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0105 LUMBERT MILL ROAD
c � - o , F i , s , YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L-.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. . Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. IA DATE: � ` Fill in please: Inn tdt611W2 goqvw��� Y)r f APPLICANT'S YOUR NAME S: S 1ESS / YOUR HOME ADDRESS: ry\7, U di1 eta' �� + �` TELEPHONE # Home Telephone Number ` 9 V e rvF:F Est, kty `+� 9 E I N OR • E-MA I L: rj a NAMEOF CORPORATION: C� P� C ` < r NAME OF NEW BUSINESS- a Wuw. See c_ TYPE OF BUSINESS Akt-ryW— t�SdA-C-K IS THIS A HOME OCCUPATION? YES or NO ADDRESS OF BUSINESS rvo MA MAP/PARCEL NUMBER v - (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. MUST COMPLY WITH HOME OCCUPATION 1. BUILDING COMMISSIONE S OFFICE � RULES AND REGULATIONS. FAILURE TO This individual has be wl�oof any per e irements that pertain to this type of business. COMPLY MAY ROULT IN FINES, thorized Signat re* 0 ENTS: r ( v 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** t COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: i V' JlL V i ✓«i 1RV Vim.IV JlV Building Department Services " dFTHE T -�•t, Brian Florence,CBO Building Commissioner - ° t aAxxsrtisr�. 200 Main Street,Hyannis,MA 02601. . buss. 7 1639• ,�� www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION bate: Name: V� ' Phone _�3 -q3o-qol a Address: ;� 6 m,! l Village: Cw4ee(JZk CW Name of Business: I CO 11�Y M�[.. �P/I�CU rV ` ll�CPA Type of Business:—�� Map/L.of `�'U V� RiTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,*subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the.dwelling: there shall be no increase in noise or odor,no visual . alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no.increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard, • There is no exterior storage or display of materials or equipment • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing-the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall bg employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. - + I,the tmdzrsigDAd,have read and agree with the above restrictions for my home occupation I am r'giste ' Applicant: Date: Homeoc.doc Rev.06/20/16 r Town of Barnstable *Permit# TF1E Expires 6 months om issue date Regulatory Services Fee S2 * sAxrisresr.E. Thomas F.Geiler,Director X-PRESS PERMIT Building Aivision Tom Perry,CBO, Building Commissioner MAR 1 3 2013 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 TOWN 09.8AFRNW&E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY d Not Vafid without Red X-Press Imprint Map/parcel Number Property Address o S L v h g-r 4 V.Residential Value of Work 1I/ Minimum fee of,$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name e a 4 4- !—, ,4(� S Telephone Number Home Improvement Contractor License#(if applicable) �� d Construction Supervisor's License#(if applicable) s �/ JJSJWorlunan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name f o c�e G iL 10 (, Workman's Comp.Policy# C-L 5-b o 7 l `� Q I 2 0 (Z Copy of Insurance Compliance Certificate must accompany-each permit. Permit RrRe-roof st(check box) (hurricane nailed)(stripping old shingles) All construction debris.will be taken to A j ����£� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) e-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum 35)#of windows ❑ Smoke/CarbonMonoxide detectors 4 floor plans marked with red Sand inspections required: Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: y n-Mrn r MrrlvM-RNhnildina neEmit fnrmslEX MS.doc F 0 sAxrrsrns[.E, i q� 1639. Town of Barnstable prEO MPS A , Regulatory Services t Thomas F. Geiler,Director Building Division Thomas Perry,CBO. r' Building Commissioner 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Pr , o er Owner Must P tY Complete and Sign. This Section If Using A Builder I - as Owner of the subject . ro e l P P rtY hereby authorize to act on rny behalf, in all matters relative to work authorized b this building ermit application for: . Y g P PP (Address of Job) Sign e of Owner Date Print.Name If Property Owner is'applying for permit,please,complete the Homeowners License Exemption Form on;the reverse side. : Q:\WPFILESTORMSIbuilding permit fbnnslEXPRESS.doc` °F1T°wti Town of Barnstable Regulatory Services RnxxSTAar-e, ' Thomas F.Geiler,Director 'OLEO M9. ill Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m.a.us Office:. 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name 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 twos.. 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 Rerfo`rmed 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. , \•mot FI %..J"`'✓ F } /i. The undersigned "homeowner"certifies that he/she understands th'e Townlof Bamstable5 Budding Department minimum inspection procedures and.requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner ti i 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. + 1 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 j I K 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 # y supervisor." ! e . , ` 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. - Anr " .. .. . The Corrttrrr unwalth r,,f�ussachussi#s Deprtment of ludrasbgal Accidenft O,face of Investigations 600 Washington Street ' Boston, M4172111 . wnw.inas&gav1dia Workers' Compensation:Insurance davit Bifilders/Contractors/E.Iectricmns/Phtmbers Apphcant Information PleasePrint Ltegi Name(Batonflndvidz�al)1 i S TJc'�2(cdP t► e.r��- C p rr Address' T r i4 rCityfstate/Zip: ` t f r o:2 S� Phone 4- S�G 73 Tire'you an employer?Check the appropriate box Type of project(required): 1 am a employer wits, 4- ❑ I ate.a general.contractor and I 6' ❑New unction jemployeess(full ancVor arMiMe).* Davebidtlia sub-cantzact�rs 2.❑ I am a sale proprietof or partner- listed on.the attached sheet. 7. ❑Remodeling ship and helve no employees 'These sob-contractors have g- ❑De=h ion wadd i, for me in any capacity.. employees and have deers' 9. ❑Building addition COMP.insura o-- O 1VDFITL3, comp.insurance ... 1 G. 5. ❑ We are a corporation and its El Electrical regains or additionsrequired] . 3.❑ I am a homeowner doing all work officers have exercised tixir I L Plumbing repairs or addi#ions r o€exemption per MOL myself a workers' . its p- U. of �Y [l`T �p 1 ees.�,and we have no reF� insurance required,]T c. 152,empto e { } o workers' 1311'Other { " camp.insurance required.}: *Any applicm ihst checks box#1 must also fM tint hive section below shirring their waters'compencntiarn policy infurmsdcn 1 Houteownem who submit this affibsvat 1m&cx=g they aredo9og an wat and then hire outside contractors urnsI submit anew affidavit indicating such- tContrn,cou sthat check this boat must attached an additional sheet showing the came of the soh-wmtracton and state whether ar northose entities have employees. if the sub-contmaors have employ"%they nnmprovide their workers'camp.policy number I49M all 8Mp1VJ'rr that is providing wormers'cumpensadon it mnwce far way emrplay 6= Bel`om is the poffcy atzd jab sits inform ad-am . Insurance Company Name;�g t�n S11n n ITV c r s' 6L-5 U .c An C� Policy or.Sal€ins..Lic.# ► • t�C S"oC)7 l�(�6 6( 2p I off— Expiration Date: O i Ci lstatel Job Site.Addr>?ss. "6(� 'U 4w,,b er tY �F Attach a cop of the workers'compensation pacg declaration page(showing the policy number and expiration date). Fair to secure coverage as requited under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500_00 and`or one-yeas imprisonmeai,as well as civil penalties in the€a m of a STOP WOFX ORDER and a tine of up to$250-00 a day against the violator. Be advised that a copy,of this statement shay be forwarded to the Office of Ir-estsgatiims of the DIA for insurance cad-erage verificati I do Hereby c *agar thapaitns a ndpeanaMies re.fgedmq drat the infonnadam prmvtded above is true and correct Si Date: Phone# � — © cial arse niy. Do not write in this axgrr,tv be coMpletsd bs Gi#y ar ta+vat officiaL 1 City ar lCe► n* PermidUcense Al Issumng Authority(circle tine): w 1;.Board of Health 3.Buffing Department 3,Cijyfl'own Clerk 4.Electrical Inspector 5.Phtn�bing Inspector 6.Other. Phone#: . of rice nsu-riref7�ffuFs&BMj e'WWedu'ia on s,iccuse u� rcg�sarauuu rrum rod:.wurvmw use umy _ HOME IMPROVEMENT CONTRACTOR before the expiration date. ff found return to: Registration ,170270 Type. Office of Consumer Affairs and Business Regulation Expiration: 1014/2013 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 - ' E��ELOPMENT`CORP ci )COTE SHIELDS '2 BRIAR PATCH004 A 1 ECVILLE,MA 02655 a Undersecretary Not valid without signature: ent of Public . :� S„:u d ut Bciil(Iin��'Re�,li:I.iY�nz�:�;iji(! �t:uril:it-ds Cor!st action Supervisor L icPnse License:. CS 6EiM98 ;COTT S SHIELDS 'Y 72 BRIAR PATCH RD OSTERVILLE,MA:02655 3.. ation: 711012013 Tr=: 21168 Client#: 151.30 2TRISDE 'ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/2312012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil PHONE 508 775-1620 FAX 5087781218 A/C,No Ext: A/C,No Insurance Agency E-MAIL ADDRESS: 9731yannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:Landmark American Insurance Co INSURED TRI-S Development Corp. INSURER B:Associated Employers Insurance . 72 Briar Patch Road INSURER C: Osterville; MA 02655 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT RR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR WVD POLICY NUMBER MM/DDIYY /Y MM/DDY A GENERAL LIABILITY LBA15641500 04/02/2012 64/0212013 EACH OCCURRENCE $1,000 000 X COMMERCIAL GENERAL LIABILITY PREMISESEaE�r ante $100,000 CLAIMS-MADE FX1 OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JE 0. LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracadent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCC5007148012012 5/01/2012 05/01/201 X wo STLTU-S 0TTH- AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? NI N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES Attach ACORD 101 Additional Remarks Schedule,if m r i i( more space s required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S98326/M98325 LS1 TOWN OF BARNSTABLE BUILDING PERMIT ATION Map - Parcel �O ADate # Health Division v I OIL NOv 1310 sued Conservation Division I 1 13 o i Tax Coll for �' �/ ter' L ✓0 0 & � c SE , ('111 Treasur l t �I�I I��IC �Y�TEM UST 1:,A: INSTALLED IN COMPLIANCE Planning Dept. VVIT'H TITLE 5 Date Definitive Plan Approved by Planning Board3'�IRONQNTAL COD Historic-OKH Preservation/Hyannis Project Street Address _ 0 T LQ n-'be,_r Village CQc, 2t'y \Vz Owner 1�rno-S " - alv btr Address sc�rr� Telephone ��©� l dad Permit Request s 1\ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new�� Valuation Zoning District_Flood Plain Groundwater Overlay Construction Type Lot Size �� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure QS Historic House: Cl Yes 6d"No On Old King's Highway: ❑Yes C'No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ii Basement Unfinished Area(sq.ft) 1 1 a !i" Number of Baths: Full: existing I m new Half: existing new Number of Bedrooms: existing new _ e� Total Room Count (not including baths): existing new First Floor Room Count EL Heat Type and Fuel: MIG' as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes YNo Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes 540 Detached garage:❑existing ❑new size Pool: ❑existing Cl new size Barn:❑existing ❑new size Attached garage:5existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes CA If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name rr 10L\J ei Telephone Number , Addres, License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 11 r= FOR OFFICIAL USE ONLY q? F.. - PERMIT NO. r_t DATE ISSUED MAP/PARCEL NO.:'# •FI "� �� 1. .. , ADDRESS ' _ti VILLAGE OWNER. DATE OF INSPECTION: ' t FOUNDATION r • s, FRAME �23 zZ a I INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. :� r The CommonweaulhofMassacnuser� Department of Industrial Accidents O1Bca011aresON&Oos 600 Washington Street Boston,Mass. 02111 Workers' Compensation L=rance Affidavit name: U r location. 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K?, -n"K .}. ,3,R,:?o-:a:3:: ....::::......... .........:::'v2::"•X:4::::Lv.. ?iv{:::v:i... •: Fag=to secure coverage as requited®der seetton ISA of MQ.1S2 east lrad fo the lorposiflaa of a>mioal penaltles of a 6aa up to 53.500.00 and/or am yam,tuprisomnent as wen as civa pm-m—in the form ofa 31'OP WORK ORDER Sad a Qoe o[5100.00 a day agaimd me. I ondesstmd<bat a copy of this Statement may be forwarded to the Once of Investigations of the DU for oova'age veeitleadoa UltdRr pturu tArQlhCf O provrdad above it&w.and correct: I do hereby certify P fpaJw9�° On Date !1 -- `'Sipature Fhtme s 5b� 420 �b 1� print name on Joll oincial use only do not write in this area to be completed by city or town ol�dal - permiWtxme ii • QBt+ffding pepartinmt city or town: (]Licensing Board Osdecnnews Office ❑check if immediate response is required ❑Health Depsetmeat phone —❑Other contact person: (leraeu 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to Provide workers' compensation for their employees. As quo ted from the"law",an employee is defined as every Person in the service of another under any contract of hire. express or implied, oral or written. oration or other,legal entity,or any two or more of An employer is defined as an individual,partnership,assohe-leg l repi entatives of a deceased employer, or the receiver or • thc'foregoing engaged in a joint enterprise,and including the legal repres to ees. However the owner of a trustee of au individual,partnership,associatiod&other legal entity,employing�P Y or the occupant of the dwelling house of e ' house having not more than three apartments and who resides thercin, or dw lIin, wok on sack dwelling house or an grounds persons to do maintenance,censtivction repair another who employs p to be an 1 of such 1 be deemed employer. building appurtenant thereto shall not because employment . 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews- MGL chapter applicant who has a license or permit to operate a business or to construct buildings in the commonwealth for any app of P COVMP Additionally,neither the not produced acceptable evidence of compliance with the insaraacer 1he �of public work until commonwealth nor any of its political subdivisions shall enter into have been presented to the comra�-►*^ acceptable evidence of compliance with the insurance=gairemeais authority. Applicants Please fill in the workers'compensation affidavit cry,by�8 the.b=that applies to your situation and company names,address and Phone numbers along with a crate of insurance as all affidavits may be supplyingariment o f lndusmal Accidents for afiasma»ce coverage• Also be sure to sign and _ submitted to the Dep artowntltattbe application for the permit or license is date the affidavit The affidavit should be reamed to the�Shoald�Bove my �regarding the"law"or if you being requested,not the Department of Tndustrial.�ccidmts- below. are required to obtain a workers'compensation policy,Please caII the Departmeirt at the mtmber listed City or Towns _ ...__....._. ._.. . has tact a space at the bottom of the Please be scare that the affidavit is complete and printed legibly. The Department provided regarding the applicant.bottom affidavit for you to fill out in the event the Office of Inv has contact 9en enaut/licease number which will be used as a refetrace mmber. The affidavits may be zet®en t^ be sine to fill in the p have bees made• ' the Department by marl or FAX unless other arrange The Office of Investigations would like to thank you in advance for you cooperation and should you have any questons. please do not hesitate to give us a call. xx The Department's address,telephone and fax number The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imteovations 600 Washington street Boston,Ma. 02111 fax#: (617)727-7749 9 or 375 phone#: (617) 727-4900 ext. 406,40 r 7io CMR Appnfda J Tab1eJ3=b(eeaduuuQ Prsserip&e Paeka;a for One 2"TwO-Fgu*Reddmdal Ruddlotp Heteed with Ford Fads MAXIMUM himm M ceiling well Floor eaaemea< slab H==g/Cooling Amz�8� U-� R Wuc' R-Vgoo'L RwahLJ wall paim= F.gwpm= Effi= Y' Ito-valuewvalna' Padrage p' 5/01 to 6500 Heada6 Dew Da Q 12°/. 0.40 3E 13 19 l0 6 Normal R 12% 0.52 30 19 19 10 6 Normal 9 l2•/. 0.50 38 13 . 19...- r 10. .6 85 AFUE T f 15% 036 38 13 2J WA NI ' Normal U IS'/a 0.46 38 19 19 10 6 Normal V 15•/. 0." 38 13 23 WA WA 95 AFUE w 15% 0.52 30 19 19 10 130- y i5 AFUE X 18% 032 38 13 25 WA Normal 19% 0.42 3E 19 25 WA Normal Z 18% 0.42 38 13 19 10 90 AFUE AA IS•/. 0.50 30 19 19 10 6 90AnM 1. ADDRESS OF PROPERTY: © �`� rr,\VJZ5-�' . � y �03 Q 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 1 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZINGAREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: ` YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table JSZ.lb: ' 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 ° the total glazing area may be excluded from the U-value requirement. area,expressed as a percentage. Up to 1/o of Sl S S or exam le,3 ft of decorative.glass may be excluded from a building designwith 300 ft of lazing area. F p ' 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 its:center-of-glass U-values cannot be used. whole units: S 11 ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. t f used). Do not include 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing( 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. T.e entire opaque portion of any individual basement wall with an average depth less than 50%below gra F de must mezt the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned br..,ements must be included with the other glazing. Basement doors must meet the door U-value requirement d_scribed in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4,or 5. If you plan to install more than one 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.la 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(035 for doors). 43 f THE Tp The Town of Barnstable swxNsreec.e. g Regulatory Services �A . 6. Thomas F. Geiler, Director, TED MA'S Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-79.0-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion: improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: � O Estimated Cost � � Address of Work: Owner's Name: S Qv Date of Application. 1 `3 C7 I 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 TWORK UNREGISTERED NOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT 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. R Date Owner' ame q:forms:AfUav:rev-070601 r RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE 6 6 New Building Additions $50.00 Alterations/Renov ons $25.00 Building Permit Amendment $25.00 - FEE VALUE WORKSHEET NEW LIVING SPACE "- square feet x$96/sq.foot= �" x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE A r square feet x$64/sq.foot= r x.0031 plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft` >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= tea . STAND ALONE PERMITS Open Porch x$30.00 (number) Deck x$30.00= .. (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 o(plus above if applicable) Permit Fee proicost f �pF THE The Town of Barnstable aARN rA ta g Regulatory Services 1639- �'4 Thomas F. Geiler, DirectorniAtt` Building Division Peter F. DiMatteo, Building-Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1 JOB LOCATION: O 5 slice[ village number 5 O� ZO "HOMEOWNER": hom phone# work phone# name CURRENT MAILING ADDRESS: stale zip code city/town ings Of six units or The current exemption for"homeowners"was dl idual f r0include does not possess a license, less crov d that less and to allow homeowners to engage an individual the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who-owns a parcel of land on yvhich he/she resides or d��d st uctture�s adecesso which such use is, and/or intended to be,a one or two-family dwelling,attach mod shall not be considered farm structures. A person who constructs more than one home in a two-year p a homeowner. Such"homeowner)shoes on ble for aubmit to the ll such work ing official rformed under he buildin ceptable to the grmit. Building Official,that he/she shall be r p (Section 109.1.1) es responsibility for compliance with the State Building Code and The undersigned"homeowner"assum other applicable codes,bylaws,rules and regulations. ing The undersigned"homeowner"certifies that he/she understands a Town of that he/she arnwil comply withsaid Department minimum inspection procedures and requirements procedures and requ' ments. 9 Sign a of Homeown Approval of Building Official Note: Three-family dwellings containing 335C.�cubic f et or larger will be required to comply with the State Building Code Section 127 HOMEOWNER'S EXEMPTION ennit is re wired shall be exempt from the The Code states that: "Any homeowner performing work for which a building p q 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." the responsibilities of a supervisor(see Many homeowners who use this exemption are unaware that they are assuming Poften Appendix Q.Rules r Regulations ularly whenothe hhomelng Construction Supervisors.section owner hires unlicensedersons. in this 2.15) case.our Board cannot proceed ais lack of awareness gains[the serious problems.particularly communities require.as part of the penile[ 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 application.that the homeowner certify that he/she are understands d respoadopt suchta form/a ties of a Supervisor. for on a las rcommunity.thisissue is a form currently used by several towns. You may Q:FORMS:EXEMM N a f `105 p LOT 11 — _,�V ,cU = -- {-—-- .. 4 LOT ' . .. ., r' 12 - X. LOT 13 LOT 38 o LOT 39 ES. ZON RC This MORTGAGE INSPECTION Plan is For FLOOD ZONE. "C Bank Use Only OWN: _(ZEWE,9[YL4F------- REGISTRY OWNER: _BAN_DALLA&Z'LLA_fld8__ _Y_—____ --.—BUYER: -JAME25— _DAIVGIE'RTY----------- ---------- PLAN -REF: _31043 ,I__. _SCALE:1" 30' FT. BY.CERTIFY TO M&P OF 11 sT-AVE8JfAY—ZZTU—INIUT�4L C—F.--'Q.THAT THE BUILDING PAUL cys YANKEE SUROEY OWN ON THIS PLAN IS LOCATED ON THE GROUND AS CONSULTANTS HOWN AND THAT ITS: POSITION DOES _--- CONFORM A. MIAiTHEW TH1. E`'ZONING LAW SETBACK REQUIREMENTS OF THE No. 320g8 e 143 ROUTE 149 OWN .OF ---HARAV19TABLE -------------AND THAT 9mr a� MARSTONS MILLS, MA. 02848 F AfCI � �`` DOES NOT— .LIE WITHIN THE SPECIAL FLOOD. HAZARD ss, STER� �Q TEL:` 428-0055 REA; AS 'SHOWN ON THE H.0 D: MAP DATED_.Z_1&jj2._- °NA1 LnNos FAX. 420`5553 o u it =Pa e 250001 '0016 C qq' THIS PLAN NOT MADE FROM AN INSTRUMENT SURVEY NOT TO BE USED FOR FENCES ETC. 8471 KJH ,fil w/1 4-, 7' THE TOWN , OF BARNSTABLE IDARIFS LL 2639- BUILD! INSPECTO am APPLICATION FOR PERMIT TO ..................... .... ... ............. ......................... ...... ............................................ - TYPE OF CONSTRUCTION ........... .. ..................................."s...If/ ........... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ......... ................................. ... .�? � � 1........... /! �< ........................ Proposed Use ........2... ... .......... .............................. .............................4................................................ ......... ............... . ............... C. .............C ..... �"`.......... � 0� ... ..Zoning District ..................... .... C. ....... ..... Fire District .......... ..... .. .....0.. .Name of Owner ... ............ .... . ..............Addres/ ..... . . ...... f r Name of Builder ....................................................................Address .................................................................. ...... ..........Address .......... Name of Architect gzl-e—e... . ............ ....................... Number of Rooms .............1—.5.......... . ... dlounclation ....... ...... ............................ Exterior ...... 4—,�..... .. .... . ...........Roofing ................. ............................ .. .................. 2 Floors ........... 4....44... . .. ............... -:.Interior ........... .. . ............... .................... . ........... mbing ....... . ...................................... Heating a-LIA,....... .. ........ Fireplace ........... ..................................................................Approximate Cos>tfi..... 0 0 d ............................................... 4S, Definitive Plan Approved by Planning Board --------------------------------19--------- Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD 0 HEALTH UJI (9 < V) IM 00 a. X V) a z < LU N41 L > W 0 < b 3 ca 0 Xj:! , L L C1. , U- 0u) Q. Ll- LU 0 Im Uj 0 Z arr OBI < C. I X LAJ tJY Lit'. aJ J W Ul UJI z N 0 a. < (D C) :?-- < j Z LL z (n < 0 iz . CL LLI I-z < L) Uj X 5; LLJ < < z I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ... Name ..... .......... . .. . .... ............ � kJonzeglio, Felix 15403 one story single family diqelling /0-5" Lumbert Mill Road Location Centerville #12- Permit -G August 15 72 /*144 r42* Date Completed ...19 40 PERMIT REFUSED ---.----.—.--.~..----.—_.~_—.—.' ^' Approved ................................................ lQ ' . � ' -------.--'---.—.....—..---~..--.. ----.---.--------.--,...—^.-...^- � / � Assessor's map and lot number ...M ... ..�I'r�...�.. 1 �(/�/ �/ MUST - VSewa e�Permi+.number - L �.. OAAIN A &AR LE4! STATE THEro », 1 T N OF BARNST�'+ MEEa � DA13STADIiE. : ;+ "�� BUt?LDING INSPECTOR i6 9 R C APPLICATION: FOR PERMIT TO ...:.... ......... .. ........!./............................................. f� TYPE OF CONSTRUCTION ........................................ -".:rt1�G?n!?....................... ..... ......... Gi ........ . . ..........................19.�r n, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according tto/the following i formation: Location ......... Q. ..... Y�� 4 ..................... ....................................................... ProposedUse ................ .. .................................................................................... .......................... �..............................Fire District .......�.....�.......... Zoning District .............................. .......... ................ .............................. Name of Owner 1�F�4 L'. .�....... ::....7f .ry .. ......Address ..................................... '! P� Nameof Builder .....................................................:..............Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .......� . ..........�• 7.1ASS-n ... ..............................Roofing .1I&.............. ............................................ Floors ...... ......Y��/�'.....................................................Interior ............ . . ..�4�..��.. e.'................. Heating ...... Q??..................................................Plumbing ........ ............................................................ Fireplace ..................................................................................Approximate Cost .... .. M.......... ................. . Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions\ Fee .�_................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH " � r I • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � Harvey,` __--_-- A. � . , . 20168 to and enclose ` No ................. Permit fo, .................................... � porch ------------..`-----.------.. 105 Lunbwert Mill Road Location ----_.—.. --. .. --. .. .. --- ~ .. ..... .. . .. . _______.. .��u�mr��I�m__________. . � Randall A° Harvey Owner .------__.,__.__,—____—. / frame Typo of Construction -------------- ~^----..------..—.,.----.�.—.---.. - . r� Plot ............................. Lot ................................ -J- _ � r ' ^ y@ay 3 ' 78 Permit Granted -----.--- ]..�.�.�,-- g � � ` Date of Inspection --. ' --]g Dote 'Completed ��' �� lA � ' —'7—' —'y'—' -'—''�' ^ ' PERMIT . . - �lV ----._—....—.--.----..'—. . !- . ~''r—^'--'' ................................... ---'' ........................................................ `--.—..^,x. .--...~......---...�,—.-.,�-.....—.. '--..�.-..---.......~.—......,—..—.--..— � - ~ , Approved ................................................ ]9 � - --------^--^—'--^^~^''------^—'' � . ----------------.--.—....—.—.,. . / '\ ^ -------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- P ------------------------------------ ------------------- --------------------- - - _ ;; - 1 !! ------------------------------------------------- i - e � 3 A- Vz� fi ----- -- ------- ---- ------- ------- -------- ------ ------ -------- -------- ------- ------ - N BEDROOM ADDITION -�= 105 LUMBERT MILL RD., C'V1 LLE q � o = a f1-1 c. f LIVING AREA 1195sgft F f , i i - I - I �Q`�1 . i � � g ' 10� L�r► '��.t2� ��e�.. � C va�.L� 4 -- 1 f z i 1 i s i j 'R avM El�pe�`1viJ 1�S LUMC��`z i I Z.(. 1 1 . 11I rc t i. ...i..�._.. _...._ ____..�,.� .1 y. 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