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HomeMy WebLinkAbout0302 AMES WAY ry 3�� � � �� �.., �4 �. s l L - � .. `� -, � - ., 8 ip � �, Y .. �. W L � � .. .. .� C ,. l � ,. _, ,- $., 1 -^ - St` C. f � �. � ` � i ` RI ,. .. .. _ ,. ,. !y � ,. �. .. .. �. a ,, � � k ., �� P Building ost!This lard SoThat it�sVisible'Fromthe Street�A roved Plans.Must Town of Barnstable be„Retamed on Job andahis Card Must be Kept IARNE3TABtdS, ,:a�*aa • b �PostedUntil'Final Inspection HasBeen Made r ,; �, Where aCertificate'°of Occu anc as,Re u�red suchBu�ldm shall£Not'be Occupieduntil a Final Inspection has been made 1 er 1t c'"k`..s: v. Permit No. B-20-749 Applicant Name: Anatoli Sivitski Approvals Date Issued: 03/12/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/12/2020 Foundation: Location: 302 AMES WAY,CENTERVILLE Map/Lot 170-057-017 Zoning District: RC Sheathing: Owner on Record: BARTLETT,JOSEPH&DANIELLE Contractor Name" :ANATOLI SIVITSKI Framing: 1 Address: 29 BEVERLY AVENUE , Con;tractor;License CSSL 106040 2 UXBRIDGE, MA 01569 ` Este Project Cost: $8,900.00 Chimney: Description: replacing roof 1,5 Permit Fee: $45.39 Insulation: r Fee Paid $45.39 Project ReviewReq: k te 3/12/2020 � Final: Da5� n — Plumbing/Gas U/A/ Rough Plumbing:.. _.. _ �; SBuilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work apthonied by this permit is commenced within six months afterassuance. All work authorized by this permit shall conform to the approved application and thelapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and st uccttures>shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public 1 s pectI n for the entire duration of the Final Gas: work until the completion of the same. y Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Build ni g and fire Officials are provided on this it. Minimum of Five Call Inspections Required for All Construction Work:' ' Service: 1.Foundation or Footing = �� i Rough: 2.Sheathing Inspection , 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final All Permit.Cards are the property of the APPLICANT-ISSUED RECIPIENT �N� ?�E 9 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION M Map 1�0 Parcel D,S 0I Application# Health Division q 1._3 p � ' : , _ Conservation Division ILS obi Permit# 9 �' 7 Tax Collector .° Date Issued P �-0 6 EXISTING SEPTIC SYSTEM � 00 Treasurer ' IMITED TOy _#OF BEDROOMplication Fee -o� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -3D a A mw W5 ) Village Co ✓niyyi% Owner _Tt4tl �, Address sti n-,e— Telephone y? Y40-3.37 2 Permit Request , U �® _ of Grid ' ae n� 160 � Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation "D,00 U Construction Type Lot Size �� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �1( Two Family ❑ Multi-Family(#units) Age of Existing Structure D Historic House: ❑Yes )'No On Old King's Highway: ❑Yes XNo Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) �d _ Number of Baths: Full:existing Z new Half:existing new 0 Number of Bedrooms: existing 3 new J Total Room Count(not including baths):existing new evk, First Floor_Room Count Heat Type and Fuel: ❑Gas V Oil ❑Electric ❑Other Central Air: ❑Yes 4 No Fireplaces: Existing I 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:Xexisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review# Current Use Proposed Use e BUILDER INFORMATION Name kv Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9 i FOR OFFICIAL USE ONLY PERMIT NO. DATE,ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER • j DATE OF INSPECTION: FOUNDATION e FRAME 3CG Z9 "3p G ,., 1, INSULATION $ 0.` �' P FIREPLACE ELECTRICAL: ROUGH! kD FINAL + PLUMBING: ROUGH a FINAL to GAS: ROUGH FINAL R FINAL BUILDING.- DATE CLOSED OUT ASSOCIATION PLAN NO.. ' y .y' ,*'THETown"of Barnstable Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director y MASS. �A 1639. Building Division rEo �A 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 u Please Print DATE: 3- OG /' 1 JOB LOCATION: 302 A 4', & W.., number (� street village "HOMEOWNER y e?�r�Lt �P,Rf t c -694YS-3.J 77 5—o 2- 9, f y name j home phone# work phone# <, CURRENT MAILING ADDRESS: I". O OX 6 6 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six.units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Sign ure 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 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations d 600 Washington Street Boston,l4 02111 °,M 5�•`' , !www.mas&gov/dia c, ®Yorkers' Compensation Insurance Affidavrit: Builders/Contractors/Electricians/Pluxmers kalicant Information Please Print Legibly name (Business/organizatiowh&vidual): V_Wr_F_!1 Pe4 I Address: 36 A (rtf wGA City/State/Zip: 6,4f^I &faG Z Phone#: (d 1 hyd 37 2 ►re you an employer? Check the-appropriate bog:. Type of project(required): ❑ 1 am a employer with 4. ❑ I am a general contractor and I 6 employees (full and/or part-time).* have hired the sub-contractors ❑New.construction ❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g• Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. l �uued.] � officers have exercised theirE Electrical repairs or.additions I am a homeowner doing all work right ref exemption per MGL 11-❑ Plumbing repairs or additions myself. No workers' comp. C. 152, §1(4),and we have no 12-❑ Roof repairs insurance required.] t employees.[No workers' comp.insurance required.] 13.❑ Other ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: N. [omeowners who submit this affidavit-indicating they are doing.all work and then hire,outside contractors must submit a new affidavit indicating such mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. tm an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site formation. - surance Company Name: jlicy#or Self-ins. Lie. #: Expiration Date: b.Site Address: City/State/Zip: `tach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ilure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ie 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_ 'up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of vestigations of the DiA for insurance coverage verification. to hereby certify under the pains apf penalties of perjury that the information provided above is true and correct: ature:. 4zz- Dater Lone#: �k'G ®ff icial 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#: Informationan* d Instruktions t Aassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for'their employees. 'ursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, :xpress or implied,oral or written." �n employer is defined as`.`a individual,partnership, association, corporation or other legal entity,or any two or more >f the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the 'eceiver or trustee of an individual,partnership, association or other legal entity, employing employees. Howeyer:the )caner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the swelling house of another who employs persons to do maintenance, construction or repair work-on such dwelling house �r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone numbers)along with their cerrificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships`(LL P)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or.town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure'to fill in the perixiit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that.a valid affidavit is on file for:future permit$Or-h6enses..A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license orpermit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit- The Office of Investigations would like to thank you in.advance for your cooperation and should you have any questions, Please do not hesitate to give us a call. The Department's address,telephone and.fax cumber: The Commonwealth of Massachusetts . Department of Industrial.Accidents ..Office gf,nvestiga#ons 600 Washington Street Boston,MA 0211 L ' Tel. #617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-7274749 tevised 5-26-05 �,mass.gov/-- Town of Barnstable • 4 Regulatory Services BAMSTABI.E Thomas F.Geiler,Director 9 MASS `gyp>Eo �a`' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. 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. l ] Type of Work: i 7cl® Estimated Cost So,0 a 0 yo Address of Work: 36J l ti Owner's Name: Date of Application: 3-1 ,Z`0 (D 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 Contractor Name Registration No. OR ate Owner's Name Q:forms.homeaffidav r pi;,e pz4 aps for dnm aad 7w*--Fmu4 RmidaAd Saitdb W Asmild've'h!` � 131aslag (03 Ce113ag WAR Floor Basr>sest Stab •1Hagltk�ollttg Ate'C/a) LT�vaiue� R•vslua9 1t,mu®' R YWud wag Pes�as3er F.gdFrmeat J lltdeae� g vim+ R va3s�er Fie • 3701 to d3G0 Fleatia D DAW Norarsl 12/a 00 33 13 19 10 i R 12°h U21 30 —E9 19 10 6 •t5a & g 120/a' 0.20 33 13 19 10 d. 13 25 NIA NIA - T— 1st_.. 03E-- — orrnal— ---- •1 A,46 31 19 19 t0 �' Y.; •' ,. t.y•1g'l1 A,¢¢: 33 . '13 3g NIA AFtJL .,. . �T•• 13'!a O,S2 19 19 10 d caz�l A . At< 38 • '13'` ZS A x lg 032 'NIA 0.42 38 t9 N!A •1g'/• 0,4Z 38 13 19 10 i 90AM Z•• AFVE I,A 120A O.iQ 30 19 19 10 1 •ADDRESS OF PRQPaRTx: ' 0� Z, $QVARE FQOTAQE OF ALL�{TER70R WAt,LS;;•----,.......-- -..... .. .•.•----... ... —.. • SQVARE FOOTAGE OF ALL'GLAZING; . ' ,• ' ' . d,. /a CfLAZiNG AREA a 03 DWMED BY#2); SELECT PACT GB(Q AA-see chod above); '• 'p '1TE; ®THM Mcu WVOLVW METHODS OF DETMUZxNaa EiaRGY REQUMMMTS ARE AVAILABLE, ASK VS FOR TES WFORMATION, � > > E�II,DIN�a IN8PECT4RAPPROVAL; gafarms�19��3G3z 730 CMR App9ndix J Footnote to?'able d5.2.1bo � lass doors, skylights, and + area is the ratio of the area of the glazrng assemblies ('including sliding-g gross wall Cflazmg ' ,meat windows if located In walls that enclose conditioned sip a m>may b®excluded from the U yatlue requirement. bas ressed as a percentage.Up to 1!®of the total glazingill area;;expressed . glazing area For example,3 ftz of doaerativa glass racy be excle tested and docunien ed by��manufacturer In accordance with 3 After January 1, 1999, giazing U-values anus b 5 3�. U•vatu,s era for• , . the National Fenestration Rating Council Cr;MC) test procedure, or taken from Table Jl. . I whole units: cant glassU=values cannot be used. substituted for 3 g If the insulation achieves the fill a The cai g.R values do not assume a raised or oversIzed � construction. +' o R 30 insulation m*y'be two over the•exterior walls without compressi n, a caYi ' ' ,�,.�� � resent th,-sum• �. ty<— InsuYatlon l�j'Zi frauga��-aisy bViU a rhitad°for=R=49�insulatidn: C tie shoo Ind u t.>?®placed between . — Insulation ,°n e .For ventilatbd�oilings, g insulation Plus msulatmg sheathing(if•us•d)-, the conditioned space and the vent'lated portion ofthe roof, if used)•no not include` insulation plus insulating sheathing'( 4 Wall.R-Yalu,represent the sum.of the wall cavity . ercaraple,an R 19 requirement could'be met Errs B?. exterior siding stractaral sheathing,.end Interior drywall. Wall requa'eraehts apply'to by R 19 cavity insulation OR R 13 cavity Insulation plus R•6 insulating Zpply►Ing. ,sae er mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame constriic�tion. wood .',moms apply to floors over unconditioned spaces(such as uncopdidonad crawls"paces;basements, Is The floor reVii P trements. I de must or garages),Floors aver outside air must meet the ceiling requ of conditioned. fire o aque portion of any Individual basement wall withdovws and sUdia�g �ss5daorbselaw gra The ea P ulrament'as above-grade walls, W requirement meat the same 'R=value req fig. Basement doors must Ineet.to door,U•-?valua basiMents must be Included with the other glazing. d.scribed in Note b. '-The R value requirements are for unheated slabs.Add as additional R•Z for heated slabs. °it lan to'install more ' if the building utilizes elgdde resistance lieatin8 u na Ieca°f cooliance ling equiproach pment,the'egwpjnent with the lowest than one plece of heating equipment or more,than e p fist maet.or exceed the efficiency required by the selected p able]5.2,1a m aT 'eno qu � own s, .effect Y, . e closest city or t OTES: table lavols.Insulation R value are m��acceptable-levels. N acceptable-'slues are maximum p d.V v nts, as an one • are include struotural comp a)C31azlag R.value roquiresnonts are for insulation only and a not anal greater than 0.35.boor U-values must be tested b)Opaque doors In the building envelope must have a V yalua no 1 a ailhe include the manufacturer 1n accordance with the NFRC test procedure or taken ow m the door U value ' anted by them tin for that door d docum . a U value rating an an aggregate a door. If a door contains glass and ggTe o determine compliance of th in?able J1,5.3b• our windows and use the opaque door U vaiuo t glass'area of tlae door with y One door raay be excluded from this requirement(1,c d I$ace wall compoonen include)'two or more areas with c)If araing,`wad flear,basemen%wan,slab•acip, Y Pof elation levels,the component complies if the ar,a-welghtad g®R if 6 we;g a average U- different braw to s component' Glazing or door components a requirement for that comp a uirement(0.35 for doors), e R vahi q e V-Value r q value of all windows or doors is less than or equal to ---..__.......__—__ _ 43 fHF Tpk, ' The Town of Barnstable ISTAIBM Department of Health Safety and Environmental Services uss � , Building Division 367 Main Street,Hyannis,MA 02601 " ;08.862-4038 ;08-790.6230 PLAN REVIEW 3wner: � r Map/Parcel: (70- — 0.5 .7 — Of '7 ?rojectAddress: C.)-- 4 Builder: D c"Q.9 The following items were noted on reviewing: i� PI r� j rS 0L PTO K zP KG-, 1 F Reviewed by: , Ar--IA" Date: �"-0 M J Y pper- _ Y: jay � J r a €�Y �s��P�� 9 5Dor AM , I i 4a IT IA. "o AIqg i fji 1 i J I - I I y to y + INC It E Y 5 i 1 2 rf, � - Jr ,v ?r/p 1 r �Gocl } I A TPC v INN y a 401 .� ., .s jc"' 4 - yr Cyr N G I f Lv ��/l 0 z �� F Y2 ! s'� f �-� f 9 v'_ a'` .��t ... Y ..... C a.. �' fi ` d __ ,3 J �� ��., ter i� T- JUV rr � - _..r-....-...r...h.u..•rr-m,... .. .�__ ;,'n' ��`�`"�Y � mac': A�j .✓ �u� e+ - ._ J • • yr. tY. tirf^ `qq1 • 40, .......... y r - r v M . � Y v ^l� r� F .'�.: � • - � is I, _ , �t - - -- f t LET qL _� I F y7 v ` Wocr� rAj � i xl5TlA Ir— D Gu ooD Zo S�z EE i 77 JAMES c.r] TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map '' Parcel 05 70 Permit# ?M 3 Health Division® `�'�� Date Issued Conservation Division <�� - Q Application Fee Tax Collector_ Permit Fee Treasurer /tafflSEPTIC SYSTEM MUST BF Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 30) AAW, Village'T C 7 'V/ #6— Owner ®� Address �• a e Q�ekb to C.QrJ 'yflLe Z Telephone 5d00— Permit Request offk 3 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation D Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family " Two Family O Multi-Family(#units) �. Age of Existing Structure Historic House: 0 Yes 4 No On Old King's Highway: ❑Yes )'No Basement Type: #Full ❑Crawl O Walkout ❑Other Basement Finished Area(sq.ft.) _('� Basement Unfinished Area(sq.ft) Number of Baths: Full: existing o 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: 0 Yes )i�No Detached garage:0 existing Cl new size Pool: 0 existing ❑new size Barn:O existing 0 new size Attached garage:0 existing Cl new size Shed: existing 0 new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use BUILDER INFORMATION Name Telephone Number �53LOP-6APP7 Address 36 Au Ne4 y License# C.m 4,1V Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ���r �/, Y/u�✓J SIGNATURE DATE FOR OFFICIAL USE ONLY ,?EtMIT NO. DATE:IISSUED MAPK/PARCEL NO. r ` ADDRESS - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGM= FINAL ftl PLUMBING: ROUG y sl.,.0� FINAL tV M� GAS: ROUG% r=m FINAL FINAL BUILDING ; ta�3 �0 I tit N DATE CLOSED OUT 0 ASSOCIATION PLAN NO. I IKE Town of Barnstable - ,x�' Regulatory Services BAMSPABLE, : Thomas F.Geiler,DirectorMAM - 1639. ,��� Building Division Ajf N1°�A Tom Perry,Building Commissioner 260 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ----------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: 7,✓ JOB LOCATION: 3d a �j ivul VJ q `� �Q� iI,��Ge / Do�G 2— ^n—u�mff__P_P4 ber sstreetvillage"HOMEOWNER": J" name home phone# work phone# CURRENT MAILING ADDRESS:ALI city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements Signa re of f164owner,0 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 alicensed 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 . E Tow. of Barnstable .' ofTM � • , ' Regulatory Services f sseatrt a Thomas F.Geller,1)irector, q�Al.k Building Division b h1P • Toth Ferry,Building Commissioner' ' 200 Main Street, Hyannis,MA 02601 0 Office: 508.852-4038 Fax. 508-796 3 2 0 pate ' AFMAVIT ' FSOME MPRO'YEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION. MGL e,142A requ=—es that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition,to any pre-existing owner-occupied buiidiug containi:dg at least one but not more than four dwelling units or to structures which are ad]aeent to such residence or building b e done by registered contractors,with certain exceptions,along with other requirements, , e • Type of Work: '//�c yu 'w7 Fstun�tecl Cast ,�y6 D - Address of Work: Ovruer's Name;_ � .. ;Date afApplication: �/5��_ '- • •• • I hereby certify that: Registration is not required for the following reason(s); ' []Work excluded bylaw tR7db Under$1,000 Building not 07mer-occupied Downer pulling own permit Notice is hereby given that; • OARS PULLING THMR OWN PERMIT OR DEALING WITH UNREGISTERED COI'i'I'I,•CTORS FOR AYPLICAB,LE HOME IMPROVEMENT WORSDO-NOT H.AYE ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUI`iD UNDER MGL c.142k, SIGNED UNMBR?BNALTIM OF PEPJURY Ihereby apply foi aPermit as 60 agent of the owner; Date . Contractor Name RegistrationNo. Owner's vcne I V -._ _ The Commonwealth of Massachusetts - - Department of Industrial Accidents' 660'Washington Street - 1 Boston,Mass. 02111'. v workers, Com ensation Insurance Affidavit-General Businesses // / /ti}.W;y..:tiar. •;ar,P+'�PS,.•`'�v+. .�.. :ti 'j: '� ,„�',w1stV], _ / name _,a_ 3d� N��e VV,� �� - �377 work site location full address o one $ sines e: EJ I am.a sole proprietor and haven u T'p • []Retail❑Restaurant%Bai/Aating�F,stablisbment working in any capacity. ❑ Office D Sal'es(mcluding.Real Estate, Autos etc.) ❑I am an em to er with etn to es(full& art time: Other /r�,/%/% %///�//%%%%%/�/%/%//////%/%/%/%%/�%//%/%/ I am an ev ployer providing:Workers' compensation for my employees working on this job.. com an '. aine: `.t., j.•r:. '�=i>• 4 •.:,• r»:- :7 ..�.. � •' '•t•''' ). �• mow',. i �' 1•�::(. >,.•t. 1, sddr'e'ss ;, _ ;t.t .• i:.:., 4. .:�;a::s//•i±,.' r; .: •, .Cr ....1':.4+•�•1.• ,,,L..7 •l:l• •.t •.P� '� •'•1•Z:; .t•j,.•: ti, ... ., hone.#r 5, L :���r>r• :'.. •.i: ! ;;{r ^.! .t••L' .i. '',�•t. .:s• �•5;1.C• 'r•!•4:' 'i . [] I am a sole proprietor and have hired the independent contractors listed below who have the following workers' .compensation polices: COm G!'. ,1'.a:.�� '•,. .::l:r,fr .•t.• '1i ' .., ; •t :rh",:�,'• i-;:;'r •i •�+�' ' .. `.t`:'. a �. ••i _ •ri.�: (: address:: _ 4 .h. .4:e., �`r• ,•;'. :t k•'Tr, •5 4..,a.;..:�a,•a:•{,.•i. •i r'. .lye. ( t•r: YI�'; `(,S, Cl :,iy`,•. 1.:�1:�` 's''S,�?�' ,f,• •.� 'se .i�_r.M�:' :':i i .. ,:.; �.� y- :r•, r: `•'ii'•k•i�.'' -;�. 'fit. • •`, %ysr: �;I` '• , �".e.'.`,a.,:r..;;,r,at; ' ..`, , '11C :��': r.. �Fl��.,`.`�': ?i� •t'. ins'iirence'co. :•�� _ .t,,•irt ;" .. IM ''•^''' l///////%�///%�/, FIR coin aD• tl9ate.+., a:• it '' address: •rJ •.',, L•1. .Y, •{:• ••3�.." ,:i l., .tOZl V:}I'>•:. itsurancpig0:' 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$1,500.00 and/or one yearn'imprLsonment as well as civil penalties in the form of a STOP WORK ORDER and a rma of$100.00 a day against me. I'understand that a copy of this statement be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby c ify u er e pat 'and penalties of perjury that Me information provided above is Prue ancorrect . tUre _ Date _ :;�J lV --y Signa .� Phone# .'y0_tj y�r .17 Print C .�J official use oaty do not write in this area to be completed by city or town official ar permit/license ❑Building Department , ,> city or town: • ❑Licensing Board [)Selectmen's Office -check if immediate response is required ❑Health Department contact person: phone#; ❑Other a (rev5ed Sept 2M3) Information and Instructions. vlassachusetts General Laws ch4 pter�152 section 25.requires all employers to provide workers' compensation for their. loyees: As quoted from the law', an employee is.defined as every person in the service'of another under arty contract lie oral or written. ofhire; express or unp . •� 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 owher of a dwelling house having-not-more than three apartments and-who resides therein, or the.occupant:of the dwelling house of ?sobs to do.maintenance, construction or repair work on such dwelling house 6r on the grounds or another who employs�E buildingappurtenant 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 dr renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has eeptable evidence'of compliance with the insurance coverage required. Additionally,neither the not produced ac ' cotrnnonwealth nor.any.of it s political subdivisions shall enter into any contract for the performance of public work until ompliance with the insurance requirements of this chapter have been presented to the contracting acceptable evidence of c authority. APPlicant� . . Please fill in .the workers' compensation affidavit completely,by checking the box that applies to your situation:;Please supply company name, 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 ffid'"law"or if you ate ain a workers'.compensation policy,please call the Department at the number'listed.below. aired to obt ,. re . , . City or Towns . Please be sure that the affidavit is cbmplete andprinted legibly. The Department has provided a space at the bottom of,the affidavit for Xou.to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fi1l..in the pe1rrntlhcense number.which will be used as a reference number. The.affidavits may.be.returned to the Departmentb}�•rna or FAX unless other:arrangements have been made. The Office of Investigations would hike to'thank you in advance for you cooperation and should you have any questions,, ' please do not hesitate to give us a•call.- The Department's address,telephone and fax number: :.• , , The Commonwealth Of Massachusetts• Department of Industrial Accidents 6iflce of j�esfi�tlens ' 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext:406 b5&A 36 you Ir j J Page 2 of 2 NORTHEAST BUSINESS TRUST Premium Report Prepared For:Joe Binette,Mashpee,MA, 02649(Act#1104060654) Quote#:410407000711 Prepared By: Ed Barulli 800-464-0039 Ext.]] Date:7/16/2004 This proposal does not constitute a guarantee of benefits,coverage,or rates.Final rates are based on actual enrollment. Rates for medical plans apply if enrolled on 811/2004 Joe Binette Mashpee _ t_.eI'191PS �. Namw _ — i/F _— Dob Home Zip F 1/l!1970 _� a arrler Reserves the right to revise these rates at any time before or during the policy year If there is a change in law or regulation increasing the carrier's cost of providing the health plan elected. Northeast Business Trust(NBT),a leading provider of group medical plans for over 25 years will be happy to assist you in setting up a medical plan best suited for your business.Please review the enclosed material and call any of our health care specialists who can assist you if you have any questions,Ph: 800 464-0039 Fax:(978)663-5431 Website:http://wA,"I.nbtgroup.com www.nbt rou .com g P WA �6a( �P . ast fi�SSc4� e�n1 ,wb e , fJ �to"o I l�- �� S 1 7/16/04 10:49:47 am +1 801 0 MRS P.1 Mountain Financial: "Where the goal is M 4 U fN ? A 1 N to make our agents Happy"! financia group ine. Requirements Received July 16, 2004 Mr. Jeffrey G Pepi EPIS PO Box 86 Centerville. MA 02632 Application 7 1748227 US Financial 0000336780 YLkSSAN M. GH,ADBAN _ 23 WIDOW COOMBS WALK SANDWICH,MA 02563 Thank you for choosing Mountain Financial and your assistance in the underwriting process. The following requirements were received and sent to the carrier: Requirement Received Req Of Status VERIFY 07/16/2004 Carrier Received COMPANY REPLACING? In order to expedite the underwriting process, please note that Mountain Financial is responsible for all ordering of APS and Inspection reports. All MEDS and.tabs call be ordered by Mountain Financial upon your request via phone or e-mail. Please contact us if we can be of izirther assistance. Phone: 800-377-6344 Fax: 208-472-3438 s ptHEip�� Thee Town of Barnstable _ inW O,' BAR`1STABLE. ' Department of Health Safety and Environmental Services 9 MASS. 0a PrFOMPya• Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Peck l 3011') Location 36Z AYtieS Permit Number 78Z�3 Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: y mk5SiA., ori(? Sono 4111'� J Z \\ (( ' Q k S i cl.e b ow I)A C otn�-Yl vl o uS 1 11 I I\G 1 I 1 vt s S ,M U 5� e 1 r\ 't Z I". &C s(U rid C e yo3'I -- Please call: 508-862-4048 for re-inspection. Inspected by U L... DateI610y U TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ��Map :� Parcel 05, 6 Permit# 1+9 �, � 2 5 2�i �b2 �1�3� 7� o Bi,RI siABLE Health-Division Date Issued Conservation Division ., g o Application Fee Tax Collector o Permit Fee ✓��� Treasurer SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. VM TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REOULATIOM13 Historic`OKH Preservation/Hyannis Project Street Address 3y -� AIm-s t&i �2 TWOS/ A /n'7 C�ZG� Village �l Owner c�c-. Address 36d, 1 Af /Jet AnA�I, Telephone a"-3 7, Permit Request,a r Square feet: 1 st floor: existingOL proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation "o Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 'RNo On Old King's Highway: ❑Yes 1)cNo Basement Type: *Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) _ Basement Unfinished Area(sq.ft) 5�7� 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 1�fNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes V'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:)4 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address b� f ��� License# .Q kCJi1$i A-vA 02,63 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO vY► SIGNATURE IAIDATE ��� e�y� a FOR OFFICIAL USE ONLY ev ., Ph NO. DATE ISSUED MAP/PARCEL NO. - 7 -~ �'F I 'ADDRESS' ~� VTILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION =� FIREPLACE ' a ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH--a to FINAL GAS: ROUGHS i T FINAL'-' Y� FINAL BUILDING - DATE CLOSED OUT .^, ASSOCIATION PLAN NO-"---- r" ` c V d All OTE:not all symbols will appear on a map : QZ`—�- GOLF COURSE FisIRWAY EDGE OF DECIDUOUS TREES ,r• " -`" � EDGE OF BRUSH t ORCHARD OR NURSERY [ EDGE OF CONIFEROUS TREES MARSH AREA MAP 170 ~~~ --- EDGE OF WATER MAP 17 =__ /// DIRT ROAD 7 1 62 DRIVEWAY . j1 . �—PARKING LOT J t PAVED ROAD i 18 �� 3 ❑ # 03 \ � � DRAINAGE DITCH — PATH/TRAIL MAP 170 PARCEL LINE** — MnPtto PA MAP# 11 ( J� 7 / 21 E PARCEL NUMBER j #1860 —HOUSE NUMBER f' ok� 2 FOOT CONTOUR LINE ( � �( io 10 FOOT CONTOUR LINE Elevation based on NGVD29 1 1 4.9 SPOT ELEVATION j M APB STONE WALL o -X--X— FENCE 2 ® � RETAINING WALL -- — # ( . RAIL ROAD TRACK STONE JETTY POOL SWIMMING POOL PORCH/DECK ❑ BUILDING/STRUCTURE E r_.n...r._r. DOCK/PIER t . ...._ \ 4 Q HYDRANT �`'�•�.�\ e VALVE O MANHOLE o POST 0" .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 I C I N F O R M A T I O N S Y S T E M S U N I T .p SIGN ® STORM DRAIN M PRINTED SFAIE:IN FEET *NOTE:This map is on 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 James 1"=100'scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE TOWER w "•- e 0 20 40 National Ma Accuracy Standards at this do not re resent actual relationships to ph wl o6 ech Cor oration. Planimehics,topography,and vegetation were mapped to meet National Map Accuracy Standards f:\dgn\conservation.dgn 05/28/02 02:34:33 PM Town of Barnstable �OFINE Tp� " Regulatory Services Thomas F.Geiler,Director BARNSTABLE, y MASS. $ g, 1639. Building Division ArEo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ) ` JOB LOCATION:. , lf@S VW� (/�eh-)0J_,'1_( °'14 0 Re,9.2 �n5 number street village 2 villagee .HOMEOWNER,,: Q �h I �Op '�y7�f�W"�Jb �"�! 337 name —T home phone# work phone# CURRENT MAILING ADDRESS: / - s city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspec,'on o edures and re ements and that he/she will comply with said procedures and re a ents. Sign re of Ho eowner 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 ..`E\ The Commonwealth of Massachusetts _ Department of.Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location 30 2 A� �%4 �j 1 city vet/ 3 2- yhone# ❑ I am a homeowner performing all work myself. I am 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. _ ::::.:.: :: :.:: :comparrv>name :: ....................... . SSi sddf� :n:i;i'r:;si;:;: ':•::;ii:i%; >::•:< '':;:'i::i<;:`:.`%4i:";;i<>:;; .. 'f, ... .. ..... ... ... >: ....:: :..:.::.:.... M.;. phone .:... ................... � CBi`CD:i';i: ;" i:.i;' i iYyjiyi; i;i`y:i.'2:<::::?•:`�<i';:;':':`?f">ir:::i:.` :::::`a.:1:;:�:'.::.,,:°i <'i is^.:2 i>; ris�an ❑ 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: tonioa y n a� es sz>=` b esn-raa ................................ c $n as ..:::.<:»::>::>::::..;.;;::. :....:....... X.M0httn # ih 1i. Failure to secure coverage as required m►der 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 weII as dvII 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 fo ed to the Office of Investigations of the DIA for coverage verification .I do hereby c u t d penalties of perjury that the information provided above is true and correct Date. Signature Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# OBuflding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; ❑Other Oevised 9/95 PJA) 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. An employer is defined as an individual,partnership, association, corporation or other legal entity,or any two or more of the fore oin engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or g , gJ 1P � g g P e of an individual partnership, association or other legal entity, employingpemployees. However the owner of a . trustee ,p p, g 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 ' situation and Please fill in the workers co ensation affidavit completely,b checking the box that applies to our n►P P Y� Y g PP Y 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 requiredto obtaui 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 permitllicense number which will be used as a reference number. The affidavits may be returned 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 questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 OptME r Town of Barnstable Regulatory Services sni ,MASS. " Thomas F.Geiler,Director 9 nss. � �p i63q. ♦� Y renµa�°i 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: �1/`e l� // K— Estimated Costi Address of Work: ( Owner's Name: p Date of Application:S/sza��o® Z, I hereby certify that: a Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied NOwner 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 ent he owner: a ate ontractor 14anie I Registration No. OR Date - Owner's Name r Q:forms:homeaffidav BOiSE- Single 11-7/8" AJSTM 20 MSR Joist1J01 BC CALL®9.2 Design Report-US 1 span I No cantilevers 1 0/12 slope Tuesday,April 04,2006 09:47 Build 141 12"OCS I Repetitive I Glued&nailed construction File Name: BC CALC Project Job Name: Pepi Residence Description:1st floor joist Address: Nye Rd Specifier: Bill Campbell City, State,Zip: Barnstable, Ma Designer: Customer: Jeff Pepi Company: Shepley Wood Products Code reports: ESR-1144 Misc: 1 i y 20-00-00 ' BO,2-1/2" B1,2-1/2" LL 400 Ibs LL 400 Ibs DL 100 Ibs DL 100 Ibs Total Horizontal Product Length=20-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% . 90% 115% 133% 125% OCS 1 Standard Load Unf.Area Left 00-00-00 20-00-00 40 psf 10 psf 12" Controls Summary Value %Allowable• Duration Load Case /Span Location DISCIOSure Pos. Moment 2428 ft-Ibs 55.2% 100% 1 1 = Internal Completeness and accuracy of input must End Reaction 490 Ibs 42.8% 100% 1 1 -Right be verified by anyone who would rely on Total Load Defl: U556(0.426") 43.2% 1 1 output as evidence of suitability for Live Load Defl. U694(0.341") 69.1% 1 1 particular application.Output here based Max Defl. 0.426" 42.6% 1' 1 on building code-accepted design properties and analysis methods. Span/Depth 19.9 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dirn.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Wall/Plate 2-1/2"x 2-1/2" 500 Ibs 18.8% n/a Spruce-Pine-Fir (8 ask questions,please call B1 Wall/Plate 2-1/2"x 2-1/2" 500 Ibs 18.8% n/a Spruce-Pine-Fir 00)232-0788 before installation. BC CALCO,BC FRAMER®,AJS-, Notes ALLJOISTV, BC RIM BOARD- BCI®, BOISE GLULAM- SIMPLE FRAMING Design meets Code minimum(L/240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets User specified (L/480) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND-,VERSA-STUDS are Composite El value based on 23/32"thick sheathing glued and nailed to joist. trademarks of Boise Wood Products, L.L.C. User Notes Floor load only { Page 1 of 1 The Town of Barnstable MAS& Department of Health Safety and Environmental Services 1659. 'OrFD Mo►'t�' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION W C evv-re-'—U c Location of shed(address) Village 30 Property er's name Telephone number �X [ � O n s- /o f Size of Shed Map/Parcel# SifnaMe I Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic Distract 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. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN ' Q-forms-shedreg �- lV 47- 12 _ /OD of , 45 3 AC. o / SOO6 `o 33/ 00. 00 N o 43 15000 � Q � �� m ,1 � OO�� 4 O, b lr� 1630 6 �.. 7p �E�S 15-956 7. L- 80. D _ ,�_ � V i G� AV 3o.v � �P S (+p ' S2 _ S 82 O ' S _ \90 ,rt�,vr,,,� r f _ �/82 2D 28 YI/ 2.4283 _ l SUS T •• A/ /0"42'00",F- SO. 07 A .4 �� l �yy SE ANS C'✓,�CLE 46 48 7 Zocos 2� . To T,al i , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map (`70 Parcel 07'1 ~ O ( '� ' < Permit# .J� �• ' Health Division 'Date Issued /� /v —v�000 Conservation Division Fee n:;;Pe6^ Tax Collector Treasurer /�G -e--- /i�T ��� 2cb�` Planning Dept. , • Date Definitive Plan Approved by Planning Board Historic-OKH, Preservation/Hyannis , Project Street Address Village - Owner q— N Address Telephone T L -7 3 Of Permit Request 'z-e U0, Q-0 i Square feet: 1 st floor: ex' ing proposed 2nd floor:existing proposed Total new d Estimated Project Co ,5—D Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House:, ❑Yes ❑No' On Old King's Highway: ❑Yes O No- Basement Type: ❑Full ❑Crawl ' ❑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 ❑Oil ❑Electric ❑Other r 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 L1 Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name 0 ca jL)e Telephone Number Address 30), hoy r wG� License# �•��e/v�r'e, 14 vdG 3 Z- Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE V/1 DATE t g FOR OFFICIAL USE ONLY PERMIT NO.., DATE ISSUED MAP/PARCEL NO. — — ADDRESS ,. E VILLAGE _ �. , r ` OWNER ' , ,. i + .— ' . �.. •, `°, � .-.' � DATE OF INSPECTION: t FOUNDATION Y . FRAME - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL' t _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL + FINAL BUILDING DATE CLOSED OUT a ' ASSOCIATION PLAN NO. i d The Town of Barnstable `0�' Department of Health Safety and Environmental Services rEo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law OJob Under S1,000 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. L06. rul d D ontractor Name Registration No. OR d Lot p � Date 's Name q:forms:Affidav The Commonwealth of Massachusetts Department of Industrial Accidents office efiorestigatioos _ t 600 Washington Sheet - _ Boston,Mass. 02111 Workers' Compensation Insurance Affidavit i 1 on 0 J^t U 0 '�2 ci #�-�t�r 1 4� hone#56��y'�T-7joq I am a homeowner performing all work myseffi ❑ I am a sole proprictor and have no one worldn in anv�pachy I am an employer din wofl=1 compensation for my employees working on this job. x. cum "ss > > > » £ > 2 % ill Y! }'al cv insuancRRIN ❑ I am a sole.proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following h to '9n nam ........ ,... :address::% :::.... .:. . �< .................. ........:...... .%.a< ..x r :.:w::::r.:}}:a}:::.:.::::::...., .n....• vvyw:.}.. v:..}�.......:...:::....... ::::nv:.:•.:vv:::::::::::.::.;;..:.................' ........::::..............::::•}. ..r:.::::::::::{?ri;•i}}:a:•}i}:•}::i:n:Ti:}i:iii:;:i:`vi::iiiiip}}j$:::v:.v.vivr:::+:.:v.v::::`�:?S:i'^:.'}:v:x.•....:::::::v:r:..v.-:�v::.:.`::x?;4ii:},}r:.... ............ .......... ........n.......• .............. ................... K......w::.};.}}}}:..::'::a:x:w:-v}}:.. v..vvw. .............::•:....f.......:........................::•:nv:..........r............ l[�g. :a ...... ....:... .................r ......... .... .... ,....r.,,,............- .....:•:...fi. ,..:..:...............Yt-"•••}i';:;:,::::::::::r•r::•fi;}.<.•.;•{,:a;{.�;c,:;eYw:::%:.•::.". .. ,,. .v .....rrn,n....,......:v::::::::......•:v........ ,w...n...a... ...:.......... ::::::,.......vxw::.v:.r.,{{�:•.v}:!•::.v..........:{\}:... ............. .................................... :: e:. ....::..:: .ram .. :;i::::;':i:}:!i};isiii:;i i:isji i}:J}}:•:J}}i:?Ji^iii;}:;{(:;::::4i;;.;}}i:<•:i:::4ii:•:}:;::.;:^: ::: ::i:::i:i:::;:;.ii ;:i}i>:v'vi::: :;:{•:}:4Y.... ......i:<y.y::ry::;::::::.;}..:::i::'-'-ii:•:-.} .. - :!• :v::::::::.�::.::}i:•i:x;•}}:!;• :ice::::::'::::::::ii}:}ii}::::�:::•:. -... -- - .................... `ene .......... ..:.::::.}:}:•:v'-}T:�}:•}}:a}:or}>xi>:•x•iw:fi::•:i.•rvvvn}iai}:•}x�:}:-i}:;•x?::::v::. :.:::n:..?::i::...::::::::.:::.::.....:v::v::::i:•::::4<:aii}:{•}:':?}}:•:fi:gi:•}:ia:a:•;:,T�?;.:j:•iv:•:�+.j:•?::}:•i:fi;ti;' OIi ��j:!?:.iiiiiiiY::::?:4iiiJi?:::�i ::::.::�::::::.:.:.�.:......::: n�nrsnce Failure to secure coverage as required under section 25A of MGL 152 can lead to the imposLtlam of erlomiasl penaltln of a stile�to 51,500.00 andlor one yea'imprisonment as weR as civa penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against ne. I understand that a copy of this statmunt may be forwarded to the Of ace of Investigations of the DIA for coverage verideation I do hereby certi Pau", Penalties°f pa*q that the injormmion provided about is trio wad coned Date j d° Signature �' �C1. phone# Print name ofndal use only do not write in this area to be completed by city or town otfldal city or town: peemit4lcense# ❑Building Department ❑Licensing Board NQL ❑checkif immediate response is required ❑Selectmen's OtIIce _ ❑Health Department contact person: phone#, fir----. WN (wind 9/95 PJIy ' e own of Barnstable tNE.p= ° 'a. Department of Health Safety and Environmental Services Building Division ` t?Aexsrest.B. ' 367 Main Street,Hyannis MA 02601 MASS. � 1639• pTEO PAA'I Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE:— JOB LOCATION: 3 O--A Ayes 6,4-u o A number street village "HOMEOWNER": ,�, 54^t name home phone# work phone# CURRENT MAILING ADDRESS:" city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said proc dur s and /r/e/((J��/}��iremeQuv b Si atu f Homeowner" r 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN November 17, 2000 To Whom it May Concern: This letter is in reference to my daughter's house at 302 Ames Way, Centerville. Presently my daughter and son-in-law are adding a master bedroom,building permit #49478. As an inspector for the town I will not be doing any inspections at this project and was not included with the permitting process. However,being the good dad that I am, I will be helping them from time to time. I have no financial interests in this project. . Sincerely, Tom Perry Local Inspector r TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATIONrl -_ Map / V Parcel `� �f Permit# qTY Health Division .h �J t�` Z Date Issued /O--JD e� Conservation Division ' - Fee Tax Collector, Treasurer b ov SEPTIC SYSTEM MUST EE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 ENVIRONMENTAL CODE Al Date Definitive Plan Approved by Planning Board TOWN REGULATIONS' Historic-OKH Preservation/Hyannis 1' Project Street Address 30CR am-tos. way , c t ),11 e mLz- Village v��e OwnerdelP. Y' —P I ChD le, fe—P, 1 Address 0o� an)es unu Cenrioxe— Telephone Permit Request C 01 Square feet: 1st floor: existing5—Ma— proposed Q 2nd floor: existing proposed nD Total new �7V Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size ,3 r7 , /6 /,/ randfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ' Two Family ❑ Multi-Family(#units) Age of Existing Structure - Historic House: ❑Yes Ao On Old King's Highway: ❑Yes No Basement Type: ❑ Full 06rawl ❑Walkout 100ther x Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 9-1 t0 Number of Baths: Full: existing new Half: existing I new Number of Bedrooms: existing_ new I 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 Wo Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn: ❑existing ❑new size r Attached garage:❑existing ❑new size Shed: existing ❑new size I 0 Other: Zor'iing Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes WNo If yes, site plan review# 4. Current Use Proposed Use BUILDER INFORMATION Name r wneg tL Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE la, DATE Iiq FOR OFFICIAL USE ONLY. PgkMIT NO. DATE ISSUED ' ` ' MAP/PARCEL NO.JF } _ ADDRESS ,, VILLAGE. r OWNER DATE OF INSPECTIo&*y FOUNDATION,jl Im :MA t -FRAME,' '' • ? .t _ ` r INSULATION r v FIREPLACE s ELECTRICAL: ROUGH;$ �' � FINAL F PLUMBING: ROUGJ�; '! C: FINAL' M, GAS: ROUGI r a FINAL ` FINAL BUILDING 1K a 1 J DATE CLOSED OUT ASSOCIATION PLAN NO. ► ` ¢' .,� i MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit . # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE : 1 or 2 family, detached HEATING SYSTEM TYPE : Other (Non-Electric Resistance) DATE: 10-20-2000 DATE OF PLANS : 10-20-2000 TITLE : PROJECT INFORMATION: PEPI COMPLIANCE: PASSES Required UA = 109 Your Home = 109 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 440 30 . 0 0 . 0 16 WALLS : Wood Frame, 16" O.C. 503 15 . 0 0 . 0 39 GLAZING: Windows or Doors 73 0 . 360 26 DOORS 21 0 . 350 7 FLOORS : Over Unconditioned Space 440 19 . 0 21 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these . documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 . 4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE : 10-20-2000 Bldg. Dept . Use CEILINGS : [ ] 1 . R-30 Comments/Location WALLS : [ ] 1 . Wood Frame., 16" O.C. , R-15 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value : 0 . 36 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS : [ ] 1 . U-value : 0 . 35 Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE : [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3 " clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must .be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications . DUCT INSULATION: [m ] Ducts in unconditioned spaces must be insulated to R-5 .. Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC . system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 'and J4 .4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- LIVING SPACE (high end construction) square feet X S11�/,sq. foot= (above average construction) ' square feet X S96/sq. foot= U (average construction) square feet,X S$7/sq. foot= GARAGE (UNFINISHED) square feet X S25/sq. foot._ PORCH square feet X S20/sq. foot= DECK square feet X S15/sq. foot= OTIM square feet X S??/sq. foot= ' Total Estimated Project Cost For Office Use Only /nclusionary Affordab/e Housing Fes Residential Commercial" Property Owner's Name Project Location Project Value P umber "Existing Sq. Ft. "Prop ed New Sq.Ft. Fee S 1AHFORM 1/3/00 r anxxsrABLL The Town of Barnstable 9� * Regulatory Services _. Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax:' 508-790-6230 Permit no. qq Date Z1J i la AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion. improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not-more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other. requirements. Type of Work: Estimated Cost Address of Work: 3Dc� 6"S - L2a Owner's Name: `l "cho P4 I Date of Application:T_ , I hereby certify that: ` Registration is not required for the following reason(s): ork excluded by law OJob Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. lqh= 19h 0-4k al Dat Owner's Name :forms:Affidav i _ The Commonwealth of Massachusetts =� Department of Industrial Accidents = OI/�ce of/ocestigations t 600 Washington Street Boston,Mass. 02111 -- Workers' Com ensation Insurance Affidavit i name: location- .it,— Y)1 I hone# IfYI am a homeowner performing all work myself. ❑ I am a sole ietor and have no one workin in anv capacity ❑ I am an employer providing workers'.compensation for.my employees working_on this job. ::.. :..:... iiddress. <:<: >:.:::: ..:.:::: . ..:: ...<.:;:::,.: .. atone.#s g ..:.: it I a sole proprietor,general contractor, omeowner,( cle one)and have hired the contractors listed below who have- the following workers' compensation polices: 3 - ::....:::<:::::::>::::>::>; . ::. companyna�ue adsess:: .................:::::: ..::...: :::::::.:::::::::::::::.::::::::.:::::.:::::::::.:.::::::::::.:::::::::.... . ........... ................................................................. n hone:#, ........................:::....:.... > z >: hsnrarrce•ca.:: ,.:. :..... . ... _.. opity#< ;;; ;•.::::,:.;:�.:;::::.::;::.>;:.;:.::;::::;•.,;;>.:: .;>;>::::.:>:<�':�":�?<>" _.. adtltess.. j 'tihtin 'i' ii:'` ' i:`ii:` is [y..}''` >:?: ::i: ::? -- - M. dug. :. _ Fafiure 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,S00.00 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. I understand that a copy of this statement may be forwarded to the Offlce of Investigations of the DU for coverage verification. I do hereby certify under the pains penalties of perjury that the information provided above is trw and cone Date C� �Sigoature m Print name -2 t` Phone# �Z o :300 official use only do not write in this area to be completed by city or town oillcial city or town: permit/license# []Building Department ❑Licensing Board. _ ❑checkif lmmediate response is required ❑Selectmen's Office - ❑Health Department contact person: phone#; — ❑Other Uevind 9195 PJA) 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. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged•rn 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 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 spa ce at the bottom of the in the event the Office of 'ons has to contact you regarding the applicant. Please affidavit for you to fill out vivestrgatt be sure to fill in the permitllicense number which will be used as a reference number. The affidavits may be returned in - the FAX unless other arrangements have been made. the Department by mail arr�ng . The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 1020- 6� QCILt� fi�Y7Ctk Gf�mCe�'/YCulS �'On�/� M�J�rrx2�aa I�� � � l� SCLl� nutt�cC- �- �'� Sub CUnfiac�'tS QD zi du c FCC . �lUck6Le -� i F1HE rj The Town of Barnstable BARNSTABM M^S Regulatory Services rE1639. Building Division 367 Main Street,Hyannis MA 026QI Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION j f Please Print DATE: /D V) 40 - JOB LOCATION: number et village 4 "HOMEOWNER"f lojd �CPoLQ_ j O name home phone/# work phone# CURRENT MAILING ADDRESS: w P�'L Y(/� lL.e_ a-- 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,provide d 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 require Ve . 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/ceitification for use in your community. Q:FORMS:EXEMPTN I, V rt�ANl I N G SECTION :• - - - - ALL DIMENSION LUt~18ER SHALL COLLAR TIE SE K0 SPF No.2 OR GETI"ER. � @ �B"O G. 2 xAFTER @ PYCXC- Zx(UCEILING anIgt a SHINGLE W/Is Le. FELT 1 �Ix PINE FRCI R-30 KRUT FACE) Fo BATIS R- UNFAcEp Fg BATTS SOFFIT VENt W/6•MIL POLY VAPOR 9ARRIEA O u 12Noo Fp) PINE Sorra L_ 2x FLOOR 401ST LD Misr 2No FLooR) ~���� Dom . • . "'�"'-` SILL SILL SEAL ��.• 1 0 AN[NpR BOLT � 6•p' OC. ~CONmn FOUNDATIO N INALI. i SMOKE DETECTORS O.K. B 0 3 � RNSTABL BUILDING DEPT. elk � . co + n � �� Curne s W q C-7 510, CZ-) LV 6;V, } — r.)--may """"1 r—•—� d v 4�LJ Nil, Dc� w II Cerrp e r �. E p 0 1 heC -+ TOWN OF BARNSTABLE Permit No. - ----- ------------ Building Inspector ■... �I!' Cash ---------------------- �`°""Y�\ OCCUPANCY PERMIT Bond -----------------__-- i J�Li "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address ?99 I,4-Q Sl+nre Dr, , hi, Mills Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .....................................................1 19......_ _ .................................................................................._........._._.......... Building Inspector SeL )Irmit number SYSRM MU 1AISTALUD IN COMPL LE, TOWN . OF 'BIARNSTAKE' BUILDINQ A.."'SPECTOR APPLICATION FOR PERMIT ....... . . ~�, .-._-.-.-��-�.-::..--]R����2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for o foU � Location ....... ........... ...... . ............ ........................................... Proposed Use ...... --._----_---.----------^_-________.._.. p " Zoning District -..Rne District ........................................ � � u� � � Nome of ` �=���f��,� A66rms � °="=. ---- -- �" ---------..`=~="="==�.-.^--.=.=-=-�' ' Nome of Bv//6o, --��-- � j��-�~�-------AJ6ssx ------------_----------..----. Nome of Architect ----------------------A66resa ............................ .. -...-----.- N 6e of ��� ---------.. �� �� --------_. - 1 � Exie,io, �^���� -----------.RouGng .. ------_-_. 11�r Roum ............... -------------..|noerior ----'/.. ...................................... - Heating ........ -.�K-............................................................Plumbing ...................... ............................................... ,� Fireplace '-- ----------------.Approximote Coo --..- �� �� �� r] *���- Definitive Plan Approved by Planning Board 19--------. Area --.srm-- Diagram of Lot and Building with Dimensions Fee � '�� ----' v^'� �' -------. SUBJECT TO APPROVAL OF BOARD OF HEALTH � I hereby agree to conform to | � � ^ ` - / ^ ' _ . . j . � ' � � � all the Rules and Regulations of the Town of Barnstable regarding the above � =. .�°.. .......... r BREEN, JOSEPH ---„i� 2'24.7.�..... Permit for One l/.2...Story „Single„Fam ly,.,Dwelling............ yam....... Location ....Lat;...R.4.4......3. Y.... �. ................... ............................... Owner ............................ t { Type of Construction ...........k:x:ame.................. r ................. Plot ........ .............. Lot ................................ Permit Granted ........... ...4.19 $0 r . i Date of Inspection c !Date -Completed .. .��.......: .�'" .........19 r try PERMIT REFUSED .. .: .:.......................... ..... 19 tn. .` ...................................................... 1.0.............................................................. ........ ............................................ - Approved .... . ............:........................ 19 t' ..! `.. .. .................................................... n f h v su E Z O L. ¢f' ILI ,STD f. o 144.atj. EWYIYO)7t,ne"•77Tp�. o, / 10x.. /. 9J'p9 � d. O p I 404 Z „S,L r �W P b \. 1� t �• ,r NZ ..Y/f !� ! '?^f BO.IC ;C sfiax. �ir7�r .2c1 f"t; _ IL 71 S.p .,+. .. ... .- ..-.� ,...._..__,. .., "'1 .. 4. ._ ... _ ._. "4 .... .,...,..:y .-• - -_r , d.:..:- ice" - . • off, - 3 `pA v i - �►-C o at /c+rs '. y ?f ,�s r �ia ;7 ... 11 110 0-1 / 16dr jr l , : O?j OF All • i a? ? raaA``� �yG OFjk�s v ry i+Z` FRANK a O tiG �j ; \ v k o CONERY J o FRANK Na.6232 O CONERY y - i � � U - J 65 . � t FFS `aC, �p AL . D P; lV o f �A . r y - Al T E.R v/k k AE. MASS d OWNITO I3 NJ tv Sol, { — FRANK CONERY I TRENTON ST. HYANNiS, MASS. 0ZWl 'O° � a�tETSREO ENcilNtEt9e r LANO 11NRV�YOP1 ' r 4 SCALE 1 IN ",Za IFT1 8 f I,91,90 ---------------- .sh0�rnl � �-7 P14r " Idej IAf,1/7 &C. ' �. ��. 3.24 �. 7.�. I �, a�/`s r / yam« d dy .�3 r�is - t' j g��r�a ,C�p � Q/ ��4It b ( boo � 0aih /23. zo 1 � o. / 0 3 0ski ..5/c, N 'L.,r>.�v 7 ,e VC -T / wry 6/ I._ ell t c a or s ///.�a17 9' 1 oo A0 e ' _ 6y fir. , . ��.,� rV�k f Avr� Of M- l v/ o ul ry + FRANK �b2 CONERY io FRANK rn+ No. 6232 U r CONERY co *t p No. 6573 O + c T r E��a``� Way -0 / °1 _ P LA.N OF LAN D W Te R u/kke- MASS, CERTIFY THAT THIS PLAN SHOWS �I ©p- THE ACTUAL LOCATION OF THE o STRUCTURE ON THE LAND AND j� � ° �d -S ZE-: k-1- E nI THAT IT C-ObiFORMS WITH T E � `��� a � � t FRANKr CONERY 5 TRENTON ST. { _< 13Y-LAWS OF THE TOWN � It 3 n HYANNi S, MASS. 02601 REGISTERED ENaINEE* 8 LAND SURVEYOR ti d SCALE 1 1 N -20 T • • L:J/f Y'/,9V o s 11/7 1 771 //0 6,Q,-k.y ` � V-!4 Zvi ¢�- � IQ , es_if�,v S •\0 - . � � •� � � b � . ; � .S�T�)rp. ..��D. .,�Q is. �7l YlYd)7 tT1 c. �'T 4 t ` !`* ' Ndr} * O _ � Lam/ % / i�; -5e Z"!G T Ct h /< 1 01 � - :� t. _ �<;•�: _//A/7 •sl=�'�:=%•®.It •:! J':L�77 rid - ,t .,Y - .— ..r>t2i:v -R-•_f,:-M*i-•-+.'�' -+.rT�,�Ocai�=inwv-- ,:J:ei+reT '_�r.•:m•".� N - rti:�Lt.-. �' p ., ` r •1 ' •f, a - r Cal c Y - — _ __, _._ ., _. •.,...,1-�.0 1.,.._... .:ry ,_yt._ _ 1.. .. _,a. 7 ... ,-. .•4'� n r -,. ..n r,r. R -'^r' ti. r-at. �...i-.-:.•.a�.ti..:�•.`-_i- a^a . _ .$, r .n ,. ...i. . .. ,r. t.i,. .._ U� ,. , .'7. :.e-•-••.:. :-F *..- t-.r.:i:• s - e��— _.. d. . • ay, , 1 - _ t •,r.� .. � D, .� ,, � ,. �� .:.i:a:..:e-;ya •�> �r:h .. ... - �O- .. art-.--"% •;a _. - i� .t . .. gzr;. G . '�/ �• L � � •;��,,f opt. � .. yi , j ' � .r. ._ ,.; .. fat• n� € ., - `• �- 771 i77 %9 v ��c... •• ��s i'� ors .///.Zo� ell .0 - mfJp.v f e _ f I J 1 1� �511'OF_ M , qj FRA . _ \ r c COW. NER H FRANK rn �� I a.�, •-* -°- " NO.:6232 CON ERY y 4 US O''. .,:-it .� ... �1Ca � sic. �. ��31 _4 b� �� `' '`� =rpQ`G�-`,-;•���� �, » � ,p N0.'6573 ao, ST O c ,> -••tt ',>� �'1��°"- ? ,s••r� \90 '�F 15T�� h ' , 1 0 tom✓` c -P�l AN ®F AND - v .Qj IAI FRANK CQN#ERY 5 TRE&TON. ST, . A y�h F9YANNiS. MASS. 02601LP m ' _ �•• ,•, -.ad... - ._..a.,— _ - T - _ ....a;.u:._r r __ , ,RECd15TBRE0'.6Aftiitd�E�!'A'LAP/D.'1.IRN4zEYO�i r'.. SCALE t .�N..��D.. ;: r • �.`I Ile rN- kA p SMOKE DETECTORS REVIEWED BAR PSTA�BL=EB UILDING DEPT. DATE ------------- FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING IMPORTANT ANY CONSTRUCTION THAT INCREASES LIVING SPACE BEYOND 1200 SQ. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. 7.4 n ' r 0 ` it V03 ia CA � C A ` C1 `- { t,, �.......«._ has•. �- �`. ..._....,,-... � y � ) 0 1��."� UPID� �/� �� v c� h. , o � 2 3a ih - •i. � � v , /S/o car�fi C ,�is�c s G � _ •- /,", 9-,r6 fit, C \, as. � A v S I . 1) ! N' '. O�V.,3 TR IJ C T 0/Y 0 f c e T p l . . � 03 � ,,� � '`� `� .� � .:S s��hr '•' f. o. Nf�s.s. �'�n Y�ro�? rn a ale ivc 001, Vi I.14 ([ 77 -34 WPE VI VVIC /749 x y - •t� S - r' i. r .Y L ' - -• r_sr.�.._.a.. .. • r - .ram ......_ .. ... _. - \ •'_t.. w i. • ,.:ten LVV - _— z T ' G a�. 41 • hI fer.;LrT,e c 3 \_ �'" •' O 1 FRANK �� yam, �.� S. I . 1U$ -4 FRANK ... o CONERY X -' _ No.,6232 t� to �} v o WINERY No_.6573�O ONAL �' C{• 7.7 d4 _ 1 •O x l ` a 1 o ' � � J °I`a PLAN of -LAN ,vTr-- R vlk x. e- MASS. OWNED 1 •+ y. ; u I ° Sol, FRANK CONERY TRNTflN Srt. HYANNiS, MASS. 0201 o SCALE 1 IN .20 ]'T. 6/I.9/.