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Home My WebLink About0253 SEA STREET �� _� L�i �. 1 1 s Town of Barnstable *Permit# ' Building Department . - Fee 6 o issu e snxxsrABLE, : Brian Florence,CBO ,MASS, Building Commissioner • 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Officer 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION- RESIDENTIAL ONLY Not,Valid without Red X-Press Imprint Map/parcel Number Property Address ol5 3 EA A 6't RAL T 9414AJLJLs gR sidential ' Value of Work$ J`��• Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Alzj I C&"\ SAS@. AS 46 a aC. . Contractor's Name U17 ,rP�e, r I ^ �cq, ;/0G 'Telephone Number Home Improvement.Contractor License#(if applicable) Email: C'lr14C4sT;.-ALr Fi4 -05' t>r�G /s Construction Supervisor's License#(if applicable)'.. Cg, �3'�'[?fWorkman's Compensation Insurance Check one:. - _ o E ❑ I sole'proprietor ❑ the Homeowner I have Worker's Compensation Insurance NOV 1 `2017 Insurance Company Name. S a Cj�� AH N ST ABLE Workman's Comp.Policy# 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 ❑Re-roof(hurricane nailed)(not stripping..Going over _,existing layers of roof) Re-side 3 Replacement Windows/doors/sliders.U=Value (maximum.32)#of windows . 4 RIT 9"I R #of doors: *Where required: Issuance o s permit does not exempt complian with other town department regulations,i.e.Historic,Conservation,etc.. ***Note: Property Owner must sign Pr rty Owner Letter of Permission. A copy of the Home Imp ement Contractors License&Construction Supervisors License is required. SIGNATURE QAWPFILESTORMSTXPRESS2017 7'lie Commomveaith ofMassad iusetts Department o,f gnd=triat Accidads - Office of lavex igatie= 600 Washbigton Street Boston,MA 02111 IvrommasagovIdia Workers' Compensaficm Insurauce Affidavit Bmlr_iersiCantra:cturs/Elech cians rPhumbers Applicant Infarma{ an Please Print �blY Noe Oudaessnga ationlFa ai} CZ �,l�e� � Address: Po Are you an employer?Checkthe appropriate bias: ' Type of project(reguir ed): I. a a employer with � 4. ❑I am a general contractor and I employees(full andfor part-time)* have luredthe sub-co�a�rs 6. ❑New oons[rucEioa 2.❑ I am a sale propdetor orgartner- listed on the attached sheet 7- ❑Remodeing ship and have no.empleyees These sub-contractors have 8_.❑Demolitibm wodang forme in any capacity. employees and hnre wo&ers' 9. ❑ rF su Building additia [No wodber8'Comp.insurance Comp.menr=M required_] S. ❑ We are a corporatifln and its 10❑Electrcal repairs or add ions 3-❑ I mna homeauner doing all work officers have exem.ised ihcsr 1L❑Plumbingrepairs or additions myself[No wo'rlmm'comp- right of emamption and we r L 12_❑Iioofrepairs insurmce requre&]i § t� employ-[NO'odoe& 13_0 Other. Co9IIp_IMMUM M required-] ;Any zmHcmtdmt efieftbox 91 m fina mast else otihe sKfionb9vwshuvdag&drvialere c=npa md=paHcyinfiamxdML' Hameoamemwho submit dtis S6dnir iudkx hag,they axe da ng sH war mA then hoe autsi&cnnt=ft — submit a new afridavk iadicatino stcb_ fCont�actu6 tFisi ebec7[dds box aaust attached oat sdditional sheet showing tbename of doe sub-cont[sdam and state whether ar not those eahtk5bave empioyees.Iftbe sab-c=txctm have employs,dwy=stpmvide their worken'tomp.pGrky number- -Tam an Hetoov is f7ta policy anti job s to irz,format&iL Insurance Company Name: 6AtmAe, .7 t Policy�or Self-ius.Iic_� l,�G'DDD�3�� E�piratiou Date: Job Address: "�-e�- Attach a copy of the workers'compensation policy-declaration page(showing the policy number and expiation date). Fai7.ure to secure coverage as requiredund n f MGL a 1572 can lead to the imlpositioa of criminal penalties of a fine up to$1,54D 0D and1or one " 'sow it e11 as civil penalties jn the form of a STOP WORK ORDERand a tine of up to$2.50_Da a day a.-aiijoEe violator- Be a - d that a copy of this statement maybe farwarded to the Office of Irrvestigations of1he Djkf&r ims>a�ce co ge"Mrificaticm I do hereby U10"tha pains adpaiawas of a 'es} attars iraforrtxs<6Wj prmidcd abm�a is true and correct Date Ph Q cial rise harry. Do prat wrke in this area,to be campteted by city arfonm afjiciat Si City or Town.- Pertmtl eased Issuing Authority(circle one): L Board of$eaIth Z.I3uti ng Department 3.6tY£mm Qerk d;Electrical luspector S.Plumbing Inspector 6.Other Contact Person: Phone#: information and Instructions . Massaclmsctts G-,-- :ral Laws chapter 152 requires all employers provide workers'compensation for their er uployees. Pm s-aaz�tu this stye,an M247I0YIW is defined as.6.every person in the service of another under any contract of hire, express ar implied,oral or wzitf f A anpk yer is defined as" m an �idnA partnership,associati�corporation or other Iegal er�ty, or any two or more of the foregoing engaged is a Joint a terpd=,and including the legal zapr w atives of a deceased employer,cr the receiver or trast=of m bdMdaaL part =hip,association or other legal entity,employing employees. However fhe owner of a dweIImg house having not more than.three apartments and who resides therein,or the occupant ofthe - dwPl�house of another who employs persons to do maintenan w,comsftuction or repay worm on such dweIIing house or on the,grounds or builBmg aj pmXr ztthereto shall not because of sach employment be deemed to bean employer." MGL chapter 152,§25C(6)also stains that'every state or local Rcensing agency shall withhold the issuance or renewal of a Be— e,or permit to operate a business or to construct buffdiuV in the commonwealth for any. applicantw•h.o has not produced acceptable evidence of compliance yvith the hisura.nce.coverage regnired�" Additionally,,M(ff-chapter 152,§25C( )sumps"Nefther the commonwealth nor jr y ofits poldical subdivisions shall enter infn any contract for the performance ofpmhhc woiic u of acxeptable evidence of compliance with the insm-an m, ` requaeanents of this dhaptr'r have been preseniEdin the contiactmg amthozzty_" '" AppHcarris Please f 1.out the wozi='compensation affidavit completely;by chug the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addrers(es)and PhOIIe mtznber(s) along with their ceriifica±e(s)of Insrn-Ence. Limited Liability Compames(LLQ or L=tedLiabiIify Partnerships(LLP)withno employee$Other.tian the members or partners,are not required to carry woz$eas'compeusafion insurance. If an LLC or LLP does have employees,a policy is required Be advised that this afhdayit maybe suhmiit�d to the Department of Industrial Aecidemts for confirmation of insurance coverage: Also be sure to sign and date the affidavit: The affidavit should be-retnme-d to the city or town that the application for the permit or license is being requested,not the Department of I nsb al.A ccidmis. Shouldyou have airy questi=regarding the law or ifyou are recurred to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should eater their seIf-insurance license nrlmber on the appropriate Ime. City or Town Officials Please be sure that the affidavit is complete andprinted.legiibly. The Depar[memthas provided a space of the applicant. ofthe affidavit for youto fill ouitinthe event the o�Office oflnvestigati has to corzfactyoumgazdingtTze appllicant P Ims a be sine to fill in the pen;j t ceme,number which will be used as a refe=ce u=ber_ In addition,an applicant that must submit multiple pem 1WHcense applit:aiiozis in.any given year,need only submit one affidavit indicating current policy inbrmation(if necessary)and under`job Site Address"tie applicant should write"aII IocatLons n (may or town)."A copy of the-affidavit that has been officially stamped or madce:d by the city Qr town maybe provided to the applicant as proofthat a valid affidavit is on file for fatal 'permits or license;& Anew affidavit must be f Mt--d out each year.Where a'h n:Le owner'or cid=is obtaining a license or permit not rP7airri to any business or conmeacial venom (i-e" a dog license or permit to bum leaves eft.)said person is NOT reqairzA to complete this affidavit The Office of Investigations would lilce to blank you in.advance for your:cooperation and should YOU have any qunsiions, please do not hesRzb,-to givens a call- The Departments address,inlephone andfax nnmrber_ - .. - . - 'I3�e - Degaitmemt of hidlistdal Accidents ��11�fA EMI lF Fax 617 727 7749 Revised 4-24-07gQ�� i °Frr+e rqf, r Town of.Barnstable Building Department. • snRxstE. Brian Florence,CBO 9 �A s639. �� g Buildin Commissioner len i�ve+ 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs . Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This.Section If Using A Builder• as Owner of the subject property hereby authorize �1- ?-.,IIv , to act on my behalf, in all matters relative to work authorized by this building permit application for: 0? 6a.S�„T- (Address of Job) **Pool fences and,alarrns'are the responsibility of is are not to be filled or utilized before fen s installed and all in ections are performed and acc ed. - S' ature of Owner Signature of Applicant Print Name Print Name Dae Q:FORMS:OWNERPERMISSIONPOOLS Rev:10/17 I<vVVu Vi "dal uaaaUIV, �OFTHE To Building Department ; ,Y os Brian Florence CBO .; t Building Commissioner =AMSTABM ' v MASS. $ 200 Main Street, Hyannis,MA 02601 sb39• ♦0 iOrEo 3rg a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: r JOB LOCATION: 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. DEFINMON 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 buildine Hermit. (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. 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." i 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 to amend and adopt such a form/certification for use in your community. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY`() 11/15/2017 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 have ADDITIONAL INSURED provisions or 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 Kathy Silvia NAME: The Fair Insurance Agency Inc. AICNNo Ert: (508)775-3131 aC No): (508)790-1677 619 Main Street E-MAIL ADDRESS: kathy@thefairagency.COm Suite 1 INSURER(S)AFFORDING COVERAGE NAIC# Centerville MA 02632 INSURER A: Essex Insurance Co INSURED INSURER B: Savers Property&Cas.-ARWC 31771 The Waquoit Group LLC,DBA:GCI Builders DBA,Paul Mazzola INSURER C: PO BOX 509 INSURER D: INSURER E.: Marstons Mills MA 02W INSURER F: COVERAGES CERTIFICATE NUMBER: CL17111501631 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MPM/DDY EFF POLICY17CP DY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 G O E 500,000 CLAIMS-MADE OCCUR PREMISES Ea occurtence $ MED EXP(Any one person) $ 10,000 A 2CZ8811 05/28/2017 05/28/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 M POLICY❑JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 Individual Risk Mod Prem OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO _ BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? N/A WC0002374 05/28/2017 05/28/2018 (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Andi Carrot ACCORDANCE WITH THE POLICY PROVISIONS. 253 Sea Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 uy� i 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE..BUILDING PERMIT APPLICATION_. Map Parcel' ' - Application # Health Division - ✓' Date Issued Conservation Division ? Application Fee %I Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address ,ZE3 eG , Village Owner dt c�> �� o�� Address Telephone _ ,yam 7 7 S- ,rl 543 Permit Request Al2.t-1 ,?�,e a J�:nl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 S Rrd_� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a-' Two Family ❑ Multi-Family (# units) Age of Existing Structure �(<"— Historic House: ❑Yes ,.4+16' On Old King's Highway: ❑Yes ❑ No Basement Type: a1full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 36(J fl Basement Unfinished Area (sq.ft) 02 o Number of Baths: Full: existing / new Half: existing new Number of Bedrooms: 62 existing _new Total Room Count (not including baths): existing new First Floor RoomCount Heat Type and Fuel: &( as ❑ Oil ❑(Electric ❑ Other 00 �. J Central Air: ❑Yes 2H16 Fireplaces: Existing_ New Existing wood/coal stove: 0 Yes _ No Detached garage: ®'existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing LJ new sizb_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes LTNo If yes, site plan review# Current Use -- _ _ ___ _ _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) / lcy,�2,jc—Name , 01,v91 a Telephone Number Addr` ,s 3 DS 9` License# k(4 `?We, Home Improvement Contractor# CP Worker's Compensation # [ALLONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOATURE DATE �1 FOR OFFICIAL USE ONLY - 4PPLICATION# D�TE ISSUED MAP/PARCEL NO. " ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL = ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a .' Tfie Coi�xmor�weccftJ� ofmassachusezts -Depar menx of TndustridAccidentg. 'Office of-11i-PesdkaIiorls 600 9��shtlglorl Street Boseon, AL4 02111 , .. t r 'tVlVW.Ir1aSS.g'OvIdia Workers' Compensation Yns>zrance Affda•vit: Builders/Contractors/EIectriciaus/�'Iulilbt rs - Please Print Le "bI A ` Iicant Informa-tion Name (Busi�csslOrganiiation/Lndividual): City/StatdZip: Are you an employer: Check the appropriate box. Type of project(required): I.❑ I am a cmploycr with - 4 [ '� a general contractor and I ,• 6 .0 Naw wn&uction employees (full and/or part-tir�c).* Nava fiired thc'sab-contractors listed on the attached sheet 7. [ tmodeling 2.❑ I am a'sole proprietor or partner- •r Thcso sub-contractors have g '] Demolition ship and hav0 no rmployccs working for room any capacity.' carployees and bave workers' 9 Building addition comp. incur-aamt °' [No workers' comp,insurance 10.E]•Electrical repairs or additio required] `5•i❑ W e are a corporation and its ' officers have cxcrc;*;d their 1I_[�Plumbing repairs or additio: 3.❑•I am a bomcowner doing all work right of exeinption'per MGL myself. [No workers' Go.mp. g 12.[] Roofrcpairs in.cl,rancc required]1 c, 152, §1(4), and wo have no ' 13.] Other, tniployees.,[No workers comp, insurance required.] *Any applicant that chce'ks box to must also fill out t}ic rec6on below showing their workers' comp—hon po)icy information. t Homcownei-c who aubroit this tin diratng they arc:doing all work and thcn hirr outside can tractors inusl submit n new a�i&vi tin dicating such. xConb-actom ifizt cheek this box tmat attaf_hcd an e6ditimd'sheet showing the nariu of the sub-conlraetors and sta{c whether or nofthpse enlidts have cnployecs. if'thc sub-�,bntraetors have miploycci,they muri provide:their workers'comp-policy number. P Y g , p rlsalinri ucsurartce fbr'my employces' BeCaty is tote p'oCicy arfdjob sffe ram an errz lo' er Ad is provtdut workers corn e inforrnatiort t w e n . �Y r . Insuzanct Company IfZXw ' policy# or Self ins. I ic.#: r Ezpir•ation Date: City/Statc;Zips Job Sitc kddress: Attach a copy of the workers'''comp.ensation policy declaration pabe'(sbow-ing the policy number and expiration date). Failure to sr,=c 4covcragc as required under Section 25A of MGL c. 152 can lead to imposition of cnrn;rial penalties of a fins up"tti 31;500,DO and/or ono-ycar imprisonment, as well as civil penalti'cs in tho'form ofa'STOP WORK ORDER and 2 fv of up to'5250.D0 a day against the violator Bc advisr d that a copy of this statcmerit may forwarded to the Office of Invcsti ations of thc`nIA forinsurancc overa cvcrificatiom X do hereby ce er e p in pertaltles ofperjury that the irrformadoh provided rtbove•'s true,and correct. Datt; �� — Phone•#: Offccial use only. Do not Write in.this area, ro be completed by city or town offtciaZ . 5 City or`TorYn; Pt rinit/License 4 4R ` l smog Authority(circle one) 1'. Board of-Health 2.' Building Department'3, City/Towa Clerk 4:Electrica Inspector °5. Plumbing Inspector: 6. 0 th e r ' com cnsatioa for thcir.eozployecs; to ers Rfor ation and histructions to road e workers p r wires all emp y P ct of]lire, Massachusetts Gcncral Laws chapter 152 cq Pursuant to this statute, an employee is defined as "...cYcry person in the service of another under any contra express or implied, oral or wntten- • or other Icgal entity, or any two or more An ernplDyer is dtancd as "an individual,partnership, association, eorpores-cn or the c a ed is a Dint enterprise, and including the legal representatives of a deceased employer, of the foregoing ng g 1 g ty, p yin c to cos. However the receiver or izusteo of an indindual,partnersluP� association or other legal enti em to g mp y owner of a dwelling boost having not more than three apartments and who resides therein, or the occupant of the dwcWn.g house of another wir-,York ho employs persons to do rnaintV am cc of s h emplooyrncnt be deemed to beon SuchL dan employer. wclling or on the grounds or building apPlirtLOan"thereto shall not b MGL chapter 152, §25C(6) also states that"cYery state or local licensing agency shall)�ithhold the issuance or ren.e�ai of a license or permit to operate a buslness or to constructe vs�d n stin ttrhan cram erage required for y applicant Who has not produced acceptable eYidence the GnplJan Additionally,MGL obapter 152, §25C(7)states 'Neither the conunon ble cvidcnce of omplir.ny of its ee q Lthd th l�uShall a�c cntcr•into any contract for,rho performance of public work untilP zcquircmcnts of this chapter have been presented to the contracting authority. Applicants, cEag the boxes that apply to your situation and, i. Please fill out the workers' comp atio( adder ss(cs) and phone)nompletely,by umbcr(s)along with tbcir ecrtiiicate(s)of necessary, supply sub-coatractox s names), insurance. Limited Liability Companics'(LLC) or Limited Liability Pazta�s�p$Dr. If an)LLC oroLLP does have other man the raombcrsorpaxtners, arcnotrequucdto carry workers compensationins of Indus employecp es, a policy is required ac advised that this affidavx5tmayara tobsigm nd date tlaed to the lafflda-t•ntThe afGdavatlsbould Accidents for confirmation of insurance coverage. Also b bo ret=c;d to the city or town that the application for the permit or�yr o c i o �rcgewsr ttcA o obtain aeworkers' of Jndustrial Accidents. Should you have any questions regarding th y corapen idc)n policy,please call the Department at the nur4ber listed below. Sclf-insured companies should enter their self-insurmr license number on the a ropriatc liar. CIty or ToTrp OtAclnls Plcasc be sure that the affidavit is conoplcte and printed legibly. The Department has provtact udce erdtng the.the °II of tho affidavit for you to fill out in the event the Officech will bcIn-ycsusod as ah fero ncccnumbcr. In addition, an applicant Please b sure fn fill in the permit/liccnsc numb tbat must submit multiple permi4ccnse applications in any given year,aced only submit onp affidavit indicating current policy information(if poecssary) and under"Job Site Address" tho applicant should write"all locatir town may bons'n to-(city th ciC or town)."A cbpy of the efi�daa dancers on file focca r ffuturlly tc permits opcd or rkccnsc s A nowoaffidavit mustbe filled out each &ppvrant as proof that a yah year.'Whero a horse owner or citizen is obtaining a license or permit not related do any business or commercial venture (ie, a dog license ox•permit to Mein loaves ctc.) said persou is NOT required to complete this affidavit would]rice thank you tha you in advance for your cooperation and should you baYc any questions, Iha Office ofInvcstigations please do not hesitate fo give us a call. 716 Dcpal tment's address, tclephoac,md fax number: Tha Commonwealth of Massarhtl rrtts Dega nrrAt of Ind- �O Arcidt*nts Office of 7myesttigatians 600 Wsshingtan Street $gstan, MA 02111 Tel; # 617-727-490.0 ext 406 Qr 1-877-MASSAFE Fax# S17-727-7749 Revised 11-22-06 www.mass.gov/dia I _ . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 66/04/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). - PRODUCER - Schlegel & Schlegel Insurance Brokers Inc NAME:NAME:PHONE FAX 34 MAIN STREET FILo.EXq: (A/C,No): --MA ADDRESS: - - PRODUCER _ - • CUSTOMER ID#: - West Yarmouth, MA 02673 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERANGM INSURANCE - Jerome Tremblay w$UREReLIBERTY MUTUAL 5 Pierre Vernier Drive INSURER c INSURER D: Sandwich, MA 02563 INSURERE: 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 LT POLICY TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP _ (MMIDDIYYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY MP00413T 02/09/2010 02/09/2011 r A EACH OCCURRENCE $30O OOO - ][ COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence) $500,000 CLAIMS-MADE a OCCUR - MED EXP(Any one person) $10,0 00 . -- PERSONAL&ADV INJURY $300.,000 GENERAL AGGREGATE $600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $600,OOO POLICY PRO- - - - _ JECT LOC $' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $- - - - (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS - - BODILYINJURY(Peraccident) $ _SCHEDULED AUTOS • _ - - PROPERTY DAMAGE $ HIRED AUTOS r (Per accident) NON-OWNED AUTOS - _ $ $ UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DEDUCTIBLE + RETENTION $ $ B WORKERS COMPENSATION WC1-31S-0908306 06/04/201006/04/2011 X WC STATU- OTT- - AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ ZOO OOO OFFICER/MEMBER EXCLUDED? N/A .. , (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ '100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,OOO DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)THE WORKERS COMPENSATION POLICY DOES NOT.PROVIDE COVERAGE FOR JEROME TREMBLAY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4 - AUTH R ZED REP ESE TIV - - ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registeredYtlarks of ACORD 'yam � '• , � - '". . op714�Tp Town of JJ�'C`I.rn �`G bl ' Regulatory Services. f _ L P-Hs-rAHLE, ' Thomas F, Geiler,Director, y 1659. �`�� k� ;Building 7�ivision _ . Tom'Perry', Building Commissioner 200'lvlain Street, Hyannis, MA 02601 wtvw.toivn:barnsta iile-ma.us Fax; 508 790 62' office: 508-862-403 8fi Z'tOpe t� O�nr✓t must c oxnplete .a d S g This SeC io If Us ' ig h �3uilde 1 , as Owiiet of the sdbj.ect propetty hereby authorize to act on my behalf, 3 In all matters relative to work authorized by this-building permit applicatlotz<for.' _ (Addtes's of iob) +. Si gn-a re of Owner ate -Print Name ' - .if Property"O'wner is applying for perrnk pleasfe complete the Homeowners License f+ , Exernption.Porm on th'e reverse side: F ToW.0 of Banastable y"P 0pJHE rp�y� ' RegulatorY Sezy;.ces Thomas F. Geiler, Director sAt�,sr,tat.r:, . MISS. -�� Building Division sd7P• ,� PjFo N��A Tom Perry,Building Commissioner 200 Main Street, 'Hyannis, MA 02601 R wjy.town.bariistable.ma.us Fax; 508-790-6230- Office: 508-862-4038 T3014EOWN>rR LICENSE EXEAIPTION Plcnse Print DATE: JO$LOCATION; street yi)iage number 111-10MEOWNL•R': home phone 9 work phone# name CURRETIT MAfLINO ADDRESS: state city/town rip code ss cUings of six., ts or jr The current exemption for"home�ers''was extended to doeinclude not }osscu ess a li ens, Provided that tha owner acts as to allow homeowners to engage an individual for hire who p superYisor. DEFINITION OF HOAIEO)VNER . person(s) who owns a parcel of land on'which he/she resides tie atceedssoo r tolsueh use and/or farm tinctures,A to be, a one or two-family dwelling, attached or detached structures accessory person who constructs more than one home ll?Official on.aaforintacdceptable to the Bu shall not bo ilding Officiered a al,that he/she shall be "homeowner".shall submit•to the Building Off res onsib)c for all such Work erformed under the buildin em�if, (Section 109.1,1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules.and regulations. ablc Th'a undersigned "homeowner" certifies that he/she understands he/she}ri 1 comp ye Town Bvrithtsaid procedures and Department minimum inspection procedures and requirements 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 ROMEOwNER'S EXEMPTION it is required Shall bedc states that: "Any homeowner performing work for which a building perrn exempt from the provisions on 1 o9.1,1 -licensing of construction Superyisors);provided that if the homeowner engag of this section(Sec es a pason(s)for hire to do such The Co ti work, that such Homcotirncr sha)1 act as supervisor, the Appendix la, Many homeowners who use s�ctio ptlOn are unaware Scat on at 1thcy are assu la k of awarcnesooftcn)resu)LsCins rioussproblcnuppartic Q,y Rules &•Regulations for Licensing Con P when nccm.hocowncr hires unlicensed persons, In this case,our Board cannot proceed against the unlieenscd person as it would N th a license• SUpetYisor. The homeowner acting as Supervisor is uitimatcly responsible. part of To ensure that thehomeowncr is fu)ly aware dersuands the c)fhnshcrTccs rlsi f a Slutics,a y r tAe 1 sit page of Lhisaisssue iss a(form currcntlyit 1used by that the homeowner ccrtifythat hdshe ern , rn ✓r,riifea(;nn for use in your community. Board of Building Regulatio s anc tan ar s License or registration valid for.individul use only. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 113239 d ^ " Board of Building Regulations and Standards EXplration 5/27/2011 Tr# 283104 One Ashburton Place Rm.1301 {r1Typ dividual Boston,Ma.02108 MICHAEL J.DINOIA ' MICHAEL DiNOIAAj i 32 OUTPOST LN 1> � CENTERVILLE,MA 02632_3— Administrator Not v id i hout signature ,�. Massuchusetfs- Department n E t of Public Safeh " r Boa4'd ofBuildin<.Re«ufitti ons and St'tndar s Construction Supervisor License License: CS 58441 ° ' ' . Rest ricte,d.to 00 - ;;MICHAEL J`-DINOIA 32 OUTPOST LN. : l =CENTERVILLE, MA'02632 . Expiration: 10/15/2011 Commissioner Tr#- AQWA < JOB RIMAJUA ,vo i t►'� TAYLOR DESIGN ASSOC., INC. SHEET NO. ` OF } P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY DATE Tel./Fax: (508) 790-4686 CHECKED BY DAT .�r 0 -r AMVIV I b KA, SCALE TAYL . ... T ...... ..... .... ...............1 � . 5 30 s .� it 4 1 4. x.�o h,.� . . R-�-�rr5c-s. Cp , . m c SPsz- D C ... «� ��, ....... ..................... .. z Is..*-moo- ' ... ..: - � . 0 M ` .S$ "L cam'. . ? t_ .�' Y ._g. .: ...... . . .. . 1 � `t _ ... coo 7—7 Pc - tc �L '1 ti L . .. 4��Rr. fez ... _.. 3• o oFt ro,,, Town of Barnstable *Permit - Expir �1 nths from issue date, Regulatory Services Fee • snxrtsrnsr.e, r n�nsa 0$ Thomas F.Geiler,Director IFG, 4 A 1 wULI Building Division Tom Perry,CBO, Building Commissioner OC -200 Main Street,Hyannis,MA 02601 s a3 r, www.town.bamstable.ma.us Offii0 N 6P4'08 :Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL.ONLY Not Valid without Red X-Press Imprint --j Map/parcel Number j(p Property Address �, .. &2 OResidential Value of Work 0�,206 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �� Contractor's Name - C--Telephone Number SIO -4/- Z G —3 YW Home Improvement Contractor License#(if applicable) C Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one`. ❑ I am a sole proprietor ❑ I jrp.Iiie Homeowner f have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#_ Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles)'All construction debris will be to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value ,cJ (maximum.44)#of windows *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 IJo rovement Contractors License"&Construction Supervisors License is required. / R SIGNATURE: , .. Q:\WPFILES\FORMS\building 'ennit'forrns\EXPRESS.doc Revised 090809 I 'J' ±Massachusetts- Department of Puhlic Safety Board of Building Re,gulations and Standards Construction Supervisor License tT _ License: CS 76085 Restricted to: 00 °t LEIF E BOTTCHER 825 CEDAR STREET W BARNSTABLE, MA 02668 ` Expiration: 8/30/2011 ('i,tnmisiuncr Tr#: 5635 6711 -P :4 Boar o u11 in e ula,��n g g s an Mnar s One'Ashburton Place - Room 1301 Boston. Massachusetts'02108 Home Improvement Contractor Registration Registration: 111950 Type: DBA Expiration: 1/8/2011 Tr# 279079 LEIF BOTTCHER HOME IMP. CONT_RACTO f LEIF BOTTCHER - 825 CEDAR ST _ ``' W. BARNSTABLE, MA 02668 Update Address and return card.Mark reason_ for change. i-CAt 0 SOM-07/07-PC8490 Address Renewal Employment Lost Card - � �� The Commonwealth ofMassachttsetts Department oflndustrial Accidents Office of Investigations I' 600 Washington Street Boston, MA 02111 '� Z•-�. i•vww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: fo C City/State/Zip: Phone #: 6�U�c36 Z YaC2 Are you an employer?Check the appropriate box: Type of project(required): 1.U/II am a employer with �� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in an capacity. employees and have workers' y p y• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 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 l l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per,MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. ther Z aj 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 andjob site information. Insurance Company Name: Policy#or Self-ins.Lid. --#: %Q i?z7f 5 5 Expiration Date: —(G Job Site Address: �5 � —S City/State/Zip: �2� 2 7 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 ce �_,F- anenalties of perjury that the information provided above is true and correct. Si attire:: —Date: V Z22 Phone#: �) DSS ZZl✓ 2: 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. Ci,ty/Town Clerk 4. Electrical Inspector 5. PlumbingInspector . P 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 ewployee 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, constriction 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 conunonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727=4900 ext 406 or 1-877-MASSAFE Fax # 617-127-7749 Revised 4-24-07 www.tnass.gov/dia tr r DIME ro Town of Barnstable Regulatory Services BARNSrABLF, " Thomas F. Geiler,Director rsnss. en,y,g. 6. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79OL6230 Property Owner Must Complete and Sign This. Section If Usine A Builder I, I - , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of J b n r v 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:FORM&OWNERPERMISSION t - Town of Barnstable o Regulatory Services Thomas F. Geiler,Director IAMSTABLE. MASS. 1639. a,� Building Division lEDr Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 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 acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.L 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 P 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. 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 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 hdshe 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. Q:\WPFILES\FORMS\bomeexempt.DOC AM PACE 2/002 Fax Server ACORD. CERTIFICATE OF INSURANCE PRODUCER . DATE(MM\DD\YY) 10-20-09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BRYDEN S SL'I.,LIVAN INS AC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 88 F'ALMOLITH RD HOLDER. THIS CERTIIEICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAC;E AFFORDED BY THE POLICIES BELOW- HYANNIS,MA 02601 COMPANIES AFFORDING COVERAGE '232 NY COMPANY INSURED A "TRAVELERS INDEMNTi'Y COMPANY COMPANY LF.IF BOT"TCHER IIoMp, B IMPROVIsMRNT I INC. 525 CEDAR STREET' COMPANY WEST BARNSTABLF;,MA 02668 C COMPANY COVERAGE D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L;STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONOFIION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSI0IIS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM S. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER DATE(MMIDDIYY) DATE COMMERCIAL GENERAL LIMITS CLAIMS MADE GENERAL AGGREGATE g OCCUR. PRODUCTS-COMP/OP AGO, $ OWNER'S&2 CONTRACTOR'S PROT. PERSONAL 8R ADV,INJURY $ EACH OCCURRENCE $ FIRE DAMAGE(Any one lira) $ AUTOMOBILE LIABILITY ANY AUTO MED.EXPENSE(Ally one person) $ ALL OWNED AUTOS COMBINED SINGLE LIMIT SCHEDULE AUTOS BODILY INJURY(Per Person) $ HIRED AUTOS GODILYIN'JURY(Per Accident)NON-OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY $ ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY; EACH ACCIDENT EXCESS LIABILITY AGREGATE $ UMBRELLA FORM q OTHER THAN UMBRELLA FORM EACH OCCURRENCE WORKER'S COMPENSATION AND AGGREGATE $ $ A EMPOLYER'S LIABILITY THE PROPRIETOR/ 1_113-0407MU63-09 07-30-09 07-30-10 STATUTORY LIMITS PARTNERS/EXECUTIVE X INCL EACH ACCIDENT X OFFICERS ARE: DISEASE-POLICY LIMIT EXCL $ 100,000 $ 500,000 OTHER DISEASE-EACH EMPLOYEE $ 100.000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLE;SIRESTRICTIONSISPECIAL ITEMS TII1S REPLACES ANY PRIOP,CER11FICATE ISSUED TO TI{C CERTIFICATE HOLDER Arr-T NG WO REF:5gC:I.,OVER ROAD,YARMOUT(i RK ERS COMP CO'/GR AGE. CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE OF.SCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE1SSUING COMPANY WILL ENDEAVOR TO MAIL ID DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE!SHALL IMPOSE NOOSLIGATION OR LIABILITY OF ANY KIND UPON THE CCMPANY ITS AGENTS OR REPRESENTATIVES. ACORD 25-5(3/93) AUTHORIZED REPRESENTA"'IVE Charles J Clad, 10/16/2009 15:17 7815985957 DIVIRGILIO GROUP PAGE 01/01 A oRnRTI1=1C"gTE O� LIABILITY INSURANCE DATE{MMICWYYYY) F270 UCER C E ixgi7 io insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BroadwayONLY AND CONFERS Nth RfGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFICATE DOES N07 AMEND, EXTEND OR . . Box 8065 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lynn, MA 01904 INSURE4 -, ...............INSURERS AFFORDING COVERAGE NAIL# HOb1E =MPRovE1NxS INC iNSURERA: Westezn World _--- - ....- 625 CEDAR $'[ INSURER o: LEIF BOTTCHER INS LIRE R C: _.. WEST B STABL9, MA 02668 INSURER(5� COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAUL.BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVVIT I FTpNDIJV ANY REQUIREMENT,TERM OR CONDrrION OF ANY CONT TACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NOT 8E 19SAN OR MAY PERTAIN,THE INSURANCE AFFORDED BY THlii POt ICl ES DESCRIBED HEREIN 1S SUBUECT TO AU.THE TERMS, THIS CERTI AND E NAYNQ BE I OF SUCH POLICIES.AGGRMATE LIMITS SHOWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS. TWA! ADD,....___... -- POLICY NUMBER EOUCY EFFECf1VE POUCY EXPIRATION ....... ,-GENFRAL LIABILITY LIMITS - - A X COMMERCIAL(IFNI:ttALLIABILITY NP15 1,Z34142 EaCFIOCCUR,RENCE F ,j,.000,C0a r GE TO RENTED CLAIMS MADE ! 0 CCU R FF. sESIC!"', 3 5�,000 i _ ME EXP(Arn'one perem) S_ 5,000 _ PF,R50NAL8 AOVINJLIRY N 1 000,000 (3F.N'LAGOREGATCI,IMITAPPLIESP OENERALAGGREGATE R 2 000,000^ r F R; , PouGY PRO I LOC PRODUCTS-COMPIOP AGGLL 1,200,000 AUTOMOBILE UASI LITY ANYAUTO I COMRINCD SINOLE LIMIT ALL b WNED AUTOS (Er,nccltlom) SCHEDULF.OAUTOS 130MlILYI AIRY £ HIRED AUTOS .,� NON-OWNED AUTOS BODILY INJURY (P nr a celdant) 3 PROPERTY DAMAGE GARAGE u)B0.lTY (F'eroeCldenl) $ ANYAUTD AU1_00 LY ,EA ACCIDENT OTHER THAN EA ACC $ EXCESS I UMBRELLA LIABIIJTY AUTO ONLY: AGG $ f - - OCCUR CLnIMgMADE EACNOCCURRENCE - AQ@REGATE - _ O'0UCTIB'E S. Iib ErEN 3 iZRKM COMPENSATION AND EMPLOYERS'LIABILITY WC STATU• OTH- ANVPROPRIETORIPARTNERIFXECUTNE Y� ORY.LJMISS_, —, O.rICF.WMEMBER EXCLUDED? (MAndatorylnNH) AQHACCIDENr S SF'ECIALPROVIS ONS bnl"w E.L.DISEASE EA EMPLOYE $ OTHER E 1.DISEASF,-POLICY LIMIT g I DB56RIPTION OF OPERATIONS I LOW`4TION51 VEHICLES/EXCLuS_10NS ADDED BY ENDORSEMENT J SPECIAL PROVISION$ carpentry, Roofing Contractor Re: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFT HE ABOVE DESCRIBEDPOLICIE$BECANCELLED BEFORE THE EXPIRATION DATF,THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL-_0 NOTICF,TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 30 SHALL IMPOSE NO OALIOATION 0R LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 2S(2009/09) 1'atxick J. Cranne 1988-2009 ORD RpORATION. All rights The ACND name and 1090 are registered marks 0 ACORp reserupd. TOWN OF BARNSJABLE BUILDING PERMIT„APPLICATION Map /� (> Parcel - Permit# U He i ision , � Date Issued Conservation Division n Fee , q 0 Tax Collector' Treasurer Planning Dept. e �� '✓ Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis 3 Project Street Address xojJ SEA Village / r 19NNI s 02-6 0 1 Owner A/y D f 0,/1 e U Address 63 WOOD 911q 4 Ve Telephone Permit Request i5i4rt"�1 (L�:a 1'� �Z-el�2 6 I L)! A) A eW AejjT l�j evlJ IN i rz i ryi J / =`square feet: 1 st floor: existingproposed 2nd floor: existing proposed Total new N` 11 /n� .,Valuation d` '29ing District Flood Plain Groundwater Overlay Construction Type W od b FX AAE Lot Size J`J� Grandfathered: LiYes ❑No If yes, attach supporting documentation. ` Dwelling Type: Single Family Z Two Family ❑ Multi-Family(#units) Age of Existing Structure-7 t4k Historic House: ❑Yes <o On Old King's Highway: ❑Yes Basement Type: .,ZFull ❑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 baths): existing �g� new First Floor Room Count Heat Type and Fuel: WG"as ❑Oil 0 Electric ❑Other Central Air: ❑Yes ) No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:d 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 26 If yes, site plan review# Current Use NU M Proposed Use 519 In � BUILDER INFORMATION Name b/ri' S ?O 1S UecT, Telephone Number SOY 771 57 Address .1 5 " License# . ©o O Home Improvement Contractor# //0 6r-7 Worker's Compensation# 6 hW3 --VQ 33 ALL CONSTRUCTION DEBRIS-RESULTING FROM THIS PROJECT WILL BE TAKEN TO 2 fM 0 Ve,8- I 6 Pz SIGNATURE -0 DATE _ 9 FOR OFFICIAL USE ONLY -� *Ml'y NO:% 49q .3 i } DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE, - OWNER i •• -• Q � F � -, _ , ., - - DATE OF,INSPECTIONS FOUNDATION FRAME INSULATION e ' FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL' r • GAS: ROUGH FINAL! FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO. a, r s r �F 1HE Tp� : .,IMSTABLL ; The Town of Barnstable ,' : `e$ Regulatory Services ? A'Eo►��° Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax-� 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW i SUPPLEMENT TO PERMIT APPLICATION f 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: �.`r1 U.f`� ,� Estimated Cost 0 0 C� Address of Work: 0?,JY`ei,�52 S�LA S T P) q OZl U r Owner's Name: A" /V D, j ( P 0 Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law OJob 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 I hereby apply for a permit as th agent of the owner: 001 I Date Contractor Name Registration No: OR F Date Owner's Name q:forms:Affidav r LIVING SPACE Value. (high end construction) square feet X$115/sq._foot (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot=—O ® � GARAGE (UNFINISHED) square feet X.$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER O ATb V-0-0-'`1 /4eA-t square feet X$??/sq. foot=. Total Estimated Project Value For Office Use Only --In clusionary Affordarble Housing Fee Residential Commercial" Property Owner's Name Project Location Project Value Permit Number "Existing Sq. Ft. ' "Proposed New Sq. Ft. Fee $ IAHFORM 1/3/00 Die Lommonwe Department of Industrial Accidents - ' =7 Office OlIOYBstiffa fODs 600 Washington Street Boston,Mass 02111 Workers' Compensation fimrance Affidavit a , ,,, M,��/�� i� name: location: _ phone# — city ❑ I am a homeowner performing all work myself ❑ I a n a sole ropnetor and have no one working is any acxty /' %%%////%%%/////////I///ems///com�ens/ation for my employees working on this obi%��%//////%///%///%/%%%%%: F�tjI am an employer providing P .:.{•..;::;::.P P g comDnnv name: address: • city- NN- S . ....� p s � insure n ❑ I am a sole proprietor, general contractor; or homeowner(circle one)and have hired the contractors listed below w h, have the follo«1ng workers' compensation polices: ;. .: company name' address. c .... .. ...... . ::.�::::. .. .. ... ........ .........,:..:......:..:.....:..:.:... .............. :...... ... : i..�.:...:..:...�:....,.,....:.••..r...v.....-..�7?...,. M.•:�.:v_::•:• ::•.•.v5...;...:.}:?¢:.!?,:::::.:.:v::v::::�::::::: . ::.. :isi: ..... in-0nne o ' .:::: r w.::..:.}:.;:x.:.:{.:•.?' ::•::,:?:•::J::v:::::::{:•.:i:k::•.bv:i:w::::::}:::::}::,.;:;{},�,i:'.i:7?;J}:}J::•?J{i•':rr$:•J:•}i�::••::�?;:•J�J:`:4�i:ivii:ri;�}'+.?00 /FREE // v.... :... ............... •..:.::i::••4:::.:...:.;. ..;.:. xJ:??{4:}:ii}'v:ti:•iJ::•:::}ii:v::'J{AC•:?Ji:•::ii:.:::ij2;;}::i•;iii:........ : i:: name: comnan .:. address: :. UZI city: ::::.,Y•:?•>::.:.:::::.:..::.::..............:.......... :.. :-.....:..:..;. Y-... ofR ....... .... insnrnnce co / ,,,•se ., n of crtminzi enalties of a Hne up to S1,500.00 andlo FaHure to secure coverage as regmred under Section ISA of MG-1 152.eaniead to thetmpo� P one years'imprisonment as well ss civil Penalties in the form of a SPOP.WORK ORDER and a f xte of S100.00 a day against me. I understand that e rwarded to the OlIIce o[Invatlgatlom o[theflLl for coverageyeti8cstlon. copy of this statement may be fo I do hereby certify'under the pains and penalties of perjury that the information provided above is true mid coned Date Signature Phone# Print name - ortownotHcial Fcontact nly do not write in this area to be completed 6y dry permitMeense# • (]Baliding Department ❑Licensing Board❑Slecunen-s Oillce mmediste mponse is required ❑Health Department on: phone#; ❑Other r, muea:,.:5 F!Ai r Information and Instructions ' Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thy.: oted from the "law",an employee is defined as every Person in the service of another under auy cc.-�---- employees. As qu . of hire, express or implied, oral or written. An employer is defined as an individual,partnership, rP 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=plover, or the recce.,a 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 the or the occupant of the dwelling house cf. another who employs persons to do maintenance , construction or repair work oat such dwelling house or on the gro=ds 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 rere- of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h. not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither'h. nmD any��for the performance of public wort commonwealth nor any of its political subdivisions shall enter . of this chapter have been presented to the cone- acceptable evidence of compliance with the insurance c---_ authority. /�/ Applicants vit completely, checidng the box that applies to your situation anc ' easation affidavit omP y,by Please fill in the workers comp hone nimbers��with a certificate davits may be of insurance as all affi supplying company��' o �dd d�trral Accidents for of insurance coverage. Also be sure to sign uc ' to the Department submitted eP application for the permit or iic...... or town that the app P �r date the affidavit. The affidavit should be returned to the city have�Y questions ��the "law" a being requested,not the Department of Industrial Accidents. ��Dept at�amber listed below. are required to obtain a workers' compensation policy,P City or Towns tinted legibly. The Department has provided a space at the bottom of= Please be sure that the affidavit is complete and p Y• � the applicant please affidavit for you to fill out is the event the Office of has to ca =ct You apP be sure to fill in the peiaiitllicense number which will be used as a reference number. The affidavits may be reurrre3 to 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. i7 The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of invesmadons 600 Washington street _ Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 7=CZMAp mdk j ' •- . . Pree:iptEre Paeicaga for Qaa and Twa■Famillr Reaideaatai Batldtala Sated with FaasrY Foeb - MAXIMUM IYlQ1AVi[1M ag �g �g wall nw 8asemea: Slab Arm'(K) U•vatu� wVail , R dmi- z4mfilet wau Fgici� t'ar�age &vaLsat &Waled 5701 to 6600 Hnda;De�eea Dam I Q 12% 0.40 33 13 19 to , 6 Notmai I It 12% 0.52 30 19 19 •10 6 No=si 9 12•A 0.30 n 13 19 to: 6 iS AFUE T 13% 036 3E 13 23 WA WA . Nmami � U 13% 0A6 3E 19 19 10 6 Naemai Lx — 3s 13 2?' WA !SAtVE I3% 0 SZ 30 19 19 AFt7E tE�/. ,, _ m —- _ 13.: W . � wA. ... wANmeasl IVA a42 3a 19 2S wA WA Noemal lE'/. 0.42 3f 13 19 10 6 90AFUE IV/. 030 30 19 19 10 6 90AE�JE I. ADDRESS OF PROPERTY: v�� S f A 57— 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: Q , 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 DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a I 780 CMR Appendix J 4 .., Footnotes to Table JS.Z.lb: •• ` 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.opaquepdoors) to the gross wall area, expressed as a percentage. Up to 1%of the total,glazing area maY be excluded from the U-value requirement. For example,3 fl of decorative glass may be excluded-fi my a building design with 300ryft of glazing area- be After January 1, 1999,glazing U-values must be tested and documented.by a ie.maaufacturer in accordance with the National Fenestration Rating Council (NFRC) test,procedutr, or taken from Table JI.53a. 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 consauaron. It the insulation achieves'the fu11 insulation thickness over the exterior walls..without.:campression wR 30f.insulatton may be substituted'for R-38 insulation and R-38 insulation may:besnhstrtstted for R-49 ursulatroa CeiIurg R values represent the sum of cavity insulation plus insulating sheathing (if used) :For veatilatedceilings,.insulating sheathing must be placed between the condidoned space MU ue Yc.;"-" wall cavity insulation plus insulating sheathing (if used).,Do not include Wall R-values represent the stmt`_of they �, x exterior siding,structural sheathing,and iatenor drywaiL For.example,an R 19`tquiiefnent could be met EITHER insulaaon--plus R-6 tnsulatzng sheathing..Wall requirements apply to by R-l9 cavity insulation OR R=I3caxity . wood-flame or mass.(concrete,masomY,log)wall canstriicaons,but do not apply to mefal frame construction.~ 'The floor requirements apply to floors over qq dkioned spaces-fsuch as unconditioned,mawlspaces,basements, or garages).Floors over outside air must meet the 01ag requirttuents. ,. M o The entire opaque portion of any individual basement wall with an average.depth less than 50/o below grade must. meet the same R value requirement as above-grade walk s W-mdows. 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. _ 3 'The R-value requirements are for unheated slabs Add-an additionalR 2 for healed slabs: ,. • If the building utilizes electric ietrstancx h_catg� T prance approach 3, 4,_or 5 gIf you,pian to install more than one piece of heating equipment or;tnore than one piece of cooling.egwpment, the equipment with the lowest .. efficiency must meet or exceed the`afficien the selected e F 'For Heating Degree Day requirements of the closest city or town see Table JS.Za a NOTES: . -.a.a .-r .+z...x�as..� �� .y,..y s.lea�-•+ 'ft� ..a'i& . s � x:'..,_v ... .. . • le levels. Insttlauon R values air minimum acceptable levels. a)Glazing areas and U-values are-maitnaum alb _M.- R-value requirements are for insulanon.�r%ly andLdo not include strtrctura!components. f ...�- b)Opaque doors in the building envelope�must:hav�a LLU value no thaw 035. Door U-values must be sated M and documented by the manufacturer in-acxordance.wdt the NFRC testcedure or taken from the door 0-value. in Table JI.5.3b. If a door contains glass and an aggregate U value;rating for that door>s not avaiia6le;include the glass area of the door with your windows and-use the opaque door.U value to determine compliance of the door. ...,. h -w.... ,... One door may be excluded from this requirement(Le.,may have a U-value greater than'034 =°- c)If a ceiling,wall,floor,basement wall,slab-edge,oucrawl space wall component includes two or snore areas with different insulation levels,the component complies if tine area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing door`comPoneats coinplyafahe aria-weighted average U- value of all windows or doors is less than or equal to the U-value requuement(035 for doors). aZ J03ejislu1wpV L09Z0 VW 'SINNVAH 1S Jl2l2MH0 Bl . IHS ASIOS 2I SVWOH.L 00-:91 POP14se 1 s- WL9l :cu _Z00Z/1V&0:swjdxg '. 4461 kM0 GwP43jte MGM S"J':je1wnN s` a0SIA213dnS NOinnI lSN00 :esuean t SNouvinmu WaIUte do aaVOe j ; ✓�ie �arr✓Ynoa�uea oue �` `Ra - - - ' `' ` '"' �7 t '�'�•�,� ��`` I may— ,�- d m �� a� „ and of Building Regulations and Standards" � - V g .tV y r r a One Ashburton Place Room 1301= ' Boston , Massachusetts. '02108 , Home Improvement Contractor RegistratioOF as Registration: 110657 Expiration11✓3l00 Type Individual ONE.IHPROVEMEHT CONTRACTOR � Registration: 110657 THOMAS R BOISVERT �� ' Ezpiiation: 11/3/00 THOMAS BOISVERT Nx � � � Type: ,. Individual 15 CHERRY ST HYANNIS MA 02601 THOMRS R BOISVERT , � S BOISVERT ADMINIsTRA.OR _._.ERRY-ST -- t HYRHRIS 0260 1 1' t , ikit s r i i 4, 91 t\ �' M I j sr_M..� i a� • Ff Rol ell JI— / rV H-c f _ r t i ��aracr'w.9r.+�:f"T_�'.Yirt.:..�Y.'^ x.rr:��.;�,-[_"•��_.T•�'ly�"wr'"{v..fMn7Rv'Tlh.. '•:. .. .... F...}."i: ."'�'• ",.tii1^.,,.::�fy.-:.t;y..."V>'�,- ri�'."a..� 'I* .�..-�:. -.f''c P`of.1HE, ti The Town of Barnstable . 9 BARNSTABLE.� Department of Health Safety and Environmental Services MASS. 039. �0 �prFDMA'a Building Division 367 Main Street,Hyannis,MA 02601 : - 2-Office: 508 86 4038 ,Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Typeof Inspection 75r � P y �' l�' Location 53 Sept, q4-, Permit Number 7"V 7 3 -7 Owner Builder One notice to remain on job site, one notice on file in Building Department. artment. The following items need correcting: 6t4Q k a Please call: .508-862-4038 for re-inspection. Inspected by I, Date /r 6 71c7b TOWN•OF BARNSTABLE BUILDING PERMIT APPLICATION Map' —3:::)2 Parcels Permit# Sb :3 Jh Date Issued lion Fees/ Tax Collector (��4100 L h .A Treasurer , Historic-OKH Preservation/Hyannis Project Street Address 2-SZ Village /'`� oy)-,> Owner / Address .,ti•� Telephone O /5-2 5 c�rX-I�, � i �4d �r, SEA" Permit Request 1%v-2ejo-o, �Y ar).6 0A't—TD�. �r��li(e lS 1N� �✓V �'c�-l��✓ f��5 -N� WIR-i e:N )k��rsy<`ir�r� ��rr�,�(xreln�s�,�� iI01;1 ),? .; h�'r, La�� Square feet: 1 st floor: existing �� / �ppr�oposed 2nd floor: existing proposed Total new c3� Valuation Zoning District Flood Plain Groundwater Overlay Construction Type W w b F�?_Am C Lot Size 7 Grandfathiered: ❑Yes ❑ No. If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: Cl Yes II No On Old King's Highway: ❑Yes ❑No Basement Type: XFull ❑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 baths): existing new First Floor Room Count Heat Type and Fuel: j 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:Cl existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use _ 0In Proposed Use �,7)q/r'e BUILDER INFORMATION Name C) m O (S0-e d-- Telephone Number 7- { ?9 � Address O C- Iz n,�y License# 0 o 5? f Home Improvement Contractor# 1/ 0657 Worker's Compensation# G 40 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 13 SIGNATURE DATE —'t FOR OFFICIAL USE ONLY . z PERMIT NO. 14 DATE ISSUED y $ w MAP/PARCEL NO. ADDRESS VILLAGE OWNER .. DATE OF INSPECTION y v f FOUNDATION h FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING DATE CLOSED OUTj ASSOCIATION PLAN NO. - �inv - e 0 v e� ofIME r ■nerrsrwec.e. • The Town of Ba rnstable � Services Thomas Fa Geller Director CEO MA't� Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date �- O 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: Chi 0 De LJ/Voj Estimated Cost Address of Work: A,,,-1-9,<_3 Sex 5T. 6 Owner's Name: i4 ) C Q(LOL e-- Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the )agent of the owner: © 1 S Uea-7, 00 I gl Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav —`=�-_- The Commonwealth of Massachusetts Department of Industrial Accidents Office o/I085089oos _ - 600 Washington Street Boston,Mass 02111 Workers' Co . ensation Insurance davit name: location city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worlds in envcapacitv Iam an a foyer providing workers' compensation for my employees.working on this job.:mP :: : ::::::::::::: ..:.........................:.::::::::::::.::::.::.......:::..:::::::.:.::.:: :..........::::.::::,.:............::::::: gompanv name aeldre ss 1 f �:.1'!':ii'�iii:�:':!::':�.':�:�:��i:':::�:�ii:':':ii:�:i Zvitin:!�iii:�:'":;?;:tiJ}iv?;::.yi:i�.:. '.•+i::v�;i:,:: tttsurance co: ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com an .name... :.:<:<:::::: ............... ............... ................................ s:.r..:. .... ... .......... a.................................... .. ..............,.:.::.:::.v:...,Y....:.�:::::.?•}:-:?}::::::?•:?nvi•.,.....:,wtW,n.YWi��;:..?i{..:;:. .. ''$: i:'::i: :::i:.';;:::::;:»:::::; iii:.:::.i.:..i::::i:>.':.:::::::.:..:::':' "% >.:::.'::::i:::d:':',•':::;i::':::::i:::;:i::::::;:;i:;::?;;:; ::;;:: `:`:: d ::.:::.::::::.::?-::.: .;:. hone . :.:. :.:::.'. ::....:. ::..::.:::.... ........ :::.:....,........:... ...... ?.:::::.....: >i nsaranc : o gee to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of ertadnal penames of a foe up to 51,500.00 and/or one years'imprtsonment as wen as dvff penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I=derst=d that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage veri�on. I do hereby certify under the pabu and penalties of perjury that the information provided above is tru'and coned Si�at -T-7 ( Z-' (4—d � Print name P&M# ------------------- official use only do not write in this area to be completed by city or town official city or town: perndtAicense 0 ❑Buiiding Department ❑umnsnng Board ❑check if immediate response is required ❑Selectmen's Office (]Health Department contact person: phone#; ❑Other Ua ued 9195 PIA) 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 c. 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 worm 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 Iicensing 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 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 checldng the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurancecoverage. Also be sure to sign and "n 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 „ou are required to obtain a workers' co®pensatioia policy,please call the Department at the number listed below. y.x womsm /. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottoin 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 peimit/license number which will be used as a reference number. The affidavits may be returned fo the Department by mail or FAX unless other arrangemeatss 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 office of investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 .•. 7Ab1a.L't.Zlb( coutimumq Pts?aigtlrs Pseics�for aas aad TwfFia Rddes gam$Bond writ FomT Fasis • MA71001ium AffaI11B"m W+�B 01=29 Cdit Watt now g"m"q" 91sb Ses:ia;,� A0=1 lGvstad &vsloeL &vdaet Walt. � Nrv+lr� SJOI toAiOo Re�asDet�Da�s' Q 12: d" n 13 I9 IO 6 TZ 12:5 = 30 i9 19 ..f0 6 NaraR It t9 Ip 6 0 A T 13'S 036 I? 29 N/A •WA N0; IJ 13% n 19 19 t0 6 Norte WA !S AFU W ISS 10 W f9 Ip. 6 CAM x IM o.3z WA WA Nm�ai T IVA p,S2 � 19 ?5: WA WA Nord Z IVA 1 a42 ?= I? f9 10 6 90AF11E AA f E'l. QJ0 1p !9 19 10 6 90 AFEM I. ADDRESS OFPROPERTY: Z SQUARE F OOTAGE.OF ALL EX'=OR WALLS: S� j 3. SQUARE FOOTAGE OF ALL GLAZING. 4. %GLAZIING AREA,03 DIVIDED BY#7): S. SELECT PACKAGE(Q—AA-we Than move): NOTE: OTHEZZ MORE INVOLVED METHODS OF DMMINING EMGY REQ ARE AVABABLE. ASK US FOR THIS 24FORMA710N. BUILDING INSPECTOR APPROVAL; = NO: q-forrrrs4990303a 790 CMFL Appendix J Footnotes to Table JS.Zlb: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights. and bascmcat windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall aura, expressed as a percemage. Up to 1%of the total glaang.area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded fiom a building design with 300 fls of glazing area. 2 After January 1, I999,glazing U-values must be tasted and documented by the maaufactu=in accordance with the National Feaasa den Rating Council (I'MP test procedure, or taken from Table 11.5.3a. U-values are for whole uaits:center-of-glass U-values raanot be rned. . The lulling R-values do not assume a raised or ovasmed truss consavetian. If the insulation achieves the full insulation thickness.over the euaior walls without camprzss.on, R-30 insulation may be substituted for R-38 insulation and R-33 insulation may be substimted for R-49 insulation. Cer'Iiag R-vahues trprrseat the sutra of raviry insulation plus insulatingChcMbiffg (If used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space auci tilt vawflamd p.'I I Ia of tr:.—jE 'Wall R-values represent the sum of the wall'cavity insulation phis insulating sbeathing (if used). Do not include exterior siding,s=c=W sheathing,and interior drywall.For example,an R-19-rquirement could be met HI MR by R-19 cavity insulation OR R-I3 cavity msuilatiam plus R-6 insulating sheathing. Nall ru uineraeau apply to wood-frame or man(cot=r,mammy,log)wall eom==dons,but do not apply to metal-frame caasauaiML 'The floor requirements apply to floors over an, Waned,spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside airm=nip etthe caTmgZzgctirrmenss. 'The 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 glaaag. Basement doors must meet the door U-value :rqui:=cnr dsscribcd in Note b. 'The R-value rrquiremeats;am for tmheatrd slabs.Add an additional R-2 for heated slabs. ' If the building uttTiza electric redstance heating no compliance approach 3, 4, or S. 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 atceed the effici acy rzquil- I by the selected packages 'For Hiatmg Degree Day requit 9 ofthe closest city ortom see Table JS.Z.Ia NOTES: a) Glazing arras and U-values are acaprable IevelL Insulation R-values art minimum acceptable levels. , R-value requiremems are for insulation only and do not imuluude snuca:ral ratmpoaents. 3) Opaque doors in the building emvehope must have a U-value no greater than 035.Door U-values must be tested tad documented by the maaufaaurer in accordance with the NFRC test procedure or taken from the door U-value Table JIS3b.If a door contains glass and an aggregate U-value rating for that door is not available, include the _lass area of the door with your windows and use the opaque door U-value to determine compliance of the door. )ne door may be excluded from this requirement(Le,may have a U-value greaser than 035). If a ceiling, wall,floor,basement wa71,slab-edge,or crawl space wall component includes two or more arras with if==insulation Ievels, the component complies if the area-weighted average R-value is greater than or equal to :e R-value requirement for that eomponeat Glazing or door components comply if the area-weighted average U- :iuc of all windows or doors is less thaw or equal to the U-value requirement(0.35 for doors). J0j8jjS1u1wpV WOO VW 'SINNVAH 1S AUH3HO 9l 1a3AS109 a SVWOH.L 00 :01 Pep64sea &OL91 :ou•Jl. Z00Z1=0:9w1dx3, " NMO :SPP4;Jlg Me= So :joIWnN U0SIAa3dnS NOLLonNlSNOO :99usan I . 'ard of Building Regulations and Standardsrt One Ashburton Place — Room Boston , Massachusetts 02108� Home Improvement' Contractor Registration:, : ate Registration: 110657 Expiration s.11/3/00� Type: Individual - -- _z - 7""`�` ONE.IHPROVEHENT CONTRACTOR ' Registration:._ . � 110657� THOMAS R BOISVERT Ezpitation: 11/3/00 THOMAS BOISVERT _ - - .Type � . Individual 15 CHERRY ST - - HYANNIS MA 02601 � THOHAS R BOISVERT s .asp _ OCAS BOISVERT x S CHERRY ST _--.- __.._.ADMIWSTR mR --- HYANNIS HA 0260 i MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE : 1 or 2 family, detached HEATING SYSTEM TYPE : Other (Non-Electric Resistance) DATE : 12-4-2000 DATE OF PLANS : TITLE : COMPLIANCE: PASSES Required UA = 149 Your Home = 129 Area or Insul Sheath Glazing/Door Perimeter' R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1000 24 . 0 0 . 0 42 WALLS : Wood Frame, 16" O.C. 689 13 . 0 3 . 0 49 GLAZING: Windows or Doors 116 0 . 330 38 HVAC EFFICIENCY: Furnace, 90 . 0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 . 4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE: 12-4-2000 Bldg. Dept . Use CEILINGS : [ ] 1 . R-24 Comments/Location WALLS : [ ] 1 . Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value : 0 . 33 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Furnace, 90 . 0 AFUE ,or higher Make . and Model Number THERMOSTATS : [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3 " clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications . DUCT INSULATION: [ .] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape . Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . I Y •�� T'EMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 . 4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- i MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 12-4-2000 DATE OF PLANS : 12040 TITLE : ANDI CAROLE PROJECT INFORMATION: 251 SEA STREET COMPANY INFORMATION: TOM BOISVERT COMPLIANCE : PASSES Required UA = 207 Your Home = 189 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1000 19 . 0 0 . 0 51 WALLS : Wood Frame, 16" O.C. 689 15 . 0 0 . 0 53 GLAZING: Windows or Doors 116 0 . 330 38 FLOORS : Over Unconditioned Space 992 19 . 0 47 HVAC EFFICIENCY: Furnace, 90 . 0 AFUE -------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections . 780CMR 1310 and J4 .4 . Builder/Designer Date i to MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 ANDI CAROLE DATE : 12-4-2000 Bldg. Dept . Use CEILINGS : [ ] 1 . R-19 Comments/Location WALLS : [ ] 1 . Wood Frame, 16" O.C. , R-15 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value : 0 . 33 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Furnace, 90 . 0 AFUE or higher Make and Model Number THERMOSTATS : [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE : [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3 " clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compli-ance 'can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: 0 [ ]' All ducts must be sealed with mastic and fibrous backing tape . Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. ' HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system -is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, ,Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- Assessor's map and lot number .. : .../..... ....7 THE Sewage Permit number r-r/C:....R.:. :..l;l:.....-.. r,r�.....,�?.R.��w�,c.. � �7, w�' BAH.H9TABLE, i House number ....................:................................................... r rasa 039, \00 'E4 MPY a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ . ................................................................. TYPE OF CONSTRUCTION ...../.hJ,•�`�',�, .?2... /�A.........!! . 5 .... . .4.0. ............................... � 19,i I�... TO THE INSPECTOR OF BUILDINGS: The undersigned hereb�y7 applies for a permit according to the following information: Location � .....`-?. ��......., "7�'.............. .................................................... .................. ....... ... ProposedUse / 4'.A ..............................................:...................::............................................................................ ©upi Zoning District .........Fire District ........................................................:..................... Name of Owner- .... .. .•..... {° t, /'► , O.Address '.p'. Name of Builder !!a>,.f�r ... .......................Address , , e .1/ � '..: ?'..... �a... + , �> Nameof Architect .........e ........................... 1 Address ........ .�......................................... ............................. Number of Rooms / r..................................................Foundation ....... , ..................................:......... • .. Exterior .........! „/L/...........................!..........................Roofing ?f 7.. Floors ........! 2.r' . r'�"'.............................................Interior ........:.'? .... ................................................ HeatingJ/: .................................................................Plumbing ........... w/ r................................................................... Fireplace /�l .................................Approximate Costr7.....................P......................... .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area .............................._ �? 75 Diagram of Lot and Building with Dimensions Fee ............................................. .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH f 9' 4,e I l� I hereby agree to conform to all the Rules aid Regulations of the Town of Barnstable regarding the above construction. Name 2. .. .. ........... y r 21814 Benoualid, Dr. Henri A. No ...2181.4... Permit for ...................zu�. ...................... ..... .......... Location ... ............... .... .....................uyanjaia........................................... Owner ..... ............ Type of Construction ........frame....................... .......................................... ............................... I Plot ......................... . Lot ................................ Permit Granted .................. .......8....19 79 s ' Date of Inspectio ..................................... Date Completed ....,......:............................19 f E PER/RF f i ......................................... ......... 19 . ...� ....................... .... . . ....................... .......................... .................................................... ............................................................................... Approved ................................................ 19 i ............................................................................... t ............................................................................... L THE OW, 1639. ��0N0NiN0N ��m � ��N� 0� N0N �� -- -_ - ---- - -- ~~ ~ ~~ .~~ ~~~~ ~ ~~ ~~ . APPLICATION FOR PERMIT TO ............Akrl��.............................................. -TYPE OF J� �, � �-. ��-.. ��--.. _��_..�^.��. ��.............. ........^........ ` .............e:��.�^�-.-----lQ��'�' ^, /, T{iTHE INSPECTOR OF'8V|C6|NGS:- - The undersigned hereby applies for o permit according to the following information: , ' �� | - ��. "�� /��_. �� . Location ��-----,."--`^�.*-°--.--^��S0�@�'[=----.-------------.,---------_--. Use .......�-�x�f��,......................................... --_------.---------- | � �-'--- �' ---'--------- / Zoning District -..��-,-........-..�.�..�--.---.Rne District --'-----------___,,______._. ' - ' ` �� /� �� wc 1 �� ,�� pc� =��«� �� N � �' �Name u=nn,��.�..��*.��/�-..o,.^.A�.nw�u� ��*�*�.pmo,e» � Nome of BvU6e, � �.......................Address Afy- J�^z� u�� .Nome of Architect --- --------------'A66nes --."�60�---------------------- � *^ Number of Rooms —^ Foundation ...... L ................................. ........... ` Exie,io, `--.�� ell.......................................................Roofing -- ............................................ Floors --'«�"� .............................................Interior --- --------____________ . Heating -. ----------------.----..F1om6ng ---. -.. ' ' . `~ I Fireplace .----- -----------------.Approximooe Cost ----..er��^��r---... ^_ ' //' ~7 r � Definitive Plan by Planning Board 1Q_---' Area ---/.*` �� ^��r - ��~ . - Diagram of Lot and Building with Dimensions ` Fee ----.��.��'---. SUBJECT TO APPROVAL OF BOARD OF HEALTH x ` | . � [ � � � / ` ' | hereby agree to conform to all the Rules �mgob� ��nG� t� ��e construction. � ^�� m .-.^.°.^�Z�v ........... 21814 BauooaIid, Dr. Henri A ' , . . ` ` . � . No218!4--.. Permit —Add. .±o''dwall�o� ` ^~ . ----.. --------------. �' ^ ^ . Location .- .�St~-----------.. ' - , ~ . ------.fyannia--------------. Owner .Dr. .HmociJ\. . . 990 ' ' . . . x � . ' . . , ' ' ' / .. PERMIT REFUSED lA ' --.-------------.. -----------------.---. � ^ ----------^------~^--' ' ---------.—..--..—.---~— � ` . ---.--...-----.~---.---- ' Approved , . . . ' . —�--------------.. 19 . / . ^ r ` --.. ............. -----_.-----.--.--.— .` . . _...._.________________~,.,_._,. / ��. � u i i — — — — stucco— — — — — — — — w _-.-.__..__ Ll- - -- STUCCO - > U W -1 F ►w-- � - 01 EXISTING FRONT ELEVATION PROPOSED FRONT ELE\/AT I ON U � SCALE: 114" = V-0" SCALE: 114" = V-0" (N � II 11 O O ' Ill z EXISTING RIGHT ELF:\/AT I ON z SCALE: 114" = 1'-0" Lt_1 Q Q U � z -wi W o — ^ 4 z OL W Z I �I I � - ------------ STUCCO — N ® T lie F � � O - 3'-O" o g � SHEET 1 OF 2 PROPOSED RIGHT ELE\/AT I ON PORTICO SIDE SCALE: 114" = 1'-0" SCALE: 114" = 1'-0" JOB: 1005 DRAWN BY: KW DATE: 5/17/10 � 1 Wi �- EDGE OF > DRIVEWAY LPL �2 REWORKED MASONRY STEPS = U 31_0" i U 61 - NEW PORTICO ABOVE EXISTING, FOOTPRINT ==J_ ANGLE BRACKETS ^^,, FOR SUPPORT �L } pu ROOFING TILE FULL COVERAGE z p" rr---i�---Tr---n---7r---ri---7T---rr---i ICE 4 WATER SHIELD # 14'- II II II II II II it II II O I I I I I I I I 1 1 I I I I I I 1 1 ix6 T#G BEAD BD NEW PORCH ROOT �n O,G. I I 11 f l— SHEATHING 5 2 r 1 1 I I i t i i ► I 1 1 I I I I I I � 1NE RAFTER x12 EXTEND EXISTING �r LAYS OVER EXISTING I I I I I I I I I I I I I I I f I I SIMPSON gX10 f' BEARING WALL FOR W ROOF STRUCTURE I I 11 I I I I I I I I I I 1 1 I I H2.5 ® EA. RAFTER II II f ti II II II II If I RAFTER SUPPORT II I II II II II II II II 1 i t I I I I f I I I I I I I I I I 6x12 3 2x8 HDR it II II II II II II II II -- 1I sx8m, SIMPSON EXTEND EXISTING - - _ __ - PINE COLUMN SP4 (20G, SEARING WALL FOR I I I 11 I I I I I I i i i I COLUMN TO EXISTING "RAFTER SUPPORT I I I I I I I I i t HDR TYP. FIRST FLOOR � I I I I I _ I II II II II II II II II II II II it II - EXISTING I ► I I I � �' CO CONCRETE STOOP I II II I II II it II 11 O REMOVE EXISTING VESTIBULE WALLS � 6"x12" PINE HDR - �-1--- -� -.-1 I_ �.s.t _ .��_ ._t_r_r� n n II II II IILu < 8 x8 PINE COLUMN SIMPSON POST BASE CONNECTOR TYP. 1 1 f I 11 I I t f 12" CONCRETE PIER I I I I I i t I I I I I I I t I f 26" U I I I 1 1 i t I I I I t l I I 1 1 BIG FOOT FOOTING o / I I I I I I ► I I I I I I I I I I = LO SIMPSON POST BASE CONNECTOR ' EXISTING BASEMENT / n/ II II II II II II it II II II II II II II II II II II o_ Lu Z II it II II II II II II II '^ it II II II II II Ilt II EXISTING SLA� Lo II II II II II II II II II ri II II Il II II II II II II 11 II II II II II II II II II II II II II II II II II o SECTION ION I I /�f1 11 ,II II II II II II II II II � "4x10"PINE RAFTERS A1�14.® 24 O.C. SCALE: 114" = V-0" R n �, -- 6u x12 PINE HDR -I-f- - ► 1-t —4.1 -I- -++- -I- �— F- 12" CONCRETE PIER -11---LI 1---lL--J� 1.L---u EET 2 OF --` � 26" BIG FOOT FOOTING S 2 8"x8" PINE COLUMN I SIMPSON POST BASE CONNECTOR TYP 41-7 1/2" 4'-7 1/2" 4'-7 1/2" 17'-0" PROPOSED FORG�4 PLAN SCALE: 114" 1'-D" A A2 �oB: 1005 DRAWN BY: KH DATE: 5/17/10