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HomeMy WebLinkAbout0514 OAKLAND ROAD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel , Application # 4 Health Division Date Issued Z —` --l..�f � _" Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village \ �I 04Ny-�a-_7"' Owner U5 Loy _" Address Telephone Permit RequestIS Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay -- . Project Valuation Construction Type Q 4 r ZE .Lot Size Grandfathered: ❑Yes ❑ No If yes, attach porting docume tbntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# ,_:nits) _ 9q Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings ighway 0 Yes`, ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other - Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing`new Total Room Count (not including bath ;): 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name `�. b l��SY��U�I Telephone Number Address � * License # U �-1 Home Improvement Contractor# r Worker's Compensation # 3n•-:ap ALL CONSTRUCTION DEBRIS RESULTING �FROM ^THIS PROJECT WILL BETAKEN TO f-NW Mftk-V SIGNATURE DATE �� -" FOR OFFICIAL USE ONLY APPLICATION# a F DATE ISSUED MAP/PARCEL NO. r f ADDRESS VILLAGE { OWNER r DATE OF INSPECTION: FOUNDATION FRAME INSULATION s, FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 4 DATE CLOSED OUT ASSOCIATION PLAN NO. .y - ' Print Form The Commonwealth. of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): `Rebello Construction Address: 2780 G.A.R. Highway, Box 28 City/State/Zip: Swansea, MA 02777 Phone#: (508)567-4109 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 1 9 4. ❑ I am a general contractor and I 6. Newconstruction,. ❑ employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- 'listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition ' workingfor me in an capacity. employees and have workers' y p .9. ❑ Building addition [No workers'comp. insurance comp.insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions q ] , 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp: ' right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no weatherization-Resi employees. [No workers' 13.❑✓ Other comp.insurance required:] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet'showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.' I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Ins.Co. Policy#or Self-ins.Lic.#: WC5-31 S-362857-023 Expiration Date: `07/27/ 14 Job Site Address: \ ^�\ cx�A City/State/Zip: a ,n 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 certify u d he ins and enalties ofperjuiy that the in ormation provided above is true and correct Signature- -- -- -- ate: -----—-=- — Phone 4: (508)567-4109 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#: REBEL-2 OP ID: MA ACORO' "OF �{ PATE(MM/DDmrY) CERTIFICATE "OF LIABILITY INSURANCEMM/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)-must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Phone: 508-675-0308 NAME: Maria Arruda . E Partners ins.Mizher Division 560 Wilbur Ave. Fax: 508-675-3006 AICONN Ext:508-491-3176' FAX Na 508-491-3108 Swansea,MA 02777 EMAIL Kristine Rodrigues-Swansea ADDREss:marruda@partnersinsgrpllc.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Safety Insurance Co. 33618 INSURED Rebello Construction Inc. - INSURER B:Liberty Mutual Ins. Co. Carl J. Rebello 2780 G.A.R.Highway-Box 28 INSURER C:NGM Insurance Company 14788 Swansea,MA 02777 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP - LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C COMMERCIAL GENERAL LIABILITY MPT4696E _ 05IO2/2013 05/0212014 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS-MADE 7OCCUR MED EXP(Any one person) $ 10,000 X Business Owners PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ . AUTOMOBILE LIABILITY " COMBINED SINGLE LIMIT Ea accident $ A ANY AUTO 6206368'- 05/26/2013 05/26/2014 BODILY INJURY(Per person) $ ALL OWNED X SCTOS HEDULED AUTOS AU BODILY INJURY(Per accident) $ 1,000,000 NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE CUT4696E 05/02/2013 05/02/2014 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION - WC STATU- OTH- _ AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE WC5-315-362857-023 07/27/2013 07/27/2014 E.L.EACH ACCIDENT. $ 500,000 OFFICER/MEMBER EXCLUDED' Fy] N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSURED'S RECORDS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i • . L/)ZIi�O'J7EM�.�1�2�.ULQ�2Tf..��l�'P����6l�LlT.O.v.. .• Vffice of Consumer Affairs&Busioe9s Regulation T license:or regiiiraiionvalid;for;individul use only OME IMPROVEMENTCONTRACTOR- Offiee of Con§ume Affai Iffoupd return iP rs and Business Regalatiod Registration: 170375 Type: l0 Park Plaza-Suite 5110 Explradon�10114=15,,- Supplement�Card' Boston,MA 02116'" a - REBELLO CONSTRUCTIOW Nt C DA}l1D HEBEAT r PP 2780 GAR HWY 026 SWANSEA, MA 02777 Uodersccreta[y, Not valid-with ut sigi4iurel Odssachusetts-Department of Public Safety l :'Board of Building Regulations kid Standards n .._ Construction Supe sor , License: C&056216 ..? DAVMJHEBER'-`•`` 247 CENTRAL AVE New Bedford MAr027 r Expiration " Commissiont r 10/24/2014 E _ THE Town of Barnstable Regulatory Services Mnss. Richard V.5cali,Interim Director a ►`e� 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 I, 146W ,as Owner of the subject property hereby authorize Reiolulo �'�i`f YIAVC l B"A) to act on+i ay 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. Sigt of Owner Signature of Applicant r Print Name Print Name Town of Barnstable :. Regulatory Services .. . Richard V.Scali,Interim Director Building Division a BARN rAMA $ Tom Perry;Building Commissioner- - --? 11U.9$. :. .. is . 9 1634. `�$' 200 Main Street, Hyannis,MA 02601 www.town"barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE:" J01310CATION number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall-not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form a* acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section. 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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. HOMEOWNIIM'S EXFMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities"of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness.often results in serious problems,.particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as.it would with a licensed Supervisor..The homeowner,acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit.application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. y' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION O Q_ Map A7pl Parcel 4639iQY�a / Permit#,�7/ 7 Health Division AH II?-pyYN ( k Date.Issued cT--/ /� ENVIRCNt r, Conservation Division 'l� "lA( L�/. 4 it Fee _. A0 ,W A 0% ( 'K Tax Collector f Treasurer___ om t. J Date finit' pp d by a oa tor' -01 ese ry / annis Project Street Address I N 0 a 1</a J Al. l .a., r , 4 . ('r-b a/ Village Owner Address - __t 14 (iG I< f,,,,d Telephone 6 0$) 750 Permit Request Rte�l 492ALM &QWA *L :73 :fO F—(v/5.T— F_Q7�, V1 U, DL e Be e�CQ Square feet: lst�f ���� loor-existing93S- _ro d 2nd floor:existing 7/� proposed Total new Estimated Project Cost- f 14, L W Zoning District C - =1 Flood Plain Groundwater Overlay Construction Type r Lot Size 11� .2 9 a Grandfathered: 114es ❑No If yes, attach supporting documentation. Dwelling Type: Single Family a/' Two Family ❑ Multi-Family(#units) Age of Existing Structure a 4.a Cs Historic House: ❑Yes &No On Old King's Highway: ❑Yes t�o Basement Type: Rfull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) .0 "l6 Basement Unfinished Area(sq.ft) �,3 9 SF Number of Baths: Full: existing a new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count S Heat Type and Fuel: Q16'as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes O'Ko Fireplaces: Existing f New Existing wood/coal stove: ❑Yes ❑No Detached garage:Uf'iexisting ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size I� Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No ,If yes,site plan review# Current Use Proposed Use �r! ; BUILDER INFORMATION c Name Telephone NumberGr Address License#. / Nam Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE a,&,; DATE FOR OFFICIAL USE ONLY PERMIT NO . ' . DATE ISSUED MAP/PARCEL NO. ' f r t ADDRESS VILLAGE _ t r . 4 1 ' ... w _ OWNS_ R - , DATE OF INSPECTION: V 1 .AI FOUNDATION ' FRAME INSULATION ' F •FIREPLACE �- ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL µ ` GAS: ROUGH FINAL ± -FINAL BUILDING DATE CLOSED OUT a ASSOCIATION PLAN NO. 1 ± 9 ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE square feet X $55/sq. foot= GARAGE (UNFINISHED) square feet X $25/sq. foot PORCH square feet X $20/sq. foot= DECK square feet X $15/sq. foot= OTHER square feet X$??/sq.Moot= Total Estimated Project Cost `L r g990915b The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-403 8 Ralph Crossen Fax: 508-790-6230 Building'Commissione, 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: P6—avcA0,, I/C0jVV 1,V J Estimated Cost Address of Work: -v 1 1-I Or- K/u,J lea, CIQ60 l Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Under$1,000 Building not owner-occupied G]O wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRAC TORS FOR APPLICABLE HOME IMPROV EMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. D de Owner's Name g1orms Affidav I. `_''"�"_�` w The Commonwealth of Massachusetts — Department of Industrial Accidents , -- Affee oll�esdooffoos __ 600 Washington Street • "... v Boston,Mass. 02111 =-`;� Workers' Com ensation Insurance Affidavit r , r / Mi. name: ` �' location• s J G/ �(G/�'- //�� ci S hone# .T I am a hom weer performing all work myself. ❑ I am a sole p net/or and have no one worlds in any achy %%%%//% %/%/%%%/%%%/%%��%%%%%%%%%% %%/%///%/% �O/D//%/%%%��%%/%%%/%%/%%%/%%%%%/%%////��%/%%%�%%%%%%%%////////�%%%O��i,. ❑ I am an employer providing workers' compensation for my I.employees working_on this job. : :: :::::: :::: ::::::::::::: :: :: comaanv name ;: .::::::....... .: address cites .. phone#. :.; ..:::. insurance co., _,. oNcv# :::::::::»:::::: ❑ I am a sole proprietor,general contractor, -hhont4---r circle one)and have hired the contractors listed below who have . the following workers' compensation polices: ;:. >:::::.;;::::;:::..:.:.:'.,:: >::>.:*`,:.>::::>:::X-.::>:.::::.:....:::.::.:::..:...::::.. companvname .....::::::;:::. .. .. .:. . ;:.::.;::.;:.:;:.. ::::::.:......::.: :: address.: :....&....:.;:.;.::..::::::::::::..;..;:. . ::::...:...<. :.::::.:.:.<: 1. .:.:.::::.:::..::::..:..:.:::::.:.--.-. :. :. :..:.:::..:.:.................................................................:::.-&-..:.......................................:::..............................................::.....................:..... :.<:. .........::::..:...........................................:.....................::....::.:................................._...::.:::::::::. y ...:::.:>:..:::::::.:: c�ity' :.;:.;::::::::::::::::.:.::::.::.....:..:...:::.::.:.:............................. .;:.:.;:;::.;:.;: non r. :•>:.r.•::::.�:::: •::.wc•..v.•.Y.v <*. ' ... i:::::::::: ::::::::�: r ..:::::::`:::::: ::> :::::::::: ::i:::i::^:< is<:::•::r:>::::i::ii:i::+i:::::;;Y:t:i::::i::::::::::::'' :::' ieanrance.co.. .-r r/%///%%/ comaanv name• >::»:::>:::<: :»;:;: _.. ,... ::.;::.:::.:::::::::::::..:.::. address: _ ... ..... :.... ...... . shone# ?`;;:>:'> t lfV' ::::::.::.: >s> < :>:> i ntnran oli tv# ll .Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or . one yearn imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I • I do hereby certify the pains and penalties o perjury that the information provided above is truo and correct Date rI y Signaturenn�� — Print nme �� Phone# 7"�0 2e3-r official use only do not write in this area to be completed by city or town official city or town: permitJllcense# ❑Building Department ❑Licensing Board - ❑checkif immediate response is required ❑Selectmen's Office . ❑Health Department . contact person: phone#; - Other_ (revised 9/95 p)A) 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 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 f license or permit too operate a business or to construct buildings in the commonwealth for an applicant who has o a p p g Y PP 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 0111ce of Investigations 600 Washington Street ' Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 . � •, • ?a6b.�LZib(wed) • pseeripttre Package for Qaa and Two-Fawdy gnid=tW Bulldlap Sated with Faasit Fuck MAXIMUM MCUMUM Quing wallFloor 8aatamt Slab HadnFjCoolia8 GlazingAnal U-value= Rrvaluer R valuae RrvalutJ Wall FIB &W1� EMa� Paeiraae R.vaiat &valeta' 3701 to 6500 Eleadnx Degree D&W Qn 0 33 13 19 10 6 Normal R 30 19 19 10 6 N� S 33 13 19 10 " 6 B AFt1E T 33 13 2S WA WA Normal U 33 19 19 10 6 N� �• •••• V�• !S AFVE r 1.17i &44 NM .�.. w is% 03z 30 19 19 10 . 6 is AFUE X IS% 0.32 33 13 2S WA WA Normal T IS% 0.42 33 19 2S WA WA Normal Z 1VAA 0.42 33 13 19 10 6 "ARM M 13'/. 0.S0 30 19 19 10 6 90 AF[JE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-fotnss-f980303a 780 CMR Appendix J Footnotes to Table J51.1b: It and ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, basement windows if located in walls that enclose conditioned space,but excluding opaque doors) to the gross wail area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 R=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 JI.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-38 insulation and R 38 insulation may be substituted for R-49 insulation. Ceiling R values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between - veud ;,f the tr me conaitioned spac;c auu uio rcuulakd Yo dor. 'Wall R values represent the stun of the wait cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R 19'requirement could be met EITHER by R 19 cavity insulation OR R-13 cavity insulation plus R-b insulating sheathing. Wall requirements apply to wood-flame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. I unconditioned such as unconditioned crawlspaces,basements, I to floors over unto The floor negtrutments apply spaces or garages).Floors over outside air must meet the ceiling requirements. 'Ile entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described 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 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5Z.1 a 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 structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. 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 JI.53b. 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 035). 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. GIazing or door components comply if the area-weighted average ess than or equal U- value of all windows or doors _is l ual to the U-value requirement(0.35 for doors). 43 I "� c� epal=�rn>r�::.° :.'• °��::.=. �a a an nvlronmenta ,.g:y ti=��w _ �_ Building Division 367 Main Street,Hyannis MA 02601 ntu►s�' �► . Ep Moa• Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: ( �( �Q 14 lewd IC/�r�, r vf7 ,hCy. number r street village "HOMEOWNER": Kc re, t L,f L r-r!- 1 fw? -2 go-a,F LL name home phone# work phone# CURRENT MAILING ADDRESS: -s—( K o a l.,j c4 t,G N/1/if cirJ/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 Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"sW submit to the Building Official on a fora acceptable to the Building Official,that he/she Shall be responsible for all such work performed under the building wit. (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 requirements. of omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q.Rules&Regulations for.Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the uniicensed personas itwouid with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN t ` i i I-M i ...................... - - --�-�N 1 00 tea, � sue. S 'af • «: t a �1 • 9 � � . ' � •� � •�� f �_ -- -- - ��� 1 _ -- �-+---- - •_r �- I �. _._ _... - -_... � � •-�l � � � �� I I _ _.___ �. � ��� • �,- t BUILDING SKETCH :.wer/Client EHR HART,KAREN =dress A 514 OAKLAND ROAD Cit HYANNIS Count BARNSTABLE lender/Client FAMILY FUNDING CORPORATION state MA Zip Code 02601 i_ Ey "le V - a -------------------- C-1 r SEP-24-1999 1.5:25 BARNSTABLE H9!6I 15037789.312 P.01 \ } ) Tele hone 5081 771-7222 Barnstable p Fax(508)778,9312 jj.�� .} Leased Housing Dept. (308)771.7-192 Hou sing Author l.y 146 South Street•Hyannis.Mass. 02601 ZONING; VERIFICATION TO: Gloria Urenas FROM: Robert Hooper, Leased� b Housing Coordinator RE: Legal Rental Unit Verification Date: Address: Village: ydL Unit Type: S g1 L Ea. ;114 Bedroom Size: 3 Map & Parcel No.: The owner of the above listed property is entering Into a contract with us for the rental of the property as listed above. Please verify by signing below that the unit is legal and meets all zoning requirements for a rental In the town of Barnstable. If It does not, please list reason here: ------------------------------------------- rhankyou for r assistance in this mattr S4Vune — Ve ame Date VIA FAX: 790-6230 MRVP section B. Rev,9198 Equal Housing opportunity Agency TOTAL P.01 Assessor's offioe. (1st floor):. /- TwE Assessor's map and lot number ...... 7° .'..Q.fllQ............ . . .. ' Board of Health-(3rd floor): .,�GG 7 s e� e Sewage Permit' number .... 1............ .. � ................. DAaJ7T►8L � Engineering Department Ord floor): / rwa 039. House number ..............................sue.��,, ......... ...v. ... �..... oe��1W APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P;M. only TOWN OF 'BARNSTABLE BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO ...CQN S T�IZ✓!!� ........ TYPE OF CONSTRUCTION ..........W.0d 40....r—t2A j?e................................. ........................................... w �d.".. .. ........................19e..-- TO THE INSPECTOR OF BUILDINGS:,, 9, -The undersigned hereby applies for a permit according lto/ thee� following information: Location ......r� ....,�o ./r 4-4/11,61 . ............ ............................................................. ProposedUse ........'S.v ....2 .d. .............................................................................................................. ............. `. " �( Zoning District ... ..-.e..-...�.................................................Fire District .5...........................:. ...................... r� Name of Owner Sh/h�.�....... T.A.9.0.-`,�.................Address .a�y....04A.4, ... Name of Builder �9.d/!Y... . ....... [ 6/S,(/.. .:....Address .. .r.C'!. .a. ... Name of Architect ........Address ......... ......................................................................... n Number of Rooms .......-.�.............. ...................................Foundation d.Ui.e....Gj.....0 6N - . IA 4ExIeriar .�. 1.. .. G.�... .... �>rZ.S..........Roofing A ... .!a.L ...... .....1VJ°'................................. �Floors .....c �5?�. G...............................................Interior ... .. ..r ............U/C .) 4.7;. Heating e- s .............................:,f:...........Plumbing ........:................................................................ ..................... Fireplace ........ ....'...........................................................Approximate Cost ............. $� ©d 6.................................. Definitive Plan Approved by Planning Board ________________________________19-------- . Area ..S'� r-�......................... R� - Diagram of Lot and Building with Dimensions Fee ............ ................... ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH W 9-x/sTi�� �aoarriati . /Ju�se- f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS - I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regbrding the above construction. r c, Name ...1.... . .....:.............. ! Construction Supervisor's License ...d v/ So/d ................................. ,i; JARO!i, SHIRLEY A=272-060 No 32322 Permit for ..P4.i.1.d...A.DD.I.TI.ON 1. .. .... .. .... .. Single Family. Dwelling.......... Location ....5.1.8...0.axla.nd....Road.................. ............"..........Hyannis...................:................. Owner ...Sbirley..ITMgs ........... ............................... Type of Construction ...F.............rame ......................... ................................................................................. Plot ............................ Lot ................................ Permit Gran-ed ..... ..........ig 88 Date of Inspection ......................... .........19 Date Completed ......................................19 Assessor's offioe (1st floor): ` *THE "Assessor's"Assessor's map and lot number ......27.° : .e(r7P ... Board of Health (3rd floor): C_ �4$ Q"1')�' Y! r Cti Sewage Permit number ......,7'................. � ...... .... .. r Engineering Department Ord floor): y9 t. r� �� House number �1 ,� pesT`�� .............................. .. .......... APPLICATIONS PROCESSED 8:30.9:30 A.M. and 1:00-2:00 P.M. $aV14j'dri ., LATIOWS TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...CdN. .1 :�T.......O ....v M...4.Qj0..L...1122N...... TYPE OF CONSTRUCTION .......... &fif e................................................................................ ev....-..`f. •......................19ee "TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to/ the following information: Location ..............��y.......4../ . / .... .:.......... ...... / .............................................................. ProposedUse ........ .�N.... d.............................:............................................................................................................... Zoning District .. e ..-... .................................................Fire District ... ..)a1g1VtV;S...................................................... Name of Ownerh/ �.I�...... .. ..f? `................Address '�� ... 1�1. �! �lti .... .......... /�!�. � 1a Name of Builder ..........................................:. Address .. ..........................t�... ... ..... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...............................................................:..Foundation ..........�..T ................... Exterior � � dN�.. . ..........Roofing -� . � ..... 5. /� , . 0be-j . ......................�l Floors R.P..6 ..%—�/.r��r.............................................Interior ...�U/�!!�l/.�� ..�.. ...�,�V.q ........... ' H C= �.e� I. ........................................Plumbin Heating ................................. g .......................................................................... Fireplace ........ ........................................................................Approximate Cost ............1� ......................................... Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ........ Diagram of Lot and Building with Dimensions Fee' ........J�.. ....t........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH W Sys I �oav►� 9 Novse, r `rk 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 ...1... ............. .. .. '!!e .J.............. Construction Supervisor's License ... v.1. 1le ...................... ' JAROS-l-,SHIRLEY - No 32322 Permit for Build Addition - ............ .................................... Single Family Dwelling .t .. ............................................................ Y _ LocatF )) . Oakland Road Hyannis : �r a Owner ....f . Jaros . Shirley... ........... ............ .................. - r Type ofrConstructiow............................................. " ............................. ................. Plot ............. ...... .... Lot .............................. , r. •October•• 5 88 Permit Granted ..... . . .e...........19 Date of Inspe0ion ..........19 ' Date,'Completed ....... I y. wit s..r iJ et '