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I 1,1771-� I , 4 t��3 I �, I, , "i 1�-, a,1, , � , , I I 1�1 4� ( ... - ", !P R, " ���I�l��1,I I 11.", I 1�;`,�k , ,I I ... �� I i 1�J'k,N"",I,,ijcA,p R ,�"4iv�'I'io�� ,�!'i"4n�111:12-,!�,���,�'llil�i i, , '4 el t!k , 1i; � M-`l,ili A�l �,,i�, ,I ,."k Q vVeL .... ,I - I� _ tJ i i it � I 44� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _ Permit# y o Health Division Date Issued b 3 O Conservation Divisions 2-40Z Application Fee Tax Collector /® e Permit Fefe ___�50 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address CV1 Village _ "e4-v " t[f Owner �►,'4u L U n.►�✓+- (? f3�f Address 3 C AP ��,��a�S J� CewJ(rUJ(-e Telephone Permit Request 'rc Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o w•.w Construction Type to y6-Q �� Lot Size 7."(J 5 Grandfathered: ❑Yes 21-146"If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure v cS NC3 Historic House: ❑Yes 04446 On Old King's Highway: ❑Yes �o^ Basement Type: ®-Fro ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Cn?2 5Q P�; Number of Baths: Full: existing / new Half:existing ! new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing 77 new First Floor Room Count Heat Type and Fuel: 045'as Cl Oil ❑ Electric ❑Other - a Central Air: ❑Yes l0-116­ Fireplaces: Existing New Existing wood/coal stover 0 Yes!? C-Pd Detached garage: 0 existing ❑new size Pool:O existing O new size Barn:O existinC_0 new -size C/1 CD Attached garage:Ong ❑new size Shed:9,61is-fing ❑new size Other: ., z v� Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ m Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name 010-16- Telephone Number �;y�- y�� 7 L SO Address i`(�<� '���I License# nn,Sq(q o�,G 3 Z Home Improvement Contractor# [ O 3 1 Worker's Compensation# rct,r C� ( 5s a 762�-p2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� �� i FOR OFFICIAL USE ONLY 4 s PERMIT NO. DATEAISSUED MAP%PARCEL-NO., r J ADDRESS ! r'_•. VILLAGE OWNER DATE OF INSPECTION-'; FOUNDATION FRAME INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL FINAL BUILDING :r DATE CLOSED OUT ASSOCIATION PLAN NO. ; j P`�ptNti. The Town of Barnstable , {,BARS SAB S! 01 Department of Health Safety and Environmental Services 679• �0 pTFDMP'�� - Building Division 367 Main Street,Hyannis, MA 02601 i Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: G l ! 12'i I Map/Parcel: Project Address CAPT �/ Tg�u Mtn.'' } ,p Builder: l4,=TU12- , PPi -612,x, ` Ire . The following items were noted Jleviemn 9C 1etl ,1 5 iC 0h, 4'Fs 5 esi�,�ry a y i 1-) APO o2 4 46 �T't-frzt,� I�oz-rS 7;rize, .L5 -/)ce.t e✓15.2L E'qY I` 1 . i Reviewed by: Date: q:building:forms:review a T-t- _A_ e Ll r T • r . .�� \\ �. .._ 6 � 1 t a 1 �� a 0eQ,� ►6e�toe�' E.� I a 1' 4 r -— --- _�/ze Pomvrw7u�vcc%/ ���-aaaac�ucoet7'6 II BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numbe 51 005414 { B�iildae 6 0A$hl no: 25257 Re r cE _ PETER J APPLE 37 BAIRD WAY CENTERVILLE, Administrator I ZNE Town of Barnstable T�ti "P Regulatory Services BAMSTABLX, Thomas F.Geller,Director MAn 9�A ' ' Building Division rED MPf Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. [ Type of Work: Estimated Cost Address of Work: 53 ceolj Owner's Name: ��✓�' �i�e(`�' Date of Application:_9. //a 6 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 El 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 the owner: Date Contractor Name Registration No. OR Date Owner's Name 1 Q:fcmis:homeaffidav - The Commonwealth of Massachusetts — Department of Industrial Accidents — Office 011HO Mg8119 is t 600 Washington Street Boston,Mass. 02111 Workers Compensation Insurance Affidavit L location: .... 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'f tt•:}�;:;:iii}:}:;::}:j;}+i:�:::{:'r::i:�:v:}:}}:>Y;:}i}ri•li;:;vv.v:F.}'4}y:;:}v.}':•:�'{v:::'v::::::::::::::•::w::::::••: In711T8t1CP"CO�E::>;:::<z::;4:},:;<:}<:•};•.}};{{{.;;::.,.,..,..,,,.:..:........ . ....:.::....:,.::..,..::..,.>.. .. .. .. FaSm a to secure coverage as required raider Section 25A of MGL 152 can lead to the imposition of criminal penaltin oI a fine nP to$1,500.00 md/or one yem,imprisonment a,well as dvfi penalties in the form of a STOP WORK ORDER and a Ste of$100.00 s day against ma I undetatand that a copy of this statement forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby c fy under he p penalties of perjury that the information provided above is truo and eorred e� Date Signature �,f� , Phone# Print name official use only do not write in this area to be completed by city or town official permit/iicensc# ❑Building Department city or town: ❑Licensing Board ❑Selectrnen'eOffice ❑checkif immediate response i'required OHealth Deputnent contact person: phone#; - Mother Ucyioad 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged 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 along with a certificate of insurance as all affidavits maybe 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 p e''rmit/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 amce of lovesugau0na 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7� ct Parcel ��� Permit# 4 g DF A NSTABLE Health Division _ � R I�� ® d 04 Date Issued 6 I f oY Conservation Division JUN - I AM 8: 49 Application Fee Tax Collector Permit Fee Treasurer Uiky1S10N SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS P Project Street Address 3 "t%44rQ Village , Owner Address 33 'e- �.y�f-N� Telephone T-G Permit Request���9✓�vt,cd"3 Square feet: 1st 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 ❑ 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: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached.garage:❑existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION -Names_ c A---- Telephone Number s It Address ��c ? �I License# 0 y � y� e- Home Improvement Contractor# Worker's Compensation# ALL CONSTRU ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r DATE l ) FOR OFFICIAL USE ONLY PgRMIT NO. 's DATE ISSUED { MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION FRAME ;t - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: ROUGIj 5 FINAL FINAL BUILDING p ! i rr. 4— 5.® !•- C� 'r m0 � 4 DATE CLOSED OUT 2 0 Or Kv O �— E ASSOCIATION PLAN NO.N 7 S � Q —`—= The Commonwealth of Massachusetts �—_ -- Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Compensation.-Insurance Affidavit-General Businesses name: � �e .O�✓- r address state: zin6r•e—) b �. phone# .5 0 ' Y a t work site location(full address): ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBar/Eating Establishment working in any capacity. ❑Once❑ Sales(including Real Estate,Autos etc.), ❑I am an em to er with etn to ees(full& art time.) ❑Other an employer providing vYorkers' comuensation for my employees working on this job.. 'N c✓ :. - coIIiAanV IIame: •� �C• ,��"-A " '°•�. . •�1 ! addresss'' 7��•`-� m t• hon #•'•: city` � .fr16. U .insurance.co I am a sole proprietor and ave hired the independent contractors listed below who have the following workers' compensation polices: comn by name: address: hone'#� D ante co. X:. O 1C :.# msur ._ ... ...';� / 1 %/O/%/m////%%i .. r 3:.. 4: .•'ewe• ,... . .. :.;.,,,.. .:..:.: address:. . ., cityi: ;phone'#c . . ,.. .. O C insurance co: • •• •��" 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 it copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ; I do hereby certi under t pains and pen e of perjury hat the information provided above is true an corr ct. Signature ma`s Date Print name �� e " r�l�' CJ Ad Phone# � official use only do not write in this area to be completed by city or town official city or town: permit/license# []Building Department ❑Licensing Board ❑'check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; ❑Other (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for their. employees: As quoted from the I'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 mare of the foregoing engaged in ajoint 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 apartrnents and who resides therein, or the.oceupant: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. . 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 of FAX.unless other arrangements have been made. The Office of Investigations would hike to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Blow of In"Sugadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext:406 Town of Barnstable E roe"o� Regulatory Services ' T40MRS F.Geiler,Director 33WId ng DiviS10 �lFD MP�k Tom Perry,Building Commissioner - 200 Main Street,Ryanms,MA 02601 508-790-6230 Office.. 50s_$62-4038 ' permit no. AP`FIDAVIT SOME=7MPRQV IM T CONTR.A.GrOR LAW_ — - - SUpPI,EMENT TO PERMIT APPLICA'I'IO er-occu ied� con ersio MGL c.142A requires that the"reaanstruction,alterations,renovation,zepair,modemization. � - - en removal,demolition,or construction of an additionto any pre-existing owrr P bmprovem t, units or to structures which are add acent to containing at least one but not than four dwelling binding be done by registered coatractozs,with certain exce boas,along with other P. such residence or banding requirem a c o t �d C-- _ �° Cos e Estimated _ _... _ . ,r Type of -.. address of Work: - .. Owner's - ]Date..of ApP — n _ - ertify that Y hereby� -_ . ed foz the following reason(s): Registration is not rel vir []Work excluded by law ... . []Job Under S 1,000 -- - ., _ d E] -Building not owaer-occupie ' - - a []Owner pulling own pe rmit Notice is hereby given that: OR DEALING WITH UNREGISTERED OVF OYmRS PULLING THEIR OWN PERMIT CTORS FOR APPLTCABZE RGRA IlYIP GUARANTX FUND UNDER M L MINT WOpXDO NOT 142A, CONTRA. ACCESS TO THE ARBITRATION PRO GRAM OR ,...y.. SIGNED UNDER PENALTIES OF PERNR - a I for apermit as th t of the owner: Ihereby Pp �r/0' l p ��� � Registrationllo. Contractor Name . . Date OR (lnmer'S Naive _ r B;p"ARC OF BUILD'I�IG f�EGULATIQ,NS License {O NSTRUCTION SUPERVISOR �. i Nu,;'be` 005414 tlt t' Y fQ 206 Tr:no: 25467 Red r ! TER J Ave f" i PE 37 B"AIIRD WrAX M CENTERVI.LLE, MA 02, commissioner F - o.lee �arr�nwreiueaCl�i a�.��roaac/uraet Board of Building Regulations and Standards HOME IR RQVEMENT CONTRACTOR 114� 4"03218 E`xp#aii#on 7j.612004 , APPLETON CONSTI2()GTION ;T Peter Appleton 37 Baird Way Centerville,N1A 02632 Administrator i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l° Parcel Permit# 471 1� �p/ Health Division v -11f Date Issued Conservation Divisio _� 2— Application Fee Tax Collector Treasurer �— oZ' ©� INSTAL COMPLIANCE Planning Dept. "TITLE i ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis ��ddn�d Project Street Address _ 3 C A.0 ki !% � J W Village (� e ��e yil b4 6 b 3 Owner Ptq y e t d' "�' � Address 33 C g pt, J o y�s an. Telephone Permit Request nab / o a 0 /q rJd V e U-��'✓+Ge: ��� S ,��r�Q � © a-e Cee Square feet: 1 st floor: existing proposed 2nd floor: existing �' proposed `��� Total new y1SZ Zoning District Flood Plain Groundwater Overlay Project Valuation IS;a(U), c.0 Construction Type w a 3!2 r4 0-0-e, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes &IQo On Old King's Highway: ❑Yes 5<0 Basement Type: Q-Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) "7, Number of Baths: Full: existing 02 new — Half: existing new Number of Bedrooms: existing 2) new Total Room Count(not including baths):existing new 1 First Floor Roorrount w Heat Type and Fuel: u-Gas ❑Oil ❑ Electric ❑Other o .� 3C Central Air: (Elles ❑ No Fireplaces: Existing ON'e.. New Existing wood/coals ove: ❑.,lies 54h' w Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existi g ❑n w sib+ Attached garage: sting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name -e,^��� '�] P o"U/ Telephone Number �a IF— �) — �O 5-0 Address UA-`/ License# �`/1�� Home Improvement Contractor# ' to 3 02 7 i— Worker's Compensation# G%y 1-1:, 31-5_ 7'0Z Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO D Ae SIGNATURE . DATE //57 J6 �- i FOR OFFICIAL USE ONLY PERMIT NO. 4 DATE ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE4' { ` OWNER •,ems ,. - _- . DATE OF INSPECTION: FOUNDATION 1 FRAME INSULATION U Q FIREPLACE t 3 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH • . FINAL. GAS: ROUGH', : FINAL• , ' •`' #cam �;, e.1 �'. " FINAL BUILDING : 3 .` :`•' i' 'i DATE CLOSED OUT ; G l ASSOCIATION-PLAN'NO I ZJ RESIDENTIAL BUILDING PERMIT FEES ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 - Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE ( 13$ r square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE 1 square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft� >i20 sf-500 sf $35.00 >500 sf-750 sf 50.00 - >750 sf- 1000 sf 75.00 >1000 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96Isq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= - (number) Inground Swimming Pool .$60.00 Above Ground Swimming Pool $25.00 -- Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost f M CMR Appendix J Table JS.tlb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuels MAXIMUM MINIMUM Glazing Glaring Ceiling Wall I Floor Basement Stab Heating/Cooling Area'(%) U-value; R-value' R-value' R-value' Wall Pcsimeter Equipment Efficicnryr Page R value° R valud 5701 to 6500 Hating Degree Days' Q 12% 0.40 1 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 1 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 19% 0.32 38 13 25 N/A N/A Nomud Y 18% 0.42 38 19 25 N/A N/A Normal Z 12% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: iP 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: T 6 54 -4. 3. SQUARE FOOTAGE OF ALL GLAZING: O Q T—'f- 4. %GLAZING AREA(#3 DIVIDED BY#2): m J 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-f980303a 780 CMR Appendix J Footnotes to Table J6.2.1b: 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 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. Z 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. s 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 d-scr►bed 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. t i.e. may have a U-value lue eater than 0.35 r may be excluded from this requirement( y 1� )• One door y q c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components•comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 Town of Barnstable .Regulatory .Services BMAMMSTA 'MASS.� ` Thomas F.Geiler,Director ye Mass. ,� lf1639. 6. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION 42A requires that the"reconstruction,alterations renovation repair,modernization conversion MGL c. 1 eq n, p , 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: �`� �a�(a yr /� ic �b4..� Estimated Cost Address of Work: 33 Cam' ti 1 Ci o fs fzp C V fiJ-C V J 1`4. Owner's Name: 106 L (d- Date of Application: 7 LO Z— I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000. ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the a jo1;heo1Arner: -5 _7L0 C Date Contractor Name Registration No., OR Date Owner's Name Q:forms:homeaffidav - 5 �� The Commonwealth of Massachusetts ._ ` ' . _- - ' Department of Industrial Accidents Office ofinyestigativns . . < 600 Washington Street „ C:; Boston,Mass. 02111 Workers' Com ensation Insurance davit 1 name: ,( e ` I/`tT d u e-- I . 1. . location: Z 6 4"e,0 ,Al city C,i- -ew-V %I I'e, 41 fi . 6,!�k � 3 I ,hone# 5 a d' — 1Z D —7 1 6 ❑ I am a homeowner performing all work myself. . ❑ I am a sole r netor and have no one workin man ca achy ///%///% /%%%%%%//%%%%%%/O%//%%%%%%%%%%%%%%%%%/%%/%%//%%%/%%%/%%%��/%%%%%%%%%%/%//%/%/G%�//O%%�%�%/�%%��//G�%�//G%%/ ❑ I am an employer providing workers'compensation for my employees working on this job. ., i rh►m SII :;name :;.:..:. .::.. :::.. _.............. . 19 �.. �. -.:....:i/...:.�.:�/::..:iZ:.:.:i�:.�:i/�:.��:iZi:.i�:i�.:i�:i/�;.:.�q—:A/�..�:/�.�:/�.i�:./�,:�:./�i.�:./�::�:.�I.-..:.*.i—-.�./�i.i:./...�i ::::::..:.:..:..........:..::............ ........:....:.::::::::..:::::::::.::. ..:.......:....................................................... ... .... :. ..... .. ............ .... ... ... .......::.:::::::::::. city ..........::x........ :.:::::::;:.::.:..::..:.::....::..:.::::.:.... . ��^#- .... �` Y ,_ ,hone# _ :::.:::::::::..... i :. ::;i:<:::::: .... ........................:. .: :::::::::.::.:::::::..»:..... ...:....:::: ::::::.�.:: ..::.....:. :. .:...:.. ::..::. .....�.�::::..::::::.:>::.:::::.:�::::::::::.:. .. ........�:.>i::H':ii::,:r:.. 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':i::f>'e)j:: ;:y is is::Lv:;i::ii:v::i'{.i: .......:::.ij:.'^$::.i)ii i:;:;:::i::i:;ii?:iiSii:>.'iyyi;:i;'.I%i.i i......i:i::?jiiij:i:'!i.':iii:L::i::;is::<�:S;ii:;:j<t L;i:;i'<i:jj}: '4:4iiiiii:•iiii:J:•'v'r::: hii::•i:i i`::.:::%`i:?.`:i::}:i.}v:�<:'i:.i'::::.::::..v:;.:v::v.::•: ::: v••. :: .:.::. .........:.::::.:........:. :c an;mane:::>:::':;;;:»::>::>::: »:<:::?i;?::'::>::>: ::::`: ::::....I :<::::.;::...:......... ....:...:.. .... ........ _. . ... ....... .... ................................... `' :':::: ss ' <"s:::?[' " %::%` :3 •'::> <'�::> gas sa> 3 r : :%:'�"t5' 35 ;:';'333'%'S; :< :i ass:+: >:assL't 3 i;t )>:< E?i ",•a2^+s ti j :address ":.: tl :::.::::::........:.:................................................................ ;. jy :. iIIsursn 22222"" EL �. Faihn a to secm a 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 b orwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify t pains and enalties of perjury that the information provided above is true and correct Signature c, . Date 5�/� 7 % � - Print name A—L✓� Iie d t✓ Phone# _ 56 C— L/Z S-^? Or,() official use only do not write in this area to be completed by city or town official . City or town: permit/license# - ❑Building Department . ❑Licensing Board ❑checkif immediate response is required ❑Selechnen's Office _ ❑Health Department contact person: phone#; ❑Other OevisW 9/95 PJA) .. Information and Instructions Rj. 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 iocal 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. i Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for.the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required,to obtain-a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pernutJlicense number which will be used as a reference number. The affidavits may be r `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 Investlgagons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 t a,4,o rLBr` eo one +�aN _ R - - y lip F • t - . . . . . ' . , s1. ' I. I . ., . 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S,4 t r uec 14+�''4 r ,. PA.'Fos - p ►�� ��o�e rr,��.�G • rates o� I�� j fq o of A/1 F rq- 4 The Town of Barnstable f BARNSTABLE. Department of Health Safety and Environmental Services MASS. w 9� e67q. `0m a� pTF1639. Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862`-'4038 Fax: 508-790-6230 PLAN REVIEW Owner: Tv T" Map/Parcel: Project Address: F3 6APi Builder: � F 1 The following items were noted on reviewing: X f 5 7-0,1G �14(G J4 G �a u/Y 2>,4 -/d/y 3) IY ✓LG /A S Si c/ e Reviewed by: Date: ✓�y[ 2' q:building:forms:review . I f I � ✓/ce -Pomvrriauuea� a��vacrc�ivael7a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR !: 005414 Nunnbl �CS tSiate 4 7� 2 Tr. o: 2598 1 i n f -D8�h2fi10 I Restricted Tadb t PETER J APPLtTQN t r CENTERVILLE, MA 02632 Aft.."inistrdter I (C\ ✓ire'�Oaavrno¢eu�ea�i o�✓�aaaac/uae�a HONE IMPROVEMENT CONTRACTOR Registration: 103218 I Expiration: 07/06/2002 I Type: OBA I I APPLETON CONSTRUCTION � PP ter Appleton I ADMINISTRATOR JJ Baird Nay i Centerville MA 02632 err 96a Town of Barnstable Approved_) Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 0 Home Occupation Registration Date: Name: / a �% �, Phone#: 9 d 7/1r 6T310 Address: .� Village: D Name of Business: 0 , �} Type of Business: — �Q/L�(� ap/Lot:��% �� Zoning District�Zoning Districts RF and RC-1 require Special Permit from Zoning Board of Appeals. 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 in traffic above normal `4 residential vohunes;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. ri •" 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. t/— 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 toed. �--No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. ` I, the undersi ve read and agree with the above restrictions for my home occupation I a/m/re . tering. Applicant: Date U� Homeoc.doc .. 4 jjjjoyyi Hof Barnstable iBLE �ftHE Tp� do t; Regulatory Services . � &masfV Geiler,Director BM M MBLFE 9 . g Building Division Farra�n P1-r-r Y,,.B._u.,�il,d,�ing Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 . Fax: 508-790-6230 p d° PERMIT#(Q U l FEE: $ V SHED REGISTRATION 120 square feet or less R Location of shed(address) Village. _ � C �i Property owner's name Telephone number sy Size of Shed Map/Parcel# Signatur Date Hyannis Main Street Waterfront Historic District? &C) Old King's Highway Historic District Commission jurisdiction? /I/ ? , �F,, `�, Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ �' _Parcel Permit# Z Health Division - 1 T Date Issued Conservation Division h Fee `T Tax Collector (J//<- y��� �Z-- Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis l.�Project Street Address AJ -� N S '� Village l Q�'J - +M V/- Owner P6� L �� �� �'� � Address 3� C,��'� � �s A R D Telephone 6�'-�� �� SS 3 b Permit Request Od d,v 4 0,� %o / f< r� 1ti�s 11<✓' ��`��d; u� 1 J r�� Square feet�t floor: existing (�� (o proposed f 2nd floor: existing y�� proposed / d Total new Valuation I !S�j Zoning District Flood Plain Groundwater Overlay Construction Type V"a-E-- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family b--*'—Two Family ❑ Multi-Family(#units) Age of Existing Structure `' y rS Historic House: ❑Yes O-No' On Old King's Highway: ❑Yes &tlo , Basement Type: ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) G Number of Baths: Full: existing 6 new "�^ Half:existing oar new Number of Bedrooms: existing 3 new �- Total Room Count(not including baths): existing 65� new I First Floor Room Count Heat Type and Fuel: Ud'as ❑Oil ❑ Electric ❑Other ,Central Air: ❑Yes 0-Ko— Fireplaces: Existing 0#, �>-, New Existing wood/coal stove: O Yes &Hfo- Detached garage: J existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:u4xistling ❑new size L xZ6 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION C elf ' Name Pi V 6 Telephone Number Address t��,Po License# 00S911,( Home Improvement Contractor# f y 3 Worker's Compensation# � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE d �-- ' FOR OFFICIAL USE ONLY k - PERMIT NO. ' DATE ISSUED r' MAP/PARCEL NO. ADDRESS - VILLAGE OWNER - r DATE OF INSPECTION: FOUNDATION -„ FRAME "7 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ,j PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING' DATE CLOSED,OUT ' ASSOCIATION PLAN NO. 3 1. � r• 1 RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions S50.00 ° �� Alterations/Renovations $25.00 Building Permit Amendment S25.00 FEE VALUE WORKSHEET NEW LIVING SPACE y 7 �1 square feet x$96Isq.foot= 1 60•40 x.0031— plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$641sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftC >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 - >'150 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96Isq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) FireplacelChimney x$25.00= (nunber) Inground Swimming Pool . .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost The Commonwealth of Massachusetts ' Department of Industrial Accidents oNce of/firesmosmoos . 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location city �•f�'L/��✓z/2i�✓C phone ❑ I am a homeowner performing all work myself. ❑ I am a sole r ri,or and have no one workii in capacity I am an employer providing workers' compensation ............ :tom am :.name.:::.:...... .... ......� .......... . .:.. ..:....................... .......... ........................................... ............ .......... .... . . < ;. tw lnsurante:co_.::,;;:;.: ..f. : .. ".;�,:.:.:..::..�..... ..... ......................:.:...:.:. ol�cv.#:.::.. '.:.....�,. ..:..:.::.....�,:.:......... / ❑ 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: �r`ame �>�>' ?> >`` f`% zrj' % % `iti?' i� £ %i �k� 2<2<< !y`� < 2 ?% Is` ................... con an n :AddTe1 i:•iiii::4::: t S.L h �h�natrc • sa ;name:�::::<:::<:::<::<:�>><::>::;:;:::>_:::::::::z::::::»:>::::»:;::::�:><:��::::�;::::::::::<:<:{:>:,........,. .............. ..... ....... ............ ............. Arse ,. ... .:::•:�:;;.:�•;:.::•:::::::::.�::: O 'li��� rinratce Fall=to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of c dndual penalties of a fine up to.S1;S00.00 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 mtdeastaad that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify a pains anApenaldes ojpedury that the information provided above is true and correct Signature Print name 4-1 e-r Phone# S D official we only do not write in this area to be completed by city or town OMCW city or town: permitNcense# ❑Bufidtng Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑HealthDepari went contact person: phone#; _ ❑Other- livmW 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged 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 p of its political subdivisions shall enter into an commonwealth nor any Y 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-on the workers'_compensation affidavit completely,by checking the box that applies:to your situation and supplying`company names, address and phone numbers along with a certificate of insurance as all affidavits maybe 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 pi 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 Me of Investlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 q The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the`reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.at least one but not more than four dwelling units or to structures which are adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ADO 0-j n Estimated Cost ��, u� t— Address of Work: 3 C A P 'A—, i 7✓� 1-� S ( � �`eti�c f ( I Owner's Name: y L^ l> I e Date of Application: ( 16 I hereby certify that: Registration is not required for the following reason(s): 0Work 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 a t of the owner: 9 Date V Contractor Name Registration No. OR q:forms:Affidav :rev-122001 iTabJ*J=b( Yreacriptive Packsgo for ane aad T"9 Famill Reaideadd BaNhW Stead with Fossil Foeb MAXIMUM Glaring Glaring Ceiling Wall floor Basemeac Slab. HamwCcolrug Arm'(%) U-value R-value' A vatua� R,Valu a Wall Flamers F35cimcy' Padcaa_e I &www� &vet 5701 to 650o Hestia;Desee*Dow Q 12-1. 0.40 38 13 19 10 6 Noel R 1 12% 0.52 30 19 19 10 6 Nor mal 9. 12% 0.50 38 13 19 to. 6 85 AM T 15% OJ6 38 13 21 NIA WA Normal U 15% 0.46 38 19 19 10 6 Normal v 159/8 0.44 38 13 25 WA WA 83 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38. 13 23 NM NM Noraal Y 19% 0.42 38 19 25 NIA WA Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA is% 03o 30 l9 19 l0 6 90AFilE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: WOO Ft 3. SQUARE FOOTAGE OF ALL GLAZING: r+ 4. %GLAZING AREA(#3 DIVIDED BY#2): U , 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 Footnotes to Table J5.2.1b: ` 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 ft'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 requ irement 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,Iog)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. 71:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mc_: the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned br..;ements must be included with the other glazing. Basement doors must meet the door U-value requirement d_scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment,the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels.Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include sttucttual components. b) Opaque doors in the building envelope must have a U-value no greater than 035.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. 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(Le.,may have a U-value greater than 035). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I i HOME IMPROVEMENT CONTRACTOR, Registration: 103218 Expiration: 07/06/2002 Type: DBA APPLETON CONSTRUCTION PP I ter Appleton ADMINISTRATOR " Baird Nay Centerville MA 02632 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 005414 p s Birthdate: 06/08/1954 Expires: 06/08/2002 Tr.no: 25981 Restricted To: 00 PETER J APPLETON 37 BAIRD WAY a."6. � CENTERVILLE, MA 02632 Administrator i n' I 1 i �� `J,a��'� i i E r . � P; ���L�p ��r.� z�� �. ���t� �' :" 4 I 7 oor 1JS t D' $ 9�Jr �v �4����- c -- Fe •Ay?�'r� An err S ��+�! 4 oP ��f� r-0 r r i �. ljq 4 1 'Floor P I✓+k ID >e� t e d I a� �-F NQ F/vim, f.4, in �kA �EVOV' l � Flo 0 AAA --------------- pI -3 i z 1 r� 2 ai X SHED REGISTRATION location of she (ad ess) property owner's name size of shed A//V/-� signature date Old King's Highway Historic District Commission jurisdiction? All� THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN x shed I � a-r\t- SILL f1,E✓.,-- - FEET ADO✓E PDQ13 RLOr )OLA /`/ SCALE - / ��='-D.47 -�6 PLAN 2EFE•,LENCE: �/N t�C1i os k, NEee6Y CIE.?TiFY TNA T T/-/E EX1S7- 1,V6 FOUMDA 7"/ON LOCAT/ON /3 0:MP.E 5 6 y As*6HOWAI AN17_1'�_a_��,__CONFOEeM i'Y/Ti4� SU��� Ts•!E SU/LD/N� �'�Tl3AC�C',�EQUiPEM��/7' a Z7/o� ao'L,1 �` . � Asse or's reap and lot nu er ..A192, - #158............. ��� SEPTIC SYSTEM MUST BE S( INSTALLED IN COMPLIANCE ` Sewage Permit ,number .. ............... WITH ARTICLE 11 STATE 4� w SANITARY CODE AND TOWN. o*THETo TOWN OF BAR SI ` ABLE r+ 89HBSTODLE; i 039 MP BUILDING INSPECTOR ca AjF� Y p. `'"I ''APPLICATION~FOR` PERMIT TO ..i 1•d ...... ...................... One �uell t= TYPE OF CONSTRUCTION .................Fa...........mil..Y....O..................in.9.............................................................................. C .•a .... .................. ...................19.�.6.. TO THE INSPECTOR OF BUILDINGS: - �r -ird � Pgned-hereby applies for a permit according to the following information: Location ....•Lot #3 Capa '•n•.••••Li�jah Road, Centerville ........................................................................................ Proposed Use Dw e 11 i ng Zoning District RC ..................Fire District Center.-Osterville F .O. Telle en-Perrone Assoc In 20 Cor oration `Road Nameof Owner ...............9...........................................�........�rddress ..................p.................................,....Q.�f?.!?.a o........... Name of Builder Tellegen-Perrone Assoc, In&ddress ..20...L:orporation Road, Dennis ........ .......... ..... ........... Nameof Architect .....N.on.e..................................................Address ..................................................................................... Number of Rooms 6 ........Foundation 10 poured COnCrete .......................................................... ............................................................. Exterior ..5./8r1....P..1.Y.......C9da.r...t...Clpp.board...........Roofing ..... ...4:b:....ASP..ha.l.t............................. Floors ....i.."....PICIR......AV.er...1/2.'. ...p.1.y.w.oad.............Interior ..1Z "...Shee•t•rock............................................. g FWA - Gas g 1 ll2 Baths RUC Waste Heating Plumbing ..................................................... p Used masonr Yes Approximate Cost 000.00 Fireplace ................................Y................................................ .............s.............................................. �. Definitive Plan Approved by Planning Board _____9-_10- .......19 73 Area E ....... gS ' ���7 �s' Diagram of Lot and Building with Dimensions / Fee 2.. ./ - o— SUBJECT TO APPROVAL OF BOARD OF HEALTH i 71z b I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Cs�C� Name ........................................... ....... - Tel ne Am000i a - -10�l�8- Permit for 1 1/2 _. _ ..m�����__ ' � ~ -----. .+ ~ Location ..Rwo��______ ` . ' Centerville . ^-^----------------~------- \ - ^ Tell Associates - ..'- ---------------------- ^ TVp6 of Construction ...........fram��........ ............ ---..~— --------------------. � ^ . ` 'Plot ...................... Lot --.—� -�..' ..---- � � ^ . ' June 76 . Permit Granted -.. 19 \ . ^ 'Dote.of Inspection ...' 19 � ' ' ' ' Date Completed -- .^�J��---lQ . . � � ����0� REFUSED -------^-----------_- l� � ~~- , . . . . . .......................................... �.. .................... . -----.--.-'-----.-~--~-.-.---. . . -------'r-^--------'-----^^-' /~ . . z Approved —'-------------'' 19 --------------------------' . ----------------------.---.. . � ' Assessor's :map and lot number ............................ Se ' a--Rermit number G� T"Er° TOWN OF BARNSTABLE EAWSTADLE, i E1 a 6 9 r BUILDING INSPECTOR 0 Mpy°' 'i APPLICATION 4OR-PERMIT TO 3u..l d TYPE OF CONSTRUCTION .:....C7ne...�..mi .. D..r a' 7 .. n n ............................... TO THE INSPECTOR OF BUILDINGS: 6 The undersigned hereby applies for a permit according to the following information: Location .....Lot... 3 Caot 'n . L.i jah Read, Cent,nrv.J.1;1a............................................................................. Proposed Use .1...Qw...l.. ..nQ ............:................................................................................................................................................ Zoning District ..........R..C............................................................Fire District ,.C.2nte,r.M.-.D.s.t.e.r.v.i.l.l.e...F.......D..... ................. .. .. . .. .. . .. .. . .. .. Name of Owner .Te.1,1eoen.- e,r.rone...Ass.Oc . I.9 ddress ..20...C°rporation Road p.pr?. s Name of Builder Tellenen-Fe.rrone Assoc. Zr?Address ..fin Corooration Road, Dennis Name of Architect .....Ngne ................Address .................................. .................................................................................... Number of Rooms ........ ........................................................Foundation 1C" noured concrete .......................................................................... Exterior ..5�. "... .v. .... Par...+...��.gnh!?a.r ..........Roofing. ..... '. '... .:b. Sn,ha.I.'.................................... Floors ....ill...p i nQ r1Uor 1 �7�r n t r��T+na+ri � �?.. Shc�etTcack :...,................,......:............... Interior. ..:..:...::................................................... HeatingF�A - ..........................................! .............................................................Plumbing .... 1/2....Bath.s...R.U. Waste Fireplace Used 411asonry Yes ............................................................................APProximate Cost ....$2.C...0.0.0.....CC. ...................... ......... V ACC 9-10. 7 3'--. RC Definitive Plan Approved by Planning Board _______________________________19__ _ Area ...... Diagram of Lot and Building with 'Dimensions a Fee ......... .:..:::.':;. ........ ..''..4... SUBJECT. TO APPROVAL OF BOARD OF HEALTH K� f d � lrt•�/ /r J ?J I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........................................ .......................... . .... Tellegen-Ferrone Associated, A=192-158 P?No .....I 58..'Permit for ..... ........... 1 famil dwellin .................... Location .................. .............C.euk P ..... ........ .............................. Owner .............. Type of Construction ..............1 KA.rqg................. . .......................................... ..... .. ............ Plot ............................ t .......... ............. 0 .............. /-Juti 15 76 Permit Granted ................ .... ..................19 Date.of Inspection ............ .......................19 Date Completed ......... 19 ...................... PERMIT REFUSED ................................................................ 19 . . ................................ .......................................................................... ........................�:...................................................... ................................................................... Approved ................................................ 19 ......................................... . ............................................................................... 1 01,K !. F DE ED REF 8367j238 °° JW, PLAN REF.•274/5 ZONING: SRC" SETBACKS 1 �o FR-20 SD.-10 RR:10'` A.M. 192/159 ( CFLQ0D_ZONE.. �.0 { AQVIFER PROTECTION ,w 0 VERLA Y DISTRICT .r A.M. 192/128 , 206. 4 4 11 E . N85 03 - W w LOCUS MAP A.M. 1921158 0� c� Y AREA= 19,588E sq/ft o CB gHE IQ i 192/127Co IV , PLOT PLAN OF LAND 00 PREPARED FOR a HSE s3.5' PA UL GIBERTI & 33 D: l DONNA VIGODA- GIBE'RTI 4j �8 2'; LOCATED 0 33 CAP N LIJAH S ROAD CB ,!� (fnd) n•I°,�'' CENTER VILLE; MA. r SE'PTEMBER 13, 2001 A.M 1921157 YANKEE SURVEY CONSULTANTS P. O. BOX 265 {, UN T 5, 40B INDUSTRY ROAD ' MARSTONS MILLS, MA. 02648 PH. 508 428 0055 FAX 508 420-5553 GRAPHIC 'SCALE I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE 30 0 15 30 60 120 IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL STANDARDS 1'OR THE PRACTICE OF LAND SURVEYING d� A IN . TH COMMONWEALTH OF MASSACHUSETTS. ! ( IN FEET ) PA UL A. MERITHEW, P.L.S. AT 1 inch _ 30 ft. JOBW 52893 CB o DIED REF.8367/238 0 �o tiPoSK� 4°� PLAN REF.•274/5 `O o ZONING: »RC,» • SET BACKS• - FR.•20 o j m SD.-10� 9c RR. 10 L0 A.M. 192/159 {. FLOOD ZONE. "C" AQUIFER PROTECTION i 0 VERLA Y DISTRICT A.M. 192 128 206. 44 N85 03'11 . LOCUS MAP ti A.M. 192/158 rn � � 3 AREA= 19,588f sq/ft <t. CB \ 514E 1¢�, A.M. ;; q 192/127 $°�� `� - :- cv P ` PLOT PLAN OF LAND PREPARED FOR .HSE,,,, , 63.5• PA UL GIBERTI & 33 �• DONNA VIGODA- GIBERTI 8 2', LOCATED 33 .CAP'N LIJAH'S ROAD CB GPI lb (fna) CENTER VILLE; MA. SEPTEMBER 13, 2001 A.M. 1921157 YANKEE SURVEY CONSULTANTS P. O. BOX 265 UNI T 5, 40B INDUSTRY ROAD - �� MARSTONS MILLS, MA. 02648 PH.(508)428 0055 FAX(508)420-5553 GRAPHIC SCALE I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE \J 30 0 15 30 e0 720 IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL STANDARDS FOR THE PRACTICE OF LAND SURVEYING IA' TH COMMONWEALTH OF MASSACHUSETTS.Q.awl ( IN FEET ) I inch = 30 ft. PA UL A. MERITHEW, T;L S. A T k_ JOBS 52893 CB {i DEED REF 8367/238 °�PoS�'no PLAN REF. 274/5 0`O 3 ZONING. SETBACKS: FR:20 ' SD.•10 ` 9c `N =d RR:10 A.M. 192 159 FLOOD ZONE• ''C" AQUIFER PROTECTION 0 VERLA Y DISTRICT �90 � A.M. 1921128 206. 4 4 ` N85 03'11';E LOCUS MAP ti �O A.M. 1921158Qrl cn AREA= 19,588f Sq/ft o CB 192/127 $ `�: - PLOT PLAN OF LAND O z PREPARED FOR s�o� 9�c'� ��. #3 6 5 PA UL GIBERTI & �a DONNA VIGODA— GIBERTI 2 „ O LOCATED CB 1133 CAP'N LIJAH'S' ROAD CENTER VILL.E, MA. SEPTEMBER 13, 2001 A.M. 1921157 i~ `y YANKEE SUR I/EY CONSUL TANTS P. O. BOX 265 UNIT 5, 403 INDUSTRY ROAD MARSTONS MILLS, MA. 02648 ' PH. (508)428-0055 — FAX(508)420-5553 GRAPHIC SCALE I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE \J 30 0 is 30 60 120 IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN � - TH COMMONWEALTH OF MASSACHUSETTS. 13 ! ( IN FEET ). 1 inch = 30 ft. PA-UL A. MERITHEW, P.L S. AT JOEW 52893 CB /r DLED REF 8367/,c38., _ PLAN REF 274/5 oleo a l ZONING: „RC*" SETBACKS: � o FR:20 SD:10' 9 `C RR:10' A.M. 192/159 FLOOD ZONE: "C" � AQUIFER PROTECTION 0 VERLA Y DISTRICT A.M. _ 1921128 !l 0006. 44' i . V85 0311 E' LOCUS MAP ti A.M. 1921158 c AREA 19,588f sq/ft o � o CB .\ HE ISt�, U1 ,,,, A.M. , i 192/127 $� tiP �;e, , , PLOT PLAN OF LAND ,,, ii �1 0 I �o " ,; ,,,?O' i} PREPARED FOR PA UL GIBERTI & �s�o 9�G� �• HS� �, � . . 63.5' � , �. DONNA VIGODA— GIBERTI ly �g Ole" LOCATED 1 i' #33 CAP'N LIJAH'S ROAD ro (fnd) CENTER VILLE, MA. SEPTEMBER 13, 2001 A.M. 1921157 YANKEE SURVEY CONSULTANTS P. O. BOX 265:_ UNIT 5, 408 INDUSTRY ROAD M RSTONS MIL MA'.' 02648 A L S, - - -5553 ,. PH.(508�428 0055 FAX(508�420 GRAPHIC SCALE I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL 30 0 ,s 3o so Aso STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN - -- TH COMMONWEALTH OF MASSACHUSETTS. ( IN FEET ) 0 '� 1 inch = 30 ft. PA UL A. MERITHEW, P.L S. AT JOBS 52893 CB _ j