HomeMy WebLinkAbout0066 MULBERRY STREET (off Y-)
I
PERMITXPRESS
b ,
Town of Barnstable *Permit
2013 Regulatory Services a e�6n e
rssue
MRNEresr a.
T NSTABLE Thomas F.Geiler,Director
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 PE MT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address 6� ly w_a 2/Z 12 y � j . .Y/�/�� 14
I
Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address gQ'1,kx J i / 'WjU)4R.D 510/F F
Contractor's Name /4we emQ&q_,P. Telephone Number Q y,- 7.57
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance ,
Check one:
�❑ a sole proprietor
R 1 am the Homeowner
❑ J have Worker's Compensation Insurance J
Insurance Company Name
Workman's Comp.Policy#
_ Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
[v Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Dag P
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon,Monoxide detectors 4 floor plans marked wiih red S and,inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission..
A copy of the Home Improvement Contractors License&Construction Supervisors License is
r fi . -
SIGNATURE:
Q:\WPFaM\FORMS\buildmg permit forms\EXPRESS.
Revised 061313
M
.The Commonweah*of Massachuseits Depart7nent of Industrial Accidents
I Pike of Investigations
600 Washington Street
y Boston,Mfl 02111
wrwtu mass govldia
Workers' Compensation Insurance Affidavit:Builders/ContractarsIFle tricians/Plumbers
Applicant Information Please Print Legibly
Name(&esmesslOhgaBi�tion!Indivdua�}- f'i�70�2J �l/�/�" /
Address:-- S!.
city/State/Zip: -f A)15 (90 1 Phone i�--
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4- ❑ I am.a general contractor and.i
employees(full and/or port-time).
* have hired the sub-contractors 6. New constnrctiara
2.❑ I am a sole proprietor or partner listed can the attached sheet I ❑ �g
ship and have no employees These sub-contractors have 8. ❑Demolitim
working forme in any capacity. employees and have workers'
[No workers' comp-invxanre comp.msurADMI 9. ❑Building addition
rpf6mid_] 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions
3_ am a homeowner doing all work offic ers;have exercised dmir I LF1 Plumbing repairs or additions
myself [No workers.'camp- right of exemption per MGL 12_0 Roof repairs
insurance required_]i c_152,§1(4),and we have no
employees.[No workers' 13.0 0then
comp-insurance required]
'Any applicaaE that checks baa#i mast also fill oat the section below shawingtheir workers`caution policy infar�tioa
Fomeoaraers wba sabmit this afbd-Tot iadicatiog dbey are doing all wal and then hue oats&canumMrs must sobmit a new affidavit mdicatiag such_
IConuac m that chect this bar:mast attached sic additional sheet showing the time of the sab-ca�and stare whets arm of those entities have
employees.If the sob-raniractnrs have emplbyee%they Est provide their workers'romp.polkT munber-
I am an employer that isprouidh;g workers'cony nsattan inmr mce far my ernpluy ea& Beioow is the policy and job site
infot�rrahim
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 requited 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 fanm of a STOP WORK ORDER and a fine
of up to$230.00 a day against the violator. Be advised that a copy of this statement may be forded to The Office of
Investigations,of the DIA for insurance coverage won.
I do hereby an the pains. a of say that the ir�fot9rQatian provided above is bus and correct
Si Date:
Phone#:
OBkal use oanly. Do not writs in this area,to be minpieted by raty or town*jPc at
City or Town: Permitiffikense#
issuing Authority(oacle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone t!:
Town of Barnstable
Regulatory Services
�nrvsrwirE. `' Thomas F.Geiler,Director
a`6� 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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: V/3
JOB LOCATION: t�9� /��V`^✓L I�� I I - I I"v i 5
m=ba street .. village
"HOMEOWNER" v work hone#
name home phone# P
CURRENT MAILING ADDRESS: 640
I�YA-A1A(S / p�
crty/tnwn state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
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 and "homeowne ' es that he/she understands the Town of Barnstable Building Department minimum inspection
prose es an equire h will comply with said procedures and requirements.
• 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 EXMNffTION
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 pp tuon a form thaatt the en meown used b ce S that he/she understands the responsibilities of a.Supervisor. On the last page
Of this issue htoh �aunt towns.'You may care t amend and adopt such a formicertification for use in `
your community.
" C:\Users\decollk\AppData\Local\Microsoft\Vrmdows\Temporary Internet Ffies\ContentoudooMQRE6ZUBN\EXPRFSS.doe
Revised 053012
EVE ro Town of Barnstable
w Regulatory Services
LASS. �+ Thomas F. Geiler,Director
1639. 1�
' Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstablema.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must t
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
(Address of Job)
Pool fences and alarms are the responsibility of the`applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
QTORNMOWNERPERMISSIONPOOLS 62012
ICI
TOWN OF.,BARNSTABLE,BUILDIN.Q,.,1. PERMITIAPPL,ICAT.ION
71
Map- rf) - Par 'Application
Health Division Date Issued
Conservation Division Application Fee
Planning'Dept
Permit Fee'
Date Definitive,Plan Approved by Planning Board
Historic - OKH Preservation Hyannis
Project Street Address M V L S of.Al '61'
Village
Owner 14,051 `16�fwo 6W1 :f
Address
Telephone 514 Cf 1 4�0
Permit Request _aaoi; tl o owe idpaul, orz twio. p" 050*aeime r
film,m, &.)l ain, ffm jA*6?, j-wgj a wMr
► NO" A120A all *"-r W
Square feet: 1 st floor: existing—proposed '2nd floor: existing proposed Total new
Zoning District .-Flood Plain Groundwater.,Overlay
Project Valuation d,06,00 Construction Type
Lot Size Grandfatherod: Ll Yes LJ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family Ll Multi-Family (# units)
Age of Existing Structure &X5' Historic House: U Yes I(No On Old King's Highway: La Yes YNo
Basement Type: )(Full LJ Crawl LJ Walkout LJ Other
J
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing_) new Half: existing X new
Number of Bedrooms: existing —new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: -4 Gas U Oil Ll Electric Ll Other
Central Air: LJ Yes CdNo Fireplaces: Existing New Existing wood/co
stover]Yes)6 No
C__3
Detached garage: L11 existing LJ new size—Pool: L] existing LJ new size Barn: J exisling 046:96 -"gize—
rn
existing ❑ new size Shed: ❑ existing LJ new size Other:Attached garage existing Ll
to X T41 co>
Zoning Board of Appeals Authorization Ll Appeal # Recorded LJ
Commercial L3 Yes �No if yes, site plan review#
N)
Current Use Proposed Use W+Tth%--
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) 3 T;
602 � Lffl
rN a me-"' Tii7ep R081�M�LFIIUQ (V ICT TL -j so-n--e Number- -
I-Add ressi5 0 ti P Y"k _k1 ul)WS P�� License#
�11 A I NV 0 Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
&6)** CON 01'A-MVr10tA V�0- CONT4144 Fr%,
.SIGNATURE bA—MO 9
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
w
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
J FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
rF
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' a 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLibly
GNa enl Business/Organization/Individual): Ro 51 t9 rLj t E)_L
Add dr-e
City/State/Zip: IA lv '1 S 1� Phon�e..# C?zQ, J?pq C{ Lf b
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2. rtner listed on the attached sheet. T. 14 Remodeling
El I am a sole proprietor or pa
ship and have no employees These sub-contractors have g. Demolition
workingfor in an capacity. employees and have workers'
y p �'• -[No workers' comp.-insurance comp.insurance.t-
9. ❑Building addition
required.] 5. 0 We are a corporation and its 10.® Electrical repairs or additions
3.[ 1 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.
XContractors.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 maybe forwarded to the Office,of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of erjury that the information provided above is true and correct
S �' Date: 60.1 l
IPhe#:1, a_3q a "7 V
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 permittlicense 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 officiallystamped or marked by the city or town maybe 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=774
Revised l 1-22-06
WVAV.mass.gov/dia
ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00)
Applicant Name: Rc)51'Arry l ID, �� [Site—Address: r4 U(_ 7�tLR v 5wc
print TOR: 1 1�4f�
Applicant P_�_h n: 5bR 5?ZN q'j Lj b p
LApplic`ant Signa p , ��. Date-o ApPP ca66n,.
.o
NEW CONSTRUCTION: choose ONE of the following two'options)
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR
NEW ONE- AND TWO-FAMILY BUILDINGS
MAXIMUM MINIMUM
Ceiling or Slab
Option 1: Basement
P Fenestration exposed Wall Floor Perimeter
U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER
R-Value R-Value and Depth
National Appliance Energy
R-10, Conservation Act(NAECA)of
3 5 R-3 8 R-19 R=19 R-10 4 ft. 1987 as amended,minimums or
eater as applicable
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
❑ Option 2: 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 http://www.energ cY odes.gov/rescheck/
ADDITIONS OR ALTERATIONS.TO EXXISTING BUILDINGS.OVER.5 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 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 glazing is> 40 % proceed to "SUNROOM" section
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING
LOW-RISE RESIDENTIAL BUILDINGS
MAXIMUM MINIMUM
❑ Fenestration .Ceiling and Wall Floor. Basement Wall Slab Perimeter
U-factor Exposed floors R-Value R-Value R-value R-Value and Value
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
P�OFTHE t�ti
Regulatory Services
BARNSj"LF Thomas F.Geiler,Director
krAss
� yes¢ .•� Building Division
PlED a Tom Perry,Building Commissioner
--------_—__�.._-- 200 Main_Street,_Ay_annis,MA 02601_ _.. -------__,----- -----._.__ ..
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
i Please Print
DATE: OZ I n,` O 9
JOB LOCATION: U0
`�nu�mber street 2 village 1 ^7
"HOMEOWNER": SkRt,)\b,�l,rI 5b%- 53)A--4pp 3)40
name home phone# work phone#
CURRENT MAILING ADDRESS: 6D � �5 �`f♦j•.
T e ti®1� 1 1N11� CGL625
City/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
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 fans 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 buildingpermit. (Section 109.1.1)
The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that,he/she understands the Town of Barnstable Building Department.
minimum inspection procedures and requirements and that he/she will comply with said procedures and
quirements. •
h
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this.section_(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuring the responsibilities of a supervisor(see Appendix Q,
f 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 helshe 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 fonnlcertification for use in your community.
Q:forms:homeexempt
sra,� Town of Barn-stable
Regulatory Services
i •
i�►ss'BIZ, Thomas F.Geiler,Director
En.19. 16 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:
a •
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit ple mp ete.
Homeowners License Exemption Form on a reverse side.
Q:FORMS:O WNERPERMISS ION
_ .. ._. . _ _ - ._ -- -- r
y
I
, MPORT NT
ICONSTRUCTION2 0 SQ AT INCR€ - -
ANY TH EASE$ LIVING SPACE
QND t 0 -FT--PEFr EV
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- _._ :-,. _.:_.__.... lLlk;r�24.►y_( /..ta.v _U_ads;Q>+`t;_ LNSTALLATION !OF ADDITIONAL SMOKE DETECTORS
_$EPARATE_PERMIT IS REQUIRED FOR THE
INS ALLATION OF SMOKE DETEC O S THE ELECTRICAL -"
j,>s i�air
�.- _ _;._:— pERryjR pOES NOT$ATESFY-Tk11S OUIREMENT
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If o f Mamac4a6etb Official Use Only
A �]partment of ire Serviced Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (leave blank
lug
APPLICATION FOR PERMIT TO PERFORM ELECTR AL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C ,527 C 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: eJ
City or Town of: „ Aejtk"64f To the Inspe res:
By this application the undersigned gives notice of his or her intention to perform the elect a ork described below.
Location(Street&Number)
Owner or Tenant j Telephone Noc-56- :Z37-9///O
Owner's Address
Is this permit in conjunction with a building pe U9 Ye (Check Appropriate Box)
Purpose of Building ili uthorization No.
Existing Service Amps / Volts O d Undgrd❑ No. of Meters
New Service Amps / Volts h ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Propose lectrical Work: S
`o t N `� .
Com letion o the ollowin t e be waived b the Ins ector o Wires.
f Tota I
No.of Recessed Luminaires of Cer p.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No. f Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ o.of L iner
cy Lighting
PA rnd. d. BatteryUnitn
No.of Recep le Out le of Oil Burners 'Wh FIRE ALARNkNo.of Zones
No.of Switches No.of Gas Burners o. I D
Init ev s
No.o anges No.of Air Cond. Tonal No. ing D evi
No.o to Dispose Heat Pump waber.. ons K No,of -Contained
Totals: W Detection/Alerting Devices
No.of ish hers Space/Area g Local El Municipal her
Connection
of ers Heating liancis K ecurity Systems:*
No.of Devices or Eq valent
o. er , of o.of Data Wiring:
ters Si ns Ballasts )0)w No.of Devices ivalent
s` No.Hyd sage Bathtubs No.of Mot s Total HP Telecommuni ion firing:
No.of D Equivalent
y OTHER: NA
Wa la, diti de[aiI if desired, or reg red by the Inspector of Wires.
F— ? Estimated Value of Elec rical Work: D , ( n required by municipal p lic
z ' Work to Start: p Inspections to be reque ed i cordance with ME and upon completion.
INSURANCE OV GE: Unless waived by the owne o pe it for the perfo c f electrical work may issue unless
(�= the licensee provides proof of liability insuranc "c pleted operation"cove r its substantial equivalent. The
01 • 4 undersigned certifies that such coverage is in f ce, d h e ibited proof of e to a permit issuing office.
CL 92 CHECK ONE: INSURANCE ❑ BOND O ER (Specify:)
' I certify,under the pains and penalties of pert t t the information c this tcation is t e an omple .
FIRM NAME: LI
Licensee: J�(Jy1Q Q� /� Sig e
(If applicable, enter "exempt"in the license number line.) u
< Address: t
*Per M.G.L.c. 147,s.57-61,security work requires Departmen )eeoes
Safety"S"License: L
OWNER'S INSURANCE WAIVER: I am aware that the Lice not have the liabilityt
erage normally
required by law. By my signature below,I hereby wai requnt. I am the(check one ❑owner's agent.
Owner/Agent
Signature Te hone PERMIT FEI S
r
E The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
T Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
'LNali18 Busi en si/.Ocganization/Individual): (�(JA)A"�-b S 0)l I`'1
Address: A)UrR flyt ik-M-JS kh I >Q .Y4J4UOISR AL4 - ado`Zf
City/_Saate/Zip:•� Phone#: .�0 - 7 -�'�
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Memodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
� 9. ❑ Building addition
[No workers' comp.insurance comp. insurance.❑ We are a corporation �
--required-] 5. oration and its f 0.❑ Electf cal-repairs-or-additions..Z>
y 3-Qa am a homeowner d`o t—all work officers have exercised their 11.❑ Plumbing repairs or additions
'- -myself:[No-wor-leers-com :"'> right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp, insurance required.]
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is 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 certi -4rn7er the pains an n ies o jury that the information provided above is true and correct.
Si g' � ? ] Date:"-�y
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 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
Revised 4-24-07 Fax# 617-727-7749
www.mass.gov/dia
Town of Barnstable
o� Regulatory Services
` Thomas F. Geiler,Director
' SARNSTABLE,
MASS.
1639. A,m� Building Division
TfD MAt
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
Office: 508-862-4038 Fax: 508-790-6230
REQUEST FOR ELECTRICAL INSPECTION
ELECTRICAL PERMIT NUMBER
(Permit required in order to process inspection)
Today's Date Requested Date of Inspection
hereby request an inspection under Massachusetts
General
(Electrician)
Law chapter 143, section 3L and 237 CMR 4.02(3).
The installation will be ready for inspection at �'Zl(JIL
(Property Location)
Type of inspection requested:
❑ Temporary Service ❑ Service Re-inspection
❑ Excavation ❑ Rough Re-inspection
❑ Service Inspection ❑ Final Re-inspection
(� Rough Inspection for ($100.00 Re-inspection Fee)
CALRAf,9
❑ Final Inspection for
❑ Other
Owner or tenant f 9,0 A J R-b
Licensee's name, address, and phone
License number Licensee's Signature
This section to be completed by Barnstable Inspector of Wires
Inspection date . ❑Approved ❑Not Approved
This work was not approved for violation of the following Articles and Sections of the MA
Electrical Code:
Q:WPFiles:forms:electrequest
Rev:4/8/08
Barnstable Assessing Search Results Page 1 of 2
v
" [. /
Home: Departments:Assessors Division: Property Assessment Search Results
66 �J
Owner:
COCHRAN, MATTHEW E& ROSIANI DProperty Sketch legend .
Map/Parcel/Parcel Extension
310 /355/
Mailing Address
COCHRAN, MATTHEW E& ROSIANI D
y
66 MULBERRY ST
HYANNIS, MA. 02601
2005 Assessed Values:
Appraised Value Assessed Value
Building Value: $91,000 $91,000
Extra Features: $0 $0
Outbuildings: $0 $0
Land Value: $ 148,700 $ 148,700 Interactive Property Map: Ma re}durires Plug in:
Totals:$239,700 $239,700 I have visited the maps before
Show Me The Map ,
April 2001 photos available W
Sales History:
Owner: Sale Date Book/Page: Sale Price:
COCHRAN, MATTHEW E& ROSIANI D 4/15/1999 12201/178 $ 103,000
LORENTZEN, E R JR& HEWITT,J P 5/15/1996 10228212 $85,000
LABRECQUE, ROGER J&DENISE 8/15/1991 7657/022 $83,000
FLAHERTY,THOMAS J 4/15/1982 3473/274 $47,000
2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Land Bank Tax $43.51 Town Fire District Rates Other 1
$6.05 Barnstable- Residential $2.12 Land B.
Barnstable-Commercial $2.80
Hyannis FD Tax(Residential) $364.34 C.O.M.M.-All Classes $1.01
Cotuit FD-All Classes $1.28
Town Tax(Residential) $ 1,450.19 Hyannis-Residential $1.52
Hyannis-Commercial $2.39
W Barnstable-Residential $1.44
W Barnstable-Commercial $2.10
http://www.town.bamstable.ma.us/Assessing/Assess05/displayparce103.asp?mappar=3103... 2/22/2006
Barnstable Assessing Search Results Page 2 of 2
Total: $ 1,858.04 Due to rounding differences these values may vary
Land and Building Information
Land Building
Lot Size(Acres) 0.25 Year Built 1971
Appraised Value $ 148,700 Living Area 950
Assessed Value $ 148,700 Replacement Cost$ 108,290
Depreciation 16
Building Value 91,000
Construction Details
Style Ranch Interior Floors Carpet
Model Residential Interior Walls Drywall
Grade Average Minus Heat Fuel Gas
Stories 1 Story Heat Type Hot Water
Exterior Walls Wood Shingle AC Type None
Roof Structure Gable/Hip Bedrooms 2 Bedrooms
Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom
Total Rooms 4 Rooms
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/Assessing/Assess05/displayparce103.asp?mappar=3103... 2/22/2006
The Town of Barnstable
Department of Health, Safety and Environmental Services
mum = Building Division
1659.��� 367 Main Street,Hyannis MA 02601
Office: 508-790.6227 Ralph Cross
Fax: 508-790-6230 Building Commissior
Home Occupation Registration
Date:
Name: a is
Address: ( (a NLdLa,� s Village: VL7,t7WAU)
Type of Business: e. Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home
occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance.
provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or
odor, no visual alteration to the premises which would suggest anything other than a residential use;no increase in
traffic above normal residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject
to the following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,
located within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,
and there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke, dust or other particular
matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in
excess of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary
Home Occupation,and not within the required front yard
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or
one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and
not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of
the dwelling unit.
I, the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: / _ � -- Date: s —"f