y0�8(7 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor E?"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 ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) K'Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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 require . 'SIGNATURE: Q:\WPFILES\FORMS\buildi pe it forms\EXPRESS.doc Revised 040215 r1 Ile Comttromwea.Itih of-Wassachusetts Department of Industrial Accidews �► - - f3ffl-ce af'Investigations $ - 600 Washingtorr Street Boston,?31A 02111 tkynt,.niass govIdia Mturkers' Campensation Insurance Affidavit:BmidersiContracturslEIectricians/Plumbers Applicant Infarmaf an Please Print 1*.UbIX Name(Busmessl0rganization/Fndivizlnal} T= V i�o 2,e- P1 Address: P� c� A o JS :t6C C ity/StatelZip_,)61v ay,S 00 2 7- /\/I 6- Phone Are you an employer?Check the appropriate bo=: Type of project(required): 1.❑ I am a employer with 4. ❑I am a general contractor and I employees(full.arldl`or part-time).* have hired.the sub-coatmcto� 6- ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees. These sub-contractors have g- ❑Demolition wodting for me in any capacity employees and have workers' 9- ❑Building addition [No u-orkers' camp.insurance comp-msuranae-1 ,fequ%red-] 5. ❑ We are a corpomtion and its 10:❑Electrical repairs,or additions 3. 1 am.a homeoumer doing all work officers have exercised their 1LE]Plumbing repairs or'additions, myself o workers' right of exemption per MGL �5' � - 12-❑Roof repairs insurance required,.]T c.152, §1(4h and we have no _ 13.[V��Other employees-[No workers' camp.insurance required-] Yv e2 /f f/V6 LE S *Any WBantihat checks box#1 ranst also M out the section below shming di&vndexe compensation policy infannsticaL l oamoavaers who submit this affidatof indkztm1 they are damg all wal sad then hire outside contractors amd sohmit anew affidavit mdicRting sorb fCaaitactors that check this boat must attached an additions/sheet sliotcing the acme of the sub-contrsums and state whether or nut those entities have employees.Ifthesub-canttsctorshave employees;they amsipmvide their aorkeW comp.policy number. lam art eztzpker that ispranzding ivarkers'cottgmesrrdaii innurance for nzy eniployees. Below is the policy and jab site informatiom Insurance Company Name: Policy,4L or-Relf--ins.Lic-4: Expiration Date: Job Site Address- City/State/Zip,: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c- 1572 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 ODDER 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 cap erage verificaian I do hereby certify undsr t pains andpenabYes ofpedury tfratthe uz,formatrozrpm i&d abm a is true and correct Sit taiure: Date: O,-- Phone Offs ial use enly. Do teat write in th&area,to be campleted by city ortonn offidaL City or T'o,%u: Permitffikense# Issuing Authority(drde one): 1.Board of Health 2.Building Department 3.Cfty]Toavn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone it: Information and Ilstrucfions Massachusetts General Laws c1iapter 152 requires all employers to provide wormers'compensation for their employees. Pmmuantto this Sb&tt,an erzpldyee is defined as."-.every person in the service of another under any contract of hire, ` express or implied,oral or written.." An eznpfoyer is defined as"an individual,paxtnersbip,association,corporation or other legal entity,or any two or more of the foregoing engaged-in a joint enhaTrise,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 - dwPiT�house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or binlding appurtena�thleret o sbaIl not becanse 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 n,cnrance.coveragerequired." Additionally,M&L chapter 152, §25C(7)states"Neither the commonwealth nor Zay of ifs political subdivisions shall enter ink any contract for the performance ofpublic work until acceptable evidence of compliance with the inenranc6. requirements of this chapter have Been presented to the contracting aufhozity." Applicants Please fill out the workers'compensation affidavit completely,by cherl the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), addresses)and phone number(s) along with their cerf'icate(s)of inct rra oce. Limited.Liability Companies(LLC) or Limited Liabn7ityPartnerships(LLP)with no employees other than the members or partners,are not reg red to cant'woike-s' compensation insu:[-mce. If an LLC or LLP does have employees, a policy is regoaed. Be advised that this affidavit may be suhmith!�d to the Department of Industrial Accidents for confirmation of iasEiran ce coverage. Also be sure to sign and date the affidavit. The affidavit should be rut=e-d to the city or town the the application for the permit or license is being requested,not the Drpa:1ment of Tna stet al 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 list-d below. Self-insured companies should enter their self-in%u-ance license number an 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 tine 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 pemlitllicense number which will be used as a reference number. In addition, an applicant that must submit multiple p=itllicense applications in any given year,need only submit one affidavit indicating ca rreat p olicy in brmation(if necessary)and under"Job Sit-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 proofthat 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 Iuvesdgadms would like to thank you in advance for your cooperation and should you have any question, please do not hesitate to give us a call- The,Department's address,telephone and fax number. The commawealffic of Massachusd-,tts . Deparb nmt cif I�idMtdak Accidents �itce of�nive�g�tZo� �Q�-�ats�ingtan Stet Boston,MA G211I TeL 4 617 727-49QO Qxt 4-06 or 1-a7 -I RAFF Fax#617-727-7M Revised 4-24-07 .masg.9Q-1T1dia l �pF'INE 1p� r • a • 1AENSfABLE, • - _ Town of Barnstable Arm" , Regulatory Services Richard V.Scali,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, , 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: (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. } QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services �oFtHME rAty,` Richard V.Scali,Director Building Division ` snxr►szesr E Tom Perry;Building Commissioner v� 1639. ��� 200 Main Street, Hyannis,MA 02601 prEo � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: r/fJ /021Z1 JOB LOCATION�.� �GHA/�L E`'S A/ V,/V number street village "HOMEOWNER": el ✓ name A home phone## work phone# . CURRENT MAILING ADDRESS: �- C - b z_z7nVn/r5 PooeT 0aol3 g 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 r uirements and that he/she will comply with said procedures and requirements. Signature 0-1 meowrier Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Parcel Detail Page 1 of 3 n ap 1, �v Logged In As: Parcel Detail Wednesday,October 21 2015 Parcel Lookup Parcellnfo ..T,.__W...._rr. Parcel ID 309-089 I Developer Lot LOTS 51 &52 I Location 37 CHARLES --71 Pri Frontage 100 Sec Road ASHINGTON AVE EX sec Frontage 00 � I Village HYANNIS I Fire DistrictHYANNIS Town sewer exists at this address YeS �I Road Index 02$5 k Interactive Map Owner Info Owner CONNORS,TIMOTHY N) CO %PEREIRA, FLAVIO C _..•___ Owner Streets PO BOX 460 I Street2[7 a —, I city DENNIS PORT I state[WA-- Zip 02639 -—1 Country »� Land Info ...............................---.................................................................................._..................................................................:.................. _ Acres�0 23 use Single Fam ML-0 D1 I zoning RB I Nghbd 0104 Topography Level I RoadPaved � Utilities All PUbIiQGaS Location[-- Construction Info Building 1 of 1 Year 1920 � ,,.,,I si Roof uct Gable/Hip T '�:Wood Shingle Wall Living 1267 `I Roof AC GIs/Cmp AC wNone Area - Cover �J Type Style Conventional wail all Rooms i3 Bedrooms Model Residential FloorCarpet R oath ms n1 Full-0 Half Grade verage�Minus eat Hot Water Total 6 Rooms Type%� Rooms » „ Stories FIT Fuel Oilound- F ation?Conc. BIO Gross Area r 2304 � �I Permit History Issue Date Purpose Permit# Amount Insp Date Comments 10/16/1998 Repair Work 34095 $2,500 7/1/1999 12:00:00 AM Visit History.. Date . Who Purpose http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25249 10/21/2015 Parcel Detail Page 2 of 3 8/3/2015 12:00:00 AM Pamela Taylor In Office Review 6/6/2003 12:00:00 AM Paul Talbot Meas/Est 3/15/2001, 12:00:00 AM SM Meas/Listed-Interior Access 7/1/1999 12:00:00 AM Andrew Machado Meas/Listed-Interior Access 11/15/1987 12:00:00 AM ME Meas/Est - Sales History Line Sale Date Owner Book/Page Sale Price 1 1/6/1989 CONNORS, TIMOTHY M 6586/203 $75,000 2 11/2/1988 CONNORS, WILLIAM E 6506/199 $1 3 4/26/1974 LANING, DAVID M &CONNORS, WILLIAM E 2031/266 $0 4 1/26/2015 PEREIRA, FLAVIO C 28649/262 $145,000 - Assessment History Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2015 $90,100 $14,700 $0 $65,600 $170,400 2 2014 $90,100 $14,700 $0 $65,600 $170,400 3 2013 $90,100 ` $14,700 $0 $65,600 $170,400 4 2012 $93,500 $14,700 $0 $65,600 $173,800 5 2011 $126,700 $0 $1,100 $65,600 $193,400 6 2010 $126,600 $0 $1,100 $100,900 $228,600 7 2009 $142,400 $0 $500 $137,400 $280,300 8 2008 $127,900 $0 $500 $143,200 $271,600 10 2007 $136,100 $0 $500 $143,200 $279,800 11 2006 $106,800 $0 $500 $142,600 $249,900 12 2005 $94,400 $0 $600 $128,100 $223,100 13 2004 $76,400 $0 $600 $96,000 $173,000 14 2003 $68,200 $0 $600 $35,400 $104,200 15 2002 $68,200 $0 $600 $35,400 $104,200 16 2001 $68,200 $0 $600 $35,400 $104,200 17 2000 $65,800 $0 $300 $21,700 $87,800 18 1999 $54,000 $0 $300 $21,700 $76,000 19 1998 $54,000 $0 $300 $21,700 $76,000 20 1997 $44,900 $0 $0 $18,600 $64,200 21 1996 $44,900 $0 $0 $18,600 $64,200 22 1995 $44,900 $0 $0 $18,600 $64,200 23 1994 $49,400 $0 $0 $22,400 $72,500 24 1993 $49,400 $0 $0 $22,400 $72,500 25 1992 $56,300 $0 $0 $24,800 $81,900 26 1991 $70,000 $0 $0 $40,400 $111,100 27 1990 $70,000 $0 $0 $40,400 $111,100 28 1989 $70,000 $0 $0 $40,400 $111,100 29 1988 $53,500 $0 $0 $17,500 $71,000 30 1987 $53,500 $0 $0 $17,500 $71,000 Iittp.Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=25249 10/21/2015 Parcel Detail Page 3 of 3 L 31 ( 1986 ( $53,5001 $01 $01 $17,5001 $71,00011 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25249 10/21/2015 Q :a t - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O gel , Permit# ' 3 D .5 `�. klealth Division ��' 9� Date Issued to ( Conservation Division Fee Y'ax Collector �IJreasurer .APPLICANT MUST OBTAIN A SEWER CQNNECTION PERMIT FROM THE ENGINEERING DIVISION PRIOR TO Planning Dept. INSTRUCTION Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 7 ei S/ Village Y y e& rl n I s Owner /T ,pi o �1!g• C0 n n o q Addressrr►�- Telephone 7 0) � pp � Permit Requ it)r .Z S �u z Gi �,tY I s ��s +2 o+���-er5? �C a r'C e v.n p d e I L r v 4 h v /�0 o wI , �i-,i,Y�-�v �v r� , PU�4. f J P �3 Square feet: 1 st floor: existing 7 proposed ,2nd floor: existing S'-� proposed Total new ' Estimated Project Costs S y Zoning District Flood Plain Groundwater Overlay Construction Type W o v s Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 'Two Family ❑ Multi-Family(#units) ' Age of Existing Structure Historic House: ❑Yes t�"No On Old King's Highway: ❑Yes Ul o Basement Type: Ur Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) '2 oZ Number of Baths: Full: existing / new 0 Half:-existing a new . 6 Number of Bedrooms: existing_ new Total Room Count(not including baths): existing .—new First Floor Room Count 4 Heat Type and Fuel: LO Gas 0 Oil ❑Electric ❑Other ' Central Air: ❑Yes O No Fireplaces: Existing P Y s New Existing wood/coal.stove: 2'Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:0 existing ❑new' size Shed:M existing ❑new size Other: Zoning Board of Appeals Authorization El Appeal# Recorded❑ Commercial El Yes ®No If yes,site plan review# Current Use "o m c Proposed Use FORMATION Name `i•h y� �. ��n A v�r s Telephone Number9 71 V 5�� Address 3 7 C' �,�r /r { 7`' .License# lly �h s Home Improvement Contractor# Worker's Compensation# ALL•CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE X w/ 1 / DATE _ �. WAAL— �_._ + FOR OFFICIAL USE ONLY . [ r • ti • S ., a v . � .. .^t - _/ , , PERMIT NO. DATE ISSUED MAP/PARCEL'NO. t ' ADDRESS' � � + ; - VILLAGE 4 '' • {• c .~ 3 p � �.. , OWNER) DATE OF INSPECTION FOUNDATION FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH E FINAL FINAL BUILDING. DATE CLOSED.OUT ASSOCIATION PLAN NO. - 3 i . .. The Town of Barnstable . Rua �g Department of Health Safetp and EaviroaaieII Servlces : Bugding Division Eo 367 Main SftM Hyannis MA QZ601 . C== OfScc 10&?90.6727 Building Comraissi6-' Far S08-790-C30 For u lce sae Only Permit Oar Dare AFFMAV1T SOME IMrROVEMENT'CONTRACMR LAW SUPPLEMENT TO FMMUTAPPLICA,770N MCL a 142A req wires that the "reconstrucdon+ atterasfons, movatton. , modernizadon. conversion. lmprm►emeut, removal, demolition. or construction of as addition to any pre-esistfag at least One but sot more than tour dwelling snits or to Omer occupied building containing Contractors. with re structusW wWcb a adiacent to such residence or building be done by esgistered certain=eptiotm slang with other requirements. Type of Waric: '�e- ini � —lqe m°de- ( Fat.Cast Address of Wark: 3 7 C Owner's Name Date of Permit Appllcation: 1Z t hereby certify that: . Registration is not required for the following renson(s): Work ezdnded by law Job under S1.000. Building not ownw oaapied _ OwnerpaiQag own permit Notice PULLING� IT OWN PERM OR DEAMG W= QNRCONTREG75TERED �O ACCEW O THE FOR TION PRO GZAl4 OR GGUPLICABLE EJOME ARAtM FUND UNDER MGL 14ZA ACCF55 TO TSE�1T� SIGM MER FWALTZS OF PER=y t��app�,�_��as the agent of the Owner: Otte Contractor Yam Na on Name ____=-___ The Commonwealth of Massachusetts --` ......"IV Department of Industrial Accidents Office oflnlrestigatioas 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit —� 't ��s "/' %fin//�//////%%��%�%�%%%/%%% ////% name: / m v f y I n •► 5 location: 3 7 (f/i P.�Y s S 7`• city PLY et e,n ' S phone# l Er am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one workin in any ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. companv name: address city: phone# insurance co. R61icv# //%%i ❑ 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: company name: address: . city: phone#. insurance co. polig# companv name: address: city phone# ' insurance co. olicv# irili Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Signature ��,:/'� Dated, Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Buflding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑health Department contact person: phone#; ❑Other (revised 9/95 PJA) G. 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, constriction 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 permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. �������� �FEE ��i����i��r , The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of imlesugailoas 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 �r 780 CUR Appends J Table JS21b(eondaned) Prescriptive Packages for One and Two4Fam4 Residential Buddings Heated with F0229 Faeb MAXIMUM MIi1MUM Glazing Glazing Ceiling wail Floor 11"Imeat Slab Heating/Cooling Area'('/e) U-values R values' R value' R valuer Wall Perimeter 1 qWp= MdatY' padcage It value` R value' 5701 to 6500 Heating Degree DzW Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 95 AFUE Tr15"A 0.36 38 13 23 WA WA Normal U 0.46 38 19 19 l0 6 Normal V 0.44 38 13 2S WA WA 85 AFUE w 0.52 30 19 19 10 6 SS AFUE X 18% 0.32 38 13 25 NIA WA Normal Y 18'/e 0.42 38 19 23 WA WA Normal Z 180/0 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: '��' YES: NO: q-forms-i980303a 780 CMR Appendix J Footnotes to Table J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall ' area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table JI.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I The Town of Barnstable E .o Department of Health Safety and Environmental Services Building Division ` •" MAM 367 Main Street,Hyannis MA 02601 y M^ss. � i679. �0 ArFO IAA A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: OC JOB LOCATION: 3 7 CAA m le S `�`�j�sn q S — number street village "HOMEOWNER":/!rn uk!c Cc�r,�r°r s 6 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildin�it. (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 7requir,ments. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. QTORMSIXEMPT