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0111 GROVE STREET
f _ � _. r/� � r�irc G� � Q���'I �u s� Syte ' c7�iAiP2 _ _ . • �/13�I s Town of Barnstable *Permit#ppojjAp 'l30L9 AO ' Regulatory Services 13 2010 — t enuvsTns�,!F Mass. Richard V.Scali,Director 6 ' � 80 N S T A B LE Building Division , Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMT APPLICATION - RESIDENTIAL ONLY (, 1 Not Valid without Red X-Press Imprint Map/parcel Number L3 l Property Address 111 Grove st Hyannis ❑Residential Value of Work$ 6,500.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Inna Fedotova Contractor's Name Anatoli Sivitski Telephone Number 617-710-1001 Home Improvement Contractor License#(if applicable) 168043 Email: capecodinc@gmail.com Construction Supervisor's License#(if applicable) 106040 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name AmGuard Workman's Comp.Policy# R2WC918542 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 S&J Exco Dennis . ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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: SaU� a C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Oudook\L7U69LF2\EXPRESS(2).doc 01/25/17 P BARMABIE `""M t Town of Barnstable i6S9. A�� a Regulatory Services Richard V.Scali,Director Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must y Complete and Sign This Section If Using A Builder I, Inna Fedotova ,as Owner of the subject property hereby authorize Anatoli Siyitski to act on my behalf, in all matters relative to work authorized by this building permit application for: 111 Grove st Hyanis, MA 02601 (Address of Job) cait,rr��t�ete 9/13/2018 Signature of Owner Date Print Name ` If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollikWppData\Local\Microsoft\Windows\INetCache\Content Outlook\L7U69LF2\E.XPRESS(2).doc 01/25/17 De Commonwealth of Massachusetts Deft qfIndnstrialAcddenis Office of Invesfigadons 600 Washington Street Boston,MA 02111 wow.mass;govldia . - Workers'Compensation hnurauce Af&davit Builders/ContractorsMe�t6cians/Rumbers Applicant Information Please Feint LeO`blw Name Anatoli Sivitski Address: 27 Mill Pond rd West Yarmouth, MA 02673 . City/State/Zip: Thane##: 617-710-1001 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 to full and/or s have hired the sub�nfzactors 6, ❑New aQnstnution: employees{ part:bme)•. 2.❑ I am a sole proprietor or p utw— listed on the attached sheet 7. ❑Remodeling ship and bane no employees These sub4mntractm have g_ ❑Demolition. l woskiug for mein any capacity. �aYeesand have workers' 9. ❑Bonding addzriioa. [No w leers'cow.insurance corium.insuranceI required-] 5..❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officors have exercised their It.[]Plumbing repairs or additions ' right ofeaemptimper MGL myself�o workers �P• 1.2.0 Roof insurance required.]B c.152,.§1(4�and we have no employees (No workers' 13.0 Other comp-insurance required..] •any applicant dw chedm b=#1 mnsa also sn an the section below shumng;dwk workers"compenudoa pdUcyiafcraaadon. ?Ho>aeaernPas who submit this affidavit n dwatmg dwy sae doing all wok and dten hue outside caauacmrs n mx submu anew aSdavg.indicariag such Contaacmrs dial check this txM must attached an additional stet showing the name of the sdHmmuKuwsudsmukedmornoftwewhkshm employees. Ifthe sub<owzac=bm employes,they must psi iber workers"wnp.policy der. I am an employ'er tJiat is provideng workers'coerperrsation insnrmcca for my empk"m Below is the policy aid job site informadon rnmrance comPffiyName. AmGuard Policy#or Self-ins.Lie.# R2WC918542 FRpiration.Date: 02/06/2019 job Site Address: 111 Grove st City/State/Zip: Hyannis, MA 02601 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 emit penalties in the form of a.STOP WORK ORDER and a fine; of tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofi he DIA.for item mmce:coverage verification. I do hereby eerh fy under tha pains and,penaf#ies of pedury that8re information provided above is bare and correct Signattge: 1491Z�9; S� Date: 9/13/2018 pgm#: 617-710-1001 Offleial use onb i. Do not wMe indds area;,to be completed by city ortown of vial- City or Town: PermitlLiceme# Issuing Authority(circle one): 1.Board of Health 2..Building Department.3.City(fown Clerk 4.Electrical Inspector S..Phrmbhg Inspector 6.Other Contact Person: Phone Office of Consumer Affairs and`Business Regulation 0ne'Ashburt0 Place;-`Suit ifl! r Bo"ston, Mas usetts 02108 Home Improvemen o actor Registration M. TYPe Corporation CAPE COD HOME IMPROVEMENT,INC Registration 168043 Expiration 12/06/2018 27MILL POND RD:_ r WEST YARMOUTK MA .02673 $ ` Update Address antl Return Card SCA 1 20M-0SN7 2e u7om�mroouapa/�/o�C�/�aaaac%ucaeCa Office of Consumer Affairs&.Business Regutation ` x HOME IMP4iOVEMENTCOtdTRACTOR Registration valttl for individual,use only; TYPE: porDoration before he expiration date If found return to i at :Expiration Office of Copsumer Affairs and Business Regulation 168 2/O6/2018 10 Park Plaza=Sw ':CAPE GOHOM tM-=T u Ai1E INC D" Boston,MA ANATOLI SIVITSKI' 27 MILL POND RD. WEST--YARMO.UTH,MA, 73 Not valid wit out ignature t; - - Undersecreta.. ;_ry ; 77777 :ic3UO1SSltt;lwd s r a 4 3 y' 1 KT . . �.� 1'. 3 •• :� Pox: •£j• � £ }S"` " £197r0��W I fl ,a IN2l1a►A ISM xr k x x a Nod#1g1uu, z r„ V v m. I�ISIft�S � 10:l�fNd , 44, Q .Q3E 15 57 �,. . dz 4. V Z ' s �eupu+ u€,?� nuip�rno a .. i&Q +9 �at > uowtuo �.. -� AC& DATE(MMIDDIYYM ��. CERTIFICATE OF LIABILITY INSURANCE 03/16/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseme s. PRODUCER �E: Victoria Sharapova ALD Insurance Agency Inc. PHONE 617-787-7877 FAX 617-787-7876 60A Brighton Avenue AIc No): Allston,MA 02134 E-MAILom: Comm@aldinsurance.com ADDINSURER 8 AFFORDING COVERAGE NAIC# INSURERA: ATLANTIC CHARTER INSURANCE COMPANY 44326 INSURED Belcape Construction LLC INSURERB: AMGUARD INSURANCE COMPANY 42390 42 WOODBURY AVE Hyannis,MA02601 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE TEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AD L SUER POLICY NUMBER POLICY EFF MPOLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY L270000577 01/14/2018 1/14/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE V OCCUR P REMIREMISES DAMAGE T Ea RE EDrrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ . 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECOT LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SIN LE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ B WORKERS COMPENSATION R2WC918542 02/06/2018 02/06/2019V1 LIABILITY YIN ERR AND EMPLOYERS'LLITY Y I N ANY PROPRIETORIPARTNER/EXECUTNE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN -- ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Insulation Certificate .Number and Street City W VS46 County Subdivision Lot Number Permit Number Description of Installation ROOF 22 Q Product /��or/�i l 5 Lot Number Thickness (inches) 5* Thermal Resistance (R-Value) 30 CEILING Product Lot Number Thickness (inches) Thermal Resistance (R-Value) Loose Fill Type - Brand Name Contractor's minimum installed wightKt2 lb Minimum thickness inches Manufacturer's installed weight=perrsquare foot to achieve Thermal Resistance (R-Value) EXTERIOR WALL Product 115,'D 1-3, .�z l 5 Lot Number Thickness (inches) Z L tiNc eS Thermal Resistance (R-Value) RAISED FLOOR Product 4U/� Lot Number Thickness (inches) Thermal Resistance (R-Value) . SLAB FLOOR Product Nf/} Lot Number Thickness (inches) Thermal Resistance(R-Value) Width (inches) FOUNDATION WALL Product AJ eo) Lot Number Thickness (inches) Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards. General Contractor(Builder) License Number Signature and Title Date Sub-Contractor(Insulation Installer) License Number vAN � �% 'ies✓K�q ou/ye�. 05>/ 20�0 Signature and Title Date is a BioBased� `��►F1ED pEgIER Insulation Certified Dealer B/OBAS'EO Revised August 2008 gyp} /NSULAT/ON A ®gBeD�� ►N$v� Y LO LO Living Room o _© NChimney N --- 6'-83/16"-- o M 3'-0 9/16„ j 2'-8 9/16" „ 6 —Z Ok 9 zz Ln ! rj ^ Zo pD O I_ ) LO ZZ V) �-'• CL p _ ' O b � a � q --- — -- 10'-3„ —- -- — VN ¢ Proposed ia'-115i " } i Bathroom (currently Hallway) shower p v _ 3 2�6"Q'6'-2' 2'-9" 1T-9 1/16' to g� i 1 ------ 21k 6-,si ---�_— „zip 9-s _ — ---, ( oG C� `OAP W }ram S J Q ti G.. �Sy U3 ui ��oWw0 Q M EJ • r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r. o` 3?M c Map Parcel ' Application # Health Division P I CC t Date Issued a 8 Conservation Division .1 Application Fee Planning Dept. Permit Fee �d Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/Hyannis Pro Street Address h P - Village Owner 1•�►-�-d �C� Address. 6,74� zzd, Kz<, Telephone 06 `,Permit�R6q__uest -QfXZZ Square feet: 1st floor: existing proposed 2nd floor: existing propose Total new Zoning District Flood Plain Groundwater Overlay Project Valuat®rn a0, ` 0 00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes �,No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: A, existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas *Oil ❑ Electric ❑ Other CD Central Air: ❑Yes No Fireplaces: Existing tNew Existing woo' stove= ❑YNo i Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing L�I'new5'size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: { w Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ CD Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUIL-DER OR HOMEOWNER) _ Name Telephone Number t9 �7 l Y ©D-9 "�- l Address __ V - License# c4 ruwv,��:, og,60i Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEB S RESULTING FROM THIS PROJECT WILL E TAKEN TO SI NG A URE DATE �� o2.q 2®�29 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 Ilt The Commonwealth of Massach usetts Department of Industrial Accidents ` Office of Investigations 600 Washington Street c Boston, MA 02111 -7 may' www.mass.gov/dia Workers'-C—ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers '�_�Aprpficant Information Please Print Le ibl Name (Business/Organization/Individual): Address: V'2 I, City/State/Zip: Y\V\k 5 Yn �0( Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).*, have hired thesub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.t C required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions q •] officers have exercised their 1 I. Plumbing repairs or additions �,. IGam a homeowner doing all work ❑ g P yself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine tof 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. Lby certify tinder the pains and p alties.ofperjury that the information provided above is true and correct • Date: b `` 4,0 � 7 Official use only. Do not write in this area, to be completed by city or town.officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with.the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia ' ENE•RG'Y CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR Old; AND TWO-FAIVZTL'Y DETACHED RESIDENTIAL CONSTRUCTION (760 CMR 61.00) Apphca fName: Site Address: I I Ga - print Town: Applicant Phone: "N 06 Applicant Signature: Date of Application: z909 NEW CONSTRUCTION: choose ONE of the following two'o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MA)QMUM 'MINIMUM Q Ceiling or Slab Option l: Basement Fenestration exposed Wall Floor Perimeter AFUE U-factor floors R Value R-Valu R-Value e wall R Value HSPF SEER R-Value and Depth National Appliance Encrgy .35 R-3 8 R-19 R-19 R-10 R-10) Conscrvatioh Act(NAECA)of 4 ft. 1987 as amended,minimums or cater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: 4 REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at hftp://www.cnerg• cY odes.goy/rrscheck/ ADDZ'� OlVS OR T RATXONS.TO EXISTING TJLY.DIl GS.O. . . YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b•-.a) SF 100 x - _ % of glazing (b) Glazing area equals SF b a If glazing is<-40%.use the chart below. • . If g.lating is> 40 % .rpcee,'d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS � MAX MUM ' Fenestration .Ceiling and -wall Floor Basement Wall Slab Perimeter U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39 R-37 a R-13 • R-19 R-10 R-10, 4 feet. a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i,e.not compressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form found in Appendix 120T Town of Barnstable Regulatory Services RASrABLF- ; Thomas F. Geiler,Director RN � 16S9. ,�� Building Division PrEn Tom Perry,Building Cotntnissioner 200 Maiu Street; Hyannis, MA 02601 Rww.town.barnstable.ma.us Office:_508-862-4038 Fax: S09-790-6230 DALHOMEOWNER LICENSE EXEMPTION �� 9 Please Print DATE: " , ` JOB LOCATION: number street llagc E name home one# work..gbone# CURRENT MAILING ADDRESS: "a. C-4 S tel— Vity/tOw7o state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 Of5cial 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. Tbr,umdersi ed"homeowner"certifies that.he/sbe understands the Town of Barnstable Building Department minii.num inspection procedures and requirements and that he/she will comply with said procedures and re ruts. ::g-5ig a—tiIm 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 pernat is required shall be exempt from the provisions of this section,(Seetion 1 D9.1.1 -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 cxerrrption are unaware that they arc assurning 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/ccrtification for use in your community. Q:forrns:homccxcmpt 1 Y r Town of Barnstable Regulatory Services qB.ARNaLY- Thomas F_ Geiler,Director d.19.- Building Division Toni Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.b arnstabl e.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 to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. i1 Fz r Town of Barnstable \ Permit# �S` GI ,p Expires 6 months from iss date Regulatory Services Fee * sa tNSUBLE, ` 9 MASS.039. Thomas F.Geiler,Director i639. �� ArFD MP'I A Building Division Tom Perry,CBO; Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ( Not Valid without Red X-Press Imprint Map/parcel Number 0 r" Property Address [Residential Value of Work Jyr tad Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address C/ , oys L�rJ Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑ -A-PRESS PERMITWorkman's Compensation Insurance ' Check one: T Q I am a sole proprietor 9 2009 I am the Homeowner 'TOWN OF� gARNSTt�BL�' 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(stripping old shingles) All construction debris will be taken to ❑Re-roof(not.stripping. Going over existing layers of roof) (�Re-side #of doors [ Replacement Windows/doors/sliders.U-Value (maximum.44)#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: Q:\WPFILES\FORMS\building permit fo ms\EXPRESS.doC Revised 090809 '4 The Comm6nivealth of Massachusetts Department of Industrial Accidents Office of Investigations t" 600 Washington Street Boston, MA 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit:,Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual)' Address: ,o/4 City/State/Zip: ``� ��©� Phone #: . Are you an employer? Check the appropriate box: Type of project(required): L❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).*= have hired the sub-contractors 6. ❑New construction 2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.# required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.) t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 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 r 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. 1 do hereby certify tinder the pains and penalties of perjury that the'information provided above is,trice and correct Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ' 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract.of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house PP or on the grounds or buildingappurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any compliance with the insurance coverage required." applicant who has not produced acceptable evidence ofg q PP Additionally,MGL chapter 152, §25C(7) states Nether 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 ' completely,b checkin the boxes that apply to our situation and, if Please fill out the workers compensation affidavit y g PP Y Y necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only.submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-72774900 ext 406 or 1-877-MASSAFE Fax # 617-127-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable o Regulatory Services •saurtsrasr.E. Thomas F.Geiler,Director Mass. 9`bA 039. a,�� Building Division TES ` Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Q Please Print DATE: JOB LOCAT ION: umber street village HOMEOWNER": � Vuo�s�,��H oG2 9 name I home phone# work phone# CURRENT MAILING ADDRESS: 9 pDve- S/- 6 /town state zip c e 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 an equirements and that he/she will comply with said procedures and requireme Signatwe o er 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 fonn/certification for use in your community. Q:\WPFILES\FORMS\ho-meexempLDOC �THETo Town of Barnstable Regulatory Services vMAE& E$; Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:OWNERPERMISSION YOU WISH TO.OPEN A BUSINESS? For Your.Idc nformation: Business certificates [cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in tow you must el by M:G.L-it does not dive you permission to operate.) Business Certificates are available at the Town Clerk's Office; 1' FL.[367h Main Street, Hyannis, MA.02601 (Town Hall) , 'stn�ezwa aNLLYeP�k' i' OATE• ///L/�- CiVr/Q. ". Fill in please:. APPLIGANTS YOUR NAME:___ YOUR HOME ADDRESS:_ S 7— TELEPHONE # Home Tele _ phone Number NAME OF IVEW BU 'IIVts'S /V S ZC)TD ----__ 1S THIS A-HOME DI-CUPATII]NYES ADDRESS OF BUS14VE5S 67- 4$±V1t11AP/PARCEL NUMBER `�— When starting a new business there are several things you must do in order-to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you rnpy need.. YOU Rd. & Main Street],to make sure you have the appropriate.permits and licenses.required tollegally opera08T GO Ote Your Main Isintss (cornern this town Yarmouth '1. BUILDING COMMIS510NER'S O FICE �I���� �� This individual has been inform. d•of a permit requirements that pertain to,this ,. p � type;ofbusiness. Authprized Si t e** COMMENTS: 2. BOARD OF HEAL This individual has infor e of he' er it re ents that.pertain to this type of business. ALIthoriged Si atur COMMENTS:.. 3: .CONSUMER AFFAIRS LIC[ NG AUTHORITY) This individual has e Ic i e ui is that pertain to this type of business. Authorized Signatu e COMMENTS: a `sown f arnstalle 90 ce c0eharlmeni �ANST1.9 OIUT l P. O. BOX B NEIL A. NIGHTINGALE 1200 PHINNEY'S LANE_ TELEPHONE: 775-0387 CHIEF OF POLICE 790-0062cE _ HYANNIS, MA 02601 AREA CODE.508 March 28, 1996 TO Ms. Gloria Urenas Town of Barnstable Building ,Department FROM : : (Michael ,F ' D,amery, Sergeant 4 ' ' Barnstable Police Department SUBJECT: COMPLAINT OF UNREGISTEREDTRAILER AT Ill' GROVE STREET, - HYANNIS This is in response to your memorandum of March .26th and received by .me on March 28, 1996, regarding 111 Grove Street, Hyannis. Patrolman Paul B. MacDonald had ' conversation with the occupant of that house on the same date. The trailer is parked on private property not the roadway, however, the property owner advised Ptl. MacDonald that he would have it removed after 4:00 P.M. today. (Refer to B.P.D. Incident #96008016) . Feel free to contact either Ptl. MacDonald or me if there are any further questions regarding this matter. Michael F. Damery Sergeant - B.P.D. TovM of Barnstable Building Department } ComplainVInquiry Report Date: �J - Rec'd by: Assessor's No.:mVa Complaint Name: 4;W4 Location Address: / ; -9,-5P, Originator Nwne: 9� CL� Street: Pillage:. ? State• Zip: Telephone: D/E 7 71 Complaint . Description: f 2 dZr, Inquiry 0 Description: For Office Use Only Inspector's Action/Comments Date: Inspector. Follow-up Action Additional Info. Attached Copy Disaibution. LG7ute-Department File i Town of Barnstable • Building Department ComplainVInquiry Report Date: ��`"Fe— Rec'd by: � Assessor's No.: Complaint Name: 7 Location Address: M/p r Originator Naine: Street: �a Vdlage: �./�� State: G'c- Zip: C.-2 G d� Telephone: D/E Complaint , Description: Inquiry Description: For Office Use Only Inspector's Action/Comments Date: Inspector. o�-�- - — — � Follow-up Action Additional Info. Attached Gopy Distribudon. Hl to-Department File Fellow-Inspector Town of Barnstable Building Department ComplainVInquiry Report Date: - 9 Rec'd by: Assessor's No.: 5vG Complaint Name: Location Address: M/P ,� Originator Nwne: 2,,a,",- Street: Village: �!� State: Zip: Telephone: D/E 7 7/ L Complaint . Description: Inquiry Description: For Office Use Only Inspector's Action/Comments Date: Inspector. Follow-up Action Additional Info. Attached Copy Distvibuaon: MVic-Depamnent File I'elloFv-Inspector n:.,L- incn&rmr(Retum to Office Afanamr) n �� � ,��� �� � c � ��� s � /' ;�� � � � �z , �` , , s =s , � , z � _ froo - �l3s - � s98 a�� ��� ' 24-0" ' �10 13'-8 1/8" �' 4'-5 7/8" ,f' �_A•�-v_dfJ1 , -3 IMPORTANT ,_0,.x 4._8,. w 5'-0"x 4'-8" ANY CONSTRUCTION THAT INCREASES LIVING SPACE 5'4 6'-2" n) BEYOND 1200 SO. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL 4�41 /, (currently Kitchen) \ 2�-1 PERMIT DOES NOT SATISFY THIS REQUIREMENT. Proposed BedrQ 1 10„ r_ in Z CD ,o (currently Garage) - "` -. IMPORTANT.3-o"x6 a" UPGRADE REQUIRED ------ 0 STATE BUILDING CODE REQUIRES THE UPGRADING OF 1W-0 1/2" A'2'-10 1/2" r 0 SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN 3-1 ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. Proposed Kitchen, � �. � Q NOTE: A SEPARATE PERMIT IS REQUIRE D FOR THE `) �' �+ i' T-5" i' co INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL. - PERMIT DOES NOT SATISFY THIS REQUIREMENT. 9'-5 3/8 3'4,4 5/8" 6'-0"x 6.8"SD - - J1. Q14, ) sv -- --� = O O 3-0"x6 8" 5'-6 1/2 �' ' 5'-5 1/2" CD r 7[ o SMOKE DETECTORS PEVIEWED rn LL8 FINSTABLE BUILDING DEPT.. xo� DATE CARBON MONOXIDE ALARMS Bedroom 2 m o MUST BE INSTALLED PEA MASSACHUSETTS 9UE FIRE DEPARTMENT DATE " - BOTH SIGNATURES ARE REQUIRED FOR PERMITTING i 6'-4" o LO Mechanical Room —' ' 5'-7" T-5' A' N ,�, 6'-4" Scale 114 inch = 1 foot I i r • _ t i.' Ci f � .t' 4 Ph n# m --fit S e ` W < t= [aI � mtc m m rn T v oc rn eo r t:� »- rr r co z' rf1 i rr, fri r,y" '1] ril In I fn rill tit ca Fri