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�! � � � � ���urd . . � .. r, s � � . s F t� ry , . _ . � � .. �-- e o a .. P - � � �� t �e _ � � 4 u { .. .� ,: � ;: n - � ,. .. � ,. ., .. - ,. Town.of Barnstable *Permit#3 ON6 Y�0� Expires 6 months ro is�u�date Regulatory Services Fee U BnRrrsrnsr.E. 9� amass. $1639. Richard V.Scali,Director �0 ATFD MA'I A _ BDu1 ing Div-i o - — --- -- Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us , Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -. RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number M r�4�-� Property Address ® (p Residential Value of Work$ a ex)6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) Ov ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor O�I am the Homeowner �K� ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. _ Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ` T�Re-side Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows C.c #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is quired. , SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 `, Town of Barnstable ` Regulatory-Services yMU LE.� 'Richard V.Scali,Director 1 39. Building Division T-©m-Perry,Building Cen nissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 4 Property Owner Must ` -- 61h fete and Sign-4his Sectt'on PIf Using A-Buildert_. fl_,., $.� 3 I, A \ as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of job) " "Pool fences and alarms-are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. nature of Owner Signature of Applicant Print Name Print Name Date Q:FORM S:O WNERPERMISSIOINTPOOLS Town of Barnstable y Regulatory Services �aFE rOiy,L Richard V.Scali,Director Building Division snxxsT Tom Perry,Building Commissioner MASS.9� 200 Main Street, Hyannis,MA 02601 prED µA't A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print _ DATE: +i=,- - JOB LOCATION: 'D T'Q�Z V K =. number - - street village to ^ 2 name home phone# - work phone# CURRENT MAILING ADDRESS: e_5`t v 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 j , I 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 Deparhneat minimum inspection pr edur and requirements and that he/she will comply with said procedures and requirements. Siynature 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. M HOMEOWNER'S EXEMPTION 1 • 1 .�, 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) Thisdack of awarenesg 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 akform/certification for use in your community. Q:\WPFILES\FORMS\building permit fo ms\EXPRESS.doc Revised 061313 r The trm).,nanxc iTt of Uassaclhms DepCrrhnent afhu&s&id Accidents Bastan,MA ai l -' wttnv.rritxs�ga�dut 'moorkets, CampensatfitonInsurance davit:BuildersfConLra_ctors/Eiectricians/Mumhers `canrt In formation. Please Priat b - Flame t3Usija,_s- 0Tzan zafiM ivi 0_w\l �A0-1 \ ;' ." r _ C i ,S:tatz/ �V LV , Phone 6 a d .Are you an,employer?Check the appropriate biro Type—'of project s �-_ I am a e�ta1 contt d I Pr I racor ma �e'4�e�: 1_❑ I a_*n a employer with ❑ g F 6= ❑New consf action. employees{fait andlorpart-dime}* havebj the sub-confmctors. 7__❑ I ztn a sore proprietor tyrparfner- ` listed on the attached sheet: 7- ❑REmode.ag ship and have no employees These€ub-contractors have g_ ❑Demolition -,vorkang for me in any capes ci y_ empla}qes and have rtolkers' 9_ ❑Building$uil �addition l {3 wor�IS' comp.inva anre. comp-insuraIIce_1 . 3_❑ We are a corporatimaud its la_Q Electrical repairs or additions officers haN�exercised fheir 11_. Pldmbin airs or additions, a homamvn�doing all wtx'ec ❑ �� rrryset£ [No waulmn'comp- right of eimnoptioaper MGL 11.0 Roof repairs �rezxa„re required]F c_ 152,§1(4} and we have no, employees-[No roomers' 1-3-1-1 odiwr comp_insmanc-reguired-1, *Any sppEcanl a'*`at cCmcks bes f1 um5t eso fM 01A th-_Serd0a bE10W d YWb3g iueII WorkEle rnmpeas Gn pviiq'i fa 9 Hnm cwn-s 0 sab�it ffiis Xf f i icsti g they aze+iGing sn zr0�c s rhea h re o�vsidr=couiiactars vmsi submit a a a dmit a�ca sacFi ( i�c tors tH ci c1_x�c this box must stt�ched as:d3iaonaI sheet shvwiag the ampe of the say- s Xmd stsffi uhethK donut those fizva carp uyees_ Ts the sul-cant actuts h-se employees,they must piuvide th=-+r workers'comp-Policy number_ I ant ata e:npZoyer That is prmidiffgttror.Viers'coTzz rurtivn irmtrartce far my enWLVgsm gelotr is the policy and job site lnShcBAce Go�ipa)2` Name:.. Polx-y ff Cr Self rap_Lt.<_- ExpirationDate: Job Site hd Tss: Cify115tate/ziP: Attach a copy of the trarkers'compensation policy declaration page(showing the policy n-awher and ration date). Failure to stare coverage as required under Sectioa 25_k of MGL c_ 152 can lead to the imposition of crim nal pmalties of a E M up to$15010a awvor tine-yearimpfivonmeent as well as civil pem1fies M_ fhe form of a STOP WORK ORDER and a of up.to�250_0+0 a clay against the violator_ Be advised that a copy of this statement maybe far warded to the Office of Imrestigations of the DIA far inszzance coverage veriEcation_ dri here c rr. tkspni s tirrrlpeng iss Dfpetitcry fhatthe in formctf-aaPrini d abzwa i s bwz artd correct Simatuzz: 1��f t� p 73ate.: Phone P t7,UiciaL is OnT . DU not Write in this area,ta bs completed by city or town o�tciaL City-or Town: _Pzmi#JLicense ff Issuing Antharity(circle oat=)_ t 1.beard of Health Bu-9ding Deparbnent 1 Cie IYTtaR a Clerk 4.Electrical Inspector S.Plumbing IncstFec€or 6.Other t Contact Fersan; phone# 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute, an employee is defined as"__.every person in the service of another under any contract of hire, express or implied oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased-employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees- However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall"withhold he issuance or renewal of a license or permit to operate a business or to construct buildings in 1be.*comrconwea:th for ujy applicant whb,has not p-roduced acce-of.ble evidence of compliance driE:n the irisurattce.cover age requirec+." AdditionaIIy;MGI;chapter 152, §25C('!�s ates"Neither the tom iovrea tl`ror any'of its poll teal-s�.ibdiv�sions sliail enter into any contract for the performance of public work until acceptable evidence of compliance v ith the insur-ance 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 sita.ation and,iz necessary,supply sub-contractors)name(s),addresses)and phone n,ber(s)along with t_heu cerb_Ec ie(_) of insurance. Limited Liability Co_,-Lpames("LLC)or Limited Liability Partm rships(L.LP)Yvih no employes other Than the members or partners,are not requ�ced to carry workers' compensation=' u7ance_ If an L`L.0 or LLP does have , employees, a policy is required_ fie advised hat his affidavit may be s lbmiited to the Department of indueuraI Accidents for confirmation of insI Once cover age. Also be sure to sign anal date the 2ffid2N t 'I he ar-f vit should be retuned to the city or town that he application for the permit or license is being rtquested, not the Dcpastment of Industrial Accidents. Should you.Lave any questions regarding the larw or if you are requ1-ed to obt3a'n a workers' compensation policy,please call he Department at he number listed below. Self—ionised companies should enter heir self-insurance license number oa he appropriate at. City or Town OfFacials PIease be sure that the affidavit is complete and printed legibly, The Depariment has provided a space at the bottom of the affidavit for you to.fill out y he event the Office of Investigations has to contact you regard lag the applicant- Please be sure to fill in the pemi`[hr-c se number which will be used as a ref rence number. In addition- an applicant that must submit multiple perm.ii/license applications in any given year,need only submit one of-davit indicai r g cu,_ent policy information (ifnecessary) and under"Job Site Address"the applicant should 'rate"ail locations in ___(city or town)."A copy of the affidavit that has been officially stamped or marked by he city or town may be prov-idk-d to ilia applicant as proof that a valid affidavit is on file for future permits or licenses_ Anew affidavit m,--t be'filled out each year_Where a home owner or omen is obtaining a license or permit not related to any business or coMMercial venture a dog license or permit to burn leaves etc.)said person is NOT required to complete this aff dw it_ The Office of Investigations would Eke to thank you in advance for your cooperation and should you have any ques aons, please do not hesitate to give us a ca il_ The Department's address,telephone and fax number: Common-Health of Massachust�tls _ `1 Dtparfi�nentQfIiidusirialAQ61ats5 Q-�xee�z��es4g�tFo-ns 600 wasliimgtan Sit Ttl,, 6I 7;727-4 9-00 w 4-06 or Revised 4-24-07 F�ix 9 6I7-727-7It9 a � AC� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel "l Application Health Division Conservation Division ol 40LP Permit# Tax Collector Date Issued r Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board - Historic-OKH Preservation/Hyannis Project Street Address Village C�,r,,.-k e J \J 4 Owner �e �'i/}f✓> �`��ea.� S Address Telephone S'� J Z y Permit Request 3 e�I LoA, ��f�`- p tr` o ✓I Lc d Square feet: 1 st floor:existing >u 0 proposed 2nd floor:existing proposed 900 Total new �U Zoning District Flood Plain Groundwater Overlay ,r Project Valuation Construction Type w a�vo Lot Size d �4 . Grandfathered: ❑Yes U-NT If yes, attach supporting documentation. x tw Dwelling Type: Single Family U-`___Two Family ❑ Multi-Family(#units) Age of Existing Structure 1 `iIr Historic House: ❑Yes &-W— On Old King's-I ighway: CO Yes &-No-- Basement Type: II ❑Crawl ❑Walkout ❑Other `f Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) If vu Number of Baths: Full:existing Q new ©W Half:existing new Number of Bedrooms: existing new op 9 Total Room Count(not including baths):existing new 60J First Floor Room Count . Heat Type and Fuel: ®'G as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes C�I�1Vo Fireplaces: Existing New Existing wood/coal stove: ❑Yes 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 D-Appeal Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION C Name otxv,-f-✓' _ �e 6,j,� Telephone Number � y d` �� 7 S-U Address�7 .04 r!0 �.- Uf -1 License# a,1 eVv Ua 63:1 Home Improvement Contractor# .3 v4 i Worker's Compensation# i,_1c_(_5c)QL� U g2a�W b ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE C� h FOR OFFICIAL USE ONLY' vl ;� PERMIT.NO. DATE ISSUED , MAP/PARCEL NO. "ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION r 0,-7 �- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINALBUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. W _21 -2 � � CY c' oLli W A. w W OG W ra. ?1pQco �o FoLl Qor lox W o�.Cc) ` Oil 5oik [, t400 SMOKE DETECTORS REVIEWED /&, ,.02 /1 ge +TE BUILDING DEPT. DATE _ CARBON MONOXIDE ALARMS F MUST BE INSTALLED PER IRE DEPARTMENT DATE + MASSACHUSETTS BUILDING D®D1 BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 1 rtl�ta} I7 Li � n Fir �Li: `•��� `�/4 f s I 1 V ; t k t / V G�SISF Y11 wAtI 4_I Vu�f 1 f , 1 , T � I � r d -- As- IL Pl -ff � I � I I. I-; I- I -,-,----1--F•-1--I-I-d I 11- I -r----k--- {- - VF ljv 4- {{ -- I t r �.��� f ' �� @ ' . y ` � _ q s { 4 t �� y • � • � � 1 5,���►.�1 `'fi f ovn �� X O �- FL� IA 70 iN r �t o i C(o/4 1 21he Commonwealth ofMassachusetts. Department oflndustrldAccidents Office of Investigations 600 Washington Street Boston, MA 02111 y www.mass.gov/dia' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information ' Please Print LezibIy Name (Business/Orsanization&9vidu4: l.1 a�—• (f U 4•� f✓�y e— r a t� Address: 3 2 ✓� '�� �+ -� City/State/Zip: • wA e-V'J, r A q (o 2— Phone#: A=Oumployer? Check the appropriate boa; Type of project(required): 1, mployer-ith'_2 _ 4. ❑ I am a general contractor and I 6. ❑New construction employees (fall and/or part-time).* have hired The sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t �• Remodeling ship and have no employees These sub-contractors have SS ❑ Demolition worlemg for mein any capacity. workers' comp,insurance. 9. M-Egilding addition [No workers' Pomp.insurance S. ❑ We are a corporation and rts, , required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of 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' 43.❑ Offer carp.insurance required.] *Any applicant that checlo box#1 most elso fill out the section below showing their workers'compensation policyinforraetion: ' t Homeownen who submit this affidavit indicating they are doing all work andtheu hire outside comb ctors must submit anew affidavit indicating each ZContractvts ffiat check this boa mast attached an additional sheet showing the acme of the subcontractors sad their wo&ae comp,policy foformatiaa. I am an employer that is providing workers'compensiation insurance for.my employees. Below is the pollcy and job site Tnformadon. ' '-Insiaeneo CompanyATame:__ /f 1,01 At9- `L-sgz,,/y T S- Policy�or Ss.Luc. w L ��y7 �� o a you mac: 6 Job Site Address: ✓�t�✓J city/state/Zip C;��.1�e✓ ��, t� . Attach a copy of the workers' compensation polky dedaratfon page(showing.the policy number and expiration date). Failure to secure-coverage as reined under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,5W.40 and/or one-year imprisonment,as well as civil,penalties in the.fa m of.a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er the airs and pe ties of perjury that the information provided above is true and correct; Sr taro: Date: i, A Phone#: Off,exi,µ3i. . Be £M,rMs-fifta,to Ix c' pie d b''04 or UM#JJimid Cityor Town: PermitUcense# � Issul. g Authority(circle one): 1.Boz*d of Fleaith 2.Building Department 3.City/1 owm Clerk a.Electrical Inspector 5.F'lumbina Iuspes tar• 6.Other I Coetad Fersou: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensatimforlbeir employees. , Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of lie, express or*lied,.&al or written." An employer is defined as•"an individual,partnership,association; corporation dr other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartiaents'and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, cotstruction or repair work nn such dwelling house or on tho 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 it business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coYerage required" Additionally,MGL chapter 152,§25C(7)states"Neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performanct ofpublic work until acceptable evidence of coma liance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by chedldng the boxes that apply to your sitnation and, if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificates)of msuraace. Limited Uab4lity Companies(LLC)or Lmrited Liability Partnerships(LLP)with no employow other than the members or piers,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. At 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;oat the Deparf rent of Industrial Accidents. Should you have my questions regarding the law or if you are required to obtain a workers' compomationpolicy,-please call the Department at the member listed below, Self-insured companies s-hohla caber then' self irmrance 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. Qf$�affidavit for you to fill outin the event the OfEiice of Investigations has to contact you regarding the applicant - Please be sure to fill in The permii9cense number which will be used as a reference amber. In addition,an agplicaart That crust 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 o$cially stamped or markedby the city or town may be provided to the applicantas proof that-a valid affidavit is m file for future permits or licenses, A new af5dsvit mustbe filled out each year.Where a dome owner or citizen is obtaining a license or permit notrdated to any business or commercial venture (Lt. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of ivestigations would like to thank you in advance fox your cooperation and should you have nay questions, please do not hesitate to give us a call. The Department's address,telephone and fax camber: The Commonwealth of Musadmsetts Department of Industrial.Accidents (Yfice af&Ve8*"@W 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 eznt 406 or 1 o77-MASSAFE ' Fa_{#61.7-727-7749 . Revised 5-26-05 wwmass.gov/dia oFt► Town of Barnstable Regulatory Services M s�I'E Thomas F.Geiler,Director E1639. i� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: �O�c�-Q✓� Estimated Cost C>') �i w Address of Work: `S 2 64 r:O b, u4,2) C,ewJZ✓' 63 Z Owner's Name: J �IyJ Date of Application: 0 I hereby certify that: r 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 f r a permit as the a t of the owner: 00, L4 6 1, Date Contractor Name Registration No. OR Date Owner's Name Q:wpfiles.forms:homeaffi day M CMK ApperWk J Table J53-lb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with-Awii fuels MAXIMUM MINIMUM GIazing Glaring Ceiling Wall Floor Basement Slab Heating/Cooling Am'(%) U-value= R-value' R-value' R-value' Wall Perimeter Equipment Efftciencyl pie R-value° R-value' 5701 to 6500 Heating Degree Days' t ` 12% 0.40 '38-' - 13 _ 19_... _.10 - . 1 6 -Noi'm`sl_•_: R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 036 38 13 25 NIA NIA Normal U 15% 1 0.46 38 19 19 1 10 6 Normal V 15% 0.44 38 13 _ 2S N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38 13 25 N/A NIA Normal Y 18% 0.42 38 19 25 N/A NIA Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 1 6 90 AFUE 1. ADDRESS OF PROPERTY: 5 Z 60t✓`✓9 �o i spy• 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: _TqV4 S . 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): Q NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table J8.2.1b: , ' Glazing area is the ratio of.the area of the glazing assemblies (including sliding-glass doors, gkylights; 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. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the Naiional 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 buss construction: If the insulation-achieves1he 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 R49 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 u .o a insulation insulating sheathing if used). Do not include r s m f the wall caul insul on plus P n' P g g ( � 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-b insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as.unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding. glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a 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 �oelm,� Town of Barnstable Regulatory Services t Thomas F.Geller,Director Building Division. Tom Perry, Biulding Commissioner 200 Main Street, Fjya=is,MA b2601 W"Aown.b arnstable.ma.us office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Scction. If Using A Builder a E N 1 S ,as.Owner of the subject property hereby authorize �e���! fi I to act on my behalf, m all matters relative to work authorized bythis building permit application for. C(?,,i Oro P off. 3 (Address of Job Signa Owner Date QC--R4R Nil Print Name ` Q:F0RMS:0WNBRPERMIMS10W pESI6N gATA 5196LF— FAMIL`( 3 $ELW-m W Wo' 6AI�AC�E ;..SEPI t C TAWL 33a )c t So j t Q9S (PD DISPoSA L PIS I-►ooa GAS /z STor►t ,J� r � . ._, 5IDeW4U— AWeA (Be, SF G� ...,,.:::'�s;_:.�'.•':ti�8 5FX 2.5 —.• d1oC�PD, 0 � � � O i BOTTOM A¢Z Is s F 'g rc be s `1s Per G TfTCAL t)e6I6N = 54e, 'TOTAL VA I t_y (•i-0YV -�3'�oGPc�;,'o K fiz P�n� qq 'PE¢GaLATt oN IFA7E. I �J 2MIu�LES j F . TANS _ a w PETER of .. ;..... .. SULLIVANcob tm.s�ocs . .ss No. 29733 S 04S, 1-7 T��l + f J ( 1 OF GC3 . J ` P° 1 �4 qq° f6 ER vt..1~ Il-d-gt TF'= io( =10o FG9 n P V.c do I DOD i�,, (QV 3 MKT i4v 9ivc, SGAtLC �l,� Ii1v 412, BbX 974 TAN1! Boat GAL 97 �'- d i 7 WM9m i sTo�lE . 10 2 WEIOPED 'Pac t. - Cif ICI© PLOT Plat�1 Lot�"C(Ot`t : c�lJT r i j-L 11 FLA N 51�OWIJ NEWN COMTL, z7 WtTA I-AE 5t LAJE +1D 15 l-04ATr5D W 14IL1 PE vxw M,&Iu, FL :.:_... �e xYEz-TA - p�5510�JdL. LA1J'D Su�V�`/vzz5 K FL,4l,J IS NOT' T34ED oN tiN IIJ4'WWEI r \.\j I L_ E+JGr�1 EEtt.S 6L)rz� mTU TO E OW3ET5 44OUL,'p Qvr -3E . 05'(r--2vILLr- MA44 . t : �SLD ro E;TaBust� Ptz��ty t�+JES NOTICE NOTICE TO " TO EMPLOYEES EMPLOYEES f The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED EMPLOYERS INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY WCC 5005786022006 03/16/2006 - 03/16/2007 POLICY NUMBER EFFECTIVE DATES Malcolm & Parsons Insurance 6 Freeman Street- P 0 Box 527 Agency Inc Stoughton, MA 02072 781 344-3200 NAMkOF INSURANCE AGENT ADDRESS PHONE Peter Appleton dba Appleton Construction 37 Baird Way Centerville, MA 02632 EMPLOYER ADDRESS 05/15/2006 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS Board of Building Regulatio sand Standards License or registration valid for individul use only HOME IMPROVEMENT TRACTOR before the expiration date. If found return to: %y" Board of Building Regulations and Standards Registration: 103218 One Ashburton Place Rm 1301 Expiration .76/2008 Boston,Ma.02108 - f �� tiype DBA APPLETON CONSTRC1CTt4N Peter Appleton ;<< 37 Baird Way <;F'" � —�'—---------- Centerville, MA 02632`'" =" Deputy Administrator . Not valid without sign re � a % Number CpNsr% /N RFG 0 p8 FRV/" NS / F.kPrreS �,, jl 414 SOR 3 ER✓ estr�� 2pd8 �B APp k fepF, t;; C Al/O SET. �0. . -s' Tr,. . FNTFRV/�EYMq��s f ' n� 24�g1 .__ co I on er 12/13/06 Jeff, The owner of 52 Baird Way, Centerville, has submitted an application for a family apartment over the garage with exterior access. We are waiting for him to return the recorded Agreement for Family Apartment. Builder, Peter Appleton, came in today to say the owner may have changed his mind, his daughter may not be moving here, and he wanted to know if he could still have exterior stairway. I referred him to you and Amnesty. He asked me to hold the application for now. Lois Cc: file 0/f,LD� y Pry, PAY����. PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE 200LMATN S REETMENT ' HYANNIS, MA 02601 r DATE: 11/08/06 TIME: 09:00 -----------------TOTALS----------------- PERMIT $ PAID 50.00 AMT TENDERED: 50.00 CHANGEPLIEp: 50.00 APPLICATION NUMBER: 20064472 PAYMENT METH: CHECK PAYMENT REF: 5412 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ! / Parcel . Health Division ;y Conservation Division Permit# Tax Collector 6atsue'd Treasurer Application Fee ,�tq Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -,5-2— ���Cip U✓o�-J , C �� of j 3 Village �:'ew�ew� Owner �e_D eo, > Address Telephone Permit Request m��� yj��isJurf u. �ti P D �e�, v ✓� �L C�S ) 7' cJ Square feet: 1st floor:existing proposed 2nd floor:existing proposed '7,1 Total new d Zoning District Flood Plain Groundwater Overlay Project Valuation v . �� Construction Type goQ f#q✓jd,, 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 91,�o On Old King's Highway: ❑Yes UAe-' Basement Type: Mfull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 0 0,__ new Half:existing L"Q-- new Number of Bedrooms: existing 2 new 0� Total Room Count(not including baths):existing new First Floor Room Count J� Heat Type and Fuel: las ❑Oil ❑Electric ❑Other Central Air: ❑Yes o o Fireplaces: Existing Op _ New Existing wood/coal stove: ❑Yes m-Aloes' Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Cl existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION__ Name ; Y` � e-� C�ICJ Telephone Numbera Address 'a> �� .w ✓� License# 0-S- `� t ( i,A a� , p'�✓V� ! 3� Home Improvement Contractor# / C) Worker's Compensation# WLC, Su S�UO�o�60 ALL CONSTRUCTION DEB RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r` DATE �� d FOR OFFICIAL USE ONLY r b r PERMIT NO. DATE ISSUED i, MAP/PARCEL NO. k s - t: r ADDRESS, VILLAGE OWNER - l • DATE OF INSPECTION: FOUNDATION v FRAME INSULATION i e � 1 , FIREPLACE ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ! t i r ..n�:- N!`r+•aa.a,?-vc:.Y'+ivt .'«�'lw+lve.'c'4 j�-v.'-Sr��„l^d e;i,f...;.N- F.=``,'+1' `rttt�'��ff{,^�.� .f�f, � a a�. � t fi,^� � xN�-� � ry�� �.�Tr.� air:: w.c��, a ` TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION 00t Map r ! / Parcel �` 4/ Application# 6W qu v v y Health Division ► Conservation Division `Permit# V Tax Collector Date'lssued Treasurer Application Fee i -:;'O Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ro i.o to'--/ { zy- r Village Owner vi f/D Address S Z 0,4, ro Telephone Permit Request �" f/ r �'� '� � { a v�'FtDy ��"� v ✓C � -s > �� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed 7 2�) Total new 7)J Zoning District Flood Plain Groundwater Overlay Project Valuation , ,Construction Type ,.:.,nVo- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family G Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes U-No On Old King's Highway: ❑Yes O-No—"' Basement Type: O'Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing t Ai new..1/0 IJ Q__ Half:existing C)L, new Number of Bedrooms: existing new 0 !j e " e �Total Room Count(not including baths):existing new First Floor Room Count a .Heat Type and Fuel: ©-Ga�❑Oil ❑Electric ❑Other Central Air: ❑Yes OINo Fireplaces: Existing '>P e New Existing wood/coal stove: ❑Yes ©.Noy'" Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes _❑No If yes, site plan review# Current Use Proposed Use BUILDER-INFORMATION . Name 1�/-�-�e_ s('' N ! i�J Telephone Number v � p Address License# 0 0 5 ``h - 1 vtl 0 D�_> 3 � Home)mprovement Contractor# / U Worker's Compensation# W C C- ALL CONSTRUCTION DEBBIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE // 00 6/ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts 4 Department of Industrial Accidents Z Office of Investigations '' '�`' a 600 Washington Street .4 Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,[ Please Print Lezibly Name (Business/Organization/Individual): Y'AD t r_J ,o B— a 0. fi✓�Vc �ir ,D P Address: ?� '� J91 ('� �,,,✓�.) City/State/Zip: 'Oft-�GrJI � l.t �M�! 07.E 113hone 2(7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a empI ith T 4. ❑ I am a general contractor and I 6. ❑New construction employees d/or part-time).* have hiredthe�sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet..1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp.insurance. g, wilding addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their to-El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs 6r additions . myself. [No workers' comp. c. 152, §1(4),andwe have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. l Insurance Company Name: Policy#or Self-ins.Lie.#: L--C L _5_00S7 "d d db Expiration Date: 1 L Job Site Address: '�� (i�-�" City/State/Zip: 196 e",/�t'. 19 Attach a copy of the workers' compensation po cy declaration page(showing the policy number and expira ion date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a . fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do'hereby certif der a pains a p nalties of perjury that the information provided above is true and correct Signature- Date: ` O Phone#: L5 5 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuiIding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -Information and Instructions r Y Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual.,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s),of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: ` The Commonwealth of Massachusetts Departmtent of Industrial Accidents Office of bvestigations 600 Washington Street Boston,MA 02111 TeL #617-727-4900 ext 406 or 1-877 MASS'E Fax#�617-727-7749 Revised 5-26-OS w mass.gov/dia f oF"E, Town of Barnstable y �°^ Regulatory Services MASS. Thomas F. Geiler,Director 9 i►L►ss. � . 019. Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Tice: 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 din containing at least one but not more than four dwelling units.or to structures which are adjacent to building g g such residence or building be done by registered contractors,with certain exceptions,along with of er requirements. Type of Work: Ne, 1' d �' i Estimated Cost Address of Work:. Z ►'� �`' l� �w � 3 Owner's Name: Date of Application: 6 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 MBuilding 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 PERTLTRY I hereby pply r a permit as the agent of caner: 9- Date/ ContractopAigfiature Registration No. OR Date Owner's Signature ( :w. fles.forms:homeaffidav Rev: 060606 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $ 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE Q _ square feet x$96/sq. foot= x.0041= "3 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/.sq.foot= x.0041= plus ftom below("applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation(Moving $150.00 (plus above if applicable) Proicost Permit Fee Rev:063004 r F 'I,Bte J IV(=anneal Pr criptive Packages far due and TV►o-Family R=4eotW Baildlop'HesW tsitb Fvssil Fuels MAximilm MINIMUM Glazing Glazing Ceiling Wall Floor ELL ma Slab HezdnglCooling Ama'C/a) U-value; R-value' R-value4 R-value° Wall Pessmeta &IwFmcrjt Emacmc? Package R-vaIueJ R-value' 370I to 6500 Heating Degree Days' Q� 12% 0.40 38 13 19 10 6 Nomsal R r 21. -•-=0.52--30�. ..-�.:�1-9-•-^-� - l.9�10�=�6';"' Namsal r s L-"1214—0:30a—'31s—IS-- 19 10 6 �SS�l1E T 15% 036 38 13 25 NIA N/A Nomnal U 15% 0.46 38 19 19 10 6 Norm[ V 15% 0.44 38 13 25 NIA N/A 83 AFUE W 13% 0S1 30 19 19 10 6 85 AFUE X 19% 032 38 • 13 23 N/A NIA Normal Y 19%. 0.42 38 19 23 NIA NIA Normal Z 18% 6.42 38 13 19 10 6 90 AFUE AA 10/. 0.30 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4, %GLAZING AREA(#3 DIVIDED BY 42): a S� 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS' ARE AVAILABLE. ASK US FOR THIS INFORMATION. • i BUILDING INSPECTOR APPROVAL: YES:. NO: Q-fbrms-®80303 a 4 ft ►q,,o Town of Barnstable ti Regulatory Services BARNSrABM ` Thomas F. Geiler,Director MASS. g �A�FD.19. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, AC-PE KI f ,as Owner of the subject property hereby authorize 6:4 e.— 16v��Ul4 to act on my behalf, in all matters relative to work authorized by this building permit application for: ro (Address of job) l � U Signatur of 0wne ate , Print Name Q:FORMS:OWNERPERMIS SIGN f Board of Building Regulatiohs and ��aaauStandards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration, 103218 Board of Building Regulations and Standards Expiration Z16/2008 One Ashburton Place Rm 1301 7Ype DBA Boston,Ma.02108 APPLETON CONSTRICTION , Peter Appleton 37 Baird Way 4 ; Centerville, MA 02632 Deputy Administrator ✓ — -- Not valid without sign re • ��77-- ea�� �/�/�ocic/u�aeC,Ca i� /�ie �omvm°°uu j BOARD OF<3UILDING REGULATIONS I 'License: CONSTRUCTION SUPERVISOR Number _CS„ 005414 e t s E�cpires 0608120;06 Tr.no: 24791 Restricted; 00 IPETER J APPLETON y 37 BAIRD WAY CENTERVILLE, MA'0,2 Commissioner W 3 xiio= 33a GPI TAWv- < Idoo GALS x I I- ►doo GA . �Z STo►lE - SIDEWdIL AID 166 sF A�i'F, SF X 2 5 d10 C�i'D J \Q BOTTOM 1 6 5(= o qq `TOTAL DA I L-Y �'I.Olt/ =3a6frJ;,'o u N fiz Peon rA\NL o _ q `o as �y DOF uxtL .►� r "� 7W.PETER {....•: a SULLIVAN �o " s No. 2973315-41 O I .. � .13441 (tp OF G B EL=ioo.o 9q-1 i ti �10 f d TEST' I�l�tg =god �, TF= toi OLIr' 11-d-81 F6-lop too ----w - ----�r�- L + . P V. Lb W • ,uv ... � iuv ets•� LK T r14, I oar iud yin. TtiNI I Bo►Jt'� GAL `� f lAuc>t. LE WIA 7` WA69ep '-To9E 2-44 .. .1 :...r_. .. SAS l o---+�— • 6eZrIj-I© P.Or 'FLAfJ 'pE�/ELUpED '»tLyFI cr- LoG.�TtOr.! . 'PLANt RQJC�. l CGMl Y TEAT T4S I)W Eu-Ja�. �GVJ N �IF�a N �M'Pc. S wtTa TNE.- 5 i IJiJ E G-oaTm w mop t�o►u, 6-S4-ql- XrErZ Kt. K FLAQ K, NOT' T34ED OW hN MJWMEtYr r-k�j t t_ E-RQ61 EGL5 SuRa/>r f My %F- OFFSE`i"s 44fluLx> Q yr "as 2V ILi.� MA•,4 . uses T'o GZABU59 PVZFEl2:fV U Wei APPLICANT s AL6►) E ` ✓?� ! t_ NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES R The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED EMPLOYERS INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY WCC 5005786022006 03/16/2006 - 03/16/2007 POLICY NUMBER EFFECTIVE DATES Malcolm & Parsons Insurance 6 Freeman Street-P O Box 527 Agency Inc Stoughton PHONE MA 02072 344-3200 NAME OF INSURANCE AGENT ADDRESS PHONE Peter Appleton Centerville, MA 02632 dba Appleton Construction 37 Baird Way EMPLOYER ADDRESS 03/23/2006 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER. f fJ'� r r � `•� /f iIL E 1960 ee ` I , It a f I I, i { 11 11 I �r- �ff it i , it till OA X it I ; 5 6 s V bok i jf. , , ►5 1/0 , �=r,&v—e� �. C9 i ,1 ,{ � ' Ik 1 !I a �, if 1 t 4, tt I ! �1 Ii t1!• 14 t � V t�t6 �;ai �, , /f Ct FA, z y 3J s y r f �\\ � I I is;j I i ,a 0�o 1 e � nji v` ! ( IE } � F 4 tq;oe6 r 1--1-:--! -1T_ �'r �--�—w -,v% - o -,-�--;- Ovit1� -- - - --- IT 1 -- - - -- a-► - A `CP 06 6C } - --- - - -- - - -- - ---vt - UIV all I �� why` �✓�� ' ,e�, �� } ._ f .++�w.Wr�-awa. '' a r . --t- 16 r { j + i i � -i a —"_ --_ —«- - �-— •'{ - — — V � 4.Y 3 11 � j4o - V 4 } I , t _ _ t F 1 j — Y r t } 10 , a r , i 1 r , w S _ ' J l � i . .; .Gam- � � �� ; �-�✓r�^-, � G l�v�w�S ��_/�`-���n - . T i I I 4 , r I T 1 f 1 j � t • �QL9, J � ! i n I , F ' ( - - i -. � -Y 1 _ �.. Y- _ ...,_•` _ _ .._y_ _ _._. .. - _.. _ tom,_ __ _I. { 0iJL r 11 r t ! 9 i f , r t � i 4 , _ ., f f J Q . i . I .-._t _' -_ -- ' _ •�. �_ _.. . _ .. .. to V. 1 fOrA vf- �.4 r ' i 'q, F f �� ; i _ I • l • S i 1 , i , Y_ ti 1 � 3 , w _ + , , Ala i� ®:O . VV , { , way ,��_ �V47- NEI Li • r G`/V YYY �Li5 V(/"UII IlOO 11V MOOEN Em VWYYom s L 32 7 $WIG a L—— ®H ® ,L Arl& L IL V/r,111lJ��LV r - b MM q AI PHAAff ONONS 2% 6M VCR Am CUM �® CDX ZM OAK 6m a/c m (ALT OL SEALER Y M�/n °,It�QP°o o���1 0, a • 0m M�/n G°Q d 4m COMCMUE 20 32 36 scale A 24X24 DOUBLEHUNG PAilO DOOR A _. B 32X24 DOUBLEHUNG DINNING ROOM IQTCHEK MASTER BEDROOM C 24X16 DOUBLEHUNG B to X 12 10 X 12 16 X 12 A nt EZ NG ROOM GUEST BEDROOM 16 X 12 13.6 X 12 FOYER B _ = Mill [OT16 Noma qbQ Mv. and mg@. emod D@d@nb La 67 [3wffd Mn @w 6mwao h@UM no. 62 C, TOWN OF BARNSTABLE 35266 Permit No. .. BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash u `' HYANNIS.MASS.02601 Bond ....v............ CERTIFICATE OF USE AND OCCUPANCY Issued to Alen E. Small Address Lot #67, 52 Baird Wav Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ] ecember, 31.... ..., I9....... .2........ . . ............. ............. ������ . .... .. .. .... ... Building Inspector J�'�•�e TOWN OF BARNSTABLE BUILDING DEPARTMENT »i°T soTOWN OFFICE BUILDING �g ....9• �� HYANNIS, MASS. 02601 �OIUY M' MEMO TO: Town Clerk FROM: Building/Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $k......... ......:�"'�. �~ .................................................._....... .......... ..........» ...._................ _ issued to `t'.�'�... ' ....�`°.. .. �i�ftf� Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �(�C�"- LI DATA .:_ �JES161.1 - ATA '51W!,L?✓ FAMILY 3 $EDWZ0 W tX 1 o 0o GAL_ Dt� PIT I-I DDa 6AL 51DEWALL ARCA (66 sF � 4 j C J �� BOTTOM A2EA - 76 !SF ItoF, exn FIT- TOTAL va5ld W - 540 6W, 110 9 TOtAL. Alt-Y F�oYV =33oGPi ;,'ou _. PEQGDLAT!oN =t l�►2M s u �ES� — ? D L _ o t114.OF NO, MER r ;r :q s 'ER Cka SULLIVANfob ,�• tas9ocs rs: "a No. 29733 (S 04S ' ram~ v- A- r4� f "` F��i R r- D Ewr �7- Mrl//Yw� _ EL=ioo.o qq•1 cNti �q° f6 &. T 5T' l�lg am V/A\` l it..t 11-q-gI ' iog TF= Im Lvk�K + 5� IDOD fuv 3• ` MKT 6-A . lfl,� loco* 14V eoK q�•4 S�rlc �o►Jc GAL TaNL �- /,-d-r'I/Ztl WA49EP I j --ToaE MEP, 2 �� z c-�=yi �( ►11 cz 2�d 69ZTITI® PI-07 �LdN IEI-oP� 'Ptzvr-ILz - L.l.h1T���.VII�LL 3 ��-gn EGA LE—', DATE �- 2�•q'� PLAN 2e -FRf- F1JC S i cf-=fif :74AAT .T* .Dweu-way, OwN Wt2wN'' Co/qpL, WITA 114E SIVE 1,1E (-vr �`1 ISET MO. C; 'CIE- IDA OF`Stm-5TTAga � 15 ' 'I-o,CA VD W► PL `I31L 34-3 pE0FESSlC JAL- LAWD Sup-Vvlcc5 AK FZAO K NOT' T3A/p 04 &14 c"J I L � EiJ61 N EEtc.5 SuRal A�1D 'I�{tir �F-F5E'i-S �I�DUI� tJ IIC a 5TE2vILLG MA'S , uSL� ro GTABU45 Ptz t y U N�5 i 1 ( I , ES T GT//ST-T � 4 92 ; `��"'olif�iV�F ���.C..qi(! •.2�'�'�.2E'itfC F7' E Li�ir'y/.c.✓ TNT' �Ldavo�,gfy Lor 6.7 DA z'E� BIZ .tloT-.B� ALGER & SCHILLING ATTORNEYS AT LAW 886 MAIN STREET R O. BOX 449 OSTERVILLE, MASS. 02 6 5 5-044 9 TELEPHONE 428-8594 JOHN R. ALGER AREA CODE 508 THEODORE A. SCHILLING TELECOPIER 420-3162 July 7, 1992 Mr. Joseph Daluz Building Inspector Town of Barnstable 367 Main Street Hyannis, MA 02601 Attention: Mrs. Robbins Dear Mr. Daluz : Alan E. Small is the owner. of Lot 67 on a plan in Plan Book 343, pages 84 through 86 . He has recently applied for a building permit. The adjoining land, Lot 68, is owned by Alan E. Small and Rachel H. Maguire, trustees of West Precinct Realty Trust under, a Declaration of Trust dated September 1, 1978, recorded in Plan Book 2806, Page 70 . The beneficiaries . of the West Precinct Realty Trust have never been Alan E. Small individually but have been members of ,the Maguire family and Richard Maguire is ; currently and has for many 'Years been the beneficial owner of Lot 68 . It is my opinion that these two lots :have. ,not mere;-ad; JRA:sb s COMMONWEALTH DEPARTMENT OF PUSUC SAFETY` s OF - 1010 COMMON —� MASSACHUSETTS BOSTON,MASS.ONWEALTH AVE. 02215 EXPIRATION DATE C O NS TRL I C E ER VLS.O ENCLOSE CHECK OR MONEY ORDER 06/30/1993 R FOR REQUIRED FEE, RESTRICTIONS NONE EFFECTIVE DATE LIC-NO. o" MADE PAYABLE TO 0 06/30/1 991 000.056 " s' "COMMISSIONER OF PUBLIC SAFETY" m JOHN J; BALDNER JR MRSTN MITI. MA PHOTO(BLASTING OPR ONLY, FEE: 2 6 4 8 ,`;..P TE A S E� � 100.00. rI fiF NOTEJNCVJ� E, ' HEIGHT: Nor vALro uNr F E C T u Q CARRTHIS IED MUST BE �P/>,�", /�AEe� CARRIEDONTHEPERSONpF i�V /��j OTHERS•RIGHT THUMB PRINT THE HOLDER WHEN ENGAG sT,iBEo m rHlsoccuPAnoNS10NgrURE OF ENSEE « SIGN NAME IN FU $E 1 VV 200M-2.87-81429 • 2' COMMISSIONER LINE URE fa any„' , x ✓� , t 1179 Assmors office(1st Floor). . Assessors map an tnumber �0 00 Conservation _��r -'�J`� SEPTIC SyS���l a�?�_ •. Board of Health(3rd floor): 1 111STAL LED IN CO )t TAX Sewage Permit number -C �P • Engineering Department(3rd floor): House number ��I�OIYEN°�d�L Ito wr'r r• Definitive Plan Approved by Planning Board 19, �10 TOWN REGU �0 AAPPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only ,' �� TOWN OF BA-RNSTABLE BUILDING �,/INSPECTOR ,/ / f o APPLICATION FOR PERMIT TO S/� CI e- ��// /Z W�. TYPE OF CONSTRUCTION —y r 0 6 100 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: CIO Location L O r 67 L5 i 7�'� u/ /7�y ce4 lt31` USG G Proposed Use 0 we « i/&6 Zoning District C Fire District Name of Owner, -�C— �� C, Address/ // Yr!/ti Name of Builder -7b :-4L 0JV4f(- 4�'Address r' ��� �/''Pc'ly ,r]�/Gd? /�j�d d•C� Name of Architect Address Number of Rooms Foundation K lowep o`ckce7�2 rIIN Exterior CL/� ® f'!� T � / � �P �- A R'o ng� a PzV/51Z 7— Floors. 01J7dJA Interior Heating cd/� ��' Plumbing cz! > TS Fireplace O/V4t-v Approximate Cost 5-y JV0 Area �U t S Di a am of Lot and Building with Dimensions z3�q r/ Fe 4;9 C� *37� z�- GO A r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam onstruction Supervisor's License Q�� SMALL, ALAN E. 3526.6 Permit For One Story M 5 Single Family Dwelling ; Lodation Lot #6.7, 52 Baird Way Centerville Owner i ,+'Alan iE Small eel ! . fi Type of Construction Frame �•; .; ., , - �". � I � - `w, '` ' `'• :� '. i At f rh Plot PLot Perlmit'Gjtrinted ' August 10•1 i 19 92 '. ; t A. Date of Inspection ' 19 19 �: :, i _�-' it• � tix (.�� �1 �� ry i � `i 1 a'i i 1,; ' �"' r . ' ' � ram-; i .. ; :•�� „' r-� { '�5 y: i • /r t ; i f `pFiMETp��� The Town of Barnstable BARE.MASS Department of Health Safetyand Environmental Services Y . 0a 019.pTEDMP�� Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection �fvv�.� Location Jc' - 012 4 t_ �0.V Permit Number 0(o 3 Owner Builder One notice to remain on job site,one notice on file in Building Department. The followingitems need correcting: `` `` 1 \ �"'i rib o °n� d� 0.` � 1 ► � A 3 A-t\ )NA , ` `6AS On 6-e_ ;OIWJ - a 4 whc_cfrt.AA t/ yv3y Please call: 508-862-483ftior re-inspection. Inspected by jz;�� Date 0� `pFTNE The Town of Barnstable 4 � 9 BARN --';- . MASS. D` Department of Health Safety and Environmental Services .: • t639• �0 AIFDMP'�A Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Fro�yv�4 Location J a- lP,6: +-c W c-V Permit Number c� d 0(D�33 G Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: 0C_k (N� 'c a� cek� k V\GS 0� �jl�� \ � Ives S�DtV�� � ��Z�. Su,� -3 a � �e /° L .-''l A�1 Dcr\< 1eA's Jwv.s 0.vvv r GSA h qx D fb.Der 1/ CU p\ i Dok45-ko r'2 (Ai re� Qrn,,,-A t Ve-A5 h ce,. C roots y03`/ Please call: 508-862463.8-for re-inspection. Inspected by uL-,' r��4= Date )��2�YOU