Loading...
HomeMy WebLinkAbout0004 SYLVAN DRIVE �" _ -_- -_ - v -.� ._ - - __ . .��-� I"� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma r Parcel 06-4- Permit# �o a / 7 Health Division &7162d Date Issued - Q� Conservation Divisio Z_ Application Fee Tax Collector '17—©o/) Permit Fee 177. D 7 Treasurer �-/7 SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TIRE S Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS ^A Project Street Address SVL I AIV DC Village _ _YyANA1/S Owner 5 41 bL `v 6412Y Address 4 :5VW4N 52 Telephone 775-0I be::) Permit Request 06fnh D S [7�Z' AX-In2w (auav z 6UF-S-r oow , _ U OM lO &/24FT5 PWo M 14 ' X, 1-7 ' Square feet: 1 st floor:existing proposed 2nd floor: existing C2 proposed Total new 394 Zoning District Flood Plain Groundwater Overlay Project Valuation /JrOiO�"� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentat9d. o�. CD Dwelling Type: Single Family M111" Two Family ❑ Multi-Family(#units) < -- T1 Zn --i t/ Age of Existing Structure ��J Historic House: ❑Yes �lo On Old King's Hig y: ❑)§ o s Basement Type: M Full 0 Crawl ❑Walkout ❑Other no co Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I i Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_ new !0-- Total Room Count(not including baths): existing 4 new a First Floor Room Count 4- Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New 2. Existing wood/coal stove: ❑Yes 2'No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:t(existing ❑new size Shed:6/existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Cl Yes uli o If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name OW/VEif�'c%/ � � 6A yF. Telephone Number _�75 0I�� Address, 4= DI, License# �'� T 1�-N11� S ; /"�►t D2�� Home Improvement Contractor# Worker's Compensation# ALL CONSTRU ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 17 4Wr' D2. FOR OFFICIAL USE ONLY i 4 PERMjT-NO. DATE ISSUED MAP/PARCEL NO. ` ADDRESS .Y VILLAGE OWNER ' DATE OF INSPECTION: ' r FOUNDATION ► 1 FRAME M i INSULATION (Kld- FIREPLACE i ELECTRICAL: ROUGH c0 '" FINAL PLUMBING: ROUGH. *710 FINAL L.i a" -i4' 6 Y3E GAS: ROUGH - V FINAL 1 , FINAL BUILDING11. " e%s n C3 tA ra ` DATE CLOSED OUT' E # m i ASSOCIATION.PLAN NO. I RESIDENTIAL BUILDING PERNIIT FEES .' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LI , 07 VING S ACE { -7 square feet x$96/sq.foot= --`� / 20 x.4031= 7 plus from below(if applicable) , ALTERATIONS/RENOVATIONS OF EXISTING SPACE ' square feet x$64/sq.foot x.0031= r plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft� >l20 sf-500 sf S 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75:00' >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch _x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool . $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) O Permit Fee projcost I - M CMR Appawdit J Table JS-2-lb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Hated with Food Fuel MAXIMUM MINIMUM Glazing Glaring Ceiling Wall Floor Basement Slab Heating/Cooling Area (/o) U-value' R-valor R-value' R-value' Wall Perimeter Equipment Efficiency' Package R value° R valud 5701 to 6500 Hating Degree Days Q 12% 0.40 38 13 19 10 6 Normal R 120/6 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 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 NIA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 19% 0.32 38 13 25 N/A N/A Normal Y 18% 0.42 38 19 25 N/A N/A Normal Z 19% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 30 19 119 101 6 90 AFUE 1. ADDRESS OF PROPERTY: 4 SaLVAN 21 �y�n►Nl s . M�, oZ�l 4 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: ��SGc� P,�D57� L14T, 3. SQUARE FOOTAGE OF ALL GLAZING: 4/ w/iNs lJLAriNy LOW "IF �/UF.p1ay A. %GLAZING AREA(#3 DIVIDED BY#2): Jc- 5. SELECT PACKAGE(Q--AA-see chart above): WALL6 /Z,lC CElWJ(,-7 23& NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303 a 780 CMR Appendix J Footnotes to Table J6.2.1b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 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. 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. s The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside au requirements. must meet the ceiling q The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as 69ve-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 J1.5.3b. If a door contains glass and an`aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or 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). 43 �O*THE lay, Town of Barnstable Regulatory Services vBAMASS. Thomas F.Geiler,Director �p i639 ♦0 rEON,p.,A 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. �> A � Av Type of Work: F[O�D 1J�Z7 4DDITIOA1 Estimated Cost / 000 Address of Work: 4- 5 yt y tf 7ANAms .% �Ik ozl4ol 5 4U.,L/ �7i�-12�Owner's Name: � 2E AVE Date of Application: /5 0 2.. I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ]Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Loactor Name Registration No. 6Aq(� Date Owner's Name Q:fomis:homeaffidav The Commonwealth of Massachusetts -- — .f Department o De art Industrial Accidents - — P Office offnvesMations . 600 Washington Street c� Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit A location: 4— STLUAN D12 4 citV1_4 IkNN6 i HA, 0Z(aD( — phone# 775-01bb ® I a homeowner performing all work myself. ( a sole r rietor and have no one worki>1 in an ca achy ', ❑ I am an employer providing workers' compensation for my employees working•on this job. •_•.. .. .. .. . ..• .. •. . . S 'C'%%% y`` '` i% ?``iy city 1t15112911 ...................................:.._...... .............._:............. .. 1 I am a sole proprietor, general contracto or homeowner ircle one)and have hired the contractors listed below who have the following workers'compensation polices: minnanv n m :a :j5:::?::::: i::;:`:::f::i::i:::;d:`;::::::;C::i::�:::i;i:::::::�:::::::'::;:;::::;:;:::::::•::•:::i:::::::<.::.: :::c:::F:::: ':;'':>: ............:..:::.:;::;:::.;.: .;.:::::::...... :it>$n:ranee:ca:::»:>;<:<;:»>:::<:;>:>;::>:«:;:«:::»::>;:»::;:::>::>::>:<::<::?.;:?::.;::;;:.;;:.;:.:=:::.;:.;:.;:<.;;:;.:::.;:<.;':,;:.;::,.>::::.;:.::.;:.:<.:.>:.;:.>;:.>::<: ':':i>'C�S�i::is1:%:::iv:ii:i'r?i: :';:};:i;:;:il<n;i:i:;.;?<li:C.'•:F ..in.y.j,i!jy: Y:tyy;;:»i'{:;tiy{;:;:;:;i:>;i:};:iij::tiit :$?.`ii:::}•::;:?v::^i::'r 4i'ri:<::i':•i?rv: ?;•}:i??•i}i:i:Liiiiii+:Y.v•:v?^:iiii:ii.:?:i+?:i?$: :addies's ... ::...:::.::.::•::••:::.::.....I.....:.............::•::.::::::.:.::.:::::::::::..:::::.:::::.::::::::.::.:•:::.....:::.:...::.:...•..:::::.::.:::.li6a # ..... : l! Fafure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIAL for coverage verification .I do hereby c under e p ' d penalties of perjury that the information provided above is true and correct Signature Date /! A14V ©2 Print name AW A, 2ECAVE Phone# -776 L 9)p official use only do not write in this area to be completed by city or town official city or town: permtt/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selechnen's Office __ ❑Health Department contact person: phone#; ❑Other acyieed 9/95 PJA) s Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. _ r An employer is defined as an individual,partnership, association, corporation or other legal entity,°or many 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 iinldividual,°partnership, association or other legal entity,!employing employers,:�Howevei ahe.:owner of a . dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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 commonwealth nor any of its political subdivisions shall enter into any contract for the.performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. a j Applicants Please fill in the workers' compensation affidavit completely;by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required.to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please _. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be re i ieii to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question. 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 0mce of lovesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 Town of Barnstable �pF fiNE Tp� Regulatory Services BAHNSTABLE Thomas F.Geiler,Director MASS. 1639. Building Division rent s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /7 MAW A 01 JOB LOCATION: 4 6VL I AAI WE tl11ANNI S Off! number ��� street village "HOMEOWNER": 64i2' / ( 6AV'F 775—c1AR> name thome phone# work phone# CURRENT MAILING ADDRESS: 4 S'�LVA AlluyG -H YANNIS Ml� OZIoDI 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. e understands the Town of Barnstable Building Departmentmi* The undersigned homeowner certifies that he/she un um inspection procedures and requirements and that he/she will comply with said procedures and requ ements Sign re of omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S 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 aF4,eMEC!5 'CO . . 1-0 3 c�,eEAZ,eODtiNI _ .BA21V _ GLDS G[USET 15-4'•x i3 2o'x P.42C-92. GA2'/2� SALLY/ 2E VE 4 :5 L,I-mAiDvz NVANn//s,•MA, oz6O1 ..E'X/STING FZC5T FLQO2 PLAN t/¢"_/'o,, oeawAl By, 6,,eeo4 vE /6 IwAv oz G 4eY A 541-LY�.eEr-4VL � EXIST/Nb /�O� ExISTlNG �� 4 SYLVAN DR, N,YANN/S, MA, 02,9,01 c SECOND S7Ue�/AODlTlOIV A FLOOR PLAN o- S PEST 242 N DWAI 01 6.,eaG4VE 22 APOL 2 DO _ =ATTIC ST'ORA&E _GDEST ROOM to' GLOS. /45 SQ f-F G24FTS RAM... _ /7 5 /O' — 8 8/2 ST02AGiE GLOS. -9 35 6, 8205 0='` 1_(V/Dp.iNS '.N �cSL113 K C4gCu33—/ FzAr'C4S Q, EG4VE 6%6 .,AMA yLv,4N Dz , WANN/S MA SEGoNQ ShooY ADDj-r1oN 3' .. W.SIDE El srROucrURAL 5NEZT 1 c4 2� nE, res p1AWN f3.y. if R�G4VE 2 Z AP21 L �OZ s e —TtiF�38M GLEdiZP/n/E:.L,�U.VE2_..__ hC lO FA 5CIA , TIMBERLINE WHEATNE-VOOD WI,/4"BEAD 90 YEAP- -- RAFT R'MATE rs`ro` 2,c10 JOIST I!o'O.C. 3-2rc(o 3�4' Y4 OWN D Ix 12 Y"GR)OVE r LLD- 2OOF .. 7YVEK WRAP � TF� TyVEK TAPE N' o oc /x to MAO BpAW 5#EAING 'JOIST Ifj O.G. �'rd — 35'-Co TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map Parcel 054 Permit# '31506 Health Division ®' F40W Date Issued Conservation Division ce 0 9 Q L- ' Fee 00 c Tax Collect = /374. a/l Treasure Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 14 VLV" DOVE Village Owner Address __-5AHF ` Telephone J®b e775--011be) Permit Request Cff&L6 C OaDF UIJ &w eaogA e , ADDO(:i fod `f-/.mi. Square feet: 1 st floor: existing 400 proposed 2nd floor:existing proposed Total new Estimated Project Cost /fit 000 Zoning District Flood Plain Groundwater Overlay Construction Type Gi/L'01) Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure_ 50 ' Historic House: ❑Yes 51 o On Old King's Highway: ❑Yes Zo Basement Type: C Full MCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas YOil ❑Electric ❑Other Central Air: ❑Yes U44/0 Fireplaces: Existing New Existing wood/coal stove: ElYes ❑No Detached garage:/existing 'sting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: 0 new size Shed:❑existin ❑'new size Other: g 9 9 Zoning Board of Appeal;No ut --rization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes,site plan review# Current Use Proposed Use BUILDE FORMATION 1 Name 414 VF Telephone Number Address4 5YLVAN W License#. AWP15 MA ozwl Home Improvement Contractor# Worker's Compensation# ALL CONSTRU TI DEBRn ESU TING FROM THIS PROJECT WILL BETAKEN TO 1011 SIGNATURE . DATE a - FOR OFFICIAL USE ONLY ` ~ PER_MIT,NO. =, DATE ISSUED' _ MAP/PARCEL NO. ,+ ADDRESS ` 4 xVILLAGE { h` OWNER^ :-, DATE OF INSPECTId.I�;' FOUNDATION i FRAMEIN INSULATION . - 1 - 4. ' FIREPLACE ' 17 i t ELECTRICAL: ROUGH t FINAL PLUMBING:- ROUGH FINAL t '' GAS:" ROUGH FINAL FINAL BUILDING- ' ,_ • .,'• •,_ £r' ^. � . � # 'r ' DATE CLOSED;OUT ' ASSOCIATION'PLAN NO. S The Commonwealth of Massachusetts Department of Industrial Accidents ' ,��==: - Ofllce of/m�est/gat�oas a 600 Washington Street - - Boston,Mass. 02111 workers' Compensation Insurance Affidavit - i name location GI" 1,77 LOAN ci H e �� hone# -7®o I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workin in any acity ' %/%//////%%------ e 1 din workers' compensation for my employees working on this job. :: I am an mp P g........................:.:::.:::::::::::::::::.::::::::::.::.::::::::::::::::. :....._.:....:. ❑ .....................: :::::.:.........::::::.::::::::::..:...........::::.::::::.::::::::::::................::::::::::::.........::::::::::..........:..::::::.:::........ e coinvanv >:�:;G:`r::::T$»>. ::.....:>i:::;::ii:;:;iii:««:>::::>:>::;:{:;::•;::;:. R»<::::«:;;;;;:::;: address.. ... :;;;:<.::;. :.. one# city d h C:.. ..... ::i:::::..... is{•iiii:?::::.ii.•.. :. ii:::ii.iiii ii::}ii vi.....ii: _. .:: : :: .,�.,;::'.ii::xii::.: :.:::::•�.::�>':....... .. .:. :.,... inSnraRCCEO. ; ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have Hired the contractors listed below who have the followmgworke ' compensation po...i..c..e..s..:...........:.:..:.:.................................:.:.:.:.:.:.::. ;....::...: address..: .....................:... ...........::.:::.::.:..::.:....::::::::...::. ....................... ............................ . ........................:.::.:....... 4:. :Yx :ii+ :::is�:i�:j:;ii:}i?:'{.:L?:ii<;:C;ri:j'r:�ii:isii:':{i :?:� ::;:}iii'i:{•i ...:::...:............... .............................................................. .............................................................................................. ..:�::::::•+::::::::•�:........................ ...........::•:::::::::•.� • :.�.vnriii:�iv:.v.v:'::::.:�i:.:::: :iiiiii ' ................:•::.�::::::::.�:::::::::.�4:4YAiiii n;}i:viiii:4iii;:iii:v:i ii.::.............:........ i.� ::#'.;'}:? }i:;i::._.}:.:?:•isi• :ii:i':;:i}::;:•:vy:::>: .:ili?i::!'::.::••::::::.::::::!:ii:tiii:•i:ti•::: . �::.:::::...:...::..::::::!•:'i.:•::::::::w:::::x::?G:4i:�:w::::::::::w:<i:%•ii:<i•i:•i:{{{::i:4i:{•iY.?:>::::�%'•iii:.i?•:.ii}:iiYii}iii:4ii iii}::•:ii:•i:: �llCP • ........�..... >:i :i3:: ?::::� ii ;: '%;;:; i;?E;:: `?' ii x;i:;:2....... .. naRl :.:::ir:;•iir:?•:?:iiii::i:;::;i::::::ti':: :: w ::i'r'^:i'r::::i::::::: C aR :::.::::•::...................:.................................. >:ti•':i :i::i :': address : .............. . h.................................................. ............. ...................:.�:.�:.�::.�:...........................:::::.�.::::.:::::.:.:....::.�:.::..:.:......... ...................................................................ii:iii::i:•:'::}:.:......... ...............................::::::::.�.:�::::::::::::::::::v4ii:•iiiii:':i::ii:•:ii ii iii i iii v:i iii:\�iiiiii iiii:^�i iji'Fii iiii i:ifiii ii:i�iii:iii?:Liv:i:•ii:?i4ii:vii::. .n.•.. vi: i.... ...................................................................................... ::.:::::::.�:::::v:::::::•iii::•i�Y•ii:{C;;4ihi:?•ii:?L:L}:Y:iii':•ii:i:•:•i}iii::.:?.}:•:;::;i:•;:iii:?•i:•iiii;{i;{ii;{?:::::::?;:i?4iii:vi ii:•iii i:'i:i$i:..:j ;ii%'�`....... ..... ........ ...... .,... ..::•...::........:•..::.::.::.ii::•:•:is{r,??:%iiiii:?4:iiii::::ii:>.<ti::ii::::ii::ii:Ci:iii:tiSi:iti•:ii::ti::iti:?iiii:i{:: .., uli .. . Faihm to secure coverage as required order Section 25A of MGL 152 can lead to the lmpositlon of c tuinal penaldes of a are up to s1Awoo and/or one years'imprisomnent as weII as civilpensities in the form of a STOP WORK ORDER and a true of$100.00 a day against me. I understand that a copy of this a may bFm�r to the Office of Investigations otthe DIA for coverage verification I do hereby c underenaltw of perjury that the information provided above is trw cud correct PE Signature Date Priest name A r4t Ail r Phone# 45D6—776L C 18 oincial use only do not write in this area to be completed by city or town official city or town, perndt/license# oBunding Depattrnent C3Ucrosing Board ❑checkitirmnedbde response is required ❑Selectmen's Office OHealth Depardnent — aOthe contact person: phone#; r_ grmed 9l95 PJN . Off y Town of Barnstable . . °F The Q ,�►ar�srna�. : Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner 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. yyAA,,II� 11 Type of Work: i7ft�`�/!N�� ° Estimated Cost ®e��I Address of Work: �,7`t Owner's Name: Date of Application: J()AZ C � I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job U der$1,000 OB ' ing not owner-occupied wrier 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: Dat Contractor Name Registration No. OR f, Date Owner's Name q:fbmis:Affidav . PYANW, MASS, 92.lo4f, i I I 2D'Z2 Two ycr�a v' v i --------------- 4 S yL V,4N De1V,F- Z'kl2 V 2D' N/�IJ/JIS, /VI�SS . 02100./ h`/GN P.�.4�✓1 iz BWLTUP Mt4D&- /q,roGyTYE /2 L-ITE 7PAA611" • _ SP�UG� 2-?4-AXE-STOP A14lL k � /V�-,vv 20 6 20' y Engineering Dept. (3rd floor) Map Parcel) Permit# House# � �(�, Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00 4:34 ga - CIS 3 �� Fee Ping Dept (1���- n»� 63 s �?� Ct 19 ^ TOWN OF BARNSTABLE `�° Building.Permit Application Project Street Address Village_ �/Jl� Owner 6AW ' B ,aka, ZErAAE, Address 5 AW40 AL Telephone 77 OI 'Permit Reque FEPZA FF, W 1 NOM5 O-A r,- 'r 449F5 TO 644P&A)2b JJJCAQJ5F WAtL- SlZF T- 6a" AW 1A6114 4?f, — /ZhCED OUT 1kW1 IA1Ff5-7P-rD *57MX7- First Floor square feet Second Floor square feet, Construction Type Estimated Project Cost $ 133,000 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Famil ❑ Multi-Famil #units Y Y( ) Age of Existing Structure 40 Historic House ❑Yes P(No On Old King's Highway ❑Yes °A No Basement Type: [Full 1 Crawl El Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths):Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ,Oil p Electric 0'.0ther Central Air ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove Yes ❑No Garage: Detached(size) Qthei Detached Structures: ❑Pool(size) /�� O/A *Attached(size) ZD XW ❑Barn(size) 2C 1 ❑None ❑Shed(size). ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use Builder Information Name el-)�,,n-ter- Telephone Number Address License# 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 SIGNATURE DATE (95 . �('p BUILDING PERMIT D NIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED 4 MAP/PARCEL NO. ADDRESS j VILLAGE -� OWNER a DATE OF INSPECTION: - FOUNDAThON ' FRAME { INSULATION ' 'FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL FINAL BUILDING r ' DATE CLOSED OUT ` ASSOCIATION PLAN NO. t • The Town of Barnstable °kTMe'0Y'�1•o Department of Health Safety and Environmental Services Building Division 8A = 367 Main Street,Hymmis MA 02601 mum Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE F.REMP noN Please Print DATE: JOB LOCATION: 4— 5"i numbbQerr ,�a �q , , street village ER"HOMEOWN ": � 4 �T 1(.U! P _ ���✓ �� same home phone# work phone# CURRENT MAumG ADDRESS: 4- '%:064J DOVE 77`I/ N01 J MA, &M01 city/town state rip code The current exemption for" "was extended to include owner-eccunied 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 stmervisor. DEFINMON OF HOMEOVAM 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 - reseonsible for ail such work performed under the buildin .(Sectitm 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 inspeca cedures and requirements and that he/she will comply with said procedures and reKMA ' en JT� . 70 Signalit of meowner 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 E7CEmpnoN 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 homeownas who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Ilansing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, pantiaulariy 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 erotic that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that Wshe rmdastands the responsibilities of a Supervisor. On the last page of thls issue is a form cm=tjy used by samai towns. You may care to amend and adopt such a form/cati ication for use in your community. A The Commonwealth of Massachusetts \y i •+ i ___'.=�;:� Department of Industrial Accidents 1� OIfiCBOI/nYeSl/gal/0/IS " 600 1i'ashinrton Street Boston, Alas. 02111 `-' Workers' Compensation Insurance Affidavit ... F_�..�..�.. »wwww-� .._.». .... ._.».r.w. .. w._ ... ....rwt �••tiM. P.; •��rr:Ainu'•±Y. +ww/M•K�..w`^rnn .w,. . ItF Finn information• Please PRINT lebtbly s, , name. . _ A tJ�l location am a homeown pe orming all work myself. 1 am a sole proprietor and have no one working in any capacity . .2`rzn°'•^�!:�+" Ap' "� ':b" 7f,TR9y aa7tp+raR�t'x'.t�pA•!+`5�fi�u�'; �. •.Z.'iLS+' "�212�T�`r �„zf„ ?�p,?.�e�,a�+^.:.�'�.`'`�.... +4•.p�n 5...:aiaLS.u...:+ 'GrK .;aii4n....r ....LYSJbxYr.W.ab .._......:., .'e.'n. ...• .. '.. :.,.�...,.. Ni.�ii.sv�.�+ .�4i: ' r..�...u�e•f'w. I am an employer providing workers' compensation for my employees working on this job. company name: address: may: phone#• . insurance co policy# I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name, - address: city. phone#• Insurance co policy# ._» ... .,. ..- ._... rrM +:-:N�vn.'=••�-r.•:'.�^'T'.R'^'�:'T' ^.*;'�T^� �u':.->,•3i�F�,`7r,L.,v, swn..� .;P. .. .�,a- '^'"? .,,u " :aryisut4 company name: address: city: phone#• insurance co 11olic1# _ ss'Attach additional shcef if neceary _ _ , .._,._._.. _.�:�..tw-' .: �'.."'"y.c:�{�■��'' Sri-:--`��'"�'-_"'• �' '2kt' :fu3c�is�e1: Failure to secure coverage as required under Section 25A of AtGL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this st ment may be forwarded to the Orrice or Investigations of the D1A for coverage verification. I do herebt•ce i •under a pai r a, penalties of perjun,'that the information provided above is true and correct. Signature Date Print name Phone# a...T 7officialse only do not write in this area to be completed by city or town officialwn: permit/license# r•1Building DepartmentLicensing BoardO ceck if immediate response is required OSelectmen's Office pllcalth Department contact person: phone M. nOther (revised 3105 P3A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted tom the "law", an enrpinree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enzpl(!ver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the forcgoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on,the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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 commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. 7777 7- Cite or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorn of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to cive us a call. ►' :M tf,.w... .,..n.....-.s....^VT,f.'T.... ..17YRT.h'./"rwVL�I'_+.'..OR.�A"L�` p�.. .f .TRIVlT'.'-I:T:Y.R�yii7'IMR The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �TMe of B Barnstable The Town MMAS& � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. C 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 adjacent o such residence or bui dwelling structures which are adlac ld ng be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost Address of Work: Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _ _ ob under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that:OWNERS PULLING THEIR COABLE _HOME IMPROVEMENT WORK D OR DEALING WrM ORNOT HAVE CONTRACTORS FOR APPLI ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I here apply 11A a it as the agent of the owner. Date Contractor Name Registration No. OR • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB_ LOCATION ✓YGVAN POW— HY41JIV15 Number Street address Section of town "HOMEOWNER" z.f�f�c- �AULI E- 77`J7� Name Home phone Work phone PRESENT MAILING ADDRESS 4 �IGVi4�� 1 `':''• 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Person(sY who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town .of Barnstable Building Depar ent minimum inspection. procedures and requirements and that he/she will comp with a' procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 a Home Owner engages a person(s) for hire to do such work, that such Home Owner caner hall act as - _ Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix PP 4, Rules and Regulations at'ions for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed_ Supervisor. The Home "dwner- actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, . man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community.