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HomeMy WebLinkAbout0097 SIXTH AVENUE (HYANNIS) _ �Y Town of Barnstable *Permit# 1 Expires 6 months from issue date Regulatory Services Fee co Thomas F.Geiler,Director X-PRESS, 0 Building Division ( ����� Tom Perry,CBO, Building Commissioner JUL 0 6 2006 200 Main Street,Hyannis,MA 02601 TO www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 1 Number oZ. fi Li 1 �, Map/parce y U�0 Property Address ��T �Q 1�•Q esidential Value of Work 4� (7 Minimum fee of$25.00 for work under$6000.00 � E Owner's Name&Address ('JE \� , q `7 ` ��C of Contractor's Named (;1 �� /\"'1� S Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) H �Workman's Compensation Insurance Check one: nI am a sole proprietor I am the Homeowner ❑-I have Worker's Compensation Insurance. Insurance Company Name I "4 i . r Workman's Comp.Policy# '" \Ip(S L1 U Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken tof a� blA D/ ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. A ***Note: Property Owner must sign Property Owner Letter of Permission. of Home Improve Contractors License is re ed. SIGNATURE: Q:Forms:expmtrg Revise061306 ..! � t��,�. �- 3. �:c � ?.R+c s'�;''r, ` jam• � i;(1A�014"�'�. b HOME IMPROVEMENT CONTRACTOR Registration: 148238 Ex_.pilr tIona_9/14/2007 ":Type:. Individual / DONALD A SANTOS DONALD SANT05 .45 HIGGINS CROWELL: -� W YARMOUTH,MA`026721 Administrator e�LL• ro I 4t '•Plop:,y_ NATIONAL GRANGE MUTUAL INSURED INSURANCE COMPANY 55 West Street, Keene, NH-03431 1 Telephone:1-888 646-7736 CONTRACTORS POLICY DECLARATIONS Named Insured and Mailing Address DONALD A SANTOS Policy Number: MPB49785 45 HIGGINS CROWELL RD Account Number: CAC B49785 WEST YARMOUTH, MA 02673 Agent: KEVIN MCGRATH INS AGENCY INC AGENT PHONE : 508 394 7648 Producer Code: 20.0596 POLICYHOLDER INFORMATION Named Insureds Business: CARPENTRY RESIDENTIAL Entity: INDIVIDUAL Policy Term: 12 Effective: 04/27/06 (12:01 A.M. Standard Time at the address . Expiration: 04/27/07 of the Named Insured stated above) In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. See the attached schedules for Description of Premises, Property Coverage, Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. [Personal USINESSOWNERS LIABILITY COVERAGE ability B Medical Expenses - each occurrence LIMITS OF INSURANCE and Advertising Injury Limit $ 11000,000 Products-Completed Operations A $ 11000, 000 Aggregate Limit $ 2, 000 ,00oGeneral Aggregate Limit Fire Legal Liability $ 2, 0 0 0, 0 0 0 - any one fire or explosion Medical Expense Limit - per person $ 500 , 000 $ 10 , 000 . Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- ages reduces the amount of insurance we provide during the applicable annual period. Please refer to :section DA. of the Susinessowners Liability Coverage Form. For policies subject to premium audit: Annual Audit Applies. Commercial Inland Marine Coverage Part $ 116 Estimated Annual Premium: S 11094 TOTAL PREMIUM AND CHARGES S 1 ,210 Countersigned: By: 64-5470 (9/00) 03/08/06, RENEWAL MP I O ont Page# of pages Ou Proposal Submitted To: / e Job Name �. Job# .Address i, Job Location e V! l h� Date Date of PI s Phone# 03_65&, 1 q / ^ Fax _ _ `,,t Architect We hereby submit specifications and estimates for: o(�P� i tv���— of � __ ac✓r�fir-► �n ��� -., r We propose hereby to furnish material and labor—.complete in accordance with the above specifications'for the sum of: $ 5�� Dollars with.payments to be made as follows: fw• �� DPD✓1 Cc�rt�p!aG-Li n Any alteration or deviation from above specifications involving extra costs will be Respectfully �GiJ executed only upon written order, and will become an extra charge over and submitted above the estimate:All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. Rcceptance of Vropo: � The above prices,specifications and conditions are satisfactory and are Slgnat e Gr�� ✓t GV hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature NC3819 • (C\ l ni* VV/fsI/�V/sirosaiar• vJ i..wuu»............-. 3�` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia , Workers' Compensation•Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information - Please Print Legibly Name: usiness/or ation/Individual): 5nX^10 �Od��•' Address:+ LM.e �� City/State/Zip: - M(�. O aAv_1 3 Phone#' L� Are you an employer? Check the,appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 employees (full and/or part-time). * � have hired the sub-contractors ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. t 7, ❑ Remodeling ship and have no employees These sub-contractors have 8: [] Demolition- working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition (No workers' Gump.insurance . S. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs og additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.(No workers' comp, c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t . employees. [No workers'. 13her 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 submitthis affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. lContractara thatdieckthiabox must attached as additional sheet showing the name of the sub-contmbtors and their workers'comp,policy iafoxznation. I am an employer that is providing workers compensation Insurance for my employees. Below is the policy,and job site information. Insurance Company Name: C Policy#or Self-ins.Lie.M. Expiration Date Job Site Address: S r City/State/Zip: Attach a copy of the workers' compensation Policy eclaratfoa 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 oi•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=., end penalties of r'ury that the information provided above is true and correct Si afore: Date: l��e Phone# G -'� -l ' '3 \ -' Official use only. Do not write in this area,t®be completed by city or town gfftciaL City or Town: Permit/License# Issuing Authority (circle one): 1.Board of health 2.Building Department 3.Cityl—I own Clerk 4.Electrical inspector 5..Plumbing Inspeedtor- 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or.on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealths for any applicant wbo has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152;§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to tine contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply td your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an I:LC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Dep artment of industrial Accidents for confirmation of•mSUrance 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' cormpensatim 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$se affidavit for you to fill out in the event the Office of Investigations has to coutact-you regarding the applicant.. Please be sure to Ml in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit cease 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. Anew 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would 13le 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. t 617-727-4900 eat 406•or 1 o77-M-ASSAFE Fax#617-727-7749 Revised 5-26-05 Www.Il12SS.gOv/(7].a #J Town of Barnstable *Permit# '`���6�' Expires 6 monthsfrom issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division X-PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 OCT 2 0 2005 www.town.barnstable.ma.us Office: 508-862-4038 TOW AOMM23--ABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint :ap/parcel Number y3�®l0 7 .operty Address 7 5� Tzv- Xvfo-` 3 Residential Value of Work VS 716.0 6 Minimum fee of$25.00 for work under$6000.00 wner's Name &AddressPAO r. ontractor's Name C Telephone Number + do— 7,9 64 A�'�// bme Improvement Contractor License#(if applicable) j onstruction Supervisor's License#(if applicable) 00'99 7� ]Workman's Compensation Insurance Ch one: [�yI am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance ►surance Company Name lorkman's Comp.Policy# 'opy of Insurance Compliance Certificate must be on file. ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Reside ❑ Replacement Windows. U-Value (maximum.44) "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. Home Improvement Con actors License is required. IGNATURE: Torms:expmtrg evise071405 ti .v - • _ ✓/ae�amm�anwea� o�,./�ydoacfu�ae�4 �'�'1 + Board of Building Regulations and Standards HOME IMP gOVEMENT CONTRACTOR Regist4pj!N, 116609 E�pira on 8 912006 kncNual 41v BILLY E CAUTHE i s BILLY CAUTHEN 86BETHLANE ` � ��� G'L--•. "`� ' HYANNIS,MA 02601 �" Administrator —-- �lzeo�rvrw.uueald ' o��/�ciaoac�ivaeka BOARD OF B-UILDIN:G REGULATIONS License: CONSTRUCTION SUPERVISOR Niumbeik-1•\ 009975 Ex fret 08�107 Tr.no: 1905.0 { RT.b Dom{ rS' -A Y f BILLY E CAUTHE 1 [ 86 B-TH LN � ! ` _�� * ' HYANNIS, MA 026A oj� II Copimissioner I. OFTNE tp Town of Barnstable ° Regulatory Services ° s�R.T!M ' Thomas F.Geiler,Director '°�EONU,'Ia Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder A2(' S( ,as Owner of the subject property hereby authorize %-! 4�, to act on my behalf, in all matters relative to work authorized by this building permit application for: 61`7 5/k74 LAI IYX�- (Address of Job) /o Zv o� Signature of Owner Date h �S �e ��Zor•�5 V Print Name Q:FORMS:OWNERPERMIS SION " . The 'Town of liarnstame 1"9. Regulatory Services Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 f Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition;or construction of an addition to any pre-existing owner-occupied' building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. w� Type of Work: 217 1� - 2. Istiniated Cost O� �1 � . �� Address of Work_: �� 5S*77�4 -Pi�G� l�C�eo1 9N/Ti y '7 Z Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law ❑Job Under$1,000 []Building not owner-occupied E]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. Date Co for Name Registration No. OR Date Ow s Name q:forms:Affidav 1 S � ♦ I • 1 �- 11 1 / 11 LI •'1 a 1�1• 1 11 1_ 1 �, 11 . 11 1 1 1 1 1 . 1 / 1 1 1 / 1 I'-- L� 1 • 1 .11 • K11 M . . ' 1 1_ •1 1, a r 1 1111:AI 1 / 1 1 11 :11111 1 • • /•� 1 . 1 1 ./ . 11 1 i11111 / • 1 do not Write in am to be compleW by cfty or tmm vl II 1 11 , 1 1 1 1 1 W . • �, 1 1 / M 1 1 1 1 11 �1 •• 1 MI I . 1 / 1 1 �• 1 •1 111 1 �/ •- 1• ••1 1 1 ' 1 nl II 1 � 1 1 11 1 11 1 w �1 11 1 1 1 1 1 1 1 •�1:1111 � ' _ / � •11II •111 1% 11 . OMCW ofAcw Use ■ III city 13SdectineWsOface ■ ■ ■ , phone contact persom v-; Information and Instructions J Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees: As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work mi such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.. Additionally,neid=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. gg EFEAM ' Applicants 4_ the box that lies to situation and `s Please fill in the workers' compensation affidavit completely,by checking applies Y� 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 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. VIVE City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fell out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the p i-�er iW icense nsmbee which will be used as a reference number. The affidavits may b.a returned t" the Department by mail or FAX unless other arrangeaiects have been made. The Office of Investigations would lice 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 member. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Iwestlpallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 7=CURAgpmdtsl Tabla.lS,2.lb(eoedaaed) l�ipdre Paella for Oar aad?wrFamOf Rdidmdai Baildtap Seamd with Fad Faeh . MAJQMtJA'1 ��� 1�/Cooli� �� Wall Roar Bonn" S ab FlSa� m al Will . Fwimp r Am'CK) Uwab d Wvdud Rrvai� is vdud Paeh 3101 to 6500 Heaeia;Degm Dale a 19 .10 6 Noemd Q tZK a4o 6 mf=d B Q32 30 19 19 10 M AM S I2� 030 3: U 19 10 6 WA No 13 2? WA. w T 15 036 U _-6 Na=d It1S'Jfi OA6 3f 19 19 - -i0 — v 15% OM 35 U IRS AM 2S WA WA 19 19 10 6 as AFtJE W 0% 032 WA Noel x 12% 032 3= � 2s WA N� T 1E'A 0+42 3i 19 2S WA WA 13 19 10 6 90 AEVE Z IVA OA2 n 6 90 AEEJE AA 12% 030 30 l9 19 t0 1. ADDRESS OF PROPERTY: 7 SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTIM MORE IlWOLVED METHODS,OF D G ENERGY REQUIItIEMEN'TS ARE AVAILABLE. ASK US FOR THIS INFORMATION. I BUMDING INSPECTOR APPROVAL: YES: NO: a for=.f9gM03a 780 CMR Appendix J Footnotes to Table J5.7.1b: sliding-glass lass doors, skylights, and assemblies (including g-g . the glazing ( g Glazing area is the ratio of the area of gl g e doors)to the gross wall basement windows if located in walls that enclose conditioned space,but excluding opaque area,expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-value requirement For example,3 8=of decorative glass may be excluded from a building design with 300 ft of glazing area. =After January 1, 1999,glazing U-values must be tested and documented by the manufacwrer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.532. U-values are for whole units:center-of-glass U-values cannot be used e full ' The ailing R values do not assume a raised or oversized truss construction. If the insulation achieves four R-38 insulation thickness over the exterior walls without compression, R-30 insulation may be substituted insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity kmdatim Plus insulating shag (tf used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof- 'Wall R-values represent the sum of the wall cavity insulation Plus insulating sheathing(if used). Do not include exterior siding,stnuctuual sheathing,and interior drywall.For example,an R 19 requirement could be--- EITHER by R-19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction- 5 The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `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 glazing- Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. `If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package:. 'For Heating Degree Day requirements of the closest city or town sex Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no 'than 035.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table JIS.3b. Ma door.contains glass and an aggregate U-value raring for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(Le.,may have a U-value greater than 035). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R value is greater than or equal to the R value requirement for that component Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). I ESTIMA TED PROJECT COST WORKSHEET Value LIVING SPACE (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= GARAGE (UNFINISHED) square feet X.$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= J OTHER square feet X$??/sq.foot= Total Estimated Project Value �'7co© � r fi. fr " The Town of Barnstable anan►srnsL& 1 159- �e� Regulatory Services Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-7 90-62=0 HOMEOWNER LICENSE EXEI%EMON Please Print DATE: �. _ `^ / (� � �9,� JOB LOCATION: S � 4 lug V eJT kA dM s a I"``^, OZ brZ number sheet - � ` p village "HOMEOWNER": _l 1�f1iy141 GKWCN ��N� �O �/� 14N9 Cr? (P?-2top? • name home hone# P work phone Ft • CURRENT MAILING ADDRESS: ��' A- CO"Lr'1��� city/town state rip 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 res onsible for all such work erfo p p tined under the butIding permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,Hiles and regulations. The undersigned"homeow '..F effi es that he/she understands the Town of Barnstable Building Department mini do rocedures and requirements and that he/she will comply with said procedures ant e/of omeowner Approval of Building Official Note: Three-family dwellings containing.35.000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXE141FnON 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:EXEMPTN o N C7 f0 N N N _ O 0 Q Q - CO Q IN (O C G) O la v U U) IL LU LLJ I li r -,a i2 S, I J Cov a I c I _ fG N L N C C R i G1 a O r N I I � I � _ A1F�S S'N 1` COS Z . � 5 c F((7LI (77 t 4` TOykN OF BARNSTABLE BUILDING PE A PLICATION Map Parcel f 'r7 trf `?� 2��1 Permit#, Kf Health Division 2F.1_70 41'v1ff - �.� ;� . Date IssuedCOO 22 �� Conservation Division :��a '''' Fee s�� fa ,sj - aa2/01 Ut Is Tax Collector - `tL 2(c Treasurer f.„ �u �L:D IN C®G�9�'������rn Planning Dept. /'�� — WITH TITLE 5 f 1/JR0 MENTAL CODE AND Date Definitive Plan Approved by Planning Board �(W`TO N REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 9r7 f�ixrH j-e�, UJ4,&t �S VVI: Village am n� G " k VpfN,)�S�� " Owner 6v-LSr P6(+`(0 Address 50 5:T' ?LA►0ydei OVA,z Telephone E 05? Permit Request dZK d� Y i Square feet: 1 st floor: existing ICAO v proposed s 2nd floor: existing N proposed 0 - Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) r Age of Existing Structure lg q_T Historic House: ❑Yes o On Old King's Highway: ❑Yes t Alo 'Basement Type: YFull ❑Crawl . ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I00 Number of Baths: Full: existing a: new G Half: existing new (2.2 Number of Bedrooms: existing 3 new o Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: �YGaS . ❑Oil ❑ Electric ❑Other Central Air: ❑Yes YNo Fireplaces: Existing New O . Existing wood/coal stove: ❑Yes VNo Detach�� arage:❑existing ❑new size P9.oj ❑existing ❑new size Barn: ❑existing ❑new size Attached garage:❑existing ❑new size Sb.ed.:❑existing ❑new size Other: AIW Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �i2 ' I FOR OFFICIAL USE ONLY I PERMIT NO. DATE ISSUED ► MAP/PARCEL NO: ADDR#"�,- i VILLAGE OWNER - ,n� r ' DATE OF INSPECTION r FOUNDATION ; FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL , . PLUMBING: ROUGH FINAL ' f GAS: ROUGH FINAL a FINAL BUILDING j r.� b t, a DATE CLOSED OUT - r- - ASSOCIATION PLAN NO. , Tile Commonwealth of Massacliuse= E =i= —�.Z w��—= ;�-. Department of Industrial Accidents , - Of1fCrD/IDYCSIIgSIIOdS -- 600 Washington Street . 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I mAersrmd that S statsm= beto of DUfor ♦edWatioa. - o�of thin iasy rwarded to the Once �e I do it certify ssiidQ t and o.fP information prvvtdedabow is&ur and correct Siatmr `' Date s o '77S 4/�Y� Pant name rls7d ✓ mac— Pbaaa# (ram fo?S $70 AMW ojncW use only do not write in this area to be completed by cfty or town oindal city or town: pervamceme q ❑$tdldin;Depar=cnl . ❑Ilcensm;Board ❑cbecklf iamtediate response is requited ❑Sciecunen's OIDu ❑Health Department contact person: pmneth, ❑other :•••1• • • • �• • will • • • - �got • /1.1• �• • • / ..• 4d sob Meow •.•/ • .1• •M w•1 .11• • 1• w.V • • •• •1 p • • • • • • /• • •1• • Y. • 1 1 • Y 1 • / 1 • / r • 1 • • •./. / do •1• 11 11 1 1 1 • / • • ♦ 1 I - I r / 1 1 1 • 1 •1.01•I•1/ • 1 I /•1 .1/ • •1 ••. •• 1••.: v• ••1 • '• •1• 1 I w•/Iti 1111• .•• • ••111• M •r. • • • •1 r•nIn .•• lu /• 11 IIt.••• • � /• •• ••1/.JMw Y•11.1• �•• v:•• •1• .1.1 1 • 1 r•1•II• .•1 10/• 1•� r•11.1•.1• • •Y.1••w • •1 �-� .•• • • • •111 11./•/ •ww •111• _ ' 1/• rw •I•.r.•• •1 11 1/ .11 . ' •• • IL •• Odom loss_;* /• •• � •.1 •••w•1 •/ 111•IIAv••Y ••w •w•10, 1.1 ••111.1••/✓.1• •1• •1 11 11•:1• ••• •�1 •1 1 1 11 1 _ 'J• .II 1 .1•• ••:•• •1• f•1 •• ••I.1111 •/ -. • •u �.•r.• •11• •• •1 •I• �• /• • •r.11• •••/•.•�.w •�•n11•-.IA.•• •li • • • -� v .-: � •• � w•r. •••wa .• ����j/�/�// ���� I• Hill• •d •�• • • • 1 '" IA - to sol-volops • • 1 •1 ••/ /• ./� •11 1• /• •wt• /• •• Y •! 1 •wv■ •I:1• •1•A • /• r•I.1•: _ M ••I r1 •11/ • It .1• / ••IHI • •• •• • 1 I• •• •••1.1/1 r..•• IIII•• •... •• 111 • ' 1 / ♦�• M•� •r is OVENON ••• •• •• • •/•11 .••• r.► U•Ii• •w NO1 - • �1• - • 1r ITS • - 1 1 1 1 1 1 1 1 1 • " 1 1 1 1 1 i l 1 1 • 1 1 1 1 � � � � / � 1 1 The Town of Barnstable �. Regulatory Services Ec +"�� Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230. Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. / Type of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑ , ilding not owner-occupied ner 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 Contractor ame Registration No. OR Date Owner's-Name q:forms:Affidav " The Town of Barnstable tr►sntsr�tt:. 94, 16,39. �. Regulatory Services Thomas F. Geller, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-62=0 HOMEOWNER LICENSE EJLE1 EMON Please Print DATE: 3' 22 - C) t JOB LOCATION: number street V village "HOMEOWNER":��117�o( `p1? �-1�(OtZ(t�. • 0 Y home phone# Cwork phone ) • CURRENT MAILING'ADDRESS: j P\2a�-, wry/town state rip 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 buildine permit (Section 109.1.1) c The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,roles 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 jedures and requirements. 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 EXEMP'ITON 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 as supervisor."s)for hire to do such work,that such Homeowner shall act u ervisor." 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 pan 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:EXEMP'IN -ro�r—, Co 5C61- -3-C2(-s-rs- 12,-KtO 73.eA�S Z)-12 ('hoc t3ce�� X:4e�y� 10 Val" i v • - s 2. w 'hn UV om3 I�yflvf 6L?6, I ti D. so�47us cT -4-7-7 • t Pf �� j 1 : TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION= Map .--its Parcel C677 Permit# � Health Division Date Issued Conservation Division SEPTIP" SYSTEM MSS 0� INSTAL , Tax Collector e y1�el � WITH TITLE 5 ENVIRONMENTAL CODE AND Treasurer g _ t.� _ �/ ��/ L 1OWN REGULATIONS Planning Dept:_ Q— Date Definitive Plan Approved by Planning Board " s F Historic-OKH Preservation/Hyannis 3 [ Project Street Address Au<_,n ,e_ Village Owner ���s�p (14,No✓S4�A2 Address iAtAr-'To+'i U T Telephone Permit Request \ -1nZ� I CRX Square feet: 1st floor: existing t too proposed 3h*,R— 2nd floor: existing W� proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: (J Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family )if Two Family ❑ Multi-Family(#units) Age of Existing Structure 1L Historic House: ❑Yes Vlo On Old King's Highway: ❑Yes 4No Basement Type: '154 Full ❑Crawl "❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1(00 Number of Baths: Full: existing 1 new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing Co new First Floor Room Count Heat Type and Fuel: UGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes l No Fireplaces: Existing New_ Existing wood/coal stove: ❑Yes ❑No uv Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size 'e"o �o Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: PO r� Zoning Board of AppealsAuthorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes site plan review# Current Use S� 1at— (2g,0 �'W- Proposed Use I � ER INFORMATION lam3�� C2 L( r �ap) Name Jn Telephone Number a Address �`� 7*U.'vT 0,(� C;� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEB S RESULT rFROM T ;ROJ T WILL BE TAKEN TO �,� S► ��-vS ✓ SIGNATURE DATE FOR OFFICIAL USE ONLY = \P PERMIT NO. 4 -SATE ISSUED MAP/PARCEL-NO. - ADDRESS' ,.. VILLAGE: - z OWNER Y -, DATE OF INSPECTION , 6 FOUNDATION FRAME t INSULATION t N , FIREPLACE - ELECTRICAL: "ROUGH, FINAL PLUMBING: -ROUGH P :- 'FINAL ` �'s I -: -_ » i GAS: '-ROU'GH. T. FINAL I FINAL BUILDING DATE CLOSED OUT r!: I, ASSOCIATION PLAN NO. t. 5 MORTGAGE INSPECTION PLAN UNREGISTERED LAND FILE NO.: 126715 ADDRESS: 97 SIXTH AVENUE, BARNSTABLE, MA DEED BOOK:7298 PAGE: 62 ATTORNEY: LAW OFFICES OF FRANK & LEBWITH. P.C. JO-0332 PLAN BOOK: 34 PAGE:23 LOT(S):470+472 BLK LENDER: SUMMIT MORTGAGE PLAN NUMBER: OF OWNER:PAUL D. CARR & EXECUTOR U/W/O GEORGE V. CARR APPLICANT: CHRISTOPHER C. & ELIZABETH B. SHORTSLEEVE REGISTERED.LAND DATE: 02/23/2001 SCALE: 1"=20' REGISTRATION BOOK: PAGE: CERTIFICATE OF TITLE: PLAN NUMBER: LOT(S): FLOOD HAZARD INFORMATION FLOOD MAP COMMUNITY NO.: 250001 ZONE: C ASSESSORS MAP PANEL: 0008D DATED: 07/02/1992 MAP: BLOCK: PARCEL: LOT 583 LOT 585 80.00' n LOTS 470 & 472 89000 . . a �o Ot Qo 0 0 0 0 LOT 474 a �� o W Z_ CL 80.00, CON RETE BOUND SIXTH AVENUE MORTGAGE LENDER USE ONLY THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT �DESLAURIFRS OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. & )V%QCIATB INC. w 40 KENWOOD CIRCLE, SUITE 8, FRANKLIN, MA 02038 THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED TEL.:(800)287-8800 FAX.:(508)528-4011 DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN. OF Mq�� THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN ROBERT o A SPECIAL FLOOD HAZARD ZONE. EDWARD BISSONNETT H THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER N0. 31300 WAS IN COMPLIANCE WITH THE LOCAL ZONING BY-LAWS IN �/STER 9 �o EFFECT WHEN CONSTRUCTED WITH RESPECT TO STRUCTURALF SETBACK REQUIREMENTS ONLY, OR IS EXEMPT FROM VIOLATION NA( LAND ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII. CHAPTER 40A, SECTION 7. GENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, Informaton, and belief as the result of a mortgage inspection tape survey made to the normal standard of care of registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date. (3) This plan was not made for recording purposes, for use In preparing deed descriptions or for construction. (4) Verifications of property line dimensions, building offsets, fences, or lot configuration may be accomplished by an accurate instrument survey. TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION C,96.7 Map Parcel Permit# ,.]2 Z Health Division Date Issued a h Conservation Division Fee IJs �J Tax Collector . % `/ l I r,--�'"b ilc SYS T Edna] F& 9 INSTALLED IN COMPLIANCE t Treasure ` WITH TITLE 5 Planning Dept. ENVIRONMENTAL C®®E ANC TOWN REGULATIOI�1� Date Definitive Plan Approved by Planning Board /l A C , Historic-OKH Preservation/Hyannis Project Street Address q7 !E�ixc-rN A"u-c- Village VJ��:, � Owner Lkri 'UPAM �uu� it �`�cdress T✓'�tn �l �c�(r�lv��2rlM ch'z�2 Telephone lue- am Lc_ yis-sr1s)7 Permit Request n N\,oye- Loa-& 3' ­V� ����.-� ►�,�E2�o2 ��ti2 ��N � P���1 i. Square feet: 1st floor: existing 11,00 proposed 5'PRC 2nd floor: existing Q i- proposed A- Total new Valuation — Zoning District Flood Plain Groundwater Overlay 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 56 e� ON5 Historic House: ❑Yes � On Old King's Highway: ❑Yes �N Basement Type: W Full ❑Crawl =❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1 Number of Baths: Full: existing new Half: existing new c!) Number of Bedrooms: existing_ new Total Room Count(not including baths): existing CQ new 0 First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing �_ New 4 Existing wood/coal stove: ❑Yes ONo Detached garage:❑existing ❑new size Pam: ❑existing ❑new size Blarn:❑existing ❑new size (J Q&0 Attached arage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No �A-o If site,plan review# Current Use a5LJ -J/* Proposed Use �Y/ORP_PAY BUILDER INFORMATION �pS t� �36�l Name &\ 1 Telephone Number 5dl�)- i -gcigv (�"o Address , 1NUT':�_TReeJ License# D�� �^ l , Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO OoJ S C 1 E 'TXkwt �hE05 "`2 SIGNATURE DATE 7Za v FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS,," ,' VILLAGE OWNER �'.rQlOtk r ..• r DATE OF INSPECTION: T FOUNDATION FRAME 3 INSULATION > FIREPLACE ,. • i ELECTRICAL: ROUGH' FINAL PLUMBING: ROUGH _w FINAL anY GAS: _ ROUGH `= FINAL = FINAL BUILDING • S DATE CLOSED OUT i ASSOCIATION PLAN NO. y 4 . y i 1 The Commonwealth of Massachusetts _ • F 3—, Department of Industrial Accidents .,' O!!!Ct 01ldYCSllgSllOdS .. �: 600 Washington Sheet Boston,Mars 02111 Workers' Camoensation Insurance davit name: .�� � h,�r�✓ ��: � � location city rhone# ' l�/51{fy9 ff-I am a homeowner performing all wmc myscM ❑ I am a sole munz etor and have no one vvmiiw in any caDaciM ❑ I am as employer providing workers' c=mpeasatioa for my employees rwarldng on this job. d� ...::v:::::::::.:::v:nv::•:-:::•::::v:::.�::.v...................: :.v.:pY.i Y.}:};t•}>:}i:{{:{:::::•:..• •:.:i4}::IX{fiv..................::::w:,-- .. {4%i}v`.:}::;}}:•}}:?! _.:Yi^:;'iiiis? ,'::::•.�:f�:`::2v:iirr::: _..... ;?;•:}i t9'4}}}:;•}Y...... .. .;•{i...� ..;L:::i;::b:j•.;:::;:;:::{:::.:Y6i:1:�:::4::^:4i:::::.:. -::::.�::::.. ..:::::..:.�::}:?w::::i::•}:i}:•}iii::::n::::::v:v::.::?{•}:i:::w.vvw: ....%,.... -..... nv.x,.... .. .:vr.%:J;{{•iin`vr.:•:3v:}:•}: ......:::::•:: �i ..:..;.;v::•::;..+`:::::.::::.v:}:<-._::-.�:::�•.:�.�::._:: .::..�:.;;¢>.:::?::::w.v:•k+4}i}i}i:;!;:,}:}}:•:;•}::4:;8}:'{•:fi:<v:;i•::::w.v::r•::•wf............ .;..;..�,;;.:.::;!;;t <::::.:::;.:;:�;:;:.}}:;.:�:,...::a::,,,:.-...,.::....:..::.::.;..,,,.;::::,,:::;.. ................,.:•::.:..........:...........::::.::--............-..:.•:::.?{•%:•:,p�.�w,,•:t•:•::•;fi'ti:`•.:•:ie .. ..r.:o-.•kso.. 4:..... ...rtr::::%•::::::::.:::::::.�:.:�:::-::::::::s.:::... :::..:....�...:..:. ..... ................ t... .i.,wn.. ar.:r.{?•. ..Awno..t..c�. t,:tt,::•n ...„..a .... ........ tn.:....4..... .. l:� .. �. .....gda :....}......n.... : ...n..... +v:::.�:- w:r.v::n�.v.::�Fv}7::•}::.�::•{�iiii:;�ii?•ii:ii:::y:�s;<.::.-.,•,...-,:..........,,.:•:::,,........,�}.....,............v;.s:�.•::,.t.,..:..x..::'•}+'"y?�?....rr ...%.......:..n.,.c,it{:::.;•,{,.•::.�.�::::..}:...«;:{}::} ........:.............................................. :.... n..n4.t.....n: :,v.3}.x•:�•:mvn..::nw:y,.;; v:v::.;. .....r:::.:v:i:;;.;:;.:..:•:::-::.,::.:. 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I understand that$ cuff of this state-PutsasT be to to the OIDce t IA for covaa;e ralaatlAa I do here3y certify Pairs p of p infomaian Provided abaw is Ow.and correct Sigaatore �� Date ` �G,�'�IT� ,,,r✓` Plume It �'0 8 7 � 'f�Pi 9 .Print name use do not write in this area to be completed or town otIIcial aiIIdsl T Pad by�7 city or town: Peeadocense 0 ❑$molding Deparencul 011censtng Board Q check ifimmediate response is requited QSeieet en's OIDce (:]Health Department contact person: phone it; - ❑Other ••• • • • �• • •/•• • r L / I •.►1••�• M • •• • • • • •• • • • • • • �• • •r•1• �• • • • w• • • , I / • •••�• • //• •1 •. •• • • •M .•• •1• • •• .•••1• • • •�• i1• • • •• • • • • • • •• w•r• • • • II SIN • I • • • of • • J: • w.w••Y. • w, • • • �.H•• • • • • • N• •1 • ■•.r • 1• • • •t• • • •w • .. �•••• • w•a• • Is • w•H• • • • �• 1 • • • •• •• •. 1• • •• ••• • .iiilad I ,far.0 92004-044:0-is Is • 1• ."do ••A •• •1 •• • •. of • • • • •• • •• •:• • Is Itkh as I Mwok I I« oil 411to • • •• • • • •w•. •1 •.• I• • Ia 84• *I--. A&.1-Rep W.1 644we .n001• • r• mow••—• • • .1• ••••1• • w •. ••w �«• •n • rum it .r I • 1 • I11 1 / t .11 • 1 Y11 + 1 •• 1 1 • / r • / • • J. 1 •1 - .1. 11 11 t • 1 1 • • • : I r • • • • - • r • . r I I //1• / 1 1 11 1• 1 r / •Y. • • • •1 M•11.1• .1• • logo•t $si.,11••:••« �• tl• .•••w•1•. • •• «•.•••� • •ter• • .+w•1 �• • •• •1.1• • •411.1 • «•� .�•I n ••• •r .I .0 • w. u •• •• emu• .••o• .0• •••• 1• • «010040.•• • IY..I•+ • •1 .1. • • • •111 •I/J•• •tiA •111• 1•I «w ••• ✓.I• •1 t• •• .1•« 1 •• • IL ask-, • 1.1 jFw•111.1••. salle.0 •lips I •••:1•« «• •./ y 1 • II I •JI .0 • . M. •• • 11 •• • • 1 V• • t • • •J•••—• 1• 11 «1 ' •1 /• • I •• .• •I J• • •••• •It 1./ I• •�••••t1 •1 lelas • ••• • • •�• I 1 U •.•••••r.• •1 • �1• ••% V« ..+/lw 1 • • • • • • it' ..1 • • t..� • •11 w1• •••• • •• •1 ••• �• I• ••Y.•/• •'•1•.��••. •••I..1•w.AY..• •It • • • .� v •+. i •• � �••Y. •.•.•.1 .• •• •11.•• •w 1�• • • • ME • 1 I •••. • 1 •IIas A • •• «•1.1 Y. « • • • ..••r.•••r• •• • •• •� .u . • 11 • • .u « 7101, 1 1 11 11 1 1 1 • • 1 " • •11 • 1 1 1 • 1 • 1 1 � 1 1 • 1 1 r l 1 1 1 • 1 1 - • 1 1 1 1 • 1 1 1 The Town of Barnstable s • s�ttrrsrnare. - 163 �,� Regulatory Services Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790=6230. Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: r7 S'z/raf '4z`�n ee�- l'. � G� ��lS' r,✓� . �v — Owner's Name:— Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 QB. jlding not owner-occupied j caner 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 C ,act e. Registration No. O Date Owner's ame q:fomis:Affidav L The Town of Barnstable BAMSr"M 9� 1659. Regulatory Services '�Eo trto.�a Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: �� 7' /�l/� d✓ l% / : ✓r h'I number // // e street village HOMEOWNER": d�/'lj L�.v2l�i�✓ t . , _. C7 362 time home phone# / work phone# • CURRENT MAILING ADDRESS- city/town state rip 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,toles and regulations. The undersigned"home ifies that she understands the Town of Barnstable Building Department mini on ed s and requirements and that he/she will comply with said procedures nts. Si azure-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'EXEMPnON 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 n 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:EXEMM N i 1 , ! cD si i � � t 4 i T ' ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 5� V Parcel O 7 Permit# fa®r!i 7 Health Division Date Issued4-7 e17 Conservation Divisio Fee Tax Collector figTi' SYSTEM MUST BE. Treasurer � I' `w LL ® IN COMPLIANCE Planning Dept. K� # y%' WITH TITLE 5 NX;' . � ,'!0N �ENTAL C01)E Afi��'� Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address f 7 & 1ve Village to, ff%L4 Z.Z1 f ,erjl� Owner Stfp 275� loG� Address ;5_6 S1� Awvb/ Telephoned Permit Request i�wvl-Ue I syf-vq �& 14y126 -V Psi ,S, rsT/-v S reno Vejadl -ir IvTlw�/ 4; w-44 ��S�tlz Square feet: 1st floor: existing proposed d 2nd floor: existing proposed Total new Valuation e,,.T7o"a U Zoning District Flood Plain Groundwater Overlay Construction Typetl� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 911" Two Family ❑ Multi-Family(#units) Age of Existing Structure 46 /LS Historic House: ❑Yes 9 No On Old King's Highway: ❑Yes C9'I�lo Basement Type: 0"Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) &ZI0 57 Number of Baths: Full: existing ` new Half:existing new Number of Bedrooms: existing .3 new Total Room Count(not including baths): existing o� new First Floor Room Count Heat Type and Fuel: O"GGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 0"No Fireplaces: Existing �_ New Existing wood/coal stov : ❑Yes 011;ro Detached garage: ❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing, ❑new�s'ize Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: ai w Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes O"No If yes, site plan review# Current Use � -fit mil, u�l� Proposed Use BUILDER INFORMATION Name 9/Xc, ��tl�tl��,/ Telephone Number -G�7s'd -U� � Address License# UlUct'}�?r y /wti`S I Uv2 0/ Home Improvement Contractor# IAA e} I\ Worker's Compensation# �C'�-0a2A�e�; � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE ���! DATE �1� 61 i FOR OFFICIAL USE ONLY P-ERMIT NO. f DATE`'ISSUED MAP/PARCEL NO: ADDRESS - VILLAGE OWNER • DATE OF INSPECTION: FOUNDATION r s , . FRAME ' 1 r INSULATION FIREPLACE �f i ELECTRICAL: ROUGH FINAL — x r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r ' F FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. F S Table JL%lb(eeastasaa� am ma prrleripthe Pmelca;a for Dd Two-Fan*Roddsda!BattdloW Amsad with Food Foal* SWIMUM IY@YQ1tUM Glaring . Glaring Ceiling Wait Floor Bnemest Slab �m EMd==-? Area,('/•) U-value Revalue' R-valuo' Rrvand � Paeicaae i 5701 to 6500 Heath;merve Dow Normal Q 1211. 0.40 33 13 19 10 6 R 12•J. 032 30 19 19 10 6 Normal S ES AFVE 1 '. . 0.50, 3E, a 13 19 10' 6 2S T 15% 036 311 13 25 NIA Nll� N==l U'. 15% 0.46 3E 19 19 10 6 Normal v 159/. 0.44 3E 13 2S WA NIA E5 ARM W 15% 032 30 19 19 10 6 E5 AFUE X 18% 032 3E 13 23 NIA NIA Normal Y 19% 0.42 3E 19 2S WA NIA N=md Z 19% 0.42 38 13 19 10 6 90AFUE AA 1E•/. 030 30 19 19 10 6 90AFUE 1'. ADDRESS OF PROPERTY: ye L4 3� 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: • 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENmGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. i BUILDING INSPECTOR APPROVAL: YES: NO: q4b=4980303a Footnotes to Table J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylight and basement windows if located in walls that enclose conditioned space,but excluding opaque doors) to the gross ll area. expressed as a percentage. Up to 1%of the total glaring area may be exeluded.from the U-value requirement. For example,3 ft=of decorative glass may be excluded from a building design with.300 ft of glazing area. After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with. the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 31.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness. over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R.49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and'the ventilated portion of the roof. Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall.For example,an R.19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavity insulation plus K-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,Iog)wall constructions,but do not apply to metal-flame construction. The floor requirements apply to floors over unconditioned spaces(snch as unconditioned crawlspaces,basements, or garages).FIoors over outside air must meet the ceiling requirements. ' The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must Windows and sliding ass.doors of conditioned requirement as above- g � m�-_.• the same R-value teq i�a wails. Win bz!.,ements must be included with the other glazing. Basement doors must meet the door U-value requirement d_scribed in Note b. the Rq-value requirements are for unheated slabs.Add an additional R-2 ate for heated slabs. " If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece.of heating equipment or.more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES.. a) Glazing areas and U-values are maximum acceptable.levels.Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested and documented by the manufacturerIin accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawi space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R value is greater than.or equal to the R-value requirement for that component. Glazing or door components comply if the area weighted average U value of all windows or doors is less - than oreq ual to the U-value requirement(0.35 for doors). . _ 43 l RESIDENTIAL BIJII,DING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING'SPACE square feet x$96/sq foot= x.0031= plus from below.(if applicable) ALTERATIONS/RENOVATIONS OF EMSTING SPACE a a ' square feet x$64/sq.foot= f f 33 ,U� _x.003 1= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft , >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch _x$30.00= (number) Deck ._.-x$30.00= (number) Fireplace/Chimney _x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocationtmoving $150.00 (plus above if applicable) Permit Fee PMjcost _�_ '° _— r Department of Industrial Accidents Office aflovesff9affaas _ — 600 Washington Street - Boston,Mass.,.02111 Workers' Cora ensation Insurance Affidavit • �� gip`-�l� l� it,on. _ �✓y/tsls ; !�! 1;4 0 phone I am a homeowner performing all.work myself. lam a sole etor and have no one workin in achy //% /////%%/%/l%// /%/%/%/////%%///%% er rovidin workers co ensation for spy employees working onthis job. :?}::{{?{}v:?:::?::n:•:,:}};:.;}}J:.;:$::;4::.;:L4}::<.}},;:{.}:•: an era 1 g mP......... ...... .......,.:.,.::::.::•:.::::::::::.:::...:..::?.r:.::.:.•:::::.:::t??:.>:.i:.}•:4}}}:::;;;:.r, I am o3' P ..................................................n...:........,..r.r...............:.:::..:..............................::..:::::.::::`:::::.�:n..Y.}:?.?:.}:;•}:•}:i:::i:•:}}};.;}•:.:.::.:r;:}::r:::.�::•:Y::}:.:;.. .:..:..::...:. ............::. .. r.: :................. :....::::::{-}:4:•:::v:•:r:.v:::;{fi;;:::::4'L{•}•.}}}:•.;•}:n.}.v:::•}::•}}:•:$:::pY:.}:$i:::$'{.:;{•:vr::.:......::•:.v......a:::•:::::.::.....::...v....,........:::.::•:......:• �. ....,•::::::r.v:••w:::nv.:::n:•.v'.J:•}}:{{{•}:;::};:.'l.•:•}:::3::::?x;3:•i:•}:4'{{?4:t{i;i?:•Yv.v:::??::S.v:-::::•:::x::::::::::::..............n................. ....... .. ... ...n, }.,. r ......r.....r........ ,.......... ...1......r.. r:::••:.}::•:;,+.y:v;:;;:;:::_;:r•:•}•:::.r•::_,:r.::•;}:`••:•.::......;. :...... .:....n.. .:r... . ... ........... .. ........_:....rarr.:•:•:.r.::.�:r{•::r:n•::•.::r:::. r...r...........:.....4::•:::::•.... ....,: h•:•:..:::.:::: n.c•: ....................:::::::?:.{:•,:•:r::::::..:::::::::{-•..'.-::•.;!..:::.:�:.:,•::::.:::.,�.::.::.}J:4:{•J:•nr.}.�:�r:;•}:•r::•::r.•:.•xi:Y::•�{•}:{::•n••Y{i;?•i:::}:•:t::`::;}:$$:::;}}}:•::.. :.a. .......:.::.......:........,-:::::::.r::::...... .......... ....n.......::::::::n•: :::...:..:::::{v:•:......a... ......\•.•::'•}v}:•:4::•:{:• ...:Sv....:..:......r. �::.2•:::::::.?}:•:::{{n};.;!•.:;:;:i:¢}X{�:•:L.:•.v suranc�::etr::}:.:::::.........:..x:::.:.t::..�:?:::.:•;n•;:;::..a;?<';{>Y::;v:.:::::::l.r,:.....:,.r—•.:.:.:.:...:. . 0000 o ] I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who sve the fallow compensation polices: wing workers ........... ........::.::.:::.:,.:::r.�::::.r.::::.n.n.::.,.:::::;::..:..,:.::::::•:n:.:::::.:::r::::::.,..:..::..,,.::::. •}7}}}}}:x,..}.3:fi;r}}:3? :;fit•{.:}::' $$}•:'.:;5$:•}$SS:}%:t?{:ji;7}::•:r:;i }$'is w:}::••. .... ••:::.?4:w.v:Y:::::{{{::•}:J: ;:�•..;v ;}:•:}:;:{: ; .:?$$:}r.:::Yl:i:•:{;4:L{{.};$•}::}:iy:.v:::: }v:....:•:::::.. 5m ..... r:.:.:,.n..::r.•:.... r # ....,..............r.... ...?..:�,r::-- ...........r..........:... ...r...�::::::•:••:::,.. ...z••}:.�::•.•:::.........:..:t.., r...........:.,...:J:n•.:: �::.:;•}:{.. ?::•r.;•}::::.:......... v;;;;•}:•:4:•;:•}:................:::•:•::;• • :.:r.:•::....:::.:::.�:{:;;•.,a;..,.c:r:�:.r::}•:::..... ,.,....r:n.,.:.?;.}:??rr::•.�::.�.�::4;:••::t?:,::.:....::::::.::::n•::::.:::•.{..:. h•:r•::::x..i..v,4:%v::::/'v:-r...:n...x::::4:vn•r.•:....::.r..::•................. .v....... .. ...........::::::::••...... -:: ...:.v....:w:n•.................. .... ...::: ...... .....:................v-v:•:•.v.v::::.v::::.v{.}}v}}'F.;!r:{•}:.}•.y:::•'r,:;::•:};{i�';>:ti4}:}fi:4:•ti;:4:;i:}?'i:}:tir•{}:j•:{•:•:{{S•}i': � reSS..... :::.......................: :.:.r...... ................:::.•... :.........................:.{:•.....r...........r.::.....,..r................:::•:v. r: .3:•:-::vv::..v:•:�!::::::w,}:.:•y,.;:;:•:::{:;••:$tib;y:?;i:$:%:{TT.$;!•;:: ..............:v.:.......n.•.,•••.l..:_..r:.....:.............:.v:v:... ........v•. 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I umderztand that a :opy of this statement may be forwarded to the Office of Investigations of the DIA for coverate verification do hereby certify the pains axid enaldes of perjury that the information provided above is truce and tarred Date z3 5igaature � . P rint �'�- ,� LSD/ Phone ly do not write in this area to be completed by city or town ofticial pernsit/liewe# ❑Building Deparint ❑Licensor=Board mediate response is required ❑Sdectrnen's Office .ClHeolth Department on: phone#; ❑Other. (raised 9195 PJ1a Information and Instructions ' sachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their lovees. As quoted from the 'law'; an employee is defined as every person in the service of another under any cortract re, express or implied, oral or written. wmployer is defined as an individual; partnership, association, corporation or other legal entity, or any two or more of .'oregoing engaged in a joint enterprise, and including the legal representatives of a deceased'employer, or the receiver or tee of an individual, partnership, association or other legal entity, employing-employees. However the owner of•a lling house having not more than three apartments and who resides therein; or the occupant of the dowelling house of her who employs persons to do maintenance, construction or repair work on such dwelling house or on the,grounds or ding appurtenant thereto shall not because-of such employment be deemed to be an employer. -L chapter 152 section 25 also states that every state or local licensing'agency shall withhold the:issuance or renewal .license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has produced acceptable evidence:of compliance with the insurance coverage required. Additionally,.neither the unonwealth nor any of its political subdivisions shau enter into any contract for the performance of public work until eptable,evidence of compliance with the insurance requirements of t avehis chapter h been presented to the.contracting aority. plicants ase fill in the workers', compensation'affidavit completely,by checking the box that applies;to your situation and )plying.compnny:naMes, address and phone numbers along 'with a certificate of insurance°as all affidavits maybe )witted to the Department-of Industrial Accidents for confirmation of*.insurance coverage: Also be sure to sign and. Ee the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is ng requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you s required to obtain a•workers' compensation policy,,please call the Department at the number listed below. ty or,Towns mse be-sure that the affidavit is*complete and printed legibly. The Department.has provided a space at the bottom of the adavit for you to fill out in the event.the Office of Investigations has to contact you regarding the applicant. Please sure to fill in the peiinit/license number which will be used as a reference number. The affidavit;'May be retmmed in Department by mail or FAX have-bemmade:-."��----- �--•_..r....r.�..:._...., __.. . . ie Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• ease do not hesitate to give us a call. ae Departzneat's address,telephone and fax number: . ' The Commonwealth Of Massachusetts' Department of Industrial Accidents Office of Wiestlgatlons 600 Washington Street Boston,Ma. 02111. fax#: (617) 727-7749 phone#:(617) 727.4900 ext. 406, 4.09..or.. 375. I • q The Town of Barnstable Regulatory Services Thomas F. Geiler, Director -Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.at least one but not more than four dwelling units or to structures which are-adjacent to such residence or building be done by registered contractors,.with-certain exceptions,along with other requirements. Q� Type.of Work: /Q/ZCk ieyo,"dr"641 Estimated Cost Address of Work: 004r Owner's Name:• (1V V V U e_ swo gr 5`G��ULS Date of Application: /6 2-- I hereby certify that: Registration is not required for the following reason(-): ❑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: Date Contractor Name Registration No. OR g1orms:Affidav :rev-122001 i INPROVVENT CONTRACTOR o Registration' I16604 a Evi ration: 06/zg/7002 Type: Individual ! BILLY'E CAWTHEN I i a BILLY CAl1TNEN �CQ7j�O &7--44'BETH LANE ADMINISTRATOR NYAItN'IS .I ftA 02601 BOARD OF BUILDIN S K�-GULATiQMS License OONSTRUCTION&I kov SORt � Number CS 0099175 f Birth ,08/13l194,2 I Ezprres:<;08113f2003 Tr.w 2479 ! ' Restcicted ;OD � ' 1 � j BILLY E CAUTHEtI, 86 BETH LNG, >`,> .' fHYANNIS, MA 02601 Adrministrator 1 1 f i The T. N� BAR VSTA RLE, Department of Health Safety and Environmental Services 9 MASS. 0 �p 1639 �0 IfUMPyn, wilding Division 367 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW r Owner: 4/V 1\1F GT Map/Parcel: Project Address: 1?7 . ✓ f Builder: The following items were noted on reviewing: ,rt^/ o vN!7/l>i4iY r y. i' .vf Reviewed by: Date: q:buiI ding:forms:review i i"j � �%.,�� i ram.;= t � , Via,. ' + W4 11'6 1711 159 152 79 4'1 3'2 7 9 75 Usting si ndeck v, Bedroom Kitchen Bedroom Closet Ll I <V N fD w (Pella French Doors to replace * N ebsting screen doors)So io Po Bath Existing Porch Dining (To be glassed in with Pella Living Room casement windows in place of e)dsBng screening.) Bedroom N iV y 1,s L ANG AREA 1s 1567 sq ft I F W4 I .�� .� .�*y -- ;� ,.�� �� _ .:� � ,j. �� � R. � � ^* ,... � .: ��t� �.` ,. a ��`. c�1. A :i x �.1 :� 4 ��?� ' .. �,, g�, !� y �. .��� �� '1 �� �