HomeMy WebLinkAbout0022 CAP'N LIJAH'S ROAD �A � ... •' ,_,y .n //fir/!dd//ff '
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Application number................................................
Fee . ............... ........................
Ste :
Building Inspectors Initials.... .............................
M� y
Date Issued.:......? A..�.�7.......................................
AUG 13 2019
i
URN U� 6ARIMS IABL.E Map/Parcel.............:...................................................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY,INFORMATION
Address of Project: (�/� ► G1 S Cry fe,VV
NUMBER S ET VILLAGE
Owner's Name: Phone Number R K 5 7 33 ff
it
Email Address: El,D 9a ��DU ' COS Cell Phone Number 5'Am e J
Project cost$ �'dd Check one Residential y Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
❑ Siding' r ED Windows (no header change)# 21 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 �Glv yr d -,4
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable)# (attach copy)
Construction Supervisor's License# (attach copy)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS/N
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
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 bask left side right side
.-HOMEOWNER'S LICENSE-EXEMPTION
Homeowner's Name: 64kL Sid
Telephone Number; J -3 _� `3 3 'N Cell or Work number 5,1/i e
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 20
instable
-_'_Signature` Date K of l
APPLICANT'S SIGNATURE
Sign ature L
�
All permit appl' s re subject to a uilding official's approval prior to issuance.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Nalile(Business/Organization/Individual): 614rL-1 �eo q G
Addr-ess: z2
e-- 1�
City/State/Zip: ����YI/III� �� �PnOn#: O 367 3 J�9—
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. ❑ I am a general contractor and I
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 g, ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P n'• $ 9. ❑Building addition
[No workers'comp.insurance comp. insurance.
uired.J 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
Sam a homeowner doing all work officers have.exercised their 11.❑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.[1 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.
$Contractors 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.#: Expiration Date:
Job Site Address: City/State/Zip: `
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. '
I do hereby certify under'the pains a 'es ofperjury that the information provided above is.true and correct
Si-atFe_.- +Date:..
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
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"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has.not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to cant'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 LavestigabQas
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-NIASSAFE
Revised 4-24-07
Fax#617-727-7749
www.mass.gov/dia
-Application num e I
DateIssued...........9..bkK.... ................... .................
t63; t Building•Inspectors Initials
� SEP 0 7. 2018 � . �
_ Map/Parcel...... .. .� .. ........�...............
TOWN 01� _bAHNS 1'ABLF-
TOWN OF BARNSTABL
E
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: C-11
NUMBER STREET VILLAGE
Owner's Name: V "5+rzlk Phone Number SUB 3 le 7
Email Address: �' Cell Phone Number .30 3 3 Y
Project cost $ 111J Gay t Check one Residential (/ Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize v�.
to make application fo a building accordance with 780 CMR
Owner Signature:' ; Date: `
TYPE OF WORK
❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization
❑ors (no header change)# Commercial.Doors require an inspector's review
1 Roof(not applying more than 1 layer of shingles)
>> Construction Debris will be going to y t4.C G pl_N O_1!�t �-e V J
CONTRACTOR'S INFORMATION
Contractor's name ) �,a q. 5 V
40
Home Improvement Contractors Re 'stration(if applicable) # �Z3� (.,, -7 (attach copy)
Construction Supervisor's License (attach copy)
Email of Contractor •l�F r' hone number
ALL PROPERTIES THAT HAVE STRUCTU ES ER 7 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUSTaOBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
*For Tents Only* d
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.
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
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 left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name: r
Telephone Number Cell or Work number .50 7
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
r
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
x
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Pleas Print Legibly
�C—Name(Business/Organizatio ndividual): H
4-Address:
ity/State/Zip: S Phone#:
Are you an employer. Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
yees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.8 I 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'many capacity. employees and have workers'
Y P �'• $ 9. ❑Building addition
[No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Pl
myself � ' right of exemption per MGL mg repairs or additions
o workers comp.Y P insurance required.]t c. 152,§1(4),and we have no 12. oof repairs
�
employees. o 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.#: Expiration Date:
Job Site Address: City/State/Zip:
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 foam of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi er the pains a pen es of perjury that the information provided above . true and correct .
Signature: Date:
Phone#: _
Official use only. Do not write in this area;to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
K
Information and Instructions ;r
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 1152, §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
i sub-contractor(s)names address es and hone numbers along with their certificates of
necessary,supply ( ),address(es) p ( ) g ( )
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
Fax#617-727-7749
Revised 4-24-07
www.mass.govfdia
d Massachusetts Department,of Public Safety >
Board of,Building Regulations and Standards ,
License: CS-098018 -
Construction Supervisor
f THOMAS S ELDRIDGE
16 AVALON CIRCLE
OSTERVILLE MA 02665
i
�1,�t<�ui �� > :�-- Expiration:
Commissioner_ 06/03/2019
i'
e
• �szsawsmr?Ss� ,�7.az`ai.�:s`raca�� taa�sw,s:.:�rr�. .
lie �ra�znaryiacc1ecr,�CL afC `�c�sicccaeC
Office of Consumer Affairs&,Business Regulation
HOME IMPROVEMENT CONTRACTOR
- TYPE: Individual
Registration Expiration
a;l 3067 12/01/2018 ?o
s*
THOMAS ELDR�IDtt
GE� ;', ..
THOMAS ELDR�IDGE,' r'
16 Avalon Clr
Osterville,MA 02655
Undersecretary
Assessor's map and. lot number .......... .fc.7......
n
i-i" - f•,.r' ,7 6.i% •3`• (//� — ��� �� ( (c` !v e:=:J� rJUST BE
IN COMPLIANCE
Sewage' Permit}number �''•ft I ARTICLE II STATE
........................................................".
", 1 1` ARY CODE AND T®WN
�FTHEtO � i TOWN N OF A,R.NgtAtL-R-�-`yam
i BA"STODLE, • r Ge 4
DUI=LD
9 M3a � IN G3q. •� G INSPECTOR'
APPLICATION FOR" PERMIT TOAz/ .c�............
c ... .......................
TYPEOF CONSTRUCTION ...... ... ...........................:...............................................
u � i....c
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit accord�ing� to the following information:
Location ..... .............� ................G:.�'rr�i .......� ........................................................
Proposed Use ....... ./. ,1�>. ii.�l
.............................................................................I.........................
Zoning District ..Fire District 4°° /
Name of Owner .......ei ! '/'m:-q—Address
Name of Builder ... .....`...�� . ..................................Address .....................
.............. ......... ... . .
Nameof Architect ..... ....t!��Y`..- --.r.........................Address ...... ... .......................................................................
Number of Rooms ..................................................................Foundation .. ........... 0.......C". 'd....... ...�d.../G..,..
Exterior .,/ .....,yam ,.: ..�-� /. / .1. ��..Roofing .. ! ........ �1. .....................
�...... ..� Y......
Floors .............. lam. re.............................................Interior ..0........ .. .. .. . /` d.�.r ...................
'o,
/ ... .""
......... ...... ,...............Heating ...............................Plumbing .. 4
Fireplace ... .............. ..................Approximate Cost ........,. `1K ................................
Definitive Plan Approved by Planning Board ________________________________19________. Area
Diagram of Lot and Building with Dimensions Fee ........... ...........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
xaF
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... ...... ....6. .............................
Tellegen-Ferrone
1,8820 1 1/2 story,
No ................. Permit for ....................................
Angle family dwelling
4
.......................................................................
JL% Capt. Lijah Road
LoccitioroF............................I..............................
Centerville
...............................................................................
Tellegen-Ferrone
Owner ..................................................................
frame
Type of Construction ..........................................
................................................................................
Plot ............................ Lot ...........#38...............
`4 1
Permit Granted .....
..19 76
,Date of Inspection'6.. . ... .. ......... —19
Date Completed ........... 9
1,01
141
PERMIT REFUSED
................................................................ 19
.............................................................................
...............................................................................
...............................................................................
...............................................................................
Approv6d ................................................ 19
...............................................................................
............................................................................:'..
•
Assessor's map and loth number ..........
//....•........ ,-,_._--------~
$e4age ''Permit number ....`lS...................................................
FTNE TOWN OF BARNSTABLE
i Ell ABLE' i �%
°.�opya.•�� BUILDING INSPECTOR t
r
' APPLICATION FOR PERMIT TO �
TYPE OF CONSTRUCTION ....... ... ..� .9► .�................:..
X
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit accordiinng� to the follow,iinng information:
Location .....�" F`.��.�................../ A,1 i /�.•....=il�..�� ,...........:...........................................
!?................... ...... .................. ..�
ProposedUse / /r.?,�/' .r' .....:........................................................................................................................
Zoning District ...................................Fire District ' '<..� /�- '
Name of Owner ... /,��►2,�J....... �'",�!n—,. Address ........................ .....................................................
.............
Name of Builder ... Address ............... r......;,.....�/i�l .............................
Nameof Architect ...........r' fir,.-...-.. ........................Address ... ',. ...................................................................
Number of Rooms ..:....................................:..........................Foundation ..................................
Exierior �+ r..... ...-' /..�'fi .......!r/,/...Roofing �..�.�....... ......................
r
Floors .................. .................:..............................................Interior ...../...............,...,,.........;........:r'•�s�...�
Heating a'��'' ...� ......Plumbing ......; !�!// ...... ?+ �'.+^ .........
g ............................................................................ f 4 . . ..................
Fireplace /'ilrca ..................Approximate Cost .......... 1k ..................................:....
Definitive Plan Approved by Planning.Board ________________________________19________. Area ".
1
Diagram of Lot and Building with. Dimensions Fee ' W`''
SUBJECT TO APPROVAL OF BOARD OF HEALTH 1
hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. ........... ...: .. .............................
TelleQmo~Farrmoa A=192~186 '
7 ' .
lU&:;_�- rmfor l 1/2 story,
Nos....— Pa
------------ '
single family dwelling '
--------------------------'
.
' r /-�`" t. �i1ah Road.....................
_' ----—°----- —— --
'
' Centerville '
................................. .
C�vvna, ____.��lle�ao~�arrmz�'_`____.
. '
frame , .
Type of Construction --------------
'
. .
pkz
'
.
Rx November 18 76 '
Permit Granted -------------.lV
Date of Inspection -------.-----l9 '
' Dote Completed ------------..lA
`
'
PERMIT REFUSED '
' ' ------~-----.---------. lV /
�
^
......................... ~............ .....................................
`
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` --- --.
Als
pprove
. .
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19
^ .
/ -----..=�=�^. °—~.,.
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Iry
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map I Parcel ` v i..� Permit#
J �i
�Health-Divisions - 2-o a�" °/ — �b ��fw0lABLE .. Date Issued - 2 R) -
D -
Cons n—�ervation Divisio 4 i P _ Application Fee
i �S
Tax Collector � �� Permit Fee �
Treasurer D/;, 10�
Planning Dept. EXIS"M WPM M4wf
Date Definitive Plan Approved by Planning Board I JMREDTO'':�OF IMROOMS
Historic-OKH Preservation/Hyannis
Project Street Address C b r 4
Village Vi e
Owner aAry Address
Telephone
Permit Request �` ®o'T e ee A
Square feet: 1st floor: existing ®® proposed 2nd floor: existing /W 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 f Two Family ❑ Multi-Family(#units)
Age of Existing Structure Vvv5 Historic House: ❑Yes P No On Old King's Highway: ❑Yes ;'No
Basement Type: IkFull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) cel!�
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing / new
Total Room Count(not including baths): existing 1I new First Floor Room Count
Heat Type and Fuel: OGas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes ONO Fireplaces: Existing � New Existing wood/coal stove: ❑Yes Ft
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garageA existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ;1"N"o If yes,site plan review#
Current Use Owt erg occr 1,' Proposed Use 4.�-•
WILDER INFORMATION
Name 6 �� Telephone Number
Address _ i License#
a
Ca I fle Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGN UTA RE'--_, DATE f ��
. k
7 '
FOR OFFICIAL USE ONLY
PERMIT NO.
DAA E�ISSUED
r o .y_,
MAP/PARCEL NO.
'r
ADDRESS VILLAGE
OWNER j
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL '
GAS: ROUGH FINAL
FINAL BUILDING ..
DATE CLOSED OUT r
ASSOCIATION PLAN NO.
}
c� `
Town of Barnstable
Regulatory Services
l BAHl SUB Thomas F.Geiler,Director
A 3 A`�� r Building Division
�BD MA'S •
' Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: $48-790-6230
Permit no.
Date
AFFIDAVIT
! HOME IMPROVEMENT CONTRACTOR LAW
:- SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142Arequires 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.
e�J
Type of Work: ` e sf V14C_ ��oN Estimated Cost
C �� , .
Address of Work:_ �/ S
Owner's Name: ��' *
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s);
E]Work excluded by law
4, �2'Job'Under 51,000
[]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 OG�VI OR G�ARME?.N�TY F��ERMGL HAVE
ACCESS ACCESS TO THE ARBITRATION PR
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date
Contractor Name Registration No.
OR
Vate4�
Owne '
Q:fonns:homeaffidav
' - The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
`- 600 Washington Street, a Floor
- Boston,Mass. 02111
Workers'Compensation Insurance Affidavit:Buildin lumbin /Electrical Contractors
namea ),
Caddres'
city N �64 e E state: zi : vhone# 7 7
work s to location-f-full-address):
Q I-am-a-homeowner performing all work myself. Project Type: ❑New Construction[]Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑Bu)ldmg Addition
�.�r_�.a.���...x'�Y :til«�' "„'.+'��^ '?k� E,.�:�.r..d..R ryn. .... ... :,r.., a'AA d .?` ..h „ .�,T ..t .. .....';�1, lx.�•�` ..
❑ I am an employer providing workers' compensation for my employees working on this job.
company name-
address:
city \'d phone#:
�.r
Insurance co. ia#
❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
city phone#•
insurance co. oli #
•
company name:
address:
city: phone#•
insurance co. oil #
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 51,500.00 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 D1A for coverage verification.
}
I do hereby certify under the pains sa ies of perjury that the information provided above is true /d c rrect. +
Signature Date ! G
4
Print name Phone#
7person:
nly do not write in this area to be completed by city or town official
: permittlicense# Building DepartJ
❑Licensing Boardimmediate response is required ❑Selectmen's Off❑Health Departm
son: phone#; ❑Other
03) _ - -
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 requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned.to the city or town that the application for the permit or license is
being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' compensation policy,please call the Department at the number listed below.
MAW
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 returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of investigations
600.Washington Street,7`h Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone #: (617) 727-4900 ext.406
Reg'04tory Services
-rTUoM.s�F.:Geiler,Director
9�A 9 '.:Building Division , .. M..
`:-Tom Per'ry;`Bfirilding Commissioner -
200 Main Street, Hyannis,MA 02601 '
www.town.barnsfable.ma.us
Office: 508-862-4038
Fax: 508-790-6230
H�Nj�� WNER LICENSE EXEMPTION
_ ""-Please PPInt
DATE
r—
JOB LOCATION: C-c. L (6)61 P�'(!I '(/(` e A-5Z
number street village
"HOMEOWNER': 6,1 77L E 1
name ho/me phone# wo% one#
CURRENT MA11ING 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 strictures 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,thathe/she shall be
responsible for all such work performed under the bp
ldin 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 Tovym of Barnstable Building IDepartment
minimum inspection procedR=44udrequirements and that he/she will comply with said procedures and
re nts.
Signature of H er
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required-to comply with the
State Building Code Section.127.0 Construction Control..
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot.proceed against the unlicensed person as it would with a licensed
Supervisor:The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by'
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexernpt
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ENVJQOwMENT�L COOS. TiT�„� Q ,
AIVD TOt c/�J. OF. SA��y,S T AB G E LEA C f-/ 2.4.TE` 'C
TOP. OF . HE.dGTh' QEG(JL.AT/On/S
FOUN.C>gT/OA/ "' P20AOS E a L EIGN
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1'IAN1-/0LE #CO✓6,� TO E-X TEN IZ)-ro . - f., TO
LV� TN/1/ /' OF G/lVi5.V Ea
TOWN OF BARNSTABLE
DEPARTMENT OF HEALTH SAFETY AND
ENVIRONMENTAL SERVICES
BUILDING DIVISION
STOP WORK
THIS STRUCTURE AND/OR PREMISES HAS BEEN
INSPECTED AND THE FOLLOWING VIOLATIONS
OF THE BUILDING CODE AND/OR ZONING
ORDINANCE HAVE BEEN FOUND:
3)
4)
YOU ARE HEREBY NOTIFIED THAT
NO ADDITIONA .0 ORK SIIALL BE UNDER"I AI Ij,N
UP r THESE P+,' _1VIISES, O°R THE PREI�ZISI S
OCCUPIED TI'LTHE`A"� VE V OTIONS
,mob- . ...�� .�..,.a�,.�.,a.,� <,,..,,:_- _
ARE CORRECTED.
ANY PERSON REMOVING THIS NOTICE WITHOUT
PROPER AUTHORlZATTON 'SHALLBE LIABLE
TO A FINE OF NOT LESS THAN FIFTY, NOR
MORE THAN ONE HUNDRED DOLLARS.
r
Address
Date -, ) ; /•j `-✓
Building Commissioner
' 4q ��
The Town. of Barnstable
Department of Health, Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph M.Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration`
Date: /Z UCH
Name: C_) Cc Phone#:
/} Vill e
Address: l G�✓1 r I �i 6 S 2 a g
Name of Business: f
Type of Business: •.d!-7L/'V1 V Map/Lot:
INTENTi ~Iris the-intent of this section to Tallow the-residents of the Town of Barnstable to operate a home
„ r occupation withinasingle..family dwellings,subject to,the provisions of Section 41.4 of the Zoning ordinance,
-- provided that.the-activity shall not.be discernible from outstde.the dwelling:, there shall be no increase in noise or
_._ ..
—odor-, the premises which would°suggest-anythutgother than a residential use; no increase m
traffic above-normal residential-vol"times;zandtno'increase inaiuorgroundwater pollution.
After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to
__,the-following..conditions:
The activity is carried on by the permanent resident of a single family residential dwelling unit, located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
' . There are no external alterations to the dwelling which are not customary in residential buildings, and
there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
_ •--'The use does not involve the production of-offensive noise, vibration, smoke, dust or other particular
matter, odors, electrical disturbance, heat, glare,humidity or other objectionable effects.
There is-no storage or'use"of toxic or-hazardous materials, or flammable or explosive materials, in
excess of normal household quantities.
- . Any need for parking generated by such use.shall.be met on same lot containing the Customary
Home Occupation, and not within the required front yard.
• There is no exterior storage or display of material's or equipment.
• There is no commercial vehicles related to the Customary Home Occupation, other than one van or one
pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to
exceed 4 tires, parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business, the'street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I, the undersigned, h ve read and'agree with the above restrictions for my home occupation I am registering.
Applicant: Date: /O /z O0
Homeoc.doc
�TMero� The Town of Barnstable
Department of Health, Safety and Environmental Services
Ae Building Division
� 1639. ���� 367 Main Street,Hyannis MA 02601
ArFD MA't
Office: 508-790-6227 Ralph M.Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration
Date: "
,4&'z�4z z_1�0D(X Ic V5 7 7 5- -7� ��
Name: Phone
Address: - _ _ Village: r--nEZ 71�1 ����
Type of Business: /�t��1/>� �j��17(���;1�2N Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase m traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and
there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in.excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,hive rea and . with the above restrictions for my home occupation I am registering.
Applicant: / / Date:
Homeoc.doc
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The Town of Barnstable
• a�xxsrasc,E. • .
059�-
Department of Health Safety and Environmental Services
10rEo na't' 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. +
r
Date a
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: v/ Est. Cost
Address of Work: '
y—
Owners Name
Date of Permit Application: a? �U
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
/c
Date O 's Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office ef/nvestiyatfens
-- 600 Washington Street'
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name:
r ,
location:
city phone# ,
I a homeowner performing all work myself.
am a sole proprietor and have no one working in any capacity'
MEM
I am an employer providing workers' compensation for my employees working on this job.
comnanv name:
address.
all phone:#.
insnranee co. pohcv#
I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
thy/following workers'compensation polices:
Jy' f U v7i1 r H
ddress. r�/ �.
nce eo. '00-
�t'.l ! '1 o is :# l f � � J
r,
� ISM
m n n m
/3
=�ci h n #. �r h
n nra
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 DIA for coverage verification.
/do hereby certify der the pains and Pena ies of perjury that the information provided above'is true and co eet.
Signature Date
Print name d � i Phone#
official use only do not write in this area to be completed by city or town official +
city or town: s permit/license# nBuilding Department
❑Licensing Board
❑check if immediate response is required []Selectmen's Office
❑Health Department
contact person: phone#; r•IOther
(revised 3/95 PJA) - ..
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation fortheir
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 requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the'box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents;for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested,
not the Department of•Industrial Accidents. Should you have any,questions regarding the"law"or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
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 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.
02.
ME
The Department's address,telephcne and.fax nuu is+.;>I:
T11c
dtfiee of invesdoallous
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900" ext. 406, 409 or 375
MCURAppmftj
Table JS.2.1b(eondaoeo
Ps no ptive PaeiraM for One and Tiro-Family RealdeatW Buildings Hand with Fad Fula
MAXIMUM MINIMUM
Glazing Glazing Ceiling Wall Floor 8asemeat Slab HatinwCooliag
Afeal('A) U-value= R value' R value' R velu iPme�t
e� Wall tftim= l� F.ffiaes�
Pacirage Rrvelue' R value
5/01 to 6500 Headug Deem Dare'
Q 12% 1 0.40 38 1 13 1 19 10 6 Nonni
R 12% M2 30 19, 1 19 10 6 Normai
S 12-A 0.50 3E 1 13 1 19 .10 6 0 AFUE
Tr=-V
0.36 38 13 23 WA WA T'lorrrra!
U 0.46 3E 19 19 IO 6 Normal Y
V 0.44 38 13 23 WA WA IS AFUE
W 1 0.52 30 19 19 10 6 1 85 AFUE
X 19% 0.U2 3E 13 15 N/A WA Normal
Normal
rE181% 0.41 3E 19 25 WA WA Norma!
Z 18% 0.42 3E 13 19 10 j 6 90 AFUE
AA 18Y• 0.50 30 19 19 10 1 6 90 AFUE
I. ADDRESS OF PROPERTY:
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: �( O
3. SQUARE FOOTAGE OF ALL GLAZING: vC
4. %GLAZING AREA(#3 DIVIDED BY#2): r�o L�
5. 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-forms-080303a
780 CMR Appendix J
Footnotes to Table 35.2.1b:
` Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and
basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the.gross wall
area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement.
For example,3 fV of decorative glass may be excluded from a building design with 300 ft'of glazing area.
2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
whole units:center-of-glass U-values cannot be used.
' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full
insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include
exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER
by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall constructions, but do not apply to metal-frame construction.
'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 wails. Windows and sliding glass doors of conditioned
basements must be included with the other glazing. Basement doors must meet the door U-value requirement
described in Note b.
'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more
than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest
efficiency must meet or exceed the efficiency required by the selected package.
'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a
NOTES:
a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels.
R-value requirements are for insulation only and do not include structural components.
b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
c) If a ceiling,wall,floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with
different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
i
43
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE ..... .
, JOB. LOCATION 1'J. t� ��'"�/ �� �e✓1T� v� (l e v/'/�4- ::.
Number Str address Section of town
"HOMEOWNER" �hON .�v -7 7Jr�78 J~Qe-77 -.'O.
Nade Home phone Work phone .
PRESENT MAILING ADDRESS
City town State Zip code
The current exemption for "homeowners" was extended to include owner-occupies
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one 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 Offic'-
on a form acceptable to the Building Official, that he/she shall be responsib
for all such work performed under the building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes responsibility for compliance with the St.
Building Code and other applicable codes, by-laws,. 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 comppi with said pro edures and requirements.
HOMEOWNER'S SIGNATURE ./
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35 , 000 cubic feet, or larger, will be required
to comply with State Building-Code. Section 127. 0, Construction Control.
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner performing work for which a:= building
permit is required shall be exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that i1
Home Owner engages a person (s) for hire to do such work, that such Home Owr.
shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see, Appendix Q, Rules and Regulations
for licensing Construction. Supervisors, Section 2. 15) . This lack of awaren
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it would with licensed Supervisor. The Home " wner act
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/Fier responsibilities, m:
^r-=uniti.es require, as part of the permit application, that the Home Owner
�tify that he/she understands the responsibilities of a supervisor. On tl
. st 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.
t
>:
a•:
':is • �Il't::.'
.•w. �•YrY•:
Of e - 144 ,&mad umeM
HOME IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards
One Ashburton Place - Roorn 1301
Boston , Massachusetts 02108
HOME. IMPROVEMENT CONTRACTOR
Registration 123067 {Expiration 12/02/98
Type - INUIVIUUAL Ta
HOME IMPROVEMENT CONTRACTOR
Registration 123067
THOMAS SCOTT EDL..DRIDGE Type - INDIVIDUAL
THOMAS S . ELDRIDGE Expiration 12/02/98
138 SPRING ST
HYANNIS MA 02601 THOMAS SCOTT EDLDRIDGE
THOMAS S. ELDRIDGE
G�eMeo 7� ifrr L438 SPRING ST
:% :` ADMINISTRATOR HYANNIS MA 02601
gas 9g � ^�
ARM = ��
u,�„� m�
, �c� I
i
Engineering Dept.(3rd floor) Map AV, Parcel ! 8C Permit#
House# j 2-
,.Board of Health(3rd floor)(8:15 :9:30/,1:00-4:30)
J
conservation Office(4th floor)(8:30-9:30/1:00-2:00) Z
d,
-Ptmming-De01.(1st floor/School Admin. Bldg.) 4 n' a-
_ m.�a2 T B�E
DFStre�t
proved by Planning Board 19 INSTALLED ' E
T WIT ,
TOWN OF�BARNSTAME� IRONIMEN DE AND
Building Permit Application
ress
Village Celil�i�i y i// C-- {
Owner 613s^ Qr ' x e4 Address . 1' 1-4 5 G1
'
Telephone .550 lk -
Permit Request
_ a
e e �e 74 v x (5 o 19Z
f
:First Floor ., 7;, square feet Second Floor �/SL f square feet
Construction Type to dd 14rA-w e-
Estimated Project Cost $ R, ooc
Zoning District f� Flood Plain Water Protection
Lot Size 4J i 73? +dy_ Grandfathered ❑Yes ❑No
Dwelling Type: Single Family F Two Family ❑ Multi-Family(#units)
Age of Existing Structure ;5--?OVk5 Historic House ❑Yes 54 No On Old King's Highway ❑Yes gd No
Basement Type: IA Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) j Basement Unfinished Area(sq.ft 6 7Z
r Number of Baths: Full: Existing / New �2— Half: Existing _= New
No. of Bedrooms: Existing 3 New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: )d Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes .4 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 Uf No If yes, site plan review#
Current Use Proposed Use
/ Builder Information 1
Name �y ill Gf Telephone Number J 7 7 6-9
Address 3 1/1 C, License#
1- ®� Home Improvement Contractor# /a 3o & Z
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE
BUILDING PERMIT DENIED FOR THE FOLL• tIGREASN ) g
c
. h
FOR OFFICIAL USE ONLY ;
}
- `-PERMIT NO. • r � �� •.` s - ', , ,. - v - - •n - .•. 3 +
`DATE ISSUED f -
MAP/PARCEL NO.
.. c � _ •, .j a ,.
ADDRESS t ; VILLAGE`
OWNER
DATE OF INSPECTION:
i t i
FOUNDATION' i i
FRAME
INSULATION '• - - t -. :� •� ` ;' �; . , F* _ •- - 1
FIREPLACE
ELECTRICAL: , ROUGH FINAL ~
PLUMBING:. ROUGH: ` FINAL
GAS: ROi GH e FINAL s r y r
FINAL BUILDING _ -ir
DATE CLOSED OUT: s .��eta 0 _
ASSOCIATION PLAN-A '4 t i
l/ � �
` - � :.. :... 'V ,�. - ..,r�^"µ3-., .3�.':'1 t..•L..: 3..Y.-..»:•� __ :T.•F::'Z ..Yylo., L..."'^�'..'^v.G ��1
rz � r
.��., ar�z;�-,.;,:...._ _ __.�. .,.�,.,...... _.,..,...____ ,,•:<-.,�.;.c:.� ___.,..rMs.a....u..Er'„li ri.��i�
C .. _. .. ... _... ._ _:. _._ _.. _
�)
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' I
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I
_. _._ _ _
r _. � _ _.... r_. _ __.___-__.____
l
_ .. . ._ _
( _. ..
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u _ 4 �__ i
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�._�-' —. 1— � .- -� .- Ir- � — L— �_._—.'--.�� � _ .. ..
• � i I � I
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j r . SEPTiC SVS7LM4j tydu�o J"
�ssessors office(1st Floor): INSTALLED 9N COMPL - ..'��a
'Assessor's map and lot number — WITH TITLE nor.T to`
ons rvation ew
Board,of Health(3rd floor): / ` TOWNS REGUL/4 � IT�ntti
Seaga Permit number ,� �J 9
En ineering Department(3rd floor): i67o• `�8'
House number �o r�r►
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO go/ 6 L/e-Gl�
TYPE OF CONSTRUCTION _(,(f (� r Y �
i
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location " cew4nl///
Proposed Use
Zoning District Fire District
Name of Owner ✓ Address C J�eY� , /yf�Q 0.2X 3 Z
Name of Builder Address
Name of Architect Address nn
Number of Rooms Foundation fey/ Ni ai^s
Exterior Roofing
{�/
Floors ►'" o ole:D Interior
Heating Plumbing -7�y)
Fireplace Approximate Cost /ice (
Area
®0
Diagram of Lot and Building with Dimensions Fee 0
r��ov�
�d dew
�p I
D D��
14 � L
►ti
0
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS It
f
I hereby agree to conform to all the Rules and Regulations of the v n of Barnstable regarding the above construction.
Name
Construction Supervisor's License ?1�
I!� STRONG,, GARY
t
A
a
` No ~3072 Permit For ADD DECK e-
Single Family Dwelling ;
s R �
.Location',22 Cap'n Lij ah' s ,Road -
Centerville
m +
Owner Gary `Strong 3 y _+ '
r= 9
Frame
,
Type of.Construction
R {
, k
Ro
Plot Lot
6
Permit Granted May 21 , � i 19 92
Date of Inspection f 19
rr
Date Completed 19
`
e } .
t� i
33 !!
C/l�-t �-tee-.. �{ �
Property Location: 22 CAPT LIJAHS RD MAP ID: 192/186/
Vision ID: 13731 Other ID: Bldg#: 1 Card 1 of 1 Print Date:02/08/2001
e f s :
Description Code .Appraised a ue Assessed value
2 CAPN LIJAHS RD ESIDNTL 1010 93,300 93,300 80l
ENTERVILLE,MA 02632 Barnstable 2000,M4
5 ��(o ccoun an Ref.
Tax Dist. 300 Land Ct#
er.Prop. #SR VISION
Life Estate
DL 1 LOT 38 Notes:
DL 2
GIS ID: 7orall1l ,
q ..
RUING, FA, J9
� 1 r -(-ode Assessed vatue 1r. Loae Assessed value Yr. Code Assessed Value
VINCOLA,ROSE 5932/231 09/15/1987 U 1 1 A30,600
VINCOLA,KEITH D 2502/342 Q 0 1999 1010 65,9001998 1010 65,900
ota: oar- 96,509 7—oTaT- 93,uuu
._ is signature ac now a ges a visit y a Data o ector or Assessor
...� .> ,
Year typelDescription Code Description Number mount omm. nt.
Appraised Bldg.Value(Card) 909600
Appraised XF(B)Value(Bldg) 2,700
o a Appraised OB(L)Value(Bldg) 0
Appraised Land Value(Bldg) 30,600
x Special Land Value
Total Appraised Card Value 123,900
Total Appraised Parcel Value 123,900
Valuation Method: Cost/Market Valuation
Net TotalAppraised Parcel a ue - 123,9u
..
\ ...
omme Dat041
e Issue ate type Description mount Insp. ate o omp. ate omp. urpose esut
3126t AD IN ew Addition easur emo mg m Frc
B35072 5/1/92 AD 750 1/15/93 100 CEDECK 3/15/93 ME
B18820 11/1/76 ND 14,000 0 CE 11/2 S
Use Code Description Zone rontage Depth units unitPrice L Pactor S.I. ctor otes- ,/ pecia ricing /. nit rice Land Value
1 1010 Single Fain o es: ,
i o a Card�ana uniallarce o a an rea: �'otat Landa u ,
Z
Property Location: 22 CAPT LIJAHS RD MAP ID: 192/186/
Vision ID:13731 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 02/08/2001
�..�,
ement escrrptron ommercia a a emen
e_,ype oonia Element escrrpbon
ModelStyl 1 Residential Heat
VVDK
Grade C' C Frame Type
Baths/Plumbing
Stories 1 2 Stories
Occupancy 0Ceiling/Wall FUS
ooms/Prtns 1 GR
Exterior Wall 1 11 lapboard /o Common Wall
2 14 Wood Shingle Wall Height
Roof Structure 03 able/Hip 16
Roof Cover 03 sph/F GIs/Cmp
AS BAS
Interior Wall 1 5 Drywall ° BM
2 Element (;ode Description actor 12
2
Interior Floor 1 14 Carpet Uomplex 1
2 Floor Adj
Unit Location 12
eating Fuel 03 Gas 9
Heating Type 5 of Water umber of Units 8 2
C Type 01 None Number of Levels 24
/o Ownership
Bedrooms 04 Bedrooms
Bathrooms 2.5 2 1/2 Bathrms ._: .. ' • ;,- �
1 2 Full+1H
na j.Base Rate
otal Rooms 10 10 Rooms ize Adj.Factor 0.95183
Grade(Q)Index 1.04 24
ath Type Adj.Base Rate 47.52
Kitchen Style Bldg.Value New 129,492
Year Built 1977
ff.Year Built 1980
rml Physcl Dep 17
uncnl Obslnc
con Obslnc
g" peel.Cond.Code UIC
pecl Cond% 0
Code Description ercenta a verall%Cond. 70
mg a ram 100
eprec.Bldg Value 0,600
131,
Code Description 1,721 units Unit Price Yr. Dp Rt %Cnd Apr. value
prep- ,
o e Description LivingArea Uross Area Eff.�Area Unit Cost unaeprec. value
First oor 816 816 816 47.52 38,776
FEP Porch,Enclosed,Finished 0 135 95 33.44 4,514
FGR Attached Garage 0 624 218 16.60 10,359
FUS Upper Story,Finished 1,440 1,440 1,440 47.52 .68,429
UBM Basement,Unfinished 0 672 134 9.48 6,368
WDK Wood Deck 0 224 22 4.67 1,045
9S,
t. Gross LivlLease Area 2,25o! 3,9111 2,7251 Bldg Vak 129,492
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