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HomeMy WebLinkAbout0095 SPRING STREET 9� �s���� ��', �� �� i Town of Barnstable _ Y u w Building SA"IMe Post This Card So That it iisible From•the Street Apparoved Plans Must be;Retamed on Job and this Card Must be Kept spa ,��' Posted Until Final Inspection Has Been Made � � �~ � � 1 .. ° eaa Where a Certificate of Occupancy,is Required,such Building shall Not be Occupied until a Final Inspection'has been ade �� lt m Permit NO. B-20-74 Applicant Name: TROY A THOMAS Approvals Date Issued: 01/13/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/13/2020 Foundation: Location: 95 SPRING STREET, HYANNIS Map/Lot: 328-022 . Zoning District: SF Sheathing: Owner on Record: DONNELLY, RONALD J '',Contractor,Name: .TROY A THOMAS Framing: 1 o. Address: 95 SPRING STREET Contractor License: CSSL-099913 2 HYANNIS, MA 02601 rz.Est. Project Cost: $5,990.00 Chimney: Description: Roof Permit Fee: $35.00 Insulation: Fee Paid: $35.00 Project Review Req: n, Final: Date 1/13/2020 c77� { 4 Plumbing/Gas z Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance. All work authorized by this permit shall conform to the approved application and'the approved construction documents,;for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures`,shall be in compliance with the local zoning by laws'and codes. This permit shall be displayed in a location clearly visible from access street or,roa&and shall be maintained open for public"inspection for the entire duration of the Final Gas: work until the completion of the same. NPR Electrical f The Certificate of Occupancy will not be issued until all applicable signatures by the•Buildmg and,Rre�Officials are provided on thispermit. Minimum of Five Call Inspections Required for All Construction Work: ry Service: 1..Foundation or Footing Rough: 2.Sheathing Inspection K,�, -: , m� g f 3:All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior.to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Pers acting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department , Building plans are to be available'on site C Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r Application number........ ....... .®.a. .. Fee.............................. �:�..................... _ Building Inspectors Initials..... Date Issued:..................1...�.. ....... .................. Map/Parcel....................... � :t ....................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY-INFORMATION Address of Project: S.xdn f u2d -/ ��vMs , 4 ®r NUh&ER STREET VILLAGE Owner's Name: A&1,X A/e// ` Phone Number Email Address: ` _ Cell Phone Number t � 65-5-1 -=i Project cost$ Check one Residential onunercl- - OWNER'S AUTHORIZATION, '; _ Z" ' As owner of the above property I hereby authorize } to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to 01 CONTRACTOR'S INFORMATION Contractor's name 2220P21 d/k-f � Home Improvement Contractors Registration(if applicable)'#,` ` � L�r,7 (attach copy) Construction Supervisor's License.# Q FFF13 (attach copy) Email of Contracto ,d S Afuxc ,V i� phone number sw ALL PROPERTIES THAT HAVE STRUCTU ES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYES IN A 2urr^0%6A+0%#rrn#0+r vnl►IRA►ICrADVAIAI LIICTADlr AODDAI/AI DCCADC A DCDAAtrrAAl DCIMWn APPLICATION NUMBER............................................................ y *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event ✓ Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tentmust be attached. Provide,a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No_;_.if yes,a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours o 8:00am-9.30 am or 3.30" m-d:3 m. Commercial events m require Fire Department approval. ,f P 0P may 4 P PP *WOOD/COAL/PELLET STOVES Manufacturer# ' Model/I.D. Fuel Type Testing Lab Offsets,from combustibles: front back left side right side 'k HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in'accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 , CMR and the Town of Ba stable. Signature Date-1 7-9Or9O APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior`to,issuance. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -Please-Print Legibly Name (Business/Organization/Individual): �B1N!/Z� Address: 0, 9x I�� City/State/Zip: te, Phone#: Are you an employer?Check the a propriate box: Type of project(required): 1. am a employer with 4. E] I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). , ,. listed,on the ❑attached sheet. 7: Remodeling 2.El I am a sole proprietor or partner " .;.; ship and have no employees These sub-contractors have- g,' 0 Demolition workingfor me in an capacity. employees and have workers' Y 9. ❑Building addition [No workers'comp.insurance fw•_-comp..insurance.: required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. I LE3 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I'll12.❑Roof repairs ' insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill'out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: wev� •✓33 ` Policy#or Self-ins.Lic.#: 0 Pd5 3 a Expiration Date: Job Site Address: "' City/State/Zip: J Attach a copy of the wor ers c mpensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains a d penalties of perjury that the informationprovided above is.true and correc r Si ature: Date: 17' f0 Phone#: ?.V. - Official use only. Do not write-in this area,to be completed by city or town`ofcial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other •�., Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.,In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your'cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,'telephone and fax number: -The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE �. Fax#617-727-7749 Revised 4-24-07 '"` ' rw,maSS.gOV/dia THOMAS HOME IMPROVEMENTS LLC.PROPOSES TO PERFORM THE FOLLOWING WORK: Location of proposed work: Mr. Ronald Donnelly 95 Spring Street Hyannis, MA 02601 Date on which construction should begin: January 2020 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of. this,contract. , The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may. need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,-and that such variation is not to be considered a violation of this contract. Cost for labor and materials under this contract: ,$51990.00 30 yr.GAF/Elk Timberline HD Architectural shingle(Life Time Limited Warranty)_ In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$65.00 for a carpenter and$45.00 for a carpenter's laborer,plus the cost of materials. i -Roof to be stripped and cleaned of all old shingles and debris -All debris from the roof will be tarped covering all bushes&shrubs -Roof to be papered first 3 ft with weather watch leak barrier,Synthetic roof underlayment,and installed with Timberline architectural shingles using galvanized nails..(Storm nailed) 1%roof nails -8"drip edge& rake metal to be installed -yard`to be magnetized-for nails&leftclean as upon arrival- -Cobra ridge vent to be installed on all ridges -Timbertex premium ridge cap to be installed -A 10-yard dump trailer will be needed on site;and will.be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract a$560.00 deposit is due. Further payments under this contract are as follows: " 1/2 of the estimate due at the start;and remainder due at completion of the job: Balance of all materials and labor,shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed'under this contract for a period' of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and.tear,which shall be the responsibility of the homeowner.- All.warranties..for the materials supplied.by.the contractor shall'be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or,evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility, for the contractor under,the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on-this date: Date: Homeown /01 Contractor ®� Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con,�tluctio�t,51� r Specialty �j. CSSL-099913 : J_ UPI res •04/1,$/2020 1w r ;F Ic r TROY A THOMASa e ' 499 NOTTINGIU DRIP , CENTERVILLE 263 � Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE KCorporation befpr.Q the expiration date. If-found return to: Reaistration'-\1 Expiration Office of Consumer Affairs and Business Regulation 185422 06/08/2020 One Ashburton Place Suite'130: • TROY THOMAS HO IV1PRp\/EIAENTS,INC BosEon,MA 02108 , , + i TROY THOMAS v` 499 NOTTINGHAM �k CENTERVILLE,MA 02632 NOt aI d with S19118tUf@ Undersecretary . 4 oAtcfrwrl CEkTIFICATE QF:WAMLITY INS TRANCE Dar ols THIS CERTIFICATE 6 AS A 7`f1E2 OF 1lffORMATIOD!ONLY AND.GONFIB:S:li0 RR#1TS UPON THE coov"7E'FIOLDER THiS MM��►► CERTIFICATE DOES NOT A OR 81EGATNMY ANM, E(TM Olt ALTER THE CO AGE AFFORIM BY THE P :(CIE'8 BELOW. THIS CERfIFIICATE OF INSL#tAHM DOES NOT CONSWrM A CONTRACT BETWEEN THE 18SULW INSURERS .AUTHOR'' REPRESENTATIVE OR,M- 2E!CER.AND THE IMPORTANT: If the Cwtifisebe holder is en ADD0,0 L BiSURED.ttra poBcypas)must fo"'AittNiIONAL DaumpaoWstons or be . If SUBROGIA11ON 3WANED,su*d th So IN and.cwWftft of the poYgl PON"nwy%"ko.swwdwmneft A statement an this certilfcate does not carder rWft to bw holder hi of such PRODUCER Mark Sylvia Insurance Agency,LLC Hot6 2781 404 Main Street f COnr Centamille,MA 02632 j s 1 • Farm F hrauranoe e i Thmm Hom lmpmvements 4Cc PO BOX 1n Centervft MA o2832 f COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF WSUNANCE LISTED BELOW HAVE BEEN ISSU®TO THE NAMED ABpVE FOR THE POLICY PERIOD INDICATED. NO'MATNSFANDING ANY REQUIREMWT,TOM OR CONDITION OF ANY CONTRACT OR OTHtBt DO XI MENT WW RESPECT TO WFEE�1 THE CERTIFICATE MAYBE ISSUED OR MAY P.ERTA81� THE INSURANCE AFFORDED.BY T1�PO 8 pE tEN IS SUBJECT TO ALL,Tim TEAS, EXCLUSIONS AND CONDITIONS OF SUCH .LiiMITS SHAM MAY HAVE 8EEN fum.0 m BY PA *A6M$;. _ elSR rmoFBteURANC! tllAfts COMMERCIAL slewlLuasarrY � 1000. 00 umzimaE 0 OCCUR A N 200IM416 5J01/20t9 f3Jb1/2020 PEiw01V11La trVJURY s 1'D00 GMAGQREGATELLQTAPPLE8PEft j AGMQATE 2: x pm" ACT a LOC PRODUCTS-COMHOPAGGopm _ _ AUTOMORILBUAMILIN AM W O ec LYeLluaiclP >;. AUTOS ONLY Y S IA ED = SOORY 9L lY(Par aodtMnn S AUTOS OKY ` _ UMNIIELLA LUG flow t ; 0oaeas LM 1, /IO� WORKER84 11Tr0U ; IFE; _ aro Lutes,nr ..�—� A EXCIArOEO? ryl dfA N 2001W6063 !fl01R019 5lO112020 L EAG!lf1CC�ENT : 1000 00 s L o�eEAse.-Ef► 1 i100 00 r awa»u+eor �. _POLL . . 1.000 1 Or�CiOFOPE8tA7lONSf.LOCAllOrIB/YIBp.E�µt�RD1A1,Ad�wW8wrr1�8ehwW►�bs�alwAiiierAl�e�Ma�iind! Carpentry Insurance oavem p is Wnbd to the terms,ins. O#wk ritatiorrs And�: oontellrlsd aI the oer6ficstte ir>surance shelf be deemed to haws alloW,w g ved or aWided ft ammp p vjkW by the poft per- 1 t�I.DER i - 81101IL,D ANY OFHB T AMIR POLKM soon THE t*�EPIRATION )at7E .71491 OF. 'NMCE IN01. BIE OEWIIERED IN Tartu of Bwmmbb Bulft dept A *wMm 1I P0IJ&`r Pam. 200 Main Street ' �rrrrrrowreieowreese�rAn+ie .:.. _ _ Fax: Emit 011f88.M5 ACO tD CORPORATION. AS rWft NSW"d• ACM 26(21&VI) TM ACOM same and l"o.era"Intend nrortls of ACM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • 11 Map c� Parcel v �Lc;�� d?J Permit# 8301 Health Division 5 PLAYV'fi-�D tA,,,3-7 Date Issued Conservation Division i C! �� �' l 1 Fee 05 o Tax Collector CONNECTED S Application Fee # EWER ACCOUNT Treasurer .3 Planning Dept. cked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address Village -4-`i I S R gly S �" G LL:. l Owner ry N, Address Telephone _ (�� '_ C., 7 Permit Request P b(+1 o nJ -- C t o 5 &�- ; " S-o c's ®-ate lTG . rs Square feet: 1st floor: existing� proposed 2nd floor: existing .s t�- proposed Total new ` Valuation s gc on Zoning District 0 0 0 Flood Plain -C Groundwater Overlay Construction Type QJ G O Lot Size'S_ fl �� �--- Grandfathered: Ca Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Z_.-Two F ily ❑ Multi-Famil # Age of Existing Structure h Historic House: ❑Y No n Old King's Highway: ❑Yes Zo Basement Type: ❑ Full ❑Crawl ❑Walkout O 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 >Z No Fireplaces: Existing New Existing wood/coal stove: ❑Yes l4 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 YNo If yes, site plan review# Current Use t5 Proposed Use BUILDER INFORMATION s Named Telephone Number b s' Address C; �-a License# Mcf Ai / 0 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ®` FOR OFFICIAL USE ONLY v PERMIT NO. f r DATE ISSUED MAP/PARCEL NO. w r r ADDRESS'" VILLAGE OWNER t DATE OF INSPECTI® FOUNDATION rn �~ e7 FRAME IN INSULATION FIREPLACE d ELECTRICAL: ROUGH FINAL 5 i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts - Department of hidtzstrial Accidents office of Investigations' 600 Washington Street. • Boston,MA 02111' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Binders/Contractors/Electridaiis(Plutnbers licant Infflrmation ' Please Print Le 'bl . pr 'oalIadividual}: ZAJ aine(Bu essl gaaizatt ddress• �- �.�- - • . City/State/Zip:: of ro e¢t r e aired kre you as employer? heckthe.appro wate boa:. ;T9pe P 3 . ( q )• Z — • 4. ❑ I am a general contractor and I .6, New w construction. am aMoyer with employees (full and/or part time}* have hired the kb-contractors : 7. ❑ Remodeling I am•a sole proprietor or parEner- listed on the attached sheet$ andhaveno employees. These sub-contractors have � .8. �❑ Demolition ship workers' comp.insurance. g, ❑ Building addition y,►orking forme in any•capacity. [No wozgcray comp.insuraace 5• ❑ we are a corporation and`its 1o.❑ Electrical repairs or.additions officers have exercised their ,.., ed.] t of ex lion er MGL -11•❑ Plumbing repairs or additions 3: am a homeowner doing,,a work . p c. 152,§1(4),and we have no.. 12.[] Roof repairs myself.[No workers comp. employees.[No workers ayse, nc. regnired.]t 13: ] Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section-below showing their workers'compensation policy information Homeowners who sabntitthis affidavit indicating they me doing all-work aadtheubire outside contractors must subnit it new a$davitiadicating such. Contractors that check this boa must attached as additional sheet shdwmg the name df the sub-contractors and their workers' tivn. ..-. 'compensation insurance for my employees.'Below is the policy and job site, f am an employer that is providing workers Information. [nsurance.Company Name. Policy#or Self-ins.Lic.#: Expiration Date• Job Site Address: City/State/7' Attach a copy of the workers' compensation policy declaration page(showing the policy number and•expiration date)• Endure lties of a to,secure coverage as requiredunder Section 25A of MGL c. 152 cari lead to the imposition of cnminalpena fine up to$1,500.00 and/or one-year iozprisomment, as well as civil penalties in t$e form of a 8TOPVORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statementmay fie forwarded to.the Office of Investigations of the DIA for insurance coverage verification. I doh hereby certify under the pains and pe ties of perjury that the information provided above is true qnd correct. ' Date: q� rI Q� ' Si atare: Phone#: �© Officlal use only. 'Do not write in this area,to be completed by city.or town official City or Town: Permi�tUcense# Issuing g Authority(circle one): 1.Board of Health 2.Building Department 3.Chy/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#• _- d bstrU' dion•s•Information aii . ••. ter i5Z f Hires all emp yens pr ensatim for their employees. to to ovide workers' comF' 'contract of hire, Massachusetts General Laws chap eq person in the service of another under any pmt to this statute an employee is defined as"...every p express or implied,oral or written." . r more al ti oranytw • lion or other le erl ty, ,, • ora g . . ciatio ers ,,also. . .zy fRrP ,. An employer is defined as: azvisla��P ' the le r resentatives of a deceasea employer,or the' m a joint enterprise, and inelu$mg gal ep er: e of the foregoing engaged ] lo• ees. HoRte!'. individual,partnership,association or other Legal entity,employing emp Y• ant of the r trustee of an 'd ther orthe occap receive10 owner of a dwelling house having not more than three apartments and who resides em, house of another who employs persons to do maintenance,construction or repair woik'on such dwelling house dwelling �� shall notbecause of such employmentbe deemedto be as employer." or on the grounds or building aPP . « in age shall withhold the issuance or C also states that every s{ateor local]teens g g �Y h for ant' • chapter 152,§25 (d} sin-thecommonwealt p MGL ap permit too erate i business or to construct buil € Tenewal of a license or p P. applicant who'has not produced acceptable eyidence%of compliance with the insurance coverage line al esube�ions'shall Pei 152 25C states `Neither the commonwealth nor any of its'p aIl MGL chapter § (� ce of co �iaacewith the insurance Addition y� enter into nay contract for the performance of public work until acceptable.eve en enter into is of-this chapter have been presented to the contracting authority." Applicants davit'c completely,by checking the boxes that apply to Your situation and,if Plcase fill out theworkers' condensation affi omp certifieate(s)of address(es)and phone uim*er(s) alongwith to t es other than-the necessary,supply sub-contractor(s)names}; with no emp •Y insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) members or p artaers; are not required to carry workers' compensation insurance. If an LLC or LeIa.P f have Be advised that this affidavit may b e submitted 1A the Dep The affidavit should erriployees, a,policy is required. iron of insurance coverage., 'also be sure to sign and date af#3davit: ues. not tive]�epar`6nmt of Accidents for confirma�. ' be returned to the crt5'or U that the application for the Permit.or license is being req ted, uestions regarding the law' if you are required to Industrial Accidents. Should ton have any q companies should-enter thew' compensationpolioy,pleasecalltheDeparSmentatthenumberlistedbelowti Self-insured se lf license number on the appropriate line. City or Town Officials . 'bly has provided a space at the bottom Please be sure that the affidtofil out the event the Offiit is complete and t ce of Investigations has to contact you regarding the applicant; of the affidavit for you to fill applicant • Please be sure'to fill in theperrnitllicense number which wffibe used as a reference member. In additiAn, an alrp thatase be submitmultiPle permit/license applications in any given year,need only submit one affidavit indicating current and under"Job Site Address"'tlie applicant should write"all locations in_(crtY or policy information(if necessary) s ed or marked by the city or town may be provided to the �ysn)."A spy of the affidavitthathas been officially tamp licant as proof that•a valid affidavit is G.U.B10 for;future permits orn Ce��ted to any�ainess or coaaDer�venture aPP year.Where a home owner of citizen obtaining a hcense or p complete this affidavit (ie. a dog license or permit to burn leaves etc.)said person is NOT required to ce of Imrestigations would like to thank you in advance for your COOP ration and should you have any questions, The Offs please do not hesitate to give.us a call. s hone and fax number: ' TheDeparlment's addres ,tel ep • ' . The Commonwealth of Massachusetts . . I epa rent 4ludustrialAccidmts .. ..Office q Investigations ;• 500'Washington Street . 4 -BOMD,MA 02111, Tel.#617-727-4900 ext 40.6 or-1-877 MASSAFE Fax#617-7274749 ` emA*PA 1.26-05 www.mass.govIdea . ... Town of Barnstable ° .o Regulatory Services RMNST01;E,_. Thomas F.Geiler,Director iOrEo. 1. 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 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 ofWork: 1!� Estimated Cost ODD oov y Address of Work: —1 J` 1`M 4 -1V IV Owner's Name: '� ry Date of Application: 10C3 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑lob Under$1,000 OBuilding not owner-occupied Oftner 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 e- Date Owner's Name Q:forms:homeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.0.0 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq,foot x.0041= plus 6om.below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 1" { square feet x$64/sq.foot= �# z :' x.0041= plow(if applicable) . GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= 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.0041= 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 Relocation/Moving $150.00 (plus above if applicable) Projeost Permit Fee Rcv:063004 Table JS=b..(eontinued) k Prescriptive Packages for Oae and Two-Faaniiy Rnldendal Buildings Heated with F000 F°lb • MAXIMUM MINIMUM Glazing CiIaxiag Ceiling Wall Floor riflumeat Slab HeatinglCooling Wall perimeter Equipment EQ'ieiesey� Arm'(�•) U-valuer R-value R-value+ R valU2 i R perimeter Package R-va3ve 5701 to 6500 Heating Degree Days' /e 0.40 38 13 19 10 6 NoNormal12 Q' ' Nctmal R 12'/. OS2 30 — 19 19 10 6' 3 12•/.' 0.50 38 13 19 10 6 BSaStIE ---T— � --�5!/.._.._.03.6._-._. _38 NIA Normal. 13 2S N/A — . . ..U... IS% 0.46 38 19 19 ,-._ 101, .. . - NIA 8S:AFtJE . :. . : :. :.,.IS% 0.44: 38 - 13- 2S N/A 83AFUE 30 19 19 10 6 X is% 032.' 38 13� 25 .- N/A NIA Normal. y :12% ' 0.42• 38 19:� 25 NIA N/A Normal Z .- 12% 0.42 38 13 ' 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1.-ADDRESS OF PROPERTY: aN N G 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:. E �` : sG �:f: .. • . 3. SQUARE FOOTAGE•OF ALL-GLAZING: l tp 4. %.GLAZING AREA(#3 DIVIDED BY#2): �-„ LLB.= 4 5. SELECT PACKAGE(Q--AA-see chart above): tl NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUII.,DING INSPECTOR APPROVAL: YES: NO: q•focros-f980303a 780 CMR Appendix J Footnotes to Table J6.2.1b: lass doors, skylights, and ' a Glazing area is the ratio of the area of the glazing assemblies ('Including sliding-g basement windows if located in walls that enclosetotal conditioned lzing area may be excluded from the U-valuer equireniente gross i area,expressed as a percentage.Up to 1/o of theg For example,3 ft of decorative glass may be excluded from a building design with 300 if of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented or by the from Table J manufacturer in acvalues arc for the National Fenestration Rating Council (PiMQ test procece with dur , 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-extenor walls without compression, R 30 Insulation may:be substituted for R 38 Ceiling R-Yalues-represent-the-sum••of cavity— ..__• insulation an R 3�insu�afion may be Wb9 tiited`for`R=49 insulation. , laced between . insulation plus insulating sheathing(if.used):For ventilated ceilings, Insulating sheaving must.be.p the conditioned space and the ventilated portion of the roof. use ,. 4 Wall R-values represent the sum-of the wall cavity insulation plus insulatingsh ni p n{ould bDmet Eo not mITHER exterior siding,structural sheathing,.and Interior drywall.For example,an R req 4 apply by R 19 cavity insulation OR R 13 cavity insulation plus R 6 insulating sheathing. Wall requirements a 1 to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned cmwlspaces;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 AR 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 elgttric 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 -values are maximumaacceptable e levels. structural p nen a minimum acceptable-levels. R value requirerrients are for insulation only b)Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested documented b the manufacturer in accordance with the NFRC test procedure or taken from the doorc tide the and doe Y U-value rating for that door is not available, In in Table 11.5.3b.If a door contains glass and an aggregate glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door maybe excluded from this requirement(i.e.,mahsv component ater m c)If a ceiling,wall,floor,basement wall,slab-edge,of crawlpace wall includes two or more areas with different-insulation levels,the component complies if o door components comply if the area-weighted the o average*al U- the R-value requirement for that component.Glazing value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 lzcc7c7ccton -PIC PIN z Ehnis tocat6on, Of property: Hyann�s I.Ot 13 i � deck g p ' - '�95 2 st0►7. 3D'dwe�lin9 � VL Commonwealth of Massachusetts DEPARTMENT OF FIRE SERVICES-DIVISION OF FIRE PREVENTION P.O. Box 1025 - State Road, Stow, MA 01775 HYANNIS .3 , 2004 CERTIFICATE OF COMPLIANCE CHAPTER 148, SECTION 26F, M.G.L. This a .fies that the property located at 2,C SAWa& s% has been equipped with approved smoke detectors and was found to be in compliance with Chapter 148, Section 26F,Massachusetts General Law. Inspection/Testing completed on: V 13 ,2 by: (Ins tor) Fee Pd. [ ] Harold S. Brunelle.Chief Head of Fire Department NOTE:This certificate expires sixty(60)days from date of issue (Sellers Copy) i 3 Town of Barnstable ` oEtne r� 0, Via' o� Regulatory Services • Thomas F.Geiler,Director sARxsTA= i63y �0 Building Division °�fc►+►'`'�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Tice: 508-862-4038 HO OWNER LICENSE MNYTION Please Print j DATE: n p^� ' JOB LOCATION* '-1 C-, ,C��, village number steet .'HOMEOwNER": home phon # work p one# name CURRENT MA11,WG ADDRESS: city/town sate 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 su eg visor. 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 reponsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. gnatun of er 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. `� HOMEOW ermit is required shall NER'S EREMPTION The Code states that Any homeowner perform a exempt from the provisions performing work for which a building p 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 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 can t amend and adopt such a forni/certification for use in your community. A. c hnmeexm t _ J LjNL - ".,+--"- Y . 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