Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0084 JUNIPER ROAD
i r 1 f. i i 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3C� P2 ` Map 3vtWVarcel ® • Application#` T�� Health Division Date Issued ( LS Conservation Division T Application Fee Tax Collector Permit Fee Treasurer �llsh - Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address/Q.'�� -J�C-.Wa� Village Owner Address �� "/V °�( Telephone 3F' ' _9®.- �-- Permit Request 3 94411L Square feet: 1 st floor:existing f o-Proposed 2nd floor:existing ✓ proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation" 1 1 el K Construction Type Lot Size Gl/,lam_ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Q,,/ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 2- new Half:existing I new Number of Bedrooms: .existing 3 new Total Room Count(not including baths):existing -7 new First Floor Room Count �- t Heat Type and Fuel: dens ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coals.#ove: ❑Yes ==0 No Detached garage: , xisting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size c` J CZ Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Z -� 1 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ r4, Commercial ❑Yes' ❑No_ If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION j NameW Telephone Number I Address F License# �JA Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE i .. .` _ FOR OFFICIAL USE ONLY _. APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: .FOUNDATION i FRAME la1121 D 6 bh to INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. 'r w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 s www.mass.gov/dia y Workers} Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual):. Address: r�IV Ala e City/State/Zip: � 1i't l� Phone.#: I o? 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' . y p t3'• #� 9. �Building addition � [No workers' comp.insurance comp.insurance. required] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3. I am ahomeowner doing all work 11.❑Plumbing repairs or additions ���V/ myself [No workers' comp. right of exemption per MGL 12.E]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#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 provide their workers'comp.policy number. lam 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 certi -nder the pains-and penalties of perjury that the information provided above is true and correct Sienature: Date: —7 I �/ Phone#: Official use only. Do not write in this area,to be completed by city or town ofJcciaL 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( )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 compliarce with the inscurnce requirements of this chapter have been presented*to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxe's that apply to your situation and,if necessary,supply sub-conf actors)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 fixture 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 t6 give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washingtori Street Boston,MA 02111 Tel. #617-727-4 900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 www.mass.goY/dia r �tHE,p Town-of Barnstable . Regulatory Services !sR� Thomas F.Geller,Director BuRdin Division�TED MPI� b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date . AFFIDAVIT HOME DYIPROVEMENT 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: X� Estimated Cost ,kddress of Work: Owner's Name: . 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 ner 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. O OR L� Date Owner's Name Q:f=1s:hameaffldav • Tame.fTs7tn(ecamaae� . . • p`.a riptiv°p,4mgei foe d=aad T o-.F v=q Ruldeattsl Baiidtdg+Hesta7 t►9ih ' FFel: JkAxfMjw • 115RVIRILINI 4iaang Glazing Gelling Wall Favor IlL=rsd .R cit�Et6aea • Slab ' GIA:r nff U-vatnc= R-valor' ' K-s alue' R y4uc? Wall -�cw EoP� _ `y Pa 'e.m3e R $70I ta•d3D0 H tiag J lcgm Dm�s' ' IZ°/a• 0.40 38 I3 I9 10 Now 12% 0.52 30 19 ' 19 10. b 3dvm�1 It - • S ' '•85�F{JE • 12VA p.30 91 I3 I9 10 Normal ,� I3Bre 036 • 31 13 25 NIA NIA. IS°�� 0.4� 31 I9 19 1O Normal 11 13 AF{J5 y 15% 0.44 31 13 29� NIA ��' �A;TM Rl 13% 0M 30 19 I9 10 S 13% 032 31 . 13 21 NIA N'IA Normal NaMMI 18�!. L47 38 19 ZS NIA NIA` g0 AMFUE 13% 0,42 31. 13 19 IG $ � 1"o*fe 0.30• 30 19 19 10 y 8 LS;3A ppDRE55 OF PROPEF�'I'Y: � • . t SQUARE FOOTAGE OF ALL EXTERIOR WALLS; 3, SQUARE F00TAGE C)F ALL GLAZING; ------------ 4, °,/, bLAZINO AREA•(93 DIVIDED BY',u,Z): SELECT PACKAGE(Q v AA see chart abavc); V Q 'MOTE; OTHER MdRE I--VQLVED NMTHODS OF DHIMY .G Mi ERGY REQUMENIEI�'T5 ARE AVAILABLE. ASK.,TJS FOR THIS MORMATIONI • z BU�t,D33�GTdSPECTOR A�FRDYAL: q�rit�-�oQ303a . Town of Barnstable CF THE Tp� Regulatory Services BMMSfABLE, : Thomas F. Geiler,Director 9�Ar 039. A.O� Building Division ED MA't 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: number U street —yam / (�village "HOMEOWNER": 0A/V 1 /� �`�vp��T v I --)ff-/-3F7 name / r home phone# work phone# CURRENT MAILING ADDRESS: City/town f 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, min' um inspection procedures and requirements and that he/she will comply with said procedures and re ui eme ts. S 17 Z5f omeowner 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 r A i Cd I60 0o �o O w /moo o ao 0 I lUJ 77 1.9' A _FRONT ELEVATinry r T �o ao �a 0 ao 40 Q aoILL I 10.' ._ . _.. . ._i i_.... .. ._.. . . .. . .-1-0'--.. B RIGHT ELEVATION g LEFT ELEVAI =f s B a nur G . n yr 19' A exist'g ridge board exist'g triple 2x4 column exist'g collar tie i l P exist'g 2x6 @ 16"o/c rafter exist'g dble 2x10 beam exist'g 4x6 p.t.post house-wall .. stand off post on conc.foot'g existing grade exist'g slate fir. " '' exist'g slab.... existing concrete fo j t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel Q� � Application# o) Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee / r Date Definitive Plan Approved by Planning Board C40 �� 7 Historic-OKH Preservation/Hyannis Project Street Address <:K0� C�c�1*9:&, D C'-Village Q� km V N`11'-- Owner CA-%aX06bt-�,Z n� L-k4c YK, Address r fp Telephone 3 '%a-t Zo 3 f i G41 tt "M 3557 90*51 Permit Request G-wA - d"�% f4, Square feet: 1 st floor:existing 2000+proposed 2nd floor:existing � proposed Total new Zoning District Flood Plain Groundwater Overlay - Project Valuation Construction Type Lot Size '"/���'-e- Grandfathered: ❑Yes ❑No If yes, attach supportir�documen#ation. ��; lay Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) C-n Age of Existing Structure Historic House: ❑Yes 4Ao On Old King's Highway: `d YesE=T CA Basement Type: 5'Full ❑Crawl ❑Walkout ❑Other Basement Finished Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing I new Number of Bedrooms: existing :3 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: YGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing 2, New Existing wood/coal stove: ❑Yes ❑No Detached garage:12rexisting ❑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 0 No If yes, site plan review# Current Use Proposed Use c_ BUILDER INFORMATION Name 1�` Telephone Number -78, 9 a6l Address sl._. Za x License# �-.-U Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (40,06LX s SIGNATURE DATE iI- 9 -O FOR OFFICIAL USE ONLY PERMIT NO. c DATE,ISSUED P • MAP/PARCEL NO. P i i ADDRESS, VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION I ' F FIREPLACE s ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i i} t Ty ,, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 4i'df 1 a 1600 Washington Street \K ; Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ? G Address: City/State/Zip: 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.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. 1 workers' comp.insurance. g, ❑Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.R� I am a homeowner doing all work right of exemption per MGL 11,❑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' 13.❑ 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. tContractors 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' nd the pains and penalties of perjury that the information provided above is true and correct Signature: 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"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-contractors)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 ndustrial 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 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 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 Off ee of Investigations 600 Washington Street Boston,.M-A 02111 Tel, #617-727-4900 ext 406 or 1-8.77-MASWE Fax#i 617-727-77-49 Revised 5-26-OS www.mass.gov/dia I . 11, �f�11E_ own of 13arnstable y Regulatory Services � $ Thomas F.Geiler,Director 1639. 6p�►`� Building Division Tom-Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstable.ma.us nce: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement;removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along VA-11 o+ker requirements. Type of Work: &M-i5 Estimated Cost 19 P Address of Work: Owner's Name: ��121J 1D Gi' 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 CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142Aa SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No, OR //- 9' /aLd r)�- 5ate Owner's S .nature Q:wpfiles.forms:homeaff day Rev: 060606 ti Isole J3:3.1a teoatfonet Pseaeriptive Packages for dne and Two-Family ResidentW Balldiags Heated with Fva Fuels MAX2MUM MINIMUM Glaring Glazing Ceiling Wall Floor Buwtew S18b Heariag/cooling Area'('/a) U-value R-valuer R-value' R•valuel wall Perimeter Equipment E.Mcieacy' page R-vues R values 5701 to 6500 Heating Degree Days' 12% 0.40 3 13 _(9 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.30 38 13 19 10 6 115-AFUE T 13% 036 38 13 23 N/A NIA Normal U 15% 0.46 38 I9 19 10 6 Normal V 15'/. 0.44 38 13 23 NIA N/A 83 AFUE w 15% 0.52 30 19 19 10 6 85 AFUE X 12% 032 38 13 25 NIA NIA Normal Y 18Y.. 0.42 38 19 25 NIA NIA Normal Z 18% 6.42 38 13 19 10 6 90 AFUE AA I3% 0.50 30 19 19 1 10 i 6 90 AFUE 1. ADDRESS OF PROPERTY: LA n �-t V) 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(93,DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): Q NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUMMIENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. ' BUILDING INSPECTOR APPROVAL: YES:. NO: q-forms-5 80303 a pFSHE Town of Barnstable � 1p�� yP o* Regulatory Services ' Thomas F.Geiler,Director seartsrn13 B.&6 9uilding Division 9� s63y `e� .. QED A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Dffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE. i l• l ' JOB LOCATION: j G l9•,-y i LL- number I street 1 S� village "HOMEOWNER': �R.\-�w 1 -�^ LA � ��1 U a4 3 t I .name n home phone# work phone# CURRENT MAUANG ADDRESS: 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 of 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 rriinunurn inspection procedures and requirements and that he/she will comply with said procedures and re ents ignature o omeowner 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 My 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 fomi/certification for use in your community: Q:forms:homeexempt Ar A exist'g ridge board exist'g triple 2x4 column exist'g collar tie - I i' exist'g 2x6 @ 16"o/c rafter exist'g dble 2x10 beam exist'g 46 p.t.post house-wall-. stand off post on cone.foot'g exist'g slate fir. existing grade '' . .. .exist'g slab existing concrete fo r4- a .- i 4 S B � e N N I a n im. o n yr 119r r A A i I l�J �t cl I �f �- 1.9' q FRONT ELEVATION J IN Ix �a O ao 4o B RIGHT ELEVATION g LEFT ELEVAI Nt ' r , f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel . Permit# Health Division Date Issued Conservation Division - 6 Z i 00 _ Fee Tax Collector Treasur a�l SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH IMs Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND - TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village� �- 1't LL, Owner 1" L kky�_ Ic-i 20 Address 94 3 Telephone s 8 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size `t'7 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family X Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes X No Basement Type: -' ull r ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ,Basement Unfinished Area(sq.ft) I Number of Baths: Full: existing new Half: existing 1 new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count t Bleat Type and Fuel: *Gas ❑Oil , ❑ Electric ❑Other Central Air: ❑Yes �KNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garageX 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 = BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ �/, r , ' r FOR OFFICIAL USE ONLY _ ` PERMIT,NO. 1 _ DATE^ISSUED MAP/PARCEL NO. r + " ADDRESS t _ ` ` VILLAGE ' OWNER DATE OF INSPECTION FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ° ROUGH FINAL'-', ' in i PLUMBING: R0UGJ+ ti FINAL GAS: ROUGE, FINAL ! ti FINAL BUILDING ' .: DATE CLOSED OUT - f r� 50 t ASSOCIATION PLAN NO.��� _ �t The Commonwealth of Massachusetts ` Department of Industrial Accidents '�`-�� 011lce oflnyesti9stioas 600 Washington Street Boston,Mass. 02111 ; Workers' Com ensation Insaraace davit //%%%/���/�%%%//'/%%%%%%//////i"i%%' name: location `'� `�i honeell # city �work niySel� I am a homeow=P�o�g is , 'et or and have no one any . . loyees worlangian tris job. :::;.>:;;: .:>:; : workers ..... 1 dmS �P an :. :....v:r..::,:. :..{.{:::::............::.........::.::. am r... ,,....rv.,.... ... :.:.........:..................... w ............... ...... .:.......:::v....• ....v..wr- v , -. v:••.:?�:...:::•.v:::::::.v••::.v:::::::::::::::::::.v:::::.i:� i<•4:i>:•::o t{:::5::�':;'.,:......... .......... ..........:.:..:::•-:.•:::•:::•:.}:::rr•xxTr}{. +y}YC•Pf}...,cf,- 46dtt,+r✓•.::}•::::.x:=C.. ......::::::::: comtDanv n m {;,, z>.w:.,: ..r:4..4:..w............ ,•:::::.;,. . w : ::•........................... w...ww•:w.:A:• ::...... :....-.. ......... ...::......m;w.....;:. ..w.YJ.r:•.i�tv.{r...?rx:.v.^i:•}}}..:•: ...v},r.::.....:::v:.....: . 4:•.{w.:..::::.. .......?ii::::::::.i::::::.v.::...........• :.r:J..,.xw.{.;{.r,.,x•:::::::: ...................... :..:::.w::;.;.....-.....wv..,.:::::::.}}}:v.,... ........ ........... ........ ....... .......... .......... ....w.................. .... ...._ .... ..x:}}x4:}i}:C$'{±.:.:v::v:v:•i'^.:.;:,::r{•:�•jY.:;.i:::.:::.?':•ii:/v:{i•:>:•:::;.�::............. ..::.::.:.:�.�..:...�::::.�.....�:::::w.::r-v...;;•:}::w r. +v::::::::w:.............. :v,vw. vw.}•.• .rx::••r{+.w.w::..w:::{••;•.. .. .... ..... ..w: ........ 1T`...... .... '- �-+•:'�o:;vi:,:jiii:i:;i:�::i'%:ii:::.:;?y:5»:;:?:;<:..;;�_:;::�:4::.:. ................:.....................v,w.....•...........}, ....v.•r........f...:1•{l-•.......... .... ....:�::.:..::v:vi::wivi}:{•::i'�::Y•i7:v}r}}:4i::v.:•.::..:... ...-}.-r:?,•:.i}yjX S?iiti-{:C{+��7!�;::'•::•i:•is:,':;::<$:;:y::{:i}{i:'S':i`:;.'•:;:;:;:v}:{}:?:;i?.i:}�ii�`:^?'i:=:y:isi>Jii:�i:�::.i:;:y�:}:i':i:�i::v)::n`(':�i::'?•»?:;:}j�v?.���:J'�>'�.:. ' ..:....}.:-.: SK ..:.......,. •i:.}}}:.:;::s>:.}:.}}:;:rx.}:::>::;:::{;.:ii:.is,.?.::<:<k:;.x.:{-}::::.: <.::}:;.:::.,:.::.:.:..:.:::::.r..:.:,.:::.::•:.:.. ///// circle one)and have hired the conuactors listed below who ❑ I am a sole prgPdc=BeII � 0r' have . ca.oI1 • easation ... workers comp.......... all ... w....r ........ ...... ..... ,- : the f g .... ..w .w,. ,......... . .......... .....:. ...... ... .......... �( }w... . wr.. . ....s :::.::..:. ........:.:.:.. ....,r,...:.:..:....,::.,...,............ .... ..� +5..... ....... lt1AM e..:..:......,...... . ...... vn : .:.::... .: .... .+\ vim,^:'Y: w.. .. .....-..nv:: ... ........ ...........- ........wr. h ....."."" ..N,..... :i...w .... v..}w. ........:vrv:,..:.;... xv.,v�:-r...,.. .................... ............v:r.::w:v.. v.:....; ................. .. .... r..,. .... r... t r:_ ...... ..x:.;w}•:._:.>�::::::::::::::•::::.. r:.::•:{.x..r:.iii;:;;:«�i:ii>::>;::.-. ...... ...... .........:...........:....... ... .LrwY4 w}v4.4.f�..K:M1T. .... ......::............•...rxw.A:�-:....,,. . . .... ,:.....,•..�,...,:•..,........,•.,,.. ...:.,•}w•r•:r.r. ,.,,w.xw:{.:.�::::::.::•}::{:;•}.s::;z�:��:=::is•>:<.;:-::........::.::...:.;:. ............. :::•:::::........•• .......r}:;;{:;..:,}f.;Y,..;}. }.+��c{••'xY.u�.7iw. C.•��.h'f w"'�.:. -htN,, ..... ..... ...... ........ .w..:..•:... .ffh .Avx �7} SN-Y`:•...::.:v.J�.�r$(�,%!;'{.intii}:x??<•w r... j .. ......:.....:..•::::: v,... r -.....-. �...:i•:{:i}'•}'l:'•:•}}}}:•f'^}:4::•}:•:{•x<4:!{4i:4:<J:{{•ii:•}:4:{:•::•i:•::.......-.....w:::..;-:::._::.::..... ... ....,. r. •.vvv:v., ......: . v ......... ... ...w•f...w.{. { ... { MR. p ,.v>,f..... ..w,.,w... ....i}:.-}4:,v,{.•::�w::{.tii:ail::�`�?i:2?:ii::�S:•ii:�ii::�{i::t�i:` ...........:-.. ._.:....4 .:}.. .,-y M . �.�.... \•::v:.:vv..?.......;k{}$.Y ... ... ..... ...x w .i44. ., ..... ...- w .. .v.....v.....r:}:i:::.::.. :v-v:i{.};:•:n•.;.:4}•�::::.,,v:.v.,:::.;v.-�{;i:::.v .:::::.. .... ...:::::......::::•.......:...rxi::........:v ::. ?'}-,�-.�:�r qs4.?vwviw,4. .,wn. r. - :•......:::::......:...::::.......;\�:i}'.}.::v:;�}y,fi.+l,$ S'A;.. -,...r ,} - :• .•-0,Yt i�f`+ „-`r:�rrr'»M:N}'?:k•`•;>i:,-: AIi[P'N::-::.:::._:::••':.•.'•.:•.�:.,:.::.:..,.,.:._..,.-....._.....•....-.. ... i ////�/��%��% -:.::ir::;:?.:::•2�:::::::::;{;,:;�:`�:� %%' ';;?�,}G,'•:..?.:xi?::... ..'�fe,� . �..•�2'.'.:.�4-•.�;X :� ..--. ////�////////. /�/ ce�ca' - ttn >;. / v.r.:..f .... ..... { , ,.: mow........:..:..... ....:.........:..........::..........:.,w:.-.r{........ .w�,e�..,4. {:. .,..sr :r.w.s..t..,.rw•:w•..:•-.,..r.�.}:::•... ...,:....:::..w•.•x:.� iii}?;i+}>'w?i:�..:...... ... .. r. ::.}... ::.i. .........................:... ... '.?t..::.. wni ......:::::: . .... ................... .r..:•::•:::•:..........-.....-...:..,:::i:::.;iii}:.}:}.}:•:-.v:r:....v.:.. .x::nv.tv;::.,:•}:iii<i}:�:;i<;ii:<y:•:•}}:i•}:ii:;{{{•i}:•}:i..-.;:.........,-..-.. .....:::.::. .::...::... ..-.. .. ..vv..-.. }...... ............. X. • :.�:•>:::::::::::•.... ...............:.v:::Y.+!•iY,.;}4W.v:.,4xNw.yth,�::}Kr'•i.w.'.'•,}'• ...............?ki<..... ,•:::::;".•E3�........ {.:. ...... .... w f.4..} gac4 :.}. .. .,•., ,oxyi:,4:r?•}:•}x�:-}x•}}i:{•:x•}:•::::�r:�:-.::'-::::�r:{•»::�::�:r>:•::•::•::•>::":�:::::::;:.,�;a:�:<�:: titP. :.. •r:::.::.-ww , .. {l4 ...tv�•.: ..: . ,, ;. : ... :•....... �K�� ...•}::.:.::::::::::..r.... ... r .:,..•wy}.............3c.. .,. : .a.YM.i.,.a...........4.........-..?s....:..................::..:::::::::•:::::......-... ...........:.........-. ....-.....,:•:::•...w..y .,r..,..:• .......:v wS.. fi ,.bw+w ,.,tib'. .?'{.oc..}.!eco. .4w�..,............... ..........:,........... .r.r. ww:M1r .....{ .. wry .... "• w.•.v.: {...F...-...:,:. w:................... .... .... ....r ..-.. -vx ... ......w.�y ,Y... -...... ..r,\r .}7!. ..... m::::::v:......:::::.i'Lfi}:4'•i:4:•Y•}`i:v'vi?iii': ..............................:::w:::: .....4...:.w.r..w. ..... rwvx,.v. .v+wr..:^•. .•w.^'^........::•. •.x{:iS.S ...:::v......::::::.....:::.vw..•::.:::.'.?!........... ,•x:{vr..::::h•.......4.:S;v Y..::•:•: ;... :::i4::v::}..,:::.;Y.r.:•.v�:.:..- ::::.....::::::......::::•........;r.........v• :..,:,�carx.-.4.{y:Y:•al...:fi4<,}a.;°;°R�%X:'>"•�'!'.�.•�..•:`:e?°a�ct'?:,:a::•:}:::::•... ......�O�iCV# :..;.;�;,.,.:::�:;:.�::.;�:,:,., .... / inLstirance co::>:';::;':'>:=::: ...... 'r"" w to S1SGO•00 an&or tinder Section 2SA of MQ.1S2 etoi lnd to� of eadmittal penalties of a Sae ttp . FaIIm a to sector coverage as regoised. . eaaltles the loan of a S?OP wORS ORDER and a Sue of S100.00 a dap against me. I tatdets�d that a one pears'impri+omnent as MR as dvD p of the DIA for eoveage vedacstbn. copy of this Statement may be fozwarded to the Of lm of Investitdions aialties of Perry�dw snf°rm�On p1 D1ida above is try,and coned I do hereby certify tht pants p DateSi- -7 Print name f� rho# G only do not W m ftte in b area to be completed by city or town of rild otndat use Y g Department � ❑Bulldin permdtluceme# city or town: ❑Licensing Basta ❑Selectmen's Office checkif immediate response is required ❑Health Department phone#; Other contact person• Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employe to person, the servicevide eof another under an", cc�" employees. As quoted from the"law", an employee is defined as every of hire, express or implied, oral or written- armershi association, corporation or.othe'r legal`eritity;br`an�-rno,or more ,�n employer is defined as an individual, P P� • th. the foregoing engaged in a'joint enterprise, and including the legal representatives of a deceased}employer, or association or other legal entity, employing employees. However the owner of a trustee of an individual, partnership, or the occu ant of.the dweliuL house,�: dwelling house having not more than three apartments and who resides therein, p another who employs persons to do maintenance , construction or repair work on such dwelling house or on the�ouy ano P be deemed tabe an employer. building appurtenant thereto shall not because of such employment MGL chapter 152 section 25 also states that every state or local licensing agency shall o ithhold for he iss an appiicantce r of a license or permit to operate a business or to construct buildings in the comet not produced acceptable evidence of compliance with the insurance coverage required. Additionally, ne:ther the common«ealth nor any of its political,subdivisions shall enter into any contract for the performance of public work uny �--_ acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contis authority. , „ :applicants lease fill in the workers' compensation affidavit completely,by checking the box that applies to your sn=uon and P with a certificate of insurance as all am—davits-may be ss lv ng company names,address and phone numbers along PP Y questionsof Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an.: s-l6mitted to the Department or town that the application for the permit or Iicanse L. date the affidavit. The affidavit should be returned to the city as re arding the "Iaw" or being requested, not the Department of Industrial Accidents• Should you haveg are required to obtain a workers' compensation policy,Please callthe Department at the member 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 e the has to contact you regarding the applicant- Please affidavit for you to fill out in the event the Office of number. The affidavits may be returned To be sure to fill in the permit Irene number which will be used as a reference the Department by main or FAX unless other arrangements have been made. to thank you in advance for you cooperation and should you have any questions.The office of Investigations would like please do not hesitate to give us a call. i The Deparanent's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavestlDauons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 eat. 406, 409 or 375 ,aF THe r� The Town of Barnstable a,►ruvsresr.s. • 9 ��� Department of Health Safety and Environmental Services �,,rED 5,ta Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner 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. L Type of Work: �� � E e`L Estimated CostiP o�2p Address of Work: Owner's Name: Date of Application: �Ql 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 IMPROVEMENT WORK DO NOT HAVE CONTRACTORS FOR APPLICABLE HOME 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: Contractor Narne Registration No. Date OR D eO�����Owner's Name q:forms:Affidav f The Town of Barnstable FtHe Department of Health Safety and Environmental Services Building Division BARNS ABLE, ' 367 Main Street,Hyannis MA 02601 MASS. 9 i639. �prFD MA'1� Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION / Please Print DATE: a, v� 6� _ JOB LOCATION:_ number - street village p "HOMEOWNER": /��✓C �C 17 J2O �-, -+�`�6 name Q home phone# work phone# CURRENT MAILING ADDRESS: 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 minimum inspection procedures and requirements and that he/she will comply with said V es and re uirements.f 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN i Sze -7"7s- ,tL �1 I } ; I j ' u zY, o DROP � e 1 N ASSESSORS MAP. 230 PARCEL: _42 • raWAWar LASS FLOOD ZONE: C S ]V"Ar MARSHTE YS LOCATION YAP 40.6 LOTS 20 & 27 - - - '� 36.e . 20.284 f S.F. 1 (0.47± AC.) 4 y, /• 1 1 r i 1 x 1 40. ` o i �. 40.3 1 se.E ' ,t � �6/ � •• " 1N9ERTS�40s � 1 pia TING µ2 Glot f1w w DENCHMARK Ar 40.4 . se.4 FOOD SrAlrX ELEVATION-VAS 0 \ ON 00 M67 \41.2 10 - r ���- - - - 42 42.0 42.0 48.5 O 48 9'd \ .41 405 40B sa.b POLY LINER(Sss DETAIL THIS SHEET) aLSV.(aELi r BEY: EXISTING CONTOUR — — PROPOSED CONTOUR. ........................... -EXISTING SPOT ELEVATION: 2" PROPOSED SPOT ELEVATION: 25 TEST HOLE: UTILITY POLE: -0- SLEV.Of FINISHRD PROPOSED GRADS-450 GRADS OVER LINER-4" FENCE LINE: —••—•• (TOP OP L/NSR-44D) HYDRANT: -b RETAINING HALL: ® b• TREE: 0 4s.o ® 44.4 DM Goa MG © GRADZ Nc DSMAREST-HaLSLLAN SNGINSSRING 40 MIL POLY LINER PROPOSED LEACHING ARSA 24 SCHOOL STREET P.O.soz 4es PSRMA-GAIIRD(OR SQUAL) TOP Of PEASrONE SLAM-"a ISST DENNIS,MASSACHUSSTTS 01670 (75,s S) TOP OF LINER 91".-44,0 PHONS&PAX:(508)3e8-77to SEPTIC SYSTEM LINER AND FILL DETAIL h � • � s TEST HOLE LOGS NOTES: I. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD +/-) ENGINEER: THOMAS MCLELLAN P.E. 2, MUNICAPAL HATER IS AVAILABLE. WITNESS: GLEN'XARRINGTON R.S. 3. SCHEDULE 40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTE 7 DATE: 1-14-99 PAY: 9347 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 # H-20 LA PERCOTION RATE:_< 2 MIN/IN LOADING SPECIFICATIONS. TH-1 S. PIPE PITCH - I/e d: 1/4' PER FOOT, (UNLESS NOTED OTHERWISE). 43.5 TH-2 6. FIRST Z OF PIPE OUT OF D-BOX TO BE SET LEVEL. D/A NORIO' E� 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODAT8 THE • 1farR 31Z'�p �� USE OF A GARBAGE DISPOSAL. B HORIZOx 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE SAND fOrR 6 STATE OF MASS. ENVIRONMENTAL CODE(TITLE FIVE)AND LOCAL •. 101 R /a 4oD HEALTH REGULATIONS. F HORIZON 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR Zsr 3 SAND TO CONSTRUCTION. f0. GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO oBsaRvaD 34.5 EXCEED 3.01. GRWNDWATER It. EXISTING CESS POOLS ARE TO BE PUMPED AND FILLED WITH SAND 99b OR REMOVED. USCS CROUNDWATaR ADJUSTMENT: f2. ALL UNSUITABLE SOIL(B HORIZON, APPROX. 42'DEEP) WITHIPj Sr OF WELL:AJW-247,ZONs:C.ADJUSTMENT:4r PROPOSED LEACH AREA IS TO BE REMOVED AND REPLACED WI7 H CLEAN MEDIUM SAND. 13. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW 14. EXISTING CESS POOLS ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. EPTIC SYSTEM DESIGN f5. SEPTIC TANK AND PUMP CHAMBER ARE TO BE WATER PROOFED BY MANUFACTURER WITH IPANEX CONCRETE ADDITIVE OR CONSEAL 56. A 6'EZ WRAP IS ALSO REQUIRED FOR BOTH TANKS. WW ESTIMATE: BXDROOMS AT flo AL/DAY/BEDROOM-440 CAL/DAY SNPTIC TANK: II COL CAL/DAY s 2 DAYS Mg-CAL 7SX 1500 CALLON S7IC TANK �EACHINC AREA: Fart. L� 5JrJr,, § lr USX 6 INFILTRATO STANDARD CHAMBERS WITHM 4'-OF STONE ALL AR ND AND Of BETWEEN ROWS paH (267V s 20P s r DEEP) DI SIDE AREA: 47's 2 17 12-55 04)- 41 CAL/DAY BOTTOM ARXA:2C76 Ix 20.E-540 SF(74)- 400 CAL/DAY CAPACITY!-_LCAL/DAY EXISTING FLOOR PLAN SEPTIC SYSTEM SECTION- - cmirss WIrMIN Ir or 2'PEASTONE FINISHED GRADS COVER 01s R PUMP TO BE f�Na COVER BE WrrHIN 442 b'or aRADs� rlretx r of rlNlsa cRLDs. 3/4'-1 1/2' FIRST FLOOR I r PC►(PRassum LINs) WASHED STONE it ELNVa-44.0 ti 38S I a 39.4 _ ELE9. 3925 34 5 LBY. MOLE 43 8 D-BOX 4983 43A 1500 AL ELXV. ELEV ELEV. (6'OF ELEV. XLEV. ELEV. SEPTIC TANK PUMP CHAMBER(foo0 CAL CHECK STONE �.-26,78 s 20.O=� (6" OF STONE UNDER OR SEPTIC TANK)WITH MYaRS VALVE UNDER) 6 MECHANIC Y COMPACTED) SRM-4 PUMP.PUMP ALARM (TEE d Ina) 4356 PACKAGE TO ea INSTALLED IN DWELLING POWERED TXX SIZES: NLNV. BY A CIRCUIT SEPARATE INLET.6-UP,13'DOWN FROM rqq9 PUMP USX B INFILTRATORS(STANDARD CHAMBERS)((H-EO) ON OFlr' OUTLET. B•UP.f DOWN POWER.(DISTANCE SWITCH TO B BE IrA N WITH r OF STONE ALL AROUND AND ar BXraia`XN ROWS + E W (CAS BAFFLE AT OE TINT TEN) (DISTANCE DATWsxm ON SWITCH (26.7W s 2OZ s?'DEEP) (H-20) -AND ALARM TO-BE 1,r) -_- 90UlANCT IRCE-11)45 LBO L8S � •- --HICII.WATER MARS,"-d:J BASEMENT-ON=WALL-36D < IEIc"or SEPTIC TANK- ►Aao LIPS XffANCT FORCE-8X5 US LBS (USGS ADJUSraD GROUNDWATER ELEV.- W.0) fE/CHT OF SOIL MIR TANK;-SM Les WEIGHT OF SEPTIC TANK-8,240 LOS WEIGHT OF SOIL OVER TANK-4100 LBS SITE AND SEWAGE PLAN APPROVED BY: DATE: LOCATION: - i OF at _84 JUNIPER ROAD io►N _CENTERVILLE. MA ICWL t S q$haam � ik PREPARED FOR A. & B. CANCO 'IC'Yh 1 SCALE: f-= so' DATE: lfis/,q9 REFERENCE: PLAN BOOK 122 PAGE 89 THOMAS MCLELLAN, PE. JOHN Z. DEMAREST JR., PL.S. -; TOWN:OF BARNSTABLE BUILDING PERMIT APPLICATION' i 2 Map � J Parcel_ y� Permit# �{ Health Division �(6 � !1�� �C Date Issued (� 2cm Conservation Division 3. 0D a4 Fee Tax Collector Treasurer , t SEPT a fC SYSTEM MUST BE Planning Dept. INSTALLED INCOMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ' ENVIRONMENTAL CODE AND Historic'-OKH' Preservation/Hyannis TOWN REGULATIONS Project Street Address Village �p Owner I� Z&LG_Abq colz-VEIQO Address �y /IiD�IZ D t�E'hT92Zv)",1�' Telephone C�LOO) 7 7 5 e /99� -' Permit Request�7� ( ,nh z4 e, 7- O.(JE S•222 Square feet: 1st floor:existing /?Z� proposed 2nd floor:existing proposed /vim Total new Estimated Project Cost 2-0- ' Zoning District Q- I Flood Plain 700C C Groundwater Overlay Construction Type Lwob !/IXIr�r ' Lot Size Z Z S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. r Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ` Historic House: O Yes No On Old King's Highway: ❑Yes �ko Basement Type: g Full ❑Crawl ❑Walkout ❑Other i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths:' Full:existing 2- new Half:existing jo� new Number of Bedrooms: existing new Total Room Count(not including baths):existing �J new First.Floor Room Count Heat Type and Fuel: '4 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 14 No Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes No Detached garageA existing ❑new -size Zce�_ 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 XNo If yes,site plan review# Current Use 1Le2�.e ' Proposed Use BUILDER INFORMATION Name �LGI.�'G �`�� ti� Z Telephone Number fP8 77/ 86�� Address 6 5 . CA6e,4Fk S,7— License# O5 6 3'410 C c �2yiL a Home Improvement Contractor# Worker's Compensation# - O 3 2 —C�Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREDATE - 3 0' �� 1 _gip r FOR OFFICIAL USE ONLY ' PERMIT NO. a DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ' % ^a _ � _ r + • � ', i; • ' • DATE OF INSPECTION?: 'f FOUNDATION j 'con �/ ` . •Y a y r f 1 + FRAME f INSULATION- • is _ � _ - r - FIREPLACE { ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL t - • 4 _ GAS: r ' ROUGHS FINAL ' .i � u ' . •' _ _ ice^ ry •~ - i - .. . . } FINAL BUILDING'] � ?`" • -t" 4 ' \; •• � .:% � ,,.ter, ��. 3 � '' [' ' J + ; ` � ' DATE CLOSED OUT t-i - ASSOCIATION PLAN NO. The Commonwealth of Massachusetts �� j� —•• - Department of Industrial Accidents ' _�; ���-•- =--= Olflce of/mrestigatioas -_ - 600 Washington Street -- Boston,Mass. 02111 Workers' Compensation Insurance davit name /,l�I L /��'/'1 G to If L 7, location Y 7 J —t4 n )OWL /f;0 crtv f_Yg I Z y/L L ZF--' phone# ❑ I am a homeowner performing all work myself: ❑ I am a sole proprietor and have no one worlds in any ca achy rovidin workers' compensation for my employees working on this job. Iam an employer p.............g..:.::..:..::::.:<.;:::::..:.;.:.:_::.. .::.::....: :..:.:. ::::...............:..:..::::.:.. company name ddress.:. ...:.. ..,,.... cr . - insurance co. 2 .'� ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have o lices: the following workers'... ° n...:. .polices: ::>::;:;>::::: com any n —. ..... ....::,.::... ............ ..................... ....::..:...:.::...................... n.. .. .. .. .......... .. ...................:•::::::::.�:::::::::tvw::::::::::::::'::::w.�::•.�:::::v::.�: ::•i:: V.:::.�::.�::... add �`on .•:#���G:�+';::':�i s;S: .......................: ;:: : ::s�:s�i i::;y<i:;(:i::;:,}:;:';: :�:;'?:�:��:r:.... '�h ................. c any name: ::.::;::::;.;:.:::::.:,•.;;;:::;;;; >: address: .......... ` ........:::::.. on :.:...............:.:........... ........... a . ............................ .... ............................... . ...... ...... .................................... ................ ................... .:............ in�iimnc FaSnre to secmt coverage as regaitYd ceder Section ZSA of MGL r52 can lead to the imposition of crhainai penaitin of a Sae up to 51�00.00 and/or om yam,imprisonment as well as duff penalttn to the form of a STOP WORK ORDER and a Sue of 5100.00 a day agaiart me. I understand that a copy of this statement may be forwarded to the Once of Iavesttgatlons of the DIA for coverage verfScaflon. 1 do hereby certify under the parrs and Pen o Perjury that the information provided above is trw and totted Date $IglStllre • tl..Printname Phone# ���— oincial use only do not write in this area to be completed by city or town oSicial perndt/ffcense# ❑Building Department re city or town: QLicensing Board ❑Sdeetaien's Office ❑check if immediate response i,required ❑health Department contact person phone#; Other (towed 9/95 PIA) FLOOD ZONE. C" RES. ZONE. RD-1" I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE F2=23.P� ASSESSORS MAP 230/42 WEQUAQUEr LAKE IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL J,=�`�s PLAN #122/89 K STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN " Community—Panel #250001 0015 C TH�Erp MMONWEALTH OF MASSACHUSETTS Grt.�.4• Iwo � e PAUL A. MERITHEW, P.L S. DA r � Locus ,"` �' A��jp .ram �7•A �►`� to cp�rY 0 HSE #84 w o- ravK LOCUS MAP �C ) �4�� ♦ ' 64.4 n Y C PORCH 1 6K61/N ANC PoIBCN � PUMP Oo aU� I PPoP�,1D6C'K D�K PLOT PLAN OF LAND ,� AI annmov 11,.5 36 oI ,r job- PREPARED FOR.• o° �_- , 20 MARK CORDE'IRO 564 33 ti� �� AssESSORs LOCATED A T. �.pk60 , AREA=20285fS.F. �+ LOT 54 84 JUNIPER ROAD 2 CENTER VILLE MA. O 6 ASSESSORS 2� CPo 0 0 LOT 42 cAizACE �o JUL Y 11,2000 a o- GRAPHIC SCALE OO 30 0 15 30 80 120 N✓ 561 O'Y� ( IN FEET ) �� c9w 5r3`3a ASSESSORS 1 inch = 30 ft. S LOT 43 YANKEE SURVEY CONSUL TANTS SEPTIC INFO P.O. BOX 265 �0 TAKEN FROM TIE CARD UNIT 1, 403 INDUSTRY ROAD "t FOUND AT TOWN HALL MARSTONS MILLS, MA. 02648 PH.(508)428-0055 - FAX(508)420-5553 JOB #52426JF _ °� The Town of Barnstable $ Department of Health Safety and Environmental Services Fta 59. Building Division 367 Main Street,Hyannis MA 0260I Ralph Crosse" Office: 508-790-6227 b I3uiIding Comra, Fax: 508.790-6230 For office use only y ° ; Permit no- Date AFFIDAVIT HOME WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. removal, demolition, or construction of an addition to any pfiezisting conversion, improvement, 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. 117 Est. • Type of Work: �,��/� /®!7 �'/d / viL1, Address of Work:— i Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH DUNREGGISTEO NOT ERE E . CONTRACTORS -:.FOR' ,,APPLIGIBLE HOME IMPROVEMENT WORK ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL�.14ZA w SIGNED UNDER PENALTIES OF PERJURY I hereby apply fora permit as the agent of the owner. LLIY-7M &),)bt .'Zi5 / 7 Registration No. Contractor Name Date 677 Pam_ 1 EypARp.pF BOIL DING REGULATIONS t s:•` License: CONSTRUCTION SUPERVISOR plumbs C '' 056340 . 1011911�54 , s 1 i � 2 Tr.no: 272" 3 CENTERtlIhJ.� MA-02632 Administrator }. Y MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 8-31-2000 DATE OF PLANS : TITLE: COMPLIANCE: PASSES Required UA = 102 Your Home = 92 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 384 30 . 0 0 . 0 14 WALLS : Wood Frame, 16" O.C. 540 13 . 0 0 . 0 44, GLAZING: Windows or Doors 40 0 .400 16 FLOORS : Over Unconditioned Space 384 19 . 0 18 COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . 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 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer L>`J �c zIt4L26" Date c J MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE: 8-31-2000 Bldg. Dept . Use CEILINGS : [ ] 1 . R-30 Comments/Location WALLS : [ ] 1 . Wood Frame, 16" O.C. , R-13 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value: 0 .40 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .511 clearance from combustible materials and 3" clearance from insulation. 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-values must be clearly marked on the building plans or specifications . DUCT INSULATION: [ l Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . 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. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Bdlding Department Use Only) ------------------------- ..._._......-----.may=.v��.... _.�__.._. � _ a4-o• � - •i '_ I_" _.=,.-_._. _ :.rn ........_;'a_moo' - -�'' .� j I aki dYiCf Gt/EA •QG"._�l (04 LA If I c. �• ° I H P q- n O J ` E i t s -- �, d•,A° ,�a .•. �® 3 .S1*P ..._.-._.._.. .... i 1 J I �i �; .Q 1'• y ice. I R�gtr+------' ii �r . . r' gyp• lr _� j �b cz. x Pnn�x L� 8•.3'ExPo�v2c O j I.t^•4'�4 a �,� b. ..70 tt � I I � O � 41i�1�3f t� d�dtl/NAwsJ �, V i + 1 E � IZ,.j xix '� iw � i � p� � +N•OGN.NAOLT__ sQ i r'� I i c PE TR X up ppID It Ji�'f xdr ell oh 70 iL it o Li L _ s ea I i i °LL; I � 7:�p•ti 4V try* .r_ �i 7' .. , ..� '•d .� �+ it i t � Z 4. tzib -Z!57 s SMOKE DETECTORS O.K. o00 Q BAR S ATN B B ILDING DEPT. d OC"P-