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HomeMy WebLinkAbout0024 HARBOR BLUFFS ROAD �ebac _Wn/ i � __ W� t l i�, i �,._ - ---------- Application number � � Qa _ Fee .................� �...o ............:................ NOV 2 ,0i 1 � � i � Building Inspectors Initials.... .............................. aIZ ��a tossued....((....,,.��......��jj'' ......................................... Map/Parcel....`......................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION:, ROOF/SED NG/WINDOWS/DOORS/TENTS/STOVES/WEATI-ERIZATION PROPERTY INFORMATION Address of Proj ect: " 1a ( �CL�vC- U F i NUMBED STREET VILLM E (Owner's Name: e►�� , S�.�5 Phone Number Email Address: e nr, ,�tiS i�s�i (a tM Cell Phone Number 0 7 l S-^l Project cost$ >a 000 Check one -Residential`- L,,--- Commercial OWNER'S AUTHORIZATION As owner of the above prope I hereby authorize , to make application for 1 g permit in accordance with 780 CMR Owner Signature: Date: a TYPE OF WORK o header change)# 0 Insulation/Weatherization © Siding 0 Windows (n , El Doors(no header change)# Commercial Doors require an inspector's review D-R of(not applying more than l layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION , Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.....................................................:...... *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S-LICENSE EXEMPTION Homeowner's Name:' l c nkA Telephone Number -� 5Ot J $G Ce11=or Work number 5'0� a$o��5 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the f Barnstable. Signature• Date ( r APPLICANT'S APPLICANT'&SIGNATURE Signature Date All permit applic 'o rsare subject to a building officials approval prior to issuance. _ . The Commonwealth of Massachusetts w Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly <-Name (Business/Organization/Individual):_6/r_0K T",1i A_41( r Address: &4 3 QM (LJ City/State/Zip:_ ,�,otc 'l"A G° ^ 1 Phone#: rGrS 3.cS o `775 � 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 * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). , 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. repairs required.] 5. ❑ 10. Electrical We are a corporation and its ❑ p s 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 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. $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. 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 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 D or insurance coverage verification. I do hereby certi d e pains and penalties of perjury that the information provided above is true and correct ' Si ature: 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#: 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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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.##617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gOv/dia ��QyoF7HETo�♦� ► OWN OF BARNSTABLE i MARISTLELE, i M6 9 BUILDING INSPECTOR �Fo wnY a' APPLICATION FOR PERMIT TO B.U.(...L.-D...... 5L l....(� :...................... TYPE OF CONSTRUCTION ...1 .10.f2 qk.1. ,..... .I.rUC ....�/�t 1.t.,.4�. ............................................... ......... . .NE..... :.........�9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: _ Location ....t o..I ....1.y......jf A.R.a. !R.........�..0 . ......��...... ` 1.................................... Proposed Use .......... .L ALL ...4F.a ./ Zoning District ... ............... ...........Fire District ( S, �'✓� � � C';;j :............. .................... Name of Owner . . .�12,0YM.........p?KeQ.).9.(I4.6-41.1..Address ..)y/. R.a4�t� ...�.t�.�.� VIS Name of Builder .IV.77e.A 111.F1DD&g4--Address. ...........(,,Ij..Q. .C.: :1.. .1'�,.......................... 4. Name of Architect /,� ..t. L f1 .Address Number of Rooms �A Foundation v i+�"............ ... ................................................................ Exterior {.I..T..G....�.�... a.. —.. ....T.t.O........................Roofing ... ................. Floors .... /� .` .�-.... /. L.....�'...�' �Q .(..........Interior ........... .. .. .LL-........................ /£� Heating ..... . L..............�.��.�......................................Plumbing ..............L ?�..�?�I�T�/ S ..................................................... Fireplace ......Approximate Cost �' v O Definitive Plan Approved by Planning Board -----------__________________19 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH 5 E P t R tg't EL y v K) toe L) L.0-F a ri S t W e 2 t-I N I JZ®O� -9 ATE !IV UJi LL V349 U- ( per, � '� Cn � _ o -z 7 W > \ -V RE � •. G U—W, Y . � Z 0 0 11 kN i y Cf). U T I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . L• Ili..��... .... ................... .NameVO ... Lindstrom, Carl & Ralph McCracken _.. 12 150 .... .... Permit for ... one story........... . No .... single family dwelling 4 ............................................................................... Location Harbor Bluff Road ............................................................... . Hyannis g Owner Carl...Lindstrom. . ... & xalph McCracken ........ .... .......... ........ ........................ frame z , Type of Construction ........................................... { `' ................................................................................ Plot ............................ Lot ..................#14...... F i June Permit Granted ........... .....9 ............:. ...19 72 i' `!L �6,S Date of Inspection .... ....9.................1 Date Completed ......z .......19 I � 1 PERMIT REFUSED I ................................................................ 19 '{{ I i ............................................................................... R .... ....................................................................... ............................................................................... ................................................................. .......... a Approved ................................................ 19 i r ............................................................................... .................... ......................................................... i r j 9 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. ' `,� Application # 0_0 Health Division Date Issued Ji Z Conservation Division Application Fee Planning Dept. Permit Fee 577 Date Definitive Plan Approved by Planning Board P1 _ Historic - OKH _ Preservation /Hyannis Project Street Address d, �C&r f2 Village k1Lk&%nri !N Owner Address `F C ►C d�c '�3 I v EF �� Telephone Permit Request �z�ksoQpr, -c-rno c. VeO\0+cr wi. n Ace Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation IQ.(BUD Construction Type CG �ej Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure u<. 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 CD �new ` Number of Bedrooms: -�-� existing new ��`;; � o IF Total Room Count (not including baths): existing & new First Floor Roorri,Count �� c Heat Type and Fuel: 56 Gas ❑ Oil ❑ Electric ❑ Other Central Air: 66 Yes ❑ No Fireplaces: Existing New Existing wood/co I stover Ye ❑ No a-- Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ rNew size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes A No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION _', _- (BUILDER OR HOMEOWNER) Name (-. 1cr-r ��s��.e \1� Telephone Number SW' o'ItO '17S -7 Address C&4 MAC kc, License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S 4--S exc0 SIGNATURE DATE b f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. w ADDRESS VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION 'FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NOi 4 •M i The Commonwealth of Massachusetts Department of Industrial Accidents Y Y _ Office of Investigations 600 Washington Street _ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): V Itrr, k\ Address: aye City/State/Zip: n Ma L&f Phone #: 5 D?f 61W $� Are you an employer. heck the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 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.1 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 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK_ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c nder the pains and penalties of perjury that the information provided above is trite and correct. Si nature: Date: IO ot 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#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or 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 penult 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 pennit/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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable ofir+e ray ��. o Regulatory Services RA STAB Thomas F. Geiler,Director 14 Building Division Tom Perry,Building Commissioner 200 Mairi Street, Hyannis,MA 026.01 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print ATE: /06 Zn k JOB LOCATION: a ' CJJUS OVc-�— t"1\G.nnlS number street jA Iage name home phone# work.pbone# CURRENT MAILING ADDRESS: city/town state rip code • t 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. DEFINMON OF HOMEOWNER Persons)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' ection procedures and requirements and that he/she will comply with said procedures and re e ignaturc of nieo 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 cxc"mpt from the provisions of this scction.(Section 109.1.1 -Licensing of constriction 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 bftcn 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:forms:homccxcmpt Y r Town of Barnstable Regulatory Services M < f �$"s;''& Thomas F_ Geiler,Director i6396. Fa�a Building Division Toni Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Nvww.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property-Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act oa 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. i _ 1 I 1W T r a A.+ L h 7 ft x, ol �, _��, ••-... ,....�... i i to Y t � i p: 4 -=} { ,(. w �{ �c ap i� 1 : y _ „ C-�-ENERG Y CONSERVAT-ION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR. ON3✓- AND TWO-FAMILY DETACHED RESIDENTIAL•CONSTRUCTION (780 CMR 61.00) Applicant Name: C K(� Site Address: --� prin! // Town: �hA4 S Applicant Phone; 0 �V 5 Applicant Signature: Date of Application: loct . NEW CONSTRUCTION: cbo se qNF, of the following two•o Lions 780 CKR TABLE 6107.1 PRESCRIPTIVE EN7yrEL0PE C0101PONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS h A JMTTM MINIMUM Ceiling or Slab ❑ Option 1: Fenestration exposed Wall Floor Basement perimeter U-factor floors R-Value R-Value R-Value wall R-Value 4F UE HSPF SEEI R-Value and Depth National Appliancc-Encrgy 3 5 R-3 8 R-19 R=19 R-10 R-10) Conscrvation Act(NAECA)of 4 ft.• 1987 as amcndcd,minimums or cattr as applicabIr Note: This form is not required if you choose either of the two versions ofREScheck as listed below. ❑ Option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck--Web which can be accessed at http'//www.ener>7Ycodes.f?oy/rescheck/ AbDX O1vS:OR'A TAT RATXONS.TO E3aS'TING BULL INGS,.O:VER 5 YEARS OZ.D* *buildings under 5 years old must use option#1 or 42 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 6 Q if •lazin i :�: 0%.use the chart below. If gla±iDg is y 40 % rocee.•d to "SUNROOM” section 780 CMR TABLE 61Q1.3 PRESCRYPTI)VE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM NfINJMUM Ceiling and Slab Perimeier Fenestration -Wall Floor Basement Wall R_Value U-factor Exposed floors R-Value R-value R-Value R-Value and De th .39 R-37 a R-13 . R-19 R-10 R-10, 4 feet EL 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 El 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 TOXIN Of BARNSTABLE - :.2�`_��>✓ ��z'c� _�DD`1� (��SD,. 2109 OCT 16 PO 3: 2 I Avc5 : 2x!b. Vj4:'�c f G UT_T��S �— DIVISION � 307, (P,e- -roe A WIT T Zoor o� •'P�ICHs=LE \\ Y N AT __..� ..___ CUDILU -, L) N0.34774 L STRUCTURASTtE L` I `�Q _......._.._. {4 DID, oil I,5" BQA-1 CA AE0 - I � `V TD PROPOSED MODIFICATIONS MICHELE CUDILO, P.E. Consulting Structural Engineer Centerville, Massachusetts 02632 508 771-7601 EXISTING RESIDENCE FRAMING Drawn By: MC Date: 10 14 09 i i Drawing 24 HARBOR BLUFFS ROAD Scale: AS NOTED Rev. T� HYANNIS, MA 0 S K— 1 File Nanne:Jasinski Project No.:2009-149 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 3 egg, _ Permit# 2 2 Date Issued Fee 2 I �� xTax Collector ,r. Treasurer Q. Ak ow Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address d iL- Z31oll�-P Village -� Owner � n �A51NS�C Address 01 H A2r502 WuC- Telephone L+S� Permit Request na t-P hr vs 6 r h,AnQ iE roY- 5-'ito& A D� di 57"ALC. nge ll-) 6 8,eAI, =r lA_D ba,aD fgnAn- 4 h P UKE Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost t0gopo"'o Zoning District Flood Plain, Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family �ff- Two Family ❑ Multi-Family(#units) Age of Existing Structure a5- Historic House: ❑Yes 3"o On Old King's Highway: ❑Yes -No Basement Type: J.Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing C new Half:existing new Number of Bedrooms: existing new ' Total Room Count(not including baths): existing. (4 new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil S.Electric ❑Other Central Air: ❑Yes )&No Fireplaces: Existing V 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 " a BUILDER INFORMATION Name J Pe—V CoQ Telephone Number 3 9 $ Address License# a-5?2 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C�AaKX-rra4(X- L-.AN.D SIGNATURE ��� DATE _ 0 ' } FOR OFFICIAL USE ONLY r PERMIT NO. DATE ISSUED MAP/PARCEL NO. "= " ADDRESS E VILLAGE a OWNtR DATE OF INSPECTION: - FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL .. FINAL BUILDING DATE CLOSED OUT I 1 ASSOCIATION PLAN NO. , �� ,F _ The Commonwealth of Massachusetts — . 11 a _-" -- Department of Industrial Accidents office a/1085918 ORS 600 Washington Street • --.-. Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: :::�__7An3 ,MAC_,S r�� location 0-13 N)CQ�o nt, city P as uJ t C 4 61 f�' pa,1P L( 5 phone# A SO" I Cf Scl ❑ I am a homeowner performing all work myself �I am a sole rietor and have no one worlds in acity I am an emplI.oyer providing workers' compensation for my employees working on this job. . 1-1 comnanv .:::.>.:.�::...�::.�::::::::::::::. ..:::::.:•::::::..........:;: :.>::: :::.:..:.::.:;::::.:::.>:;:::.;:.::::::::::::::::::::.:�::::::::. .Ad egg ::;> ,..:::::::.:;:::";;:;;>;:: _.__ ;: .................... .:. cites::::::: «:: :::::::'>. ;:::;.:;;.:;;.>::.;;;,:;;. : _ n 'one .::::..:;...:::.::.::...:.::... insurance co ..:;........, oiicv# / .. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: . .>::.::::..;;:.: x.....::::.;:.;;:..;:..::.:. : .: comnanv name,;. 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Fafinre to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisomnent as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that e copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the painsand penalties of perjury that the information provided above is&w.and coned Signature \ Date 1 I 0 ° 1i< _ _ Printname = r-, ,J :��—P,,_- K5®r,9 Phone•# -4`�© n S ------------- official.use only do not write in this area to be completed by city or town ofiidal • city or town• perndtAicense# ❑Building Depsrbmmt Licensin Board ❑ g ❑check if immediate response is required ❑Selectmen's Ofce . __ ❑Hedlth Departmeot contact person: • phone#; ❑Other Ori;ed 9195 Pt q Information and Instructions r Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or`other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein.,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. >- _ Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure.to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the."law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided'a space at the bottom of flue 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 permrt/license number which will be used as a reference number. The affidavits may be re4ume`d io the Department by mai7 or FAX unless other arrangements have been made. _ The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. 1117 IMENE The Department's address;telephone and fax number: The Commonwealth Of Massachusetts .Department of Industrial Accidents Me of Iwesdoadons 600 Washington Street ' Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 f►&SHE r, .� The Town of Barnstable be • BAMSTnBLE. • 9eb 16 9. $' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date q` t o,qq 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: Estimated Cost f ©,ooO' Address of Work: a%A tA-NfZA®*_. \ Owner's Name:_(ro tee) �5 tL Date of Application: 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: i Date Contractor N e Registration No. OR Date Owner's Name q:forms:Affidav <'Sze �umvrrzo�uuea�e a�..; acluc�tel�r 1 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nueiber -.Expires: — RestrCcted'To BB sT IAN V ACKSON✓ 273 MAIN ST* c N HARWICH, MA 02645 J r �t -�.. j q.7y,tt ..�s r. �`?•,t 4; f� t� 7t� v�f: #.t y''' '�"A yam'' "• f..t ��`rir y j tt - t�-a" > ,:.' ✓Ae 71TONtlN9XOn(G�[4� I? v g� UHOME INPROVEMENT CONTRRCTOR. Registration 106523 ;, Expiration 7/23/OO ; Type � r a ,.JACSON CONSTRUCTION w t Ian Jackson':' ' ADMINISWMR m MAIN STREET"." . • HARYICH >_MA 02645