HomeMy WebLinkAbout0215 MITCHELL'S WAY ,,�
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F Town of Barnstable *Permit#
JUL Expires 6 months to issue date
2 Regula.tory Services Fe
TOWN OF : awxr+s�rABLE, � Thomas F. Geiler, Director .
3 °. Building Division
prfb Ma'+
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508779076230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint .
Map/parcel Number _ 0 e) 7
Property Address f'
(Residential Value of Work ' ��✓` d - Cd Minimum fee of$25.,00 for work under $6000.00
Owner's Name&Address 17 �64
&,4
Contractor's Name fe&7- (fe)N f t INC- Telephone Number T e?—
Home Improvement Contractor'License# (if applicable)
[5orkman'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 be on file.
Permit Request(check box). /1
["Re-roof(stripping old shingles) All construction debris will be taken to ( fir
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/doors/sliders. U-Value (maximum..44)
*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 is required.
SIGNATURE:
r
Island Sd* andRoof ing
a division of RLTConstnxtion,Inc.
Proposal To: July 22,2008
Cynthia Pena
215 Mitchells Way
Hyannis, Ma.
We are pleased to submit the following specifications and estimates for roof replacement.
Remove existing asphalt shingles and flashings.
Install aluminum drip edge and pipe flashings.
Install 3 ft. ice shield to eaves, valleys, cheeks and chimneys.
Install 30 lb..paper to remaining roof.
Install 30 yr. Certainteed architectural grade shingles. .
Install ridge vent to all ridges.
Clean up and haul away debris.
We hereby propose'to furnish material and labor- complete in accordance with the above
specification, for the.sum of: $4,500.00
PAYMENT TO BE MADE AS FOLLOWS: Payment in full due upon completion
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner
according to standard practices. Any alterations or deviations from the above specifications involving
extra costs will be executed only upon written orders,and will become an extra charge over and above the
estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to
carry fire,wind damage and other necessary insurance. RLT Construction,Inc. carries General Liability
and Workman's Compensation Insurance. Certificates of Insurance provided upon request..
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are
satisfactory and hereby accepted. You are authorized to do the work as specified.
Payment will be made as outlined above.
Date of Acceptance: Signature l�ez
Start Date: Signature � .1177
J,r
31 Manni Circle Centerville, Massachusetts 02632
Telephone 508.420.5243 and 508.833.5249 • .fax 508.420.1776 • Em.dcaperoofer@caperoofer.com
Board oP.•rBuild� �Jea� �` ���uiee
low g Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 134286
Expiration
! ? 1T/22/2009 Tr# 133426
RLT CO "
TYPe DBA.
NST. IN ISLAND'
RONNIE TAyLOR SIDING&ROOFIN
fY fKl ..
31 MANNI CIRCLEt
CENTERVILLE;
i
' MA 023&2�'
Administrator
r
i
License or re 3
before the ex gistration valid for'Indwidul use o
Board of expiration date..If found my
Building Regulations an return to:
One Ashburton Place d Standards
Boston,Ma.02108 Rm 1301
i
CDI
t i _ .o tvand without.signature
,:r r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of 1-nvestigations
600 Washington Street
Boston,.MA 02111
wwwanass.govldia
Workers' Compensation Ynsurance Affidavit: Builders/Contractors/Electricians[Plumbers
A licant Information .
Please Print Le ibl
Namc(Businesslorganizahon/individaa): / r -,�,AJJ T I/LX—
Address:_
Ci t /State/Zi : /- sv Phone.#: V 6,
tY P l_ Pam? t
A,re you an employer? Check the appropriate bo)c Type of project(required):
1.�'I am a employer with _ 4. I am a general contractor and I 6. ❑New constriction
employees(fiill and/or part-time).* have lured the shb--contractors
2.El I am a sole proprietor or pad=r-
listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have g• Demolition
working for me in any'eapacity. employees and have workers'. 9• E]Building addition
comp.tnsurance.t
[NO workers' comp.instn ancC
5. [] We arc a corporation and its 10•[]Electrical repairs or additior
rt4 Tircd.] officers have exercised their 1 LE]Plumbing repairs or addtiom
3.❑ I am a homeowner doing all work
myself- [No workers' comp. right of exemption per MCrL 12 ❑Roof repairs
insurance rcq ire ]t c. 152, §1(4), and we have no '
13:❑ Other
employees. [No workers'
comp.mcnrancc required-]
Any applicant that ehx1cx boic#1 must also fill out the section below sbowing their wurkcre compazsatjon policy infomntion_
Homcowncrt who submit this affidavit indscatiag racy a=doing all work and thnn hire outside contractors uwst submit anew affidavit indicating such.
rContraetws that ohmic this box uvut attached an ndditiQml chest showing the name of the sub-contractoa and stain whether or not thosC entities have
cuTployers. If the sub-contractors have employees,they must pxvvidb their wmiccn'comp.policy number.
lam an employer 1naf is providing workers'eornpensas`ur:insurance far my ernplayees. Below is the.poucy.and job site
information.
inniranco Company Mim-
Policy#or Self-ins.Lic.#: Expiration Date:
rob site Aaaress: of s" dt,�i1-eje—I& �� Cityisb&zip.
Attach a copy of thewnrkers' compensation policy declaration page(showing the policy number and expiration date;
Failure to secure coverage as required tinder Scetion 25A of MGL c. 152 can lead to the imposition of criminal penalties of.
f =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 f
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DLA for ?ranct coverage verification.
I der hereby certify u the pains• enaLaes of perjury that the information provided above is true and correct
Si c: Datc: � -
are to be co bled b c' or lawn o rciaL
OT
Q ficin!use only. Do not write in this a, trrp Y uY .�
City or Town: Permit/Licetise#
Issrring Authority(circle one):
1.Board of Health 2:Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
RiightFax C1-2 4/23/2008 8 : 58 : 36 AM PAGE 3/003 Fax Server
ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 04-23-08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
MARSTONS MILLS,MA 02648
COMPANY
28Y2K A HARTFORD GROUP
INSURED COMPANY
B
R L T CONSTRUCTION INC
COMPANY
31 MANNI CIRCLE C
CENTERVILLE,MA 02632 COMPANY
D
COVERAGE
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
CO POLICY EFF POLICY.EXP
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $
CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $
OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $
FIRE DAMAGE(Any one fire) $
MED.EXPENSE(Anyone person) $
AUTOMOBILE LIABILITY s
ANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS BODILY INJURY(Per Person) $
SCHEDULE AUTOS BODILY INJURY(Per Accident) $
HIRED AUTOS PROPERTY DAMAGE $
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTOS AUTO ONLY-EA ACCIDENT $-
OTHER THAN AUTO ONLY:
EACH`ACCIDENT-.",$
AGREGATE=f "
EXCESS LIABILITY
UMBRELLA FORM EACH OCCURRENCE ? "$
OTHER'THAN UMBRELLA FORM AGGREGATE
WORKER'S COMPENSATION AND
A EMPOLYER'S LIABILITY UB-1051CO45-07 12-24-07 12-24-08 STATUTORY LIMITS ,"X
THE PROPRIETOR/ EACH ACCIDENT -i $ 100,000
PARTNERS/EXECUTIVE X INCL ' DISEASE-POLICY VIMIT ;$ 500,000
OFFICERS ARE: EXCL DISEASE-EACH EMP$'OYEE `.$ __,. 100,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO.THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
- _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
TOWN OF BARNSTABLE - EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
ATTN:BUILDING DEPARTMENT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY
200 MAIN STREET KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
:HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE
ACORD 25-5(3/93) Ramani Ayer
•t.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Map a Parcel Permit#
Health Division Date Issued
Conservation Division �> c(9 Fee .
Tax Collector
Treasurer
Planning Dept. ApPLICer1TN�STOBT,�1 Asl;
C01.1. ,•,
Date Definitive Plan Approved by Planning Board EN j1�; . ,v �Ivislorl Fklo TO
CONS`I`���0i ION.
Historic-OKH Preservation/Hyannis !
Project Street Address r-C S 6 "s Y
6
Village IY A)KS
Own er D c! t S P-enJffi Address I rc W'9
Telephone
Permit Request �A,I<io �> 0>C�� 3 Se(��y� S Q A� �dc��'''1
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—!'ice 1—U � R`ate
Square feet: 1st floor: existing proposed I® 2nd floor: existing proposed Total new
Estimated Project Cost /® 0'-730 Zoning District Flood Plain Groundwater Overlay
Construction Type c5—_A
Lot Size Grandfathered: ❑Yes O No If yes, attach supporting documentation.
Dwelling Type: Single Family U/ 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 -v/ /�-
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: - Full: existing new / Half: existing new
Number of Bedrooms: existing new NJ
4\'
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
\� P 9 9
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn.:❑existing ❑new size
1�1 Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
`J
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use S JA ac)oel I
r BUILDER INFORMATION
Name F's Telephone Number �� 3 r,3 �f 4
Address l c90 n T-11 6�( License# r du—
nA o _ ,-&/9, 3 02 Home Improvement Contractor# /c2 r 62t
Worker's Compensation# � s� S L- C. .570 7�{
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Do OT -S S t—"
SIGNATURE DATE _ Lf-a cf d
y FOR OFFICALjJSE ONLY
PERMIT NO:
DATE ISSUED t
MAP/PARCEL NO.
ADDRESS VIL•LAGE
OWNER)
DATE OF INSPECTION: 7
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FOUNDATION -
FRAME
INSULATION '
FIREPLACE _ «
o
ELECTRICAL: ROUGH FINAL ( ;
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING x '
DATE CLOSED OUT
ASSOCIATION PLAN NO. t f
t SIANDARD
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LAYOUT FLAN5 WALL 5ECTION5
%'. EX65TIMt ILDIN6 ID
cl
.. of ®'i O`
�
X 0 96.75" 96.75" 96.75"
7
(M X.) 6 (MAX.) 7�� 7 (MAX.)
3 1„
.1
`,
A � A 7
i �051 >
,.
1 Qn
'- -
5TUD10 ROOM -51DE-WALL (A)• 5TUD10ROOM - FRONT-WALL (B) 5TUDIO.ROOM 5IDE-WALL (C)
57'x 78 D :57"x 78"D , �9 c�
4,
ASSEMBLY pETA(L5 �,
ALUM.PANEL HANGER
CONNECTS TO WALLS UD5` 0
OR ROOF RAFTERS 0
SEE A OWABLE LOAD
C5TUDIO ROOM - FLOOR PLAN r � �\� TABLE FOR PANEL SIZES_ \Y� �
" NOT TO SCALE Q MINIMUM SLOPE 1:12 '°'� s
GUTTER FASCIA -
ALC V ABLE LIVE'LOAD TABLE FOR 11 FT. PANEL (WITH 10 FT. OR LE - SPAN) HEADER SUPPORT BEAM
,." , 30 PF 35 PS 40 PSF 45 PSF 50SF 55 SF '0 PSF �� .. TRANSOM(OPTIONAL)20 PSF 25 PSF ALU M.SLIDING
DOOR OR WINDOW 1..
3 HC' 3"HC 3"HC HC 3"HC 3"HG - 3"HG 3"HC+H 3"HC+H
TEMPERED GLASS "
�� 5 SLIDING DOOR ON SILL: 9 -
NC�I�E�S`FQR 5TUD10 ROOM CONSTRUCTION ei` SECTION WITH DOOR �
U F CHANNEL 0
At-� 0 0 FLOOR
'1.STRUCTURAL M BE1,05Ht,AR COMPRISE 4.WIND LOADS=20 PSF 10.ABBREVIATION
FOR 60 MPH EXPOSURE A,B;C D=DOOR 0
6663 T6 ALW'hlMJ�I F\bK65ION5 PROVIDED DECK/5LAB
BY CRAFT PkNUFACTURING COMPANY. 5. DEAD LOADS=5 PSF W �DOLI ON
I 6.DOOR AND WINDOW LOCATIONS& v �' TYPICAL STUD�(L(ZQOM SECTION
2:ALLOWAPtL ADS ARE BASED UPON WM-:VJtNDOW MULLION I OTlOSOALE
"THE �E550 OF THE ULTIMATE LOAD/2.5 51ZE5"ARE INTERCHANGEABLE. U CH�ArNNEL A
- OR THE O,'D AT SPAN/120. HC t OtJEYCOMB PANELS,
7.GLASS KNEE WALLS ARE y
3.HC'REFERS TO GRAFT-GILT HONEYCOMB INTERCHANGEABLE WITH PANELS. H=THERMALLY-BROKEN OF M PROJECT. CONTRACTOR:
PANELS WITH COATED ALUMINUM SKINS 8.WIDTH OF 5-WALL MAY VARY PER H-STIFFENER a�� AssrL�
DOOR/WINDOW LAYOUT UPTO 24FT. O/H =OVERHANG ��q, CRAIG J. ii ,
BONDED TO HONEYCOMB CORE MATERIAL Jars 10 x10 2 STU DI0 ROOM
9.AUTHORIZED FOR BETTEPLIVING (SEE SPAN TABLE5) a' c
&CONNECTED TO ADJACENT PANELS;WI1 H PSF=POUNDS/SQ.FOOT o, S;, UCTURAL
DEALER USE ONLY. 40324 GENERAL �^/j Y� UT
VINYL CLEATS OR H5.(PANEL5&AV ILift_ P=PANEL a DRAWN BY:CJJ DWG NO.:Em50-10-hc-5d w
AND 6"THICKNESS E• FT=FEET
ALUM.=ALUMINUM ®s "<'� `S�aL� SCALE:1"=50" DATE:7/19/99 A
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O F A E R I C A
A Greenhouse For Your Soul.
100 Otis Street•Northboro,MA 01532•Phone(508)393-0400•Fax(508)393-0340
4/22/00
The enclosed permit package is for the proposed building of a three-season sunroom
on a new wood deck. There will be no Electrical Work or Plumbing Work.
Included in this Permit package:
• Proof of Supervisor License and Home Remodeling Licensee
• Proof of Workers Compensation Coverage
• Debris Removal Plan
• Homeowners Permission to represent them in securing this permit
• Signed consumer information form for Sunrooms
• Engineered Plans for the sunroom
• Existing Deck Plan with upgrades
• Plot Plan locating all set-backs and septic system
Thankyou in advance for your assistance. Please call with any additional
information,you need.
Best Regards,
John Ester
Y s
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All
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Board of Building. Regui.ations and, Standards
One Ashburton Place -- Room 1301
Boston , Massachusetts 02105
Home Improvement Contractor Registration
Registration- 125168 'Expiration- 10/21/2001
e- Private Corporation
oration�
HOME IMPROVEMENT CONTRACTOR
iR tsration
12516
PATIO ROOMS OF BOSTON INC Expiration: 10to
001' '
JOHN ESLER `� `". Type. Private a io
100 OTIS ST r _
NORTHBOROUIGH MA 01552 ' PATIO ROOMS OF BOSTON INC
JOHN ESLER
ADMINISTRATOR `100 OTIS ST
j NORTHBOROUO MA 01532
✓, t� '� ,n" uf7�:",'m�. �f2e 1JOJYU/Y1.04'/.LIlP.2LLYL O�✓//LfIdQC�CJ7.G.dP.�i' "'
� k.•. _ BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
�Q Number.CS "' 074251
f Birthdate 03/09/1963
x s
Exp(res 03/ ,03' Tr.'no':- 74251'" ?
° Restrk�e o: 00
JOHN K ESLER s ✓
w. 100 OTIS STREET F,,
NORTHBORO, MA 01532 Administrator
t
t. .
The Commonwealth of Massachusetts
=1� -� - -
:I De artnierlt of liidustrial Accidents
600 Washington Street .,
Boston,Mass. 02111
��������/ Workers'•Com ensation Insurance Affidavit
�finfinr�f' 6�I %% / / t'"";'
name:
location:
city phone#
❑ I am a homeowner performing all work myself.
❑ I am a sole roprietor and have no one working in any ca acityZZ
I am an employer providing workers compensation for my employees working on this job.
company name:
address
city �v Z5`� J 3 Phone
Insurance co. nolicv 03: s(-
❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who
have
the following workers' compensation polices:
company name-
address:
phone#..
insurance co.
com anv name:
.......:..:
address: e
city. — phone#: ;: :::..:•::..;::;: ;;. ..:.
iesnranceco.. ..:...... :•. .::... oitcv#
ti
Failure to secure coverage as required under Section 15A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500,00 and/or
one years'imprisonment as well as civil penalties In the form of a STOP WORK ORDER and t<fine of SI00.00 a day again me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification.
I do here ertify under the pains and penalties of perjury that the information provided above it tru.-and correct
� ' Signature
Printnaiae
/ 5�- Phone#St"gy 3�3 - ��
# oflit uee only do not write In this area to be completed by city or town official
cfty:or town• permit/llcense 0 []Building Department
ti ❑Licensing Board.
❑check if Immediate response is required ❑Selectmen's OMce
_ ❑Health Department
contact person: -- phone M; Other.
mveo 4,05 P)Ai
vmu, N--_s-.:.—..�sv�.x- w ..,t:a
The Massachusetts State Building Code (780 CMS includes provisions to ensure that houses and
house -additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION
FORM is to be filed as part of the building permit application when a builder/contractor or homeowner,
constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a
special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR,
Appendix J, Section J 1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a
"sunroom"of any size, configuration, orientation, form of construction or percent glazing, but rather is only
intended to assist homeowners in becoming aware of some of the important energy conservation and year-
round comfort considerations involved in selecting and utilizing a"sunroom"addition.
The connection of "sunroom" structures, to residential buildings may create comfort and' energy
consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In
the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list
of product and design , considerations that a homeowner may wish to consider before actually
constructing/installing a "sunroom". It is recommended that consumers carefully review these options with
their designer, builder, or contractor, in order to minimize potential energy consumption and/or house
discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired
are important considerations.
PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS"
• Solar Orientation and Natural Shading
• Type of Glazing
• Insulating value
• Solar beat gain '
• Frame materials
• Glazing to frame sealing and gasketing materials/seal durability and/or
4.
weather tightness of the sunroom
• Adequate ventilation-Operable windows and fans _
• Applied Shading Systems
• Insulation level in floors,walls,and ceilings
• Possible Sunroom isolation from the main house via a wall and/or door or slider
• Heating and Cooling Methods: Efficiency,Zoning and Controls
Homeowner Acknowledgment
The Massachusetts State Building Code, Section J 1.1.2.3.1, requires that.the actual property owner(not the
owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to
issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential
building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read
the information in this do ent concerning sunroom comfort and energy conservation.
Signature of ActualzBuilding Owner Date
La
Print Name Addr ss of Permitted Project,
Owner Address(if different than project location) Owner's telephone number
_ • ; Jam$ ��� ���Y ��;�.� -
vN •
�, 1 .a� ..
Exception:Sunroom Additions/Consumer Notification:,Suarooms, as defined in 780 CMR
A pan lse Jx;o fC�► 1 t1,f4Ft°yC lgl�aliF if u exuir�nt 60in tha ac tipllet co requirements set firth In 780
CMR J1.1.2.1.1 and J1:1.3 provided that the actual property owner(not the owner's agent or
representative)of the structure onto which the sunroom addition is being made, provides a signed
copy of the Sunroom"CONSUMER INFORMATION FORM"(found in 780 CMR, Appendix B)
to the Building Department. This signed"CONSUMER INFORMATION FORM" shall be
submitted to the building official as a requirement of building permit issuance, and shall remain as
part of the construction documents. If such sunroom additions are separated from the main house by
a wall and are conditioned spaces, then a readily accessible manual or automatic means shall be
provided to partially restrict or shut off the heating and/or cooling input to the sunroom addition
space. That portion of a wall that separates the sunroom addition from the existing
building/dwelling unit, if an existing exterior wall,shall be allowed to remain and neither that
portion of said wall or any fenestration within said portion and common to the sunroom addition,
need comply with the thermal envelope requirements of Appendix J.`
6 l
780 CMR J2.0 DEFINITIONS
SUNROOM: An addition to an existing building/dwelling unit where the total area(rough opening
or unit dimensions) of glazed fenestration products of said addition exceeds 40%of the combined
gross wall and ceiling area of the addition.
� o . n irate
r..
oun IntYIZ
Sn11i.1K2+.1. L{k' .'sluhNYWMW ..PwA.N.W?Jw 1
Property Owner Must Complete and Sign This Section If Using A Builder
I, LZ J)oa ��A) as Owner of the subject property
hereby authorize Betterliving Patio Rooms (d.b.a. —Patio Rooms of America) to act on
my behalf, in all matters relative to work authorized by this building permit application
for(address of job) pp
Signature of Owner Date
Owner or Builder (as Agent of Owner) Must Complete and Sign This Section
as Owner/Authorized k
Agent hereby declare that the states cents and i formation on the foregoing application for ,
(address of job) ID M y-3" are true and
accurate, to the best of my knowledge and belief.
Signed under the"pains and penalties of perjury.
Print Name
Signatu of Owner/Agent Date
r
The Town of Barnstable
Department of 8ealt1i Safety and Environmental Services
pry ► Building Division k '
367 Main Street,Hyannis MA 02601
Office: 509-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commission:
For office use only k _
Permit no. ~
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. I42A 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. Est. Cost . > 6a -
Address of Work:
Owner's Name L_Q3\_>_ � ��
Date of Permit Application: — �
i hereby certify that:
Registration is not required for the following reason(s): ,
Work excluded by law,
Job under SI,000.
m. 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. I42A
SIGNED UNDER PENALTIESOF PERJURY
'. •, [hereby apply for a per as the agent of the owner.
w Contractor Name Registration No. .
Date,
'
OR
Date' Owner's name