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HomeMy WebLinkAbout0080 CAP'N JAC'S ROAD i a Application number . .... ....... Fee ........ . ... .`G .. ...o... KORR _ s ,. - Building Insspectors Initials,.-..J3 X✓... _ JUL 12 2019 Date Issued 1 J qql , �� ��/ Map/Parcel.. ....... ... ................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS%DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: - 0—.F3 ..- ✓� �,'L zzf: NUMBER STREET VILLAGE . 7 Owner's Name: fit'✓l DR'1!j( Phone Numbero� Z Email Address: Cell Phone Number Project cost$ ®® Check one Residential :Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a erm buildin it in cord ce°with 780 CMR ` . ° . Owner Signature: .a( w Date:: 2 TYPE OF WORK ❑ Siding 0 Windows (no header change)# Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Y Construction Supervisor's License# (a .,ch copy) Email of Contractor C Laj e--c4r6,0q Phone number S 3 ` �5.`)_ ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION.NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event k. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a`site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No____, if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back., deft side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date V All permit applications are subject to a building official's approval prior to issuance. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid-.for individual use.only TYPE„Corporation before the expiration date..If found return to: Reais�retion Expiration I Office of Consumer Affairs and Business Regulation �453782 .Y 01/07/2021 1060 Washington Street:Suite 710 �' Boston,MA 02118 C 8 F REMODELIN0„INC .,'�;';� � ° CARLOS H.FI UEIRQA E 20 CAPTAIN NOYE ;RD_' S.YARMOUTH;MA 02604 NOt Valid Without SIglllatUre Undersecretary. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const`ij6d §ixf�rvisor rf. CS-104107 a- ij[�pires: 08/25/2019, IRCARLOS H F16U IRO/ij 20 CAPTAIN NbYE,S ., SOUTH YARMSI' H Ml Commissioner Office of Consumer Affairs&Business Regulation i HOME IMPROVEMENT CONTRACTOR Registration valid-.for,individual use only TYPE:Corporation before the expiration date.If found return to: Registration Expiration I Office of Consumer Affairs and Business Regulation �45a792 01/07/2021 1060 Washington Street Suite 710 C&F REMODI=LLNG=!NC Boston,MA 02118 F1 1 � i 1 . CARLOS H.FIGUEIROA� <I' 20 CAPTAIN NOYESQ,R© S.YARMOUTH,MA•b26o4 Undersecretary Not valid without signature Commonwealth of Massachusetts ' # Division of Professional Licensure Board of Building Regulations and Standards Const`m6d tAiipgpisor CS-104107 y�' „ spires: 08/25/2019, ° ,14CARLOS H FIGUEIR0A ' 20 CAPTAIN NbYES�20 C R.MI +. SOUTH YARMST , 026 06� Commissioner c"" , `N l ' f ,i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation-Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Legibly NG1IT1e (Business/Organization/Individual): Address: 4 City/State/Zip: —5'- Phone#: 50�9 ,, 3 q Z Are you an employer?Che k t e appropriate box: Type of project(required): l.'E I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'comp.insurance comp. insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L F]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: At,,is-, SOCK.-SO- t 6.c 5 �'l o Expiration Date: m Y Job Site Address:—. i l City/State/Zip: C'Q­1 ►� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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. Ida hereby certify under t e pains and penalties of perjury that the information provided above is true and correct Si ature: Date: ' 1 Phone#. 7:7 q3 ae, Official use only. Do not write in this area,to be completed by.city or town official City or Town: Perm_ it/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: s, 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 the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation°and,if necessary,supply sub-contractor(s)name(s),address(es)and phone 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 permit/license number which will be used as a reference number: In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in • (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future 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" Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia o 7)a))y TUPPE CONSTRUCTION CO. LLc' 79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.TUPPERCO.COM Date: Town of Bamstable cv Thomas Perry CBO 200 Main Street o-•- o Hyannis, Ma 02601 (508) 790-6230 faxcm Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application Issued on has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #: C�/ /5 Address: Richard Tupper License # CS-69058 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION D{ t P�A! Lr Map 6 Parcel �Pprlcation # ' �`I CA[- a: I Health Division Date Issued _q)lq Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Stre t Address Q 6vf QCs. Village x C � Owner J JU f/'1 Q� Address_ OV CWA) �,1�-r Telephone :Permit Request rr.r cif 17 rccl� f&fe 'Square feet: 1 st floor: existing proposed 2nd floor: existing' proposed Total new "Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Yeas ❑ Oil ❑ Electric ❑ Other Central Air: 0<s' ❑ No Fireplaces: Existing New. Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) _ _ Name zC Ct Q.,'e— Telephone Number �! Address License # c J 00051 0'(� MI 06;'9167 Home Improvement Contractor# 3 Email zi e'�-6Q CQ Worker's Compensation #�dgM!F /`?0/�--W ALL CONSTRUCT N D BRI RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,2 l7 6 SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ;F ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: FOUNDATION FRAME t INSULATION FIREPLACE It ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING � t DAT-ECLOSED OUT i AB_S_�v,WTION PLAN NO. The Commonwealth of Massaellusetts Department of Industrial Accidents office.of In vestigations. 'I Congress Stre4 Suite l00 Boston,H4 62114-2017 VWw-mass gov%dia Workers'Compensation Insurance Affidavit: Builders/ContractorsAFIectriciansmIumbers APPiNcant Information Please Print Legibly .. . ;Dame(.Business/organizationnndirddusij: Tupper Construction Address:79B Mid Tech Dr.: . City/State/Zip:�estYamiouth,.MA 02673 Phone#:568-778-0111 Are you an employer?Check the appropriate:box: l- l am a employer with 4: :I am a general contractorand i TYPt 94roleet(required): ❑ employees(full and/or part-tune).* have hired the sub-contractors 6: New;construction 2.0 l am a sole proprietor or partner listed on the attached sheet 7. Ej Remodeling ship and have no.ernployees These.sub-contractors have 8. C]Demolition working.for me in any capacity employees:and have.workers . . . [No workers'comp.insurance p.insurance. t 9,_ ElBuilding additi comon required:) We'are a corporation and.its 10.n:Electrical repairs or additions . 10 l am a homeowner doingall work officers have exercised their B 1,0:Plumbing repairs oraddahons: myself [No workers':comp. right of exemption per MGL . . .insurance required..] c.152,§1(4),and we have no I2:D Roof repairs [No workers 13. Qther ri/ employees. ' rw comp.insurance required.] eazat i n *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 outsidt:contractors must submit anew aflidavit.indicating sued =Conaaciurs That check this box must attached an additional sheet showing the name of the sub contractors an_d state whether or not those entities have employees..tfthe sub-contractors have employees,they must provide their workers'Comp.policy number. i am an employer that is pra►jiding workers'conppensatiorn insurance for my employees Below ft.the policy and job site information: Insurance Company Name: AEIC . . . .. . PolkY#or Sell--ins,Lic.#:WCC5005593012007 Expiration Date1-1013/14 Job Site Address: .80 Capt. Jac s .Rd City/State/Zip:Centerville MA 02632 Attach a ropy of the workers'compensation policy declaration page(showing the policy number and etcpiratiion:date). Failure to secure coverage as required under Section 25.A of MG c..152 can lead:to the imposition of criminal penalties.of a . #"tie up to$1;500.00 andlt�r o e prisonntent, as well as ,ivil,penalties in the forin of a STOP WOR'K.ORDER and.a fine .of up to$250;00 a day ag st this viol tir. .8e.advised that a copy.of this statement may be forw*artled to.the Office of illvestigations of the DI for insurance overage verification. 1 nla her, cert jf y rrn er flue p ins penalties ofperiary that.the Information Provided above is true and i Direct Si to :. 6/2/14 ate:. None:one#1: . 508778 1.1 fficial.use only. Do not write in this.area,to he Completed by city or town o�clal City.or Town: Permit/l,iceitse.# xssui>agAuthorih.(circle one):: . 1:Board.of Health 2.Building Department 3:City/Town Clerk 4.Electrical Inspector S:Plumbing Inspector i6.other Contact Person: Phone#: ACV I\ TM DATE jMMiDDlYYYY). . . CERTIFICATE'OF LIABILITY INSURANCE 1 , 12/03/2013. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED I' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED,the polley(les)must be endorsed. If SUBROGATION 15 WAIVED,subject to j. the terms and conditions of.the policy,-certain policies may require an.endorsement. A statement on this certificate,does not conforrights to the ' certificate holder In lieu of such endorsement s '. PRODUCER CONTACT Lora I Lowe Southeastern Insurance Agency, Inc: Nat,�;.(508)997-6061 439 State Rd. o:(50$)990m2731 P.O. BOX 79398 PRODUCERN. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAICp INSURED INSURER A; Arbella .Protection Insurance Tupper Construction:Co LLC : aNsuRcR®: AEIC INSUREAC: CNA Surety . 271oberta .Drive INSURERS: t West Yarmouth, MA 02673 INsuRERs; - -. INSURER F COVERAGES CERTIFICATE NUMBER: 2013 14/1: REVISION NUMBER: I- THISAS TO-CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RFSPECT TO WHICH THIS . CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES:DESCRIBED HEREIN IS SUBJECT TO ALL THE.TERMS, E%CMUSIONS AND CONDITIONS OF"$u4H POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. INSR ADD BUB ROUCYEF POUCYEX -' TYPEOF INSURANCE.. . . S POLICY NUMBER _ LlMITO.. . GENERAL LIABILITY 950000874 11101/2013 11/01/2014 EACH OCCURRENCE � 1,000,000. X COMMERCIAL GENERAL LIABILITY pA Mh6E ooe Hence +� ®0 BiEe )_ 100 CLAIWrMADE r X. OCCUR MFD EXP(Any one Gerson) PFRSONAL.B ACV INJURY' S 1.000.00 GENERALAGGREGAT€ $ 2 000 00 CaEN'L AGGREGATE LIMIT APPLIES PER: _ - PRODUCTS C0MP/OP AGG S 2,000,00 PROS .. , POLICY JECT LOC ' AUTOMOBILE LIABILITY 56 1t1-GQMBINED$IN4LE LIMIT 66240000 1210112013 12/01 I20 AW AVTO . : . . -- R_ .1.00 00 . (�a acdAenC} BQPILY INJURY(Per Perepn) S ALL OWNED AUTOS A X SOHEPULEDAUTOS RODILYIWURY(Per ArAlcient) PRQPE;RTY DAMAGE $ X HIRED AUTOS (Ror art iQant) ANC X NON-OWNED AUTOS . . _ $ UMBRELLA OA13 X -OCCUR 4600059368 11/01/2613 1110111014 EACH OCCURRENCE $ . 1 000. 00 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1 000 00 DEDUCTIBLE RETENTION. . . ar°D iEa LPLP oY uaA�Lu v WCCS00559301200 10/03/2013 10/03/2014 X r Y LIMITS X YIN' - ANY PROPRIETOR/PARTNER/EXECUTIVE( N l _ RICHARD TUPPER I E.L.EACH ACCIDENT a 1 000 Op B: OFFICER/MEMBER EXCLUDED? L�I (Mandatory in NH) I LUDED FOR WC COVERAGE : F.L.DISEASE-EA EMPLOYE 00 ff yyes.describe under.. . DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1 000 OO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES.(Attach,ACORD.10.1,AddlSonal Remarks Schedule,B more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED'IN ACCORDANCE WITH THE POLICY PROVISIONS. "For Information. Purposes Only" Tupper Construction Co LLC" AUTHORIZED REPRESENTATIVE 27 Roberta Drive : W Yarmouth, MA 02673 Lora Lowe ©1988-2009 ACORD CORPORATION. All.rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD OWNER AUTHORIZATION FORM 1, (x-it «e (Owner's Name) . owner of the property located at 50 Cy J ors r4 r (Property Address) Gr r �r �P ✓, 1 1Aj 6� Z (Property Address hereby authorize V (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date i 3 f KhWiMAiYL:t Df+R}tiitlii:�IPIi; MAassachusetts-Oepartmen; t03 of Public Safety Aead.Su�i���,�.NY 12020 Board of Building Regulations and Standards �. 477:r4 12ys (,ti.t ruk tl.m i rrww.v.wm . - License:CS-069058. . RI CHARD S TUPPER 79 a MID-TECH BR WEST VA1tMObgfH MOON Tulw Expiration • (841 RIVM sa FORMINNAUaYsAMFxp*Wlof,rare5 tc�ncrr�ssto�� 72131/2014 PloPts hl41phtg People Build a 5afor WoridTM arAttaqu ' t tifEMBER . . . . Richard Tupper Tupper Construction SWIding Safety Pmressionat Member#:8158119 Exp:4f30/201 a - Office of Consumer Affairs&Business Regulation License or.registration valid for.individul use only OME IMPROVEMENT CONTRACTOR, before the ex pip"date. If found return to: 12egistration: . 178434 Type:. Office of C ffairs and Business Regulation Expiration: 4/16/2016 I:LC 10 Par aza-Su' a 5170: . ?: ;yg B ,MA 021 TUPPER CONSTRUCTION CO,.LLC. _ RICHARD TUPPER 79 B MID-TECH DR, W.YARMOUTH,MA 02673 Undersecretary No ethout signature. F1 THE Town.of Barnstable *Permit# Regulatory Services �ee 63f5l7e dale anxxsTAB14 v " i63 9. Richard V.Scali,Director A�� ArED MA1 �� ��y Building Division . ' 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 b CQ D Not Valid without Red X-Press Imprint Map/parcel Number J Property Address (Z:` C�,4, �. do Residential Value of Work$ /d Ck7CJ s Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �y iA /Qj rL1e A.e y__A Contractor's Name k 9 )�E,9-r2 Telephone Number'- Home Improvement Contractor License#(if applicable) 4 I 1 Email: Construction Supervisor's License#(if applicable) C S — 2 b 7 445 q 7 ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance J U NL 1 � 'A Insurance Company Name Workman's Comp.Policy# TOWN OF EAMMBLE 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) Re-side I ` Replacement Windows/doors/sliders.U-Value_o (maximum.35)#of windows F #of doors: • . � I ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S ind'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 re uire - - SIGNATURE: Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 Hie Commomweah*ofMassachusetts Deparhuent ofl`ardmstriid Accidents -- tie OffMIfffigations 600 WaThbigfon meet R Boston,MA 02111 wn w.mass.goiVdia Workers' CampensatianlusurauceAffidavit:Builders/ContractorsMectriciansTlumbers Applicant Information f I Please Print Legibly Name(131 l Sniz�liona ividual): AAA Ad&ess: 41 6rrl 11,'UI Van City/StateJZip- /4A Ph..4: SC� Aire you an employer?Check the appropriate bo= Type of project : mre •4. aiHi s confzactor and I 1 �r� '�- L El I am a employer with ❑ I g 6- F1 New coonstru oa employees{full and/or pact-time}* have hired thesub-eonlzactars. 2:-5�I am a sole proprietor or partner- listed on the attached sheet; 7- kRemodeliag slug and have no employees These sub-c ntractors have S. Demolition w far me in an c ci �- employees and have workers' o�zng y � � 9. ❑Building addition L`o w'orkftrs'comp_insurance comp-insurranc , required-] 5..❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ f am a homeowner doing all work of cars hate exercised their 11-f D Plumbing repairs or additions. myself[No workers'oamp_ right of eimroptiomper MGL 121-1 Roof repairs iamnaure required.]I c.152,§1(4,and we have no employees-[No workers' 13..0 Other comp-insurance required-J..; *!t_uy spplicirat tbit checks boa#1 amst also fa out the section below shaving Fhea worikers'compensation pa]icyiufdr vtrrm T Homeowners who sobmit this a$rdx,,h iMTirat arg they are doing kn u.&and then hie outside contractors mast submit a am affidnk in�lcatIDg succh-- tGoatractors thst check this book mast sttached as additional sheet shoving the i, of ffre sob- ors and state whether txnut those eadjes have employees. If the snb-cautmcttIIs have employees,they moist provide their workers'comp.policy number. lam an empFayw iliat is prmiding it�orkers'congmnmri on insurance for my emplayem HelowisthepoRcy an.d1ob site inforxtatiom Insu=ce Company-Nam- Policy 9 or Self-ins-Lie # Expiration Bate: job Site Address: City/Statelzip: Aitach a copy of the workers'compensation polies declaration page(showing the policy number and expiration date). Failure to secwe coverage as requiredundes Section 25A of MGL t:, 152 can lead to the imposition of ri inal penalties of a fine up to$1,500.00 and/or one-year imprisonnmnt,as well as civil penalties in 9ie form of a STOP WORK ORDER.and a fine of-up to S250-W a day against the violator- Be advised that a copy of this sit maybe forwarded to the Office of Im es4 ations of the DIA far imurance coverage verification_ I do hereby cerf6 render tlra aIIdpenaWes ofpedw y fhatthe info rrriationprmwided abase iss tnu and correct aitrnature: rr Date: Phone#- eC,)FiG 0Bela/use onty. Do not sprite in this area,to be completed by d(F or town oo'c&L City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityffown Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#_ 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 IocaI licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth;or lay 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 certficate(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 Indusiii.al Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. `17 e affidavit should be returried,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 caIl 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 permit/license number which will be used as a reference number. In addition-an applicant that must submit multiple permit/hcense 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 ilz (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 lice 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 Gommonvmalth of Massachusdts Depaxinent Qf Industrial Accidents Office ofkve�stigations 600 Washington Stti�et Bastous IAA 02111 Tel.A 617-727-49 0 W 406 or 1-8 MASSAFE Revised 42407 Fax#617-727-7 749 www.mass govIdia s , * snxrvsrasr.E. ,�� Town of Barnstable ArED MP't A Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete acid Sign This 'Section If Using A Builder - . - t J- as Owner of the subject l property hereby authorize l �- I (' l a to act on ray behalf, in all matters relative to work authorized by this building permit application for: 4lrv, Ile , rn d ®-2 G 3 z (Address of Job) Signature of Owner -Date Pritit Name "Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. • F LR FILES\FORMS\building permit forms\EXPRESS.doc ed 061313 Town of Barnstable r Regulatory Services P�0I.IHE rOty,L Richard V.Scali,Director , Building Division vsiAs Tom Perry,Building Commissioner MASS. v$ 1639. � 200 Main Street, Hyannis,MA 02601 prE°IA°�A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: • city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside,on which there is, or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said 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 t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 1 Massachusetts - Department of Public Safety C�1e rpooiunzoazcuecclC�o�UciGatdccc�ccde(,td Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation Construction Super%i.+ur lWe ME IMPROVEMENT CONTRACTOR License: CS-107347. '' gistration: :T71899 Type: piration 4/30%2016 DBA MICHAEL FERUL-LO FERULLO REMODELING i 40 GRISTMILL PA TfI s. Ua , Marstons Mills 02648 �. MICHAEL FERULLO ' �rt F i 40 GRISTMILL PATH Expiration MARSTONS MILLS MA 02648' Undersecretary Commissioner, 09/09/2017 1� { i 9 License or registration valid for individul use only before the expiration date. If found return to: F Office of Consumer Affairs and Business Regulation k 10 Park Plaza-Suite 5170 j Boston,MA 02116 :{ -Not valid without signature it _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel 000 Permit# Health Divis on �u 13 f �S S-1 37f Date Issued Conservation Division l -3` Fee / 94 96 Tax Collector 1 Application Fee C)O Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board M8Y �LI��IT TO B:'Oo pa Historic-OKH Preservation/Hyannis Project Street Address 0 aQ ca— Village CP—;V,+�.-e,ry c �[nn-2� Owner _244 M /J A-v-<_- / r —PY. Address C`��/� 7D4c� S Telephone ��^'� 7 S 00 Permit Request To t 16 f7t X 0 1-fi ( S-or--i Square feet: 1 floor: existing ri l Z proposed 2nd floor: existing proposed Tota4l-_new VVaIuation 0 Zoning District Flood Plain Groundwater Overlay Construction TypeQ. r' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. I � - G� f'7 Dwelling Type: Single Family 5d Two Family 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes ❑ No Basement Type: )§ Full ❑Crawl ❑Walkout O Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of.Baths: Full: existing new Half: existing C� new_ Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ;A Gas ❑Oil ❑ Electric O Other Central Air: ;6 Yes 0 No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes KNo Detached garage:0 existing 0 new size Pool: O existing 0 new size Barn:❑existing ❑new size Attached garage:))existing ❑new size 1&42 Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use l BUILDER INFORMATION Name L'. rI,�S �' ' `'�ru/<V Telephone Number a 9­0 3 Address] OLO Vk,t I1 License# 67 1 Z.9 1 Cc.y`S o�C S 1�S I 114-00&`l Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' � SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE WSUED MAP/PARCEL NO. - - ADDRESS f VILLAGE OWNER _- DATE OF INSPECTION: FOUNDATION �I� '� `�-p3 � �l' Z-1 --L3 FRAME 17--2i-a51 dYI 2-2 INSULATION 0 Y / Z- Z q -U S•, -- 't FIREPLACE ELECTRICAL: ROUGH rnr FINAL PLUMBING: ROUGH FINAL E, GAS: ROUGH w ' FINAL � FINAL BUILDING Li�\ �- -Li t DATE CLOSED OUT ASSOCIATION PLAN NO. �' RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition 5 5500.00 , t� Alterations/Renovations $50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET NEW LI NG P E -` ---{=square feet x$96/sq.foot= x.0041= �- plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 11 square feet x$64/sq.foot= x.0041= plus from below(if applicable). y 5 l , �, r,,AR.AGES'(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 50.001 >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/Cbimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocadon/Moving $150,00 (plus above if applicable) Permit Fee Projcost 1 ne "mmonweairn of massacnusetts Department of Industrial Accidents �6 d Office of Investigations ' d 600 Washington Street ;,V S't Boston,MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organizationandividual): �/ (r' ��S /.�� ✓�✓ < /D Address: (O-4Z_ a L 1> ( � 12 City/State/Zip: Guy S V I l c Phone#: Are you an employer? Check the-appropriate box:. � • : 1.l_J I�am a employer with �� 4.,] I am a general contractor and I Type of project(required) employees(full and/or part-time). have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9• wilding addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other *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. r am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. _ Insurance Company Name: Policy#or Self-ins.Lic.#: , �0 0s-l?.Is— 6 o'?p® Expiration Date: ��� '� 2 t✓ U Job Site Address:_ Ce,,Pt Ae City/State/Zip:_ Z C Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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 Df up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. r do hereby certi un r the pains and pe Ides of pe •ury that the information provided above is true and correct Si ature- Date: /'4 2,�./O S Phone#: Official use only. Do not write in this area,to be completed by city or town offIC41 City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4..Electrical Inspector 6.Other 5.Plumbing Inspector Contact Person: Phone#• 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.A_'a.n. 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 alte owner of a dwel ling 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in ' (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for:future 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street- . . Boston,MA 02111. Tel. # 617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/dia oFTME� Town of Barnstable Regulatory Services ` sAxiLMS.�;� Thomas F.Geiler,Director 9 : gym$ A 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. _ 11 Type of Work: T I Estimated Cost D �� U V d Address of Work: �S D C (4 r Owner's Name: DaV I S 1- a-V'v Pq / / e /4a,- Date of Application: C� I hereby certify that: I Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding 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: ,oJ3� Ivs C14,4r-1.e Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav no CUR AppwxUx J Table JMIb(eontlnned) prneriptive Packages for One and Two-Family Residential Bnildino Seated wig Fossil Fula MAXIMUM MINIMUM Wins Walt Floor .Bataneat Slab HminglCoolimg Charing Glaziag eta Equigmesst $f1'icic'mce Palm Areas(/•) U-value= R-vaiuer R-value' R valuc' R�s R value° Package 3701 to 6500 Heating Degree Days 6 Norcial Q• 12% 0.+40 38 13 19 10 Normal R 12•/8 0.52 30 ._ 19 19 10 6 6 $ 12'/o O.SQ 38 13 19 10 �,ftJE N/A iS Nwnw -._0"6._-- - 8 13 25 NIA --' d —Aiorcnal-- - ----- ISO, 0.46 38 19 19 10 /A 85:AFtJE 38 13 25 NIA -Nti 83 AFUE .. W 1 % OM. 30 19 19 10 NIA � Nmmal R 13% 032. 38 13: 25 NIA Normal y 18% ' 0.42 38 19` 25 NIA NIA 6 90 AFUE y . 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 1.-ADDRESS OF PROPERTY: � 1 Ate- 2, SQUARE FOOTAGE OF ALL EXTERIOR WALLS:. `t'••' 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 NIE O ETER ONING ENERGY REQUIREMENTS ARE AVAILABLE, ASK US FOR THIS BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-580303a 780 CMR-Appendix J Footnotes to Table A2.1b: Glazing area is the ratio of the area of the glazing assemblies (Including sliding-glass doors, skylights, and s if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall basement window e total glazing area may be excluded from the U-value requirement. area,expressed as a percentage.Up to 1%of th For example,3 fF of decorative glass may be excluded from a building design with 300 if of glazing area. =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 11..5.3.a. U-values are for whole units: center-of-glass U-values cannot be used. ' 3 The.ceiling.R values do not assume a raised or oversized Truss construction. If the insulation achieves the full Insulation thickness over the exterior walls without compression, R 30 insulation may:be substituted for R 38 insulation and R 3'8 insulation maybe substituted for=R-49=insulation: Ceiling R-valries=represent-ihe-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. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding, structural sheathing,.and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 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 J511a 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 11.5.3b. 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-vaIue to determine compliance of the door. One door may be excluded from this requitement(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- yalue of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 oF, Town of Barnstable Regulatory Services Thomas F.Geiler,Director p10� 'OrED IYIA� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us I Office: 508-862-403 8 Fax: 508-790-6230 i Property Owner Must Complete and Sign This Section If Using A Builder I��, ►���( f e—ra - ,as Owner of the subject property hereby authorize C) /.,s (V7 ` F�ry`/0 to act on my behalf, in all matters relative to work authorized by this building permit application for: �o C� pe- - (Address of Job) Signature of Owner Date Ar0 -,'4 t Print Name Q:FORMS:0WNEUERMISSI0N Lice nse of Cegistratioq aalid for ind9vidul u�sl•only c� 13�ard of 1}ui?clin�r�"_illations ar+3 Stana,4 cds , , rabj,r d te. If found return to ' L1Fre in earl .. ulxtions and Standards. Board 6f Building Reg HOME IMPl20�"Ef`''LTITF�v' QQ As'sburton place.Rm 1301 Reg►straUon'134401 Boston,l4'1a.02108 EXPiraWn: 1 ki, I2005 . QBA P,A`�PLY+R :MDDELING r N CHARLES FERUL:,, 20 CROSBY GR. Not valid out signature S.UENNIS,MA 02660 Administrator , BOfA.�RD OFA o� j LDI'NCyRryE 11�LA�T�p r A- L�eense CONSTRUCit erN � Sl�1�EU�IS�a`!R !.� Num�be' -S Tr .no. 265:Orp t:ommtssl'oner t yam`°f`HE'° The Town of Barnstable k BAR S ASS.. , Department of Health Safetyand Environmental Services i679• �0 pIEOMA� Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: �1 Q v� n ,� Map/Parcel: Project Address:Ric) 0-0.c, &C �LC Builder: t) ( ( C The following items were noted on reviewing: _I� u (3NA- C Y v 1'3'1 A(" C)Y S V Reviewed by: Date: q:building:forms:review ^r SM E D TEC R REVI W D r�. 9 BARNSTA / A , S ING DE .DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 73'-8" 4'-6° 7'-6" 8=7" 5'-0° 16'-3" 26'-10" r4�,i'4• ra•.a4• � •a•.�• ra•.�•4• s4•.5'4•so ra•.5.4• §2-9" A i7 i 6 Kitchen � 9 —6'-0" N Bathroom !. Dining Area Bedroom#2 e N b 4rExistingy 4� 5'4'.B'4•W b N ° ........sa.ee:°p N......... 24°5.4• rr,ea13'-11° ti ................................ 3'-1° 11'-01 14'-8" 37'40" b 1 car garage Iwo L6'-10— 4 4 Bedroom#3 O N 4 N r------- ---- 9 Master Bedroom „ I Living room I ° Mstr Bath I I I I I I Jam_e'-6° 61$1 4,40" N ° .. .. .......................................................... 4 8" 7 11" 9 5" b 9 7 10" 8'2° —� it 22'-0° ° s'o•.a.4. .. .. .. N 3-5"— —5 2" 3-1" 3-0" 5'-0"- r, 7�j Y 4 �Y • 12 match existing root pitch � 2x12 ndgeboard 2x10 r Rers 16"O.C. 35 year architectural shingle t2x6_collar ties 48'OC 1/2"CDX sheeting ( Simpson H2 Hurricane snap 1 per -(ratter(typ) 1x8 facia _ .R=3o _ 2x10 cieling joists 16"O.C. .double 2xIO header with plywood spacer W strapping 16"0C 1x3 (TYP) - ?°9YPsumboardsheetingw/ 2"vent teped joints 1x4 13/4°bed molding 1x6 maize •2x4 wall construction w/` R133 12'cdx plywood sheeting 12'gypsumboardsheeting wl _ taped Joints 'a clear'white ti r cedar shingles \ N.T.S. double 2x4 window sill(typ) ' 3W T&G plywood sheeting `2x-10.#2_BTR 16"O.C. 1x3 strapping 96'OC . -�2x8 Header for 2'8'k3'0"double hung window �trip le 2x12 giver beam _ 2x6�PT sill plate grade 12"j"bolt ancof 3 1l2"concrete column �— — 48'below grade mm 7"—fo'co crate foundation #4 reinforcing bar w-7,Poured concrete Boor 245Q49r10"reinforced footing at cola reinforced concrete footing - r 1 A Y�e F� "rS s T Yc - -3. a ar � �r a, i,'��•k m" -a '�=�# ,s, ,`k� � �2 t , „� Cz ra�,.3'' S 3 y.�a,p ��y � a�`�r.._�'•� ,r;, • -47 sca.�,'r..*.� y,:V ...L.•..'S.„•j"� »���a�Yta. 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'"c'.y rc.'� �:,'q�, z e -•-�,'�"• �.�� p¢ :�r'F'�`i^+.y,:�_ d`�'`�: � - � •-> .a-�-_�,fi...s'.^,esaue A sau -'isna.�"� �-�a` >+�.' e`°`.�^'�" .a s�;. �c.4r- t - ,�S` k:.. z �' �-.'� �V'-,r�"� * ,.�."�,.�-h. tea. ,.:.a a r' t y-»-.� �•� ;J'.t .'�l_� �.. r .i �Y.t, ' pat'+ .mow �` � $'°r ,t .xy '` - �"• +� �' `� ti - TOWN OF BARNSTABLE Permit No. { NAUS, M " Building Inspector cash - - - - - �6)0 OCCUPANCY PERMIT Bond Issued to Address 496 Cap'ii .iac's kwiu, veutery i 11_e Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19......_... .................................................................................................................. Building Inspector FROM TOWN OF BARNSTABLE BUILDING DEPARTMENT Mr. Francis Lahteine 367 MAIN STREET HYANNIS, MA Town Clerk Pone: 775-11 ZD -SUBJECT: FOLD HERE - DATE January 31, 1985.- �. MESSAGE 5;Wok has ,been completed under Building Permit '#26434 (Jamey•K.- Smith)'. Please release Bond, »` ' .. SIGNED DATE REPLY / SIGNED • . - • 1 RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY • ` » , PRINTED IN U.S.A. SENDER:--SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON.INTACT. C,�{{,d�t.C— -;~AM I l_:-e K M tag i� /� p cm'% Q trY.GAL-d'♦.ti/-1/V♦t t '� 3 3 :74:7. -W;^ '� I ;-• r. '• j i' . r 1 . , _ /I 4 y •1 ♦' 330' k.151y/�•� 4ri 5c W • u E kocx, ac. , sc-� nc .Tbti'� U "� vtS.PoSc�'l•. PI? ` ut=� •`x� PtT� .� �r��*�= : • ; ; ! •, •� � � ZZG}c 2-. ' l3o Z9 TTOAA A%1 41, LI� OT PF>Z,C; �.T.t.o►•! �d'('L• l I N 4� btw, I } c. li•t •,I 1 i, ..'.•I. • .•j , '� t•1 �.t i t (Yl /.., •t. 1 �. .�'.�. '.�•J �.1` P� •; ' •i, .,. •n ' -I�! 1 I ', � "••'.��"':� , >f 111 � - �� �;. S ��r.•.�-'I •f .;r tl 1.f, 1' L.• .i..' 1 1 � .. 3 �I 1 �n►'�I <� VA 0. A14St,�' EQ DAV D, I ; 1 f' : 1 ,'t• WULA Ant ,1 I , '.. I �. ♦ •e1.HIJL I�,.1 r �.. ,I .1 • ; '• ! j , ` ..... ..No.-29 7.6 - ,'� ; ; I'1 t \. `V k9334 S +E g i .1 ' ' ' •' f r . t (A� f' , �C:' H E��O�. , 1 1 ;`+ �.r• D,r� 1 I't t •(• 1 'f ) '� ; >il, yl_ �QNAI lop F'm 1 ilk 11�, a "�og u 4L. II 1 , _• , �• »�Isr. �{ w 5a 16V 170X• t TA►JK. �: 9_I.Y�7.7 g+1 Y I torso �� ;. � ;: � .,. °�r bat.,'.', r: ! :1.1s>�... hl�:� .. _ '•' ... !-•- � �-��-��• -��- t rt} i PIT i 4 i ii l . G Wt Tlb � _�„ � • ��, �(�I.�tA , t ,. .•t I I.. - R' h:+l..•is�,JY.I t I C T t t=t ar-> 1 FI l.E.- 1 ! l.a�a-nol,., ~ 1 1 i.lo. ' SGot.A� 1 L.6 L ► U AT tc. ' , �` 'd tiU �N� !r .c„ �, � I • ; � , - . i , . . : I tJC� t pt_G.1�1, 2tr=�E'K�.. t". Ca�CT1�Y • "AT Tt t CV 1.aG• �uUl�+p 5�•tow�.I ` , a c-so N 'w t T H •T"E -S .►ti►tom. A AwD +�"("�AGK R�4JI�M�-►'r5 OF TWF_ Towji.J °OF �I�Q.NS��c,CJf.L:'- p.h1D • I {-r Grl P�-rlac� . •377-1 l:o(:ATEc> WI'Tti At W ` T►d 'LOCAZ) PLAI W- ;, �-� ►C_{4 V t 5 A XT a t- e, 1 oA'c�- �'i�Cl� �-" . I • � ` SZ.FG.tST� czeo t.aut�' �,c,)Q,vE`�OeK Tµ1S Pt-d�.l IS► : IlUT 845EI� ow Iku 1 WIAE."T OtTr�2Vtu..C. MA S�S'y � SUICv�( TNt;. t7FFS4T;• iN®ULD UOT use0 gppt_,1G A Nt'• !' To"veYe�l►�E.•-- Issssnr's GIE map and lot-number ........ d � Sewage Permit. number I ` 7 .... I IS A .LEP h ✓ 3 i `33A"STABLE i House number..............:...... `7.��.tQ.. R,0 N . :..� .r TOM y T11 OWN OFAINSTAB`LE BUILDING INSPECTOR APPLICATION FOR PERMIT TO. .' .....Construct_.•Dvaelling 3` . :Wood frame 'TYPE .OF 'CONSTRUCTION _ MAY .gda.... D.I NGS TO;THE INSPECTOR,OF..B.I�JL--. , The undersigned hereby applies or ,permit according to fhe. following information: hot 16 .Capt. Lijah, s Road,, CentervillQ Location ................................................ ... Single family ProposedUse ................................... ................. ...... ....................................... ..... ZoningDistrict Re�� ........ .. ........ .. Fire District Cent Ost c James K. Smith Barnstable Nameof Owner ......................... ..............................:.. .......:Address ...........................:.... ......... i James K. Smith Name of Builder ...... ......... ........ ....... ........ ....... Address Name of Architect ................................. ..................... ....:...Address` ..........,.....:............:.. ed Pour concrete Number of Rooms ....5.. ......... !.. ....:...Foundation . ... clapboard & w.c .s, asphalt Exienor ............... ................. ......... ........ ...... . . . ........ ..:...... .........Roofing, ...;,..,ra..,.. ...:. hardwood drywall Floors °........ .............::......................... ...............:...................Interior .................................................. ......... gas warm air 2 baths Neafimg ....... ........Plumbing ......... ..... .... ....:..:. ....:: Fireplace .. .........Orie..: . ........ .... ....................................Approzim t C t .. .. 55,000, ..... a e. Cost Definitive Plan Approved by Planning Board ___________ _______ ____19________. Area .... .. i rt�m of Lot, and Building with"Dimensions Fee Q P pg- w ../ .... $'OBJECT TO APPROVAL .OF BOARD OF HEALTH LA t }�aM o ONE C p 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. Name .:. :....... 1................................ Construction Supervisor's License S O • SMITH, JAMS K. T* One Story 0 26A34.... Permit for = •.Single=Family Dwelling.. Lot 16, 496 CaP I s Rd. ` Location Lott Centerville; ........................................... .. ...... r , Owner. James K: Smith' ........... .... .4 Frame ,. Type of Construction' ...................................... Plot�...... a Lot ................................ � •- � ,. .................. v _........................... .;•Permit Granted ....................19 84 gate of Inspection. ..................:.....:..........19 c 41. `Date Completed /100, .." 19 t5—�f N - - � y� - • , • sue, 4 , AC ROAD 3 f ICE C g°30' v, - SEgV t N sop, Cz cap Jac s LOCUS q - : LOCUS MAP PLAN REF- 379170 , ASSESSORS MAP: IC4/60ZONING. .. LOT 24 ASSESSORS SETBACKS: 20-10-10 »C„ MAP 59 FLOOD ZONE PANEL NUMBER. 250001 0015 C DATED: 8119185 (31 20 PROPOSED � ,' Cl( PLOT PLAN OF LAND �+ ADDITION LOCATED AT 80 CAP'N JA CS ROAD 'CENTER VILLE, MA LOT 15 ASSESSORS ' MAP 61 w . , PREPARED FOR. LOT 16 DA VID & SHARON •MINE'HART w ASSESSORS' - _.:t C' MAP 60 ,.���®�.� OCTOBER 25, 2005. rn AREA=15,000fS F ,9 iT FH RE a V.• 9 2 ® S i c N --AW cn P. REV DO 1.oYLE #3 559 A REV.• �D s u YANKEE LAND SURVEYORS GRAPHIC SCALE & CONSULTANTS 20 0 10 20 40 - 1;OT 25 P. O. BOX 265 UNIT 1, 40 INDUSTRY ROAD �. ASSESSORSMARSTONS MILLS, MA 02648 1 inch = 20 f t. MAP 62 TEL• 508-428-0055 FAX 508-420-5553 SHEET 1 OF 1 JOB ! 53998 JS