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CERTIFIED PLOT PLAN I CERTIFY THAT THE FOUNDATION
SHOWN ON THIS PLAN IS LOCATED ON THE
FOR GROUND AS SHOWN HEREON AND THAT IT
LOT 38 SUNBEAM LANE HYANNIS, MA. CONFORMS TO THE MINIMUM SETBACK
REQUIREMENTS OF THE TOWN OF
BARNSTABLE.
PREPARED FOR
BAYSIDE BUILDING CO.
,E1 N OF
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SCALE: 1" =30' APRIL 30, 1998 C STEVEN W.
RUMBA y
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Weller & Associates
1645 Falmouth Rd. — Suite 4C Centerville, Ma. 02632
(508) 775-0735
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*Permit Town of Barnstable ® (SZ3
Expires 6 month`9from issu date
Qp Regulatory Services Fee
BARNBTABL
"ASS' $ 1 2015 . Richard V.Scali,Director
z6g9. �0
�F BARIVs � Building Division
LETom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press imprint
Map/parcel Number a� ?i 1.
Property Address -µM IktJ
Residential Value of Work$ Minimum fee of$35.00 for wor under$6000.00
Owner's Name&Address es ca 0-,b oa-S
Contractor's Name Telephone Number �N
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Cheone:
I am a sole proprietor
❑ I am the Homeowner. y
❑ I have Worker's Compensation Insurance .
Insurance Company Nameo�ao-v
Workman's Comp.Policy# G--> 2
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Reque .check box)
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 641r/�oy�C ��sg�y(
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required.
SIGNATURE: -
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Q:\WPFILES\FORMS\building permit forms EXPRESS.doc
Revised 040215
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"Office of Consumer Affairs&Business,Regulatipp
i ME IMPROVEMENT CONTRACTOR
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egistration 161458 .Type:
xpiration 1;0/2012016 Partnership
t MID CAPE.ROOFING
BARRY MERRILL
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r"1-1 RUSSO RD gam_
bWEST YARMOUTH,MA 02673 Undersecretary
MID CAPE ROOFING
11 RUSSO ROAD
WEST YARMOUTH,MA 02673
508-775-3799/508-385-8801
Barry Merrill
Paul Merrill
Job Site Address _ Mailing Address
Name: Name:
Street: Street: {
City: 9i' 'wii 5 City:
Telephone. S o S- 9'G z - /G G O Telephone:
- - --We hereby-proposa.to furnish all the materials and all the labor necessary for the completion-of roof
replacement of the dwelling at the above address. Mid Cape Roofing proposes to remove and dispose of
the existing roof. The roof will be replaced with Certainteed landmark 240 lb shingles. ����- ✓�S t�T
Aluminum drip edge will be installed along the gutter line. Ice&water shield installed on bottom edges 3
to protect ice back up. 15 pound felt paper will also be applied. e g es wi mistalled using 1'/4
inch roofing nails. New pipe vent collars will be installed. Ridge vent will be installed along the
. 7 ridgeline of the roof to provide proper venting of the attic space. ` `r
Mid Cape Roofing guarantees the workmanship for a.period of 10 years. All walls and landscaping will
be protected from damage;the property will be raked and cleaned of all debris.
foo
All material is guaranteed to be as specified and the above work is to be performed in accordance with
specificatio—submitted for above work and completed in a substantial workmanlike manner for the sum
of. $ S 366.m,1-All discounts have been applied.
Payment made as follows: . '
Deposit of- $ O YOB the day the job is started and remainder to be paid on completion.
Any alteration or deviation from the above specifications involving extra costs will become an
additional charge over and above the estimate and will be discussed with the homeowner.
Respectively Submitted by Mid Cape Roofing
NOTE: This proposal may be withdrawn by Mid Cape Roofing in not accepted within 30 days.
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory and are hereby accepted..Mid Cape
Roofing is hereby authorized to perform work as specified with payments made as outlined above.
Accepted: �.�t�o✓'
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Faihr to to M can IPad to t3t iroposiii=Dfrrimial p=ml6=of a
F=vp to 00 w andlnr am-ylmvim as wen as cirri prsalfi�m iize�of a S FCtF�(3�{�S$and$fin
of Bp tcy S250..EJ0 a day against ffie violdvt Be stfeis�d acop�Dfffsis �agbc h d8d tgfric Offrr e of
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yjam ac ` Laws CEVt$152 rnq==an rglopem to pride woks'=mP-03SM for fair=IP19Y GS
purmi ntto f ds an=F&T=is domed as¢—Zv=y pmscm in.fu:D ser Pu a of=Offs T=dmr any=intact of hire, .
dT f+mPHDd, olal orwIittezi�" -
An mVL7r--is dmEord as fin. pa t==;Ir II,mwciefi®,c g fion Or oilier legal mfify,or nay two or"""
d mmmm d I or the
- offfie foregoing e�igagad m a3o°nt fie,and mr�idmg�e legal fives of a emp Dyq
of an' �or_iatio or ofhcr legal eay,e�glay>zi9 emplDye�s However the
receiver r�r trBsEae mdiyirhral,ghip,
owam of EL dwel£m homDhavingnotmm-b ffim fhree apart1=113 and who insides ffieaem,car ffie Dccupmat Df the
o vctk m.or air wank a u such dweM g house
_ dwelling boase of a�er�eauplops pasaas to do tom, _ �P
or on fbe gromnds or buildmg appm- sr fhb sha.Il not because of such employmet be deemed to be-an.eoplo3,er."
2,jiM dmptr 152, §25C(6)also SW=ff.19t¢ePerg state or IDcal liceasmg agency shah wi ihDld$ie i=zn=Or
renewal of a acense or permit tD operate a basiaess or to construct bmTdmgs in the commoawcalth for airy
applicant who has not prudgi acceptable evidence of cDhrp)1aur�with.ffie TIISrn-�rnc coverage regtm-ed' -
A fft o a_lly,MM chapter Z 52,§25.CM slates=Nerther f-m commonwealth nor any of its pDhdCai subdVisdD= shall
eni=7 join EMY cD±raet for the peEfi=ange Df pubfic wcakun11 acceptable evidence of cmplimm with the instance
reqyi==Lts of firs chapter have been presetmd to fhe contiaci7ng aofhoaty.'
Please fli out fat W D13='mi:opm safion affidavit compleb�Iy,by clier ig the boxes fbat apply to your siturtzon and,if
ne=any, sI, ply sub-confrac'�i{s)name{s).addresses)a�phcme mnnbea{s)along h theme cep ( .of
incm-ance. Li mitrd Liability Compamts(LLC)or T.imitr:dLiabilityPaitne=hips(LU)W±IDD employees vdh ffim the
members or partners,are mtrequired to c my wvrkerts'comp=.-M ion inerrrrI,oe_ If as L.LC or LLP does have
employees;a policy is r eqmed. Be advised ffizt this of idavitmay be submitted tD ihe.Departmeot of Industrial
Acxdots davtThe forofamaonD �ncaWvraga sD g a ffidavit should
be relined to the city or town that the application for the permit or licrmsse is being rcq=sle:i,not die Depmtn eat of
Industrial'Accidents. Should you have any gnesLons regaiding fh e lave or if you are rimed to Dbta;,,a v*orlcexs
compensahDn policy,please call the Department at the number fisted below. Self in a companies should eater their
self-;n crn n ce license ntmmber on 1be appropiiaiE line.
City or Town Officials ' : ... .
Please be sure Ai the affidavit is complete*andptintEd legibly_ The Deparlmmthas provided a space atthe brit a
- o f you to fill Dut in the event tIm Office o � ,' 'o has to contact you regarding the ap
fthe affidavit for plicant '
Please be see iD JM.in the pmmitllicense m>mbea which will be Used as arefrrmce numbar. In addition;an appHt a
that must submit multiple pe�itrdcrnse apphraiinns iii mYp give o year,need only snbmif one affidavit indicating cunrnt =
policy informa#iDn(if necessary)and under'UDb Sit$Address"the applicant should write'all locations in (city or
t own.)"A copy of the affidavh that has been officially stamped or maimed by Iho city or town may be,provided to the
applicant as proof that a valid affidavit is on file for fvfure permits or lice n ses A new affidavit must be plied out each
year_Where a home owner or citi=is obbdaiag a license or permit notrelat ed to any business or Commercial Yentcae
a dDg license or pm it tD bum leaves etc.)said person is NOT r,mqcftn-d to complete this affidaYit
The Office of Invmstigatians would Like to thank you in advance for your cooperation and should you have aay.questions,
please dD not hesifate to give its a caIL - •
The Depar-tme;ofs address,telephone and fmi mberr
a f om-mnrr t1 Of ifa&W- u r
moat c}f hlch gal Arts _
Q�± ur
R=.6I7-727-`
Brvised 4-24-D7
of IKE ram,
* BARNSrnst.E.
Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
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
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for: .
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPHLESTORMS\building permit forms\EXPRESS.doc
Revised 040215
Town of Barnstable
Regulatory Services
oFT r�y,� Richard V.Scali,Director
Building Division
BAPIMABIX Tom Perry,Building Commissioner
MASS.
i ,59. ��� 200 Main Street, Hyannis,MA 02601
s www.town.barnstable.ma.us
f
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone# .
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official .
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
.HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
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:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revised 040215
TOWN OF BARNSTABLE
• CERTIFICATE OF OCCUPANCY
( PARCEL ID 273 255 GEOBASE ID 37680
ADDRESS 24 SUNBEAM LANE PHONE
HYANNIS ZIP --
LOT 38 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT HY
PERMIT 92739 DESCRIPTION CERTIFICATE OF OCCUPANCY
PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY-,-•-,',, ,,,,1...
C014TRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
, TOTAL
FEES:
BOND $.00 THE
CONSTRUCTION COSTS $_00
�T Qi►
756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P, E"�_
BARNSTABLE, +
MASS.
s639.
ED MA'S
BUILD-
BY �
DATE ISSUED 08/17/1908 EXPIRATION DATE
TOWN OF BARN TABLE
BUILDING PERMIT
-- �q
PARCEL ID 273 256 Qi!OBAC E III 37680
ADDRESS 14 SLINBEAM LANE PHONE
HYANNI S ZIPLOT 38 BLOCK LOT SIZE
-
r
DBA DEVELOPMENT DISTRICT H'
PERMIT - 30048 :DESCkIPT:ION SINGLE FAMILY DWELLING (ON TOWN SEWER)
PEWIT TYPE .BUI14D TITLE NEWr:RESIDENTIAL BLDG PMT
CONTRACTORS: BAYSIDE BUILDING, INC Department of Health, Safety
ARCI ITECTS:. and Environmental Serviees
'TOTAL FEES: $31 e.49 �INE
FOND $.00
CONSTI2UC'TION COSTS $ 02,740.00
d
I01 STNGLE FAM HOME DETACHED .1. PRIVATE P"', ' >,�;�b .,
B�IRNSTABLE, .
1639�-
MASS.
FD MI�►I
BUILDING DIVISION
BY ,✓
DATA: ISSUED 04/09/1.998 'EXPIRATION DATE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF EITHER TEMPORARILY OR PERMANENTLY. EN-
CROACI'IMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY C 3ADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT (OES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIP: 'M OF FOUR CALL INSPECTIONS REQUIRED
FOR A't +CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUL)ATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2. PRIOF}TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH-
(REAG TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE
3.INSUL%TION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS.
4.FINAL VSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS-
Ll
2 2 f�t �u G 2
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 BOARD QF HEALTH
OTHER: a ( r SITt PLO REVIEW AP AL
do
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT,,1S ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. �» TION.
BUILDING
PER MIT
ry A
Engineering Dept. (3rd-floor) Map 73 Parcel p�SS : Permit#
` House#- Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)
$11yQ PE PJ1 SEW
Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) �1i'IBION N�$E -
i N p$1p$To
r,
Planning Dept.(1st floor/School Admin. Bldg.) �,u S� � ;�•'�s�`&A 114E,��
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Definitive Plan Approved by Planning Board Z,3� (� .4;3 Fe 19 ;
1 M/ 57L A ' BARNSTABLE.
•j �rEOMA��`� f
TOWN OF BARN, STABLE
i Building Permit Application
6Ktr eetet Address -*c:�`/ c__�fOJV f,j iMM L 4'me caw cawv Z4 T 3 E) '
Village Y7`) iz/l5 '
Owner /5 i4 YS!Pe- Ad_dress C �✓1 .2✓lC.�
Telephone -7-71 "14 4FO ti `
Permit Request CUA,�6 7RtIC? 4- S 1416Z E r t'hlL y f1d Ate- `
First Floor square feet Second Floor square feet
Construction Type it)0O.D mie
Estimated Project Cost $ %D , W� ~,Zoning District Flood Plain Water Protection alD
Lot Size 9. 3 9 3 Grandfathered p3fes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure /V10- LIL/ Historic House ❑Yes p�o On Old King's Highway ❑Yes UVO
Basement Type: ((Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /9f 6 O'
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New .3
Total Room Count(not including baths): Existing New _�First Floor Room Count 7
Heat Type and Fuel: dGas ❑Oil ❑Electric ❑Other
Central Air ( Yes ❑No Fireplaces: Existing New / Existing wood/coal stove ❑Yes U Iqo
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) Q1 X U_ ❑Barn(size) �
❑None ❑Shed(size)
❑Other(size) --
Zoning Board of Appeals Authorization ❑ Appeal# - Recorded❑
Commercial ❑Yes IKo If yes, site plan review#
Current Use t/4CMJ i [_Ct % Proposed Use kl 5 I bFI-IC
Builder Information
Name y5 f fi' LlY /A)C Telephone Number 7 -7 /` 4 VD
Address qs— License# VS
tFN TC?-I�_ I L&E /5 ?6 3 JL Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO&rZjjZ,
SIGNATURE y DATE
BUILDING PERMIT DENIED FOR THE FO OWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. (')
DATE ISSUED,
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER i {
t
DATE OF'INSPECTION:;
FOUNDATION
i
FRAME
INSULATION
FIREPN -
x
°
C) _
ELECTRi . ROUGH FINAL -
PLUMBING�� ROUGH FINAL '
GAS: ROUGH FINAL
FINAL BUILDIi@ �'/��(// v�j'�
YES � ^ �� U , • i
•
DATE CLOSED OUT '
ASSOCIATION PLAN NO.
i
l '
N
o
o
0
V'
J S�
is 1�3•�'
-y 7e.a7
35,97
PROPOSED PLOT PLAN
FOR r
LOT 38 SUNBEAM LANE HYANNIS, MA. so+�,�V%.tx of y cy
PREPARED FOR W ti
BAYSIDE BUILDING CO. °RFss,
SURVE�o�
SCALE: V =30' APRIL 6, 1998
Weller & Associates
1645 Falmouth Rd. —Suite 4C Centerville, Ma. 02632
(508) 775-0735
Y
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code Permit #
MAScheck Software Version 2 .0
Checked by/Date
CITY: Hyannis
STATE: Massachusetts
HDD: 5973
CONSTRUCTION TYPE: 1 or 2 family, detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 4-3-1998
DATE OF PLANS: 4/3/98
TITLE: 24 SUNBEAM LANE, HYANNIS
COMPLIANCE: PASSES
Required UA = 433
Your Home = 399
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
CEILINGS 1868 30.0 0. 0 66
WALLS: Wood Frame, 2411 O.C. 1928 19.0 2.8 102
GLAZING: Windows or Doors 248 0. 350 87
GLAZING: Skylights 48 0.250 12
DOORS 124 0.350 43
FLOORS: Over Unconditioned Space 1868 19.0 89
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
sections 780CMR 1310 and J4.4.
Builder/Designer Date
Sr
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software Version 2.0
24 SUNBEAM LANE, HYANNIS
DATE: 4-3-1998
Bldg.
Dept.
Use
CEILINGS:
[ ] 1. R-30
Comments/Location
WALLS:
[ ] 1. Wood Frame, 2411 O.C. , R-19 + R-2
Comments/Location
WINDOWS AND GLASS DOORS:
[ ] 1. U-value: 0.35
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? { ] Yes [ ] No
Comments/Location
SKYLIGHTS:
[ ] 1. U-value: 0. 25
For skylights without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location.
DOORS:
[ ] 1. U-value: 0. 35
Comments/Location
FLOORS:
[ ] 1. Over Unconditioned Space, R-19
Comments/Location
AIR LEAKAGE:
[ ] Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. Recessed
lights must be type IC rated and installed with no penetrations
or installed inside an appropriate air-tight assembly with a 0. 511
clearance from combustible materials and 311 clearance from insulation.
VAPOR RETARDER:
[ ] Required on the warm-in-winter side of all non-vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
[ ] Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values and glazing U-values must be clearly
marked on the building plans or specifications.
DUCT INSULATION:
[ ] Ducts in unconditioned spaces must be insulated to R-5.
Ducts outside the building must be insulated to R-8.0.
V
DUCT CONSTRUCTION:
[ ] All ducts must be sealed with mastic and fibrous backing tape.
Pressure-sensitive tape may be used for fibrous ducts. The HVAC
system must provide a means for balancing air and water systems.
TEMPERATURE CONTROLS:
[ ] Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
[ ] Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in sections 780CMR 1310 and J4.4.
MISC REQUIREMENTS:
[ ] Refer to 780 CMR, Appendix J for requirements relating to swimming
pools, HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F, and circulating hot water systems.
----NOTES TO FIELD (Building Department Use Only)-------------------------
\4•
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.�Ie IO111)710MveaCt1 cv`,/";ac�useft�
DEPARTKENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Ruiber: Expires:
Restricted To: 00
BRIAR T DACEY
62 FEREBROOK LN
CHIERYILLE, MA 02632
The Commonwealth of Massachusetts
Department of Industrial Accidents
offla 811"esdpstliis
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant. informa
t
ion: Pf east PRQ9-Tk9flft
name: �t C��� f Azlcr &ACeR61jQW
Location: -#,z(J C'At eIIq 6F L.GU
city YfleMDrRIAPOte( nhone# �YS�
I am a homeowner pertorming all work myself.
I am a sole proprietor and have no one working in any capacit'.
(p/I am an employer prov idine workers' compensation for my employees working on this job.
company name: 69 /41" 7. PA Cr Y #34 /5AY5 /tv�- 6yicb/'�y6 /aiG
address: Rd X q
fit}: etN-1 F-12V I t L phone0: 771"/DY6
insurance co 7l/F- 010/Z&JA43 600x . -TAJr4. 6& policy N /C 7 Oi tl`T l ql Id 'It
I am a sole proprietor.<eneral contractor r homeowner(circle one) and have hired the contractors listed below vvho have
the folluwin2 worker com a ion polices: /
company names � d� / /q 7 C scljFib 1—I SL
a(ldress*
City: N:
insurance co policy b
Company name:
address:
sify: phone q•
insurance rn_ policy 0
s �
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crimieat penalties of a flue up to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Oliice of Investigations of the DtA for coverage verilteadoe.
I do hereby certify under the pains and penalties of perjury that the information provided above Is true and correct (
Signature /6�aL'l Date _3 31— Ff,
Print name I,1 t-/ 7. )>A410E Phone N -7 7 t 161 YU
. offi
cialnly do not Mrite in this area to be completed by city or town official
ci : YARMOUTF1 _ permit/license N oBuilding Department
Licensing Board
0mmediate response is required 261 (]Selectmen's Office
�llealth Department
con: phone N;_ (508) 398-2231 ext. nOther
iy
SUBCONTRACTOR'S INSURANCE
ENGINEEER:
BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866
(W) LIBERTY MUTUAL - WC1312595563023
WELLER & ASSOC: (L) NAT'L GRANGE MUT.- MSP45246
EXCAVATION & SEPTIC:
ROBERT J. OUR (L) U S F & G - 1MP30109550901
(W) U S F & G - 771521695
DECO CONSTRUCTION (L) TRAVELERS - 660364K8342
(W) LIBERTY MUTUAL - 312446298044
FOUNDATION:
BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267
(W) LIBERTY MUTUAL - WC1312201785044
WELLS:
DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92
(W) WAUSAU - 151300062926
CELLAR/GARAGE FLOORS:
MICHAEL BROWN: (L) AETNA - MP0023672849
FRAMERS:
ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9
(W) AETNA - 006CO023972416C
MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356
(W) LIBERTY MUTUAL - WC1312492127024
MASON:
SHERMAN, WAYNE: (L) COMMERCE INS CO - 'N60689
(W) WAUSAU INS - TO BE ASSIGNED
ELECTRICIAN:
CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649
(W) MISCELLANEOUS INS CO. - 070887.8 91 1
PLUMB & HEAT:
WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9
(W) EASTERN CASUALTY - POLICY IN MAIL
ALARM SYSTEM:
BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831
(W) COMMERCIAL UNION - CB0743379
CENTRAL VAC:
VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045
i
INSULATION:
MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3
(W) U S F & G - 7711099932
SHEETROCK:
MEL REED: (L) WORCESTER INS - CB817530
(W) COMMERCIAL UNION - CBH557387
INTERIOR TRIM:
DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442
M & R CARPENTRY (L) MARYLAND INS. GRP-. SCP30235965
(W) CIGNA PROP & CAS.- C80049997
OAK INSTALLER:
ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652
PAINTING:
CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF
. (W) AMERICAN POLICY - WCC 186604
GARAGE DOORS:
ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301
(W) COMMERCIAL UNION - CBH573757
STORMS & GUTTERS:
ALUMINUM PRODUCTS: (.L) AETNA - MP0021014146
(W) AETNA - JC89258880
OAK FINISHER:
AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0
CARPET, VINYL & TILE_:
CARPET BARN: (L) VERMONT MUTUAL SBP6507393
(W) PHOENIX INS. - 6NUB476J652794
TILE INSTALLER:
TONY AVERINOS: (L) ASSURRANCE CO. = CFP26528977
(W) HARTFORD FIRE - 77WZCY2409
WIRE SHELVING:
CAPE COD CLOSETS: (L) U S F & G - BSC146983441
APPLIANCES:
KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098
(W) HARTFORD INS CO - 77WZNB1603
MIRRORS & SHOWER DOORS:
L & M GLASS: (L) COMMERCIAL UNION - CBR409003
(W) U S F & G - 0071439933
LANDSCAPE & SPRINKLER:
COY'S BROOK: (L) COMMERCIAL UNION_ - ABR345850
(W) CIGNA COMPANIES - C41138178
DRIVEWAYS
NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945
(W) THE PHOENIX - UB387K530
„ A