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Home My WebLink About0130 FULLER ROAD R.. . . .� .. �� fi: . t _ . �a . . Y�� _ .. ., � z v ror ., � r _ - �.. .' .� '" Jn ". .. �. .. ., .. t r i �., ., �. .. �. .. .. .. S�.: � - �r nM� �..- ;. .., • i _ .. a .. . ,_ ��a _ z �. r ,. n -. .. _. .. ,a. , :.: t = � .... .. ,. r ,. .. . . . ,. . ., -. �, ._ . � � _ , .� �. µ .. � ,, ,. ,; ,�, �. �� ,. �, . v _ �, .. � � � �. :. _ _ . .. �. ., .. .: e - .. .n 4 a. ... r ��. ". � .. "..y � .: :. � ,. _ .. �. �. :. e.,, .. ,., o _ - .. :. _ .. � '. '. .. .y. .. .. e, _ .. - .. r « � � ." i t � y _ n � .. n a. a n' .. ., :, �, �� h .. �� i e ._ :. ... e .. ., ii� '� .. .�` .. �.. M .. � �. .. t �. as .:.. ..l r � .. .,. � .. ...' _. .. r .� .. � i. .� � � a � r ., .. { r �� . .. � ,. r .. :.. .� .. .. U -, .. .. r ` -:. �� c • � �, ,_ , `, :. ;, . . •'. , , u � , . � �� !� i _ .. - � (, �� - _ �! w E f � o REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken (section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: Section 1 —Pro e�rty Information Property Address: 130 FULLER RD,CENTERVILLE,MA 02632 Assessors Map #: Parcel #: 189-125 Land area and description Sq. ft. 9583 1 1-Storey I Single Family Building(s) description and contents Single Family Occupied: NO Occupant(s)(if borrowers so state and include name(s)) Phone: email: other: Vacant: YES Date: 12/21/2019 Anticipated Length of Vacancy: Last occupant(s))(if borrowers so state and include name(s)) U.S. Bank National Association, as Trustee for Banc of America Fun mg Corporation Mortgage Pass-Through Certificates, Series 2005-A c/o Altisource Solutions, Inc. Phone: (866)-952-6514 email: VPR@61tisource.com other: Has possession been taken If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above) Section 2—Foreclosing Party Information Foreclosing Party(full name/title) Foreclosure Case Court: Docket# i S *01 WV t Z tur Q14z w Date filed: Current Status: Foreclosing Party's representative(s) for property(entry; management, repair, etc.)(name, title,): Altisource Solutions Inc-Darren Wisniewski Company (if different from foreclosing party): Address: 1000 Abernathy Road Northpark Town Center, Building 400 Suite 200 Atlanta, GA 30328 Phone: (866)-952-6514 email: VPR@altisource.com other: If an exemption is claimed,please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure, please so state and do not complete contact information(i. e. "none" or"see above")). "Note: Please mail correspondence to Atlanta office. Darren is local to address property conditions and emergency matters." Name, title, other: Darren D Wisniewski-Regional Field Service Manager Company (if different from foreclosing party): Altisource Solutions,Inc. Address: 1000 Abernathy Road Northpark Town Center,Building 400 Suite 200 Atlanta,GA 30328 (866)952-6514 Phone(s): (407)739-3930 emall(s): VPR@altisource.com other: Darren.Wisniewski@Altisource.com Name, title, other: Company(if different from foreclosing party): Address: Phone: email: other: Attorney representing foreclosing party Firm name (if different from attorney's name): Address: Phone(s): email(s): other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 2244 of the Code of the Town of Barnstable. Date: Name: Alma Emery Title: Manager- Property Registrations I - I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable I f Mckechnie, Robert From: Callahan,JoAnna Sent: Thursday,June 20, 2019 2:52 PM To: 'Tianero, Ma.Avelina M' Cc: Mckechnie, Robert Subject: RE:.130 FULLER RD, CENTERVILLE, MA 02632 Attachments: , check 921724.pdf This escrow payment was returned with check#921726 in the amount of$10,025.78 dated 10/29/2015.This check cleared 11/9/15. 1 have attached a copy of the cleared check. JoAnna Callahan CMMAT Town of Barnstable Assistant Treasurer 508 862 4656 From: Tianero, Ma. Avelina M [mailto:Ma.Avelina.Tianero(Qbaltisource.com] Sent: Thursday, June 20, 2019 1:37 PM To: Callahan,JoAnna Cc: Mckechnie, Robert Subject: 130 FULLER RD, CENTERVILLE, MA 02632 Importance: High Good afternoon, Are you able to check on your record if the$10,000 bond check we sent for this property last July 2014 was processed? Check#172226 Date 07/11/2014 1 i CAUTION:This email originated from outside of the Town of Barnstable! Do not`click links.,open; attachments or reply, unless you recognize the sender's.email address and know-the content is safe!' 3 f 1 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed'for which possession has been taken(section 224 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: Section 1 Propegy Information Property Address: 130 Fuller Rd, CENTERVILLE, MA 02632 Assessors Map#: 189 Parcel#: 125 ` Land area and description Building(s) description and contents Occupied: NO Occupant(s)(if borrowers so state and include name(s)) Catherine R Powers c/o Ocwen Loan Servicing, LLC ' Phone: email: other: Vacant: YES Date: 05/02/2014 Anticipated Length of Vacancy: Last occupant(s) )(if borrowers so state and include name(s)) Catherine R Powers c/o Ocwen Loan.Servicing, LLC Phone: 170-612-7007 email: VPR@altisource.com other: Has possession been taken If so, please explain and complete and file'the maintenance and security plan form (unless exempt as stated above),;.. N 0 1SIA10 Section 2—Foreclosing PaM Information Foreclosing Party (full name/title).. Foreclosure Case Court: Docket-# L 0 .E Wd s 1 ail(' 411, . 1 Date filed: Current Status: Foreclosing Party's representative(s) for property (entry; management, repair, etc.)(name,title,): Company (if different from foreclosing party): Address: Phone: email: other: If an exemption is claimed,please do not complete the remainder. Other representative(s) (if foregoing,representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure,please so state and do not complete contact information(i. e. "none" or"see above")). ' Name, title, other: Garrecht William ' Company (if different from foreclosing party): Innovative Tile and Stone Inc Address: 21 Patricia Lane LAKE GROVE NY 11755 Phone(s): (631)-404-8469 email(s): wgarrecht@aol.com other: Name, title, other: Abigail McCutcheon - Supervisor Property Registration Company (if different from foreclosing party): Altisource@ Portfolio Solutions M1 Address: 2002 Summit Boulevard, Suite 600 Atlanta, Georgia 30319 Phone: 770-612=7007 email: VPR@altisource.com other:. Attorney representing foreclosing party - - Firm name (if different from attorney's name): Korde &Associates, P.C. Address: Chelmsford, MA Phone(s): (978)256-1500 email(s): other: ` I acknowledge that the information provided is accurate and correct. J also understand that any ur e information will result in non-compliance with section 224-3 of chapte of the Town of Barnstable: JUL 1 12014 Date: Name: (Sow`' Title: a I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable.' , Date: Building Commissioner, Town of Barnstable - . r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# d Health Division Date Issued. In 6-1 Conservation Division Application Fee :O Tax Collector Permit Fee 9 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address l 3 o �,a / u Village eo TC-1 Owner :owe tN, �w Gt 5 Address 1 3 r.4-y 8,J t,,, Z V d 1,e, Telephone f, off') 1) 1 b l Permit Request A60 T-f r &11c W 1 r),v n f Square feet: 1 st floor:existing proposed d® 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0,0oo,00 Construction Type Lot Size JOO f OO1 Grandfathered: ❑Yes 411�o If yes, attach supporting documentation. Dwelling Type: Single Family Z Two Family ❑ Multi-Family #units) ) Age of Existing Structure 3� Yea,S Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: Full ❑Crawl ❑Walkout L!!Other q (0w AJA r 1a& wn4,- Basement Finished Area(sq.ft.) 11-0 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing Inew Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: V Gas ❑Oil ❑ Electric ❑Other Gentral Air: ❑Yes U�No Fireplaces: Existing New Existing wood/coal stove: ❑Yes L/No Detached garage:❑e isting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: existing ❑new size Shed:0 existing ❑new size Other: �_ 7E Zoning-Board of AppealsZurization-0 Appeal-# -Commercial ❑Yes If yes, site plan review# Current Use Proposed Use r BUILDER INFORMATION' Name. r O Telephone Number OD M Address �3 U '` `� . ` License# G hV-M Jd t'l `%�. -� ~` �- Home Improvement Contractor# > Worker's Compensation# ,�. ALL CONSTRUCTION DEBRIS RESULTING FROM.THIS PROJECT WILL BE TAKEN TO �w 5 1� �n''^S Sla�fo�► SIGNATURE' DATE l 3 a I . c�! J FOR OFFICIAL USE ONLY y APPLICATION# DATE"ISSUED MAP4 PARCEL NO. ADDRESS VILLAGE OWNER _yy:}xe c} f DATE OF INSPECTION: ;- FOUNDATION 3�Sda�o oK .fj 1 - ' FRAME INSULATION FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y •,r A DATE CLOSED OUT' ASSOCIATION PLAN NO. 4; The Commonwealth of Massachusetts .Department oflndustrial Accidents Office of Investigations . a .600 Washington Street Boston,MA 02111 . ,• www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/IIndiv-i-dual): . , �0 5 y i w -Address: i City/State/Zip: C.r�r1 t V r U(ti ' Phone.#: 56� 7`7( O l" Are you an employer? Check the appropriate bog: 4. I am a eneral contractor andI Type roject(required):. 1.❑ I am a employer with ❑ g employees(full and/or part-time).* have hired the sub-contractors 6. ew construction 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑Rem eling ship and have no employees These sub-contractors have 8. ❑ molition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp.insurance.$ q ed.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . 13.0 Other comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providt;their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is.the policy and job site information. ' Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nd the par and penalties of perjury that the information provided ab ve is true and correct: Sienature: Date: .d Phone#: Official•use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the• dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to"operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented•to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies•(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. "The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sile Address"the applicant should write"all-locations in city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the, applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 604 Washington Street Boston,MA 02111 Tel. #617-727-49QG ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 &Tww.mass.gov/dia °FTHE) Town-of Barnstable yP °� ]regulatory Services * snxNsrAs , x Thomas F.Geiler,Director MASS Budding,Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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: � �� '° 11 Estimated Cost 0 ()0 U.G0 Address of Work: �Ia Ile r. Pvl Owner's Name: A U s � W 6"t, Date of Application: ` [6-2 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law Job Under$1,000 QB g not owner-occupied [� weer 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: Date Contractor Name Registration No. OR �Z_ 30 Da Owner's Name Q�'oms:hame�dav �FTHE lqy, Town of Barnstable Regulatory Services MUMSTABLE, : Thomas F. Geiler,Director Ar 6 9 A,O� Building Division Ep AAA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 3� rU number Q street village "HOMEOWNER": V OSAYI �' +dtnlL/S (566) `n/jo ), (569) name home phone# work phone# CURRENT MAILING ADDRESS: G 0 Rd C� V-(,A,, l A, city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. . The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mmimu inspection procedu s and requirements and that he/she will comply with said procedures and requir nts. Sin re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109,1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt t Permit# Permit Date REScheck Software Version 3.7 Release 1 b Compliance Certificate Project Title: New Bathroom Addition Report Date:06/29/07 Energy Code: Massachusetts Energy Code Location: Centerville(Barnstable),Massachusetts ; Construction Type: 1 or 2 Family,Detached Heating Type: other(Non-Electric Resistance) Glazing Area Percentage: 8% Heating Degree Days: 6137 Construction Site: Owner/Agent: Designer/Contractor: 130 Fuller Rd. Joe Powers Centerville,MA 02632 130 Fuller Rd. Centerville,MA 02632 nit�'�...t"�" �`' ��`"�;�-r� �� "4ky =�,4'r 'a�� .1.`y�„#'�kk� '�- • - � •... •�- �b z-:�� , �h� ,�`�, t�'�; .Kit 1`��,; �`�,,.�.�' ,.�� k,. " r...^_;,'��.rs a A+ .e, • � z•',. r Ceiling 1:Flat Ceiling or Scissor Truss: 100 30.0 0.0 4 Wall 1:Wood Frame,16"o.c.: 240 .15.0 0.0 17 Window 1:Vinyl Frame:Double Pane with Low-E: -20 0.320 6 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space:. 100 30.0 0.0 3 Furnace 1:Forced Hot Air.78 AFUE , Compliance Statement:Statement of Compliance:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 3.7 Release 1 b and to comply with the mandatory requirements listed in the REScheck Inspection ChecIdist.The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code.The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Company Name Date New Bathroom Addition Pagel of 4 H REScheck Software Version 3.7 Release 1 b Inspection Checklist Date:06/29/07 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-15.0 cavity insulation Comments: Windows: ❑ Window 1:Vinyl Frame:Double Pane with Low-E,U-factor.0.320 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Floors: ❑ Floor 1:All-Wood JoistlTruss:Over Unconditioned Space,R-30.0 cavity insulation Comments: Heating and Cooling Equipment: - ❑ Furnace 1:Forced Hot Air.78 AFUE or higher Make and Model Number: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. ❑ When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1• Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 Us)air movement from the the conditioned space to the ceiling cavity.The lighting fixture shall have been tested at 75 PA or 1.57 Ibs/ft2 pressure difference and shall be labeled. Vapor Retarder: ❑ Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment must be identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ❑ Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. - f Duct Insulation: ❑ Ducts shall be insulated per Table J4.4.7.1. Duct Construction: ❑ All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions.Mesh tape may be omitted where gaps are less than 1/8 inch.Duct tape is not permitted. ❑ The HVAC system must provide a means for balancing air and"water systems. New Bathroom Addition _ Page 2 of 4 w Temperature Controls: ' ❑.Thermostats are required for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: ❑ Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: ❑ All heated swimming pools must have an on/off heater switch and require a cover unless over 20%of the heating energy is from non-lepletable sources.Pool pumps require a time dock. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. New Bathroom Addition Page 3 of 4 v Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in Inches by Pipe Sizes Non-Circulating Runouts Circulating Mains and Runouts Heated Water Temperature("F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" .170-180 0.5 1.0 1.5 2.0" ` 140-160 0.5 0.5 .1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2:Minimum Insulation Thickness for HVAC Pipes Insulation Thickness in Inches by Pipe Sizes Fluid Temp. Piping System Types Range("F) 2"Runouts_ 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low PressurelTemperature 201-250 1.0 1.5 1.5 2.0 ' Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD:(Building Department Use Only) a a - New Bathroom Addition Page 4 of 4 CB FND FU LLER ROAD N 45'43'30" E R=567 . 96 ' IP FND 69.39' 1 L=35 .00 ' w LOT 8CD _ 10,134 SF N o It 15.3' V) EXISTING LOT 9 HOUSE EXISTING FOUNDATION LOT 7 O ppd,rWr t 16.3' Z SEPTIC TANK INFI TRATORS p W o O C C6 00 HE � 69.39' 28.82' S 45'43'30" W S 47'29'30" W LOT 30 LOT 31 NOTES: 1. HOUSE No. 130 FULLER ROAD 2. ASSESSORS No. MAP 189 PARCEL 125 I CERTIFY TH�T THE STRUCTURES ARELOCATED OW OT 8 S SHOWN. 3. ZONING DISTRICT: RD-1 4. FLOOD ZONE: ZONE C ' 5. PARCEL 125 IS IN THE AQUIFER PROTECTION OVERLAY DISTRICT. PROF SSIONAL/ AND SURVEYOR 6. EXISTING BUILDING LOT COVERAGE 17.0% /Z OS DATE: BISS + NOTE: SEPTIC SYSTEM WAS DRAWN N aF Mq D E S I G N FROM INSTALLERS SKETCH. SS�c t s� LAND SURVEYING JACKS ON LAN ENGINEERING CERTIFIED PLOT PLAN O,a2&5 LANDSCAPE ARCHITECTURE NO,32053 � PREPARED FOR s JOE POWERS ��5 BSS Design, Incorporated 130 FULLER ROAD Katherine > Bates Rd Falmouth CENTERVILLE, MASSACHUSETTS Falmouth Massachusetts 02540 .508.540.8805 FAX 508.548.8313 scole dote drawn job number dwg number 1 = 20 APRIL 29, 2005 EJP 5021 P11-17A C1DRAWINGSIP0WERSIlot8.dwg,CPP,4/2912005 2:49:27 PM YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street;Hyannis, MA 02601 (Town Hall) DATE: s�ggi Fill in please:. II � l f ' h O wr,• ,, ' x APPLICANT'S YOUR NAME: £ BUSINESS YO R HOME A DRES /3 cr C n ei � v � en fit; Vy1 G P/A 0 bl ) �1 TF EPHONE # Home Telephone Number NAME OF NEW BUSINESS c -15 TY OFBUSINESS: •ln� �� /�% tl IS THIS HOME OCCUPATION?. . YES NO ; Have you been given approval fro_ the bu}�d' g.division YES, NO ADDRESS OF BUSINESS u II Cr UJ r cri c�v >�r OD MAP/PARCEL NUMB R When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. . You MUST. GO JO Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to le6`alIV-6 a ate your business in this town. 1. BUILDING CO' SIO R'S OFFIC ��. This individu I,.ha b infer d o y permit require at pertain to this type of business. IV R UST COMPLY WITH HOME OCCUPATION LES AND REGULATIONS..Authpr d ure** C MPLY MAY RESULT NFI FAILURE TO COMMEN 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: . 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: Town of Barnstable - +E Regulatory Services P ~es Thomas F.Geiler,Director Building Division WAS Tom Perry,Building Commissioner v639- MOPED Mp'(�10 200 Main-Street, Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: a Permit#: cmi 7 HOME OCCUPATION REGISTRATION Date: s I U} r�r � wG r5 Name: 1 n J"a .Phone#: y , /� e ` Address: ) 3 0 f r u �/t � 0`� d Village: GG)17-Cr•J i Name of Business: 0 �''c 5 . �mC e Type of Business: �/o m M to it t 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 residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more-than 400-square feet o€space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by.such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. 4 • 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. x • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home'Occupation who is not a permanent resident of the: dwelling unit I,the undersigned, a read and agre 'th the above restrictions for my home occupation I am regisie ' g. Applicant cw Dater Homeoc.doc Rev.5130103 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,7Map /�_�I Parcel Permit# 9 2 Lo C) Health Division DO_ god- 3 3� / � / Date Issued �`� �� `J Conservation Division / r S, 3 /0� Application Fee d ®© Tax Collector A .A A1 Permit Fee to,5 . 4 (� Treasurer Planning Dept. EYJ=NG SEPTIC SYSTEM Date Definitive Plan Approved by Planning Board .r...� nO/FOWROOMs Historic-OKH Preservation/Hyannis Project Street Address 130 rU I(e..-C )02d car-i�Ve I t , M to czl(03 a Village ��,�� ,�_ Owner.�Cs? l q �`N L( c 11 Address 7�qzefy e IYYI Telephone 1 -X) '7'^7 Permit Request Uci root 1 ®n(?- r Qr Square feet: 1st floor: existing 00 proposed c 04 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay 71 Project Valuation . 14-0126, POO Construction Type c�_d cy,i c.Y-\ Lot Size 104139 ZS Grandfathered: ❑Yes R<oo If yes, attach supporting documentation. Dwelling Type: Single Family tH Two Family O Multi-Family(#units) Age of Existing Structure _3q cA'w • 'Historic House: ❑Yes �o On Old King's Highway: O Yes dNo Basement Type: ®'Full O Crawl ❑Walkout' O 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 t,5 new First Floor Room Count Heat Type and Fuel: M Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing C;� New Existing wood/coal stove: O Yes I&No Detached garage:0 existing ❑new size Pool:O existing ❑new size Barn:O existing D new size Attached garage:❑existing Yew sizelq',1`3�) Shed:O existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes * o . If yes,site plan review# Current Use Proposed Use ` *: BUILDER INFORMATION Name O t/n C Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE �Utl �`— DATE 3 � 0 S 4 FOR OFFICIAL USE ONLY { y. PERMIT NO. j DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION Y — PL 2— Ca S C;YL FRAME O 1\ I I INSULATION a—U FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH co FINAL Q GAS: ROUGH A FINAL FINAL BUILDING 0 1to N r ti DATE CLOSED OUT m 0 ASSOCIATION PLAN NO. -, F 730 CMR Appalls J Table J3=6(eonduued) Prescriptive Packages for Oaeand Two-Famlfy Residential Buildings Hated with Fossil Fuels MAXIMUM MINIMUM Wall Floor Basaaeat Hearing/Cooling (1lariag Glaring Ceil'mg 4 wau ZEUC ta Equipment Efficiency' Area'(%a) U-value= R-value' Revalue R-vatue� R•value6 t Package 5701 to 6500 Heating Degree Days' Now Q 12a/a 0.40 38 13 19 10 6 6 Normal R 12% 0.52 30 19 19 10 6 85 AFUE S l2a/a 0.50 38 13 19 l0 N/A Normal T 15% 036 38 13 25 N0 6 Normal U '15% 0.46 38 19 19 10 N/A 85 AFUE �/ 15% 0.44 38 13 25 N/A 6 85 AFUE. W 15% 0.52 30 19 19 10 N/A Normal X 19% 032 38 13 25 N/A rm N/A Noal Y 18% 0.42 38 19 25 N/A 90 AFUE l9% 0.42 38 13 19 10 6 2: 90 AFUE AA 18% 0.50 30 19 19 IQ 6 1. ADDRESS OF PROPERTY: Q 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE ALL GL AZING:G 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS. ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J 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. '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. 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-frariie or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 6 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 &: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 p g equipment piece of heating a ui ment 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: 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 do ors in the building envelope a must have a U-value no greater than 0.35. Door U-values must be tested with the NFRC test procedure or taken from the door U-value and documented by the manufacturer in accordance in Table J1.5.3b. If a door cont ains glass and an aggregate U value rating for tha t door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulationp P levels the component complies if the area-weighted average R-value is greater than or equal to components comply if the area-weighted average U- - ue requirement for that component. Glazing or door p y � the R val q P value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 r c The Commonwealth of Massachusetts = Department of Industrial Accidents _ Mce eflNMt POM 600 grashin,ion Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit��General Busin es address g n O 6 l7 O /' o zi : hone ci work site location fu address: 0 Retail❑Restaurant l3arilEating Establishment I am a sole proprietor and have no one Business Type; []Ofrce[]Sales(including Real Estate,Autos etc,) worldng in any capacity. I am an em to er with em to ees(full& art tine. [ Other kern' compensation IN for employees working on this job. I am an employer providing wsu , ;, , •,,1, {I: ,: :fir• +% ,. .1. tCM r•f'+:.`Y.�;�1.: .t r"' •t :+' '. rT 1 i�,:. •5,,:••1,Y 'a i�.•'�.'•_,;: • c0m en neme7 �rl•}: . , 'V':.?t'":°' ;i ! ',d:, Ft r~ y.j,: '`tt ,.?.'t"'•f'r„ ' t ."', ,.a'=L. 'r•}l '•�• •',�:+:.,'f•,.th�,., r ,.,f ja?; •$.. +A,6. +.,. •r"•y. S` ev city 7 Mv address° ~',r r•.,• , . ; .`.'., „„• •, ';i. ,. ,, , "; `: ' .�s:ri.• t. bone#•:, . rinsiiraace.co! i . / // /VA / , J = etor and have hired the independent contractors listed below who have the following workers' I am a sole propri olices: ;....... coin ens ation P '.., J:.: ;,� �'•a's" }�''•' 338m ,, `sn� :�ram: '�•' -•r .'• r� :,Sy., COm aII e: faS. ..t•, �, .i rl• c, !• _"::.. :" ,•,::.,,C:. ` One Citv:.' ,•,�' .,.,•r',. ':� .{:'1 `I?"' 't^},,' . ' r•� :•�•J� 'tl., '''' ��:,i•�i}• 't''t'+�% r'r •`" ' e:� ,'•,�',• , '�^: r�'r•�r;;i, i` .•i75;tr:}r:; +•J' .,, ://// / / /// •. S' _ insu3 ance co. . . .';• r=/ / / / /// / /// l ,/a� ,a. '% �'4•= .. r:}':,,dl= ,'�' :� n ,iY i•{'. .},. .r •p'::{'�,t• Y:t'' .t.: ;•,,,,. j..• '"r•'• , •�� l;.: :i.:�;'.: r?~,`,: ~i•'1•• •`�..t' .rl t'.e ,• •r ^IJ•'yr.•, cam'ar 'us3rte �' - aadress7 - e y w rt• {' j='i i� r 't., 3• ,'•_ •hoe#•. t,•, to 5.1,500.00 and/or. Fallure to secure coverage as required under Section f ro1mMGI5TOP wOR1C 0 ERpand a fine of E100.00es d y e;aia?�me�Y nndnfand,that� one years'imprisonment as well a,cfded to the in copy of this statement may be fareyarded to the Office of Investlgatiom of the DIAfor coverage ve}iffcatiaa• . I do hereby ceH' nd a sins a d s o perjury that the fnjred 'ormatian provided above is 3 e �r Date Signature Phone# print name 1 � - official we only do not write in this area to be completed by city or town afficial permitllicease ❑BatldiagDepartment .. city ortawa: �I,icensing Board ❑Selectmen's Ofrice ❑check if Jmediate response Is required C]HealthDepartment , phone#1 ❑Other contactperson: (Tzvhed8eyL2003) r Information and Instructions Massachusetts General Paws chapter�152 section 25 requires an employers toprovide the service of anot�h under any ensati011 for theircont t employees. As quoted from the"law",an employee is defined as every person of hire,express or ivaplied, 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 appur�cnant thereto shall not because of such cmploymentbe deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance dr 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 liance with the insurance requirements of this chapter have been presented to the contracting acceptable evidence of comp authority. VA 11I 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 subrrutted to the Departrhent of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit The affidavit shouldbe 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 obtaiu a wo-rkers'compensation policy,please call the Depamimeut at the number listedbelow. 00101 City or Towns _ Pleasebe sure.that the affidavit is complete and printed legibly. The Departmentlas 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... the perrrit/license number which will be used as a reference number. The affidavits maybe returned to be sure to fill in the Departrr e by Malt or FAX unless other aiiarig'errients havebeenmade. The office of Investigations would b-ke to thank y'ou in.advance for you cooperation and should you have any questions, please do not hesitate to give us a call. 1// % /////%'�////�////, MINE�i// % % /��/ ///// TheDepartrneat's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents M 81 In esUgOons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 f OFVE ro Town of Barnstable Regulatory Services '* BAMSPABLE, Thomas F.Geiler,Director nsass. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME LVIPROVEMENT 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: 4J J' n ^ Estimated Cost �1 � p[ Address of Work: lI //c 5 . 1�. vr� Owner's Name: J J c�Se Date of Application: 3 el I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law ❑Job Under$1,000 �lding not owner-occupied .Puwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERNIIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAD4 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. lM� 0� Date Owner's Name Q:forms:homeaffidav 4 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 �,-2,0,q square feet x$96/4q,foot= x.0041= 21 plus frombelow(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) �� x. '� square feet $32/sq.ft.=f�� 0041=y y_ 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= (Aixnber) Deck x$30.00= (number) Fireplace/Chlmney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 4V (plus above if applicable) permit Fee 5 y 9 Projcost Rev:063004 DF1NE Tn,_� Town of Barnstable Regulatory Services . ;- STABLE,' am , .___ . .... r__ .Thas�F.Geiler,Director MASS. _ 0 .� Building Division; s 39• ♦ _ Tom Perry;Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us -Office: 508-862-4038 - _ _ -,. _- =--: _Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: a5 JOB LOCATIiON: 30 number street tvillage «HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip codev The current exemption for"homeowners"was extended to include owner-occuRied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that.he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum ins ection p cedures and requirements and that he/she will comply with said procedures and requ' e Z07 V ` Si ure of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt BelSE- BC CALC®2003 DESIGN REPORT - US Tuesday, March 15,2005 14:12 Single 1 3/4" x 11 7/8" VERSA-LAM® 3100 SP File Name: J Powers 130 Fuller Road.BCC: RB01 Job Name: Joseph Powers Description: STRUCTURAL RIDGE Address: 130 Fuller Road Specifier: City,State,Zip:Centerville, MA Designer: Joe Madera Customer: Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: �0 12 Standard Load-'30 psf 115 psf Tributary 08-06-00 Ak BO B1 1530 Ibs LL 1530 Ibs LL 800 Ibs DL 800 Ibs DL Total Horizontal Length-12-00-00 General Data Load Summar y Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 12-00-00 Live 30 psf 08-06-00 115% Member Type: Roof Beam Dead 15 psf 08-06-00 90% Number of Spans: 1 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 6990 ft-Ibs 57.1% 115% 2 1 -Internal Slope: 0/12 Neg. Moment 0 ft-Ibs n/a 100% Tributary: 08-06-00 End Shear 1946 Ibs 42.1% 115% 2 1 -Left Total Load Defl. U388(0.371") 46.4% 2 1 Live Load Defl. U591 (0.244") 40.6% 2 1 Live Load: 30 psf Max Defl. 0.371" 37.1% 2 1 Dead Load: 15 psf Notes Partition Load: 0 psf Design meets Code minimum(U180)Total load deflection criteria. Duration: 115 Design meets Code minimum(U240)Live load deflection criteria. Disclosure Design meets arbitrary(1")Maximum load deflection criteria. Minimum bearing length for BO is 1-5/8". The completeness and accuracy of Minimum bearing length for B1 is 1-5/8". the input must be verified by anyone Member Slope=0,consider drainage. who would rely on the output as Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing evidence of suitability for a particular application. The output above is based upon building code-accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with the current Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions,please call (800)232-0788 before beginning product installation. BC CALC®, BC FRAMER®, BCI®, BC RIM BOARDTm, BC OSB RIM BOARDTm, BOISE GLULAMT"' VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, VERSA-STRAND-, VERSA-STUD®,ALLJOIST®and AJSTM are trademarks of Boise Cascade Corporation. Page 1 of 1 BQ-�SE" BC CALC®2003 DESIGN REPORT - US Tuesday, March 15,2005 14:12 Double 1 3/4" x 9 1/2" VERSA-LAM® 3100 SP File Name: J Powers 130 Fuller Road.BCC: RB02 Job�Name: Joseph Powers Description: BEAM SUPPORTING PORCH ROOF Address: 130 Fuller Road Specifier: City,State,Zip:Centerville, MA Designer: Joe Madera Customer: Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: �0 12 Standard Load-30 psf 1 15 psf Tributary 03-06-00 of ",�7G" � b � Qrii � a sr ,3�l ssy,,.r� f,,.� /�, .w�:✓r.rir«i.w o3„ .,9,, ..c ,✓ AL BO B1 630 Ibs LL 630 Ibs LL 371 Ibs DL 371 Ibs DL Total Horizontal Length-12-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 12-00-00 Live 30 psf 03-06-00 115% Member Type: Roof Beam Dead 15 psf 03-06-00 90% Number of Spans: 1 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 3003 ft-Ibs 18.7% 115% 2 1 -Internal Slope: 0/12 Neg. Moment 0 ft-Ibs n/a 100% Tributary: 03-06-00 End Shear 869 Ibs 11.8% 115% 2 1 -Left Total Load Defl. U925(0.156") 19.5% 2 1 Live Load Defl. U1470(0.098") 16.3% 2 1 Live Load: 30 psf Max Defl. 0.156" 15.6% 2 1 Dead Load: 15 psf Notes Partition Load: 0 psf Design meets Code minimum(U180)Total load deflection criteria. Duration: 115 Design meets Code minimum(U240)Live load deflection criteria. Disclosure Design meets arbitrary(1")Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". The completeness and accuracy of Minimum bearing length for 131 is 1-1/2". the input must be verified by anyone Member Slope=0,consider drainage. who would rely on the output as Entered/Displayed Horizontal Span Length(s)=Clear Span+112 min.end bearing+1/2 intermediate bearing evidence of suitability for a particular application. The output Connection Diagram above is based upon building code-accepted design properties Consult project design professional of record or BOISE technical representative for connection design and analysis methods. Installation Member has no side loads. of BOISE engineered wood Connectors are: 16d Sinker Nails products must be in accordance with the current Installation Guide a=2„ d and the applicable building codes. b=3„ b� To obtain an Installation Guide or if = /4" a you have any questions, please call c d=2-3-312" T • • (800)232-0788 before beginning product installation. C /\ BC CALC®, BC FRAMER®, BCI®, j BC RIM BOARD rm, BC OSB RIM BOARD- BOISE GLULAMT"' • • � VERSA-LAM®,VERSA-RIME), VERSA-RIM PLUS®, VERSA-STRAND TM, VERSA-STUD®,ALLJOISTO and AJSTm are trademarks of Boise Cascade Corporation. Page 1 of 1 c 1 1 Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoftware Version 3.5 Release le Data filename: C:\Program Files\Check\REScheck\#2384 Joe Powers.rck PROJECT TITLE: New Custom Addition CITY: Centerville(Barnstable) STATE:Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE: Other(Non-Electric Resistance) DATE: 03/07/05 DATE OF PLANS: 12-27-05 PROJECT DESCRIPTION: Joe Powers 130 Fuller Rd. Centerville,Ma. 02632 DESIGNER/CONTRACTOR: Joe Powers 130 Fuller Rd Centerville,Ma. 02632 PROJECT NOTES: Ma. Check by Cape Cod Insulation COMPLIANCE: Passes Maximum UA=67 Your Home UA=66 1.5%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 144 38.0 0.0 4 Ceiling 2: Cathedral Ceiling(no attic) 60 30.0 0.0 2 Skylight 1: Wood Frame:Double Pane with Low-E 15 0.360 5 Wall 1: Wood Frame, 16" o.c. 342 15.0 0.0 19 Window 1: Wood Frame:Double Pane with Low=E 10 0.340 1 Door 1: Solid 20 0.320 6 Door 2: Glass 60 0.340 20 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 200 30.0 0.0 7 Furnace 1: Forced Hot Air, 92 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications, .and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts t Energy Code requirements in REScheckVersion 3.5 Release le (formerly MECchecl and to comply with the mandatory requirements listed in the REScheckInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1.310 and AA Builder/Designer Date REScheck Inspection Checklist Massachusetts Energy Code REScheckSoftware Version 3.5 Release le DATE: 03/07/05 PROJECT TITLE: New Custom Addition Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling l:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation Comments: [ ] I 2. Ceiling 2: Cathedral Ceiling(no attic),R-30.0 cavity insulation Comments: I Above-Grade Walls: [ ] I 1. Wall 1: Wood Frame, 16"'o.c.,R-15.0 cavity insulation Comments: Windows: [ ] I 1. Window 1: Wood Frame:Double Pane with Low-E,U-factor: 0.340 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? [ ] Yes [ ]No Comments: I Skylights: [ ] I 1. Skylight 1: Wood Frame-.Double Pane with Low-E,U-factor: 0.360 For skylights without labeled U-factors,describe features: #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: n , Doors: [ ] I 1. Door 1: Solid,U-factor: 0.320 Comments: [ ] I 2. Door 2: Glass,U-factor: 0.340 Comments: I Floors: [ ] I 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] I 1. Furnace 1:Forced Hot Air, 92 AFUE or higher Make and Model Number Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations'between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor r Retarder: [ ] Required on the warm-in-winter side of all non-.vented'framed ceilings,walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined., [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ) Insulation R-values, glazing U-factors, and heating equipment efficiency must be clearly,marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints,seams, and connections of supply and return ductwork located outside " conditioned space,including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's in instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] J The HVAC system must provide a means for balancing air and water systems: Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A'manual'`or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.' Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1.310 and J4.4. Circulating Hot Water Systems: ; [ ] Insulate circulating hot water pipes to the levels in Table l.. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy,is from non-depletable sources. Pool pumps require a time clock.- Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. -: Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1" Up to 125" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0..5 Lo 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts V and Less 1.25" to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1:0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) _U r { A�:. . CB FND FU LLER ROAD N 45'43'30 E R=567. 96 ' IP FND 69.39' L=35.00' LOT 8 w 0 10,134 SF O I �t 6 PROPOSED PORCH 15.3' PROPOSED N ADDITION EXISTING LOT 9 HOUSE GARAGE LOT 7 DECK 43.5' TO BE REMOVED SEPTIC TANK o C11 INFILTRATORS p W p O O Co 00 rn SHE M 69.39' 28.82' ' S 45'43'30" IN S 47'29'30" W LOT 3.0 . LOT 31 NOTES: 1. HOUSE No. 130 FULLER: ROAD _ r 2. ASSESSORS No. MAP 189 PARCEL 125 1 CERTIFY THAT THE STRUCTURES ARE LOCATED ON T 8 AS SHOWN. 3. ZONING DISTRICT: RD-1 �---- . 4. FLOOD ZONE: ZONE C 5. PARCEL 125 IS IN THE 'AQUIFER PROTECTION P Es 1oNAL LA sU YOR OVERLAY DISTRICT. 6. EXISTING BUILDING LOT COVERAGE 13.07 7. PROPOSED BUILDING LOT COVERAGE 17.17 DATE- I 05 pasta of R L . BSS NOTE: SEPTIC SYSTEM WAS.DRAWN; �''P.' � a .y D E S I G N FROM INSTALLERS SKETCH. off' LAND SURVEYING BUadf CIVIL ENGINEERING CERTIFIED PLOT PLAN �o No LANDSCAPE ARCHITECTURE pry PREPARED FOR � C L JOE POWERS AND BSS Design, lncorporated 130 FULLER ROAD 164 Katharine Lee Bates Rd Falmouth Massachusetts 02540 CENTERVILLE, MASSACHUSETTS 508.540.8805 FAX 508.548.8313 REVISION: MOVED ADDITION 03/10/05 EJP scale 1„ 20' date MARCH 4, 2005 drawn ...EJP job number 5021 dwg number P11-17 TOWN OF BARNSTABLE Building Department - Foundation Permit Date3-/r- p Permit # P `� 420- Name-j . 7po toe r- -s LocationJ3 U Gi � �sor Mc—I Ca.&J-r- Insp. of Bldgs. Town of Barnstable *Permit# (9 3 Expires 6 mont s om is date 319V SM NS :10 NMOJ Regulatory Services Fee (J SON �nd Thomas F.Geiler,Director Building Division li 3d S 3Hd-X Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address K fit,r �� CLn j-r-1 'residential Value of Work y�l 000.0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 'To S��dj �q/- (� d w 5 3 0 �u �(e! ��c Gan7Z/Jc f IC �orSS. Contractor's Name 3o Cp h - wC� Telephone Number sG /� "/0�� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑Yam a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. . Permit Request(check box) [�Re-roof(stripping old shingles) All construction debris will be taken to Sra t�`C T/plxS rC/ STai do ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum..44) *Where regvired: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ome Improve ent Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 Town of Barnstable *Permit# 3 3-18t/1SN2N13 :4O NMOl Expires 6 mont s om isL45 date Regulatory Services Fee 0(� SOOZ z 9 nd Thomas F.Geiler,Director Building Division JL' 3d S3MdsX Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number_/ 9!�_l Property Address �h I�C r �Ln�l;,AJ t �� / !CS 5_ Lg4esidential Value of Work d Od.0 y Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �To S L Q h In/. few" S Contractor's Name o t✓e Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ am a sole proprietor am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �at'n f r'a b/C Tt�ttS 1 c I STgi.do ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side . ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ome Improve ent Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations 600 Washington Street y: Boston,MA 02111 �•' www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apf licant Information Please Print Legibly Na]Ile (Business/Organization/Individual): Address: 13:0 Fw Ile � City/State/Zip: L r,n 7c iQ► • � Phone#: Are you an employer? Check the-appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6• ❑New construction employees (full'and/or part-time).* have hired the sub-contractors. 2.El am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition [No orkers' comp. insurance 5• El,we are a corporation and its quired.] officers have exercised their 10.❑ Electrical repairs or.additions 3. I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.-[No workers' comp. C. 152,§1(4),and we have no _ 12.❑ Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] .3.[:] Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `• t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractws that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. - Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,500•.00 and/or one-year imprisonment, as well as,civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der he pains nd penalties of perjury that the information provided �ove js true and correct: Si afore: � Date: Phone#: Official use only. Do not write in this area,to be completed by city_or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. � Pursuant to this statute, an employee is defined as ...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as `.` du al,.:p�epbp,:association,Forporation 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 ciation or other legal entity, employing employees. Howev.,er:tlie receiver or trustee of an individual,partnership,asso �. 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 woikvn.such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,MGL chapter 152, §25C(7)states `Neither the commonwealth nor any 6f its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit of 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' the number listed below.. Self-insured companies shouhd enter their compensation policy,please call the Department at self-insurance license number on the appropriate lime. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for:future permits or licenses..Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit: The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number. The Commonwealth of Massachusetts . Department of Industrial.Accidents �, a office of Investigations 600 Washington StreetM . Boston,MA 02.111: Tel. #617-727-4900 ext 406 or-1-.877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia �I THE TOWN OF BARNSTABLE 339WSTAILE. 1639- a M BUILDIRG MSPECTOR .APPLICATION FOR PERMIT TO ......................................................................................................... TYPE OF CONSTRUCTION ... ............ Co ................19.7.1. TO THE.INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...4?.... Proposed Use ....... ........................ . ........ IL ...................................................................................................................... Zoning District ............. ........................................Fire-.'District .... ...... . ................................. '00 Name of Owner .. .. ....... ... .... .... . ...... . ...... . .....Address .. .. ... V Nameof Builder, ...........................................Address .............. ........ ................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...... ...................................................Foundation ........................ Exterior ....... ......... ...................................................Roofing ......... . ..................................................................... Floors � / 14. ......................................t.......................................Interior ................ ................................................................. Heating .......... .I........................................ Plumbing PJA .... ...... .. ............................................................. Fireplace ......... ........................................................................Approximatf- Cost ... ....................................9--IN....... Difinitive Plan Approved by Planning Board --------------------------------19-------- - 0 5-0 Diagram of Lot and Building with Dimensions ............................... U) _4 z 2 Nm 0 LL �g V) U) U I-- om LU< U) L0 A, LAI W1-- U eP� Uj < 60 rvq-�I� 60 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg�6 i g Vthe above construction. Namem e j.. e,40....... ...... .... ........ . ............................................ Coughlin, Joseph F. } DEC 3 11971 14060 one story No ................. Permit for .................................... c single family dwelling .................................................................. Fu Locationl ........... ......11er Road ............................................... Centerville .............................. ............................................. I Owner ..........Joseph. ...F, Coughlin... .......... .......... ............................. Type of Construction frame ................................................................................ Plot ........... ........ . Lot .... ............ July 16 71 " Permit Granted ..................................:.....19 Date of Inspection I-.. Date Completed ......................................19 PERMIT REFUSED ; 19 ............................................................................... r ................................................................................ ) .........................................................................:..... ............................................................................... s f Approved ................................................ 19 ............................................................................... ............................................................................... C8 FND FULLER ROAD lo)�) N 45'43'30" E R=567. 96 ' IP FND 69.39' L=35.00' w LOT 8 o 10,134 SF � 0 `r 0 0 o � 15.3' EXISTING L 0 T 9 HOUSE EXISTING FOUNDATION LOT 7 16.3' z -01 SEPTIC TANK 0 C INFILTRATORS p C4 o 0 0 o6 r> O rn HE � 69.39' 28.82' S 45'43'30" W S 47'29'30" W LOT . 30 LOT 31 NOTES: 1. HOUSE No. 130 FULLER ROAD I CERTIFY THIj THE STRUCTURES ARE 2. ASSESSORS No. MAP 189 PARCEL 125 LOCATED 0 Z8S;S:HOWN.3. ZONING DISTRICT: RD-1 4. FLOOD ZONE: ZONE C 5. PARCEL 125 IS IN THE AQUIFER PROTECTION OVERLAY DISTRICT. PROF SSIONAL AND SURVEYOR 6. EXISTING BUILDING LOT COVERAGE 17.0% DATE. BSS NOTE: SEPTIC SYSTEM WAS D �RA N OF M D E S I G N FROM INSTALLERS SKETCH. Q� v LAND SURVEYING ((y'roy JAC' ON y CIVIL ENGINEERING CERTIFIED PLOT PLAN BUNKER W85 LANDSCAPE ARCHITECTURE NO,32ffb3 � PREPARED FOR s JOE POWERS ��+� BSS Design, Incorporated 130 FULLER ROAD Katharine Lee Hates Rd Falmouth CENTERVILLE, MASSACHUSETTS Falmouth Massachusetts 02540 508.540.8805 FAX 508.548.8313 scale 1„ _ 209 dote APRIL 29, 2005 drown EJP job number 5021 dwg number P11-17A C:\DRAWINGS\P0WERSMot8.dwg,CPP.412912005 2:49:27 PM 7:!' •�` \ .1e�.e `Do ICJ -J` Q T .. ITL �, ..r Lt-FIT u L.E:FT �e t,yA-n o wl FeOAIT E/,EVATIOoJ r POWC-w-T +Z>DI710N PLAa.IS . 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