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Home My WebLink About0050 FOSTER ROAD 1 T, TOWN bF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ` Application # 2—015 013 `1 q Health Division Date Issued `�S-/��- Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 40 D S 79 /Z P, Village YV A AlA1/9 Owner -S & LZ 12 4 61-0 A , Cot/ Address /2 P Telephone Permit Request c _ OF Oe)A771IZ`T a,F :5"a v:r& WkL_1_< -OE � yiszz NG Square feet: 1 st floor: existing 17- proposed 2nd floor: existing proposed Yl —Total new- Zoning District /2 /3 Flood Plain A)0 Groundwater Overlay Project Valuation s Type�ijf 04� �/LrQ/'!� sf1109 Ln-s � �Construction T e � Lot Size ef Grandfathered: ❑Yes ❑ No If yes, attach s' ,porting documentation. Dwelling Type: Single Family N�. Two Family ❑ Multi-Family (# units) ' Age of Existing Structure-&- S- Historic House: ❑Yes L No On Old King'sjHighway:2L Yes 'No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other - =Y Basement Finished Area(sq.ft.) 17 Basement Unfinished Area (sq.ft)- Number of Baths: Full: existing_ new 0 Half: existing / new ` 0 " Number of Bedrooms: q existing new Total Room Count (not including baths): existing new -0 First Floor Room Count Heat Type and Fuel: :Gas ❑ Oil ❑ Electric ❑ Other Central Air:'y Yes ❑ No Fireplaces: Existing-New ro " Existing wood/coal stove: W Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:P existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# 1. AiL Current Use FFgDA7/,4 L Proposed Use IBC X /O�N! %1,41 APPLICANT INFORMATION ,(�, (BUILDER OR HOMEOWNER) Name /l� � / �1ri /- Telephone Number D Address o License # U � �17 Home Improvement Contractor# M Email ( 6-1%04 , C O& Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE T9�fS� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED y f MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ' I INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. . ' Depit afFndza�ri�'�1crs�ezrtr - . rA Office ofinvertigatians 600 W irshhzgtan Stt'eet _ _ Bastai .m OM , wmP-mars gavldra . W6r1mrs' Compensation Insurance AfdaviL--BtulderslContra brsMecfricLmmijPlmnbers Appiicaat Information Please Print Le _ egIy• ' •Name( ��131Li� .J ,S r �1�� - Address: S• 'IA /V IVI-f ' City,g d2l p. ST L fz 17 At Phone Are you an emplaycr?Check the mppro box; Type of protect(requited): 1.❑ I am 8 mnpluw wMa 4. Q I am a general coniradoc and I * have hand the sob-can tOZs 5 0 New can tacfian . eospinpecs(toll�dlor part one)- ' 2.Q I am a solo proprietor or perm¢- ` listed on it a affacbed ffi=t. 7. ❑R�drling sbip andhave no amplo3'ecs D so.B-E�zs bavo S. Q Dmaoliticm' Wong forme ia'my capacity razplDY=andhm woAcers' ElB� addttl on [No workers comp.insin-a = �k mAnr_� 9' 5. Q We are a corporation and its 'IO.Q Bl=t dcaln pairs or addificros. 3. I mu a homeowner all wodc offices have exercised their IL Q xuysrlf[NoWP33a&33p. . ri&ofearrptirmp Roof erMCM Rofbmgrspaus oraddifions ,,,�„�„�.„�Td.]t e.1A§1(`),and We have no repair [No workers'. I3.[Q Ofh�r• cam.insarmace xulaacd.] ` *Any appIi=tthd distil bmc#I=mt also fII Qutf=ieetioa Wow sbawiagthdrwadis'ca==m inn policy i em=.9m: �tSomeawaeawhosnbmit�ises�davitmdimtmgifieyarodnmgaIIwndcand�eahaeor�dn�aetaa�stsehmitaa�wa�davitindieaimgsoc5- . �Cantm�¢s 9xatehcc3cthis bax�st dtaeLe$an additiatusI ehxtshawiao�fbe aarne afthe s��ac�ts sad sF�whrthanrnatthasc rr�itirs have . �pLryea,Ifthe rah-matectaa hzve e�plepa;theJ�1�� -PAY sec ,. I am an azrplayer that is providing�vorkas'r�rtgazrmYpn nzrarattce far ary rlrrplapeec $elate is the pa�cy and job she infarrnafina, - Insmm=Campaay Nano.. Policy#or Self-ins.Lic.#: FaaiioaDafa: .Tob Site Address: �y�s1�1r Vim: w Aifn A a copy of the workers'mmpensatio-a policy declaration page(shotviag the polcy member and eXpiraiion date). . Failtae to secoza covm-ago as regnazdender Sectim25A ofMM c.I52 L-&L Iaadto the dmposifi=of czEnind pena him of a $na up to$1,500.00 andlor ane-year auprisoTm Ent as�Il as cif pmial-i' in tiu fo=of a STOP WORK ORDER and a fine of mp to$250-00 a day against the vialatar. Be advised brat a copy of this statmantmay be f rWarded to the Office of Invesfigkians of tine DIA for insa umm covraagz vedficatiom. I do hereby cera y wader the ams andFinalties ofPojury that fix h1farmadon praaided above is trrie and correct Phone#:- l` 0 7 Y "'�/X6 - [[F1,3 se only. Do not wrMe in ffi£s arr�to be compkfed by cRy or fmm a9'zdaL City OWII:uthority(circleon;) 3.My Taws Clerk 4.IIectricalluspecinr SPlmmbinginspertorerson: phone#: t • x Taformagon and Instructions M2sRCI(UcetfS CTc=zal Laws chapter I52 r=T3k S aH eagIoyeTs to provide worlom,compensafian for f min euzpIoyees. , pursue 3tt4 this stafzrfe,an rmpinyre is dcfined as=.every personin ff=service of anaffiw under any contract cfhiro, express orbopIied,oral arvx mz." An lWhyar is drf fund as aaa individual,patineshjp,assocfi ram,ccapmatim or offier Iegal entity,cr any two or more of the frregoi ag mgegcd in.a joint wimp r,and kchr ft the legal represmddivas cf a deceased employer,or fho receiver or trustee of an individual,par(= .amdafion or ofhcr Iegal ci fity,employing employers- However the owner of a dwmU!nghwsc hmvingnotmore 1Eum time apartments and who resides tirercm,or the occapant ofthe- dweIIing house of another who crrplcys persons to do ma;nlm;mari construction ar re pair work am sash dweIImg house or m fie grrounds or brnldmg appnrf m ihmofo sbaRnotbecaIIse of snch emplaymeat be deemed fn be an employer." MGL chapter 152,§25g6)also states that aeverystmte or local sensing agency Shall WW hoId$ie issuance or renewal of a license or permit to operate a buskess ar to eaonstrucf bmil mgs in the commonwealth for any applicantw•ho has notproduced acceptahle evidence of compT=ce with tin kmranm coverage required." Additionally,MGL chapter 15:%§25C(7)stain s-Neither the commacmwealth nor a'ny ofits political subdivisions shall carter mto may contract for the pmfm m m ofpnblm wor$unt$acceptable evideaae of crzmpffi nee with the m ]rHaC6.. rmr==eofa of this chapter have bem presented to the contracimg aofiloatyf Applicatrts Please fill out tine wmiaz 'campemsafion affidavit completely,by checiamg the boas fiiat apply to yo=sita ion and,if necessary,supPt3'sub-cant<aciDr(s)name(s), addzrss(es)Mad phonennmber(s)along with theirceaiificate(s)of iosrasnce. Limited Liahilky Companies(LLC)or Limed Liabffity Part amxhi;ps(L P)withno eaapIDyees o$ier tie.the members or pmt amms are not regz�d to.cagy wo6mrs'coznpeosafian fin mmce. If an LLC or LLP does have employees,mpolicy is rogaftmL Bc advisedthdlhis a$rdgkmaybe mahmittcd to thoDeparhnent of Iudusstrial Accidents for con5rmatim of iasarance coverage. Also be sure to sign and date the afmdavit 'The affidavit should be retxuned to the city or town f ud the applicatian fur ffie permit or license is being rcquestmcL oat the Department of Indnstrial Acd&:afs. Shouldym have any gaestions regardmg tine Iaw or if you are rcgm red to obtain aworkers' ccuupemsafion poTzcy,phase c&U fbz Depa dmeot at fiie nmmber listed below. Self-tired cmtpanics should eater their self-ins rmace license number an the appropriate line. City or Town Officials Please be sire that the affidavit is cnmpIdr.and pirated lcglIy. The Department has provided a space at the bottom of the affidavit fur you to fill out in th>r event the Office oflavestigaticm has to confect you regarding the agpli--f Please be s=to fM in the pm itllicrose mmeber winch vM be used as a rcfereace member. In addition,an applicant fiat must submit nmMple peonW iceose applit3tims in any givaa yrar,needd,only submit one affidavit indicafmg cmmmt policy won.(if necessary)and under'Uob Site Address"ffie applicaut should wri$"all 10caiions in (may or town)."A copy of the affidavit fiat has been officially staoapped car madced byiite city or town may be provided to file applicant as proof that a valid affidavit is on file for fn I penile or Iieemses. A new affidavit must be tilled ob t each year.Where a bome owner or citizen is obtai3ing a license or pcnnitnot rrda tmd fo any business or'ca nmercial Vdnb= CLe.a dog license or peank to bran leaves cte.)said person is NOT n qah- d to complete this affidavit The Office of Investigations woaldhka to thank yam in advance for your coopmmfiam and should you have any Tmstioms, please do not hesitate to give us a ealL The Departm eu:es address,trlcpb me and fax member•. . • _ Depattinmt c�f�'ndu�ialAc �nts . mice of In� tioa� . 6U4 man Street $ostioa,M&0111 ' Tel,#617'lam 4M oxt 4€16 or 1-977-MASSAIE Fax `617-727 7M Revised 424-D7 - - -pgldia -1-own ot•Bamstame Regulatory Services �oFTHE reYy Richard Y.SmIi,Director P °L r Building Division 31e3321AS3 Tom Perry,BmIdmg Commissioner 1&59- 16 200 Main 96tet; Hyannis,MA 02601 www.towa.barns(able.ma-us Office: 509-862-4038 Fax: 508-790-6230 - HOMEOWNER UCEM EXEMPTION - --- - "ptnsePrint DATE: - JOB LOCM01t• A)OA11 S number sh�st vslIage "LiOMEOWNER": / A� S, i''1 cS/0-) l ®Av name home phone# work phone# - CURRENT MAILNGADDRESS: �- ----- — -- ---— SD �bS f � 2 ----�fib¢—_plc- =� ---- ---- ----- ` Imwn state � ap 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 hie who does notpossess 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,oa which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory Insuch 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 an a form acceptable to the Building Official,that he/she shall be responsible for all such wwkperformed under the buildica permit (Section 109.1.1) a 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 nndmstarids the Town ofBarnsiable Building Departmmtminiffian inspection. procedures and requirements and#bat he/she WMLj::omply with said procedures and requirements. SignatLuz orHmNcowncr . Appmval of Building 0ffieie1 Note: Three family dwellings containing 35,000 cubic feet or larger will be requimdIto comply with the State Budding Code Section 127.0 Construction Control. HOMOWNERIS EXEMMON The Code states that "Any homeowner performing workfor which a building permit is required shall be exempt . from the provisions of this section(Section 109-11-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:US) This lack of awareness often results iri 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 resgoasibilities,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 sack a formlcertilication for use in your community. QAW EUZSIFORMSIbmldmgpemith=\E�S.doc Ravised 061313 D� A Town of Barnstable o� Regulatory Services • AtAM1ATQ • Richard V.Scab,Director 6 Building Diyfsion Tom Perry,Building Commi sioner 200 Maim Stree%Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must P �Y . Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauthorize to act on mybehA, I all matters relative to work authorized bythis building pemait application for. I (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed aad all final inspections are performed and accepted. S =re of Owner Signature of Applicant Print Name Print Name Data QFORMs:owNERPERMISsMIeooI S b 1 Y ' LWA� 89 V IF 77 fa , U I � F3 ♦ iii Do® wfm w .._ FP or WE ' 1 � � ' � L � . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'Map Parcel �!� I 'r ' OF Ei; ==r T , Application # ZoISOZ��`I Health Division r - Date Issued Conservation Division Application Fee -6 Planning Dept. p* R ft_ Permit Fee J S5• oU Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Vroject Street Address illage .41-21YXIV&I S +Owner/5/Z Z 00tt L-Wress. 5-1-2 11 T y Telephone 0 3 3 V y --57/.--� Permit Request %&%- &KAOC-le- 4/6'X7' S! I� !!LC-Coo 7' Sexisting l I Square feet: 1 st floor: q g` proposed 9/�L _2nd floor: existing proposed Total new-D- Zoning District _ Flood Plain Groundwater Overlay Pc> Project Valuation Construction Type o P 4/7/75 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 1$ Two Family ❑ Multi-Family (# units) Age of Existing Structure/P It l 0 0 Historic House: ❑Yes tp No On Old King's Highway: ❑Yes ;dNo Basement Type: Full ❑ Crawl ❑ Walkout ❑ Other C Basement Finished Area (sq.ft.) L1 q7 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new -b- Half: existing , new Lb a- Number of Bedrooms: 9 existing o new Total Room Count (not including baths): existing _new -0 First Floor Room Count Heat Type and Fuel: 9 Gas ❑ Oil ❑ Electric ❑ Other Central Air: 0 Yes ❑ No Fireplaces: Existing New - 0 Existing wood/coal stove: VYes ❑ No Detached garage: 0 existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Altif Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# �IYA Current Use 12-e S/ PG,t/l/,(�C. Proposed Use fZ of APPLICANT INFORMATION .(BUILDER OR-HOMEOWNER) Name Telephone Number 0 3 AdJ" s -,57V S7'9-/Z-A License # ?61 q 2 0 Home Improvement Contractor# Email y c 1L !?J7 E H Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ~ DATE OF INSPECTION: ` FOUNDATION z FRAME .F INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I 4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. Department oflndu hjdAcridw& . Offl a oflm'esfzgcdions 600 WashhVton Street Boston,HA 02M - "rrrarsgov Ha Workers' Compensation htslir ance�dxviL_$tiflders/CantractorsMectncmm Plmm hers Applicant Information Please Prima Le iblr' A d6s/`� /,CIIi/tY,&atm(Zip: l S -Phone#: 5 c� 'Are you an employer?Cleck the appropriate bow 4. Type of project(regmi ed): I.El am a enrpha =with ❑Iam a general contractor and I' aapIopecs(RE and/or pent 6*.* : .T lie lured the sob-cordtackns ' 6• ❑New construction 2.❑ I am a sole proprietor or partner- lknd on the barbed sheet 7. ❑Remodeling ship and have no em3playees Tbese sob-cont actors bavo 8. ❑Demob iaa. wort nrg forme in'my capacity. �plor=and have workers' [go wa,=,C O.P. nrr_kska Camp.ias rranr_�t 9. El ding addition - 5. [] We are a corporation and its I O_Q Electrical repairs or additions I am ahem doing offices have exercised their IL Ph mb' re eownea• aIl work� ❑ mg Pairs or additions CJ myself Na worlon,comp. rtbt of exenpt M per MGZ �'❑Roof repairs g==e required_]t' c.152,§I(4),and we have no i caPIoyees.[No wo±=, 13.E]offer cow.fimmanc a regnnzd *AIT applicant that char o;box#1 amst also fill oatthm Bastion below showing ffidrwark= eomp=sdion policy iafoma5m• t Homeowners who snbmitthis affidavit indicting they awe doing all wade and thm hire antsj&=3haCtnB must sabmit anow aindavrt iadira iECmrb . $L-utzd rs that ebockthis box mast atisrhed an additiorml sbcdshowingtbe nsno afthe Bab-coahaclms emd slafn whctha or not those ezerties have employees,If the sob-matmetars have rmPbY=..tbzY must pmvide thcs wm3=,comp.policy maabea I am arc ern ployer that is proph mg workers'coquerrsation insurmcre for my erxplayers. Below it the paTuy mid job site hyforn adom Iasorance Company Name: Policy#or Self-ins.Lic.#: ExpfraticmDate: Job Site Address: Affach a copy of the Workers'compensation policy declaration page(showing the polity number and cxpkxdori date). Fai7.tne to se:c=coverage as required under S=dm25A ofMGL c.152 can lead to the imposition of criminal penalties of a fin V to$1,500.00 and/or one-year imprisa�eot;as well as aivzlen palties in the fcmn of a STOP WORIK ORDER and a fine of try to$250:00 a day against the violator. Be advised that a copy of this statemexrtmay be forwarded to the Office of, Investigations of the DIA for limn mm coverage vedficatim I do�hrreby cerir,fy under p mcd penabIa ofpm jiOY that the infamu3ian provMad above is true and carrerl S' Date_ . Phone#: 0 3•' Q87cial use only. Do not write in this area,to be completed by CUY or town of"miaL City or Town: Y Permiti kense Issn>ng kuthorffy(Circle one): L Board of Health 2.Btu1dnagDepartment 3.CitpfTawn Clerk 4.TIecdzicallnspecfor 5.Plumbinglnspecfor 6 Other ConfactPerson: ??hone : . Information and Instrueflon s ' MAccarl�rsetfS Cicamal Laws chapter 152 requires all employers to provide wad='compensation for their empIoyees. Parsaantin this sfatatc,an emplaYre is dcfined as 7-.every persoa in the service of another under airy contract ofhirp, empress or implied,and or wrifz." An..rlrrph,yer is def acd as"an individual,partnership,association,cooporatim or other legal entity,or any two or more of the fi mgoing engaged in a joint eniaise,and including the legal n:presenfafives of a deceased employer,or the receiver or trustee of an individnal,pat ==hip,association or other Iegal 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 maintmence,contraction or repair work an sack dwelling house or on the grounds or bmU33g appuc�thereto shall not because of such employmed be deemed to be an employer." MOL chapter 152,§25C(6)also StatPS thnat"everystafe or local licensing agenepshall wMhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicaatwha)airs not produced acceptable evidence of cdmpEanra with the insurance:coverage required." Additionally,MGL chapter 152,§25C(7)states`Neid=the commonwealth nor any of its political subdivisions shall enter info any coact for the performance ofpnblic work until acceptable evidence of compliance with the insurance., . of this chapterhave been,presentedin the cm*m;tmg authority." Applicants , Please fill Drat the workers'compensation affidavit completely,by checking the boxes that apply to Wor sitnaiion and,if necessary,supply sob-contractors)name(s), addres (es)and phone numbers)aIongwith their=tiFacst*)of insumce. Lkaitnd Liability Companies(LLC)or Limited LiabMty Partnmmbtps(LU)with no=ploye es outer than the members or partners,are not rbquacd to carry wm 3cers'compensation insurance. If an LLC or UP does have employees,apolicy is mgniiod. Be advisedthatthis affidayitmnaybe submitizd to the Department of Industrial Accidents for confirmation ofiasurance coversgc. Also be sure to sign and date the affidavit The affidavit should be retumed to the city or town the the application for the permit or license is being requested,not the Departcaeut of Iu h strial Accident. ShouldyDu have any questions regarding the Jaw or ifyou are requited to obtain a worlmrs' compeusationpolicy,please call the Department at the number listed below. Self-insured companies should eater their self-insorance license number on the appropriate lime. City or Town Officials Please,be sore that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the,affidavit for you to fl1 out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the peunitMceose number which will be:used as a refereace number. In addition,an applicant that must submit multiple pmnitIIiC=se applitstions in any given year,need only submit one affidavit indicating cm:rcrt policy information Cif 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 mmkod by the city or town maybe provided to the - applicant as proof that a valid affidavit is on Me for$ASe permits or Iicenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not-r@ated to any business or commercial veutrue (Le, a dog license or permit to bum leaves etc.)said person is NOT rcgaired to complete this affidavit The Office of Investigations would Ulm to thank you in advance for your cooperation and should Yon have any questions, please do not hesiisto to give us a call The De"tnanfs address,telephone and fax number. The Ca=an ili of M8.SM&U3eM - I Department of Inautud Accadmt% mice of jiveW9atio= asbintan S`[reeE Bad,MA 01 1 II Tel.#617 727-4}Q4 at 406 or I 477-MASSAFE Fax#617-727 7749 Revised4-24-07 ww mas5guv[dia AWC Ui de to Wood Construction In Hig1r Wind Areas: 110 flrph lYind Zone Massachusetts Checklist for Compliance(7s0 0b'1R5301.2.1.1), Loadbearing Wall Connections Lateral(no.of 16d common nails)...........:..................(Tables 7)...................................................... Non-L•oadbearing Wall Connections Lateral(no.of 16d common nails)............................._..(fable 8).................................................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ..........................................:.............(Table 9)..................................—it _in.s 11' SIR Plate Spans able 9 I Full Height Studs (no.•of*studs).....................................(i able 9)...................................................... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(fable }.............•---................—ft_in.s 12' Sill Plate Spans.. ................:............... ...............(fable 9).................._............ _ft_in.512' .... ..... . . ... Full Height Studs(no.of studs)..._.............................••(Table 9)................................._..................... Exterior Wall Sheathing to Resist Uplift and Shear Simultanbously4. - Minimum Bulding'Dimension,W Nominal Height of Tallest Opening2 ........................................ .:-........._....... ..... s 6`I3' Sheathing Type.... ..................._..............(note 4):,............................................ , Edge Nail Spacing............. .,........(fable 10 or note 4 if less)..................... in. Feld Nail Spacing...........................................(Table 10)............. in. Shear Connection(no.of 16d common nails)(fable 10)... ..............................................._ Percent Full--Height Sheathing...-._:_........:...(fable 10).....................I.............................—% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)....._............. Maximum Building Dimension,L Nominal Height of Tallest Opening2........................................................................_s 6'B' SheathingType.............................................(note 4)................................I............_...... Edge Nail_Spacing.......................................(fable 11 or note 4 if less)..................... in. . FeldNall Spacing......................................t..(Table 11)................,................................ in. Shear Connection(no.of 16d common nails)(fable 11)........ , .......... _ Percent Full-Height Sheathing.......................(fable 11).................................................. —% . 5%Additional Sheathing for Wall with'Opening>6'8'(Design Concepts)................... Wall Cladding Ratedfor Wind Speed?....... .............................................................................................................._ 5.1 P.ODFS ' Roof framing member spans checked7.........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang .....:.............................................(Figure 19)............._ft s smaller of 2'-or U3 Truss or Rafter Connections at Loadbearing Walls ; Proprietary Connectors Uplift.......................... ...,:......(fable 12)............................................U= plf . . Lateral. ............................_..........(Table 12).......................-_........_........L= plf Shear. ...(Table 12)........................... . ...... .. . Pif Ridge Strap Connections,if collar ties not used per page 21...(Table 13). .............................T= plf Gable Rake Outlooker.................:........................(Figure 20).............—ft s smaller of 2'or Lr1 Truss or Rafter Connections at Non-Loadbearing Walls' Proprietary Connectors Uplift.. ............................ _.....(fable 14)...........................................U= Ib. Lateral(no.of 15d common nails)...(Table 14).......................................L= . lb. Roof Sheathing Type............:.::.................................(per 780 CMR Chapters 58 and 59)............. RoofSheathing Thickness............................._..:...............................................:.._in.>_7l16'WSP Roof Sheathing Fastening...........................................:(fable 2)....................... Notes: •1. . This checklist shall be met in its entirety, excluding the specific exception noted In 2,to comply with the requirements of 780 CMR•5301.21.1 Item 1.If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 ' d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure IBb 2 'Exception:Opening heights of up to 8 f.shall be permitted when 5%is added to the percent full-height sheathing - 'requirer ents shown In Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-gr6de. ' t . AW'Gidde to Wood Construction if Mal FYind.4reas:110 ftiph EYindZone Massachusetts Checklist for Compliance(7so CAIR5301 2.1.1)' - [r 1 Check Compliance 1.1 SCOPE WindSpeed(3-sea gust)..................._..............................................................................................110 mph WindExposure Category..............................................................................................................................B Wind Exposure Category................Engineering Required For Entire Project.......................................0 12 APPLICABILITY Number of Stories(a roof which exceeds 8 In 12 slope shall be considered a story) stories s 2 stories Roof Pitch................. ........................................._...............(Fig 2)............................................ S 12:12 Mean'Roof Height•................... .......(Fig 2)....................._........................... ft Building Width,W - ..(Fig 3 ' ( 9 )...................:.................._..:.__._ft S 80 Building Length,L• .:.............. ................................. .......(Fig 3)............................................. _ft S 80' Building Aspect Ratio(Lllllr) ..............................................•(Fig 4).................................................. _<3:1 Nominal Height of Tallest 0pening2 ................. (Fig 4)............................... S.B. 1.3 FRAMING CONNECTIONS General compliance with framing connections......._............ (Table 2).........._................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete...........................:.......................:.......................................................................... ConcreteMasonry.................. ..__........ ................................................................._....................... 22 ANCHORAGE TO FOUNDATION" , 5/8'Anchor Bolts4mbedded or 5/3'Proprietary Mechanical Anchors as an alternative in concrete only BoltSpgcing-general........................................:.(Table4).................:............................. in. Bolt Spacing from endroint of plate.............................(Fig 5)..................:................. In.S 6'-12'. Bolt Embedment-concrete.........................._.............(Fig 5).........................................._..... in.z 7' Bolt Embedment-masonry.........................................(Fig 5)............I............................... In.215' PlateWasher..:.............................................................(Fig 5)....................................... ..>_3'x 3'x'�' 3.1 FLOORS Floorframing member spans checked ..............................(per 780 CMR Chapter 55).................................. Maximum Floor Opening Plmenslon....................._...........(Fig 6)..........................._................... ft 512' ... Full Height Wall Studs at Floor Openings less than 2'from Exterior Wail(Fig 6)..:....................... ......... mwmum Floor Joist Setbacks Suppoifing Loadbearing Waifs or Shearwall................(Fig 7)................................................... . ft S d Maximum Cantilevered Floor Joists Supporting Loadbeanng Walls or Shearwall................(Fig a)..................... ..... ft s d .... ................. FloorBracing at Endwalls....................................................(Fig 9)............................ Floor Sheathing Type .......................................................(per 780 CMR Chapter 55).......... Floor Sheathing Thickness.........................._...............:.....(per 780 CMR Chapter 55)....................... in. Floor Sheathing Fastening.................................................(Table 2).._d nails at . in edge/_in field 4.1 WALLS Wall Height Loadbearing walls.................................... ...(Fig 10 and Table 5)............_............. ft S 10' .. F( 10 and Table 5 ' ft•S 20' Non-Loadbearing walls............:................................. ( 9 )..........._..............._ Wall Stud Spacing ........................................................(Fig 10 and Table 5)................... In.S 24'o.c. Well Story Offsets .......................................................(Figs 7&8)........................................ _ft S d 4.2 EXTERIOR WALLS' . Wood Studs Loadbearing wails........................................................(Table )...........................-.2x _ft_in. . Non-Loadbearing walls .:(Table 5)..............................2x -_ft in. Gable End Wall Bracing r Full HelghtFsdwallStuds....................... .................(Fig ID)....... .........I......---........._......... ........... WSP•Attic Floor Length.-__.....*.:.............................(Fig 11)........................................... ftzW/3 _ Gypsum Ceiling Length(f WSP not used).......:..........:(Fig 11)..........................................._ft Z 0.9W _ and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c...(Flg 11)....:.... ................................................. or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft spacing in end joist or truss bays Double Top Plate - . Splice Length ................:..........................._.........(Fig 13 and Table 6)...................................._ft Splice Connection(no.of 15d common nails)..............(i'able 6)............................ AWC Gicide/o 1+'bod Constructioit in High 111indAreas" 110 nipti !!Wind Zone Massachusetts Cheddist for Compliance(790 Ch-111 5301 2.1.1�r 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nall Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: I. Panels shall be Installed With strength axis parallel to studs, ii. All horizontal joints shall occur over and be nailed to framing. fil. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. ' iv. On two story construction,upper panels shall be attached to the top.member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 Inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection:a)new house or horizontal addition—required if project Is 1 mile or closer to shore(generally,south of Rte.26 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first'floor c)replacement ividdows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH,Exposure B may be obtained from the American Wood Council (AWC)website. . YIJ(-{MMOS EDGEF EWM ON Fi2MrAiG USElSd MA" 11TB�c it it aF. t' ii II< 1 i if fi Q u't i i d 5►� i X i { • I 1. �t 4 ;_ � . f� It < ' s; .k .1s ; � ;E iS SS I Y �14 '�tll1 I 1 t+WrLrSP�CJNG PAS u )AALPATTERN PARg . PANV+ EDOM DOUBLEMALLEDGES?ADM DUAL See Detail on Next Page Vertical and HDftnial Nailing Detail ' Ve for Panel Attachment fical and Notizon�l Nailing for Panel Attachment ;�_ J I '� •/ Town ot'liarnstable n. Regulatory Services - �oq'ME rOyy :Richard V.Scab,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www townbarnstablema.us . Office: 508-862-4038 Fax 508-790-6230 HOMEOWNER LIMM ERElS MON ,plenerrint DATE �.� n f.� µ) ' n JOB I;(X'A� II. S `' F 0 S-e/L ��Y 1 ` Y�O"'AI1 - number ) skxt q ,` village / -HOUEOWNER A/ �� Q �/Z 1 - — home phone# work phone# CURRENTMAII.INGADDRESS: -- ' ------- — —-- ------- ----—_ ---------- — ---- --- - t city/town stab 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 1, '9.1.1) 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 equirements drat he/she will comply with said procedures and requirements. Sign fHomeowner Approval of Building Official .Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Bmlding Code Section 127.0 Construction Control HOMEOWNER'S EUMMON 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 contraction 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 r proceed against the unlicensed person as it would with a Iicensed 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 town. You may care t amend and adopt such a formlcertification for use in your community. QAVTFII.ESIFOFIMbufl&gpermitf=MTRESS.doo Revised 061313 oFTM� Town of Barnstable Regulatory Services EAM&•.A xA 8 Richard V.Scab,Director i63¢ ♦0 .1 . Building Division Tom Perry,Building Commissioner _.._..._. . __._..... 200 Main Street;Hyannis,MA 02601 www.town.barnstablema.us office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete andThis Seaton If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:F0RMS:0wNMERMMSI0Ie00I S : PA [l, f w �L WA Fig r-COO fall _. . .. : it P , 77 71 GOT Nbc Xv 016 -Y.I. NA • w .m. 1 Hsi M Er r , . ,�� erypuG • , l i r Epp WA L L, �... �A. C C • F D YX G-A R 'A - r r , : : DG® NiGr. � Z I Lr i • - � �' � WA L G LLWAL 1 r ..n 4 x qtp g"'! � i I � . r V Iwo j r . .x«uunnr«.rrr.r.+oTr.n. ve. .. � •• u � 1 r I DOOM r �h 1 : r L, !X I t r• FOOT r , : 4A .. ... .. - -� a TAT S 1 ` r FXf I �p�+p V ` —{ a` TXP � . f G-A, -R,A, I , r ,gyp �,, I w : 42 0/4 LL � E , r�►lA'�• k, i, y MY . � ' ��, � P. � ' , �" ' I : , _ ' 7��.-�"V YY v�.xlnais+rl.baMmnart?nn" ., .1' t .. . �T HUN DO Y�1 FYOST : , , ` .�. , p I I DOOR; i I ... .. . . .. .. ., n�m► MOT mow. . .. ., g[v�, OCK wc-5T : / .yl Ir . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �9 Parcel Z °7� Application #jo/goo. � �^ Health Division Date Issued /0-�(0�Ytillle Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street•Address7-- `'d�� /2 CVilIage��l`/=y�9///r�l . T Owner E91A42 S'-,/9/6�IL-A Address K Telephone 6 c -3 �P_ermit_Request_�:�dl��-� �"�C' �F'` /��OFN ��yc !�' lc��4L 63��L�c�a� �-/►�-�. /�� 13/L E€ZE lyAEY AAvD &LLB 4 e& ��/f �i'��o 6l�5"3 L 0 0&/z /N SXVVZ Z0C,*T.a"V S e/Feinrt a Cc 7-&,e SAr- 4/1 /� "Pe/,W:6 _E 0115PTnOek, V 6 ZEE X72rL1ole— Square feet: 1st floor: existing% proposed /2--2nd floor: existing/yrWYproposed/Total new Zoning District � Flood Plain .&o Groundwater Overlay ',6/n (P_r_oject Valuation 2°/3_",6 b Construction Type kl oeQ /� j�ljrr6 o Lot Size , y C C Grandfathered: ❑Yes ❑ No If yes, attacoi pporting-iocentation. I—S Co Dwelling Type: Single Family %r i Two Family ❑ Multi-Family (# unitsj -3 Age of Existing Structure Historic House: ❑Yes No On Old King'', Highway: ❑ s (b'No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other nft Basement Finished Area (sq.ft.) Basement Unfinished Area (s .ft) r" Number of Baths: Full: existing T new lr�) Half: existing new rp Number of Bedrooms: q existing �;?new Total Room Count (not including baths): exis ing new First Floor Room Count -51 Heat Type and Fuel: ? Gas ❑ Oil ❑ Electric ❑Other Central Air: )411 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: )d Yes ❑ No Detached garage existing ❑ new ,size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:` existing ❑ new size�,Shed: ❑ existing ❑ new size _ Other: i 7i2 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r Commercial ❑Yes No If yes, site plan review# Current Use L. Proposed Use APPLICANT INFORMATION _ - (BUILDER OR HOMEOWNER) Name /3 / t�✓ /�ZZ�yI/L Telephone.Number---,/,G_3s�y CAdd�ress;�: Sa � /2— License# Home Improvement Contractor# Email /`'l/I/L 61-1 Worker's Compensation # ALt--�CONSTRUCTION-TDEBRIS,.RESUL-TING-FROM THIS.PROJECT WILL-BE_TA-KEN TO CSIGNATURE;.--' i r 'Gx FOR OFFICIAL USE ONLY A ,,•--APPLICATION# DATE ISSUED }a 5 MAP/PARCELNO. '. ADDRESS VILLAGE E, IF OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FI.NAL BUILDING DATE CLOSED OUT If ASSOCIATION PLAN NO. rr w Hie COMMOHnfe i off Massachmsefts Dgmrtnent ofIadm- &al Accidents --- - Office 19fInvestigadons 600 Wayhrbigfan Street Boston,.MA 02-HI wnw nass-g4mIdi x Workers' CGmpensaf au lnaurance Affidavit:Builders(C�antracturs/ElecfricianslPlumbers Applicant Information Please Print I&gih y � -{Ilrisine�slOxganizafion(fndividnai}.,��,tJ �� yt=2 CrtylStat IZ p_ S Pl `/ Phone 47- c/C9 z- Axe you an employer?Ciieck the appr 'riatebow Type of project r =4-<= I snx a contractor and.,I 3 Pa 1 {+ n'�d}- 1.❑ I am a employer with ❑ � ti_ ❑New c�onstr�action employees(full a dto e rpact dime)* have liredtoe suliomscfozs , listed on the attached sheet ��1�ocieing�.' 2_❑ I.am a sore proptittor or partner- l y sub-contractors have ., . shift and have no employees These S- ❑DeraGlitioa woricing for me.in.any capacity employees and have wodicers' g- ❑Building addition i`o workels' comp-inaum=e comp.it7¢�l , 5_❑ 11te are a corporation and its 10-❑deal repairs or additions 3_I aim a homeov mar doM9 all work officers ha"•e exercised their I L.Q Plumbing repairs or addition& f h e2wationper MGL right o my-self[No workers'comp. r 12-0 Roof repairs .- inmrance required-j I c.1552,§I(4),and-we ham-no employees-[,No•workess' 13_❑Other comp.insurrartm required-1: *Any appb omt that dlteds boa 11 Est dw fill out the section below showing Their wodeis'compensation policy infflr on- �Hvmeaa+ners vrho submit this s$idavi2 induatnrg they are tiering sI•I trout and the¢hire outside eoutraerors test stahntit a tteu aid-•avit. ��x�n�sar.I� t moms that check this bac mast sttachpd as additional sheet ffiM ng the name of&te nuts-muftacurs and state uhetiier ocnot these ogities have mpiayees If the nLVcont3xcturs have employees,da!y must pmvide their workers'comp.policy number I am an empk5wr that is prm idtrrg workers'compensation irmiraace for my emptayeas. Beiat�is thepaTicy avid}ob seta informati,F m lnsu an(e CompmyName: Poltxy 4 or Self-tuts.Ise- Y Expuattuu Bate: - ji3l}� 1£1 SjdT�SS r 6ty/StatelZtp;_ A-ach a ropy of the workers'compensation policy declaration page(shoving the polio} rtnxubE�a nd expiration date). Failure to secure coverage as mg6redunder Section 25A of MILL c. 152 can lead to the i nposition of c-rin i nal penalties of a fine up to S 1,500.Oa andlor one-yearin3prisomnerk as well as civil penalties in the foam of a STOP WORK ORDER and a fiW ofup to$250-00 a day against the violator_ Be advised that a copy of this statement may the forwarded to the Office of lm-e*gations of lie DIA for ine+trance coverage veriffication- I do hgmblr cent,f v cinder tkspi ins andpenaWas gjp,edwy dtatthe information prinided abase iss b zw and correct iSinatute Date,_ -- Phone 9: (o:3- 3 s/mil cr 1t SH j ft in th&area, . Gity or Town:. PerniitUcense# Issuing Authority(drele one).: 1.Board of Health 2.Budding Department 3.CitylI`owu Clerk 4.Electrical Inspector S._Plumbing Inspector 6.Other Contact Person. Phone 9- 6 . ;a Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iocal 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 ally 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 certificatc(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_ De 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 Dc:partraent 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. Sell 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 add-tiou,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 ILL (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 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 Common alth of Massachusetts Depaitmeat of Indust ial Accidents Gffzee of kvestigatEous 600 WashingtGa Street Boston,MA G2111 Tel.9 617-7274M ext 406 or 1-977 MAS E Revised 4-24-07 Fax#617-727-7749 www mass.gov/dia Town of Barnstable ~ " Regulatory Services ��pFn�e ray Richard V.Scali,Director Building Division Mom $ 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 ' DA-•E7 A JOB-LOCATION: j�U o@�Z/t 17 ��(�ING i village ,`HOMEOWNER": —name home phone# work phone it CURRENT MAILING ADDRESS: city/town state zip code ' The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) ` The undersigned`.`homeowner"assumes responsibility for compliancewith 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. J� r^ sij'g a,'ure of=Hon&6 eownerJ .. - 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 shaII 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 Iicensed 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:\WPFILESIFORMSIbuilding permit fb=m EXPRESS.doc Revised 061313 w Town of Barnstable y Regulatory Services *y MASS.IE� Richard V.Scali,Director �p i639' A�� rF161; , 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 e subject property hereby authorize to act on my behalf, in all matters relative to work authorize bythis boil ' permit application for. (Addi' d of J '`''Pool fences and alarms are res onsibili of the a t. Pools P tY P are not to be filled or utilizbefore fence is installed and all final inspections are performed accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPERMISSIONPOOLS -- /G! Nf!-/LS /A) MP** 1VAL1 Oe-- FL'oe�.7/.o-J^ -Q/uj C"}�iS 7/ice� �F"�o/��a�` ��Ga/z � '. . . - ..• '.. r .. .,' R Sew{• .f. . •_ j�o � fztl 1 N �N,v�3 ••�i/4. a yea/. z. � • , _ . , adz bR. DATE CLASSN ,. REV ENGINEERING .SKETCH ONLY r Town of Barnstable rmitt# 0 Expires 6 months fro issue �l • r y BMWSPABM • MASS,0 i639 � Thomas F.,Geder,Director . Building Division Tom Perry,CBO, Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62.30 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number. ."-14� Property Address p ---, [Residential Value of Work Minimum fee.of$35.00 for work under$6000.00 Owner's Name&Address ,"A Contractor's Name L _ Telephone Number Home Improvement Contractor License#(if applicable)�� '�� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance -PRESS PERMIT Check one. E�J'I am a sole proprietor ❑ I am the Homeowner P �01� ❑ I have Worker's Compensation Insurance Insurance Company Name �.. �.�pn.t r-�C BARNSTABLE 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 betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors CJ Replacement Windows/doors/sliders.U=Value i i;L (maximum.35)#of window ❑, 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 required. . SIGNATURE.. Q:\WPFILES\FORMS\ ilding permit forms\EXPRESS.doc Revised 053012 a� i{+ The Conn jarisswaUh of frSSaG,l7tSBttS lDeparinaent of Indristfial_Acciderz& Office. Of invesfigafions +=�• , .�.. fad@ T3'rrs7rtztgto7T Street ost n nwwuntass go�lditr Workers' Compensation Insurance A.ffida-v t: Builders/Coma-actoi•b/Electilic nsfPlumbers Applicant Information Please Print LezibIy Name L) J Address: Ci FstaterZip: rPhan _ 44 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 constnictio n 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑.Remodeling shipand have no employees 'ham sub-contractors have g Demolition ❑.Demo/tion workina for mein any employees and.have workers' �'capacity. ❑ 9. Building.addition [No workers'corm.insurance comp.insurance,1 required. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work afficers have exercised their 11_❑Plumbing repairs or additions myself. [No workers'mmp- right of exemption per MGL 12.0 Roof repairs insurance required.]s c. 152, §1(4),and u*e have no employe-fNo workers' 13,❑Other comp.insurance required]. "Any appiicw that checks box#1 mast also 5ll oui the section helm showing their workers'compensabon policy information- 7 Homemuers who submit this affidavit indicating they are doing all wcak and then hire outside contractors mast submit a.my affidavit indicating smb- 10mtrsctors that check this box mast attach as additional sheet showing the name of the sub-con=tors and state whether or not those eaE ies have employees. Ifthe sub-contractors have emplcyees,theymatst pmuide their work'camp.policy number. lam an einplo,,er drat is pros idi g n%rtrers'co.inperusad mi insurance for my employees. Below is the pougy and1ob site information. Insurance Company lame: Policy or Self-ins.Lic.9: Expiration.Date: Job Site Address: City/State/Zip: Attach a copy of the Workers'compensation policy declaration page(showing the policy member 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 imprisotunent,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,o€this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver fication- I do hereby cerdf v under the pair:s,andpenaiftes of pert y that the information prai Wd above is bate and correct S Date: Phone#: / 2 Y U/,�6�"� Official use only. Do not write in this area,w tar completed by cio ar tows rs crat City or Tosezt: Permit/License A Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City1rown Clerk 4.Electrical.Inspector S.Plumbing,Inspector 6.Other Contact Person: Phone 5•, •,� oFtr�tqy, _ snxxsTn BLE. 9� b 9 Town of Barnstable Regulatory ServiCTIS Thomas F. Geiler,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 as Owner of the subject property hereby authorize�� in !. ©[/ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address ofJob) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on..the reverse side. QAWHILES\FORMS\building permit forms EXPRESSADC Revised 070110 4, �oF�HE r Town of Barnstable Regulatory Services BARNSfABLE, Thomas F. Geiler, Director. 9 MASS. 1 39. 6. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all'such work performed under the building permit. (Section 109,1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. c The undersigned "homeowner"certifies that he/she understands-the Town-of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. T � y Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 vl c are(S-e— , ��r y i�/ ��i/o✓Vl ', ✓die '�an�n'o"wPalllL ° .�/Za°°Qclucaelt Massachusetts -Department of Public Safety Office of Consumer Affairs&B smess Regulation Y HOME IMPROVEMENT CONTRACTOR `�•f Board of Building Regulations and Standards. Type: Construction Supervisor R Registration 164714 - Expiration. 11/312,013 Individual License: CS-102091 I> .� ST HEN A BOUDf 5-AU -s /� I STEPHAN A BO79 U�REAU- STEPHEN BOUDREAU' #of ` 1 OSTR VII.LE]VfA 02 5 f j i 79 KING ARTHUR i r " :. OSTERVILLE, MA02655 •. Undersecretary. ` i-r J. Jy Expiration Ud t h Commissioner 05/24/2014 V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 - Parcel Application # 6/ d S_ Health Division Date Issued Z. Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village �/�/I/ Owner ,�X/^/�S Address Telephone O Permit Request v O Square feet: 1 st floor: existing ZQor osed 2nd floor: existing Proposed Total new Zoning District Flood Plain Groundwater Overlay r Project Valuation Construction Type Lot Size t:'I� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single.Family V/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes �No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl KWalkout ❑ 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 Flooroom Coufff Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes *No Fireplaces: Existing New Existing woodcoal stove: oRes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑existing =0 new? size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: I Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial --❑Yes -- No- - If yes, site-plan review #_ _ Current Use / Proposed Use t� APPLICANT INFORMATION k (BUILDER OR HOMEOWNER) Name. Telephone Number 7 7 / Address License #�� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 4T 2 SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME J INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING d DATE CLOSED OUT ASSOCIATION PLAN NO. h. ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 1 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLribly Name (Business/Organization/Individual):.SIF J r C� Address: -op , City/State/Zip: Q s hone#: 6,3� Y,;20 3 936�� 3J -2y Are you an employer?Check the appropriate box: 4. I am a general contractor and I Type of project(required); 1.❑ I am a employer with E] g employees(full and/or part-time).* have hired the sub-contractors 6. New construction I Seam a sole proprietor or partner 1 listed on the attached sheet. 7. Remodeling ship and have no employees, These sub-contractors have ` 8. ❑Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance. comp. insurance.$ 9. ❑Building addition required.],. 5. ❑ We are a corporation and its 10.( ]Electrical repairs or additions - 3.0 I am a homeowner doingall work officers have exercised their ' '11. Plumbing repairs-or.additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12:0 Roof repairs 1 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. (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 providingworkers'compensation insurance for my employees. Below is the policy and job site information r Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: . City/State/Zip:. ` Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section`25A'of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature y Date Phone#: [[60therL cial use only. Do not write in this area,to be completed by city,or town official ,or Town: Permit/License# ing Authority(circle one): oard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector tact Person: Phone#: °FEE tw,, Town of Barnstable ti Regulatory Services a s k. EMMSraBLEr - y Mass g Thomas F.Geiler,Director Fo;p�A�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 , as Owner of the subject property hereby authonz I=Ok&rt 66up R F- l/ to act on my behalf, in all matters relative to work authorized by this building permit. _57o dos i ek Rom, fliU.1�PS (Address of Job) **Pool fences and.alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of 0/her Signature o Applicant Print Name P t Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 t� Town of Barnstable �oF r°�ti o„ Regulatory Services Thomas F.Geiler,Director iAENSTABLE, � 9 MASS. 1639. 4 Building Division lFD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us J Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number. street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1,-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ✓he � !� ✓lilaaaaclrueetla t Massachusetts - Department of Public Safety �, Ofticeof'Consumer Affairs&B smessRegulation �f Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Construction SuperN isora Registration -164714 Type: Expiration 1f-/3/2013 Individual i License: CS-102091 ST HEN A 130151)6gAUb �r i' p STEPHAN A BOUftE r � v 79 KING ARTHUR DR STEPHEN BOUDREAU f OSTERVH.LE WA loll w 79 KING ARTHUR OSTERVILLE, MA 02655 Undersecretary Expiration Commissioner 05/24/2014 �VA .. .. Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee 3 snxxsrnsI e MAW Thomas F.Geiler,Director 639� Al ' DAB Building Division X•PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 0 CT — U� www.town.bamstable.ma.us Office: 508-862-4038 _: TOWN QR:%% :41BL.E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint �. Map/parcel Number Property Address i [Residential Value of Work dQ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address—!?, Gj Contractor's Nameef S elephone Number Home Improvement Contractor License#(if applicable) /.2 fZ f� yt 2—. Construction Supervisor's License#(if applicable) f'Z S/l Workman's Compensation Insurance Check one: ❑ I am a sole proprietor - I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# - Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value q �d (maximum.35)#of windows '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 required. SIGNATURE: C:\Users\decollik\AppDataTmalWicrosoft\.Windows\Temporary tntemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 - r �f:e om,7reoryccuea �✓�1 Office of Consumer Affairs&Business Regulation MEMO HOME IMPROVEMENT CONTRACTOR Registration:, .124062 Expiration 5/_8/2011 _ Tr# 700290 Type'_,.- :Pnvate Corporation Clean Surface Qtlo ding Inc Mark Bianco _ 203 Essex St �� - — Weymouth, MA 02188 .,:.>= Undersecretary . A4.- Massachusetts - Department of Public Safety Board of Building g Re,,ulations and Standards Construction Supervisor Specialty License License: CS SL 99573 Restricted.to:.WS MARK ,MANGO 203 ESSEX STREET WEYMOUTH: MA 02188 Expiration: 3/13/2012 ('onunissiuner Tr#: 99573, 1 t, r ® - DATE(MWDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE` ��. 1 PRODUCER RICHARD SOO HOO INSURANCE AGENCY IN THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1148 WASHINGTON ST SUITE 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR BOSTON, MA 021182114 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (617)338-8168 INSURERS_AFFORDING COVERAGE NAIC# INSURED CLEAN SURFACE DELEADING INC INSURER A: Liberty Mutual Group 203 ESSEX STREET INSURER B: EAST WEYMOUTH MA 02189 INSURERC: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONTYPE OF INSURANCE LIMITS GENERAL LIABILITY EACH OCCURRENCE' $ DA A RENTED COMMERCIAL GENERAL LIABILITY PRFMISFS rEa occurrence $ CLAIMS MADE I--]OCCUR MED EXP Any one person) $ _PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY j PRO-JFQT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS _ BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS _ - PROPERTY DAMAGE $ -- — (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ . ANY AUTO OTHER.THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE - - _ AGGREGATE $ _ $ I RDEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31 S-238200-010 1/28/2010 1/28/2011 �/ we STATU OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIE%ECUTIVE Y/N - E.L.EACH ACCIDENT $ 100000 ' OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500000 SPECIAL PROVISIONS below OTHER I DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Workers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the State of MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION COMMONWEALTH OF MASS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN _ DEPARTMENT OF LABOR&WORKFORCE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 19 SANDI STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BO.S`TON MA 02114 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ✓� Jeff Eldridge v Ud—' �`t� 0 ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. M CERT NO.: 6787586 CLIENT CODE: 1340548 Deb Corby_2/2/2010 9:28:37 AM Page 1 of 1 - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ivww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Lezib Name(Business/OrganizatiowIndividual) , C� 'aCY. P * Address: _ Sf X CY City/State/Zip: Phone#: ^��r 6 Are ou an employer? k the app priate box: Type of project(required): 1. with 4. ❑ I am a general contractor and I I am a employer s have hired the sub-contractors 6. ❑New constriction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ?• ❑Remodeling ship and have no employees Thy sub-contractors have - 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y � tY- I 9. ❑Building addition [No workers'comp.insurance comp.insurance. required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]T c. 152,§1(4),and we have no r employees_[No workers' 13.,9Other ` e comp.insurance required.] 944 *Any applicant that cbecks box#1 trust also fill out the section below showing their workers'compensation policy informati T 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 prtnade their workers'comp.policy number. I am an employer that is prosdding workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: 41,a t/0 Policy#or W-ins.Lic.#: G Expiration Date: Job Site Address: w� 7�/ Q� �/� aI City/State/Zip: �. T ! , 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify+uder the pains and penalties of perjury that the information prM idedTablos" is true and correct Si 1h;J1Pj'5,1,r,7A19 tune: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermidLicense# 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#: 6 oF� o + snaxsrnBi.E, 9 ' Town of Barnstable Regulatory Services Thomas F.Geiler,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, A6&4E ,as Owner of the subject property hereby authorize L g9 ti9 S�U- Ae r2 A z L=,4a to act on my behalf, in all matters relative to work authorized by this building permit application f9r: (Address of Job) Signature of Own Date l� 12-11610 -5 /7�jLz2 Print Name If Property Owner is applying for permit,please complete the Homeowners License Exempti6n Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 TOWN,OF BARNSTABLE BUILDING PERMIT APPLICATION 1 1 1 .,,..✓ - Map Parcel Jo Permit# Health Division �.�� G� a e Issued Conservation Division � j13 JODe- M P� ��L` UST qe �L / �/IEPTIC SYST SO C C Tax Collet �rINSTAU ED 1 t'APLIAN �(o T-7 U VMT=E 7 Treasu ' "%MROR EWALCOpEAND Planning Dept. ( i TOWN REGULATIONS , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis r Project Street Address &I ' Village lad 61-3,Owner�' rj 5 k n /; L �(. — Address Telephone 7 `7 Permit Request �UQ 5&Aa-e 01 1 -------J7i fcJ/ Ct 6 ��nGil n r./f 5�Ze Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation 5�L Zoning District Flood Plain Groundwater Overlay Construction Type- �\ Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family le' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's HigF y: ❑Yes L- ,No Basement Type: ❑Full Cl Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) V' Number of Baths: Full: existing new Half: existing new. ) co � rn Number of Bedrooms: existing new e 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: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number /Y Address ' � � �J�1 License# Home Improvement Contractor# A)U 7L�0 Worker's Compensation# __c a5C7�o�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t4aOmar c2 �Ca✓ f SIGNATURE DATE �:15: 0 2. fi ' FOR OFFICIAL USE ONLY - a PE IVUT NO. =E. DATE ISSUED - MAP/PARCEL NO. , ADDRESS '' VILLAGE OWNER DATE OF INSPECTION: FOUNDATIONS FRAME r �.., - Z Jr G _ INSULATION CO3 m. ' FIREPLACE ELECTRICAL: 0 FINAL r - PLUMBING: RO1G..0 FINAL - oil GAS: ROUGFP FINAL FINAL BUILDING e • DATE CLOSED OUT ASSOCIATION PLAN NO. i 7 1 �. The Town of Barnstable anarreresLr - "'" Department of Health Safety and Environmental Services . '�Fo pADY" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations, renovation, repair,modernization,conversion, improvement,removal,.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: jl mt-R Estimated Cost Address of Work: 0 Owner's Name: &c/,S Li Slam. Date of Application: 0 �O I hereby certify that: Registration is not required for the following reason(s): Work excluded bylaw Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date C�P 1 u i Cotract4 me" em u� Registration No. OR Date Owner's Name q:forms:Affidav 02e �omono�uuca�l�i. f(Ruadr� lfr HONE IMPROVEMEHI COHIRACIOR Registration: 100740 a— Expiration: 6/23/OZ- type: Private Corporatio CAPIZZI HOME IMPROVEHIMI, lbolas Capitti, Sr. 16JS Mewton Rd, ADMINISTRATOR Cotuit HA 02635 anrmasuuea a BOARD OF BUILDING REGULATIONS '.License: CONSTRUCTION SUPERVISOR i; Number: CS 057032 Expires: 09/26/2003 Tr.no: 5790 Restricted: 00 THOMAS X CAPIZZI JR 280 PERCIVAL DRe W BARNSTABLE, MA 02668 Administrator f , The Common wealth of Massachusetts Department of Industrial Accidents '� -- Office 91110yBSUg8U0DS 600 Washington Street —%; Boston, Mass: 02111 y Workers' Compensation Insurance Affidavit name'1 lao rnCt'S lQcationo _:zu zixS Ci a(I n i S phone# ❑ I am a hfomeowner performing all work myself. I am a sole proprietor and have no one working in any capacity arrarn an employer providing workers' compensation for my employees working on this job. comoany name: f 7:2--I17 rv► Qn� address- �Aft&kct_j n city: h ^' _ p one CQ� oi . GT �O I am a sole propficYor,general contractor, or homeowner(circle one) and have hired the contractors listed below who h".. the following workers' compensation polices: company name: address: city: phone# insurance:co. 012 f # comoanv naroc city uhone#• insurance>co. policy# , Failure to secure coverage as required under Section 25A of h1CL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and+ro one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 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. t do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. k Signature j Date 0 /L /0�.. t Print name % Z- Phone# official use only do not write in this area to be completed by city or town official + city or town. i ly permit/license N oBuilding Department >- Licensing Board check if immediate response is required �Seleetmen's Office 011calth Department Xcontact person: phone 11; nOther •, Ire iscd)N5 PJA) r ' I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 f I I I I Checked by/Date I I I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached , HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-10-2002 DATE OF PLANS: 4-6-02 TITLE: Little Job :#24358 PROJECT INFORMATIO : Shed Dormer COMPANY INFORMATION: Capizzi Home Improvement COMPLIANCE: PASSES Required UA = 112 Your Home = 111 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA CEILINGS 720 30.0 0.0. 25 WALLS: Wood Frame, 16" O.C. 685 13.0 0.0 56 GLAZING: Windows or Doors 7'5 0.390 29 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION-CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Little Job #24358 DATE: 5-10-2002 Bldg. ] Dept. 1 Use I I CEILINGS: [ 1 I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 I Comments/Location i I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.39 I For windows without labeled U-values, describe features: i # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures 1, shall meet one of the following requirements: 1 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944,L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I VAPOR RETARDER: [ J I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. i sl MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly I marked on the building plans or specifications. I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I I using mastic and fibrous backing tape installed according to the I 'manufacturer's installation instructions. Mesh tape may be . I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating I and/or cooling input to. each zone. or floor shall be provided. I , I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the .heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock-. [ ] I HVAC PIPING INSULATION: y I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : 1 PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-l" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 - 1 Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0..5 0.5 0.75 1.0 I refrigerant below 40. 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.) : 1 PIPE SIZES (in.) I NON-CIRCULATING I CIRCULATING MAINS 6 RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" i 170-180 0.5 I 1.0 1.5 2.0 1 140-160 0.5 I 0.5 1._0 1.5 1 100-130 0.5 I 0.5 0.5 1.0 I - ----NOTES TO FIELD (Building Department Use .Only)------------------------- X -------------- I r • f f r r — , I r t ' a • r t — � r i i r • I r ° r r - r � t r • • i r , r i t v , } t t —t — r ' ! I ' C / r , ' s E v t r i ------------ P ._—.---------_ a t ' , ---- F4 cs i 1 -- , ._.__ -____ ___�-_.__•-. __ f—-- ._ ------ ___— (� __- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, t Map 31>-7 Parcel. 1-2 TOWN OE= BAR4FAKE �26kQ Health Division 2002 MAR 14 A�at8 JsJ U Conservation Division Fee .� Tax Collector -AXj �� 3��y/�� m `�_ e T�' J , 00 Treasurer o k -- Planning Dept. ITUST ORTAIN A RFWr:13 Date Definitive Plan Approved by Planning Board "f �Tlox °FRSIIT i RU ;t F i '�'�t:.' :G&ii�, t['I510h Yl1.`tZp Historic-OKH Preservation/Hyannis Project Street'Address Village (,I�,^',o/S �J Owner l-glS ► �� T7 - Address .O 0 i/fit Telephone 715 Ji 6 7 Permit Request ( �W/2 ll 'u ya4or s /c/ >i fw ize, k" 110AA .v Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation t,2a.6S"6 . ov Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ClNo If yes, attach supporting documentation. U Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No ; Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other 3 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: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use r' BUILDER INFORMATION Name �-.6- i,ZZI Mt- T A P Telephone Number Address &Z/5 ff A"kin I�C� License# C'15 05-70 3a rQ ti/�� 0,�Lb35 Home Improvement Contractofr# /UU 7/-/0 Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r/hC,>CJ SIGNATURE DATE c r FOR OFFICIAL USE ONLY x �ERMIT NO. t DATE ISSUED MAP/PARCEL NO. , f S _ ADDRESS ' VILLAGE OWNER ` A .t l a 1 DATE OF INSPECTION: r FOUNDATION y r FRAME INSULATION { FIREPLACE ELECTRICAL: ROUGH FINAL z PLUMBING: ROUGH FINAL GAS: ROUGH FINAL _ FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4 , �. .I' The Town of Barnstable ., = �var�stE. • Department of Health Safety and Environmental Services Building Division - 367 Main Street,Hyannis MA 02601 J Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner s Permit no. t Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: If "I'ds Ll'C4 Estimated Cost J�� Address of Work: 1h &., tC� �G� t_C! Owner's Name:,IVI�kin 111�4 Date of Application: rt�n2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: jlo,h) Loje, 4, G 57 TQL� Dat Co tractor am Registration No. CAP1zil I-'orn� ?ru�ctw tit OR b Date' Owner's Name q:fortm:Affidavt �liie�amonanuxaldi a`.i�taxtat/��.ull� ; NONE IHPROVEHENT CONTRACTOR Registration: 100740 _ Expiration: 6/23/02 ' Type: Privjte Corporatio CAPIZZI NONE IHPROVEHENT, , Thous Capizzi, Sr. 164S,Nevton Rd. ADMINISTRATOR Cotuit NA 02635 ✓rie foom�noouueall� p�p✓�aavaclu�ee�ta Yj / BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR t Number. CS 057032 r Expires:09/26/2003 Tr:no: 5790. '� _ ... •F•.estricted: 00 THOMAS X CAPIZZI JR 280 PERCIVAL DRY, W BARNSTABLE, MA 02668 Administrator % i r - -- --, The C0111111oifiwet/lth of Massach//seat/ 1Nff De in/liellt O hitli s`irial fl ccitfeltts 91fice a//nyeSH93118ns GOO MishUJgtoii Street _ Bostotl, Mass. 02111 Workers' Compensation Insurance Affidavit ullnc / /1 0 In c," to atiun:l L� /v,�( ( ITz'( (� AV city C.v /-) A 1► 1" Phonc U LZ Z 37tY I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity EO am an employer providing workers' compensation for my employees working on this job. / company nomc Z. Aome ,,.��'1� QrOlie nye-n- address• _146 !YS AJ-1 (! insurance co. ��cn S()rul t�tC., P.01 CyLI_ Ct IWC0?;�l0- 61?--G 0 I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who h;,.. the following workers' compensation polices: comnanv name: a d d ress: city: phone#: insurance co policy N company name: address- city: ohvne H: insurance co. policy 11 Failure to secure coverage as required under Section 25A of A I G L 152 can Icad to the imposition of criminal penalties of a fine up to S1,500.00 andloy one years'imprisonment as well as civil penalties in the form of a STOP NVORK Oil UEIt and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of In,,cstigations of the DIA for coverage verification. I do hereby certify under the pains_ anti penalties of per;ur►.flint the infiirmation provided above is true and correct. Signature Date J101101) Print name—n rA9— Phone a 19—X R [check ly do not write in this area to be comiJeled by city or town official permit/icense# nnuilding Department G-- �Liccnsing Board F mediate response is required 0Sclectmen's Office C]Ilealth Department n: phone 11; Other 11-iud)MS PIA) , V(3►1T . V . r - ,lam,, _ �• -•p i �'�. i �_: ' - Nei✓ i I - . - �, C %3r�y F(C� r� obi s P. i- ..a.- soc '�, Q ic�—e+�e 17 TA 4-r /Vol 1 Ale • t 1 � r1om = C MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2 . 01 I I ' i Checked by/Date i I . 4 CITY : Barnstable STATE : Massachusetts HDD : 6137 CONSTRUCTION TYPE : 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE : 3-.13-2002 DATE OF PLANS : 3/802 TITLE: Little Job #24358 PROJECT INFORMATION 2nd floor renovations. COMPANY INFORMATION: Capizzi Home Improvement COMPLIANCE " PASSES Required UA = 38 Your Home 37 Area or Cavity Cont . Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 340 30 • 0 0 . 0 12 WALLS : Wood Frame, 16" O. C . 224 . 13 . 0 0 . 0 18 . GLAZING : Windows or Doors 8 0 . 390 3 GLAZING : Skylights 9 0 . 370 3 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . Tho Hc=fi nn 1 nAH fnr thi c hiii 1 Hi nn. And tho rnnl i nn 1 narl if Annrnnri a*o. E 3 I Ducts shall be insulated per Tabl.e J4 . 4 . 7 . 1. i I DUCT CONSTRUCTION : E 3 1 All accessible joints, seams, and connections of supply and return I ductwork located outside conditione.d space, including stud bays or I joist cavities/spaces used to transport a.ir, shall be sealed I. using mastic and fibrous backing tape installed._ according to the I manufacturer ' s installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted . The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS : E ]I I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating . 1 and/or .cooling input to each zone or floor shall be provided. I . HVAC EQUIPMENT SIZING : E 3 1 Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4 . 4 . Q 3 1 SWIMMING POOLS : I All heated swimming pools must have .an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock . E 3 1 HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels ( in. ) : PIPE SIZES ( in. ) S 1 HEATING SYSTEMS : TEMP (F) 2" RUNOUTS ❑-1" 1 . 25-2" 2 . 5-4" I Low pressure/temp . 201-250 1. 0 1. 5 1. 5 2 . 0 I Low temperature 120-200 0. 5 1 . 0 1. 0 1. 5 1 Steam condensate any 1 . 0 1 . 0 1 . 5 2 . 0 I COOLING SYSTEMS : 4 MAScheck INSPECTION CHECKLIST , Massachusetts Energy Code MAScheck Software Version 2. 01 Little Job #24358 DATE : 3-13-2002 Bldg- I Dept . I Use � 1 i CEILINGS : E 1 1 1 . R-30 I Comments/Location I WALLS : E 1 1, 1 . Wood Frame, 16" O . C . , R-13 Comments/Location WINDOWS AND GLASS DOORS E 3 1 1. U-value: 0 . 39 I For windows without labeled U-values, describe features . I # Panes Frame Type Thermal Break? E 1 Yes E ]I No I Comments/Location [ . SKYLIGHTS : E 3 1 1 . U-value : 0 . 37 1 For skylights without labeled U-_values, describe features: _ I # Panes Frame Type Thermal Break? E 1 Yes E 1 No I Comments/Location I AIR LEAKAGE : E 1 I Joints, penetrations, and all other such openings in the building , I envelope that are -sources .of air leakage must be sealed When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements : 1 1- Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I aasketed to prevent air leakage into the unconditioned sDace - 3D7 �ann �s 1�e,rm I '?5z, lat)orl . ob C�n2; �J � zz� t�vm� �pr�ve,rn�e� 7�3 �Da DA 02-038 Massachusetts Department of Environmental Protection �oFt ' � Bureau of Resource Protection -Wetlands WSTABLF • r WPA Form 2 — Determination of Applicability ' » MASS. 9�A i63 ,�� Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 rf039. p and Town of Barnstable Ordinances, Article XXvll A. General Information Important: When filling out From: forms on the Barnstable computer, use Conservation Commission only the tab key to move To: Applicant Property Owner(if different from applicant): your cursor- do not use the Kristen Little return key. Name Name P.O. Box 882, 50 Foster Road kMailing Address Mailing Address Hyannis MA 02601 City/Town State Zip Code City/Town State Zip Code. 1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents: GIS Skectch Plan A 5/21/02 Title Date Title Date Title Date 2. Date Request Filed: May 23 2002 B. Determination Pursuant to the authority of M.G.L. c. 131, §40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): Construct a 34 foot long dormer; install new bathroom; and increase size of bedroom. Project Location: 50 Foster Road Hyannis Street Address City/Town 307 176 Assessors Map/Plat Number Parcel/Lot Number wpaform2.doc•rev.6/12/02 Page 1 of 5 DA 02-038 Tp� Massachusetts Department of Environmental Protection FINEti Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability ' MASS. E ` v Mass. � Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 `bAr�0�3 9p. and Town of Barnstable Ordinances, Article XXvll B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s),which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department.Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. 2.The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ❑ 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform2.doc-rev.6112/02 Page 3 of 5 DA 02-038 OFIKE Ip� Massachusetts Department of Environmental Protection ti Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability ' BA MALE.Ll I ` Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and Town of Barnstable Ordinances, Article XXvll B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name Ordinance or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: by hand delivery on ❑ by certified mail, return receipt requested on - JUN 1 3 2002 Date PC, Date This Determination is vali' for`three ors from the date of issuance (except Determinations for Y ( P Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.' This Determination must be signed by a majority of the Conservation Commission. A covey must be sent to the a propriate DEP Region ffice (see Appendix A)and the property owner (if different from the app ' ant);,p OSignatures: On this t day of UNc� 2a2a,before me personally appeared qAMCOS w to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she ex c ed the same as his/her free a nd de ± ✓ otary Public be C— My commission expires wpaformldoc-rev.6/11/02 ti. Page 4 of 5 h, DA 02-038 GF tNE Ip� Massachusetts Department of Environmental Protection ti Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability ' BABNBPABLE, ' Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 1639.fn�° and Town of Barnstable Ordinances, Article XXvll D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done;or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Appendix A)to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee Action Fee Transmittal Form as and Fee Transmittal Form (see Appendix E: Request for Departmental ) provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doc•rev.6/12/02 Page 5 of 5 Fri I - _ "' LEFT ELE\1{YTID rJ RIG1V-T EL'E VA-TION I r - - L —_ SMOKE DE; T DES O.K. ?CXD/q 't .. t7,wo mawu,ys vrslx p,olmr-U;/CapizJ Home . ..�7i Impmvemerrt for the use of Caplzzi Home lmprovamsrn it rr�E D02etER AbD�TON �✓ amPbYeea and aubmmrectom.Anyorre using tease' drewl10 should aald w ell e.n x_.�,, veo e•. wn e. 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