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Home My WebLink About0295 GREEN DUNES DRIVE o 1 4 c te `f 7 _ / y 000.000, MA 4e* 4loL a �r•n �� O WTI � D✓►tE� �h�1!'C WAS{- �� anniLre►� 1 /10 DMAf so III Vx &I M . } 1 viJ vbiAEl '02AI I tri aeti Assessor's map` and lot number .. .. DFTNETp Q� �y Sewage Permit number /'l??:• . � � row ��h:ry G% • Z BHB A9TADLE, i z Q House number ... .5 raas psi 1639. \e� NOX is TOWN OF BARN'STABLE RUILDIHG IASPECTOR : . : .... . ....................::: APPLICATION..FOR PERMIT TO ..:...�".t�Y.►rs�.� ., .... � �a�I �Iac�Y�Lx. TYPE OF CONSTRUCTION ...............W..P� !.....c�.�lalr+ ........... ,................................................................... ..........................19.. l� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...5;a-4Z.ear..l.... [ ..........(j.... - ..�,.. . 4 ......... � .. 5� ................................... Proposed Use ...'4 17....................... .................Fire District ......0.-.Q..:Zoning District ...::........:. ......................:.................................. � .... .- : �v c�Name of Owner .....�,r1. . ...................Address .y. Name of Builder ..../ - 44....... :.Cc . .Address ... ........ 77� Name of Architect ...Address ...... ................................. Number of Rooms .......... ......................................................Foundation ....l.A........��urte� ..............................:............ Exlerior ....... k... ,2i ....................................Roofing ...... ........................................................ Floorstj Interior ......... Heating .....� �e�....................:........................................Plumbing .........:.:.................. Fireplace ...3- ..........................................................Approximate Cost !•••••••............................................. Definitive Plan Approved by Planning Board ________________________________19________. Area ....-3 9 S �r ............................ Diagram of Lot and Building with Dimensions Fee ............. ............................. SUBJECT TO APPROVAL. OF BOARD OF HEALTH '7. 3� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam /�e�../ ....4....................- , CONWAY, PBILLIP ' V~23681 ADDITION No ---_-- Permit for .................................... Single Family Dwelling ------'�-~----..��------.-----. . Lot #5 295 Green Doz�eo Dr. Location ------.�------------'-.. ' C Phillip Conway � �vno, -.. --_�� --.��---------. � - - ' Frame Typeof Construction -.. .____. ___. ----------------------..---.. Plot ------..�--. Lot ................................. . Permit G,o m� Deoerube�� -- lg 81 n ---------..� -- ^ - � Date of |n~r~^^~` ��-�--- �--�--~lA Dote Completed ------� - q . . PERMIT REFUSED ____~_~______,_--..--�... lA .------....----.------..------. ~' ,S, -.-------..-.---.---------...�. ----..-.--.--..-.-.~-^.-~—~-.--.�- ----.----..~.-~.------_.-..---.~' ~ A. . ---------------- lg .. ^ ' - . . ^ ^ ................................... - ~ -------''.-'----.--..--.-....-:. ` ` ' Assessor's map and lot number .....�. '.`.. ,. .......�'� F , y TN E t0 Sewage Permit number ./...... ..A w:.a! !!.! � !�..:r� f''` ✓ r ;/ e�Q.. ♦� r! Z BABHSTADLE. i ( J' House n41 umber ....... ........................................... 9 Maoa 00,s,1639. 9� mxl TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... r�n'::.� ..,. #� , - � �v.i- � R . ......... . ............... . ..... TYPEOF CONSTRUCTION .............. �......;7;;� -!,tr?:,n.;< ................................................................................. ................................................< :. 19. 1.. TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following information: Location ... �....... ...:.,.... _ _w.......... .......... .......... Gl... �Sf ................................... ProposedUse .... _. .. ......................... ........................................................................................ ZoningDistrict ...............:..................................... .............Fire District ...... . ..........................:................................... Name of Owner .... ... -3 ... :..................Address .. ......�:..a : .......... Address Name of Builder � �, x»... .....`` ..�. _ i' L. �. �, ,r a.... :. .. �......... ......... , ri _^ Name of Architect -::... . .............................................Address ...... :.:.:...::....:.:;............................................................ Number of Rooms ..........1......................................................Foundation ....:!:.:.........!. .�..: .......................................................... Exierior ........... e:::... ..... . .......................................Roofing ) l' ! ................................................................ ....... Floors ��.,.."i� !''6jn.�.... T Interior .......r .:n Y .::- :... :'.. ............................... �1 , 6 Heating �" G' .^ .................................Plumbing .................................................................................... Fireplace ..l >x,x ............................................................Approximate Cost ..... .' ..... ................................................. ? Definitive Plan Approved by Planning Board ---------------------------------1.9________. Area ............................................ Diagram of Lot and Building with Dimensions Fee �-""`�...........r.... . i SUBJECT TO APPROVAL OF BOARD OF HEALTH . W �;�t to � t 1 • - .ti i--�J'.' Ci . �Y Jl /I !r -> I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................r ,, r •!,�. L z........................... CONWAY, PHILLIP � q No`:''3 Permit for .ADDITION ............... Single Family Dwelling ...... ..................... Location Lot #5, 295 ,j(1 Green ! Dunes Dr:, f r ni sport Owner ..Phillip Con WaX Type of Construction ... rame ............................ ......."-................................... : .. ... .. F Plot ............................ Lot ................................ fI December 3 81 Permit Granted ............ ..........................19 Date of Inspecti. n ........ ...........................19 Date Complete .......... ...........................19 ERMIT REFUSED ......... 19 .......................... . ................................................. 1,410.3 ................................................................... /�1. T.... ��4 .....l..-i- .z........... Approved .....:.......................................... 19 ............................................................................... ............................................................................... Assessor's m map and lot number ..�...... ........ ......... T14E Sewage Permit number ................... .r r: j , d�Q� o+► BARNSTME, i Housig nu,,4er ...... rasa i639 \0� �1'p YAY O.• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ��+ ..... +' �' �' TYPE OF CONSTRUCTION f*-.X! N4 ' --�— !.::................9..........19 '. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies.for a permit according to the following information: Location ..... ,�, .� ,• r . -.� ^a ......... .� ........ ................; .................: .y! .!�.I: ...yxr e°y, ProposedUse ......... ..... to re,, ... ... '; !!...................................................................................... Zoning District V. ` ................................................Fire District ...�r.fl,t.�;;.�,r„.I./{ t -fir ,a;if ............... Name of Owner. � � , -3 (' *,:r. ..........Address .. �,•:.:.. i:.:.:a.:....ti+ ¢ :.. 1,�.:?.....,:a:.�, !' .:M7�1 u ..... . . .�- ..... .. Name of Builder J! '. a... -:! ar.......Address ... Nameof Architect ....................'y/#......................................Address .....................!z ...................................................... Number of Rooms to^'f:........ . .........Foundation ...... .....+► 1-�c• t C Exterior ........ t-At�.0.A............................................................Roofing ..........d�1'. ? .., :.. ................................................ Floors .......r4 r rn-.a 4� .......................................................Interior .........AA.Y. ,A.!.I....................................................... Heating A-k- ,, .........:.Plumbing ' Fireplace .....................: /�;"'a..................................................Approximate Cost ......... �3, 3r? ....................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area ..�� ...................... Diagram of Lot and Building with Dimensions 0 Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH a A y Jz + I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ___._._._._._._.____.. _.__r ________err-'1..�..L`':.?'d.�..�,,:�.�.�;,t,r�;. _ .f`.�../�..w.__...__.� �_. �•! - ---- - - Name'.......... ........... ...................:...: ...................... Conway, Mr.. & Mr,. Ph/IW.Amelljing No ...;21179... Permit for ......a...... ; .............. `., r...........7......................................... # Location Q .Qr.Q.U..P.�ea..Roa .............. ... y 3...... C� h@rvI �1 ' - R �talztliSprar ................... r r Owner ...........Mr... A-Mra.. .P.hIllip...Conway Type of Construction ........ ............. Plot ....... Lot ................................ Permit'Granted .:.........Apri:1..1D.':..:...:19 79 Date,of. Inspection ...19 } 1` , Date Completed ..........;�..: .......19 . t \ PERMIT REFUSED ......... .........................................S..' ................... .................^.. . ............ " I , ........... .F............................................................ ........................................................'.................... Approved ..... .................... ...._....:...... 19 . .......... ................................................................... 4 ................ .................................................... r Assessor's-map and lot number e..... 0 '•'` �FTHEtO Sewage Permit number SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE = EaaasTAMLE, House nu0nber WITH ARTICLE I( STATE 90 rasa iI ......................................................................... 0 16 SANITARY CODE AND TOWNNIQ �oMnra�O TOWN OF BARlALE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..........AM. 4..... ...ska...P ............... TYPE OF CONSTRUCTION ................4?.Q.oc .........Fett Axn°........................................................................ .................7..........1917. TO THE INSPECTOR OF BUILDINGS: The 'undersigned hereby appliies"for a permit according to the following information: s Location ........ ..........lk:/W.V.A:i..�........1;. . ... .)......We......_/y0,-fV./.?.4. .Aox' . ... ..M.,.,A.................. Proposed Use .........G-Vf.C4.3.:Q,.....4.!!A.....(.am.e......9.o-rw-...................................................................................... ov Zoning District ........i!l.Q.....'.................................................Fire District ...... v'ervs��...:............... Name of Owner+..... ..... .I, .)(..........Address Name of Builder H S.fxm.�.4.....?�Nr.......Address ....4m?.4.16...kn. .....Mmtr..14cn..a... Nameof Architect ...................A�&....................................Address .....................1.'I��..-...................................................... Number of Rooms .........Cd.N.C........ . 1. ......... �� ,c �e 0 �-®�.iLg N' �. �..................... Foundation .............�.. ........ ...... . . ........................... Exlerior ........4AW. :VA............................................................Roofing ...........ds.P/arm ................................................ Floors ........ .......................................................Interior .........ofv3 -.A.1.1....................................................... g ....................................................Plumbing ............./.V/A.......................................................... Heating .................?4�� A Fireplace ......................1!'V��.................................................Approximate Cost ............. ....................................... Definitive Plan Approved by Planning Board -----------_-------------------19_______. ` rea Diagram of Lot and Building with Dimensions Fee .. ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH l ei S. 1 Ajo. �( j Sze I hereby agree to conform to all the Rules and Regulations of the Town of Barns able regarding the above construction. 92 Nam ................. /Conway, Mr, A Mro, Phillip A=245-29 21179 No Perm hfor � ��. ' - —' ................................................... ,Q^A' ` Location ............. , .......................... .x................. � Owner --Mr�—&..�r�,.. . _. Type ofConstruction .............ftsuoe.................. - � Plot Dj ...... . . .... ate of Inspec/ion ....................................19 ` . . � � Date Completed ' ' ' PERMIT_ REFUSE ' ' ^ . ----------- - . ............................ - � ......... '/ —'. ..'~.. ------' —.—.—.,--. ..r^—.-...--.—.--.—..'. . � ` ---~---' —'--^—'—'--'---~--^—'' � � Approved ................................................. lV - ^ ~ � -------.-----.----.-------.— ' -----------'-------^—^—^^'—~^^' ^ . � . FEE a0 TOWN OF BARNSTABLE, MASS. ' 19 9wQm U (D•� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO Ri (� o Q (PROPERTY OWNER) (ADDRESS) ewp a TO ...................................._........._...................................................._................ H v (BUILD) (ALTER) (REPAIR) d -� .............................. ...:�......................................................_................. _..._.-'-_ MO G (TYPE OF BUILDING) _ )APPROXIMATE SIZE) M �IJN oIN LOCATION .............._._......._..............._.............._.............................................._..._ ..._........................................................................_.........................._....._•---..�_...... S fU (STREET AND NUMBER) (VILLAGE) �� NAME OF BUILDER OR CONTRACTOR _ .....�...__._.........................._...._........................._............._...__....._._........___........._........._._....... _ _— a, APPROXIMATE COST _._. a) eom I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. a) o PD 0 0 aa0 h N h (OWNER) (CONTRACTOR) A0aq 03 o ukv O O k tV a _.....----........__.............__._......_............................_............................................................................. ABUILDING INSPECTOR Subject to Approval of Board of Health. 7 ar� e TOWN OF BARNSTABLE BULK RATE COUNCIL ON AGING U.S. POSTAGE PAID 198 SOUTH STREET NON-PROFIT ORG, HYANNIS, MA, 02601 PERMIT NO. 2 Z 95 UL- I 1 I Assessor's map, and lot 'number . ........ Sofia J 1' sE g Sewage Permit number ....:. ...... WITH A Tlv w ii SANITARY .COK AND ?M °fT"ET TOWN OF BARN-MTL E i BAWSTALLE, =°o 1639•iv. UUILDING INSPECTOR ` APPLICATION FOR PERMIT TO +!! ............ rarr. �� ?� .............................. . �TYPE OF CONSTRUCTION ..............................�........ .......• ....... (�..................................................................... .............................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �+ .Location ............................................................................ Proposedt Use ........ .,� /f?.....f> • �1�..... ...�;,; !.: ..................................................... Zoning District .............R.n /..............••..............................Fire District j ................. ............... Nome of Owner ........................Address 1. ...C!%+j..r..... .. ,.._......... Name of Builder .1.1-.'•.zelt •. ...................Address .h. ��J�/��1 ..�!!. �.�........�� r�J••��'.�O Name of Architect ! ......Address .... _ r•.!!• , /... ? .�E ........................... Number of Rooms �z �....................Foundation �� ................................ ............ /J S ExienoY ... a...............5 .... - r ...... Roofing (/ A Floors ............ ....,�4"_......................................Interior ................................................ f�.....�........................................... Heating �(........... /v ��...................................Plumbing .. L .,....... ..... �' • � � ,., LYirJ Fireplace ...:: .��!<r.....<...........................................................Approximate Cost ........7 ............. ......................................... Definitive Plan Approved by Planning Board -----------____---------------19________. Area '' .t''...........r ..... �' Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH J -41 o ry N I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �� Name .... �.1 �_✓........................ Phillip Conway ' ' No --1Z388 Permit for .. —� -- ��.----------- ---- \ � ' - � �� Location ....... ��..[h��A-------. --. ' - ----------------.'..........��---.. Owner ]�z�ll�� , —.. .'��`^va}"--''�--_---'' , . ^ Type ofConstruction —..��P6--------- ---��—.--------------------.. �' � Pko .�'��—'2g--- Lot ----------' ' t ' . ' . Permit Granted ......Octnbar---..16...l9 74 � " D6te',.oF ��^° ' � Dote Completed .... .....................�.... q ^ ~^ � PERMIT REFUSED -----_--.------------. 19 ` ^ ` . ~ � .---..---~..-----------------. . . , . ..��.--.--........—.--------^—.~.�—. , . ~ r� ' ` �.—..---'—.-----~.---.----.--.--.. - _ . ~ - - `---.---.-------------------.. ^ . . _--------------. l� Approved ~ � -------.------------------- ' ~ ^ ^ ' ^ . ................ ' ' ~ ^ . | 7 Assessor's map and lot number .... -J - ''' 0 Ar//n K `G Sewage Permit number .. �FTHErO�y TOWN OF BARNSTABLE BARNSTABLE, "6 .e0� BUILDING INSPECTOR o Maya, APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse ..............................................................::....,........................................................................................................ Zoning District 1 ......................Fire District .......... . ./........................ ................................................................. Nameof Owner ..............................................Address .......... ............................................................. Nameof Builder ....................................................................Address ....... C...............................................................c............ Nameof Architect ..................................................................Address ....................:............................................................... „l Number of Rooms ....,€ -' ..............Foundation Exterior ...:....::..:................:.:....:..:::.........................................Roofing .................................................................................... Floors ...................Interior Heating ..................................................................................Plumbing ...............................:.................................................. Fireplace .................................................................................Approximate Cost .................................................................. Definitive Plan Approved b Planning Board -------------------------- - ....i:4 o..........." pp Y 9 ------19-------- . Area ...: ...... (. Diagram of Lot and Building with Dimensions Fee ........ 00 _.............. SUBJECT TO APPROVAL OF BOARD OF HEALTH - J r� ----- -- 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....................................... . ....................................... Phillip Conway 173RO Dwell-inc, No .............. Permit for .................................... ...............zq 55.................. ......................... Location .......Cr.e pn...D.i.i.n e.s.....i�ct, ............................ .........................Cz.Yi.A-.e.r. . ftI2................... Owner ....�!!4!�P..C49AWay............................... Type of Construction .........Woo.d......................... ................................................................................ 245 29 Plot ............................ Lot ................................ October 16 74 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... gmee r) Map c T J Parcel QT9 cJ Permit# ..� t - g ` House#, o? -�� Date Issued 'Board of Health(3rd floor)(8:15 9:30/.1:00- v Fee Colt n Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) R `'_[' dpJi e;:='ar Planning Dept. (1st floor/School Admin. Bldg.) _' 4144 Definitive{Plan Approved by Planning Board u - =19 5 : , p NY i TOWN OF BARNSTABLE' � t "n a ra Building Permit Application Project Street Address Village s CC'/l Owner mn 40.")&&d, , Address 2 f 6 �.-,.e s, 0agg .S 0, -Telephone 7 10 Y rlo Permit Request &i ,e , A - C First Floor (' o�,00 � -- square feet Second Floor % 00 S square feet Construction Type Estimated Project Cost $ Z 0- ®Od Zoning District Q i Flood Plain Water Protection Lot,Sizc iA n k- ,tj jl Grandfathered ❑Yes p No Dwelling Type: Single Family R/ Two Family ❑ Multi-Family(#units) Age of Existing Structure c�,?O j,r ° - Historic House ❑Yes - 210 On Old King's Highway ❑Yes Basement Type: M/Full ❑Crawl ❑Walkouts ❑Other Basement Finished Area(sq.ft.) �) r}- r Basement Unfinished Area(sq.ft) 2Ar7 3F Number of Baths: Full: Existing New Half: Existing / New LT No.of Bedrooms: Existing 3 New 0 �r g Total Room Count(not including baths): Existing New 00• First Floor Room Count Heat Type and Fuel: M/Gas ❑Oil ❑Electric ❑Other Central Air f Yes ❑No Fireplaces: Existing It- New d Existing wood/coal stove ecs No Garage: ❑Detached(size) Other Detached Structures: fool(size) 2 oX4W E(Attached(size) 2 b 1)c24 ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# , Recorded❑ Commercial ❑Yes 2,14, If yes, site plan review# —' Current Use e 5; ,, .ems Proposed Use _,<Z ar-,- .,o— Builder Information Name r� ,�� Telephone Number 5'09 Z?-3af Address ,4_ Zia UAL License# 46bta4g ' Home Improvement Contractor# l 017 wo Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE c7-67— P BUILDING PERMIT DENIED FOR THE F OWING REAS (S) _ t 7 FOR OFFICIAL USE ONLY ,PERMIT NO. b 1 DA TE ISSUED- MAP PARCEL NO. - '� � ' n T• 'f _ 1 i# 's r,` y 21, 71 ADDRESS VILLAGEt�► OWNER ry 0.i DATE OF INSPECTION: FOUNDATION FRAME 1 3' ..��J / INSULATION, Y / FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH `r FINAL t FINAL+BUILDING /0-�`f3 � DATE CLOSED OUT ASSOCIATION PLAN NO. I , 1 The Town of Barnstable • RARMAJ= • 16 ,0�' Department of Health Safety and Environmental Services prED nna��' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. 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: Est. Costw C)ncs Address of Work: Owner's Name I f-,Sftv Date of Permit Application: 5"8 `q I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name The Comamttit'calth of.4fassachusctty Deptrrtnumt of Industrial Accid�»ts t OfficeORAVesliyaaffs �• _`3 . r 600 11 asbingmen Street Boston.Alas. 02111 Workers' Compensation Insurance Affidavit dli p •Itc�int informatitn•- Plc•tse 1'RINT'1:N _arne: Incntion• C�/-1.� c, (it". phone I am a homeowner performing all work myself. I am a sole proprietor and have no one work-in_in any capacity _. . -;----• -•---,•.�.A«,,.•......ter-;-.A-,.�..-•r._.•.,___ - —._-rs` `-•......•--.__-'-- [I I am an emplover providing work-ers* compensation for my emplovees working on this job. coviumov name: address• city- [!hone#• inciirrince en. Bolin.# I am a-- �%wpvolr bent ral contractor,or homeowner(circle one)and have hired the contractors listed below who hay e the fol ow compensation polices: �� t �••�, � •- 1(l(IrCSc� � (�� ly2af 1 citt•: M �e -�,� ,\I �l ` r ' Rhone#• —SC) Rv-4z) • �®^-I"1 incurnnrr rn. - 5�11_'! .L��.7 Oh • nniiev# l . t l — \® 1 a ma9 N )VUJ - _...__.... .__ .�_�/,-'[�....._. �.. tea./\-�....- --�•�p�•,)��i'�-_---- ..y•-_ - -- -_- - _-_ _ -_--_ - _-�,�i-" .�-_ CO rtlnant• nBrB P' 9'\��` v • ��aJ`� I rin•: \ ��,��. nhone injurnnee co. r 4� �1 7 `-� nolicv# y LR`,IW Attach additional sheet itnecessa_'ry - + --+ _ _ .,•. , ..,..�.: - ..•— -- Failure to secure coverage as required under Scction 25A of NIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.UU aadiur unc y cars•imprisonment as twcll as civil penalties in the form 0172 STOP«•ORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statenieut mai be forwarded to the Office of investigations of the DIA for coverage veriGeation.. !do benchr cerrlji a Bier r/re pair: pe ra!'• f-�erjun•Mat the information provided above is true and correct. Signature Date ^Q( Print name \ �� 1 �l Phone#y��, ' �� \ ) I'T .'•ofrcini use unly do not twritc in this area to be completed by city or town official �• city or town: permiLgicensc# r iBuitding Department Licensing Board F check if immediate response is required C3Seieetmen's Office f • �llcatth Ucpartment contact person: phone f!• nUther r.` Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the employees. As quoted from the -law-. an emplt ree is defined as every person in the service of anci[licr under anv 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►nor the foreuoing 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 th 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 ]to or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or . renewal ofa 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 i been presented to the contracting authority. ..... .. -,i..y-•.\.•..mot•,:.'... `L.. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cite 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 require,. to obtain a workers' compensation policy. please call the Department at the number listed below. . City or'l owns Please be sure that the affidavit is cotmplete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fi11 out in the event the Office of Investigations has to contact you regarding the applicant. Pie be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of investi=atioils would like to thank you in advance for you cooperation and should you have any question please do not hesitate to `wive us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street G Boston,Ma. 02111 K;ar fax #: (617) 727-7749 phone. (617) 727-4900 ext. 406, 409 or 375 MCURAppwmkJ Tab1*J1=b(eon"ucd) ._-. pi an ptive Pack"=for due and Two-Familr RmidentW Buildings Anted WA F03W Fodr MAXIMUM MINIMUM Gluing Q1aaa8 Ceiling Wall Fluor Batsmeat Slob HadawcoolinE Am'(%) U-value= R wud R value' IGvaiue' Wail paimmr �WPm� a paclraae it-value B valuer 3"l to 6500 Beadnq Deem D&W Q 12--A 0.40 3E 13 19 10 6 Notmai R 12% 032 30 19 19 10 6 Normal S 12--A 030 3E 13 19 10 6 ES AFVE T iS'X. 036 3E 13 25 WA WA Noma! U 13% 0.46 3E 19 19 10 6 Nomai V 15% 0.44 3E 13 2S WA WA ES AFUE W 13% 032 30 19 19 10 6 ES AME X 18% 032 3E 1 13 23 WA WA Noma! Y 18% 0.42 3E 19 2s WA WA Notuml z 13% 142 3E 13 19 10 6 1 90 AFUE AA IE-/. om 30 19 19 10 6 90AFEJE , 1. ADDRESS OF PROPERTY: rN5 • 1 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: Jr 3. SQUARE FOOTAGE OF ALL GLAZING: 7�z 3 0 4. %GLAZING AREA(#3 DIVIDED BY#2): S. 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-foms-i980303a 780 CMR Appendix J - Footnotes to Table 35.2.1 b: 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 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 insuMon thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the'sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R 19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry, log)wall constructions, but do not apply to metal-frame construction. °The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling, wall, floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). i • • rr A 88 v, ✓he TOofnowo�itoea��o� uaell Y HOME IMPROVEMENT CONTRACTOR ' Registration 109680 ,'#Ezpirdtlon 09nlAi nTUFTS BUILDING �o bvCOVELLS'LN Mwis�►aaoR 4IARSTONS' MILLS MA 02648 :It r ,- ¢ rdldAj,;e.i'_✓+yL Yy..�":...r i O,tnYy ,i>� �' --•VT o� �. 2c15 Crean pune5, Dr. Hyanni5Port - rDnway rasidanca The room pictured below hey a small firs that dammaged only the onclosuro of tho spa. It had fov #lamog' 4 id littlo to the structure. All dfimaged materials have been removed find fire to be replaces qs they were, 32� olal 5 F A i c new 15rq l i i Existing rooms z gla�� on� lo5uro je- cxixting roams main hau9c DEPARTMENT ^F PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number Expires: Bir da,e: w I I/2 0 2000 91i29.115,' — Restricted 74. 99 �'ARRY TUFiS 95 L'OVEEVS-:'LANE NARSTAS MILLS, MA 92648