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RISE Division of Thielsch Engineering,Inc. spa ` A t;
1341 Elmwood Avenue
ENGINEERING Cranston,Rhode Island02910
DIVT
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May 1, 2013
Thomas Perry, CBO
Town of Barnstable
Building Division
200 Main Street
Hyannis, MA,02601
Re: Insulation permits
Dear Mr. Perry,
This affidavit is to certify that all insulation work completed for 25 Shorey Road has been
inspected by a Building Performance Institute (BPI) certified Professional.
All work performed meets or exceeds Federal and State,re,quirement.
Sincerely,
Erik Nerstheimer
Supervisor of Installations,
BPI certified Building Analyst Professional and Envelope Professional,
RISE Engineering, a division of Thielsch Engineering, Inc.
1341 Elmwood Avenue
Cranston, RI 02910
401-784-3700 •800-422-5365 •Fax 401-784-3710
IP08269 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.
1 ,
Map_- � Parcel ,-=Application # Z'Ot0 0�-� -1 Z
Health Division Date Issued
Conservation Division ;Application Fee
Planning Dept. _. Permit Fee 15
Date Definitive Plan Approved by Planning Board ►`� °
Historic - OKH _Preservation/Hyannis
Project Street Address _25 Shorey Road
Village West Hyannisport
Owner Karen Dasilva Address.25 Shorey Rd. W. Hyannisport, MA
Telephone 508�71=2�88
Permit Request air sealing, insulate attic and the perimeter of the basement ceiling at
the house sill
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 2484 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing —new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new, size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other 1
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ry w
Commercial ❑Yes ❑ No If yes, site plan review#
'a
Current UseJ Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name RISE Engineering Telephone Number 401-784-3700
Address 1341 Elmwood Ave, Cranston RI 02910 License# 100459
Home Improvement Contractor# 129��9
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
Erik Nerstheimer for RISE Eng.
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
t
w _ DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
.r FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r
_ The Oommon;vealth of Massachusetts
Department.of Industrial Accidents
Office of Investigations
U..
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluirlbers
Applicant Information Please Print Legibly
Marne(Business/Organization/Individual): RISE Engineering a division o'f .Thielsch Engineering
Address: 1341 Elmwood Avenue
City/State/Zip:`Cranston, RI 02910 Phone#: (401)784:-3700 or 1-800-422-5365
Are you an employer?Check the appropriate box: Type of project(required):
1. N I am an employer with 4. ❑ I am a general contractor and I 6. 0 New'construction
employees(full and/or part time).* have hired the sub-contractors 0 Remodeling
2. ❑ I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in'any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp.insurance comp.insurance. t
required] 5.0°We are a corporation and its 10. 0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 110 Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required] t c. 152, g 1(4),and we have no 12. ❑Roof repairs
employees. [no workers' 13. l Other Insulate
comp.insurance required.] ;
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If
the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for.my employees.Below is the policy and job site
information.
Insurance Company Name: The Preston Agency
Policy#or Self-ins.Lic.#: 3730961-00 Expiration Dater 1/I/11
Job Site Address: 02`� cS h City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and`egpiration (date).
Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine
up to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of
$250.00 a.day against violator. Be advised that`a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certifland the
'�Pdzns enalties ofperjury that the information provided above is true and.correct.
Date:' .
Print Name: Erik Nerstheimer Phone#:(401)784-3700 or 1-800-422-5365 ext133
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 Heath 2. Building Department 3.City/Town Clerk 4:Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone#:
F
CERTIFICATE ®F LIABILITY' INSURANCE 0P11) 47 DATE(MMIDOrYY(Y)
THIEL-1 04/13/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
on Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
PO Box 81'0 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
East Greenwich RI 02.818-0810
Phone: 401-886-8000 Fax:401-88571700 INSURERS AFFORDING COVERAGE 'NAIL#
INSURED INSURERA . Zurich—American Ins CO.
Thielsch Engineering, Inc INSURER 8:. nsot.lc.n CUsrant.e& llabl l:l ty
Thielsch Group Inc.Hi Tech R INSURER North American Capacity `
ealty Inc. _--
195 FrancRI Avenue INsuRERo: Hartford Insurance Company Cranstoston RI 02910
INSURER E:'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY:PERIOD INDICATED.NOTWPHS'rANDNG
ANY RECUIR0,1ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH.RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUEDOR '
w,,Y PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT'TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH - -
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS..
LTR INSRI TYPE OF INSURANCE POLICY NUMBER, - DATE(MM/DD1YY) DATE( /�YY) LIMITS -
_ I GENERAL'LIABILITY - - EACH OCCURRENCE, 1 1,000,0 0 0`.
A X COMMERCIAL GENERAL LIABILITY 3730962-00 04/01/lO O1/01/11 TZET�re
PREMISES(Ea occuw6) X 3 001000
CLAIMS MADE a OCCUR _ _ _ MED EXP(Any.one person) _ q ],p,0 0 0
' - PERSONAL 4ADV1N.,URY - S 1,000,000
- GENERAL AGGREGATE 52,000,000 - -
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG' $2,000,000
POLICY X JET LOG _ _— --
Emp Ben. 1,On 000
AUTOMOBILE UA81lITY - - � � - - ,- -
A X ANY AUTO 37309-63-00 04/01/10 O1/O1/11 ca accident),
EL{MI7 s 2;000,000
(Eaaccident)' '
ALL OWNED AUTOS -
. - BODILY WOURI' s. -
SCHEDULED AUTOS _ (Per pe(son). -
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS „ .. (Per scvd@rdl.
PROPERTY DAMAGE. $_
- - (Per acci0enl) - - _
GARAGE UABILl7Y - AUTO ONLY-EA ACCIDENT S
y
ANY AUTO
OTHER 71 ar•1' EA.ACC $
AUTO.ONLY: AGG g.-
EXCESSlUMBRELLA LIABILftY _ �EA,CH OCCURRENCE . $,10,0 00,00 0
-.B X OCCUR El 9263637-00 04/01/10 01/01/11 •AGGREGATE' 410,000,000
RDEDUCTIBLE
X RETENTION $1D,0 0 0 y
WORKERS COMPENSATION AND - I
EMPLOYERS'LIABILITY X TORY1_IMITS EP. e
A MYPROPRIETOR/PARTNERJEXECUTIVE 37 3 0 9 61-0.0- - !04/01/.10 01./6l/11. E.L.EACHACCIDEW .s 1,000,000
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 3 1;000,000
If yes.oescribe under -
SPECIAL PROVISIONS below F.L.DISEASE-POLICY LIMIT, -5 1;000,000
-
01HER -
CiProfessional Liab DVL000026800 04/01/10 04/01/11 Prof Liab 2,000,<000
DlLeased/Rented Eqp 02UUNTD5678 _ 04/01/10 04/01/11. Equipment 160,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES./EXCLUSIONS ADDEO BY ENDORSEMENT 1 SPECIAL PROVISIONS - '
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' 10 r OAYS''NR17TEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL -
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORaED REPRESE V
ACORD 25(2001/08) v @ACORD CORPORATION 1988
�� a T Ia�U�tED 5M'AME to�kliel�C }}�, Y1 �
RISE Engineering,' a division of Thielsch Enineering, :Inc...
Associates_; a division of Thielsch Engineering.,..Inc'.
BAL Labo.ratory; .a division of Thielsch Engineering, Inc'.
ESS Laboratory, a division of Thielsch Engineering, Inc.
ALCO Engineering, a division of Thielsch Engineering, .,Inc.
Water Management Services, a division of Thielsch Engineering, Inc.
} IN
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W 91te O ice o nsumer fail; an usmess e u atiori ,
o g
10 Park Plaza.- Suite 5170
M Boston,"l��ssachusetts 021+16
Home Improve&k
ontractor Registration
Registration: 126979
Type: Supplement Card
w Expiration.: 3/25/2012
THIELSCH ENGINEERING
ERIK NERSTHEIMER
1341 ELMWOOD AVE. h
CRANSTON, RI 02910
Address and return card.Mark reason for than
S, Update Addr . change.
- - Address .� Renewal 0E t„ �. ddresmploymen Lost Card,
DPS-CA1 0 50M-04/04-G101216 F
Office o�Con Consumer Affairu ines�Re
om�nrcao � zu�e�
S Regulation
License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration`s 979 Type 10 Park Plaza-Suite 5170
Expira _ 12 Supplement Card Boston,MA 02116
z
THIELSCH EN(A
ERIK NERSTHE
1341 ELMWOOD —
CRANSTON, R1 029' r%, Undersecretary Not valid without signature
V _
rage i 0I 1
Th'b Official Website of the Executive Office of Public Safety and Security (FOPS)
Mass.Gov Home
Public Safety
Department of Public Safety Licensee Complaints
License Type Construction Supervisor
License# 100459
Restriction WS,IC
Name Erik Nerstheimer
City, State, Zip North Scituate, RI, 02857
Expiration Date 3/28/2012
Status Current
No complaints found for this Licensee.
Back To Search
�fze U0v,7eoyzo�z ✓Jj�oeGcz �uc�e cY e c
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�- Board of T3uildina Regulations and Standaril3
License or registration varid for tndividol use only
HOME IMPROVEMENT CONTRACTOR _ i. a
before the expiration date. if found return to:
Registration,_ 120979 Board of Building Regulations and Standards.
Expiration 3/25/2010 I One Ashburton Place Rm 1301
TYPe uPplemenf Card T�c?stc�3i,l�la. 021.08
..
IELSCH ENGINEERI.N�.
I.
IK NERSTHEI"MER=
11 ELMWOOD
ANSTON, RI 02910
Admmisti to—' 11 Not valid Without sign #ere ----
hrtp://db.state.rna.us/dps/licdetails.asp?t)ctSearchT,N=(,'.qT Innmso
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NAT=2453 _.1 y
RISE ENGINEERING Federal ID#05-0405629
RI Contractor Registration No 8186
A division of•Phielsch Engineering MA Contractor Registration No 120979
CT Contractor Registration No 620120
1341.Elmwood Avenue,Cranston,"RI 02910
[ v ; - CONT6XP%
(401)784-3700 FAX(401)784-3710 Page 1
IS - THIS CONTRACT iS ENTERED INTO BETWEEN RISE - -
.. -ENGINEERING.AND THE.CUSTOMER FOR.WORK AS.
ENGINEERINGDESCRIBED BELOW
CUSTOMER . ." .. .. PHONE —� DATE ,.. 'Client S
Karen Dasilva (508)771-2388 64/10/2010 108269
SERVICE STREET BILLING STREET
25 Shorey Road 25 Shorey Rd e �'
SERVICE CITY,STATE,ZIP _ .BILLING CITY,STATE,ZIP
West Hyannisport,MA 02672 W Hyannisport,MA 026FAA
RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air le age. This work will be :
performed in concert with the use of special tools and diagnostic tests to assure that your home will be left wfflrTMqftftffIeveI of air
exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products.
Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work
will be performed at the rate of$66 per man per hour,which includes materials and testing. I7.5 man hours.
$1,155.00
RISE Engineering will provide labor and materials to install a 9.25"layer of R-30 unfaced fiberglass batts to 560 square feet of attic space.
$980.00
RISE Engineering will provide labor and materials to install an,easily moved,insulating cover for the attic access folding stair. The cover has
integral weatherstripp ing to restrict air leakage.
$160.00
RISE Engineering will provide labor and materials to'install 172 square feet of R-19 faced fiberglass insulation to the perimeter of the
basement ceiling at the house sill. r
$189.20
RISE Engineering will apply all applicable,eligible incentives to this contract_. You will be billed only the Net amount. Currently,for eligible
measures,the Cape Light Compact offers 100%incentive for air sealing.
$1,155.00
RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible
measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per.calandei year.
-$996.90
WE AGREE HEREBY TO,PURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF q
***Three Hundred Thirty-Two$301100 Dollars $332.30
UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY
UNPAID BALANCE R b0 AY8.SEE TERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONYRACTOR REGISTRATION.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK ACES
AUTHORIZED SIGNATURE RISE ENGINEERING CUSTOME ACC P NCE -
TA
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE -----_--y` I Ll
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFI ATIONS AND CONDITIONS ARE
SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK
', DAYS." AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE
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25 Shorey Road, Hyannis 12/9/05
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25 Shorey Road, Hyannis 12/9/05
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ` Parcel .Permit# 3rr3e
Health Division �V 5 —�'Z-� '�� � 1at,15 e Date Issued
Conservation Division 01 -Z& 10S Y 44 t EMMM Cn
9G.50
Tax Collector
L1MiTED TO !OF 8EDR00 (�
Treasurer ' k
Planning Dept: Checked in By '
Date Definitive Plan Approved by Planning Board Approved By
Historic-OKH Preservation/Hyannis
Project Street Address
Village
Owner cL�; 1!/ ddress S'h0 �e_ a 1S'
Telephone — '� = ~J
-s
Permit Request �7
•t ;�
CIO
r p�Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ®
- aluation C2, Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
J
Dwelling Type: Single Family ;4 Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: Cl Yes $No On Old King's Highway: ❑Yes V No
Basement Type: X Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) _ � Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing
Total Room Count(not including baths):existing new First Floor Room Count
Heat Type and Fuel: �YGas 0 Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes M No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed: existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded O
Commercial ❑Yes ❑ No If yes,site plan review# - -
Current Use Proposed Use
j UILDER INFORMATION
Li .
: .Name � Telephone Number a
� •
,Addres CJ License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUR ., DATE
r
FOR OFFICIAL USE ONLY
w
PERMIT NO. !
DATE ISSUED
MAP/PARCEL NO. `
ADDRESS VILLAGE
OWNER - �
DATE OF INSPECTION: f '
ram,- • /'�-'
FOUNDATION
FRAME
INSULATION i
i
FIREPLACE r
ELECTRICAL: RUGH FINAL
w
PLUMBING: R+I]�`UGH = FINAL
® _
GAS: RgUGH FINAL•
co
FINAL BUILDING r
DATE CLOSED OUT
ASSOCIATION PLAN NO. ' INC '
oft , Town of Barnstable
"o Regulatory Services
BA SUBLE. ; Thomas F.Geiler,Director
1 MASS. ��� Building Division
AI�O �a 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: i
JOB LOCATION: �no
number street village
"HOMEOWNER": 19Y14_ 6 yt'!* A41Q -7`7I e-23 _,� Jag
nanfe home phone# 11 work phone#
.CURRENT MAH NGADDRESS: d�h 1�1e/L1 �l, � �' �/ fi� Or a/
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
Supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"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
reqijffemen . p`
igna omeown
A oval ui ing fhc1
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 he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:fomzs:homeexempt
Town of Barnstable
°* Regulatory Services
s�xrres , ' Thomas F.Geiler,Director
9`b1639. a`0� Building Division
�fD MA'S
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adj acent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost
h ,
Address of work: �
Owner's Name: Q L ��
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
-Werner 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:
Date ConZ-2
Registration No.
r'
zc,_
e
Q*n-r :homeaffidav
SHOREY ROAD
S86 0910'E' 100. 00'
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PAT10r12
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LOT 11
LOT 12
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LOT ,9
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RES ZONE.- 'RB" This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "C"
Bank Use Only
TOWN: _ WEST HYAIVNIS ORT ------ REGISTRY OWNER: KAMM &-CATHERINE MEEHAN ----_---
DEED REF: _IZ-25 ----346 ----------BUYER: FtEF11VAVCZ'_------------_---------------_----
DATE: _12/3/99________________ PLAN REF: -13-- --------------SCALE:1"= 40 FT.
I HEREBY CERTIFY TO GR�IZ.1ANO WEBBER_HEAVY_____ y t` YANKEE SURVEY
_& SMALL L_LP -----------THAT THE BUILDING ttt
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS � CONSULTANTS
SHOWN AND THAT ITS POSITION DOES _ -- CONFORM
TO THE ZONING LAW SETBACK REQUIREMENTS OF THE ~1 INDUSTRY 40BSUITROAD
TOWN OF —__BARNSTABLE_____________AND THAT f,32M ar g
IT DOES_ NOL _ LIE WITHIN THE SPECIAL FLOOD HAZARD ,: MARSTONS MILLS, MA. D2648
AREA AS SHOWN ON THE H.U.D. MAP DATED_ 29E __ � �� -' TES,: 428-0055
L—P
mmit -Panel 250001 0008 D oJ►�'� , FAX: 420-5553
_c .-�= tom__________ THIS PLAN NOT MADE FROM AN - UMENT 28064 JF
UL A. MERITHEW PLS SURVEY NOT TO BE USED FOR FENCES ETC.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map LL ( Parcel l U ;
I R " Permit# �7 /�
F c h,lSTAB'
Health Division ® #e Issued
® 281111 ��4I �5 P,4 2: � plication Fee
Conservation Division F p
Tax Collector. ` ' Permit Fee
J
Treasurer of VIS
���� '"`
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address re cA Arl
Village P&,roll
nP
Owner KJ' Addresso76 S
Telephone c
Permit Request `z
X51Z, Z�7_L L Z26 ,0 s
Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size 6L66;d-IeQ GdG �j OGrandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structur Historic House: ❑Yes L'�NO On Old King's Highway: ❑Yes 6-AJe
Basement Type: ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: OGas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes (fa'IVo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan.review#
Current Use Proposed Use
BUILDER INFORMATION ,,��//��
Z
Name I " Telephone Number,"� e__/__71
Address License#
IA) / , Home Improvement Contractor#
t
Worker's Compensation#
( , ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
1 ,
I
SIGNATURE DATE
I
FOR OFFICIAL USE ONLY
PE�MIT NO.
DATE ISSUED
1 MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
i
DATE OF INSPECTION:
FOUNDATION
f.
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL-
GAS: ROUGH FINAL '
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r
The Commonwealth of Mas§achusetts
.- — Department of Industrial Accidents'
600 Washington Street
- ys Boston,Mass. 02111'.
workers',, Com ensation.Insurance Affidavit-General Businesses
.,y':. -'r 'w�• '•tirstes.• .rr c,��r'�yry,,. .. "';^ .;i: � "ti:Asfi]
name: _
address, 6'f etl KOt1
h state:' a
work site l0cati031 full address :
❑ I am.a sole proprietor and have no one Business Type: ElRetail Restaurant%BaAating Establishment '
working in any capacity. ❑Office[I8a1•es(mcluding-Real Estate,Autos etc.),
❑ fl
I mx
ro
am an em to er with em to ees full& art time: ❑ Other
L� I am an eWloyer providingworkers compensation for my employees working ou this job.
•'r, t:4? ''\i•'c• .tom' `::1`• •.r.. 4.r _•.;.:.4; .:t:. ,cr
'ri �: r(::\' '•I. Y .{.T., , .''1' -• •,L'T:• �t3 J. �.'.�. ..,�. ;,.j' .,
COMP
sddr'essi' `' ' �•
t, ',�;.-•i., _ •t•.,: ::�[•i•J•• �i:r•' .:i h'1:.:.. •w r•'-,•'t::r, .r? _:�.
,�•:'''C% ',4' •.t. 'rrT t, �a.r. :tr.l,"" \ ..'a. ..l' •.�''••'L :�'��••1�ii.• ti' ...
7.
Mabce.ca: :o:..I!" +t ,, ;Y `; t' .,;'ia.e!:`.}t:.. l)ZIC. •# ;L' +'
,
leproprietor and have hired the independent contractors listed below who have tie following workers'
Ram
.compensation polices:
address:. ''\'
CI .a: r.t, •'?! :,.;t., :•i;.�;• •'h"•,i. `1 's''}._�:� .. =..y:1'.;• ;'i._ ;��%x�;:.
i, a:.•:.,...' `.},•' .r.'ti.,"4', �S`• •�:' ,0-liC _#�'•.t•}i':%.-•:':,: .y.,,:.. .{''t.•ti., •L.
insurance co. >"'' rc
yi';!'lit' 'i•. '{` ..'h a:i ;..� :n%• �tj,d.ti. 'T
coin aii• name:+ ;> _
Adf2is: -
Fallure to seente coverage s9 required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a 5ne up to 51,500.00 and/or ..
one years'imprisonment as well as civil penalties in the form of a STOP FYORK'O�DER and a fine of S100A0 s_day against me. Luaderatand that s
copy of this statement maybe forevarded to the Office of investigations of the DIA for coverage verification:
I do hereby.certify nder the p ' Ind p alties of perjury that the information provided above is true rid correct
Si ature Date d
pr
int named ` I U� Phone# �"— �
official use only do not write in this area to be completed by city or town official
` r city or town: permit/License€� 701Building Department _
�LicenSing Board
❑-check if immediate response is required ❑Selectmen's Office
4 ❑Health Department .
contact person: phone#; 0Other
a (revised Sept 2003)
Information and Instructions
rkers' co ens atidh for the' r.
to ers to rovide wo ?rip �r
eral Laws chapter 152 section 25•requires all emp . y p ., •: •
Massachusetts Gen other under contract
employees: As quoted from the 4`law', an employee is.defined as every person in the service of an any, act
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 mare of
the foregoing engaged in ajoint 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 owtter of a
. �P•
dwelling bouse having'not'tnore than three apartrnents and-who resides therein,or the.occupant of thedwelling house of
do.maintenance, construction or repair work on such dwelling house or on the grounds or
another who employspersons to eto shall not because of such.employment.be deemed to be:an employer. ..:
building appurtenant ther.
MGL chapter 152 section 25 also'staies that*&e.ry state'or Incal licensing agency shall withhold the Issuance or renewal
of a license or permit.to operate a business or to construct buildings in the.cbmmonwealth 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
ompliance with the insurance requirements,of this chapter have been presented to the contracting
acceptable evidence of c .
authority.
w0nog, MONK
Applicants
'compensati
Please fill in .the workers on affidavit completely,by checking the box that applies to your situation . Please
supply company n.arne, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
to the Department of Industrial Accidents for confirmation of insurance coverage. Also'be sure to sign and date the -
affidavit, The affidavit should be returned to the city or town that the application for the permit or license is being
t the D
requested, noepartment 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 Departrilent at the number listed.below.
q
Ci or Towns .
lete andprinted legibly. The Department has provided a space at the bottom of the
Please be sure that the affidavit is comp
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 pernntllicense number.which will be used as a reference number. The.affidavits,may.be.returned to
the Dep lent by,�of FAX w less other'arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have airy questions;
please do not hesitate to give us a call.
FMI
The Department's address,telephone and:fax number: . :_• , . .
' The Commonwealth Cf Massachusetts
Department of Industrial Accidents
6ttiee of Westiptions
600 Washington Street
' Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 exL 406
Town of Barnstable
"o Regulatory Services
BAMSfABLE, Thomas F.Geiler,Director
MASS.
�A i639• A,� Building Division
rF0 MA'I
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: s
um er / street p village
"HOMEOWNER": t U O
ame home phone# work phone#
CURRENT MAILING ADDRESS:I RL2 ry)4O y—
city/to� state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with-the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"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
requ�/ets.
v
Signat a 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 he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several,towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
FENCE CO.OF CAPE COD
STANLEY J. PRATT
775-4124
1-800-582-5020 123 FALMOUTH RD.FITE.28
FAX:508-771-1377 HYANNIS,MA 02601
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TYPICAL ROOF CONSTRUCTION:.
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ROOF SMNGIES 1/Y PLYWD 4fEATNING
2 x 8 RAPTFRS AT,
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NEW B'CONCRETE FOUNDATO ,4#40 'SCAPEWF71'
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------------ --------- I ' NEW SIDING OVER
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NEW 30' 30'x 16' 2' 1-
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CONCRE7E COL PAD W/ r BEAD BOARD CEILING TYPICAL ROOF CONSTRUCTION: oW Qk1 Q
NEW 3¢'CONCRETE WILLED kIll8 1 2' I 14'x 4'P.T.POST iSiD.FEET PAPER. ASPHALT > U Q K
• LALLY COL --- - WRAPPED WITH CEDAR R3G-C FIBERGLASS ROOF SHINGLES,1/2'PLYWD SHEATHING a�nx N C G
L i J i y .F .INSULATION 8 2 2 x 10 RAFTERS AT,16'0.C. .
. i n 1 x 4 .,, INSULATION
MAHOGANY DECKING BAFFLE- -
in m _ _
I 8' 6
- r m MATCH.
P.T.2x6 JOISTS O 16'ae. WRAP 2 x 6'.W/ \®
tet moo----
ON HZ5 PINE-PANT EXIStIN(i
--
' - �___________ CUPS TYP.EACH /3 STRAPPING CONT.SCREENED VENT
L-•-J L-•-J L--J L-•-J L-•_J �.S 2• P.T.2x6 RIM RAFTER
T/2-BLUE BD. 1 x 6 FRIEZE
X//SKDA COAT O
a R CEILING ,1
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ON 24'O'BIGFOOY 1
FI]OTINC,TYP. 3/4-TdG PLYWOOD CLU i`
. A NAILED W/PL-400 GL NEW SIDING OVER
15 BUILDING FELT OVER
_ i/2'COX PLYWOOD SHEATHING OVER r
EXISTING CRT TO BE REPLACED 2 x 4 STUD$O le0.C. W
WITH 3-PLY 1�'x 7 j-1.6E LV.L _ - - R-13 KRAFT FACED FIBERGLASS BATT INSUL
40'-0' 3 SECTION py
A2 SCALE: 1 ,4 = 1-0- R-1B INSUL
FOUN BLE P.T.2 x e SILL ON SILL SEAL
NG CONCRETE BIOK. n. _
FOUNDATION e ,ryy 1 0 }'.A:9.O 48'O.C.
.. V �' h I •� 8%CONCRETE FOUNDATION co{, -
1 BASEMENT
FOUNDATION PLAN ' ®1 ' ® i ' 4' FOOTING
CON - CONT. CONCRETE r
(,r 1 _-4'-- . _ .. SLAB - _ w
SCALE: 1/4" = 1-0' S,L _ _ -
CENTER NEW LANDING ON I .
C, EXISTING FRONT DOOR _ 1 SECTION - -
A2 SCALE: 1/4- = 1'-0-
FOUNDATION KEY:
TV.Y THICK,FULL FOUNDATION WALL
® ® - WL
(E70S1IN('FOUNDATION) _ 00
- W
00
FIRST FLOOR
P.T.WOOD 5IDOP
FRONT ELEVATION
W/1 x 4 MAHOGANY DECKING
4 x 4 P•T.PDST,
SCALE: 1./4•' 1'-0 - _ • WRAPPED w PINE -
.. PAINTED-WHITE .
{
• hl _
cd1TWUOS RIDGE VENT -
F
.. NEW 30 1R. ARCHITECTURAL SHINGLES -
10'DIA
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_ CUSTOM COLUMNS. -
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RAKE W/ ABOVE
1 x 2 DRIP
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SOFFIT TO MATCH E OSTINC - - T 1•-r'1 -r n--i-T-
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COLUMNS
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_ -FIRST FLOOR .a m.,• 4-84 Y-B'
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_I zI .. --- --- 4 x 4 POST w' Na® _ 4 x 4 POST _
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RIGHT SIDE ELEVATION AREAWAY rIk LIVING Roots
SCALE: 1/4" BEDROOM."
'.. _. E10511Nc �-. BEDROOM
�1. Rk7AOVEIXISTINO.PICTUREVAN
OOr/{S'' • ��
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ET ..
FIRST FLOOR PLAN �I
SCALE: 1/4" = V-0"
rm NOTE ALL WINDOWS.ARE TO BE'ANDERSEN 400 SERIES TILT-WASH
r(ATH LOW-E ARGON FILLED INSULATING GLASS W/GRILLS BETWEEN THE GLASS r 7
PARTITION.LEGEND
FIRST FLOOR
DOSTING PARTITIONS TO _
. - BE REMOVED .
.. .. DOSTING PARTITIONS To
REMAIN -
WHITE CEDAR SHIGLES .. ..
LEFT SIDE ELEVATION '5"Tw ",= ""wx�s. PROPOSED NEW PARTITIONS
SCALE: 1/4" = V-0" -
. . .• NEW BEAMS(ABOVE)
Ul
00
FIRST FLOOR ; _ _ _ _ _—_____—___—_—____-_______—_% __—FIRST FLOOR
- � p
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SCALE: 1/4' = 1'-0" - SCALE: a/4" = 1—0'
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FOUNDATION PLAN FIRST FLOOR PLAN
SCALE: 1/4" = 1'-0" SCALE: 1/4"
It `
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FRONT STOOP FRAMING
SCALE: 1/4"
tom eux G
2: 2R -ADE
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s- y Lv.LHEA ER 2: 2 x to HEADER 1 E)OSTINC 32NCRETE BLOCK II I
FOUND" I1IIIFIIIII
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TO REMAIN
FIRST FLOOR FRAMING PLAN ROOF FRAMING PLAN SCALE: 1/4" = 1'-U' .. SCALE: 1/4" - 1'_p+ - � -
•ALL DECX FRAMING TO BE PRESSURE TREATED - - - I----�
• % (WOLMANDm.40 Les/CU.FT.) I 3/4"TeQG PLYWOOD SUB-FLOOR.CLUED -
-ALL HARDWARE&WAILS TO BE STAINLESS STEEL : - @ NAILED W/P.-400 GLUE
/ 1 x 4 MAHOGANY DECKING w/I/Or SPACING - FLOOR FRAWNG
2 x 10 FLOOR J0151$O 18'as BLOCK SPACER M RYMH j 20 OZ.ALUM.FLASHING 2: 2 x 10 BEAM,LET 1 1/Y INTO POST INSULATION
MAILER�%PL-400 GLU4 PLYWOOD E K! 3 IN
BOLT TO EACH POST
/B'DIAM.LAG BOLTS % / /THREE 3/6r DIAMETER BOLTS .
R-13 INSULATION AT 2'-Or o.a P.T.2xt0 ; 3-PLY 1 3/4'x 7 lVr 1.9E LVA-
STAGGER %�//'���/ DEtlC JOISTS GALV.METAL
JUST
2X4AT 12'as HANGER AT BOTH ENDS SIMPSON COLUMN.CAP .-
R19
STUD WALL O 7B"wa 1'AIR SPACE OF EACH JOIST,
19 INSULATION 2 10 LEDGER BOLTED TO SOLID j 2 x 10 HEADER SIMPSON STRONG-TIE POST ANCHOR 3//Y 0 STRUCTURAL -
2 x RIM BOARD BLUCK0N0 w/3/4'LAG BOLTS z4• / _t STEEL PIPE COLUMN -
LSl RIM
aa,ST SEAL BOLT HEAD .
FIB TREATED TREAT 54
FIBERGLASS SILL
OZ ALUM.FLASHING
SEAL 14'-O• I � .
8"x 8'x 5/8'
a STEEL BASE PLATE
V 1 Z-S'x FOOTING 15•CO/JCR _
2 EA x it•ANCHOR BOLTS O!•-Cr as qqT T 1---�
2 EA CORNER AND OPFICNGS
i - 8 WL POLY VAPOR.BARM CONCRETE r+,
8'CONCRETE FOUNDATION WALL � j - �.i..i
8"COMPACTED GRAVEL SLAB
2 COATS OF BR.DAMPPROOFlNG
-------------
TOP OF WALL DETAIL SCALE: 1" �- TYP. LALLY COLUMN DETAIL
1'-O" .. - .
SECTION/DETAIL
SCALE: 1/47