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0177 FULLER ROAD
_ - � . � :� j . . . ., . . , _ _ � ^ � � � 5 F ... � . � o � . . .. ° �� i ,. _ _ - .. `� - _. o 5 � o _ L� . �. .. s .. a ,. .. ... .: ,, L r _ ... _ � � 4 0 y .. c .. G n _ .: .. � a .. -. ,rs _. � „ l .... ,. - A .. � r, ,gyp _ -. - ,. 9 V�,� .5-�� fl F BARNSTABLE = 'CAPE C® +q INSUCATION - FISII OLASS SIAM LISS SPRAT FOAM 3USPINDI0 "+ YATTS OUITIRS INSULATION C/ILINOS - °`` 1-800-696-6611 V I'S'0 Town of Barnstable Regulatory Services Building Division L 200 Main St Hyannis, MA 02601, Y ' Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed'& completed the insulation and weatherization work at the property,listed below. Cape Cod Insulation did this in accordance to,the specifications listed on the building permit, application.'All work has been inspected by a certified Building Performance Institute (BPI)inspector. All work preformed'meets'or exceeds Federal & State Requirements. Property Owner `P Property Address Village /�lo�`, /-77 41Cjrz`/k ,Ri0 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (X) (22 ) Slopes. ) ) ( ) ( ) ( ) Floors WallsntC 'tier 6VOr k /�?,errorrtto/ ki y i . 'Sincerely 2eHryE ssi r, President Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel LJ Application # ST�Health Division Date Issued c C -3 S' Conservation Division Application Fee Planning. Dept. Permit Fee on O Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 177 j7�v/olee Village G'et4nea Owner Address Telephone cSVY Y_71, Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d Construction Type XaJW //1 ou�1Ae1 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Lilo On Old King's Highway: ❑Yes A(No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use -:APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��Ia Telephone Number Address kkv W,�,0Z �� License# �6f;, Home Improvement Contractor# IS-3 3 Email Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 SIGNATURE DATE ZY, R, FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s ' Masyachuseetts 1)6partmei'it.of,Pt.iblic:Safety :.:Board of Building Regulations and Standards Construction Supervisor License; CS=100988 HENRY E CASSTD , 8 SHED_ ROW { WEST YARMOLPrH ✓, aritii Expiration Commissioner 11111/2015 x Office of Consumer Affairs and'Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 1 211 5/2 0 1 6 TO 259188, CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE Y SO. YARMOUTH, MA 02664 'Update Address and return card.Mark reason for change. sca t5 zoM•osn� ❑ Address Renewal Employment �� Lost Card V/ee i0oa�r�rrza4zcve�rGC�a�C�/ �ulOcrc�culeG`/i 49"\ Office.of Consumer Affairs&Business Regulation: License.or registration valid for individul use only OME IMPROVEMENT CONTRACTOR' before the expiration date. If found return to: . egistration: 153567 Type: Office of Consumer Affairs and Business Regulation ;y xpiration 127;15/20.16 Private Corporation 10 Park Plaza-, Suite 5170 Boston,MA 02116 CAPE COD INSULATION,INC HENRY CASSIDY 18 REARDON CIRCLE'`,. '`:-_..- SO.YARMOUTH, MA 02664 Undersecretar Y `N valjwiut'sign e Tke Commonwealth of Massachusetts Department of Industrial Accidents Off ce of Investigations - �, ; 60.O.Washington Street 'Boston, NIA 02111 .www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers, Applicant Information Please Print Lellibly Name (Business/Organization/Individual): (_ %Z � ' ' a �, t! r>�✓' Address: ,� ,��' �s City/State/Zip:�_� :�a't� �, 1' .a 1 l� _ Phone #: 15� lam' i� ' • . Are you an employer. Check th-e-appropriate box: Type of project(required): I am a employer with 4, l am a genera contractor an ❑ New con l conttd I -_ • 1. � 6-. struction - I employees(full and/or part-time), have hired the sub-contractors ; 2.❑ I am a sole proprietor'or partner- listed on the attached sheet, .7. �0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, employees and have workers' insurance. 9. ❑ Building addition [No workers comp.comp. insurance p ; required.] 5. ❑ We`ar6 dcorporation and its 10.❑ Electrical repairs.or additions officers have exercised their ' 3.❑ I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers';comp, right of exemption per MGL 12.[] Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Other ..comp° insurance required.] *Any applicant that checks box 91 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 Ithen hire out contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.-.Below is the policy and job site information. Insurance Com P y an Name: 711 � i �'^ f �? . VW Policy# or Self-ins. Lic" #: Expiration Date: Job Site Address: City/State/Zip:,�2 �Q 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 one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a.fine of up to$250.00 a day against the violator. Be advised.that_a copy of this statement may be forwarded to the Office of investigations of the DIA for insurand coverage verification. I do hereby certify d the par an penalties of perjury that the information provided above is true and correct. b Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): LBoard of Health 2..Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: CAPECOD-27 BDELAWRENCE ' AICORO� - DA7�E, MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 015 THIS CERTIFICATE IS ISSUED AS A MATTER'OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER'THE COVERAGE AFFORDED'BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT, CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAx 434 Rte 134 A/c No.Ex : A/C No):(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER($)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company.see LIBERTY MUTUAL INSURED INSURER B:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc. INSURER C: 18 Reardon Circle INSURER D South Yarmouth,MA 02664 INSURER E INSURER F: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLI BR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIIYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE,�OCCUR Y CBP8263063 04/01I2015 04/01/2016 PREMISES Ea occurrence $' . 100,000 MED EXP(Any one person) $ - 5,000 w PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES,PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT a LOC s 'PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY - - _ COMBINED SINGLE LIMIT $ - - Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY.DAMAGE HIRED AUTOS AUTOS - Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ - RED RETENTION$ $ WORKERS COMPENSATION SPER OTH- AND EMPLOYERS'LIABILITY Y/N TATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE a WCE00431901 06/3012015 06/30120.16 OFFICER/MEMBER EXCLUDED? NIA A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS-below E.L.DISEASE•POLICY LIMIT $ 1,000,000 { DESCRIPTION of OPERATIONS I LOCATIONS I VEHICLES�(l�CORD 101,Addltlonal Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY,PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014'ACORD CORPORATION. All rights reserved:. ACORD 25(2014101) The ACORD name and logo are.registered,marks of ACORD f - v { - - a y •�1t+t/q F 4. mass saw PAIIIIflCtPAl1NG Spew PERMIT AUTHORIZATION.,FORM, , w I, PAMELA MORRILL ,owner of the property located at: (Owners Name,printed) 177 Fuller Rd CENTERVILLE (Property Street Address) (City) hereby authorize the Mass Save Home.Energy Services Program assigned Participating Contractor listed- below to act on my behalf and obtain_a building permit to perform insulation and/or weatherization work on my property. - X I-A A.e owners Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the,above referenced project: Participating Contractor Date For office Use only Rev.12132011 — _-------- � • _.— i - -� - - N 4. r of Tom. Town.of Barnstable i Lt Expires 6 raanths ����e9 Regulatory Services Fee =ARNSi•A UX- s� MASS' Richard V.Scali,Director 16;q. QED MP'1 A . Building Division . 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 10, Not Valid without Red X-Press Imprint Map/parcel Number Property Address . 1* L er f MCidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Q d4 crr- �� V t ��� 5 U FL Contractor's Name Telephone Number Q Home Improvement Contractor License#(if applicable) �^ 4 .Email: 5 �( Q U I L41 Construction Supervisor's License#(if applicable) C � `� ❑Workman's Compensation Insurance ® OERIAIT Check-o e: �am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name ^trO!dlBN OF R®RNPa Workman's Comp.Policy# a Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) r�/ ❑ Re-side enlacement Windows/4e> VAAifA s.U-Value . (maximum.35)#of windows #of doors: . ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&eonstruction.Supervisors License is Lreired. SIGNATURE: 17:�Z Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 1 t Revised 061313 � � � � � �� � � 4d � � � ` . � � � �� � � y � �� � - � � � : " . - - . y � - \i +; �J t _ �� . ; ��� �� . } .� f , y ar,« - !' ,j _. i -' . - .� �. � � :��, �. '6 � 7� . �� � .. � +4 _� 5 �� � ��:: `� ; ;. � _ E �' - i �,�, s The Gmm arzved&of—Vassuchmelys rA --- - ice a�'� sfigrxtiarrs ' 600 WashingtowLWeet Bas&g,MA 0211.1 wa*minasngorfdia Workers' Compensafioxx Insumuce Affidavit Butilders/C-outrac#nrsMecfriciaus/Plvmbers AA rpl ,wt Iufitrma on / Please Print,DillyName Name($rrsineB.sftmiz&on&&vidnal)_ L Address Crtyftatx fop: 6 l Phone# Are you an employer?Check the appropriate bos:- of •o"ect r _.ram. -�-�. � �_.. 4. I arrr a_ ctmfiracfor and I.... _. I..❑ I am a employer-with � . . tS_ ❑New employees{full andlarpart- me)*' h��eh red the sir acttxs -7_Tam a sole proprietor or partner, listed on the attached sheep. 7_ doling skip and have no employees These mb-contracturs have 8_ Demoliticm ,v forme in an ci employees andhave workers', �� y� � _ 9- ❑Building addition [No workers'comp:insura„re comp_msuranml required-] 5-❑ We are a corporation audits 10_C]Electrical repairs or additions 3_❑ I am a homeouTler doing all work officers hays exercised their 1 LD Plumbing repairs or additions myself[No,workers'comp- right of cimmption per MGL 120 Roof repairs irL�xanr�req-airedt]I c.152,§1(4} and wehavena employees_[Na workers' 13_❑Other comp-inm ance required.] '_`4ay app t1at cheds boa-1 trmst slso fill out the sestina below sbnuing rhea wodwe compensgiioa�POHJ-y t¢a l Samearwners vrh o submit this affid mbm a tEew affidnit inVnft�F3 Mrh =C�t�cina that check this boat mmt sttache�sn additionA sheet shonmg the nae of file sa€s c sc s=d ststg whather Dent thaw Mtffimhave anpkyees_ If the snlrcontiactm hare empIvgees,they Est provide their warless'camp.pQlfi atmiher I am azz emplapea that is prmiditig nvrke_rs campeamtion it uwargcg for my empLayee-% Eelnt>'is thepoHi7 iwd}ob site izzfnrttzahmrr. Insurance CompanyName: poesy#or Self ir<s Lim ` FxpiretionI1ate: Job Site Addiess: Cit0stawZip: Attach a cepy of the workers'compensaGm policy declaration page(showing the policy number and expiration date). Failure to secure cm-exage asreg6redunder Section;25A ofMGL c. 152 can Lead to the imposition of crimi ai pemslties of a fine up to$1,50D-(i4 andior one-yearimprisonment,as well as civil pew in the fbm of a SWOP WORK ORDER-and a fine ofup.to$250-00 a day against the violator_ Be advised that a copy of this staternent maybe-forwarded to the Office of hn estigations of the DIES far insurance.coverage veiffitation_ I do hare4t cadify74. the pruMs ad :: o. urp thatfhe inforrrztckan prmrzdad abaue' ugzmdcanwct SiEmature: Bate_ ✓EWEdal u s$only. 10-not wMe in this arere,to be carnp&ed by city or town of SciaL City or Town- PermitUcense# Issuing Autharrtg(circle one): L Board of Health 2.$u1`iiing Department I CitFlrown Cleric 4_Electrical Fnspector -5.Pfumbi rgw TTspec tar 6.Other Corst9ct 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 mployee 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 shO withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the conirnonwealth.for any applicant w'ho has not produced acceptable evidence of compliance with-the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neitbtr, he commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public vlork°until acceptable evidence of compliance with the insurance requirements of Ibis chapter have been presented to.the contracting authority." Applicants — Please fill out the workers'compensation affidavit completely,by checlrizrg 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 ceri ficafe(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. Sell insured companies should enter their self-tncttr ce license number on the appropriate at. 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/licease number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address-"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit.must be filled out each year.Where a home owner or.ciEzen is obtaining a license or permit not related to any business or commercial venture (i.t.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 Conrmonw-ealth of Massachusetts ` Depattmeat cif Industdal.Accidenfs ' �}�t�e of Tuvesfi �an,� 6QfI C�ashu>, an Street D-nston,IAA 02111 D. A 617 727-49QG W 406 or I-& MAS F Revised 4-24-07 Fax# 617-727-7-149 W .mass gavIdia of racy ` * BAxxsrasEZ « Town of Barnstable AlFD ML�y p Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790 6230 Property Owner Must Complete and Sign This Section If Using A Builder I, P0VVV'1'J0__ Y7 ' ns Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date TO_ry x 0,01- OV rt'-O Print Name If Property Owner is applying'for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit formslEXPRESS.doc Revised 061313 Town of Barnstable ` Regulatory Services YHE r°ty,L Richard V.ScaIi,Director Building Division * saxxsTnsr.& Tom Perry,Building Commissioner MASS. 200 Main Street, Hyannis,MA 02601 ATEO �p www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village :'HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityltown 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. DEFINFFION 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 Budding Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a persou(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revised 061313 _ - - - . ........ �e�ozrvr�aoazcuea�o��/�oac�u�eGY- i Office of Consumer Affairs&'Busioews egulation License or registration valid for individul use only OME';IMPROVEMENT CONTRACQ4; before the expiration date. If found return to: egistratieia 132691 :. Type: Office of Consumer Affairs and Business Regulation xpiration:; 3/23/20157, Individuiil 10 Park Plaza-Suite 5170 ® r i Boston,MA 02116' $lrQTT QUILTER SC,OTT QUILTER 4! L 3r 24� STRAWBERRY HILL R4 CENTERVILLE;:-MA.02632 uudersecreta rY II Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-078000 Yx Ub o,. SCOTT H QUILT PO BOX 727 West HyannisporE. V 2 Expiration Commissioner 02/03/2016 l oFTME�,,ti Town of Barnstable *Permit# � �.� Expires 6 months from issue date sntwsTnBte, Regulatory Services Fee � � v $ Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ` Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not[valid without Red X-Press Imprint Map/parcel Number i ��-►� Property Address In 1:0 if iL Leo 010iA" M 6,�&37ii Q Residential Value of Work Y'y31� Owner's Name&Address parm la. mow i 11 Contractor's Name JPA 1'[' , Q ul LT�3� Telephone NumberT��� 77/-M Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable).4.1 ❑Workman's.Compensation Insurance Che k one: 'PRESS PERMIT [v�'I am a sole proprietor ❑' I am the Homeowner S E P 0 4 2002 ❑ I have Worker's Compensation Insurance Insurance Company Name ,TOWN OF BARNSTABLE � Workman's Comp.Policy# Permit Reque (check box) Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going aver existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature QTorms:expmtrg Revised121901 1 ,. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ap Map Parcel Permit# - *D Health Division (J � Date Issued �' Conservation Division �' /3l Fee 120 Tax Collector 0,5/3110 i u� Treasure dol `"t "7iC 3Y S1 EM MUST EE Planning Dept. INN uALLED IN COMPLIAN WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AN Historic-OKH - Preservation/Hyannis TOWN REGULATIONS Project Street Wress /,),? V61Q49 Village Owner R2& Address t Fa Telephone '— Permit Request A)ezj.-) Square f, 1st floor: existing proposed 2nd floor: existing proposed Total new �— Valuatio ( � Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. DwellingType: Single Family re/ Two Family ❑ Multi-Family #units Yp 9 YY Y( ) / Age of Existing Structure��� Historic House: ❑Yes o On Old King's Highway: ❑Yes ZQO Basement Type: 1'Fu11 ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing�� new Total Room Count(not including baths): existingj"' _ new First Floor Room Count Heat Type and Fuel: , Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ®No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn: ❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing Cl new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name i, CAD (Dr i t i r Telephone Number �� O Address / License# d +Jl') Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY ' PERMIT NO. DATE ISSUED , Y MAP/PARCEL NO. r ADDRESS _ .< _.._ r VILLAGE K4 OWNER DATE OF INSPECTION: g67-2 f FOUNDATION FRAME ! INSULATION - FIREPLACE { ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL 1 t = ` GAS: ROUGH FINAL j' FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. ; P,pF I14EE Ip The Town of Barnstable BARNSTABLE. Department of Health Safety and Environmental Services 7 MASS. 0 1639. �0 prF�MP'�a, Building Division 367 Main Street,Hyannis, MA 02601 Office.. 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: �kb 1 L2-� ��- Map/Parcel: Project Address: ( 4--�- J R-A Builder: The following items were noted on reviewing: U) N� V1, C, c� QS -Q i CC— Reviewed by: Date: 3 q:building:forms:review \Z N. i oo syi�Lp S 9 1, �0 co G AI 3 w' P 2o,0= S.F 'E f 2'S W IDTH 4 r2 y P� S� N V / 29674 � �Pl�SUMED P�aT'Ecn oN uN Deb hRncr-E TII, 4i cH+tP►fie 7a, Ei- ,"62A,•,O FPA7"Ea Q�STE� pQ` G n ND SUR��'y CERTIFIED PLOT PLAN Lc=T 3 NEW CONSTRUCTION ONLY = c .rr��►LLE' TOP OF FOUNDATION IS 4.8 FEET IN ABOVE LOW POINT OF ADJACENT ROAD. SCALE: I"=3c' DATE: c��12�82 LDREDGE- ENGINEERING COIN CLIENT MAAA',.i I CERTIFY THAT THE FOUNDA--nc*j EGISTERED REGISTERED 0118Co SHOWN ON THIS PLAN IS LOCATED CIVIL I LAND JOB NO. ON THE GROUND AS INDICATED AND ,,e,�. CONFORMS TO THE LENGINEER SURVEYOR DR.BY, nr - 712 MAIN QT�''^ . The Town of Barnstable • Wwsr"M • Regulatory Services Thomas F. Geiler, Director. Building Division Elbert Ulshoeffer, Building Commissioner - 367 Main Street,Hyannis MA 02601 _ r Office: 508-862-4038' . Fax:l 508-790-6230 Permit no. i 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 contrac rs,with certain exceptions,along with other requirements. Type of Work: , Estimated.Cost Address of Work: Owner's Name:. Ifyi Date of Application: a '� I hereby certify that: \Registration is not required for the following reason(s): []Work excluded by law 0Job 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 ere apply f r a permit as the agent of the wner. Date C ntractor Name Registration No. OR Date Owner's Name q:fomis:Affidav is / / �(J T ISBN O / . 11 1. 11�. •• 1i1 /.1. /111 1 / .. 11 • -- - NEW.i1flu.its 111/ 1 • . 1 • . 1_ 1 ., �1 Y. 111•�11 '✓.11 111 . 11 ' .1111. . ' . /.. 1_ 1 I 1 .1 vl 11 1 � 11 1 1 ■ 1 1 1 1 - 1 11 I I 1 ■ .111 . . /. Ii ' -11 1406/ 1 wood, 1 11 w 1 1 / .11 / 1 1 �1 1 Y/ 1 / . �• / . ' 1 1 1 • MEZ MENEM= xXI 1 . / • 1 '. /. M Y/1111/�11 wl/ 111 •• Yw 1 11 1 1 1 11 1 1 V 1 • tiA I 1 1 1 1 1 I I I 11 i17A- 1 1/ li 1 1 1 of: 1/1use only do not write in this area to be completed by city or town♦ /� l�Ji' � �a �i / 0. offldd dty or town: pemdwceme# �[3BWMJng Department OLAcensing Board . response OSelectmezes • 11 E3Heslth Department contact person: phone ■ • ";:-:. :Inn • • • �• • •n/ • 1 i • i • ' •n�• :1 •.I •e • / ' • 1 • • ' Ir• ' i VA • • • • • �• a: -• 1 • n .1.1 -. r ee • • / / err. - • �il/1•: • �, • / ' -• :In • • • • - •• .a 1 • �1111• • •�1 •11 • •fops1 b 111 ..• 1 M' •11 Iq 1«• •11 • • 1 • •. •11 • • 6 oil 1 • le • • • /.1• 11 /.• /• 1 Ia 1 fete•_-. • 1 t �•1111 • 11.•/1 4 r • t• $TAP.11 �•.e/1• • .r _ _ 1 1 1 1 • 1 1 1 1 • / / 1 1 1 1 1 1 .1 1 1 1 Y 1 1 ... 1 1 1 1 • I r 1 111 1 1 1 •1 • 1 1 1 1 1 1 1 1 ' 1 / 1 I I / I • 1 • : 1 1 1 1 '1 11 1 1 I 11 II 1 r' 1 ' 1 e 1 • 1• •11 I 1�•1••./ • •11111e•11 • m;, 1 I 1 •1 •11 • 01 IA ►e 1/ r+ 1 ••1 1 Y •IILTI1P IIVs .146111/• .11 • r•1II•r.1.14go1 1 m:1 • 1/k 61 • #I ir • ••. / .1• Y. • • w/ •1 r•1tt1• .11 r • (/, I1 1/ 11 .••• _• III .•11..I I1 •) /t MI.1• 1.• 1 1_.1• r �•.=1.1 �•• • It •111• .1 111 rl•1 • 1 1 1 •. • :/. 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I � I I 11 ill 2s, I I I - -- -' f 9{ '-I __i_.1---I-- _ Lj- - .� - -f.- .............. +* * APPLICATION TOWN OF BARNSTABLE BUILDING PERMIT Map Parcel */ �/ Permit# Health Division �L"�9��` � `3�� Date Issued Conservation Division Feed Tax Collector• - 0 SEPTIC SYSTEM MUST BE Treasurer(ad: INSTALLED INCOMPLIANCE WITH TITLE 5 Planning Dept. ENVIPONI UfTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN 13E(nULAI°ON a Historic-OKH Preservation/Hyannis Project Street Address Fiv ix, 'Village Owner z9-4q o4lu L,L Address f° f7- 7- Fu Lee Ra Telephone '7 / S/ — �?3-5 Permit Request Copt L)ep—/- /0,C)o ->i r , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost b00•ba Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure / � `�nS Historic House: ❑Yes 2No On Old King's Highway: ❑Yes Ell No Basement Type`. a Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: full:existing, new.. Half:existing new Pumber of Bedrooms: existing new Total Room Count(not including baths): existing new " -First Floor Room Count Heat Type and Fuel: ®Gas ❑Oil, ❑Electric ❑Other r `✓p PK Central Air: ❑Yes U.No -Fireplaces: Existing / New i Existing wood/coal stove:, ❑Yes No Detached garage:❑existing ❑,new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:• ' 3 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No •If•yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name t�-�1 � v ENoSI/ Telephone Number 5� Address 1 Q_ pee_l� -7-0,�q A/52 License# 00 9 6 3 S C4A.reXt)tIk �'1� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / 7 3 FOR OFFICIAL USE ONLY z^ _ ' PERMIT NO. -.DATE ISSUED MAP/PARCEL NO. ' ADDRESS - VILLAGE i e • - $ .. • _ der. t , , OWNER _ t . K4 ,r k t ' I t k ,. - - - sti r• t f f _ )�, rH.,. ,. •� r4 _ { � f ' , �e DATE OF INSPECTION: FOUNDATION~ Y ► , r ) `. _ FRAME INSULATION FIREPLACE � - , � ,M � +• � } .. f , ELECTRICAL: ROUGH; - FINAL > r a. r , PLUMBING: ROUGH 's: P' FINAL s GAS: ROUGH, rri r FINAL FINAL BUILDING t. . DATE CLOSED OUT ` ASSOCIATION PLAN NO. r ) I z r The Commonwealth of Massachusetts + _:� Department of Industrial Accidents =- Office offorestfoatfons 600 Washington Street J+� Boston Mass. 02111 Woriters''Com,p nsation Insurance Affidavit name: location: 1 / 7 /f UL�,�•� /�-� city C`P—k"�(G l'C- /41A 01 (0 2j-lz_ phone# ❑ I am a homeowner performing all work myself. CK I am a sole proprietor and have no one workin in any ca acity ZZ ❑ lam an employer providing workers' compensation for my employees working on this job. camnnnv name address: city: phone#• insurance cn. nlicv# ❑ 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: companv name: address: city phone#: :....,.... .. msarnnce co. :.•: .....:..:. olity#.. ........ ..:.. ;:._ :;;.,:;:•;:.::.;;:;:,::z•::>::>;>«:_:. G///G/// //O///1////G�' camnanv name: address: city: phone k Insurance co. : :::.. :....'. olicv# xx //00/%//////////O/% Failure to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a line up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK 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 ve incation. 1 do hereby cc if under the pains d penalti of perjury that the information provided above is tru,-and co fed 1 �� �. Signature ,Q ` � Date <pt G _ Print name 1L!L� � 6, fw osk/ Phone# 5 ���-6- official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (mvaea 9l95 PJA) Information and Instructions V. 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 contr-,::, 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 c: trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imlestleatlons . 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 wlgj ' Tab1eJSLIb(CmUWued) ;J Pram rdn PaaaW for One and Two-Fsu*RNW=dd Iluddlnp Rested with Fossil FoWs MAXIMUM MINIMUM Glaaag ahzing Ceiling Wail Floor &a m= Slab Ressifi8ic=lIng Armr(%) U-value= R va1ie R value' tGvalue' Wall Aimwr Effae pin �� Brvalner 5"1 to 6300 Headati Degree Days' Q 12% 0.40 3E 13 - 19 10 6 Normal R 12% 0M 30 19 19 10 6 Normal S 129A 0.s0 38 13 19 10 6 IS AFUE T 15% 0.36 3E 13 ZS WA WA Normal U 1S•iG 0.46 3E 19 19 10 6 Normal V 1r�•.'b 0.44 3E 13 2S WA WA M AFUE W 15% 0M 30 19 19 10 6 ES AFUE Xr,13% lE•/. 0.32 3E 13 2f WA WA Normal Y19% 0.42 3E 19 2S WA WA Normal t19% 0.42 3E 13 19 10 6 90 AFUE M 030 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY. - 77 wl-e2 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: b b 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. I BUILDING INSPECTOR APP O AL: YES: NO: q-forms-t980303a Footnotes to Table J5.11b: ' 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 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table JI.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R values do not assume a raised or oversized truss construction If the insulation achieves the full insulation thickness-over the exterior walls without compression, R 30 insulation may be substituted for R 38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and,interior drywall.For example,an R I9'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-firame or mass(concrete,masonry,log)wait constructions,but do not apply to metal-frame construction: 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade wails. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements-are for unheated slabs.Add an additional R 2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a ROTES: 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 strucunzi components. b)Opaque doors in the building envelope must have a U-value no greater than 035. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.53b. 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,wail,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 - � tie i�am�nzaruuea� o�.��aaaaclzuretl� DEPARTMENT OF PUBLIC SAFETY CONSTRKHON''SUPERVISOR LICENSE I Nup er. " Expires: i Restr-�c�ed� 00 RICHAND -,SENOSKI �,tr10 PEEP TOAD RD CENTERVILLE, MA 02632 .c.•7i-,�.�.:�.,�n-P+'�,R-....-.y�,�...' �..��c...rw.rc,..r+_n_r..'Tnr...w,r,.-- ,r err . :- iµb S Yr i3i+e-• � rltFf t' J6..Ev r L s :kV` r zA 1 roQ,' y�a 4ti,en.i.k av ^�ct f•' �}. k+. ax'�€ Y� "�'id -...�. I•�d' `� T.1:�MGM 1 4 � �':µ� `. _ FAli. �'/e o�.�f!QaaQafuaeQa .giHOME IMPROVEMENT CONTRACTOR " aRegistrat On .Woo9 ` ',Type =INDVIUUAL' axFzpiration 47/21/00 . } RICHARD T:SENOSKI ; -1p , P�� ;10 Peep Toad�Rd.: ,. " erV111e MA 0202JA— Y f ADMINISTRATOR �Spnkx'He m VE . . �; The Town of Barnstable • L+axsrABU, • '1 Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. 0 00 Type of Work: �'' 0 L Estimated Cost Address of Work: Owner's Name: hx- M Dek t G. L Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED i 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 ape it as the agen of the owner`: r- Date Contractor Name Registration No. OR Date Owner's Name q:fbnns:Affidav flay Q(Jni el) r}fib � A.n NS v IXI I-N) o� to W3'� t 1 /O OWL TO Cl �lit - r., w , RemD " rti 1` ` u w , LLLs.Te-? Az UX4La . I .. .. ... .. ..__._._-...._- L kea it Li She SIP s lep �15 k P""'fl `0 �q�-n �Ns�G�re4 • - 0 � o 10 1�e� r� °� l • ,� 5 .40 D° 4JA c AIL0.`e- J JDgV _ Remy • I �5ra t � �, ,,,,►W iADDITIONS OR ALTERATIONS If located: rJ North of Route 6 - any work visible from outside-needs approval from OKH In Hyannis -If work visible from outside -Check to see if it's included in the Hyannis Historic Waterfront District if so it needs approval from them APPLICATION PACKAGE MUST INCLUDE: Map/parcel number Sign-offs from Health [� Conservation(if exterior work) Tax Collector Treasurer Street address Owner's name&address Permit request-full description of proposed project F1 Square footage-proposed project Estimated project cost Complete Dwelling information for Assessor's Office Builder's information Signature Plot plan [� 2 sets of reduced (8.5"x 11: or 8.5"x 14'� plans with cross section&qraming schedule Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name & Worker's Comp policy number Energy Compliance Form Copy of Construction Supervisor's License & Home Improvement Specialist's License OR Homeowner's License Exemption Form. Fee NOTES: CEDINEYS Need Home Improvement License No plot plan required PIERS & DOCKS C]Need Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMrrS 1 Rev 8/12198 r- TOWN OF BARNSTABLE Permit No. .._ ----- Building Inspector "MMITAX cash '639. "'Y�` OCCUPANCY PERMIT Bond --------- Issued to Lltl-k Address j �u r11' zF{ 1 7 i;1ID r,. Pf"1 d. (7r,"tf—Ir4 I I n Wiring Inspector Inspection date Plumbing Inspector Ift ' \. .!� Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 19.. -%�r ... '�-T Building Inspector .. rk • N o co Q� N R tic. oo . . A ov p� zl=:4jE=- 2b- . PV P tN OF 20,030 s.F'"F i 25 'w t DTH4 oZ �•� J F'S.B. ; 30' " 29871 '�Atsumeb PVkmB=n=w uwDEQ A-1> 6"RI, �i CFihDTSQ � �—� "EaQA+-J D PPr'T'ttE-Q k �O�BTti�h0 CERTIFIED PLOT PLAN LdT -3 FU NEW CONSTRUCTION ONLY : TOP OF FOUNDATION IS 4.8 FEET IN ABOVE LOW. -POINT OF ADJACENT - `�` . .i1� ��J:�'����, .�. • ROAD. SCALE: I"=3e� DATE: cs��12�8'1- E LOREDGE ENGINEERING CO.IN CLIENT ' I CERTIFY THAT THE Fau►.iDf47�c�J EGISTERED REGISTERED ®I18� SHOWN ON THIS PLAN IS LOCATED CIVIL I LAND JOB NO. ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR DR.BY= J'e�' CONFORMS TO THE ZONING LAWS OF BARNSTABL , M S., � AS 712 MAIN STREET CH.By: e'B'c' C�3•t2.82 _ H YA N R I S, MASS. SHEET!OF I DATE LAND SURVEYOR ,# ,/M Assessor's map-and -lot number ..... ...................... r.THE .......... Sewage Permit number ......T ... ... ............... MUST SEPTIC SYSTEM IN COMPLIAN 13AWST"LE, House number ........ 7..................................... ................ INSTAWED WIMAea TH TITLE 5 1639- AL COEDEE WN , OF B A R. X,'EYD 0 t m S BUILDING ' 11SPECTOR -1. APPLICATION FOR PERMIT TO ....Bo.- ........0.19A ..................................................... TYPE OF CONSTRUCTION ................. ........6A.P:1,1...............*......................................................... ;!.0..........1.6................iqlf. • A TO THE INSPECTOR OF BUILDINGS: -The undersigned hereby applies for a permit according to the following, information: 7- Location ........... ............. ......4........ .. ...IA.................. AJ X,Proposed Use ....... .........1A.-V.........rAl-t ........................................I......................... 0 5�-t' U I Zoning District ......... ......................................Fi�e District ...............................................r........... ................ Rd AaA) 32-50 OQ64A� 5/vo - AP - 5-007 a ar --5.Address...N,.....V61.A_4..-.Ai. ....... .3. .me of Owner ............... 1.... AleA.Ck...... ..1. -j-i fe-_�611L F-4,+1_1._,-,�y 1.Name of Builder J11(.j"C.kAX1........ .............Address .........M.A .............. . Nameof Architect ................................. ...........Address .................................................... ............................... • Number of Rooms ............... ........................ .......................Foundation Exierior ................ ..........................................,..Roofing ............6.%PLAY...L*01......................................... Floors .............C.n.k. ..........................................Interior .......9.k.�.......W.A.1.1.......................................... Heating .... .............. ............. .................................Plumbing .................... ............................. .. . .. ......................... Fireplace ...................Y . ......... ............................Approximate'Cost . . . .. .... ... ........ ....... Definitive Plan Approved by Planning Board --------------------------------- Area ............. with Dimensions Diagram of Lot and Building Vy Fee e................................. 'SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the -above construction. Name ......fk.L. 4j. ..... . . ............... 1A 23896 Two Story .... Permit for .................................... Single, Family Dwelling.............. Location Lot #3 177 Fuller Rd(. i�Centervillle i F. ... .. f;. .... .. Owner Michael Mahan ` ► v-� ^1 '� ♦ . _y !'y y.'r ij� �+^"�' Sri! _ 1( � U .tii�R %ice Cy Type-, Construction Frame c -1 ......... ................................ ............................. -' x Plot-............................ Lot ..........:..................... Permit Granted March 23, 82 . — ` ..... .....09 ..... + . Date of Inspection ........ .... 19 ' ri r Date Completed f :� 1-9 i t � I Fa r t C.� N '> �ILL` 0,� zur� £NTxy 40 _ S 40 r + i- *+�w ""' .} 1 ♦ 4 4 tj LS.,