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0401 BUCKSKIN PATH
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Ii :( rp �' p. 0 w t, , ' ` A M �y u..: y x h a s 1 �,� t p,lt A�f 1 €x a 51 q ,{ p i '' t �^i t z 1 o xt . '� .:, , �kd "i ,z� 4, a a c F't xt' ° ., tI ''' q I,, ;;r x t 4A'� . e t ! �, a }. P 1 M ,✓d t ,e.r n rS�A+� r x., S i' x F�{,h3i n. l�fl' e ' `�' p p* `3 G j 9 ilNi ; { �s 9 �� +`�, x t # r ,I .% ;N a .e` y t t �'.0 r , ,',� I.I 4 f.4 a 4_,4 r �, - - I, ... a 01 .i,;., �. L.Id..,�,. .t t � TOWN OF BARNSTABLE IJ.IBIG " PLICATION Map Parcel Permit# ' OCT 2 5 2001 - Health Division cT�� �� :.Y 0 6 Date Issued Conservation Division lQ�L3 1 BY Fees Tax Collector c\taom 41 4_7401 (,A, Treasurer Wd i6 Q„ Planning Dept._AZ APPLICANT MUST OBTAIN Date Definitive PI n Approved by Planning Board A ROAD OPENING PERMIT FROM ENGINEERING DIV. Historic'-OKH Preservation/Hyannis PRIOR TO CONSTRUCTION Project Street Address 7 01 Village (f6•W`T6__;e_V e-6' Owner U�SL-w Address v �— Telephone �� �� �� 7S-9 Permit Request o �t�F 6XIS r,^c� /3�-��2�'°� 7a �r.�>C=` n°�1��� /-�qCCC5S ldc- -75 /ACC(.a-53 e- I— 7-,�, j Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation - 2 7 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: O Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 2,© '� Historic House: ❑Yes N No On Old King's Highway: ❑Yes W No r Basement Type: 21 Full ❑Crawl ❑Walkout . O Other fu 4-- 0 Lptl STie* Basement Finished Area"(sq.ft.) 'Y Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 3 new 0 Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing r2 new 9AII C First Floor Room Count Heat Type and Fuel: 0 Gas ❑Oil ❑ Electric ❑Other Central Air: ®'Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes )29 No Detached garage:❑existing ❑new sizeWO Pool: ❑existing ❑new size /YO Barn:❑existing ❑new size d Attached garage:❑existing O new size AO Shed:❑existing Cl new size H O Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes k'No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �%7/�2 ����-��`{G�2— Telephone Number 6 �L 73 Address ,2 lc, '� ® License# o26 yY Home Improvement Contractor# 3$� Worker's Compensation# Gt/C — 3 > — 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOrzs%�r3o t SIGNATURE DATE F FOR OFFICIAL USE ONLY fi F ,PERMIT NO. `, � ► DATE ISSUED ' MAP/PARCEL NO. Y - • ADDRESS - VILLAGE OWNER F r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL S Y � PLUMBING: ROUGH FINAL L GAS: ROUGH FINAL FINAL BUILDING y t r too ' T'4, AA-_s_s' J DATE,CLOSED OUT ASSOCIATION PLAN NO. C'? The Commonweafth of Massachuserm —:; Department of Industrial Accidents _ 600 Washington Street a Boston,Mass. 02111 workers' Com ensation insurance Affidavit.,, . g2S 7�tlS �'Lj c.C,S ¢5S. ls2l04LYyhone ci am a homeowner performing all work eiL ❑ I am a sole roorietor and have no one workinLy in any Cgric an this ob � workers for watiaag ]. • x..x easauoa .f e� lover wywywy���y .: ,........:...... ' as � ...1............... .:. .................... I am P� ................ ............r.....H,>..:J..�{v Win... ... ...+.. .. ... .:. "..::::::........ ...................,.::::;::' ..................::..............................::.:.,.........................:.«:....................:....J...,........r.,.. 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Mare to secure coverage as repaired under Seedon ZSA of MQ.ISZ eaa lead to the impadllm of est�aal peoaides of a Pole up to HA M and/or am yem,imprisonment as wen as civa penalties in the form of a 6POP WORK ORDER sad a fins of S100.oO a day against me. I noderstand"a copy of this statement may be forwarded to the Once of Iavastlpflona of Gw DTAfor tavffRV vesiaeadM I do hereby eatify undo the pants and putaltier ojperjury thatthr�� provided above it&up and coned Date signature ��- Print name / 2 t-z UNION Phone# 6® V2-9— �3 anciai use only do not write in this area to be completed by city or town omdal P se ls QBaiidine pepa�t dty or town: QLteauins Board ❑sdectutews Office ❑che&Uhumediate response is required ❑HaM Depasimeat ' rnntaet person• �e�' �Otlur (tevasa 9/93 PUU Information and Instructions r P 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 inthe service of another under any�� of hue,expressP or implied, oral or written. � An emplover is defined as an individual,partnership,association,corporation or other legal entity, or any two or more of representatives of a deceased employer, or the recerver c: the foregoing engaged in a joint enterprise,and including the legal repres to ees. However the owner of a trustee of an individual,partnership,association or other legal entity,eaiploymg employees not more than three a artmetits and who resides therein,or the occupant of the dwelling house of dwelling house having P work such house or an the grounds or another who employs persons to do maintenance, or rqrAir to bean employer. building appurtenant thereto shall not because of such employment be 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews. MGL chapter in the commonwealth for any applicant who has of a license or permit to operate a business or to construct bin • �y'.�� not produced acceptable evidence of compliance with the insurance coverage required Public work until nor any of its political subdivisions shall enter into any canna for'the performance of acceptable evidence of compliance with the insurance regniremaats of this ^^^ have been presented to the^ ==— authority. Applicants Please fill is the workers' compensation affidavit completely,by checidng the.box that applies to Your situation and names,address and phone numbers along with a Gf�=as all affidavits maybe supplying company Department of hd=rial Accidents for canes of insurance coverage. Also be sere to sign and submitted to the ortawnthatthe application for the permit ar license is date the affidavit The affidavit should be retuned to the Shoald Have any g `9aw"or if you being requested,not the Department of Industrial Accidents.. ��number listed below• are required to obtain a workers'compensation policy,please caII the Department %' City or Towns 1 '�Department has provided a space at the bottom of the Please be sure that the affidavit Is complete and printed legit y. has�cantad 9� the aPpli�„.� pie affidavit for you to fill out in the event the Office of Iavestig�� be {r, be sure to fill in the pe�it/licetis e number which Will be used as a rhea nutalier. The affidavits may the Department by mail or FAX unless other arranged have been made. The Office of Investigati ons would Irke to thank you in advance for you cooperation and should you have nay questions- Please do not hesitate to give us a call. �Department's address,telephone sad fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents office of Imrosduadons 600 Washington street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727.4900 ezL 406, 409 or 375 r lib CMR Appeftm J Table JS21b(caadaaed) Preteriptive Packages for One and TW04amik Rnidmtle!BoiMbp He ad wdb Fowl Fuels MAXIMUM MIIYQ4IUM Glaang Glaang Ceiling well Floor Haeemeat Slab Heeting/Cooling Area'( U-value= 1t value' R valuo� R-valuj wall PrsitnetxE4WPm� �g Padcaae R.vahwa &value 5 l to 6500 Heating D Dada' Q IZ•/. 0.40 3E 13 19 l0 6 Normal R iZ%. 032 30 19 19 l0 6 Normal S 12% 030 38 13 19 to. 6 AFUE T 15% 0.36 3E 13 2S WA Wf Normal U iS•/. 0.46 38 19 19 10 6 Normal V 1S•/. 0." 3E 13 23 WA WA 93 AFUE w 15% 032 30 19 19 10 6 83 AFUE X 19% 032 3E 13 23 WA WA Normal Y 19% 0.42 38 19 2S WA WA Normal Z 18•/. 0.42 3E 13 19 10 6 90 AFUE AA 18% 0.50 30 1 19 1 19 IO 1 6 90 AFUE 1. ADDRESS OF PROPERTY: `/o �G� 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION: . 3 BUILDING INSPECTOR APPROVAL: YES: NO: yJ g4orms-080303a 780 CMR Appendix 1 Footnotes to Table J5.2.1b: skylights, and ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, 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 306 if of glazing 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values.do not assume a raised or oversized thus construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof t f used), Do not include 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing(� exterior siding,structural sheathing,and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. '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. 'T}a entire opaque portion of any individual basement wall with an average depth less than 50%below grade must me_t the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned Y. Basement doors must meet the door U-value requirement bz.,ements must be included with the other glazing d_scribed 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.la 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 f EVE 1py� P� MO ' The Town of Barnstable a BARNSTABLL MAC. g Regulatory Services �A i0S9' 0 � Thomas F. Geiler, Director, lE MPl Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 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 �J a c J 4 qv O Address of Work: ` Owner's Name: Date of Application: ��� 2_2_ I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT RB ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL cE ACCESS TO THE A .142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 03 `W Registration No. Date Contractor ame OR Date Owner's Name q:forms:Affidav:rev-070601 r RESIDENTUL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET 10 NEW LIVING SPACE square feet x$96/sq.foot= 2 x.0031= a plus from below(if applicable) ALTERATIONS/RENOVATIONS OF ERISTING SPACE - square feet x$64/sq.foot= x.0031= plus from below(if applicable), ACCESSORY STRUCTURE>120 sq.ftt >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.0031= STAND ALONE PERMITS. , r Open Porch x$30.00= (number) Deck x$30.00= Q C) - - (number) _ Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 ` Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost R1�Y�fR S 5 3_l2, F�D02 J�11sT `e S" -S TUBES . To bt- D�Tf�CI'J/NfD QN CONSTX,1GT/p'i' /31_L t avc,r,� o IAIH17S a _ 19,9D N y4/ QUCe,,.,txri;v P� C F1.00k PO q REl7ovF /"IfT"A M L El�1ERGENC Y. MO VE- A g /'IP FDA aEoRDD/� —Ia' 0, BUIO WoO.00" ENCLQSU�Ct SaN/O TUa E ' BULI�y�/J p 19DD1770N TO ' 897-Y ADOr1 "XlD" Brae A EX 15T/146 yOUsE ' L3EDRoo/� CN��16C S�dwE� --- -.._ BOARD OF®UILDI SY S Lteeime: CONSTRUCT10N NuMbe: CS 034647 r Tr.no: .210446 :041=002 RomWeted To. 00 28q NEWrOWN ROAD € ARSTONS 6 ILLS, MA 02W �4draei�ei t4cr .. ✓Af - i Mmm p Ion . fi mcc IIII'I O Z � cnOmW �; Z D x o ; { A O , I ! r U m z m 3 om: M m x m o o+ d m OD rn (. . a I Z w z a Z o 3 � a o C ' r 1' O� \ Q cc�� / XI�STINGEC -' feCb DK s� h SHED CF:XISTI4IG gUNDR iI❑N 17,9'. 45,2' 131' 153,76,' PEAN OF LAND IN B.ARNSTABL E, RASSACHUSE-T7'S AS PREPARED FOR fICIRENCE OLSEN PLAN SCALE:— '1 " _= 4,0' TO: FLORENCE OLSE.N DATE DRAWN— MARCH 19,01 ON THE BASIS OF MY KNOWLEDGE FILE: 1916-00 INFORMATION, I FIND, 'THAT AS A F,B.: 27 R1=SULT OF A SURVEY MADE ON THE NOTES— GROUND TO THE NORMAL STANDARD OF CARE OF' PROFESSIONAL LAND SURVEYORS PRACTICING IN THE COMMONWEALTH OF MASSACHUSETTS, THE LOCATION OF TH )ATIiON IS AS SHOWN ,H E ,�koF, PAU s9c 0 ETSER D"4TE {- PROFES ,URV YOR G o�' « TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map'' % / Parcel /06�3 Permit# 30 Health Division f Date Issued Conservation Division Fee Tax Collector . � '. Treasurer r Planning Dept: Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address C33 U a& /V r' C�� — t '•Village ✓/II�� � - � • Owner �/o t2 E_J� Address 2l'r� o k S 12 &:_7YAo9_,b AXVL��,1 Telephone Permit Request _/t) �Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed' Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type ' Lot Size Grandfathered: 0 Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family 4C Two Family 0 Multi-Family(#units) Age of Existing Structure- Historic House: ❑Yes Z(No On Old King's Highway: ❑Yes No Basement Type: ®Full ❑Crawl O Walkout 0 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: '0 Gas ❑Oil 0 Electric 0 Other Central Air: O Yes ❑No Fireplaces: Existing New Existing wood/coal stove: 0 Yes 0 No - Detached garage:O existing ❑new size Pool:O existing- O new size. Barn:O existing ❑new size Attached garage:0 existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded 0 Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use • BUILDER INFORMATION- Name d/oL D ��GfA-,EL.So�/ Telephone Number �S �)77 S " 93 0 E _ Address,��{ ��xJ� r//� .�52. License# C� ®� `�'Z�� Home Improvement Contractor# /263r;1 7 « Worker's Compensation# hfC Y — Z�S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO IbuJ4)054r SIGNATURE DATE 6 FOR OFFICIAL-USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. - ' � 'ice : 1 _ '� : - .' • '!' ADDRESS VILLAGE OWNER DATE OFrINSPECTIQI ` ' FOUNDATION + a FRAME • . INSULATION ,� i • ,. . + _' — 4 _. r` `'• .: *;, — FIREPLACE ,A- " . . i r - ;•t . , ELECTRICAL: ROUGH FINAL - F ti"•"" - ^. t 1 � .. - t .x � 'mot PLUMBING: ROUGH FINAL Y. GAS: __ '�' ROUGH � FINAL , . " t . _ . � • k . ,; . + —. . ° ,`-' :FINAL BUILDING DATE CLOSED OUT ASSOCIATION,PLAN NO. t K The Town of Barnstable tuft• a�arierwm� • Department of Health Safety and Environmental Services 6N o Building Division - 367 Main Street,Hyannis MA 02601 „ Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner t 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 CosZ5-0 Address of Work: L46 X-54 tE N T,- rJ/ Owner's Name: P e,&" O/Se Date of Application: 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 off the owner. �u��`/�i•�i L 7 D�ZSl� Date Contractor Name Registration No. OR Date Owner's Name g1orms:Affidav The Commonwealth of Massachusetts - =- Department of Industrial Accidents "�•-'• — Olf�ceof/�rest/gat�oas 600 Washington Street a,--,mac, Boston,Mass. 02111 Workers Com ensadon Insurance Affidavit location: 271 ci 1 V//ZE /4,1 02L12 phone# 7?:--93 0 F ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workin in any achy ''///� %%// %/%% %/%%%///% %/// /% %%%%% %//%/�'�/////%/%%///, I am an em foyer providing workers'compensation for my employees working on this job. P. ... company name Y'i tir�f a dress f .....::::.:.... .:::::;:.:::..' tjiiont # :'..:..:...:.::'..:::..:...:::::.......�::::::�v: ....i:.:::::,ram!!.: :.............:: ::::.::.::.:......:::............::::•:::::.:::::::::::::::::..:.:..�. •::.�:::: ::-:..-:: :.. ......:•.�:::::. ........... x. insurance ❑ 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: ;, con anv name. .:... `: : ';`.:;::`:.;. :.::..:::. address. .. . .::. :`>';'%;:;';>`:%''.`!;}'::;`:':;}:':;`'::��:: :'::.� �:�:�:;:�:'':�:5::�:%gay liplt �L� v ...:::.�.:......................... ........................ ................................ ....................... ...................................:...................................:........:.........................:............................................... H. ,. .......,..:.. ol#ev#. . ..;..... ....:.,. ,,.::. ,.. ...... :.... . ....: .... ,�//%/�/ c env na address.. :.:..,..::... ............ .......... e n�nranc oli Fallure to secure coverage as regnired under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine nP to S1,seoxo and/or one years'imprisonment as well as civil penalties in the form of'a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerd under the ains and pen p that the information provided above is trt�and correct ti�re � Hate 9 Si� —� Print name i�1%,e/ 1 /`/ lC/-114��56 /l� Phone#��D 9� 7-7 g�o� official use only do not write in this area to be completed by city or town official city or town. permit4fcense# • [3Bndlding Department ❑Licemaug Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; - ❑Other Orawd 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 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 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 requires 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 space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be ream d 10 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 fmlesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 omvnao�w.eall�C a�✓�aaoac►�ic.`v.,tld �+` BOARD OF BUILDING REGULATIONS ' +•:. License: CONSTRUCTION SUPERVISOR ; I , Number: CS 064250 Expires 04/_16/20.00 TP._no: 3388 .Restncted,To: 00 PATRICK J MICHAELSON 169 LONGVIEW DR '~�': ! / 4, CENTERVILLE, MA 02632 Administrator • t' r y Y `ail �s c •�r:HOME INPROVENENT`CONTRACTOR� ri ;Registration 120321 =r 44 INDIVIDUAL w 1/23/9 ExPIy ation ` � � •:�'ppTRICK 1. NICNAELSON�� �.� tON6V1EW DR �"' VIIIE NA p26 Lh iNis1��OR CENTER 'y ADM t 1, Engineering Dept.(3rd'floor) Map Parcel " Z 0 �`� Permit# 9 House# o 1 ems, Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation Office (4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC SY ST BE Definitive Plan roved by Planning Board 19 INSTALLED ANCE _.WIT VIRONME . E AND TOWN OF BARNSTABL 'TOWN R17G IONS Building Permit Application Project Street Address 6 I Village �� � Owner 1Yl R M K_-5 .01 S P N Address .1 14 w/9 Telephone SD � - 7 7 1 - O 7S 7 1 ' Permit Request Co oy e2 t PA}R T n P �r4 )(`d(Z W. [Zoo w1 First Floor 1300 square feet Second Floor square feet Construction Type wd4 P Estimated Project Cost $ 9 oP-OQ , Oa Zoning District Flood Plain Water Protection Lot Size A / 3 4r-2 2 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes �10 On Old King's Highway ❑Yes ErNo Basement Type: Q'i ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) FV 'Number of Baths: Full: Existing c;L-- New Half: Existing New -.,No.of Bedrooms: Existing J' New Total Room Count(not including baths): Existing .3 New / First Floor Room Count Heat Type and Fuel: Gas ❑'Oil ❑Electric ❑Other Central Air a- es ❑No Fireplaces: Existing INew Existing wood/coal stove ❑Yes ErN-o Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) &Attached(size) Li x a a- ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded p Commercial ❑Yes C9'No If yes, site plan review# Current Use 6 4 e , g P Proposed Use 3 2D iR ao!n /I Builder Information Name tv Telephone Number `7 -7 1 --'L 3 a 9 Address License# © 1 S D S!j 46i A-ry Ni D 2 6 0/ Home Improvement Contractor# /,g ! Worker's Compensation#WC -31 S- :xYY 73-o NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL A PROPOSED STRUCTURES ON THE LOT. �\, ALL CONSTRUCTI N DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �- 1 SIGNATURE DATE - �-- BUILDING PERMIT DENIED FOR THE OLLOWING REASON(S) A :dff FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED 3 + MAP/PARCEL NO. ADDRESS VILLAGE , OWNER DATE OF,INSPECTION: FOUNDATION - FRAME (t �'� i INSULATION `� �' �r6d ' t FIREPLACE _ t ELECTRICAL: ROUGH FINAL ` PLUMBING: "R0'UGH- FINAL - GAS:,. -kl5 GH'a •-- FINAL - M a �, FINAL BUILDING :r.Zz — '. ' 0 'd'r ' r _ m0 „a , r 4 1 DATE CLOSED OUT y ASSOCIATION PLANINO. d N r w , ' The Cunmrumi'eultlr of Afassachuscttt c� Kit. '� �--_���r De partmerrt of Industrial Accidents OffICP n//AV=1gallonS \�'•'w i 600 lVasJrinhtun Slrcc�t �'F"� �� Bustutr. A1uss. 02111 .fit, Workers' Compensation Insurance Affidavit Plcnse PRINT Iebl�2lY � _- Pltc•tnt Information• .__r_.. _.... name, De�9(2-t4 l) j S•e r\) locition ^t 0 13 ct e-k s k i N 74111 rin. l eNA-'e Vl Yf,f_ I t4 t phone 1 -7 t!'"�7 7 S-7 rl I am a homeowner performing all work myself. - I am a sole proprietor and have no one working in any capacity • --r.. .r.�.__�r�- ....__w.w_.�.��sr.._s+��..�7�.w�+n+l7'!.+;.%'.'n f...�w..�.�.•�.�'�...•..�.w�.��w..._.�.•w.•.-_...__...... 2--tarn an emplover providing workers' compensation for my employees working on this job. comnanv name.- Il yl�ltj l�f�I'1lS�2 �1� 0� tddress• J 7 �/ P L—4N e . lc}1'UNI honed: —7 !— L insurance En. WC - 3 1 S - a a �{ 3 'D/ C: I am a sole proprietor. general contractor, or homeowner(circle arc) and have hired the contractors listed below who have the following workers' compensaiioti polices: cmmnanv name• addres�: tin 2hone 0, insurancr ro poiirl•i1 cnmpanv nntnr- address- l rip phone it• insurance co nolicv d onal neccsry_ia_ • -^+ - __• rc '' "`•'•'may-•-"' ^'""` `:v�..� .�. ... Attach additi sheet if _ ....dam.......-..—.i�v��_�_: ._-�ilYl.i "•.Wtw�.sL Failure w secure coverage as required under Section 25A of NIGL 152 can Icad to the imposition of criminal penalties of a line up to S1.500.00 andiur one years* imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement mac be forwarded to the ogee of Investigations of the D1A for coverage verification. I do herchr cerrij•under the pains an ena/ties of perjury that the information prorided above is true and correct. Si_nat= f Daft 3 Print name Will 1 M►o T I JA rj Phone; .ram w7 rr ' oflicial lose unly do not write in this area to be completed by city or town official city or town: permit/license>Y ritluilding Department Licensing Huard check if immediate response is required aSeleetmen's office C311c2lth Department contact person: phone iO: r J01her 4 information and Instructions Massachusetts General La%+,s chapter 152 section 25 requires all employers to provide workers ecrtnpensation for the employecs. As quoted f Qom the an enipinree is defined as every person in the scrvicc of another under any contract of hire. express or implied. oral or written. An ennplurer is defined as an individual. partnership. association. corporation or other legal entity, ur any two or ma; the foregoing em_aued in a joint enterprise. and including the legal representatives of a deceased employer, or the recci er or tntstee-cif an individual , partnership. association or other legal entity, employing employees. However tJ, 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 he or on the `:rounds or building appurtenant thereto shall not because of such employment be deemed to be an empiove MGL cha*pter 152 section 25 also states that even state or local licensing.agency shall Withhold the issuance or R �i• lth for any reneW11 of a license or permit to operate a business or to construct buildings �n the common ea applicant who leas not produced acceptable evidence of compliance with the insurance coverage required. Additionaliv. 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 th`e insurance requirements of this chapter :- been presented to the con tract iiic.authority. —77 Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law''or if you are requirec to obtain a workers' compensation policy. please call the Department at the number listed below. City nC rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to give us a _ _ ... . ... . ... _.i.• ..':. :fir. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents �.. Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 r cF"E r, : . The Town of Barnstable • EARM M • 9�Ar & ►`e� Department of Health Safety and Environmental Services Ec,a� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission: For office use only 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• I`,p m b e L 6-agr4Q e Est. Cost�9 aa�• n a Address of Work: y0 ( 1_2/�-rfi C'e v al-e Owner's Name Rig, 0 S e-rj Date of Permit Application: 3 a• `qf I hereby certify that: Registration is not required for the following re:..,son(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 PROGR� iv1 OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJU 1°1` I hereby apply for a permit as.the agent of the owner: RLmr,( 6fv-51- IWIIIIAx X Date Contractor Name Registration No. OR Date Owner's Name N�vi LA OD u C145 � N CEO Ems. �5 C Cep I►'�� I _ 'Ut?`4z .� - � �goo x,C, ,�. Y T G WOO - - New wcA i � - - `�- ✓/LC 7/�O7I7/I7ZO72U/PQ�UL d��/I�GCLd6�ClQP.� � � - � - Restricted To: 00 DEPARTMENT OF PUBLIC SAFETY 46 58 CONSTRUCTION SUPERVISOR LICENSE 00 - None = r: Expires: 1G - 1 & 2 Family Homes } Restricted To: 00 Failure to possess a current edition of the Massachusetts State Buiilding Code WILLIAM J RYAN is cause for revocation of this license. 199 BETH LANE I' HYANNIS, MA 02601 Vv EA fr i . f HOME�NPROVEMENT CONTRACTOR r Regi�strati�on�iO4952t�� S F TrRe-1w-5RARTNERSHTP�'" d , } i5 AbMiNISTRA7pp � Ye`ROIS�NAO2�6O1 �'.� Engineering Dept. (3rd floor) Map { Parcel `Z Permit# M J 14 M House# �/ " Date Issued 0 12' 7 Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Fee S O Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) ,lftkt ®.Sr k1i p /Crhnnl Admin Rl v,) Z A!V���� ��L/Afte 19 7� ' RNFAB MASS p, @bib /py 1639•�p�d�.F i)e.,,,dap '"® TOWN OF BARNSTABLE E°M _ Building(Permit Application Project Street Address 1/0/ sk-in Village Owner 4- J44 0 d'-;� Address yU/ f3lfcgiakyi Telephone Permit Request 4,, IQ_ ��. ,d,— rLo 4 .0.,c R dd. VLwn w e=e l 6,4 Q.;.., v-a w.p s �g cJ/- First Floor `` square feet Second Floor ! square feet Construction Type Vh ad Q/� odd rnoacf- and Bg c k ti P 164aw , vaO s q dCD /g cr tiT n Estimated Project Cost $ L�kap,. Zoning,District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes )ANo On Old King's Highway ❑Yes '�2(No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing - New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Het Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ONo If yes, site plan review# - Current Use�s�dP,,,�1 a Proposed Use 2,as is"A a I Builder Information Name V—y n✓* (n y v►S`W Ky;-t o o Telephone Number 7 71— 6 39Y Address F eyA La✓Le, License# e Xa J1 A i s Ac. o/ Home Improvement Contractor# Z p 5l 9s� Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOg SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED t_ MAP/PARCEL NO. ,t ADDRESS r VILLAGE '" OWNER 1 ' DATE OF INSPECTION: FOUNDATION FRAME $I (t _. i INSULATION. ( l 6? "r6 FIREPLACE , w ELECTRICAL: " ROUGH FINAL PLUMBING:- ROUGH FINAL - GAS: ROUGH FINAL FINAL BUI>1Dt,65- _ DATE CLOSED°nOTRM ' ASSOCIATION P=LA;N NO.. . n ��s�VL4C� , WHEEL CHAIR RAMP SLOPE 1:12 FRONT EXISTING HOUSE OOOR 4 ° 8 Ll 17 ' 0 °° --><4 ° 10 °> 8 '> 14 0 <4 4 8 `1 EXISTING HOUSE Li EXISTING DECK SLIDER WHEEL CHAIR RAMP SLOPE 1:12 CROSS SECTOIN HANDICAP RAMP PITCH F / FODT POSTS 4X4 , JOISTS 2X8 . DECKING 5/4X6 ALL POSTS TO BE BOLTED USING 1/2" CARRIAGE BOLTS RAILINGS TO BE MOLDED P.T. STOCK 19" & 34" ABOVE DECK - �- - IVIz - -- -- f f I i I 3sn®H E)NIIStx3 30"aE) !DNIISIX3 I I 1 JJ i { i r c 1 LAUNDRY ROOM CROSS CUT CEILING JOISTS 2X6 WALL STUDS 2X4 � FLOOR JOISTS 2X8 FLOOR 3/4" T&G INSULATION PLYWOOD FLOOR 6" 5/8" DRYWALL WALLS 3 1/2" IN GARAGE CEDING 9 1/4" 112" DRYWALL IN ROOM �, THE r, The Town' of Barnstable • a�arrsrnate, • 'M �0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: re_rnadal Est.Cost Address of Work: Owner's Name Date of Permit Application: 717117 1 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: 7// ?L9 7 ��-&v C"M 101106-n Q�14 AM Date Contractor Name Registration No. OR Date Owner's Name The dntlllt7111"C 1 U : asxac iU-TC - 'mi Del arnl1C111 of I11diarrial.4CCidelnts :� • ;r . •/ OfIfCBDI/1JYP..Z'I/gd1�O115 61111 11 uslun.ran Strea ••. y.-`�`i.���� +: Busr�„r..1fu�s U2I11 workers' Compensation InsnranCe Afriidavit aitnlic t - Plcnse PRINT'Teriiiiv w-......,_. .__.—_� • nt information• _ D , name• 1�V or:✓� ��,�:,V-,i ar e�'1 c�v/ I���fi✓� ��h vi i larttinn• 7�� �8�1� SF-l N �� '/ "! ' cite• -Ae fthnne N I am a homeowner performing all work mvself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers compensation for m}yemplovees working on this job. emmii tnc nnmc• Y`�6—.t4 Co✓ S-JV-IA CTf o -1 atlrirccc• ) 9 &e cin f f u 0.cndl c S nftnnc oo Log , 1 �a incurnncc cn. L[��,�•`� �'• 6 Ina nnlic�•!! �iJC�'"�/��r}��7..3"(� �3 r—i 1 am a sole proprietor. wencral contractor, or homeowner(circle oriel and have hired the contractors listed befow who ra•, the following workers' compensation polices: cmmr7nc• n�rnc• :rtirkrrcc� cin•• nhnnc�+• incur^ncc rn nnkir�•� ••r�.-•� . mow•• �.;T... _— -�r���vr��<<;�...���. ..�,, .�;r,r�.—_. _�.....�.�.�.._. cmmnlnv n-imr, at)rlrrcc- •in• nfrnne M' ncvrsncc cn nniiey d lira[hedditi0nalShCGLifnlCesiaty• .:•. •i,r••+_.., ..di•^:..•� .-..•.•••.ir. •r...•...s..,�.�:..... +......�+s '....�...=.•• i ••••rw..—..ti 'rikurc to secure ctn•crace as required under 5ectton 3A of A1GL 152 can lead to the imposition of criminal penalties of a lineup to 51300.00 andiur nc cars' imprisonment as well:is civil penalties in the form of a STOP tt•ORR ORDER and a fine of 5100.00 a day against me. I understand that a OM of this statentctrt mat be forwarded to the Once of Investigations of the D1A.for coverage verificationo do hercht•cerr�if•tarder the pants mid penalties ojperjurr Thar the information prot7ded above is free and correet ^^attsn I`� Date _7h/?7 'Tint name �cbpw+ -Phone nffcial lose my do not write in this area to be completed by city or town official City or town: kxrmit/lieense# Mudding Department ❑Licensing Guard . check:if immediate response is required QSeleetmen's Office ❑health Department co phone#: r�Uther„_�, contact persnn: � Information and Instructions Massaeltusetts General Laws chapter 152 section 25 requires all employers to provide workers' compettsatiotl • . M �ti",an env luree is defined as every person in the service iat another undc: to ' etnpim ecs. As quoted from the P • contract of hire, express or implied. oral or wrinen. An emplarcr is defined as an individual, partnership. association. corporation or other Iei;al cntit}*• or any two the foregoin�s enazued in a joint enterprise.and including the legal representatives of a deceased employer. or recei%•er or trustee of an individual • partnership. association or other legal entity. employing employees. Hoy` owner of a dwcllin_a hottsc h2ving not Marc than three apartments and who resides therein, or the occupant of dwcllin_ house of another who employs persons to do maintenance, construction or repair work on such dwc? or oft the :grounds or building appurtenant thereto shall not because of such employment be deemed to be an er MGL cha* to 15? section � also states that evcry state or local Iicensing agency sl:all withhold the issuanc retteIV:tl of a license or permit to operate a business or to construct buildings in the commonwealth for s: applicant who ltas not produced acceptable tn,idence of compliance with the insurance coverage requirm Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for th performance of public work until acceptable evidence of compliance with the insurance requirements of this cf- been presented to the contracting authority. Applicants Please fill in the workers* compensation affidavit completely, by checking the box that applies to your situatio: supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coyera`e. Also be sure to sign and Jate the affidavit. IT 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 re to obtain a workers* compensation policy. please call the Department at the number listed below. City or towns Plewse be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bo; the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applican be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be reu the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would Iike to thank you in advance for you cooperation and should you have any qL pierse do not hesitate to _give us a C 11• The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents ... office of Investigations 600 Washington Street Boston,Ma. 02111 ir.?Y �i• rr,t�n ',*77_7749 KPARTRENT OF PUBLIC SAFETY CUSTHUTION-SUPERVISOR LICENSE a {. Expires: Resw vow tricted low is ORCHARD NAY i. SANONICH, RA 02563 , F .�.7mane?r"" 'm'°�'�t�`F4�"+``t'y�°s�'" r- t ^sr�irt��` � a •�"ti"�,.y�`S`'� K f W�.i^.ir..J��� .ram 1 I # ra.k Y p� Y 4�- ; a v 'tµ, q,�'L"&i.+a14v:xia�'k"r' xa ./yiJD 1 i;r ,',.#" i �i5•i" °y's`�}� ,, a; � 1ZMPROVEMENTz,CONTRACTORS REGISTRATION x,Board of E3u-1lding Regulations and Standards ;� 3Qne AshburtonPlace Room 1301 XiN '- Boston; Massachusetts 02108 J' `4 .-.i,4 � j ,. � .s^��,��hy r;.'4:s' �� �•,���' ,..;�,�,�, �, ,•,F.�.ti•;: .��r?;p'zz1S��-��"�"^;eri,�i� ar'��Fir ac"�� a�°� �'�� �: " "HOME IMPROVEMENT CONTR_AC OR "`� Registration 104952 F E' irata on` 07/16/98 , y Type PARTNERSHIP *�p� _ t�x g,'S• sd3' � y. psy�•�„�.�-.Fro S� � �,`�' rj�f r+r�r'�'� ��fi ''k� -�s rt '. , �+afi r�C"�,, x �.eF�••e h' ,�.-} i r s '� y 3',h rye i �t q � � �f� s � Sri ' .,y M� a< ��'�';�i,�'i< 4.t,• :t s,i,ov��^w t t f SL a '.� ,� �i��^us�x��Sa �-6Y-c.( i� ✓ A q F RYAN fiCONSTRUCTI01d ^� { 3di;iVv u s ffl -Ryan lA S k''2j aitr } =�x r f �°si W] 11 tia J -R y a n . 199 ,.Bet l l Lane Jr x �c • "S °3c }ux S 4 w .s. Hyari�nis�M�s(A 42601 .:�.�g� .;€ � �"i,� :1�r t c§$a`Fx, � R ,c4`?-r� 'd"r .,},, �a N°� `� av i *-..-1`` t ri 'r� Yx• t ,*a �r�, ly-.' A4. r,any,-k t�•fU�"j ,S.* �' sfi x , �, �"- � _ � t d�•,�`j.:'t 6 � �� : €''4p'ax1`"G,H@ 4z,�;v�ht }�. � a� y �,,PJ 4r 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel ( 'ZO �� � Permit# Health Division. �f' .� 4re 'Jf t � Date Issued C —� Conservation Division xocl Fee 6�11 2-0 Tax Collector T ' ' �% !/ SPTiC SYSTEM MUST BE • ( INSTALLED IN COMPLIANCE Treasurer WITH TIT E&PLICANT MUS?OBTAI# Planning Dept. ENVIRONMENT C a RNG MI Date Definitive Plan Approved by Planning Board ' Historic-OKH Preservation/Hyannis ,�scc,a,•, w f�4-�,�N Project Street Address U CIS S ;VL, �c� C--t*y L1 4-� Village e �, y i °� • Owner r�eYeV(C — Address 40 j Telephone f Permit Request AAA I I v l via rook .t Square feet: 1 st floor: existing proposed 3 2nd floor: existing proposed O Total new Valuation �' 70 Zoning District Flood Plain Groundwater Overlay Construction Type wo®A 2,0' 10 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes %No On Old King's Highway: O Yes A,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 Nur:�ker of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 16 Gas ❑Oil ❑ Electric Cl Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing Cl 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)P� .j� {� Telephone Number Address aac, ll.,Q_L04_7r,,i�1-yl' License# CS D (a Nr,_r, -r b-n5 hi �is M 6• Home Improvement Contractor# :3 gaO Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6'a"r jn f2 X Ule SIGNATURE DATE 9-&-Q4 p' FOR OFFICIAL USE ONLY s PBRMIT NO. 1.e5 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER y` ' DATE OF INSPECTION:= FOUNDATION •..,— r FRAME J ►'� _ INSULATION �� r t ' ' f !► y� _ . M . , FIREPLACE "w ELECTRICAL: ROUGH" FINAL _ PLUMBING: ROUGH'? FINAL GAS: ROUGH;,- FINAL FINAL BUILDING I MAI _ `=MGM CoMm _ DATE CLOSED OUT _ 1 ASSOCIATION PLAN NO. a M f NJ Co Q4 5 � ` � 1 �rc:.XISTING ' DE i:K � b SHED ° EEXISTING OUN D`AfION �q 45,2' �f 17,9' 13.1' 15:3,76/ PLAN OF LAND IN RA.RIVSTA.BL�E; MASSACHUSE71'S A5 PREPARED FOR F'LO ENCE OL,S.E'N PLAN SCALE:— '1 " == 40' TO: FLORENCE OLSE.N DATE DRAWN— MARCH 19,01 ON THE BASIS OF MY KNOWLEDGE FILE: 1916-00 INFORMATION, I FIND, THAT AS A F.B.: 27 RESULT OF A SURVEY MADE ON THE NOTES— GROUND TO THE NORMAL STANDARD OF CARE OF' PROFESSIONAL LAND SURVEYORS PRACTICING IN THE COMMONWEALTH OF V ACHUSETTS, THE LOCATION OF F )ATIION IS AS SHOW ` .,PAU s90 0 E ERci m O L o. a. DATE PR " �'OF E �I SUTRVEYOR . r-':... ....•i�"'*�f+w'�•+'-^rY,,.•';..+•�i'•r'..,Wo.�}'Kf"r;f...*....'Y:t:.�..cs++4^y..•ti*'A».'q„a.et;•..... . .. �a;s"7;g^�.,.*t...rV,..�R.r+vv-e^kr-'�.i^"�N>°'°'•r..rvY.Rad.,.w..-/Ln '. ."'�ta-••+a SFIE The Town of Barnstable. * BARNSTABM 9 MA a6;q.9.. �' Department of Health Safety and Environmental Services �p �0 rEc r�o+" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: Map/Parcel: Project Address: '4 6} � l.lC,49.,�!,,.�, Builder: The following items were noted on reviewing: _.y 4 1 Please call 508 862-4038 for re-inspection. Inspected-by: Date: q:building:forms:review EST/MA TED PROJECT COST WORKSHEET LIVING SPACE Value . (high end construction) 3 o square feet X$115/sq. foot= 3-, (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot PORCH square feet X $20/sq. foot= DECK U square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Value 35 20 For O tce Use Only lnc/usionar Aff rdableHousitzg Fee ❑ R idential Commercial" Property Owner's Name Project Location Project Value Permit Number "Existing Sq. Ft. ** oposed New Sq. Ft. Fee $ IAHFORM 1/3/00 --- The Commonwealth of Massachusetts -- Department of Industrial Accidents a( `= ' = 01IICOOIIOYCSl/g81/00s 600 Washington Street Boston,Mass 02111 Workers' Com ensation Insurance davit ������ �����������������������������������������������, name: location city phone# _- ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worlin in � ty I am an employer providing workers' compensation for® my employees working on this job. ....... ::::.:.........................................:...................:.....::..::...:............::.::::::::.::::....:......................:.:::::::.:::.:...............:..:::. { fad mD any n e .�.isa:-:::::;:::::..::.......:::::::::::,:'•:is�:�-:-:::.�:.::::�::::�:.�: -::::.......:::�..-:::::•�::::: .......:.::::::........::::.:::::•::.::.::..:::.�::::::::::•..:........................:::...::::: ::::..,::.:.:. .. ... ..................:::t.M1. ::ii geldreas Z x::::>:>:::>;:< <:<::>:>:;»:»>>'>;»:•:»»:»:.:>>::>;.»::'..;;:. r;:::.::::.;.;:::::.i::::;::»::;>:::;>:::>:::;:< i:; ;;•:•>:iii:>;:;:;•i:-iiiii:>;iii:;;-::rill:•; diver 1 # Una 7,YY -- ..... . nsurance:co;:: :::. ❑ 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: comDanv iiam ............. :.:..:..:.::.:.::.i..;:.:.::.ii:.:;.i.:....:............ .; .:::.::.::............. .. :..................:::.... ..:::..:.:.::::: :;.;r.;;.::.:;ir:.:;.;:.i:.i:.:;.; addtes :;:.;,........ :::::::..,.:.:,..... .. ::•:. i::\i?:�iiii i'},'.iiiiii:•J:<�•ii:4i:iii:'.i:i�iii:+L•:<L::�:•iij iiiiiiiiiii�i:�i<iiiiiiii •Y;){:}vti•isiii•:::::::.::J:ii:•ii:::•.iiJ:•iswi:::JiiJ::i:::i::ii::::,iiiiiii:•iii::•:::w::i:v::::::::is?•i:wiiii:4:•i:a-'::r:•"' :.......:•:::r.:i:{i^i:4S^v}:::{:.�:::: .......................:•.:�.:.:..::::::::.::......... .�.::'i•i:ii::J:::::i:i•.�:iv:rwn..•;:•::w.,•:m::y.r•.i};:::::::::::::::.�i::::.�:v::••if:�.:i•:Ji:- ,..:., ......^.., .................. ....................................................:w::v:w::,Sn.,,.r...n......... ..... w: �:•:•:w:•vx••w:v::y:::•�{4`iiiiiU};:::y......\':C•v:•:• ' ....:•:.:.....................:•::•::•::::.::r................................................:n•.:.....,..,...n.......r......n J..........,......:•:•:::. ,........ x...<....n.......v.•.,vx::.;.., ,J J.it":.ix::•. .. ........ .................................:.::i:::::.�:::::::::::::::::•::.:..... :. o :•i:?;•:?•::::•:::`�:»:.r.;•iY.•:i::.:::::::::::v::::.:_:.::::;?:-:.»?.sty"^..,;:<.i>:4:•:.iM:v::Gi�%: ' rlll[Ce::CQ >:>•:...'.>:<:r>i >.:... •i:o:;a::•>i:::;:•.�:::::•.�:.::.�.�::::.::........:.. . .. ... .::...:: O�ItSP''#. ........ .. ...... .... '��j�iG:J:iJ;:i�:i?:�ii�:�';''?;:�:i�i :<'::::ry�:j::;:{;{},:;i:,>.;:;:jig:;:;:?:�i:�:�::�:;:�:::ti>:i:;:::��<:�j :}:;i:;:;lv':.::::.::::::{:}:;:;:y:::;'�i:{;:;:y:�:y:�:its:<C::titi:..ti:}i;:}::•.ri:.j:•.;;•;}::.y.�:�.::.::.;$iYiiv,:y;;{i+j;}.;..';$;::?;�;:;i:i;:iii:ii��:iii:iii:i}i�i:iii:i::fi�iiv:+t:»iiiij:�ij::<4:+•iii:J:Ji:Ji: aD. it�ameri.:'<`.<%is:iiii'ri�ii<Xiv:::'iii�::fi:::ti;.'•:C:;:};:;:;itij}:?i;:;:;:j;''• ........ ......... :...... ..:... ::.':.rill:Jii:i:i::C:i:i:v:^:^'-i:::�:::�:i.::.iii}ii: •i:vS:�::^:•i v?::ii:�i:iiiii::i:•:: `.', L}•.,�.,.,.'.,+: 4:::``Y`�:? .... v� :•:X:;:{ :i:si... ; �'`�"`�:'ti::;>':::;i: tine a cow ............................................. ........................ :: s:ii�::;;::•:•x;••: •::•:•i:•::::•iii:::�:;:•i:•:.;;;•i:•::.::•i.:-::-i: ::•ir .;• i:-i:;•i:<;•:<�>::�>:�:::�:is�::�i:;;;�::-»:•>:::�:�:-:•i:;•.�:-::�>::->:•>r>:•.:•i:-:i:•i:•i:•i:�:•i::::.;•.�::.>';.>•.:;•:::.;....:....�::::•:: .....................<;:::.:.;::•::::.,•::::: :•::.r: ::::::.�.,•:::::::::•:::::::::..:�::.�:.�:::::::::::::-::....,::.,::.:•.�:::::::::::::::•:•.rill:•ri:;�i:•i:•r:•i:•r.;.:;_r;.�.;.r:•>:t%;<;•r:•:�r>:•i::•iirir`.�i::•i:�:•:: .... ::::............................ fit........., ::::::•:::::•.:.:,:..:..:.,.:::.:;, ::.::::::::?"::<::: FaHure to secure coverage as required under Section 25A of MGL 152 can lnd to the imposiflon of erladoai pmaltles of a Sae to SI,MOO and/or one years,h aprlsonmmi as well as civil penalties in the form of a STOP WORK ORDER and a Hue of 5100.00 a day agahist me. I undetstsnd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriHeadOIL I do hereby certify wider the pains penalties of pa*"thaj the information provided above is&a a�td eorrcd Sigut= �- - - Date 6(v D Print name ofndal use only do not write in this area to be completed by city or town official city or town: perndiNcense ii ❑Building Departmead Ouc Board �L ❑checkif hmnediste response is required O SOeehnea's Office OHealth Deparhaeai contact person: phone t!; - ❑Other, (:evaed 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 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 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 with the insurance of this chapter have been presented to the contracting acceptable evidence of compliance authority. XXXXXXXxxx Applicants licants N1 Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and l` ' address and phone numbers along with a certificate of insurance as all affidavits maybe supplying company names, { F for confirmation of insurance coverage. Also be sure to si and submitted to the Department of Industrial Accidents .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' cdompensatioa 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 peimil icense number which will be useil as a reference number. The affidavits may be retui to the Department by marl 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 Investleations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 i730CUR,ppwmft. psme:ipttre Psckga for 0aa and TwwFamly Reddmdd BoUlap Seated with FOO Fade MAXIMUM Afam M can Wall Floor. Bsaammt Slab U-valuas R•vdma &vdnat. a valuLJ Wall Plata s r Padozw R•vaba t B.vahw 9701 to 6600 Heads;Deese Dada' Q 12%. 0.40 3tt 13 19 to 6 Nmmd I< 12% am 30 19 19 10 6 Noemd S 12% om 3f !1 19 t0 6 U AFUE T 15% 036 33 t3 21 WA 'WA Nomad U iSsti OA6 3i 19 19 10 6 N=md I Z.A &44 ao 13 i�.r MAWNW 25 AFM W 15% am 1 30 19 19 to. 6 0 AFIJE x IVIS 032 M 13 . n WA WA Notmaf T IV/o OA2 n19 25 WA WA Namw Z IVA 0.42 n 13 19 to 6 90AFUE AA tE'/. Wo 30 19 19 to 6 90AIRM 1. ADDRESS OF PROPERTY: 40 I t ��_I 1r�,►.� � 2._.SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): Jr 7 S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-fomn-f980303a 780 CMR Appendix J Footnotes to Table J5.11b: lass doors, skylights, and ' Glazing area is the ratio of the area of the glazing assemblies (including sliding" basement windows if located in walls that enclose conditioned space,but excluding opaque doors) to the gross wall , e. Up to 1%of the total glazing area may be excluded from the U-value requirement. area expressed as a percentag For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing ce with =After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a tJ•values are for whole units:center-of-glass U-values cannot be used 3 The ceiling R values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness-over the exterior walls without compression, R 30 insulation may be substituted for R 3 8 insulation and R 38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the stun of cavity insulation plus insulating sheathing {If used). For ventilated ceilings, insulating sheathing must be placed between -�------u,a:�d p��;,n of he z r: me conditioned space�uuu tuc vcu 'Wall R values represent the sum of the wall cavity insulation plus insuIatirrg sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall For example,an R-19'requironent 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. '7be floor requirements apply to floors over unconditioned spaces as unconditioned caawlspaces,basements, the ce or garages).Floors over outside ate must meet g 1eQu� The entire opaque portion of any individual basement wall with an average depth less than SO%below grade must meet the same R-value requirement as above-grade walls Windows and sliding glass doors of conditioned eet the door U-value requirement basements must be included with the other glazing. Basement doors must m described in Note b. 'The R-value requirements-are for unheated slabs.Add an additional R-Z for heated slabs. ele ctric resistance heating use compliance approach 3, 4, or S. If you plan to install more• < building utilizes . If the west = p g en the equipment with the to than one piece of heating equipment or more than one piece of cc equipment, pm 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 J5.1la NOTES: le levels Insulation R values are minimum acceptable levels.' a)Glazing areas and U-values are maximum t include structural components. R-value requirements are for insulation Y b) Opaque doors in the building envelope must have a U-value no greater.than 035. 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 J1.53b. 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 V-value determine compliance of the door. One door may be excluded from this requirement(Le, y have a 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(035 for doors). 43 °F IME 31, . �{.° The Town of Barnstable 9M�0� Department of Health Safety and Environmental Services 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. \ (C__�L_Atirnated Cost Type of Work: �"G�G�-L 6-�- `�� ( 1'LQ Address of Work: LID Owner's Name: Date of Application: 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: . r 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 _ Con r Name Registration No. OR Date Owner's Name q:forms:Affidav I `,` . a ✓�ie Zoanvnzo�n.�uec�� o�../�aaoae�u�artt . t BOARD OF BUILDI G REGULATIONS r rt, License: CONSTRUCTION SUPERVISOR Number: CS 034647 4 Expires: 03/2002 1 Tr.no: 21046 i Restricted ARTWI F BELANGER �i r\, t • �� 289NEWTOWN ROAD��:��;;;� MARSTONS MILLS, MA 02648 Administrator 6 , H5PHRc-7" P%00 SRJ�i-F�Lt�S Ta I►)!-rc )4 EXl5 Tin C HOL)5E lROOr- P/T G/-1 ?'O Y(?RTC#4 CX15TI/Iro Had sC HD USE WH/76- CCVRk SHlN6 L E S - 1 n y JAI *f r •�..-'ems.. s_._. � k. .. ... j, _�"`h'�•;tSF.�-v" -'tiati:^�-^_� ,..+.....,, -..c.� �i.- -r='�-'t+s:,r�=f'�.fi�.ox. �:.�c�'w.,`� ,2..: -:+-, :T-,..'�..., � - •av u�a.r_'s'�� ,r:-E: ,•ck..�.'::.... �-.�.a#�- ,1 '"---.`�ijaR •x_..".�a •wit F y:- ;��.+r-. 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"•ap X%:�',."i"�', ,tea, t-• TM e.'-�sr QEZ.K.�, j -' ,' �.Y"<�z4 - ._ - � '�, �, .fir ` '�`.�a� ��_�g �,, •"`�' Y�5' r��\ � � �� -� t' �4' , nova., D,CK` Y y Lrrc HOUSE 3'D �C Co'� '• . 6 4 L1iC d 9 � ArIOC��N yNO e�•i5vnr ` TW Ly u 2 i I9FC3 - F . D. OLSDIV FLDOk PLAN 1 GRTGAGE INSPECT ON PLAN OMER ORROWER: MARY & JOHN SKEARY _ G BUYER:_ JoHN P. OLSO_N JR. & FLORENCE D. OLSON ADDRESS: v 401�BUCKSKIN PATH v^V _ SESSOMS _ __ .�._ _ I�Ip.33946 CENTERVILLE. MA. DEED REFERENCE: �BOOK 9412, PAGE 225 PLAN REFERENCE: _ PLAN BOOK 244, PAGE 67 � � ¢� •x �! its ASSESSOR RUERENCE: WENT FILENO. N/A - _�_.—__._ DATE_ JULY 20, 1997� OFFICE_ F(LLL N `�. 7-11 _. _ N82, t LOT . 4 ca .+ �/� �d + BULKHEAD n �a DECK I HSE #401 - � o A O PORCH r*► 1+ L=104.73' V R=302.19' ` � uOKSK I N pA rH 4 THE LOCATION OF THE ORIGIN•�L'DW£LLING SHOWN HEREON, EITHER WAS IN COMPLIANCE WITH THE: LOCAL APPLICABLE ZONING BYLAWS IN EFFECT '*,EN CONSTRU='TED (WITH RESPECT TO HORIZONTAL DEMENSIONAL REQUIREMENTS QNIA), .OR MAY BE EXEMPT FROM VIOLkJION ENFORCEMENT ACTION Us DER M.G.L. TITLE VII, CHAPTER 40A, SECTION 7, UNL S,5 OTHERWISE NOTED OR SHOWN F4,-REON. A REVIEW OP FLOOD INSURANCE h'ATE MAP COMMUNITY PANEL NUMBER__-__ 250001 0015C�-______._�_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map j 1 Parc P= /�Z S� �EP7°IC Si(STE i ad ST Btermit# 10 t 7�? tfdLI P f- �f'pate Issued Health Division .1 — INSTALLED IN Cor � Conservation Division S Z (J ENViRCFr,n: a_. " , ' Fee Tax Collector Treasurer Planning Dept. , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �01 (3u c_ s I(_1 r-, Village Ca n1 kA u ► i Lt- Jam. �ssh Address I� I.�� b Owner I/o 2 E.-cr,ce � x Wks / w1� Telephone 7 D 5 — a — 613 DO 10 M p 0 2 11;'75 Permit Request 0-9 Cam- E X t-c n'9 J,sLc C n 6C c.IC Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 3 000 6' Zoning District Flood Plain Groundwater Overlay Construction Type 0 00 4 Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwetling.Type: Single Family j Two Family ❑ Multi-Family(#units) Age of Existing Structure 8 V(24 Historic House: ❑Yes �dNo On Old King's Highway: ❑Yes ONo ` Basement Type: ES 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 3 new Total Room Count(not including baths): existing CC) new First Floor Room Count Heat Type and Fuel: dGas ❑Oil ❑Electric ❑Other Central Air: J Yes ❑No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes t dNo nr 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 , V BUILDER INFORMATION Name e Oio�g—� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /SIGNAT- . ,N-%_.r..« C��>��•. DATE 2, -AO® FOR OFFICIAL USE.ONLY &4MIT NO. _ DATE ISSUED x MAP/PARCEL NO. N ADDRESS VILLAGE t V OWNER I �' DATE OF INSPECTION: - t FOUNDATION o-0 FRAME. r Cis INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL } PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL lqiwco E' FINAL BUILDING DATE CLOSED OUT r• ASSOCIATION PLAN NO. t I MORTGAGE INSPECTION PLAN � OWNER BORROWER: , MARY & JOHN SKEARY Of o+ oy BUYER: JOHN P. OLSON JR. & FLORENCE D. OLSON o' srEPHEN P ADDRESS: 401 BUCKSKIN PATH sEssoMs y No.33945 CENTERVILLE, MA. �o� 9�01sTeP��,�+ DEED REFERENCE: BOOK". 9412, PAGE 225 PLAN REFERENCE: PLAN BOOK 244, PAGE 67 � ® ASSESSOR REFERENCE: --- CLIENT FILE NO. N/A DATE: JULY 20, 1997 OFFICE FILE NO. DF 0697-11 SCALE: 1" = 30' N 26 155 82 E LOT 4 O pLA � DECK BULKHEAD J - O O? HSE #401 O o Cn C PORCH P7 w to Fi- L=104.73' R=302.19' B U C K S K I N P A T H THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON, EITHER WAS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO HORIZONTAL DEMENSIONAL REQUIREMENTS ONLY), OR MAY BE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.G.L. TITLE VIi, CHAPTER 40A, SECTION 7, UNLESS OTHERWISE NOTED OR SHOWN HEREON. A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER 250001 _0015C_ DATED AUGUST 19`198,_— HAS BEEN CONDUCTED AND TO THE BEST OF MY INTERPRETATION, THIS DWELLING IS IN FLOOD ZONE_ C __ AND IS---.N91__- LOCATED WITHIN A SPECIAL FLOOD HAZARD ZONE. I, STEPHEN P. SESSOMS, P.L.S., HEREBY CERTIFY THAT THE ABOVE MORTGAGE INSPECTION PLAN WAS PREPARED FOR DUNNING FORMAN,KIRRANE & TERRY L.P. _ IN CONNECTION WITH A NEW MORTGAGE AND IS NOT INTENDED TO REPRESENT A PROPERTY LINE SURVEY. IT CANNOT BE USED FOR ESTABLISHING FENCE OR BUILDING LINES. THE LAND AS SHOWN HEREON IS BASED ON CLIENT FURNISHED INFORMATION AND MAY BE SUBJECT TO FURTHER OUT-SALES, TAKINGS, EASEMENTS AND RIGHTS OF WAY. NO RESPONSIBILITY IS EXTENDED HEREIN TO THE LAND OWNER OR OCCUPANT. THIS INSPECTION PLAN WAS PREPARED BY USING CURRENT DEED INFORMATION, ASSESSOR. PLANS & RECORDED PLANS WHERE AVAILABLE. FIELD DATA WAS COMPILED BY USING EXISTING MONUMEN- TATION FOUND, LINES OF OCCUPATION & EXISTING STREET LINES. IT IS NOT THE RESULT OF AN INSTRUMENT SURVEY. SESSOMS LAND SURVEYING 2072 STATE ROAD PLYMOUTH MA 02360 TEL (508) 888-8022 — FAX (508 j 888-8066 l Can/Ticr� v '� �/t aq4, �C 'r X 5' ,q A ell .. 02�6 X A.o c t4'd';k/ fl ; �x lea S A-X 6 c'4/ 5 c,,, . L-6 S 1 L1 o m h o UAJLMo / y iY The Town of Barnstable Department of Health Safety and Environmental Services Building Division BARNSTABM ' 367 Main Street,Hyannis MA 02601 KAM 9 i639 �ATFD MA't A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION ,/� ( Please Print DATE: 1 1-t y a-0U ) JOB LOCATION: O I U C ICS 1� t� Y1 �Q 12 C� l l 2 number street village "HOMEOWNER". I O rC G l�C lu D IS F_ 60 g 7 name home phone# ivork phone# CURRENT MAILING ADDRESS: D 0 I �9 �- i sb u r LA a )_ r 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 requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN CF THE Tp : . ' The Town of Barnstable ass r"LL Health Safe and Environmental Services . Depar tment of Hea E1.659. g Dep Building Division 367 Main Street,Hyannis MA 02601 0.ficd: 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. pp � Type of Work: I - d - Estimated Cost .3,oo . Address of Work: Owner's Name: t l o rt ri ep- 1 s n Date of Application: y 0 0 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 y I Z o o Date Owner's Name q:forms:Affidav The-Commonwealth of Massachusetts Department of Industrial Accidents • `= Office of/aFestigWONS 600 Washington Street ; s1 Boston,Mass. 02111 Workers' Com easation Insurance Affidavit name: 0 2 P n c� �. 0 , 5 a-r. location:` 01 J city 4! r.t £YZ c� ¢ (� • 0 2 l0 3 Z vhone#SOS 771 O 7•� I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one worku in ca achy ❑ I am an employer providing workers' compensation for my employees working on this job. cumvanv name> ...::::...:: address.: city phone# :::.: insurance co. alictF .. . -------------- ❑�I am a sole proprietor, general contractor,o omeowne circle one and have hired the contractors listed below who have the following workers' compensation polices: comvanv name _ . . . .. a ....:.::......:.. .....:::... ..... ;::::;:::....:::.............. t• o6tme#, rbli aWinFa11CBCQ .:.: _ ... name;< ::; •.:::.:::.::.:.: ::::.::nw :.:::.::::::.. address: i city tliit)IId # �—.- :XXX :•::: insurance co;.. 4. _ 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 years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and+correct Sign Date y Print name orem UGC `'3 �n—� Phone# SIDS -7'11 (i 2`!' official use only do not write in this area to be completed by city or town official city or town. permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 P1A) 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 in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the incnrance requirements of this chapter have been presented to the contracting i 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 hi murance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit.is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out inthe event the Office of Investigations has to contact you regarding g applicant. Please be sure to fill in the permit/license 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. ���������������������������������i The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents gtflce Of luesugauens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 TOWN OF BARNSTABLE am BUILDING INSPECTOR TO THE INSPEH IOR OF BUILDINGS: Location .../A-r. ...... ..... ...................................................................... Name of Owner,-.4K .........Address ........... ........................................................... Name of Builder ----------------------'A66rex ---------_---...--.---~------- Name of Architect ----------------------Ad6res .......... ---.----___ ` Number-of 7 .......................................................------------Foundo�o.n -� � .................................� =~~~~~"~� Ex� i ° ------------Ruofing -'___-____. Roos -1 ]n�,io, .� _ __________. Heating - = �� � - ---------'Plumbing -�/2 -..�����.^�_.-^,..,_�__________.. �App,oximoCou ....................... .. __ _____..Fireplace �D�nNve Plan by Planning 800v6 __-_------------'l9__--' Diagram of Lot and Building with Dimensions — � ^ | � Small, Alan f No ...1 .... .. Permit for ........oYi®.....to2'y....... single family duelling ...................................... ..................................... , L4 b( Buckskd Path Location .......................n......................................... Centerville ............................................................................... d Owner Alan Small ............. ................................................. 1 Type of Construction ........frame .................................. Plot ............................ Lot .......... ................. No Permit Granted ®der $ 19 71 Date of Inspection ....................................19 F Date Completed ... ,..........19 t i PERMIT REFUSED ................................... ............................ 19 .......:............................:.......................................... , ................................................................................ ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................