HomeMy WebLinkAbout0543 PITCHER'S WAY P)
Town of Barnstable
Building Department - 200 Main Street
&UMST"U. * Hyannis, MA 02601
9 MASS
16gq. , (508) 862-4038
Certificate of Occupancy
Application Number: 200902516 CO Number: 20080452
Parcel 10: 270144 CO Issue Date: 12101109
Location: 54.3 PITCHER'S WAY Zoning Classification: RESIDENCE B DISTRICT
Proposed Use: SINGLE FAMILY HOME
Village: HYANNIS
Gen Contractor: PROPERTY OWNER Permit Type: RC00
CERTIFICATE OF OCCUPANCY RES
Comments:
Building Department Signature Date Signed
I r
I %
tHE TOWN OF BARNSTABLE
s t Bdilding
°-� Application Ref: 200902516 •
BARNSTABLE. Issue Date: 06/22/09 Per■ ■ ■i t
y MASS.
1639. s`�� Applicant: MATOS,PAULA BALTAR Permit Number: B 20091052
ArFD MA'l
Proposed Use: SINGLE FAMILY HOME Expiration Dater . 12/20/09
Location 543 PITCHER'S WAY Zoning District RB Permit Type: RESIDENTIAL ADDITION/ALTERATIO
Map Parcel 270144 Permit Fee$ 153,00 Contractor PROPERTY OWNER
Village HYANNIS App Fee$ 50.00 License Num OWNER
Est Construction Cost$ 30,000
Remarks
APPROVED PLANS MUST BE RETAINED ON JOB AND
j RENOVATE FIRST FLOOR NO FLOOR PLAN CHANGE;REINSULATE THIS CARD MUST BE KEPT POSTED UNTIL FINAL
j AND DRYWALL INSPECTION HAS BEEN MADE. WHERE A
CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH
Owner on Record: MAT05, PAULA BALTAR BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL
Address: 800 BEARSES WAY UNIT 1 ED INSPECTION HAS BEEN-MADE.
HYANNIS, MA 02601
Application Entered by: PR Building Permit Issued By:
THIS PERMIT CONVEYS:NO RIGHT TO OCCUPY,ANY STREET,ALLY OR SIDEWALK OR ANY PART THEREOF;EITHER TEMPORARILY OR PERMANENTLY.
ENCROACHEMENTS ON PUBLIC_PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE;MUST BE APPROVED.BY THE JURISDICTION.
STREET OR ALLY GRADES AS,WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC:WORKS.
THE ISSUANCE OF THIS PERMIT DOES N&AELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE'SUBDIVISION RESTRICTIONS...,
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL.CONTSTRUCTION WORK:
1.FOUNDATION OR FOOTINGS.
2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED.
3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION.
4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH).
5.INSULATION.
6.FINAL INSPECTION BEFORE OCCUPANCY.
WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS.
WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION.
PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF
DATE THE PERMIT IS ISSUED AS NOTED ABOVE.
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A).
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BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
I-A
� oc
3 1 .f ® (1 1 Heating Inspection Approvals Engineering Dept
LrC-
Fire Dept BG' ff f tf 2 Board ofAlealtli
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
i�ame ��i�� �P�� Telephone Number
M1
Address License#
joal Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE l`"
TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION
Map Parcel Application #
Health Division Date Issued l t
Conservation Division Application Fee
Planning Dept. Permit Fee (-0
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/ Hyannis
Project Street Address 77 �-
Village VA6JAlz
Owner V� �� ( t�-, ' Address L-?0,5- ��
Telephone
Permit Request J fN/,s
cz-
Square feet: 1 st floor: exi g proposed 2nd floor: existin proposed Total new
Zoning District Flood Plain Grou water Overlay
Project Valuatio< /(7--J Co truction Type
Lot Size randfathered: ❑ s ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family .J& Two Fa ' ❑ Multi-Family (# units)
Age of Existing Structure Historic o e: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout Other
Basement Finished Area (sq.ft.) sement Unfinished Area (sq.ft)
Number of Baths: Full: existing w Half: existing new
Number of Bedrooms: e ' ting —new
Total Room Count (not including baths . existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ it ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existi wood/coal stove: ❑Yes ❑ No
Detached garage: ❑existi ❑ new size_Pool: ❑ existing ❑ new size _ Barn. ❑existing ❑ new size_
Attached garage: ❑ e ' ing ❑ 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 Telephone Number ' 3 7/
n1Address License #
L C_ A1{ Home Improvement Contractor# t '
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURES DATE
s` FOR OFFICIAL USE ONLY
APPLICATION# r:
I� r
DATE ISSUED —
MAP/PARCEL NO.
ADDRESS VILLAGE
Y `r.
OWNER
-'DATE OF INSPECTION: —
FOUNDATION
FRAMEk.
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH r FINAL
GAS: ROUGH j FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. -
The Comrrcon-Wealth ofMassachusetts
Department of rndustrid Accidents'
Office of rnvestigations
600 Washrneon Street
,Bostolt, MA 02111
www.mass.gov/dia
Wc)rkers' Compensation Yns>zrauce Mfidavit; Builders/Contractors/Electricians/Plumbers
Applicant Xnformatiori Please Print Legit
�NaI11 e'(B usin os s/Organizalion/Indi vi dual)
Ad Tess
City/S0-P ip: -Sbn4LZ (,G Phone.#:
Are you an employer? Check the appropriate box: Type of project(required):
4. [] I am a general contractor and I
1.El X am a employer with 6. ❑New construction
. employees (full and/or part-.time).* have fired the stab-contractors
listed on the attached sheet. 7. El Remodeling
2.❑ I am a'sole proprietor or partner- These sub-contractors have S. D emolition
' . ship and have no employees ❑
employees and have workers'
working for me in any capacity: 9. ❑Building addition
[No worke '.comp,•insurance imp• insurance.
rs
5. [� We are a corporation and its 10.❑ Electrical repairs or additions
required.] .
3, I am w a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12,0 Roof repairs
insurance required.]t c, 152, §1(4), and we have no
employees. [No workers' 13.❑ Other .
comp,insurance required.]
"Any applicant that cheeks box#1 must also fill out the section below showing their workers' compensation policy inf=ation.
t Homcown=who subroit this affidavit indicating they are doing all work and then hiro outside contractors must submit a new affidavitindicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-conhmztm and state wbcther err not those entities have
employers. if the sub-contractora have cmploycas,they must providb their workers'comp.policy number.
ram an employer that is pravidrng workers'compensation insurance far my employees. Beloty is the policy and job site
information.
Laurance 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-tha imposition of criminal penalties of a
Eno up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Bc advised that a copy-of this statement may be forwarded to the Office of
-Investigations of the bIA for insurance coverage verif cation.
X do hereby certip under th ains•andpenaltles of perjury that the information provided above is true and correct
CSi afore: Date; —
Phone#:
Official use only. Do not write in this area, to be completed by city or town offtclaC
City or Town: Permit/License 4
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 Instructio' ns
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their,cmplayees;
Pursuant to this statute, m employee is defined as "...every person in the service of another under any contract of hiio,
express or implied, oral or written."
An ernployer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint entirpzise, and including the legal representativos 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 hereto shall not because of.such employment be deemed to be an employer.`'`
x
MGL chapter 152, §25Q6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit 10 operate a business or to constxuet buildings in the commonwealth for UY
applicant who has not produced acceptable evidence Of compliance with the insuraance coverage required."
Additionally,MOL ohapter 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
rcquixrmcnts 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-contractors)name(s), address(cs) and phone numbers) along with their ccrtificate(s) of
insurance. Limited Liability Co opanies'(LLC) or Limited Liability Partnerships (LL.P)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP Boca have
licy is required. Be advised that this affidavit may be submitted to the Department of Industrial
employees, a po
Accidents for confmnatiort of,i_nsurmcc coverage. Also be sure to sign and date the affidavit. The the Dcartrnepartmeshould
be returned to the city or town that the application for.the permit or license is being requested, not
of
Industrial Accidents. Should you have any questions regarding tho law or if you are required to obtain a workers'
compensation policy,please call the Department at the nuraber listed below. Self-insured companies should enter thou
self-baswanco license number on the appropriato line.
City or Town Officials
Please be sure that the affidavit is'cornpiete and printed legibly. The Department has provided a space nt the bottom
of tho affidavit for you to fill out in the event the Offico of Investigations bas to contact you regarding the applicant
Please be sure to fill in the pezmit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/liccna c applications in.any given year, need only submit onp affidavit indicating current
policy information(if noccssary) and under"Job Site Address" tho applicant should write"all locations in (city or
town)."A cbpy of the affidavit that has been ofEcially stamped or marked licenses. A new e city or tow.may
b bcrovided to out each
applicant as proof that a valid affidavit is on file for future permits or
year.Whcro a home owner or citizen is obtaining a liccnsc or permit not related io any business or commercial venture
(Lc. a dog license or-permit to burn leaves etc.) said persaA 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 qucstlons,
please do not hcsitato to give us a call.
The Department's address, tclephone•and fax number;
Tht1 Commoziwt-,4th of MassachiLs rtts
D�,pazttnl� t of Indij�0 Acccidc�nts
Office of IzYe.4tipticas
600 WaShin�on Street
BQstan, MA 02111
T6; # 617-727-49 .Q ext 405 4r 1-977-MASSAFE
Fax# 617-727-7749
P_cv-iscd 11-22-06 www.mass.,goY/dia
f '
Town of Barnstable
Regulatory Services
B.&IMSTAZLE, Thomas F. Geiler,Director
PIEo Building Division
Tom Perry,Building Commissioner
_-.... _...200 Main.Street;Hyamis;Mao 02fiD1
www.town.barnstable-ma.us
Office: 50 8-962-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE ���y\]e K; Q(InSl
JOB LOCATION: 5q 3
numbs f\_ street village
"HOMEOWNER": �111 Y1�+ � ?buA so c'_�Lo.) a 3 b 7 97
name home phone# work phone#
CURRENT MAILING ADDRESS: 0.S 6f cta✓ 5�-
Lj I�GI1115, zhlf ` M
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 1'.
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 strictures 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.
IL
i
The undersigned."homeowner'certifies thathe/she understands the Town of Barastable.Buildipg pepartment
inspection procedures and requirements and that he/she will comply with said procedures and
rclemen
I�
Ily 74
Si omcowner i
Approval of Building Official
Note: Three family dwellings containing 35,000 cubic feet or larger will be required to comply with the 4,
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EICEMPTTON 1
The Code states that; "Any bomeowoer performing work for which a building permit is required shag be exempt from the provisions it
of this section(Section 109.1.1-Lieri►sireg of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such
work,that such Homeowner shall ad as supervisor."
Many homeowners who use this m=iption 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 Mould with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responnbilities,many communities require,as part of the permit application,
that the homcowncr certify thht 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 cars t amend and adopt such a form/certification.for use in your community.
Q:forns:homccxempt
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ALLAN
ASS.G-".SS.O.e.3' M.A'PX 7oA .OT o, W.HEATL.EY
;A.No,24397 Q
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Current Use Proposed Use-
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
� - � a_
`Name Qoil9Pi�g Telephone=N:umber�SG -3(aa a330
Address _(��dn License#
C"U(V Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTIONrDEBRI-81RESULThNG=FRGM=THIS=P-ROJECT WILL.BE TAKEN TO ~►J��W,,�.L v
w
SIGNATURE' '" ` -=Y" DATE` a UO9j
' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 'L 'A licatiori # ��l/ � Z� ` W
pp
Health=Division Date Issued
Conservation Division Application Fee
Planning Dept: Perm
Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
Project Street Address cY
Village �Qriv�/✓
Own "✓i�'. Qrill' Addresgc? �C;.&-;VKA Z:'` L/✓. gTi�
Telephone �9� c3c-
Permit Request _ v �=✓�S- ���
Square feet: 1 st floor: existing L.I roposed 2nd floor: existing proposed Total new
Zoning District; Flood Plain Groundwater Overlay
Project Valuationc: � ®PCr Construction Type ✓�'�
Lot Size � y G C S Grandfathered: ❑Yes' ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family --ur Two Family ❑ Multi-Family (# units)
Age of Existing Structure �� Historic House: ❑Yes 4No On Old Kingis Highway: O--Yes No
Basement Type: ®'Full ❑ Crawl ❑Walkout ❑Other
-,
Basement Finished Area (sq.ft.) D Basement Unfinished Area [ .ft)
O M�
Number of Baths: Full: existing / new a2 Half: existing =new�CO
Number of Bedrooms: J existing O new
Total Room Count (not including baths): existing new O First Floor R om Co nt r,
Heat Type and Fuel: M Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes I(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 ❑
- Coi No - If yes, site plan review # T —�
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name ��"� Tel hone NumbeK Gam'
Address p v ce e #
HomVCoensation
Contr ctor#
Work #
ALLCONSTRUC 10 DEBRISRE U ING FROM H PROJEKEN T
SIGNATURE. DATE
i FOR-OFFICIAL USE ONLY
r -
APPLICATION#
d DATE ISSUED
r MAP/PARCEL NO.
p
a �
i
s
F ADDRESS VILLAGE
a
OWNER '
DATE OF INSPECTION:
FOUNDATION
FRAME
s
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name`(Business/Organization/Individual): Se n y\',4 it
Addressf`�2-0
City/State/Zip:.—Co-�oA hs1 AAC9�Le��'hone#: /�Z� 3(o a a 33 O
A you an.employerTCheck the appropriate box: Type of project(required):
� -
4" I am a eneral'contractor=and_I
1.❑ I am a employer with �-❑T g " 6. ❑ New construction
employees(full and/or part-time).* have hired the sub=contractors._.:
2.❑ I am a sole proprietor or partner- listed'o`n`7the attachedshee 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. �empl6k�67andhaveworkers' 9. ❑ Building addition
[No workers' comp.insurance mp._insuranceJ--- -
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3[-I am a`homeowner doing all work officers have exercised their I I.El Plumbing repairs or additions
myself. o workers' c6rn . right of exemption per MGL
y � P 12.❑ Roof repairs
in surance-required: try. c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M 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 certify under the pains andpenalties of perjury that the information provide t
d above is true and correct.
Si afore: _ .e, r--Date: --Ak
Phone#: SC�S 3iv a.�3
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 do license or permit to bum 1 t( g pe eaves 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:
t
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
ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE; AND TWO-FAMILY DETACHED RESIDENTIAL'CONSTRUCTION (780 CM-R 61.00)
A 1lcant Name
`� S 1te-A es s -_
Epp_ --- :P �e r �.)19-tys I-'�'..�"�" 53v11 �3 'lam
print !! Town: I
A YVYt t
Applican.Phone:- 6 k 3(o a a33
Applicant Signature -- - - ,Date of Application:,;,„�.);A,,G .S a00 I
.. L. s
NEW CONSTRUCTI choose ONE of the following two,o Lions
780 CUR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR
NEW ONE- AND TWO-FAMILY BUILDINGS
NLAXIMUM MINIMUM
Ceiling or❑ Slab Option 1: Fenestration exposed Wall Floor Basement perimeter
Wall AFUE HSPF SEEI
U-factor floors R Value R-Value R-Value R Value
R-Value and De th
National Appliance-arrgy
3 5 R-3 8 R-19 R=19 R-10 R-10, Conservation Act(NAECA)of
4 ft.- 1997 as amended,minimums or
catty as a licable
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
❑ Option 2: 4 RES check Version 4.1.2 or later variant software analysis must be completed
780 CMR 6107.3.2
REScheck--Web which can be accessed at http•//www.energycodes.gDy/reschc,-
ADDI OIVS:OR•AALT RA IONS.TO MST I1�G BtJZLDZNGS.OVER 5 YEARS OLD
*auildings under 5 years old must use option#1 or#2 in New Construction section above,
Complete the following formula to determine the %o of glazing:
(a) Gross Wall & Ceiling Area equals Formula: (100 x b= a)
SF 100 x - _ % of glazing
(b) Glazing area equals SF b a
If glazing is<:40%.USe the chart M.D.W. If gla±ing is> 40 % roceed to "SUNROOM" section
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING
LOW-RISE RESIDENTIAL BUILDINGS
MAXIMUM MINIMUM
Ceiling and Slab Perimeter
FenestrationWall Floor Basement Wall R_Value
U-factor Exposed floors' R-Value R-value R-Value
R-Value end Depth
.3§ R-3 7 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 com ressed 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 A2pendix 120T
` Town. of Barnstable
y�P�OF THE rpm~4L -.
Regulatory Services
i Thomas F.Geiler,Director
sAxxsruc.e. .
'�. Building Division
rfD Tom Perry,Building Commissioner
- ... .-....200 Maiti=Street,—Hyannis MA 026D 1
www.town.barnstable-ma.us
Office: 50 8-962-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATECan
JOB P O LOCATI : 3 t` iny iCl UX3 cu., �+tn ct n tit S
number street village
"HO,MF.OWNfiR": e„�� liy.�en� ,s(& 3 lea a33b �Z>k_,�� 3 7� 7
name home phone# work phone#
CURRFTIT MAILING-ADDRBSS:_.�(�.S 1^t° ✓ S A
-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 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."homeownee'certifies that.he/she understands the Town of Bar- stable,Buildi�ng Deparhnent
inspection procedures and requirements and that he/she will comply with said procedures and
r ' emen nn.
�Si _ _ __ 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 bomeowmer performing work for which a building permit is required shall be cxcmpt from the provisions
of this section(Section 1D9.1.1 -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 an 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 insults 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 farm currently used by
several towns. You may can t amend and adopt such a fotm/certification.for use in your community.
Q:forms:homccxcmpt
tit
Yf /
IKEr, Town of Barnstable
Regulatory Services
9 $ Thomas F.Geiler,Director
�'tiEo a 16 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town/ab
Office: 508-862-40 8 Fax: 508-790-6230
Propertyst
Complete andection
If Us in
as Owner of the subject property
hereby authorize V to act on my behalf,
in all matters relative to work au o ' d by this building permit application for.
(Address f Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:F0 RMS:O WNERPERMISSION
i
.t3
CZ-0
c
v 48
i
I
4
BC AppraLsals
SKETCH ADDENDUM
r e :2c _ cmmty larpstat)fe SIa� .s.x RM
- �f_aaas corporation Address 14361vannounh Road.=lY
Dedr
4Q
12
Bath
Bedroom Rig tint : Nkt=
eaBr
29
d 2C
Lift Room
Bedmen Deft=
2Y
SO 1B
j
i
i
SKEMHCALC18JI11418 Area.
Al Al:40Ax240= 96D.0
A2:2Z8x20= 44A
Total Lbbig Area 1000
ClidcFORMS Appraisal Sormare 8W-622-"2-1 Page 9 of 11
Town of Barnstable
Regulatory Services
P Thomas F.Geiler,Director
Building Division
IWWSTaYHLE,
v KAM Tom Perry,Building Commissioner
id e
39• �
200 Main.Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Approved:
Fee:
Permit#:
HOME OCCUPATION REGISTRATION
Date: X V
Name: -� �0. 0. ��'T( �YJ Phone#: 60 0 30 y 'Gm q�(
Address: 'Z5- t S Village• I S - Mn oe 6
Name of Business: I l $ W Hf-1 D, i R-ndcJ
Type of Business: C, ' -n Q Map/Lot: 7D /
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 o€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
dwellingunit.
I,the undersigne , ve r d agree with the above resttri tions for my home occu ation I am registering.
Applicant �'� CC�c L /� I 1 Date:
Homeoc.doc Rev.5/30/03
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1' FL., 367
Main Street, Hyannis, MA.02601 (Town Hall)
DATE: l� 0 C
Fill in please:
s
APPLICANT'S YOUR NAME: I o_ 5
. BU INES(jS {!� Y tTJJJR H`O'ME ADDRESS: c. rS
p.xT�sa n.r 1 .J� 1 ! I V
sd 3
� ; � �50�
V TELEPHONE # Home Telephone Number 0<6
NAME OF NEW BUSINESS a TYPE OF
BUSINESS
IS THIS A HOME OCCUPATION?.�X< YES No
Have you been.given approval rom the building:division? YES- NO
ADDRESS OF BUSINESS `J i c S C1Jr� Ci�n S :MAP/:PARCELNU.MBER 4
When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth
Rd. & Main Street).to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed o y permit requirements.that pertain to this type of business.
uthprized Sign tune**61
COMMENTS: p
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS: .
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
s
GS _