HomeMy WebLinkAbout0092 NOBADEER ROAD � �a �odoeee,- r�
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Town of Barnstable
�•+�no, Building Department Services
Brian Florence,CBO MPS S��
EARMN Building Commissioner F gPF��
200 Main Street, Hyannis,MA 02601 �a�N
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
f aaa�
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PERMIT# �D. LTVI
p FEE: 3� 5.,_00
CA
SHED REGISTRATION
RESIDENTIAL ONLY ` Z
200 square feet or less ' o m
O
Location of sh (address) Village
IYX44 r�name � Telephone number.
.
M
Size of Shed Map/Parcel#
- ail
3 �a .
Sign ture Date
Hyannis Main Street Waterfront Historic District? t/
Old King's Highway Historic District Commission jurisdiction? / 3
You must file with Old King's Highway
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE
ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION
FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A
PLOT PLAN.
Q-forms-shedreg
REV-08/6/17 '
x
File rrieniber:
19111425 i UNREGISTERED LAND
JEFFERY JOHNSON,ESQ. Deed Book
Attorirev: Lot s
Lender:
QUICKEN LOANS,INC. Plait Book Page
MARTHA LEANDER&THOMAS MCCALLUM,TRUST ` REGISTERED LAND
Owner: Reg. Book 40592-C. Skeet Logs): 23
Date:
11/19/2019 Certi rcate a T itle 202897
Blk: Lot I Census Tract
Assessor's Nlti
ivioRTGA.GE INSPECTION PLAN Scale:
92,7VORADEERR0,4D, CENTERVILLE, 114
r
ILO ; 24 y E'
, i A
170.01
_ I
50
49 AC
(jam i DK f
2 STY ' LOT 24
#92
�YA • ... .
r -,STN DR'. ;,,
tK
113.36' .
NOBA '' FFP ROAD
CERTIFICATION
THE MAIN BUILDING,FOUNDATION OR DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS IN EFFECT WHEN
CONSTRUCTED(WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY)OR IS EXEMPT FROM.VIOLATION ENFORCEMENT
ACTION UNDER MASS.GENERAL LAW TITLE VII,CHAPTER 40A,SECTION 9.
FLOOD DETERMINArION
BY SCALE.THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY '
,e mA Ie-Ac.•tI Ao V r%A9YH%fli/i4 nf%iA nv'nAr Nn nnNnl FI null INCI I ANf•F PR nr6R AM +
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�pFTMME t Town of Barnstable Permit#� � S
p Expires 6 months from iss ,date
Regulatory Services Fee
g Y 1.
BMWSTA LE,
Richard V.Scali,Interim Director
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
_ Not Valid without Redly-Press Imprint
Map/parcel Number41
Property Address �� 'N� Cl CJ�[/ (kc
.Residential Value of Work$ b, Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address VULI(!Ul i bwt
Contractor's Name 'V-pscc) aL"e7 Telephone Number 6-&p, 3 j5 j
Home Improvement Contractor License#(if applicable) t Z 1+3G13 Email: ,VIAILAV -ez?t_W
Construction Supervisor's License#(if applicable) CU(o ct Y,p
❑Workman's Compensation Insurance
Ohheec one:
►� I am a sole proprietor j ;� I
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance ' p'
Insurance Company Name N C, N( S C t'� a TOWN OF 13AR SSTABLE
Workman's Comp.Policy# 1 l'7- U(Z t l
Copy of Insurance Compliance Certificate must accompany each permit. .
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 1(Al fuvice.r;_A lit k
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
N'Replacement Windows/doors/sliders.U=Value O (maximum.35)#.ofwindows I (p
#of doors,
Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e:Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: �6&-2-c�
TA EVIN D\Building Changes\EXPRESS PERMIMXPRES , oc
Revised 061313
The Ccimmonwealth of Massachnsetis
Deprartraent of Indystrial.Accide+rts
Orce;of Investigations
600 Washington Street
Boston,J"02111
w►ew.mass goodia'
Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectricianslPhumbers
Applicant Information Please.Print Legibly
Nazne 79 MayhR'Rd.
Address:
City/State/Ztp_ Phone.
Are you an employer?Check the appropriate box: Type project.of (r �}-
L Q I am a employe with 4. ❑ I am a general contractor anal I
6.:❑New construction
loyees{foil and/or pact tame}_s have Hired the sub-contractors
2_ rla�mpn a sole proprietor or partner- listed on the attached sheet. 7. ;❑Remodeling.
scup and have no employees These alto contractors have $. ❑Demolition
working for m,e in any capacity_ employees and have workers'
[No works'comp_in +�rrsrrre comp.insurance-1 9. ❑Building addition
required] � We we a 5. corporation' and its 10.0 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 ofextniiptionper PvfGL 11F❑Roofrepairs
insurance requited]I C. 152,§1(4) and we have no.
:.employees.[No workers' 131Y Other (.
comp.insurance required.]
*Any Vphcmt that checks brae#1 mnst also fill out,the section below showing their workers'compensidoa policy infon=tion_
1 Homeawum who submit this affi lnV indicating they we doing all wait and then Lace outside contractors man submit a new afdwit indicating such_
TContractun that check this bax met xMiched an additional sheet showing the name of the sub-con>zactnrs and state whether or not those enti es.liz<*e
employees.,.lf the sub contractors bane employees,they must provide,their worken comp.policy number.
I am an empLo5mr that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 1 -( ` A J-S 6 t7
Policy#or Self-ins.lic. n 5 t(+ c� Expiration Fate: 9 — l Z 2G f 4-
Job Site Address:'�1Z 0% a City/State/Zip: L yt Vu i (t 62G&2-
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 ofMGL 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 ce o under the 'ns and penalties of perjury that file iuforntatiou provided above is true and correct
Signature; c-c!'' Date: I — ZCJ`-(
f
Phone M.
Offidlal use butt'. Da not W ite in this area,to be completed by city or town of cuaL
City or Town PermtlLicense#
Issuing Authority(circle one):
1 Board of Health 2.Building Department 3.City/Town Clerk 4 Electrical Inspector 5.,Plumbing Inspector
,. .. ,
Contact Person: ; .i Phone#:;
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
i M -A= -17
DATA
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ti4ti�e.t � PROPOSAL
79 W}fcilr Rd. .
SC-3.1th Dennis, MA Q2G-!)
zu'DuCou'raistdow cc E0_I_ _ L 7 3.
(866) 898-15-11 = T0II.IFr
($08) 3-98-1511 m Dennis,, MA
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!tt ob en TO i3 u4 1 a.'a 7Y .Aii 1R r di'a':f.f -a svrtn t n er-4'b;ras -
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tkd"1ys tct!- t CLr Coro J x?r._r 1C,ar 'l! It ti�A I: l u A•4_,:.�,1'irLr J:.{AY Mole: 1 1 u L r 1 1 ut .
r�.lr%Pti..a.9',.fq,::'r.SiuSC isyrl1:7.1 t.:.,.riga,:_'fi,cl nc,i r[r y�tt:'rtJra:Ytl F /C':if r'nr'a'•Cr pht+ a^.d11ir1 — ( .-
Acceptance of Proposal -Tnr:,��., jr�:i:::,:,;:.,di-xi:;t,::.;,1A .;i,- -----
�alrJ'r..J'U "1 �q_Il_t t t J a!' � , .9! J J. 'r:BJ'Lr>'s!S"'aa B!`i: }�!Yy 11•.L'hulk By
rf'�r �ul�Uru�drucrfl(/al('r1T/rrJrrc�(rJa/t� 4, �!
gtdco of boasurnbr.Affair s 8c Buainaas it gulntl'on i. Massachusetts Department of Public Safety
ME trytMpVEMENT CONTRACTGR' Board of Building Regulations and Standards
egistrafton 124793 Ty
Con.vtruetion Supervisor 1 2 Fumlly y
t}. $PR9ktl0n: 8/251201ti fndividuai I License:CSFA-0�. N0
I, ,tIIt
. � Vasco E.Nunez,111 � � VASCO E NMZ
79 MAYFAIR RW
Vasco Nune;, III
i ? South DennisMA'02660
.T. � ; 79 Meyfair:Rd•, �a�w+,+� �^ t' _ ' tJ�°J w�
t a:gennls,MA 02660 Ubdbracerntnry -. i' a�.M r�'` Expiration
II Commissioner 10/03/2014
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'*TCOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ® Par(el 1��� Permit#
Health Division -�- It ��_ � Date Issued �—
Conservation Division I fT- l Oa 1-2 Fee,,a
Tax Collector soya� D k — I`� L — 7 1111 APP t� � � �j!�d
Treasurer — h — SEPTIC SYSTEM MUST DE
Planning Dept. INSTA:.LED IN COMPLIANCE
TITLE 5
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANU
Historic-OKH Preservation/Hyannis TOWN REGUL TIONS
Project Street Address o1U0.a� a
Village
Owner Address 9, b GA fi=�- �i c�.
Telephone 5 oSs' - y7-7 C36 9 c
Permit Request 1b"X, 1g f1�_Vjs-:I�,
v,
a
Square feet: 1 st floor: existing proposed 2g� 2nd floor: existing proposed Total ne
ry r
Valuation ag c5751z:> a Zoning District Flood Plain Groui idwater Overlay
Construction Type -Sk
Lot Size �;;Z_ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
v
Dwelling Type: Single Family a Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes -,A No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
p Number of Bedrooms: existing new
Total Room Count(not including baths): existing new 1 First Floor Room Count
'Z Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other t\�l-
Central Air: ❑Yes A No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes_ _O No ,1_ If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name�r. suJ N�c�ari��oO\\CMS Telephone Number
Address i 60 o,�S s License# 0-2 C)9 q$
:�� �. \•mot <2) Home Improvement Contractor# \ 5� h!F<
Worker's Compensation#35 u�RC ss Z!I-3,S
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IL . L S(3Y
SIGNATURE DATE d��
FOR OFFICIAL USE ONLY ?,
i •
PERMITNO.
DATE ISSUED
MAP/PARCEL NO.
_f}r.
,b
ADDRESS VILLAGE
OWNER
t
P DATE OF INSPECTION:
FOUNDATION
FRAME
Y
f INSULATION
r
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH '-- FINAL
FINAL BUILDINGrp
t'?
0
DATE CLOSED OUT
ASSOCIATION PLAN NO. -"' `_+ s'
4
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10'-2"'
EXI5f6JG 6'POOR—FROM HOUSE PROP05W NEW DECK I6'x28'x26'(APPRO))
1.2X5 Pf FRAME @ 16"O.C.
2.LE196H BOLTED I/2"15"LAC45 52"O.C.
5.J015f NANC,ERS ALL ENDS
2 4.DBL 2X8 Pf EN17 BEAM(HV 7EN)
5.DBL 2X$Pf M67 SPAN BEAM
6.VL3L 567E J0t5f5
7.(17) 12"0 X 46"DEEP FIGS W/ANCHORS
6.5/4"3CA PLY OWPLAY
A 15'-10" 9.6X6 PO5T5
10.5/4"X6"Pf DECKING
It,SfAIRS
4 4 4 4
PROP05ED 3 5EA50N PORCH
I6'X 18'(APPROX)
5fUD10 5MV ENQ051.9
4-1/2"EP5+ H ROOF 56TEM ' / SfAIR&RAL
SPAN) V'WH RAG,
II"TWPV
8"95E
4"BALUSTER SPACe
-- NEW 6 DOORS
FROM PORCH
(NOf SHOWN N
7HI5 VEW)
II�II—II—IV1&1 II I Ell IIIC-ll�lPl� , ROLE,
���I�I��I—I II �rfff
Nlh 1. +ICII ll ��II 11�'I � Eq
ly„1F
LJ, �J LJ J LJ LJ LJ LJ LJ
Proms SC'&1/8"-1'-0" Drawmq;
etterl wiving MOON P�51P�NC�
OMADEER ROPV
PATIO ROOMS 92 N
I CENT R&LE.MA02652-2566
1 (508)W Otis)3393 004M�C WS)�393 aM
a„ 1.'� •' 4} ,�}' ,,� ¢ ....
LAYOUT GLANS WALL 5EGTION5
EX15FING BUILDING
(�i7 '.�ji�', t CAN t" 4•� - 4 {
I - ..t,
96.75" r �... 96.75"
° (I•AAX) 3' (-57" 63" (MAX) 6
>;
63" 57� 3"
v v- -3 5TUDIO SIDE WALL(A) STUDIO SIDE WALL(C)
d a r
A55EM13LY DETAIL5,��d js
Y { r ALUM.PANEI-HANGER
CONNECT5 TO WALL 5TU05
OR ROOF RAFTERS i f 1
u d 96.75" 5EE ALLOWABLE LOAD
;,. DM DM (MAX) TABLE FOR PANEL SIZES
63"x781J 57"x78"D 63"x78"D
MINIMUM SLOPE 1:12 �Y
B WALL ,
—\
M 16'2"-1 SS ctc __I j .GUTTER FA5CIA —Lys
` STUDIO FLOOR PLAN
(NOT TO 5CALE) _ \—HEADER 5UPPORT BEAM
5TUDIO.FRON1 WALL(13) ALUM.SLIDING TRANSOM(OPTIONAL)
'
ALLQWAB-LE-LI-VC-LOAD TA13L'E_COf:1-7-F-T-.-I'-ANFL--WI1=H 16-F_T._01:_LL-SS_SFAN- _ �.:•
DOOR OR WINDOW —
20 PSF
4.5"EP5-+FI 52 PSF 4305 PESP�PS cFtiI..>JI 65"EP5F+I I 4 P5P 50 PSF , 6--�0 P SFTEMPERED GLA5 5 --
h.5"HG i-H h.5"HG+H "I G+H6"HC+H 6EPSi1 SILN
E SLIDINGDOOROOR45P 6"EPS+H 6"EP5+ NWITH SECTIO
°•""° FLOOR CHANNEL 5TUD10 CONSTRUCTION
i m
�F tj
t' 4.WIND LOADS=20 PSF 10.ABBREVIATIONS c hQ cnAiG (,
1.STRUCTURAL MEMBERS 5HALL COMPRISE r ti d JOHN m n _——
606316 ALUMINUM EXI"RU510N5 PROVIDED FOR 80 MPH EXP05UKE A,B,C D DOOR Joss DECK/SLAB-------I —1
DM=DOOR MULLION m sss s 4
5.DEAD LOADS=5 PSF 3 :° TYPICAL 57UDI0 SECTION
BY CRAF7 BIL{,M%+NUFACTURING COMPANY. 6.DOOR AND WINDOW LOCATIONS W WINDOW, 90 ��c ��.'
3.ALLOWABLE LOADS ARE BASED UPON WM_WINDOW MULLION T�°^••E��S°•o?',. NOT TO SCALE
THE LFSSOR<OF THE ULTIMATE LOAD/2.5 ARE INTERCHANGEABLE. U 'U G"ANNEL �`°' ]S ONAt t'�rr'
OR THE:LOAD AT SPAN/120. 7.GLA55 KNEE WALLS ARE I IC=HONEYCOMB PANELS �i --— `" --
�' �N OF sjq',T 'PROJECT: CONTRACTOR.
L--i.HC/EP5 REFERS TO CRAFT-131LT 5TRUCTURAL INTERCHANGEABLE WITH PANELS. EP5=POLYSTYRENE PANELS �1.
J�cy t
PANELS WITH ALUMINUM SKINS BONDED TO 8.WIDTI LOF B WALL MAY VARY PER H=THERMALLY BROKEIJ / cn . 16-0" x 16 2"
I IONEYCOMB/POLYSTYRENE GORES(� 4'h' DOOR/WINDOW LAYOUT UPTO 2hFT. ALUM fi STIFFENER 8 J0/H=OVERFIANGSTRUALAND6"TIIICY.NES5E5.. 9.AUTHORIZEDFOP,15ETTERLIVING n - STUDIO ENCLOSURE
P5F=POUNDS/50.F001 F 1 DWG NO.:
ADJACENT PANEI-5 ARE CONNECTED USING DEALER IJSE ONLY. P=PANEL ���IST�Pti% DRAWN BY:CJJ GENERAL LAYOUT
em5O-l6xl6.clwg
VINYL CLEATS OP.I Is. FT FEET �, I; Fx��;-.t � SCALE:1"=50"
ALUM.=ALUMINUM ;aq'�i DATE:11/27/'L000
Il(`
The Commonwealth of Massachusetts
_ - Department of Industrial Accidents
Office effnyestigalfens .
_ 600 Washington Street
- Boston,Mass. 02111
`r--� Workers' Com ensation InsuranceAffidavit
name
location: NO DAID
city r ~ f_yt L,L vhone# S —7 6 7 UG
❑ I am a homeowner performing all work myself
❑ I am a sole pr rietor and have no one workdn m* capacity
I am an e 1 er_ rovidin workers' compensation for my emplogees working on this job.::.::::::::::: :: :,:,,•:::::::::.::
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is ::.t.::•:.::.::............
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❑ I.am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who
have
the following workers compensatioohces:
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t..................
Fafiure to secure coverage as required under Section 25A of MGL 152 canlead to the imposition of ciitninal penalties of a fine-ap to S1,500.00 and/or
one years'imprisonment as well a,dvil penalties in the fo of a STOP WORK ORD�R and a Sue of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Mce of estigations of the DIA for coverage verification.
I do kereby vdedabnveisttr-true co set
certifundert uins -pen hinf- ry formation-pro
Signature
Date ✓ � '
Print name
TJAL�J`1 -' ::Phone# �OS'���3
of icialwe only do not write in this area to be completed by city or town official
City or town: permiVUcense# OBuflding Department
OLicensing Board
❑checkif immediate response is required ❑Selectmen's Office
❑llealthDepartment
contact person: phone#; _OOther
(devised 9/95 P7Ea
Information and Instructions
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 M:
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 i,s
of Industrial Accidents. Should you have any questions regarding the"law".of gf.you
being requested, not the Department
are required,to bib tain-'a workers' compensation policy,please call,'the Department at the number listed below:.'
1111101
City or.Towns
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. Plea�e•�
be sure to fill in the' ......
rn thicense numbei which wabe used as a ref&ence number. The,affidavits may. e're necC
the Department by,mail or FAX unless other arrangements have beenmade:
�. :.
ce for you cooperation and should you have an estions,
o thank you in advance Y Yam..
The Office of Investigations would like t y Y ,. P . . _ -•„ _
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
Ofilce of investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727.7749
: : phone#: (617) 727-4900 ext. 406, 409 or 375
board of Building Rcgulgkm �. =-,_ vj,�. 1
- _ Li A:se or reostrkion d ,._; indi �: use onb)
HOME IMPROVEMENT COIiT.Rk. ' aF
oe_`o e the t't ea�pira ion dare. If.sound re` t m.f:o:
P.egistr t;on 125 io5 AM o BuadAt Agu!.a_ion: and 'tand_rds
10/21/G3 Om As brown 1?iam Rm lm
Expiration :
BovAn,I1 a.02108
Ty -Private Co p�-aik-i
PATIO ROOMS OE:W O� It\lC
ANDREWS MALONE'
100 OTIS ST
...........
NOR T HBOROUGH, MA 01 532 T --- - ----...--- ------— - --
Administ- ar dot S4iid v,ithaut si .at4re
l
RO OF�u'SL CJII�'v?E:ULA IONS -
A,. Lien>e: CONSTRf!COON SO ERVISOP
�ati� F Number: CS 07099B
t
)pir Tr. no: 7227
Xvw
Restri Cied To: 16 :
ANDREW T MALONE i
41 WASHINGTON-ST':r:2
NA7 ICIC, MA 01750 =`,d nhAtmt-or
A"IMAVIT
in accordance with Article 1 Section 114.1.3 of the
Massachusetts State 3uilding Code, I certify that all debris
resulting from work associated with Pex=ait #
will be properly disposed of at Q_ R69VC-'T"9 Saltily ,
licensed solid waste disposa! facility as defined by �MGL
C11, S150A !
Signature of Permit Applicant
E .L . HA R V E Y & S O N S ire r r�conzr
68 HOPK 1 KTON RD ?riint Name of applicant
WESTBORO , MA 4
(R E 13 5)JABI i3ET �L�V�1�G Pd�► Q �1'!
Firm Name (if any)
/OJ O
1 /',��/ Address
Effective September 12 , 1991 the Departmezlt of 'Health/Code
Enforcement acting under Chapter 2 Article 13 of the 1986
d_ f f rai�cr�naal n�
WQrce$ter iceVlaCu v1 LL111 Qii%c5 %cil icut �.ro...� .-c---^
debris generated as a result of this permit. The proof
shall be a dated and signed receipt from the licensed
disposal facility containing rbe following information,
?� description of the debris, the weight and volume of the
debris and the location of the disposa l facility. The
receipt must also have a signature of the owner/operator of
the disposals facility.
y
Failure to-comply with the requirements of r-bis Ordinance
will result in enforcement action by the. City.
` TOTAL P.02
°FIHE r Town of Barnstable
Regulatory Services
" BAmsraBM ` Thomas F.Geiler,Director
v� 039.
MASS.
A,E A Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: < �c-w 1 /Wou —Estimated Cost C,U
Address of Work: 1
G
Owner's Name:_ =1 �
Date of Application: -7 S 1��✓
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 P ALTIES OF PERJURY
I he eby apply for a pe as the age f e o r:
30
ate Contractor Name Registration No.
OR
Date Owner's Name
Q:forms:homeaffidav
i
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EMSTING SPACE
square feet x$64/sq.foot= x.0031=
plus from below(if applicable)
ACCESSORY STRUCTURE>120 sq.ft�
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf-1500 sf 100.00
>1500 sf-Same as new building permit: x.0031=
square feet x$96/sq.foot=
STAND ALONE PERMITS
Open Porch x$30.00=
. (number)
Deck __x$30.00=
d0
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00 -
Above Ground Swimming Pool $25.00
Relocation/Moviug $150.00 //ll
(plus above if applicable) Permit Fee
ptojcost
.. Yrecriptlre Packaga for Uea and Twe-Famitl'Rdidaa�slai BelWiep Anted with Foaa1 Fe+h
MAXIMUM I1lmYIIHUM
Glaring . Glaring ceiling Wail now Baoemeat Slab 1II EmQ=cyl
Airs'(/.) U-value R-valud R-valuef Rrvabof Wall Paimm=
Fadra�e R.vaivas ��
5"1 to 6500 Haab De6rs+e Dam Nnttssri
Q 12% 0.40 32 13 19 10 6
R 12Y. U2 30 19 19 10 6 N=md
S 129,11 0.50 39 13 19 10' 6 95 AFUE
T 15%. 036 . 39 13 25 WA Wf Normal
U 15•/. 0.46 3E 19 19 10 6 Nomsal
V IS% 0.44 3E 13 23 WA WA 15AFUE
tS AFUE
W 15•/8 032 30 19 19 10 6
X 18% 032 38 13 23 WA WA Normal
Y 19% 0.42 Is 19 2S WA WA Noma!
Z 120/6 OA2 39 13 19 10 6 90 AFUE
AA 18% 030 30 19 19 10 6 90 AFUE
I•. ADDRESS OF PROPERTY: NO
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING:
4. %GLAZING AREA(#3 DIVIDED BY#2):
5: SELECT PACKAGE(Q—AA-see chart above):
NOTE: OTHER MORE INVOLVED METHODS-OF DETMUAINING-ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
BUILDING INSPECTOR APPROVAL:
YES: NO:
g4bmis-080303 a
Footnotes to Table J5.2.1b:
' Glazing area is.the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and
basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall
area. expressed as a percentage. Up to 1%of the total glazing area may be excluded.trom the U-value requirement.
For example,3 ft=of decorative glass may be excluded from a building design with,300 ft of glazing area.
= After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for
whole units:.center-of-glass U-values cannot be used.
The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full
insulation thickness.over the exterior walls without compression, R 30 insulation may be substituted for R-3 8
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the stun of cavity
insulation plus insulating sheathing(if rued). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include
exterior siding, structural sheathing,and interior drywalL For example,as R-19 requirement could be met EITHER
.by R-19 cavity insulation OR R 13 cavity insulation plus 1-6 insulatnig sheathing- Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction.
'Th e floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements,
or garages).FIoors over outside air must meet the ceiling requirements. '
Tl:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must
mcct the same R-value requirement as above-grade wails. Windows and sliding glass doors of conditioned
br. with the must be included w the other glazing. Basement doors must meet the door U-value requirement
d-scribed in Note b.
'The R-value requirements are for unheated slabs.Add an additional R 2 for heated slabs.
' If the building utilizes electric resistance heating use compliance approach 3;4, or S. If you plan to install more
than one piece of heating equipment or.mom than one piece of cooling equipment, the equipment with the lowest
efficiency must meet or exceed the efficiency required by the selected package-
9 For Heating Degree Day requirements of the closest city or town see Table J5.2.1a
NOTES.
a) Glazing areas and U-values are maximum acceptable.levels.Insulation R values are minimum acceptable levels.
R-value requirements are for insulation only and do not include st ucUrai components.
b) Opaque doors in the building envelope must have a U-value no greater than 0.3-5.Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U=value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
c) If a ceiling,.wall,.floor,basement wall,slab-edge,or crawl space wall component Includes two or more areas with
different insulation levels,the component complies if the area-weighted average R value is greater than or equal to
-
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). .'
43
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aino
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-rat-� J=
En
D_-
r -
•H'. ••� v5,7'YL,;, �, �..:�.C,CO�SUM. ER�NFORNL'A:'I'ION°FORNi�U�20_QM�S,� ,,,,,r:.....:�:�r�G^�f],S�T .$`. w„..�..- �.:.y.a.n...a...�..�.ew::..........—n...r.�l.�c...�:'+.�.....y .n ��= ►.o.n.... �vhyLYAr i&•�r.
asa>3c uset afe uiIilin(T Codc(78U� NIR ;A}}�'�pcn_ r tSection l 3� '�
..r.�ar.�s.
The?Massachusetts State Building Code (180 CMI?) includes provisions to ensure.that houses and
house additions meet energy efficiency standards. This supplemental CONSUMER INFORMA11ON
FORM is to be filed as part of the building permit application when a builder/contractor or homeo*ner,
coristructing/instalIing a House addition with very large percentage of grass to opaque wall, seeks to utilize a
special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR,
Appendix J, Section JI.1.2.3.I). This FORM is not intended to prevent a horneoAmer from selecting a
"sunroom" of any size, configuration, orientatio'rl, form. of construction or percent dazing, but rather is only
intended to assist homeowners in becoming aware of some of the important enemy conservation and y ear=
round comfort considerations Involved In stlenincr and, 1jtill7_In,, a "sunroom" adQftFpn.
Ine connection of "sunroom structures to residential bui!Oin&s may create comfort and energy
consumption issues due to uncontrolled solar r7ain or uncontrolled radiation cooling of `she main house. In
the selection and corist-uctioIl/Installatiorl of"suilr oohs", included below is a noIl-requIred,.open-ended list
of product and desi_n consroeratIons that a homeowner may Nish to consider before actually
constructing/irstaIIing a "sunroom". It is reconi.mcnded that consumers'carefuIiy review these options with
their designer, builder, or contractor, iiI order to mirlirnize 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 "SUI TRQOINIS"
• Solar Orientation n:id Natural SIIad"Tig
• Type.of Glazing
TnsTutarir.g valr:c
Solar heat gain
Frame materials
Glazing to frame scaling and gasketine materials/seal durability and/or
weather tightness of the sunroom
• Adequate ventilation - Operable windows'and fans
• Applied Shading Systems
• Insulation level in floors,walls, and ceilings
• Possible Sunrooin isolation from the main house via a wall and/or door or slider
• Heating and Cooling Methods: Efficiency, Zoning and Controls
Homeowner Acknoivledg:nent
The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual DroDerty 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 ackno'wledges.that she/,le has read
the Information in this docu;-lent concerning,unroori comfort and energy conservation.
qgnature of Actua! Building Owncr ' Date
Print Name Address of Permitted Project
0,Amer A.ddress (if different thall project location) Owner's telephone number
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDm)
rJoseph
ODUCER 12/18/2001
MCKeone THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P WKeone InQUrenal�A00hoy, tht), I�p6gNC�T AMEND EXTENC�t.�ppR
P.O. �DX 9�;� eR a+9®vERAOE AFPifRORD R THE Po6(Cl a aeLpW1
Ann Arbor, MI 48100=0388
_. -
INSURERS AFFORBINd COVERAGE
INSURED patio Rooms of America, Inc. --
John Ester
INsuRERA: HARTFORD INSURANCE OF THE MIDWEST
100 Otis St, INSURER B:
INSURER C: ''—
Northboro,MA 01532 --- _
INSURERD:
---- -
COVERAGES INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE D TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUC_D BY PAID CLAIMS.
LTA TYPEOFINSURANCE POLICY NUMBER 1 FIFENATO
A GENERAL LIABILITY DATE MMIDD/YY DATE MMMDNY LIMITS
COMMERCIAL GENERAL LIABILITY
35 UUC 35019 11/01/2001 11/01/2002 EACH OCCURRENCE S 1,000,000
CLAIMS MADE
FIRE DAMAGE
OCCUR (Any one fire) $ 100,000
MED EXP(Any one person) $ 5,0_0_0
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000
POLICY PRO- LOC - PRODUCTS-COMP/OP AGG $ 2000,000
A AUTOMOBILE LIABILITY 35 MCC 302718
_ ANYAUTO 11/01/2001 11/01/2002 COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS - BODILY INJURY`
X HIRED AUTOS (Per person) $
NON-OWNEDAUTOS BODILY INJURY - $
(Par accident)
PROPERTY DAMAGE $.
GARAGE LIABILITY (Per accident)
ANY AUTO AUTO ONLY-EA ACCIDENT S
OTHER THAN EA ACC $
ExcEss ugBILITY AUTO ONLY: AGG $
OCCUR El CLAIMS MADE EACH OCCURRENCE $
AGGREGATE $
DEDUCTIBLE $ !
RETENTION S - $
A WORKERS COMPENSATION AND 35 WSC FI39.35 $
EMPLOYERS'LIABILITY 08/01/2001 08/01/2002 TORY LIMITS ER
E.L.EACHACCIDENT $y 1,00D 000
E.L.DISEASE-EA EMPLOYEE $ 1,000,000
A OTHER - E.L.DISEASE-POLICY LIMIT $ - 1 000,000
PROPERLY 35 UUC 35019 11/01/2001 11/01/2002 Includes Richo;Copier AFFIC10270
Account 41997706 to include Theft
DESCRIPTION OF OPERgTIONS/LOCATIONSWEHK:LES/EXCLUSIONS ADDED BY EI OORSEMENTlS PECIAL PROVISIONS
Certificate Holder is additional insured
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
`` SHOULD A OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
INSURED COPY i DATE THERENYOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 . DAYS WRITTEN
- - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER,Its AGENTS OR
REPRESENTATIVES. _ -
AUTHORIZED REPRESENTATIVE
ACORD 25-S(7/97)
O ACORD CORPORATION 1988
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j °Find that: �� aa 3t
f�'l�e ertruoture(f�}` are;loeated site as ►` tH OF "�As '•�,* �_
line°.ar�d .f.ne o 'ooaupa't3an o�i the ��� wI�LfAM ta, y��•��
te°are`ag :shown hereon F y _
"18;'site is �situateCl, r' w
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,ssessor's map and lot number ............................................ T E to
�oF
Sewage Permit number ........................................................
339RA9TAILE,
MAS&
House number ........................................................................
1639-
TOWN OF BARNSTABLE
BUILDING ' INSPECTOR
APPLICATION FOR PERMIT TO ................ ..........
TYPE OF CONSTRUCTION .... . . ... . . .. ............................................................
71,1 �
..... .. 2 ...
...
CP9
. ....
TO THE INSPECTOR OF-BUILDINGS:
a
The undersigned hereby applies for a permit ccording to the fo wing information:
...................
_ )
Location .......... 0.
ProposedUse /�,�..........................................................................................
..................................... :7:
Zoning District ...........:If?_
...........If?_��Av: Fire District ..... ....................................................
............
Name of Owner ...... ......... ........... ...........Acldre)s�_..,
� � ;
2— ..............................................................
Name of Builder Ir.......................Address ......................
....................
Name of Architect), Aciclrek�
/
Foundation .... .................
Number of Rooms ..................�5............................................
V
Exierior ...Roofing .......................
Floors -z . . . .
. ..........................................
........................................................Interior ..... ....... .
Heating ..................... . . b i nA1-?j
................................ ....... .............L
Fireplace .................... ............... .............................Approximate Cost ........... ..................................
Definitive Plan Approved by Planning Board ------------—-------------- Area ..........................................
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF,BOARD OF HEALTH
j.
•
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Na . . .. .. . . .................................
Construction Supervisor's ..........
S L S TRUST A=250---0-
No -.................25897 Permit for ....1 z„S...9 ........
•'t
...........Single...Family Dwelling..........
Location Lot 23.,....... ...92 Nobadeer-. . Road.... "
. .... ..... .... ...............
Centerville
......................................................... ....................
S L S Trust
Owner ................:.................................................
Type of Construction Frame................. M
Plot ............................ Lot . ..............................
Permit Granted ........Dec 1,9.r.... ....19 83
Date of inspection,....................................19
Date Completed .:.....................................1.9
d
Z
o•„* ,TOWN OF BARNSTABLE Permit No. 25897
.. `o -----------------------------
t Building Inspector cash
d..4 -
--------- -
OCCUPANCY- X
�.�... PEF2Ml?= 7---Bond- .
Bona- ---------------- '- ��
Issued to S L S Trust~ Address
Lai; 23, 92 Nabad :,mad;•:.-Cent:erviiie
Wiring Inspector Inspection date lC 9--W
Plumbing Inspector : . Inspection date
Gas Inspector /"'1,0 ` Inspection date
X Engineering Department �` , / Inspection date—
Board of Health j� i� X+' \Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
-......46............. 19. ' j ..... _ ..�
Building, Ins ector
6lz Bid V/06Assessor's map and lot number .7... . w. fl j �' *THE ro
�3 ���
Se> e r'ermit number `
� lAL CODE
AND BAR33TAML\E j.
House number ............ 0......MIdO1MENI r IL
TOWN; RN: l W b 'i QED MPN
TOWN ®F - BARNSTABLE
BUILDI G IHSPE TOR
APPLICATION FOR PERMIT TO / . . .......�(/` ���..........
TYPE OF CONSTRUCTION .................Cl" ..... �..................................................
........... ........ ..19 .
TO THE INSPECTOR OF BUILDINGS: Mo `"i-iL
The undersigned hereby applies for a permit acco ding to the followl= information: _ r,
Location ................r .. ....... ........ ... .. ....... �/ /..!•` 1��/ ....`��......
Proposed Use �"1....d ? �l..r��.•
...................................................................j..�. .....:.....
Zoning District ................. .`Y. /.................................Fire District ..................��.........................................:.....
Name of Owner .....�.•., �'j...�T ..l...L...................Address ��..... [....,. .... .. �� i�rS
l,p/ /
.5.AName .of Builder ...1 .... ..�. (sD ..Address .........:...................................`.....................................
Name of Architect .. f/!.L ./. l.C� •Address .. .-f�t, •..•.......
Number of Rooms ...................... ...................................Foundation .....e rL�. ..0 ��... 1."-....
Exterior .........................................Roofing ...........................S..r'. ........................................
Floors .................. Y.. ...................................................Interior .................`./.. %1........................................... r
Heating ...............................Plumbing . .. ....:.:r .....l. . .........
Fireplace ........................................ J'+� .........................Approximate Cost ..............�. � , .C� ...........................
Definitive Plan Approved by Planning Board ------------______-----------19______. Area lJ..® ....... ..5.�....
Diagram of Lot and Building with .Dimensions Fee ... p°(� .a......... .....................
\ SUBJECT TO APPROVAL OF BOARD OF HEALTH
1
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name A.. ...........................
Construction Supervisor's License < ......f.:....:..
L S TRUST
No.......25697............ Permit for 1.4..S:WXY...............
.........Single...F.ami.jy...,pK(pjj.irjg............... ....... .. ...
Location .... ...... 914-Ade ex. Ro a'
Centerville
...................................4...........................................
L
Owner ... S.
................S...Trust.............................................
Type of,Construction ..Fr......ame..................................
..................................................................... ..........
Plot .............................. Lot ..............I...................
Permit Granted .......D.e.q.,....J.9................19 83 ,
Date of lnspecti h ..... ............ ...
Date Com leted .414&�4e......7............19
4 �yar
i .
-..Eng rieering Dept. (3rd floor) Map es Parcel Permit#'
House# s Date Issued
Fee- S '
-c �7'1"� II_� Inc
ar 19
- BARNSTABLE• ,
• t -.. __ ,. MASS.
an 1a+'��.
TOWN OF BARNSTABLE
Building Permit Application
Project Street Address bn J&C
Village
f
-Owner Address
Telephone ; 6
Permit Request
• f
First Floor d—Nz square feet Second Floor square feet
-Construction Type_
Estimated Project Cost $ rZye)- "
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family a ` Two Family ❑ Multi-Family(#units)
Age of Existing Structure .S Historic House ❑Yes per- On Old King's Highway ❑Yes ❑No
Basement Type: ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: as ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached ize) Other Detached Structures: ❑Pool(size)
ttached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
'Current Use Proposed Use
Builder Information
Name 1 Telephone Number
Address C License#
Home Improvement Contractor# //3 2 3 7
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE ASITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE F DATE
BUILDING PERMIT DE 'VELD F�,O�$/THE F OW NG REASON(S)
Q 1`3
FOR OFFICIAL USE ONLY
sib � Y' � >" < < i _ •-- ., ` .. •'r � L. � .
PERMIT NO.
DATE ISSUED.
MAP/PARCEL NO.
�; it � � � _ � _.. ^ _. � _.•"' � �.`i°;"•
r
ADDRESS a VILLAGE
,
OWNER c " . t'� I •i a
s DATE OF INSPECTION: * 1
s is �� � ' ! 1 — r . . •- i
FOUNDATION
FRAME + _
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL +
PLUMBING: ROUGH '- FINAL
GAS: ''s ROUGHr FINAL i e r t'1r • ?t
FINAL•BUILDING _
DATE CLOSED OUT
ASSOCIATION PLAN NO.
°F THE A
A.
. ��{. The Town of Barnstable
BAWMAEM
� � -Department of Health Safety and Environmental Services
lFc '� Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 t t , Ralph Crossen
Fax: 508-790-6230' Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost 29?id,
Address of Work: r� �
Owner's Name:
Date of Application:" ' Id !13
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
1 hereby apply for a permit as the agent of the owner:
w
Pat ntractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
a , ; �i-__: The Commonwealth of Massachusetts
=_ >. Department of Industrial Accidents
-
Olfice of/naestigat�ons
600 Washington Street
Boston Mass. 02111
Workers'om Pensatiioon Insurance
Affidavit
,
c
name: L,
location: J 2 ��•'�
city phone# ACI)C 3
❑ I am a homeowner performing all work myself.
am a sole ro rietor and have no one workin in any ca acity
❑ I am an employer providing workers' compensation for my employees working on this job.
companv name:
address:
_.. . -;.
city: phone#:
insurance co. policv#
❑ 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
city: phone#:
insurance co.
camrany name. -
address:
city phone#:
Insurance co.
Fallure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the forth of a STOP WORK ORDER and a One of S100.00 a day against me. I understand that a
copy of this statement may be,forwarded to the Office of Investigations of the DIA for coverage verification
I do hereby certif finder the p naltiu perjury that the information provided above is true and-correct
Signature .! _
Print name !/ f'/V d Chi Phone#
sl
([ED]
ficial use only do not write in this area to be completed by city or town official
ty or town: petmitillcense# ❑BuOding Department
❑Licensing Board
check if immediate response is required ❑Selectmen's Office
❑health Department
ntact person: phone M. ❑Other
(MA ed 9/95 P1A)
Information and Instructions
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 come-
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 c
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive:
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 c:
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 renew:
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h u
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 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. The affidavits may be returned io
the Department by mail 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.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
8111ce of Investlgadons
600 Washington Street
Boston; Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 eat. 406, 409 or 375
135113
DEPARTMENT" OF PUBLIC SAFETY 1.35113
ONE ASHBUR;C'ON PLACE, RM 1301
BOSTON '41A 02108--1618
CONSTRUCTION SUPERVISOR LICENSE =`
Number: Expires:
J Restricted To: 00 ,
� ....;:. 13T
MICHAEL J DINOIA �� .QC 1,�7)11T�
32 OUTPOST LN1 _ —•,
CENTERVILLE, MA 02632 ;,
>.' Keep top for receipt and change
of address notification.
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x r4Registration,;*413239` �:
> Eyzpirationfw 05/21/99 .�� � ;.
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