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W"M"a�­_W�,�,. a I�, 1!J� , 00;, !I, 'i 1;',l�,;'�,'."'';� ij��.'� . , � , I , , , I,";�� ", " ' ' ' ' , ,� ' i� ,,,,,I, , , �� � � , I,:� vi� , ,, , � ,I � 1.3 �,,_ , ,",, .-` 1U, " �-, ,,,­ , * ,,, " ",O";4�,,� I , sh , �,, , - - I � 1",�,"&,,%, l"*,�4 �,�;�,,'��',�,�Z:,,,: ,,'-�,_,,�,�Il,""" ;,,!,�_oo�,-_,,,�;�­ _,_,�"";4��I' � � � , � " , ......... � " " - � 106p iil , � � � - ,I i4P` '.,.',� I�j, '�,�I­­.��, `1 R,�i`.1131,Mlltol - 04f,i� 11111".0 ,, Upff"I'l �i�',,i,,,-, "4",_�!"""",."�, ,�"" �,�, �,:;;;;; ,,�,.,i�� l , No 1" A low" IN! 1 " dmu �, ��y - , -�,,��""i�il-',,'�,Sol VAMURIZA;SAY ',�I' �A �,,,�� ir, � Q 0 __I;t�,���L�,�,,�,�'li.,��1,1�4i'��,�,",4�i,,m 1 i% TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map c26 7 Parcel ®7 S;2 00 51 Permit# ocQQ M�&, S Health Division Date Issued G Conservation Division Application Fee Tax Collector Permit Fee 3 .05 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH 01 Preservation/Hyannis Project Street Address �'1 %�o,a1 g � 'Rot,- Village G MA Owner lAa-�t..rck, Fri Address G1 y C � a��Ic � ►. R& Telephone i 29 — elf e- e , 1.1"A O2 32 Permit Request 04-N 1�-_ e—'Al 6eek,00'.-) ®yccr csIi inn Square feet: 1st floor: existing proposed 2nd floor: existing 950 proposed 102.0 Total new Z Zoning District Flood Plain Groundwater Overlay Project Valuation &TOO Construction Type F1-b_nY.e- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Ef Two Family ❑ Multi-Family(#units) Age of Existing Structure 16% Historic House: ❑Yes CrNo On Old King's Highway: ❑Yes 006 Basement Type: d-Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) 0 Zy Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing —3 new Total Room Count(not including baths): existing new First Floor Room ount Heat Type and Fuel: dGas ❑Oil ❑ Electric ❑Other Central Air: 6Yes ❑No Fireplaces: Existing New Existing wood/c stove: aYes ,vrNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ i ting Vw size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: cb rr.. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2rNo If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address Z.Z.S 6rn5na(eX S+ License# 077846 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ryXe_ SIGNATURE /� �' DATE 7/07 t FOR OFFICIAL USE ONLY s _ "PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER ; DATE OF INSPECTION: FOUNDATION FRAME L_Og 7 jG7 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL , FINALBUILDING A) %)IDLO3 DATE CLOSED OUT ASSOCIATION PLAN NO. 1 The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. .02111 x airWorkers' Com ensation.'Insurance Affidavit-General Businesses iiiiia iiiiiiiiiiaiiiiii�i��iiiiiiiaiioa name: IT address: GoS Pi,-A city �C�1�1 S state: MA A av: 402- D . vhone# 5bG^1K I" q-l 1_f9 work site location full address): I am a sole proprietor and have no one Business Type: Retail Restaurant�Bai/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em to with em to ees(full& art time.)'. ❑Other I am an employer providing workers' comvensation for my employees working on this job.. comyany.nemet - addr s city: iihoiie.#: msuranc / e.cos•::....::::.;:'�..: ,...:..:.: .. .` _ `t' _ oli I am a sole proprietor and have hired the independent contractors listed below'who have the following workers' .. compensation polices: coin anv namee address: °{ e, dn eity:. # � { m urn •' `::,< .... . . coIIlAan. name ' V <• address: - . city: phone:#: : :.. V 4; insur,nsu -:. c.,.,......... a P: ..J:. ..O.C. nc_co. . . .... .:...::....::....::.•,. ,... _ li �:# R. 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 p copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the/pains andpenalties ofperjury that the information provided above is true and correct Signature _ /%� '[ Date III? (/O7 Print name 1^�-�1�-� S 'e� Phone# r fficial use only do not write in this area to be completed by city or town offictal permit/license# Building Department ❑Licensing Boarddiate response is required ❑Selectmen's Office❑Health Department phone#; ❑Other Information and Instructions Massachusetts General Laws,chapter 152 section 25.requires all employers to provide workers'compensation for their.. employees. As quoted from the 4`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 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. A.lsobe 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 b�e used as a reference number. The.affidavits maybe 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 a n of 1msfigaftnS 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEw LIVING SPACE — �—square feet x$96/sq.foot= 6—7 7,U x.0041= 7 ` plus from below(if applicable) p,I,TERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041_ STAND ALONE PERMITS Open Porch x$30.00= (number) . Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Prolcost Rev:063004 I _696 Town of Barnstable Regulatory Services' snutsr�s _ Thomas F.Geiler,Director 9$ S ���� Building Division TomPerry, Building.Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstable maxs Offioe: 508-862-4039 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I1 U P ,as Owner of the subject property A p- to act on mybehalf, hereby authonze G in all matters relative to work authorized by this building pennit application for: L( CQA 1 1/1LLt �E D, TES 1Li-, MA Address of Jo ) . 313J S* a of r Date 19 Print Name no WR Appendiu! Table J3.216(continued) Fassd Fuels Prescriptive Packages for due and Two-Family Residential Buildings Heated MAXIMUM MINIMUM Wall Floor Basement Slab Heating/Cooling Chang Glaung Ceiling Perimeter Equipment EffieieacyI rea A (%) U-value= R-valud R-value4 R valuer Rwa 7 e R tralue Package ter. 5701 to 6500 Hating Degree Days' Narmal�� 12% '0.40--'�`3813 19 l0 6 -------6 Normal�---- 19 — R 12 10 O SZ 30 6 85 AFUE $ 12°/, 0.50 38 13 19 10 Normal 13 25 N/A N/A T 15% 036 38 6 Normal U 15% 0.46 38 19 19 10 85 AFUE 13 25 N/A NIA V 15% 0.44 38 6 85 AFUE w 15% 0.52 30 19 19 10 Normal 13 25 N/A N/A )( 18% 032 38 19 25 N/A N/A Normal y 18% 0.42 38 6 90 AFUE Z 18% 0.42 38 13 19 10 90 AFUE AA 18% 0.50 30 19 19 10 6 1. ADDRESS OF PROPERTY: 1 y rr,� -V' G` — 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 6 3. SQUARE FOOTAGE OF ALL GLAZING: DIVIDED BY#2): 36 4, /o GLAZING AREA(#3 DI 5. SELECT PACKAGE(Q--AA see chart above): a NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES; N0: q4orrts4980303a 780 CMR Appendix J Footnotes to Ta ble A2.1b: • i e ratio of the area of the lazing assemblies (including sliding-glass doors, skylights, and Glazing area is the g basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall to 1%of the total lazin area may be excluded from the U-value requirement. expressed as a ercenta e.U g g area, exp p g P For example,3 ft of decorative glass may be excluded from a building design with 300 ft2 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 R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frarhe 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 described in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes eleetric 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.Ia 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 averse R-value is eater than or equal to - insulation levels the component complies if the area-weightedg gr different � P 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. . • ✓�ze �iam�imoizcuea� o�'✓Z�ac�ivae� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number '.CS, 077846 Y6 Birthdate 1J3/23/1958 : Expires 03/23/2008 Tr, no: 49304 Restricted r 00 I MICHAEL B GASPARb j 225 GOSNOLD ST HYANNIS, MA 02601 Commissioner '. fie'[oam�rrw�ruueaLC�i a�./�aaaac`u�avlta I. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR .' Registration 36522 i ,'Expiration 8l1L2008 - ,Type Individual . . MICHAEL BENJAMIN GASPARD,';• J 4 Y,.:t I' MICHAEL GASPAR WE'l I- =t a 225 Gosnold st Hyannis,MA 02601 Deputy Administrator °FTMEr�� Town of Barnstable Regulatory Services ' sAxr�sxABt,E Thomas F.Geller,Director 9 MASS. 1639. 0 MA Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date 'i J3 f0- 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: ( Zve_ %.�Lr Estimated Cost Address of Work: 3 I cy `a Z,,*,u aec,_L, - Owner's Name: Date of Application: C'S13 lJ'� I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: dL Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav y . w44^^,_`�^'::a^^� ,"$-"-» � 4�--=� �^-•-••"�^-. �g'-'��.-•.^r#ta�.......#,.,:,,..,.:y:�., $-r �" •�,^',«.�:��- 7 -�;.; .,v,..�m;:,, t .....i:,.»..,.-=...t,�«:;»�..a,. �+-` _...�,::,.,.:�..s.,,,_...�:{'-�,...� 131 , f : 9 ' + i } , I _ - _ F ._.. ..._. - .;.. _...:_._.....--, ' J... -,._.. .... _.re.�n._ _- - - _•-�,':-. mow.,_ ... __ _ �� f 7 F w I 1 i i 7 { 3 3 t t ! j :, _ � I fi 1 f � 3 [ fi ) ! ' j i � i' 1 t 1 ^i. k j .--' -! 1� •—� f �_ -„'�"o..._ .... i f i 1 4 ( p i I Ii t + r ; ......... ; I t I _ r , y t 4 a 1 t E! , fi _ r 8� N '-6"x 6=8" .. --------- 1" 14'3" t p b N X y 2'-0" Existing master bedroom _1 OD " o ,- O O O LO co v O Existing gable wall C. b - X Existing bearing wall below A o N O - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - `4=7" New expansion of bedroom on existing deckCrl ; 2"x8"Fl. beams , 2, 3„ 4► 0„ 4, 3„ - - -4, O 2' 4„ Fry Residence 16'40" 1314 Cragville Beach Rd. Centerville, MA Existing room below Fry Residence Addition section Asphalt roof shingles 1/2"CDX sheathing 1211 12" 2"x6"ceiling beams 14'--8" 2"x8"rafters R30 insulation 2W'interior walls 1/2"plaster board O OO R13 wall insulation v 3/4"subfloor Hurrican clips 2"x8"floor beams 16oc O V � O Existing room below OWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-), Parcel 60,�- Permit# �fl Health Division Date Issued P o -O y- Conservation Division EJ-► l / Application Feef 0 Tax Collector Permit Fees Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 4 31 y C.: _Al G V ILL U ►�EVE c-I r �0 4-�> Village Gc=NrE_ V I L LC Owner 0_�& A-R-b IZ` Address 2 34, r�qxL 30/�� S'I' o S YZ Telephone (vy K) Co I - 1-{SU 9 1 (e 7 Permit Request I Q-)L C 0 0-9-C H S L. 1 D?`_S 'Vy ITh W i r1 b S, e a tr 2 L-A)'�>ED, V00b V1P4 ��r'c.3i:)✓v� �g 12 proposed S� 2nd floor:existing 812— proposed 011 To Square feet: 1 st floor: existing taf~F new~ : Zoning District Flood Plain Groundwater Overlay c1b Project Valuation --Construction Type G' Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation-- Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ba Historic House: ❑Yes (8%o On Old King's Highway: Yes ;�OVo Basement Type: 'gFull 'g Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing I new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing J new 95 First Floor Room Count Heat Type and Fuel: )4 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes )d No Fireplaces: Existing New Existing wood/coal stove: ❑Yes VNo 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 Name Gi 1067 C 4-0tZV Telephone Number Address Df7 6 License# v j kA-" Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION EB)I - ULTING FROM THIS PROJECT WILL BE TAKEN TO X"�, SIGNATURE DATE �'' � FOR OFFICIAL USE ONLY s PERMIT NO. + . DATFjJ_SSUED , s .MAP/PARCEL NO. ADDRESS VILLAGE ,- OWNER - 10 DATE OF•INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL m GAS: ROUC'H t' FINAL t? -�-s 00 FI '-�FINAL BUILDING :;?•= _ rgn Mo - DATE CLOSED OUT M ASSOCIATION PLAN NO�- Q m rr, m -"S: t C _ The Commonwealth of Massachusetts Department of Industrial Accidents 600 lVasnington Street -J Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit-General Busineist:sY. name' ' l ' address• �i��e.^ state: 7i : hone# .. .. lc 7. ci work si location full address: ' ❑ am a sole proprietor and have no one Business Type: ❑Retail[]RestaurantBar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) IV; em an to er with em 1 ees(full& art time . ❑Other J am an employ p workers' compensation for my.employees working on this job. s'.. 'com av •• '- � , - C• `•,. - • ' •• hone#..'• ' • - . city: 20 v J Insurance.co;,:'.:: ;''%° / ;c`_.:.�./..• ..• �; // .l!/ ///%///// / •.;j ////i: ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: ; com'en name: address: hone ci insurance co. • • ..,..._.. . .. ,.,• - /,/ // //%/////// /// // '? •.`•'.:;'+ gib.. 'Vi'c:; •.�' - address: cIiv: .. ' .. •hone�!� ' `• •• ,.'•• _ A. insurance co•:.::•.;,•.• C�/�� i Fagure to secure coverage as required under Section 25 of MGL 152 can lead to thaimposition of criminalpenaltira of a"fin up to$1,500.00 and/or one years'imprisonment as well as civil penal the fo of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that p m copy of this statement may be forwarded a Office yestigationp of the DIA for coverage verification. I do hereby certi der the ins and, aities erjury,that.the information provided above is true and correct G Date Signature Phone# uf��►/� Print name 3� � r official use only do not write in this area to be completed by city or town official i ermittlicense# ❑Building Department city or town, p ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required Health Department '' contaetpersan: phone#; ❑Other ge (revered Sept 2003) i r Information and Instructions Massachusetts Genera:Laws chapter 152 section 25 requires all employee stop provide r tvhe service of another under for theircont act employees. As quoted from the"law", an employee is defined as every p �' 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.hall 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 corrmionwealth 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. D � ,//��// ///%/''////////////// ///////�y�%///�i�,////Ddi/��i////////////D// ///%%%/%%///////////%%///�/%////// Applicants fidavit completely,by checking the box that applies to your situation. Please Please fill in the workers' compensation af 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 artment of Industrial Accidents. Should you have any questions regarding the"law"or if you are requested, not the Dep 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 perrmit/license number which will b'e used as a reference number. The affidavits.rmybe 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. /m i%//� %�%/,� /�i%/ Nor/ The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Unke of IevMS119atlains 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 OF SHE ray, Town of Barnstable Regulatory Services BMNSPABLE, " Thomas F.Geiler,Director 9`bA,F 039. p``� 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 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:'�QzL&te wile lbuwS k-•fZ(CrJEstimated Cost S oZ Address of Work: t 3 �( C 1_+t7C� V i l.0 t)&Vf:✓f�7 � . C���:r v!Ile Owner's Name: Date of Application: 1 L 2.1 I I hereby certify that: Registration is not required for the following reason(s): E]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 permit as the agent of the owner: CC) Date, Co actor Name Registration No. R Dat 0 er's Name Q16nns:homeaf6dav RESIDENTIAL BUILDING PERMIT FEES ' APPLICATION FEE-; New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 5� Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE j square feet x$64/sq.foot= _x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.,sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) • Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 ..�� slDkti Town of Barnstable P. Regulatory Services SWgrnBLS, ' Thomas F.Geller,Director as�ss. e 6 p`�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable..xna.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, )X j�� ��� ,as Owner of the subject property hereby authorize 60el CC,A-C S1 to act on my behalf, in all matters relative to work authorized by dais building permit application for. C iz�6VN �1 �c6 . (Address of Job) G L / ;SJ' afore of Owner Date Print Name w a"Ov �NS1iUTtIOMIJIEG�t+ ► er , 'Rb 0:09013 25776 'i 3TAPM �XOUTAV Mrp�n 'g Czsoiwm ioriet N/r YAR1�h fie 1°oom� o_���lords Board of Building:Reg t6ns and Standards , HOME IMPROVEMENT CONTRACTOR Regist�tl�r 106395 23/2006 idual Y. GREGORY M. Gregory Cauley 33 A Baxter Avenu` W.Yarmouth,MA 02 - Administrator- r\ gpnea acr ?xn Frn�ur s� W���AJS �ftprd)• a03�0 R. .SIDE 2`IIiO T77 41 sb , Ieti Ek ST. 1�oRCH H4S 61Oxo 8 54 �E�LacC sLlotcs w� *ND. _ FxisnNa PORCH F�.�va1Nr �� __ N/;Q(WL�NG Z4Y6 wlNDows sq - I�.,RCH IS Ma Ir54 R 1�1uKC -poi' o�J EX rr=Yci o�2 �,� Tl9-.114---V3 513 §16 -y 3% 11 WryeA6 Nt��pb- 29� Y FLOOR PLAN FIOwPFRD Fry ee Y4°•1 er vxovm erg wH ar O�Tt� 6VtlHu 13I4 CRJ�-16VIU-E � H ,�d - C2..fi1 TERV I LLE m 1} o;uwmo r�uuem wfNDuw L c-"OµS t E:1 y3 I o 0 � nI ; boo --- _._._..._._ i i zy'3 -- -- - - --- - - -=-- ---.._.. - - _-_ - ------ T i { uTl��Ty CUlft %' 1 Evv� i Ma Parcel 7o?-06c- Permit# 0 _ ) p � House# Date Issueedy a A t0�v� � B and of Health(3rd floor)(8:15 -9:30/1:00-�3fl � -3 Z2 6 z ee Conservation Office(4th floor)(8:30-9:30/1:00=2:00) 6 PTi (S'�E�I�1ST BE SE Planning Dept. (1st floor/School Admin. Bldg.) INSTALLEDANCE WIT Definitive PI roved by Planning Board 19 EIVVII$�NME AND�� TOWN RR*, NS U TOWN OF BARNSTABLE Vd _ I Building Permit Application Project St et Address ' Village Owner J Address Telephone Permit Request First Floor square feet S and Floor square feet Construction Type Estimated Project Cost $ Zoning District ( Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑f 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 No.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 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 ❑No If yes, site plan review# Current Use Proposed Use uilder Information / NamePA"�Id-4 OjAg,�,� Telephone Number A ress Z�` License# - Home Improvement Contractor# A33LF7 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 .Z- DATE g BUILDING PERMIT DENIED FOR THE FOLLOWIN�JASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE; OWNER - ^� DATE OF•INSPECTION: FOUNDATION FRAME INSULATION r " ,FIREPLACE- ELECTRICAL: ROUGH FINAL, ` PLUMBING: ��4ROUGH FINAL" _ •' GAS: ' "IROUGH1 FINAL FINAL BUILDINR «� �!1 DATE CLOSED ASSOCIATION (PLAN,rt,0"`J " i , 1 - Ai; The Town ofBarnstable NAM , Department of Health Safety and Environmental Services ram, . BuiIding Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 BuiIding Commissions For office use only Permit no. Date AFFMA Vrr 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• ' 'Pa—Est. Cost �Q u Address of Work: /Owner's Name Date of Permit Application: — 2,/' 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000- 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 Date Owners Name The Commonwealth of Massachusetts =jam Department of Industrial Accidents ;; �, , __:_� Office of/ntrestigatioos _- 600 Washington Street Boston,Mass. 02111 Workers"Compensation Insurance Affidavit name �dw��&J ©t��1�' �- lCittS �t-a < phone# city r9elt4t,- (` l 1/Yu ❑ I am a homeowner performing all work myself. am a sole proprietor and have no one working in any ca acity ❑ I am an emplover providing workers compensation for my employees working on this job. • comannv name . address � s city h yi lS�%/l y`1 �f phone insurance co. oiicv,# . ❑ 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: tom any name: address: city phone#• insurnnce co oiicv# company name. address: hone#r city: ... . Insurance co ' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one yam,,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ins-and penalties of perjury that the information provided above is true and correct• -- Signature tv �j Date Print name Phone# ofliclal use only do not write in this area to be completed by city or town otIIcial permittlicense# • ❑Building Department city or town: ❑Licensing Board e ease is required ❑Selectmen's OMce ❑checkif immediate response ❑Health Department c phone#; Other_ contact person: (nvum 9i9s PIA) 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 orlio 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 in o 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 J �� 3 authority. Applicants ` Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supply' 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 peiii icense 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•Departmeirt's•address,telephone and fax number: , \ ` The Commonwealth Of Massachusetts1 Department of Industrial Accidents Office of Investigadons 600 Washington Street .tea.. Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375