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0065 SUOMI ROAD
' r i Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 F. Tel: 508-398-0398 Fax: 508-398-0399 11/10/2014 Thomas Perry CBO Town of Barnstable Building Division x - 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry x This affidavit is to certify that all work completed for 65 Suomi Road (#201308931) has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCloskey p C • • , n NOISIA10 a l• sill :Z1 o z ! PUii Tii ; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O 1 Parcel �r Applications 91)1 Health Division Date Issued Z_l Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address lQ� J l�CI�►'j, Village Owner RusseW Address Sac* e 2'S 4 dv, Telephone `/ 3�� Permit Request �� ��/ ✓ w �0,edt Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new- Zoning District Flood Plain Groundwater Overlay, Project Valuation Ala 1 Q0 , Construction Type , Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting d p_�gumentation. UJ Dwelling Type: Single Family 0� Two Family ❑ Multi-Family (# units) -� Age of Existing Structure Historic House: ❑Yes ❑ No On Old Ki"g's High"Way: AYes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other c> Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) q Name am m 4610key, (ql e &a4 Ve c. Telephone Number (5(Jd Address )( kutql, I 0'1 4je - License# lQ d- ) II " Y(L V Home Improvement Contractor# v 0 Worker's Compensation #NC ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE IV. DATE l �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 'E MAP/PARCEL NO. j r ADDRESS VILLAGE OWNER S DATE OF INSPECTION: FRAME . :INSULATION] FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT . ASSOCIATION PLAN NO. I �Ptnt Form l _ The Commonwealth of Massachusetts `l� , Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Cape Save,Inc. Name (Business/Organization/Individual): _— Address: 7D Huntington Avenue. City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required):. l.❑✓ I am a employer with 17 4. ❑ I am a general contractor and I t5 ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. . 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g• ❑ Demolition ship and have no employees employees and have workers' Building addition working for me in any capacity. 9• ❑ g o workers' coin insurance comp. insurance.'* [N p• 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I required.] a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL 12.❑ Roof repairs myself. [No workers comp. insurance required.]t c. 152, §1(4),and we have no 1.3.❑✓ Other Insulation employees. [No workers' 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: Technology Insurance Company Policy#or Self-ins.Lic.#: TV1I ' 3353968 Expiration Date: 04/09/2014 /� G # �� 8 04W/ Job Site Address:�`� J'lt�` / City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1.52 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 airs andpenalties o erjury t at the information provided above is true and correct i 'Date Signature: ---- __ __. -_— _ Phone#: 508-398-0398 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.'Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE ;- DATE(MMroorrYYY) 10/22/2013 THIS'CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the ce rtificate holder is a n ADDITIONAL INSURED, the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Colleen Crowley Risk Strategies Company PHONE (781)986-4400 FAX (7a1)963-4420 15 Pacella Park Drive a No: Suite 240 -INSURER(S)AFFORDING COVERAGE NAIC# Randolph Imo, 02368 INSURED INSURERA:Selective Ins. of America iNsuRERB:Safety Insurance C an 3618 Cape Save, Inc INSURERC:Teabnolo Insurance as 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL13102268490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE X-DDL SUBA POLICY NUMBER MPO��EFF MPMOL EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE I U R PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE -1 OCCUR 51994480 O/16/2013 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY X $PRO LOC $ AUTOMOBILE LIABILITY SINGLECOMBINED LIMI Ee accident 1,000,000 8 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED rZ71 SCHEDULED 6208200 1/6/2013 1/6/2014 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Peraccide t $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTIONS NIX S1994480 0/16/2013 0/16/2014 C WORKERSCOMPENSATION X Y I $ AND EMPLOYERS*LIABILITY Officers Included for OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE YIN Frag e $ 500 000 I ER OFFICERIMEMBER EXCLUDED? N❑ NIA E.L.EACH ACCIDENT (Mandatory in NH) 353968 /9/2013 /9/2014 If d scribe under E.L.DISEASE-EA EMPLOYE $ 500,000 yes, DESCReIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per'Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael Christian/CLC �� ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD t 1lassachusetts -Depar meat o-1 Public Safety Board of Building Regulations and Sta6dards' Construction Supervisor Specialty License: CSSL-102776 WILLIAM J MC CLUSICEY;;;; 37 NAUSET ROAD -} West Yarmouth NIA 02673 .. G� B =.:fJP a:lvEt • commissioner 06/28/2015 glie rl ;4 Office of Consumer Affairs and eusness Regulation == 10 Park Plaza - Suite 5170 •Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY 7=D HUNTINGTON AVENUE ' SOUTH YARMOUTH, MA 02664 _ Update Address and return card.Mark reason for change. - ;; Address ; Renewal �j Employment l Lost Card DPS-CA1'ga 5OM-04/04-Gio1216 ,;a, ✓ft6-UGllt%!)Z4lZ:ti22���G�vl"GQb:CGClIr.Gf2� -. Office of Consumer Affairs&Bainess Regulation License or registration valid for individul use only n HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ._-171380 Type: Office of Consumer Affairs and Business Regulation - �ig J Expiration '-3/14/2014, Corporation 10 Park Plaza-Suite 5170 � !�' Boston,MA 02116 CAPE SAVE INC.'-,: WILLIAM McCLUSKEY - \ 7-D HUNTINGTON AVENUE SOUTH YARMOUTH MA:02664'+ �— Undersecretary Not valid wit o signa I Building Permit Authorization I, Russell/Debra Hastings > s, as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 65 Suomi Rd Hyannis, MA 02601 Signed Date f l � I Town of Barnstable FTHE Tp� ° do Regulatory Services Thomas F.Geiler,Director + IIAMSTABM • 9� � Building Division ATE p ,t a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 PERMIT# 5� - -7 FEE: $ 6100 -7 O SHED REGISTRATION 120 square feet or less p Location of shed(address) Village y N 27 r- Property owner's name Telephone numberco l ( � Size of Shed =Map/Parcel# w r c� M Signature Date Hyannis Main Street Waterfront Historic District? PO Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) �� 7 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 / x -------------- AP :9 MA 269 MA 2 2�6 # 5 14 . 1 1 # 5 i # 65 _ _ 3 I o 268 304 # 53 h c:\conservation.dgn 7/28/2005 3:04:43 PM t, TOWN OF sARNSTAi<LE ZUIL)ING rERMIT ArrLICATION LAI Map Parcel �rro�-- r- (`��(y3 Permit# 000 Health Division �c3�`� °`g1y� / -3 }"�C, Date Issued 4 / o Conservation Division 5+ � j® �.' 9: L 9 Application Fee o elD Tax Collector 1 .iLi Permit Fee ;1 a�� Treasurer --�-�-- ���, SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANDTOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address SU° /64Q> Village ��Y!-NAILS Owner kr{Nam, QUsfo.c /�� Address &S1 Telephone 5��� 77 f f`( Permit Request 0 20 Fj6 6,t1 6Z 3- �s Square feet: 1 st floor: existing proposed 2nd fleer: existing proposed era Total new Zoning District Flood Plain Groundwater Overlay 'Project Valuation A:�) 5 00• Do Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Il Two Family ❑ Multi-Family(#units) Age of Existing Structure Al y Historic House: ❑Yes Colo On Old King's Highway: ❑Yes ebNo Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Pz a Basement Unfinished Area(sq.ft) �S Number of Baths: Full: existing ��d new C Half:existing new Number of Bedrooms: existing 3 new 0 Total Room Count(not including baths): existing new_� First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air: ❑Yes �ZNo Fireplaces: Existing _ New Existing wood/coal stove: AYes 0 No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing 0 new size Attached garage:❑existing ❑new size Shed: 0 existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number `� �` 6F Address License# Q` Home Improvement Contractor# Worker's Compensation# ( / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Axi sA) (L SIGNATURE &a&\-V DATE I�4�� FOR OFFICIAL USE ONLY ' 4 l` PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME /`I?In O INSULATION KIIV C U D /t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH-- FINAL MCO > g,, GAS: ROU�H a FINAL (V M FINAL BUILDING 9- �_ M _ 2 � wru0 �. DATE CLOSED OUT �N ASSOCIATION PLAN N©I . Town of Barnstable • ' Regulatory Servi•des Thomas F.Geiler,Director p`bA S619' k'�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508.862-4038 Fax: 508-790-6230 Permit - • Data � C AFMAVIT ' XCOME rOPOVEMENT CONTRACTOR LAW SUPPLEMENT TO PRRMiT APPLICATION MGL e.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, •inaproYement,removal,demolition,or construction of an additionto any pre-existing owner-occupied btn'Iding containmS at least one but not more than four dwelling units or to structures which aro adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements, ; • Type of Work; Estim4ted Cost - Address of Work: ` v 1 ; Owner's Name; 52 �5��t IISS�GL Date of Application: • ' I hereby certify that: Registration is not required for the following reason(s): ' 0Work excluded bylaw []Job Under S 1,000 []Building not owner-occupied )weer pulling own permit , Notice is hereby given that. • OWnRS pTjLIZG THMIR OWN PERM:[T OR DEALING WITH UNREGISTERED CONTF,kCTORS FOR APPLICAB•,LE HOME 3MPROYEMENT WOPY I)0 NOT HAYE ACCESS TO TPT AMITRATION PROGRAM OR GUAWTY FUND UNDER MGL c.1.42A, . SIGNED UNDERkENALTIES OF PERMY Ihereby apply foi apermit as the agept of the owner: Contractor Name Registration No, Date • OR --LOAM kj wner's Name • r MCMR APPwAk J Table JS.ZIb(continued) prescriptive Packages for One and Two-Family Residential Buildings Hated with Fossil Fuels MAXIMUM MINIMUM (Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Area'(%) U-value' R-value' R-value' R-value' wall Perimeter Equipment Efficiency' Parkaga I R-value' R-value' 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 r.1-0 6 85 AFUE 7' 1 % 036 36 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE w 15% 0.52 30 19 19 10 6 85 AFUE x 18% 0.32 38 13 25 N/A N/A- Normal Y 18% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: S� 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 ENERGY REQUIREMENTS. ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table A2.1b: ` Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in wallsto 1%of the total conditionedopaque lazing ea may be exc uded from the U-alue requirement• area,expressed as a percentage. Up g For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. Z 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 J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. 3 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 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. 3 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. Tire 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 see 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 greater than 0.35. 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 J 1.5.3b. 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 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(0.35 for doors). I 43 Town. of Barnstable Regulatory Services tcsr�►sts"7 Thomas F.Geller,Director eo 9. Building Division Toml'erry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . Vmm,totvn.barnstabl&ma,us , pfice; 508�862-4038 Fax; 508-790-6230 Property Ov nerMust - - - ..Complete and Sign This Section - If tJs ing A.Builder F ( t-p 1 as owner of the subject-property . herebyauthorize- �4�k . .��- to.act on mybehalf; . in all matters relative to work authorized bytbis building permit application-for, (Addxess of job) - Signature of Owner Date Print Name oF'THE r Town of Barnstable Regulatory Services BABNSrABLE, : Thomas F.Geller,Director y MASS. 1639• A.� Building Division rFn � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Ji Please Print DATE: �U)I:'��� JOB LOCATION: (o) "' /V G�tf1Lj� .number street village .HOMEOWNER': G1A,VAI(n gjlj ft/IL ,C}-77j- (at( gl-3o name home phone# v work phone# CURRENT MAILING ADDRESS: city/tovbl 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 Ef 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:fonns:homeexempt _ The Commonwealth of Massachusetts —� Department of Industrial Accidents' -- — wee 81' Dwilpffow 600'Washington Street Boston,Mass. 02111. Y W�kersI Com ensation.Insurance Affidavit-General Businesses j ' State'' ap. an�C Rhone# 8�7FZ ��y MtV work site location fall address (] jam a sole proprietor and have no one $tininess Tjpe: []Retail❑*Restaurant%Baitatiug'Establishment working in any capacity. E] Office Q Sales(including-Real Estate,Autos etc.)' [�I am an em toyer with em to ees(full& art time C Oiher ' C � • ,:• 1 . % //%%�//%/%%/G% I am an e�loyer providing wprkers' compensation for rn employees working on this fob. :+, '•.y.,..0 1'Ll,r):sti , :'''r' ••i'•`3'r ,',:,S:�Y:' r:L ,••(".' w — �i:;•;:Y::�! 1'''r com an�•name: :�:ar• : ' `.t.,: :., +J'r '•,�+.r ,�la:l:, l•:i 1 5`: •S.= .•a ,:' :tl•�T,•.•; ..�. .S::.crt j�+,•ri` ,,,I j.y'; - •d.i:� - ar.. +•«:r.: :l' +•.A< tr .,nti. •'t.: ,1•-r•,;tf +,; t• ens: aaaT :'t'; 'S•''2' '4- ':a. 'x'C�'Z';°t'�'�,,4;••'. {' ":''•'i'`jjAjt':1'•.: •�. ..•+.�L.. a ;•''�Y:, y ... • _�f •,+, •1. '�' ••:• '�•.n. "t•, i:' •'+ Siu',•r• •_.• 6ll ,••tt'' t'••t• WWWWWWWWOM, sole •ro rietor and have hired the independent contractors listed below who have`tl a following workers'' a P I am P .compensation polices: i ',�'' •ii.r.' '.[I!`;; ..L. _ :+�h�•• •„• :'s.=..'i -e t�, .4:', ..ice. 1:. :.r ;3y't�NLt.+i 1t.+:', ',n'tr:'+�ir;:: I COIL] an 'narn C r .:.. , . L,,' .;•y. ,rr +' 1 a 4! :. j:z+..}• •.< •Gyt•: ,,•exy^,.h - •:1:r fr ,'L;:;rya• •t.r; ... ,•t'.:',F^. .1„ L,y11.:"i .{i. ,:''L•.f,1. .. 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'•M._ :a'., ,:':•`•• r_. by giSsu'raac� M BOOM NO �G Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'Imprisonment as well as civil penalties in the foim of a.STOP WORK ORDER and a fine of$100.00 a day against me, I understand that g t maybe forwarded to the Office of investigations of the D1A.for coverage verification. COPY of this statemen I do hereby certi under he pa and penalties cf perjury that the information provided above is.true an r,=4 S Date Print name Phone# official use onlydo not write in this area to be completed by city or town official city or town: permitfliceme# []Building Department ❑Licensing Board ❑-check if immediate response is required ❑Selectmen's Office 011ealth Department contact person: phone#; Other _ (revised Sept 203) a ` INOWN 1 L Information and Instructions. 2assachusetts General Laws ch�apter�152 section 25.requires all employers to provide workers' compensation for'their. ,uTloyees: As quoted from the law', an employee is.defined as every person in the service'of another under any contract lie )f hire, express or unp P 'oral or written. kn employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of he foregoing engaged in a']oint enferprise, and including the legal representatives of a deceased,employer, or the receiver or association or other legal entity, employing employees. 'However the owner of a zustee of an individual,-partnership,. Swelling house having'not'tnore than three apartments and-who resides therein, or the.oceupant 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 b g appurtenant thereto shall not because pf such.employment.be deemed to be:an employer. 1 MGL chapter 152 section25 also'states that'every state*or local licensing agency shall idthhold 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 regiiired. Additionally,neither the ' commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with t�e insurance requirements of this chapter have been presented to the contracting . authority 00111 Applicants Please fill in .the workers' compensation affidavit completely,by checking the box that applies to your sitdation.:Please supply company narne, address and phone numbers along with a certificate of insurance as all affidavits may be submitted - to the Department of Industrial Accidents•for confimnation 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 the.D �ent of Industrial Accidents. Should you have any questions regardin�'the"law" or if you are requested, not ep required to obtain&;workers'.compensatimpQliCy,please call the Department at the number'listed below. City or Towns . Fleasebe sure that the affidavit is cbmplete andprinted 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 permitt/license number.which will be used as a reference number. The.affidavits may.be,returned to. the Department b* of FAX unless other arrangements have been made. _ nk you in advance for you cooperation and should you have airy questions, The Office of Investigations would like to tha please do not hesitate to give us a•ca1L- The Department s address,telephone and fax number: , The Commonwealth Of Massachusetts- Department of Industrial Accidents 6tf�Cs 0(�{f88��9118 ' 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#. 6• 727-4900 ext:406 1 ( � l 70 �S 5 jJ .Zle DO is,r. 1401 n 7� �oT a o y cnv� y-�o c�UNLA g 1 v s /V o (W roa IYI - - B I DIN - U�.SOF BARNStABLE , r PER-MIT PARCEL I D 269 112 GROBASE ID I`r:503 ADDRESS 65 S'UOM I 1_,h) D PHON 21 �iY!>NN I S �,Zip LOT 46 LC11 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY �^ PERMIT 75723 DESCRIPTION ADD qtJD/KTTG'FER APEA. DECK 24 X14 PERMIT TYPE BADDI TITLE KIII)I.NC PERMIT ADDITION CONTRACTORS: PROPERTY OWNER Department of ARCHITECTS: Regutato,,ry `S�eirv4i(ces TOTAL FEES V"S ..4 PKIND ZHE' 434 13A iJ.a./.D Al.t{..f/:1.T..a 0N V a°IN BU UD'ING U S-1r, N BY _ ,•_)A R 0 '4:r THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. I MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS. HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. .4.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS SO IT IS VISIBLE FROM BUILDING INSPECTION APPR VALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �37 API) 3 a/G 1 EATING INSPECTION APPROVALS E GINEERING DEPARTMENT (/AJ D 7 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED ONTIL 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 i VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA_ TION. NOTED ABOVE. TION. I � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION/ Map l�[ d e Parcel % ,l�� Permit# ,r Health Div1sion �-! i //0 y w ����S ������%/�® ate Issued Conservation Division Z ZIP n 5,0 7 Application Fee 1� T Tax Collector Permit Fee 20; Y Na to N Treasurer ou SYSTEM T BE Planning Dept. - 9 ILED IN CQ C , 'e'M:TITLE 5 Date Definitive Plan Approved by Planning Board _71 C E AN9- w r 4M r� Historic-OKH Preservation/Hyannis �1 Project Street Address Village (A Owner U wS , ��c'�Frn "C ( Address r95 �U �� GL Telephone 9J_77f- C'IM1 Y Permit Request (7 2 V+✓t k4a, Vkha, ()f14tq AL !iod Grpf ay. � D-C; A-tg 146 .jv has &xe4wf Cj�r� km- rhd k� s� er; ��rad) �� c�slfc.3o r'I LcS de-4c a aw,bj), (Gen, or �370 Square feet: 1 st floor: existing 10 33 proposed Ft 2nd floor: existing -0— proposed G- Total new `— Zoning District f� Flood Plain C, Groundwater Overlay Project Valuation USDO-vG Construction Type Z? '( kyd - Lot Size ®' � � Grandfathered: .❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family l Two Family ❑ Multi-Family(#units) Age of Existing Structure �3 Historic House: ❑Yes No On Old King's Highway: ❑Yes XNo Basement Type: )8 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) r.20 g 4 Basement Unfinished Area(sq.ft) 76� Number of Baths: Full: existing / new _ Half:existing — new Number of Bedrooms: existing new Total Room Count(not including baths): existing new c6hr/r First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes 7ra No Fireplaces: Existing New Existing wood/coal stove: )&Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:16 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use rn Y �- .. BUILDER INFORMATION Name' �f'� �lephone Number Address License# G�Ty�1GrGc4% Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � � �� zwoo SIGNATURE DATE r `t FOR OFFICIAL USE ONLY 2 - PERMIT NO. ' . 4 DATE ISSUED MAP/PARCEL NO. .i } . ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION �c9 b FRAME 6,,r INSULATION 06Z WS FIREPLACE �s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �i✓" :-.� ! O / �� trs r i DATE CLOSED OUT ASSOCIATION PLAN NO. F 1 If M 710� Ali Txble.t�2.1b(ecntinued] '�gasxflp'urlit ~ presarlphy ti pxrksge�i'ar dae$AdT 1""'$Lw1'}ArsidaatL4sUb gAOdia�t Bated ,, MIP(1MtT(rI •xc6ctng/Ccoling )4TAXf M vial F1carabafns 1 Fmcnz E cirncy� (}lazing C.e` {ling 4 Yxluw 7 WSJ 0/1.) V•Ys1ue� R-v�1u R•valuc R. c A•Yilua R-Yaluc gEs�sg� Vol to 6500 Hesting Drgm Dxn' 8 Kac�l 13 19 10 6 Knmtal 12,l, 0.40 31 19 19 10 6 1S At'L18 Q 1Z'h Q.i2 30 19 10 Ncrcnal R IVK O.SQ 3b 13 2s NIA NIA Narrtsai 5 15Tl a.36 78 �. 19 19 10 WA is AFVE V i5*!. 0•46 13 2.5 NIA AM v iSYi o.44 � 19 19 10 6 Momsal 041 3d 13 25 NIA NIA tlatmaI 11'!. Vs Z 19 ?S NIA 90 An% j11'/4 0.4Z 3 13 19 IQ 6 90•AFLT9 11'!. 0.4Z 19 14 i0 x 0.30 30 AA ' 1. ADDRESS OF PROPERTY: 2. SQVARE FOOTAGE OF ALLEX TEptOR WALLS: ' 5OUARE FOOTAGE OF ALL GLAZING: 3. r 4. a/a GLAZING AREA(#3 DIVIDED By#*2): b 5 Sg�,ECT PACKAGE "see chant sbovc): GY liQU(REMENxs . p- ; OTE RMORE U VOLVED METHODS OF DOE��G gNER ARE AVAILAELL', ASK VS FORTH(s B�,DIHG IHSPEC lOR APPROV�L. YES, NO' I q•fcrms•fl80303v I Town of Barnstable . o��xe rp� • •. you egulatory Services ,�• 3 Thomas F.Geiler,Director • a �` • $uildin.g Divis!Ou 9� s634• k,� '°lFo Mpg Tom Perry,Building Commissioner 200 Main Street, 11yannis,MA 02601 pax; 508-790-6230 office, 508-862-4038 ' ' permit no. , Data . AFmAVIT 1101YM IMPRO'YEMENT CONTRACTOR LAW gppLEMENT TO PERMIT APPLICATION ' 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, MGL c. pie -oecu red improvement removal,demolitiont not more than four dwelling units or to structures w�h ark ai o��nt to buq�g containing at Least one bu such residence or building be done by registered contractors,with certain exceptions,along vvi requirements, 6Y17 4V 900,06 Estimated Cost "type of Address of Work: Date of ApP I hereby certify that: Registration is not required for the following reason(s); , DWork excluded by law ' []lob Under S 1,000 , (]Building not owner-occupied `mac Owner pulling own permit Notice is hereby gIVeu that: GLSTERED RS MULLING TEEIt�OWN PERMIT EaROYEMENT WO KDO NOT MWE Cow RACTORSFORAPpT�CAB,.LEF{OME ACCESS TO THE AMITRATION PRO GRAM OR GUARANTY PUND UNDER MGL c,142A, SIGNED UNDERPSNALTIMS OF YERTCTRY Thereby sPPIY for apermit as the agept of the owner; Contractor Name RegistrationNo. Date OR / 0wner s ame i RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSAEET NEW LIVING SPACE � S square feet x$96/sq.foot= s 9 s 2 x.0031= �. plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= 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: x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS Open Porch __x$30.00= (number) � 3G, a 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) permit Fee y �, projcost r, S • �w Y��y .The Comxnanvea�th'of Massachusetts -_ Depa tment ogndustriatAccidents' ' 600'Washington Street _ Boston;Mass.-02111 ., , Worl{ers'..C m ensation.SitsuranceAffidovit-General gnsfnesses �� y3a.„"' +'h�Ya" ertrt¢ t;`f•.. t ...: .{rY- t r:E• ', •.. " r•�. address; state' I 'ta iocatieri f M address e; Retail[]RestaurantMar/Eafmg Establishment work s� etor and have no and Easiness REaYSstake,Antos etc.)' avm•a sole propn El Of i- Sales(including yrorking in anY capacity. . .r 'lo'ees full fgC' art time: ❑Other ' 1 am an ed to er with• ( . .. ///// %/%�///J/m/%D/�///s io/n/for/my//C//l o�%s worlang on this job.. ,... . k I. •• ,•,.r .. . t ; , ers t .t z am an'employer,p=l1ovi ,.. `, �: ;t ,r. ,._,• '. V! ':t�;a;t • a - '{yY '15:f•:'' ,..s 'r":t.••r"�' ait'�,\:!' 'r ••t:, ' •t'�rri, tr. a 'tt•t" ',. :t,It.,.. ,:i!.t':'i:at•• - •s^.° ,t . ..S'•.lJr � 'y� 'C .. j.. :r :..+ � � ,•., t _rts, :�". ..�••i• a. •itf•Y.:'.l :Ni't•. ''.. t'• \, ? r,.lte;'• .,•r.'...'r• 'gri net• t it t.. C �Na:tt;.{,pt:.t J, r`•. a, :is'r, t� t,5 {% i i Alt: t=r,�j•„ a '1 ' S. CODl ;;. :; 'a a: ; . •' �' 7. t :. �f r+l_ 1 .t —6:.:if \t:S I .:;,a .C;�1r ''" , I. •••.•• ' , •'}p.?; `;d.3::-,^.' aa..r,.•::'I'.:5;'1:ti;• fs'•v,• p•p�l.. , .. y 41 r tyt r ;re a't•t': 5;� ,J - r1:i 5•'•'�nr,•S'117 \{{� a I al.. '' t ,t t';y, :•, V, ,` � ••. :. 'tom r •. •tP•• '•}••, �' 'S. r�: t•• ' $'{��r'.e9S: � ;, ,. ,. ,rYr r.,,L:. jyb3.,;�'•.•: rt• < r� � .•} ., r. .,. r. ,•�;a t•%'r•.: t.• , ,`.�..�`\;..• •; • 5t '� .,al'O;:,YG.^�:;•" i. ,y. 'kY,a^.t ti ta:•' @.�t 'a•' - .: /';• i. a.f'`�'•' 1. .t•r•• } r•t 'r... rr ,.•, 110n 'TT.:.•, , .. };!� :i. a• '•` ^"r,':,• a{t' '•I} .} '{ {,'; ��:• 1{... '�C '..i' t .'t.,ti:•t.lt •1�?',t4• t'ra: `?• '� •'t Qi• �' t' ,•` '.��:';.. ", •til:t+r ' 'j a •?a i;'t DIM •} •u•.•:•7}Yu•t 'c• .•:•.1'• i'•'a'.r:.. ii�.,,, t l •trt,. .r .,s,et~'f :•i, 'r'f+t•s.i.t�>�.^Z.:•''t:'r,•f:54•i)••� 5•• ,r _ r.. >;' •a;r�ce.co:tl'Jt:.:..l:_iast;;�y 1; •:$ •.i• ;Slorkers' nsura a follOwin MTO o 'ro rietor and'havehuedthe independent contractors listed below'who have th g nsationpolices t ;,t51, r`; 4�:�tp}:r+�faC'i•`' +�rUt ?``•:�:' 'tom ••.T1: t' '•:t ^i` '.�;':''a :l; �7,Cr :'la' ,f.l{":. . '1, • ` '' ..i part �...f. t .. ..r {:t;t'iS �:y `•r '•. •• t- . 't, r .r;;•.:P.�.;ittYr,+r''" '°'..••{•'''¢.•t•r i18IIld:' 1 s , i' 'f r'"'• j t +r ia't :t.;; t COID 9I1 a.7 ::'i.•itl'aJ:t1 •.,?*_?.�;::x1• fy \ t�i,;:l":.,t t: a{., �t!; y;f 5,(: �.:.'{ •1`r: ' ; l d,.prW,'•�4a rr>,,t (., •:•.'t:3•r ` t.lr:. ',';•' ,"i{•,•V,�, t. i•, ..�, t _ •i:., •, ,•,r::a. rt .: t !�}C'•r,: .t;,:,+,.f..-. r.^t p :a. t•:r,;t. 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' Ora 6 Up to- e as re aired under Section 25A of MGL 152 can lead to the Impend a fine tio of��00 a d Y agai=t me, 1 understand that and/or}� Failure to secure eoverag 9 enalties In the form of a STOP W011K O1tDFi t one yearn'imprisonment as well as civilp copy o f this statement maybe fo3 warded to the Office of Investigations of the Dufor coverage verification do hereby certify under the pains and psnait'es bf perjury that the inform provided above is Prue and car�ecL I Data 5i�nature t Phone# t Print name v off{cial we only do not write in tbb area to be completed by city or town officiai perniit/iicense# (]B pepartznent ❑Licensiceusl ng$oard city or town: ❑Selectmen's OJEre [}'cheek if immediate response is required []HeakhDepartment • []Other . phone#; contact person: (26Y$ed Sept 20 3) __....r...-•.>:aaucv..1�,�["..Scac'�..�'--'Y"�rsXLwf�1c'.T.vsra•;.�csra"�� ' Information and Instructions' to ers to rovide•workers' a ensatidn fcr their•• Msssachiisettsereral Laws'ch�pter 152 section 25 requires all emg. y p 01nP CnV1oy ; ,As quoted'fxorn °la the w", an employee is.defined as every person in.the service o another under any contract Of hire;express oz implied; oral or wntten. I is definned as an individual,partnershiP, association, corporation or other legal entity, or any two or more of An emp the foregoing engaged•m a'J°ant enterprise,and including the legal representatives of a deeeased,employer, or the-receiver or association or other legal entity, employing employees• 'However.the owner of a trustee of an individual,partnership,. dwelling house y g,not more than three apa�nent,and-who resides therein, or the. ccupanttof the:dwelling hou s e bf peI I. - to ad majuteuance, construction or repair work on such dwelling 6io a 6r on the grounds or another who.�1o3'S e f such ' loyment.be'deemecl to b e ari employer,• r building apputtnt thereto shall not beaus o :gip . •5 licensing•agen shall withhold the issuance dr renewal MGL chapter.152 sectibn 25 also''statcs that'every state-or local li g b oY of a license or Per)'dt to operate a busIness or to construct buildings in the.6nunonwealth for any applicant who has not produced accepfable'61aence•of compliance with the insurance coverage reiluiz ed: Aiiditionally;neithbr the' ' coixrw.onwbalth nor.any.of its political subdivisions shall enter into any contract for the performance of public work unto of co lice with e insurance requirements of this chapter have been presented to the contracting acceptable evidence , _ .. authority Applicants tkze w Please frtl m Crrkers'.conpensafm afadavit completely,by checking the box that applies to your situation..Please company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted supply• 6ddents•for confitmation of insurance coverage. Also�be sure to sign and'date the to the Department•of lndustnal A affidavit. The affidavit should be returnedto the city or town that the application for the permit or license is being requested, not the peparhnent 6�X dustrial A.ceideuts. Should you have any questions regaxdin the'"Iaw"or if you are required for obtain a workers'•compensationpglicy,please call the Department at the nim3ber liste�d;below. - City or Towns • , ' ted legibly. The D ar6nent has provided a space at the bottom of the •davit is c' lete andprmep . Pleasbbe suxe_that the af6 omp affidavit for you to fll out in-the event the Offied of Investigations has to contact you regarding the apphcant. Please be sure to fill*in }?enrrnt/hcensa nee't�tlnch�be used as a reference number. •The.affidavits maybe returned tQ mail 'FAXunless othe'r'arraugementshavebeenmade, -' ` theDepartment V. or` . .. '•;, , The Office of Iuvestigations would like to thank you in advance for you cooperation and sb ould you have any questions, please do nothesitate to give us a caIJom " ro The pep eves address,telephone and fax number: , The Commonwealth Of Massachusetts- Department.of Industrial Acdclents , . Eirlce of laftes�t�erta . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 ' .rr_ ii�rn /7nR.Jnnn _._s 'AAL Town of Barnstable CF THE 1p� Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director 9 MASB. �A?i639• 61 Building Division Ep MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ---------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE:_ t i W JOB LOCATION: L5— 5 V J/ (- Q number street village GI "HOMEOWNER": MiA_/� 1 r�Y1 7�0 6TY 3 name home phone# work phone# CURRENT MAILING ADDRESS: C ,e&0i's Dzwf cA /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 sLipervisor. 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 requirgrients. 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:forms:homeexempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ;.; Maper o Parcel _ Per # Health Division y S� �� Date Issued Q Conservation Division ` c� 0 Application Fee 'S o Tax Collector Cy/�7C_ (��F' Permit Feey l 6 Treasurer (_/�`� /� ' t� SEPTIC SYSTEM MUST BF p INSTALLED I CO 5LIANCE PlanningDept. WITH Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village � t�i\�s Owner- -C Address 5 Telephone Permit Request C��Pos X `�D Square feet: 1st floor: existing proposed 5� 2nd floor: existing proposed Total new( 5 U`f Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size 1�J; 8 b O ` Grandfathered: ❑Yes JXLNo If yes, attach supporting documentation. Dwelling Type: Single FamilyA Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes JV No On Old King's Highway: ❑Yes )d No Basement Type: ,AFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) (o Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing a new Total Room Count(not including baths): existing S new First Floor Room Count 3 Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes .2 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes -,&No Detached garage:❑existing ❑new size eS Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed: existing ❑new size9 x Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ';RDNo If yes,site plan review# Current Use Proposed Use 3 SS�c BUILDER INFORMATION ins !J&.Telephone Number "- Address License# 177 O E OA 5g`1 Home Improvement Contractor# Worker's Compensation# Z5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO a`(1 ti SIGNATURE s DATE / 7be A FOR OFFICIAL USE ONLY PERMIT NO. DATE'ISSUED ' MAP/PARCEL NO. f ADDRESS- VILLAGE r" OWNER C► r ' r DATE OF INSPECTION: r IVs TO ax FOUNDATION S ' p p 3/0 "w FRAME /6 ft-t/yI D 3 Z O!/O Y r _ r INSULATION FIREPLACE s R ELECTRICAL: ROUGH FINAL PLUMBING: ROUGI1, r FINAL GAS: ROUG77 FINAL f FINAL BUILDING rn 0 �,_ � DATE CLOSED OUT. ' s� t ASSOCIATION-PLAN NOS " ' # a ' 0,*IKE r Town of Barnstable Regulatory Services BARNSTA LE,MASS. ' Thomas F.Geiler,Director y nss. $ �prf1639. 0 Building Division Tom Perry,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. Type of Work: 5 --«�� 1 6� Estimated Cos l 5 1�� , Address of Work: �o Owner's Name: Date of Application: �\ �\o I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: dVtzC__,1 — 1 a-716`� 1 7,7 9 171 ate S�N��s Contractor Name'�-c56�\Q) Registration No. OR Date Owner's Name Q:forms Umeaffidav f Massachusetts The Commonwealth o —' Department of Industrial Accidents Office ofiavestigations . - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit �%��------ location: `�5 OaloC�\ phone#5b�- ��� I l` citV ❑ 'I am a homeowner pe&rming all work myself ❑ le r rietrkin in I am a so or and have no one wo ca achy %% %% %%%%%%%%%%%%%%%%//%%%%��/%%//////%O/G%%%%%%%%%/%%///O//%%%%%��%/�%/ ns rkers' com eation for my employees working on this job. : n :•..•.•r• �t ••••• ,• - din. wo P . ..............:.:.:{.....:.....,.>..........:::<:}.<:::<<:»:::.}::�>;;.{..s::.:;.}:::.»:<::; .n......• .:.. .. n. .:....... ... ..... .... ......... .... ....}:.:.... x:.:v::::.....•:.:........;,:.::: ::::i;.}}}}}}:•:'`}}`•i;':'•,'.rr,.,;:•,;r;::{�i:•:ti:�ii.`„i?: ...... ....... ..... ........ .. , ...... .. ...... ::::.:v.,w:x:{:::nv:::x.v:;,v.v:.v.:v:.v.}.:... .:}:,}'':'ii:ii�•}•}:• r......... .............:}::.:. .... .....::.:`:•Y:3:•?}::::::::•::•}}:v}:::.iv:4::}5?S:4}?.4�:.'•j::h`i;':}:;?iiiC..v:?:Y:r: }.... .. r,•.......•:•. ..:.}..:r.::.:.v, � �... .. ......... ..••rv.:::.v:.::••.:.:v:...:.:!+:•:}:S•}:•?::•r:?:YY:4:•:YY;•.w..............::v: .... ....... sn .n 'a..... c..l..d......r.... 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I understand t]isit a' copy of tits statement maybe forwarded to the Office of Investigations of the DIA for coverage verillmtion. I do hereby-certifyunde�'lkepains d penaliies-of-perjury that-the-information-pr-o3idedabnve_islrue_cuid correct Date I a Signature —T- Phone# Print name �C�`-�`�� n' ' l official use only do not write in this area to be completed by city or town official permit/license# OBuilding Department city or town: ❑Licensing Board ❑Selectmen's Office ❑checkif immediate response is required ❑$ealthDeparlment phone#; �er-- contact person: , (devised 9/93 PIA) + Information and Instructions de workers' compensation for their 52 section 25 requires all employers to rove p s cha ter 1P Massachusetts General Law p 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 : ance construction or repair work on such dwelling house or on the grounds or o s persons to do maintenance, ep .... . another who employs p biding 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,neither the' public work until subdivisions shall enter into an commonwealth nor any of its political Y contract for the performance of p acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. FEE Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation ancf supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may b' 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 DeP artment of Industrial Accidents. Should you have any questions regarding the"law".or if you are regmred,to obtain a workers' compensation policy,please call the Department at the number listed below:. City or,Towns " ent has provided a ace at the bottom ortlle � rimed legibly.' The D Department space . .. .. Please be sure that the affidavit is complete and pep P . affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas e•A be sure to fill in the.Perm�tThc ens e number which wffl a used i s a refeience numlier.The affidavits may iie'r to a. the Department liy�maiT or•FAX unless other arrangements have been made: :r. The Office of Investigations would like to thank you in advance for you cooperation and should you have �esticns. . 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 Investlgallons 600 Washington Street ` ;t Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WOPMHEET NEW LIVING SPACE ,` y O square feet x$96/sq.foot= l�(� o 0 x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. , >120 sf-500 sf y $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= 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) Pertnit Fee projcost tic) � Vr; Av -t} r ear.-3✓- s z ys f� + -F11C- 7.N PAS. Gi/.%�� Thi� MORTGAGE For _ rr} r� �r 7i:"C i' i�{- �` a,-a r., _ n ��E. V'� �LV vJ ..-.z --_ -... __ r._v :n__>..Sv Cyr - > l,l ! t.�tYtn�- 3=} -.#i£`.�` ( �^�' r. `�' ..ALL 4 DEE J Al_ : /i' ---.-_----_.---- BUYER _FZ2;Z�L tea_- ^;��`'_'r.>` ^ `�1------ t-'T_`-jib` Ri14. -L�1_/tic?✓ S,�2 u �7 � �--._--- i - _ �^'- ^F iv' _�s'J'r_T�' f'` f .Dl C, — THAT �t't"y ` ! \. _-..7. - U _ f'1O t f.' rs'r-:j i �F -POSITION r-dG .4 D p r_t`N E i,tee �0 l�THE LL _ \(i LAW SF'i r3 `C t�f U11TE,\IT ±q— 11C �' ; s-_ ` CVQ S T E .i..i t OF I 1. L . ^l D _ � y 1'j.'` -- I� FA.�v1` _'tf. n r _ _ _ < i' ✓ — .__ ,._ N. i a r _ -3 rLA. 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Plvl=POOR MULLION 1,JP POUPIPS/60.FOGY DIO 5ECfION IYI'ICAL 51"U!.I1C/PI'S KL PL"l"5 I�C13M 51'RlJC11JKAl- 9,1101 1ZOIJI AL JOIHTS rIr hPlClia'I I HE 1_IJDS OF F AIJI LS R_ VJ=V/IIJpOVJ. I I I I:I I PANEI-5 WI111 ALUMINUM 5IJ1J5 1JONI)hP 1.0 1.101 1 EPIvll l'11T. A 1. b'dlvl=WINPOVI MLJLLION 13C=13(Ji1_DlI,IG COI7L. 'S r IJONE'YCOPAKJ/I'OI_Y51YPl,llt_GORLS F)" 4 VV' iG_I101JE1'GObA131'AhIPl.S G-INILI:IJA'N01JAl.GG II l (` 1(J.GOIIIL/\C,1C)I:101'I:OVIPI:P/',L.L.NKO7 FCIICIII C1 K LOCA! CODIF5, EEf,3=FOL Y51YR13`IC I'P,hIL"i_g IJISC=:UIJII=OF'.Iv113C P AND 6"IIJ I'i IIGICIJI_5;;).ADJACFIJ I'I'AIJt?I.5 i`01:SLINK001v15 V'/f(FI A I"IPII51 il.-P PI.001'I_I:VLI OI"[>J" ARE COUNT:CI I=P USING VIIJYI.GI I Al"5 OK I Is. I I I II:cRF•AAI.I Y 1 R:ULF IJ NI3C=IJ/\-1IOIJAI 13C {��¢ `} 3�.r� () 3.NINE IY(90)IIAM 1 PL.51GN WIIJI7 51'FI P, �)I GKI A'I L=1:ALOVC,111 t:Xl k1:101 911C I ACIc, 11MIIJUb t 1'1 C,111=1 ENFK. 513C=51ANPAKp 13C r }. [-,; I XI'08UN.1::POI:13. II.,�ILUG I UKAL PI:7,IvIIIJCi A1JIJ GOF1PI1cC[IONS 10[5L II{iTAI-l.E:I) F'_''AhILI Ivil G-IvIAIJUPNCI IIRI R w S 1'f K AI'I'L.ICAI3LC:COPF i/IJD CI3L4J MPG5 Yil LiGG, L -WALL I HIGH I 51 FC5-51'FCIPICf\1101.15 4• 4.PI=;iIGN K001"PANLL PI.Ap LOAF i 1'Sf. tv(I I I IviILLS I'FI'FIOUi. rlJs a P _bAAX-1vIAXIL IUIvh 5.POOR ANP WIIJPOW LOCH 110145/51ZL5 Ap,I' 12.CUhI I KAC I"OK TO IIJSI'1=C I";(1_L FXI�,I IIJG CUIJDI f101 IS ti - R e q 11JJ ERCI IANG]=ADLI3 I'I R 1/1P(i 5 5PCC5. AND A5 NFCIc:iS",Ia'RF PAIR ANp/OK REPLACE ALI_ y R ui/1 j- -- I'N,U,JI:C'r -'- C01 LI KAGI'OK: 6.WIDTI I OF 13-WALL MAY VAR`(I'f-IZ I IAILRIAI.S A5I'EUUlIJ:U 10 RF'hIDL'f:TI'It=1 l 5"fIZIJCfUKAL.LY 5, )l� ROOK/WINDOW LAYOUT UPIO 24 FLSOUND ANU COMM.E1L-. a'°`° TO'x 1C�' 7.f ANl°L5 MAY ONLY DE USED II•I I:001=5 13.L"=96-3/5"(MINX)POI:ALUMINUM l f PICL05lJRr_'• "r +'r 4 r� u °, _ --- AIJP WAILS OF ONE STORY t3UILPIIJGCJ OF , ;,tttu(rnJrini• ----- �J_(U(7101_NCLOSU .(_ I"-107 1/q"(MA})FOR Vlrl i'L ENCLOSURE. 3[ s�`t0314�U� j1:AV✓N 13Y.GJJ -- GONSfKUGI'IOIJ:'I`il'I_V13(1-01:113C/N13C), / PING LIO: I L AU11'101;IZI p FOR l3i_'f I 111111Fd0 P ALLK./IAAJI I IPq�IJr`I OtILI'. y F` �I`-[ f�tr efiloo-loxlo GrNI_I� L LAYOUT - - Il'I'L VI(i 01=513C)ANO IYI'L"VN(1-01'UI3C). 105.51 UDIO PI.00I:I l.A1J u mil.C I IUbI 1101"y0 5CALI, ---- --- - --------------'--- - - -- n r, 6"}- - - Sklo:(lr'�r�i t LL":1-`i ---- PATE:v1150/2003 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize Betterliving Patio Roo s (d.b.a. —Patio Rooms of America) to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job)S V 1 oV_�cl 1 I Sign ture of Owner Date Owner or Builder (as Agent of Owner) Must Complete and Sign This Section 1 as Owner/Authorized Agent hereby declare that the-statemenN and information on the foregoing application for (address of j _A- , are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name �— nature of Owner/Agent V Dat �LkrCQI�tSUI` RINFOR ' 'I } >;OFt�'�dl__"SNROQNS"w �'sn �Y ' G; hZassaehus ttse State BtWa Cede (�8f}4NR,`A�peadig'J Se �ozi JI 123'I} The Massachusetts State Building Code.(780 C��fR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER RN-FORMATION FORM is to be filed as part of the building ne1-�nit application when a builder/contractor or homeowner. constructing/inStalliP.g a house addition with very larac percentage Of Glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J1.1.2.3.1). . This. FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some.of the important energy conservation and year- a • round comfort considerations involved in selecting and utilizing a "sunroom" addition. The connection of "sunroom" structures to residential buildings may create comfort and energy . consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the i-tain house% rn the selection and constPlctiori instal ati.on of"Sunrooi::s", included below is a Pon-equ?red-.Open-ended list or product and design considerations that a homeowner :-nay ;-Dish to consider before actually ^nnctrirfina/in etallincr a '`ek�mm�m" iT iC rs -L11eJ'v cpLL VL3J Wr1 Llt *heir designer, builder, or corttractcr, in order to, rriin1:.li'e Dote' tiz.l energy consumption and/or house usSwl._ i0li issues. "r._ ait?'a_; '_y +-1'�_e :=.di to:j v v . t coi�e ImpOrta 7SlderatlOIlS� �5`i�31J�.'E.. ���✓ '..:-?L� E3It' �.C,} v1 ! ED i O Sc S. Uvlut CJ'I l,C:u lct lV lJt 6LLU i�GL41 4A :J 41lEI:L.� ® Insulating value F mme materials �riaiiu� LG it auic SeatLu�cilCl �aS aci[ri; -!lcie:Fi�i�i ._:.'c[ it i.ir$rl iti=J' an GlU1 weather tightness of the suarooin cq eic cc tl�LL Ltl2E LlU LL VL:�r GV!_ ,�..IU-11 __.. ."it _t A-pplied Shad-;nv .wcfPmc insulation level in floors,walls, and ce-HiRgs ® Possible Sunroom isolation from the main Douse via a wall and/or door or slider Reatina acid,Cooling Metaods: E;rnciency, Zoning and Controls ZZ.Tc•meo,A-ue 1::o;l-1e,;..., eut . T'ne Massachusetts State Building Code, Section Ji.1.2.3.1, requires that the actual arooerty owner (not the owner's agent or representative) ackrnowledge receipt oft-his CONSU' 11-RI 111,TORMATIONT FORM prior to issuance of a Building Permit. for a project that includes "sunroom" additions to an existing residential building.. In accordance with this requirement,-the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and enemy conservation. Signature of Actual B ilding Owner Date YCL Gd S ��Gc.O� OGt CQ C� �11'S m� 1 Print Name Address of Permitted Project 09490' ' Gc.om r t)a d rl 9��{ Ov ner Address (if different tha project location) Or.,^er's telepho:e number wC)� . DATE(MMIDONYI ACORD., CERTIFICATE OF-LIABILITY INSURANCE 03/18/2003 PRpDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF-INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Joseph McKeon@ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP McKeone Insurance Agency,,inc. ALTER THE COVERAGE AFFORDED 8Y THE RdLIC1ES BELOW. P.O. BOX 333 INSURERS AFFORDING COVERAGE Ann Arbor, MI 48106-0333 INSURES _ Patio Rooms of America INSURES A: bell rti. . dha Be#erLiving Patio Rooms INsuaeR 3 Arbella,- -- --•----• _.... _ 78 Turnpike Rd INSURER 0: Westborough,NIA 01581-1730 INSURERb: -_ — -- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEWN ISSUED TG THE INSUf?ED fYANIEDA$OVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 9E ISSUED Oht. MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESGRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, ___ _ LI 4�t Utl E TNE- LIMITS TYPE OF INSUR1tNCE _- I POCY NUMBER DATE NNfDO DATE NMID "�' I EACH OCCURRENCE is 2,DOO,dfJd A GENEAALUAMLITY 35a SBW KM6352 11/01120Q2 11/01/2004 1 CONSM=`RCIAL GENERAL LIABILITY ;FIRE➢AMAGE{Any one Fire) S 100,0OQ MEO Vf (Any onR Pern;n) CLAIMS MADE 7X]OCCUR t PEASONAL 6 ACV INJURY S _ 1000000 _C_aQLftl Ucll��/.-_—- -•_- GFNEP.AI.AGGRt(3ATE 9 ---2,0dd Od0 GEN'LAGGRErG�ATE LIMIT APPLIES PER: PRODUCTS CGNiPx1PA3C� $ ?,dOd,DOO POLICY I I PRO_ IX I LOC I g AUTOMOSILEL(ASILITY - 79957400001 121.1512002 12l1512004 COMBINED SINGLE Limrr _ 1,000,0d0 (Es s�ttlert) ANY AUTO Al,L O*ED AUT 8 00OILY INJURY., -, ; .y _ (Par person). SCHEDUIJ_D AUTOS X HIRED AUTOS BODILY INJURY (Per accident) NON•OWNE➢AUTOS PROPERTY DAMAGE S (Per accident) - I AUTO ONLY-EA ACCIDENT Is 4ARAOE LIABILTFY tSTH=RTH4N EA ACC;€ ht{YAUTD I AUTO ONLY: AGG L3XCP_SS LIABILITY_ 3ro,5gW KM8352 11I01112002 1111112OO EACH OCCURRENCE2,daD,ODo AI AGGREGATE 2,DOQ DOO OCCUR u CLAIMS WADE -- —-- S DEPUCTlBLE RETENTION S 9 wC STATU- OTH- WORK2RS COMPENSATION AND } y� 08/0112003 08/01-12004 TDRY LIMITS _� -- bKF'LOYERS'L1ABIIJT Y ��� �4`�J3J�3 E.L.EACH ACCIDENT 5 Id0,000 E.L.DISEASE-EA EMPLOYEES 1r3d,D0O E.L.0I8EASF-POLICY LIMIT 15 v 5dd:dd9 MCRIPTION OF OPERATIONSlLOCATIQNSNEMICLESIMLUS*NSADDED BY ENDORSEMENTlSPECIAL PROW94ONS CELLATION CERTIFICATE HOLDER. I I ADDITIONALINSURED;INSUFMA LETT'cR.l CAN. $HOVLD ANY OF THE ABOVE bEBCRISED POrUC1E8 BE CANCELLED BEFOiLE THE EXPIRAL nQN DATE T HEREOF,THE ISSUING INSURER WILL ENDEAVOR TD MAIL_ DAYS WRr17EM INSURED COPY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAJLURE TO DO$0 SHALL IMPOSE NO 000GATION OR WABILFrY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES., AVTMORrMM REPRESENT ACD3,D 25�17/$7� m. ®AC ORPORATIsJN 1988 ✓fie�Janrirrza�zwea�Cfi o�.�./I�sczclzuaeltc , Board of Building Regulations and Standards License or registration valid for individul use only � . HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Lf Board of Building Regulations and Standards Registrati'o_a_�3gg71 One Ashburton Place Rm 1301 ' -.,Expiration :6/2 2005 Boston,Ma.02108 l Typ'es_=Supolement Card PATIO ROOMS O�F AMERL Ga JAMES RINGER' _ 78 TURNPIKE RD WESTBOROUGH, MA01581 Administrator Not valid witho signature ,p ..i f[,� v.s Y✓,ra;irtC�ev.iGr � iii�,�rJ6CufLEG;�-,M�y BOARD OF BUILDING REGUL$TiONS ;.'-001.1. Licerse: ,CONS T RUCTION SUPERVISOR' .�' HUmlveP' n7801 Bar6ricl to 1 I✓08��000 8r20iO4 11l0 ' Pees Tr.ne: 780,16 Restricted Tcc; JAMES F RINGER 44 CANDiCE STREET-- CLINTON, NIA 0151,0 Adminisitraior �r� 3t1_ldig Coe=_, car - -_ a11 3.o:nr_ _s M�SSaGL52��5 Jr - _ . -Drt i:)(_li?r_ c,.S50C3.=`�r.�• W i E_ e p,-oper y Bcl SolIa .,a.s__ d.-L3-DoS;a - - _lip✓. eV iC`P1D- JU t1 A ? U14 ngIj r�tiY' ,:;tom �• � Lvt tif'f�t� f�..L . i.__m '=fie ara v; �.E-t-1 Jam' �- - r• a r• \ ✓evc.a =lt.:. .i_ Vim-, r (-: �"=_= 1934 e5 L Mari �T=s =5 c� of p ~kr�S^ h a11 be d t `.� y mod' S iy - - M- _ i-;a -n7i0't�1`-� 1i��0=^1zcL1vY1 DT..2 Cy 'jhe uc�,+�.-:S: �`-' t'�= g` r � u. 'r_ o1� s- - L�.,'"••�Y'•.- ✓ =1; CC On O; ±Z_ aCcit _TiLSG .alsD - Cl= d13�G33=3 �C- -X ci l i�: �O CO<TTJ�y tug �1 i`c - 7 in = =C=Cr?C18' ��` �Z by TOTAL P,0 n I Town of Barnstable FTHE 1p� regulatory Services Thomas F.Geiler,Director saaxsrABLE 9 • . g Building Division 1639. pIFD MPS A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 � �- —, PERMIT# "7 FEE: $ �� SHED REGISTRATION 120 square feet or less Location of shed(address) V Iage. oqx, 7 2d- Property owner's name Telephone number Size of-'Shed Map/Parcel# Signa a Date . Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. � � c THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg . RFV:121901 .......... LOCATIO OF PROPERT Y NOT B � STANDARD LEGEND ,• NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES - - - EDGE OF BRUSH ORCHARD OR NURSERY v EDGE OF CONIFEROUS TREES `\ MARSH AREA : \ -- — EDGE OF WATER DIRT ROAD A P Q DRIVEWAY I / E—PARKING LOT PAVED ROAD ------- / � JJJ DRAINAGE DITCH 3 : ----- PATH/TRAIL MA 2 PARCEL LINE** 269 # 5 - MAP326 MAP# i 021 PARCEL NUMBER \ #367 HOUSE NUMBER 2 FOOT CONTOUR LINE # —i�— 10 FOOT CONTOUR LINE 5 Elevation based on NGVD29 4.9 SPOT ELEVATION STONE WALL FENCE \ RETAINING WALL 1 i-- RAIL ROAD TRACK G STONE JETTY l- !Po. SWIMMING POOL ;•,. PORCH/DECK C� 0 BUILDING/STRUCTURE - DOCK/PIER HYDRANT e VALVE OO MANHOLE o POST O'P FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T o SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET NOT This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The lames ❑ TOWER 1"=100'scale map and may NOT meet of property boundaries.They ore not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o UTILITY POLE w e 0 15 30 National Map Accurory Standards at this do not represent actual relationships to physical objects Corporation. Planimetria,topography,and vegetation were mopped to meet National Map Accuracy Standards s 1 INCH=30 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. -0- LIGHT POLE O ELECTRIC BOX The Town -of Barnstable ' `" A MSS. Department of Health Safety and Environmental Services y�A 16A.SS. 1�� lFn3�a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner TOWN OF BARNSTABLE Permit:'540 SOLID FUEL STOVE PERMIT Date:14y0 I Fee: 670 Owner: ASS Phone: —5,Zf Address: fa Village: � l /� Map/Parcel: ��q �/�, Date: � l% Stove A. New sed B. Type: �J.) Circulating C. Manufacturer: b`e H4XfF Lab. No. D. Model No.: 1 g�20 Chimney A. New/ 5xEistin:&Zf existing,please note date of last cleaning) 1zl g/o j B. Flue Size_ /a ' C. Are other appliances attached to Flue? DVS D. Pre-fab Type and Manufacturer Al E. Masonry: &' k ine nlined—7//, . Hearth A. Materials: c � B. Sub Floor Construction: < f Installer Name: &-104 LA Address: P// 46X C/D; �D errc7` Phone: ZC DStij Location of Installation: �'� 1 a APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Stove.doc L _ i }, y mar Iry _y v VI �, s all e � f f , 4 7 1� � y �Na9•s9+b+[w4YeM; aam..+. "..,......r..w�,...�..b,... .,.--, ...:...._- /116 tom. ._,._.,•n ..®,.,.,,..._,.�_•.,:..... . Spy t � /V.. , , 1 H �O 4.4 !!� �` ,�' .'��•.,f :r ;'r'' / � j'J 1. +' .. r J,, ✓ �� 'F r ,f s 1 �` 1 a,�,. '°`T �x-s ' f4/4 s-rt/ r' J.�. Jf".. <"F �° der.,'"• 'i r 'f r r j:"'/ '.>r*i 1r j• f`d fr.. � ./' :J/J F ,+ J f": �•r ��,J��. �� fr � V/ / �V(-!.L+• �.� � (/ %�! el" 410-n4- M Z� ����- �'ca(2d S'atS�s 4". ��' f� (� •���` �``�� "�"`� /�`'6-�- � �T r 1 c C1 U ipt. 4� 7dts� %S 4 40k ekd-S �Se �'dES z) �� el It ems S ,�s �} olC r,eve Ox Ol te ti o Sl 3t4 (�I Sfa�Qs ; Rlfz �-�n �\ Ll ;os, e 64 0 'Tsc - �� 6l G �`` ��ta'e� �x decG� y dAfle S l� 4x , W� �(-(� 1,Svllqffk — 4 VgVue : f✓!f� die cloy s ti L ri, F `� 1 k-36 �s Aw- �Iu'el� y 4fp�ka` fl1��r,1 f--