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HomeMy WebLinkAbout0200 LUMBERT MILL ROAD B , f r or .3 1.� } •t k'.5 i tg: f. .,v. , qy ._ -. .::- -'.:,.,;., ._..,,, �r .,:�-:.. I. ,,,-,- ..; ..... .,: � 'k� ;, a=:=', ,�•' .::. .,., :.. .�.� i... ... .. ,. _., ,,i0. t. ., r, ,., .,.. .,.,,., .. x ,r.. J3 xj l: I' ?( `a. ar �t •;i�:Y6 tot . _,-.... .. t, ::. ,. ,, ,. t., .. ;.I t . ., ,.. (... rn ,:. :, a ..f. #3 •t= r._ .'„ 1 >I t.`i e- ,rt N.. s., ., .:i, ...::,.. � ,. ..t , r, ..,�.. ,.. ,4. o, „ ..s..r. .. .:. ,,... ,_.._. _a: Y�. :.:.; g'h. t },.�.:!,,,•�'lFY:^. .. , :, . ,,.._., ,:. . .. ,x 1.. %; ..r,. y r :,•. .�, ;. , .,.f f,:i 1 .`:' , k :'f. t.t. �}'' a },1'i ,, c p. tt . >,::.... :::;, ., :.. :.:.,.. .. ... .:,.f,.. ,,,,,;,,, ,,,;,,,:r •,:;:.., - .a r �.} h 9 i F „43 Z.j ,t r.. ,;�. 5 1 .•1 1 i aF t:. 1 .1 1� A .l t } :xr{. t 1 I •j; ` L J�V t fl 1 f 1 °•9 , t t , , 1 t 1 I 3'j•� .fit F,... i. l ! Fl i t 5 4 i ry ," u s .f i. t ? r° r. i l i 4 4r 4 ! A 4 t t l� ,A t. t. 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'u:•; , "_ ,., ( ,.aa��� ._, _A S xFy.4 E_,� - 1• :y ;. �`�w�n of3axs�able '°Pe yT R aaory.Ser [ces :Fee slul6 2015 $ sasq 6w Tleomas► F.C�er,Dhectcr pry� • TO ' BARNSTABLE BuflftgDivvision TOMFeaxn-CBO, Buzudin;Commissioner, 2001VWaSMez,E[YMM3 s_MA 02601 Ofce: 508.862-40-8 , IMPRESS APPT TcA roN FaX:509-790-6230 - R SID MAT L ONLY Maplp2xcejNumber_ o� V l l Jvozvali3svithoruRedx'�resslmp�rim PropetryAd&ess h D I 1 (oV Value of Works O - MWiwumfee OMS-00 forwoxkanderS6000.0o Owner's N=e&Address Contractor's Name reph=N=nber H=e itVrov=ert Co=ceorLkwseT(yairpaab]e)I laJ 53(D C0M=CTi=S 0(Z z£app&able ugezvisor sLT ) WOr 's ConV=Sationl e Cbeek one: ' ❑ II ama sole proprietor Ly I baveWorkerls mpensatioulr � 'Workmau.'s Corm.PoNzy Copy oamuraace Compiisnce Cerdfcate must accompany each permit Permo-sReq (cbeck boa) ^ Re rOof(Ixruricauanaa7ed)(s¢ F o7d'sbaa--ks) .ARC"amwactiondebrk wMbe rzkento_ e(hnx cane nailed)(not stappiog Going over ky=of=.±) ❑ RePlace�onextt'►Viudows/doors/slideis.0 Va]�,re .. -' �`(ma ffim35) o�-w3odows ,. rofdcas: ❑ SmOke/CarbonMonoxide detectors 4 goorplans maxked with ndS and inspections xe S gm . epa�caw Meemica3&Foe Permits recpbed_ 'Y4 re:cassied Is�mc£thsnamudoa�atexeagseeomF}�accleithozhetoe�zcdq regu3 at ie$isxocic Coascvatim ac ***Note: PropeztgOa�erzr�ustsz;rsProp%XlYb Mffrl.etterofPerrissfoa. �i of le Home imPr0vementC0ncmct0s license&COustmCdoxt Superrisms-Uts ue is �gIIired. SZC•�7AT'C11L•E= �, ,yam ' CaZscsld^eo18c11ppAanl7.oea�lliaote�W�doveslTempocaeyZa�a��c�,���ole�S2768D�TA • Revis�i 061313 ��ESS.doc k this would be charged for as�an extra at the rate of$6.00 per panel including Materials & Labor_ There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$110.00 per hour, plus 20% mark-yap materials. Possible Rxtra-If ice &water is found on current roof sheathing-removal of plywood will be needed as the existing ice &,water cannot be removed_ Due to its melting to plywood. Price is time and maternal at the rate of$110.00 per hour, plus 20% mark-up materials. Any deviation or alteration from'above specification will be executed upon written orders and will become an extra charge over and above the estimate. All . agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASLR CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. ]SATE OF ACCEPTANCE:,/O homeowner Fraser Construction, LLC Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 ` Home lnmprovement Contractor Registration - Regis;latioa: 112536 • Type: .DBA Expiration: 3/23/2017 Tra 263597 FRASER CONSTRUCTION CO. DEAN FRASEER P.Q. BOX 1840 CO T UIT, MA 02635 Update Address and return card_Mark reason for change. SCA T y 20ne-05111 []Address F7Renewpl E] Employment Lost Card C-�x�ie�pc�r�xoasa�at�rral�o�Q/r/lcrcaacJ.uae�Yi• - - Office of Consumer Affairs&Business Reguiation License or registration valid for indirvidul use only a OME IMPROVEMENT CONTRACTOR before the expiration date. df'foand return to; istration- 112536 Type: Office of Consumer Affairs and]Business 12egulatior. Expiration- •3/23/2017 DBA 10 ParM-=-suite 5170 Boston,MA.02116 FRASER CONSTRUC'nON CO. • /� F DEAN FRASER 104 TWINN NiEW LANE E FALMOUTH,MA 02536 Undersecretary Notva3id without signature t - ' i' Massachu ._Yes - D a t-tent of PUb- i Safe.,J ti 8ca d .ct'3ui!dir ! eg!tl iio s a- id:S-and Ards Construction Supen isor ;items,:: CS-097668 DEAN C FRASER 101 TWINN VIEW LANE. EAST FALMOUTH-MA 02536 C omm s s i;;r.a 06/07/2017 .�� FRAS:ON-01 PAAS �- CERTIFICATE OF LIABILITY INSURANCE DATE;fJl67lDDflYYY) 9129/2014 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 SUBROGA71ON IS WANED,subject to the terms and conditions of the policy,certain pollcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER t03 508 676- 09 CON E ACT Viveiros Insurance Agency,Inc. PHO NArar hie Paiva 375 Alrport Road JAIC,No •508-689-2713 IA c.No): 508324-4553 Fall River,MA 02720 ADDREss:APaiva Virrveirosinsurance.com INSURER(S)AFFORDING COVERAGE NAIC," INSURERA:Granite State Insurance.Co - - '"sue Fraser Construction LLC wsvRERB: PO Box 1845 INSURERC: Cotuit,NIA 02635 INSURER D: INSURERS: INSURER COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS 13 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 PESP=CT 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. l SR LTR TYPE OF INSURANCE INSR M M POUCYNUAMPR r, D= fmrAIDDNYM L@41TS GENERAL LIAEI Ury EACH OCCURRENCE S COMMERCIALGENERALUABILIY PREMISES Ea ocgrrerce S CLA 61S lNADE OCCUR IVIED EXP(Anyone person) S i PERSONAL&.ADVINJURY $ GENERALAGGREGAT'e $ GENLAGGREGATELMIfAPPUESPER PRODUCTSF-7 PRO- -COMPJOPAGG S POLICY JECT LOC ' S AUTOMOBILE LIABILITY G h1 s GLb UI•rll i EaacadenD S ALL OWN BODILY INJURY(Perpsrsar.) S AI�TfOS OWNED AUTOS ULED BODILY WJURY(Per acaderK; $ 1 NON-OWNED ' HIREDA'JTOS AUTOS (PERACCIOENT) $ I s UMBRELLA L1AS OCCUR EACH OCCURRENCE S EXCESS LU4B CL4IPoIS-MADE AGGREGATE S DED REf6d110N S WORKERS COMPENSATION S AND EWLOYERV LIABILITY NC STATU• OTFi. TORY IMRS aR _ A ANY PROPRIErOMPARTNERIF_XECUTIVE YIN JC WC009930601 912&12014 9126I2015 OFACEIUMEMBEREXCLUDED9 NIA E.L.EACH ACCID EDIT S 500,000 (Mandamry In NM fyes,describe under E.L,DISEASE-EA EM S PLOY $ 500,000 DESCRPTIONOFOpERATIONSbelor� EL DISEASE-POL'C"UNrr ts 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS 1VEHlcLES lAMaeh ACORD 1pt,Addiflonal Remallo Schedule,ifmore space 15 required) c CERTIFICATE HOLDER CANCELLATION SH OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division ittE EXPIRAMON DATE THEREOF. NOTICE WILL 8E DELIVERED IN 200 Main Street ACCORDANCE WITTY THE POLICY PROViSiONS. Hyannis,MA 02601- - AU'IHOR6ED REPRESENTATIVE - O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25{2010/05} The ACORD name and logo are registered marks ofACORD The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,M 4 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plulnbers Applicant Information Please Print Lepibl = Name(Business/Orga ' ton/individual): nitJ Address: q• 0 — x City/State/Zip: Phone#: 5 -�a�- a�� Are y 4 an employer?Check the appropriate box: L[ I am a employer with © 4. ❑ I am a general contractor and I Type of project(required)_ 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 g. ❑Demolition working for mein any capacity. employees and have workers' [No workers'comp.insurance comp-insurance.+ 9. ❑Building addition required.] 5. ❑ We are a corporation and its . 10•[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required-]t c. 152,§1(4),and we have no employees.[No workers' I3.❑Other Comp.in eitranCe xequized.j • 'Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy information. Homeowners wbo 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. I am an employer that is providing workers'compensation insuran information ce for my employees Below is the policy and job site t p Insurance Company Name: (��� ( �L IPSU_Ca(IC�e Col Policy#or Self-ins.Lie. Expiration Date: Job Site Address: �w � City/State/Zip. _ V AS e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required Linder Section 25A of MGL e. 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 cep under the pains andpenah*s ofpeduiy that the information provided above is true and correct- Si ature: . Date- Phone -'� Official use only. Do not write in this area,to be completed by city or town offuiaC - City or Town: Permit/License# Issuing Authority(circle one): . ILI oard o F Health 2.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector 5_Plumbing bnspector Otherntact Person- Phone# • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 4& ` Parcel 7 Permit# 30 Health Division&AG �1,-617ffvdkc Date Issued a 2000 Conservation Division U Fee /.5— _ 0 e Tax Collector N -OMWIA�)(; q V , S.PTE, : YSTEM MUST BE Treasure = M,,GTALLED IN COMPLIANCE Planning Dept, +, WITH TITLE 5 .� . ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS ° Historic-OKH Preservation/Hyannis Project Street Address �� U 6 e l ✓' L�;�' - - Village Owner OA-N D JN� ��°aJ P2'< Address �4� L Ufh 6LOW- �l i Telephone a Permit Request �F-�►/ /�' �Y� r �livv.c��✓ �f//�v� �..� l , AboLP ! _ Square fee.: 1 st floor: existing proposed" 2nd floor: existing proposed Total new Valuation SO, 000. Oa ZoningDistrict Flood Plai Groundwater Overlay e Y Construction Type ` Oal .)�`eL kxtL Owg16�e�,� L3�A1i W0010 )WA_km Lot Size 1�, 45-0 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family'1�_ Two Family ❑ Multi-Family(#units) Age of Existing Structure 32 Historic House: ❑Yes qNo On Old King's Highway: ❑Yes No Basement Type: 4Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_ new Total'Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 0Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing t New Existing wood/coal stove: ❑Yes KNo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size . Barn: ❑existing ❑new size Attached garage:'W-existing ❑new size Shedt4existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use t BUILDER INFORMATION Name C�v Telephone Number 3V _ l ? Address 3ql.3 M A(N License# �)0 7 635 02-�,'�3 G Home Improvement Contractor# l b 6 0 e Worker's Compensation# �-7doSS7 � �9Qq ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO 0610 Wg� SIGNATURE ' DATE `� � F t • FOR OFFICIAL USE ONLY - t -wPERMIT NO. ( y DATE ISSUED MAP/PARCEL NO. • . ��, . a -;t t r, r. r ' '• -t •1'`C v. '1 _ a4 - a • r, . ' t ADDRESS �. i VILLAGE. OWNER-; DATE OF INSPECTIOI � FOUNDATION FRAME r INSULATION Q �✓ YL �� � FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH r ..-FINAL GAS: ROUGH "_" FINAL 3 - " •- I� FINAL BUILDING � r�~ � I. �/ o� t�- , " - ' � 1 •~r DATE CLOSED OUT ASSOCIATION PLAN NO. OF IHE A The Town of Barnstable = &UMSTABLL 163 S. �0� Regulatory Services ArEp Mpl�' Thomas F. Geiler, Director ' ! Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax' 50-8-790-6230 Permit no. S 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. e _. YP ..-Type of Work: Gt1l [6� w 'r l �(6 �Jestirnated Cost 00 UAi 6�f` AA f r% 2� ' Address of Work: I / ,) Owner's Name:J", 00WA1 U iz e-( i_ %7� /1&100 13.e l_f�""�(J Date of Application: ad I hereby certify that: " Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ? e 2 0 bV �cc.� �e�' oS�I /06 00 Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav ESTIM LIVING SPACE Value (high end construction) square feet X$115/sq. foot (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot= ' PORCH square feet X$20/sq. foot DECK square feet X$15/sq. foot= OTHER insquare feet X$??/sq. foot= �� 1/04 Total Estimated Project Value `I i PAC For Office Use Only -lnclusionary Affordable Housing Fee Residential Commercial" Property Owner's Name Project Location Project Value Permit Number **Existing Sq. Ft. **Proposed New Sq. Ft. Fee $ IAHFORM 4/3/00 The Commonwealth o Massacnuserli Department of Industrial Accidents Office offoyestfgatfoos \y. "7r - 600 Washington Street �r Boston,Mass. 02111 Workers' Com ensation Insurance davit a i iiiiiriiirrir � name: • hone ^l 7 W cit," I am a homeowner performing all work myseiL Fi i am a sole proprietor and have no one working M'wn capacity i I am an employer providing workers' compensation for my employees working. .this fob comoanv name: I�- address: .; xx nOhdne City- W. ASSGC�i4 I"VL 1S f�Gj oiicv# �' n s u ra n cc co. / / ///%////// / /////////////////..�iii: '%��/:/�r: iiii//iio/iiG�/%r'/ii//i%%//////r/%/%%//////%%%/i%///// _ I am a sole proprietor, general contractor;or holneowner(circle one)•.and slave hired the contractors fisted below R•h�' have the follotiNing workers' compensation polices: comoanv nsme* ::•::: :::>;:•::::.:,:•-. ..:..�?:::•y.::-.:i-i::C;.'i:is}}:::j:i jit:Y`'.::.:.:: -::. i:{;(:_i:;:i:{{•i::vitv::::jY:i'?iiii'rii"$`:i{: {:t;:?Yt{.;:<:;: --: address. :... ... .:. .... - .....................:. ..:.• ..n:.......v:.....h'ii:::-:.'.':'•::i:•ri4:.....:`v:i::;.:....:......i•:{•:ih.::i::{v:;:.}y.N�:{?.?C�:;•i;;.}•nJ-;:;:::::.{:' .. ... .... .......:.::::.:..... +:•. .. .:{;..v.........nv::.:�.::- ......f:•.......n!W.•v:?•::•:.:}•:::::::::. City. :.,•::•:.:.............................. ....::...:.::::::. ::.. insurance co.: ........:...,.... F. comoanv name: address: ., � $one#i� city' :.::.::;:::>::.,:•::: •:;.;:.::•::::.:<•>:::::::. 77777777 insurance co o 0MAltion of criminal penalties of a fine n to S1.S00.00 uta/o p Paiute so secure a coverage as regmred under Section 29A of MGL 152 can lead to the impu°itl°ftc of S100.00 a day against me. I un erstattd that a one years'impri�orunent as well ai cavil peiutltle�tn:the:lorm-ofa-STOP.WOE ORDER and__ _ _ h copy of this statement may be forwarded to the OlIIce of Investigations of theflIA fur eovera�e veri8catlon. x:- Sze__ I do Hereby ceni der t pains pen es of perjury that the information provided alcove is true and correct �-7-- Si�iature Print name olticW use only do not write in this area to be completed by city or town of ciai permitNcense# ❑Building Department city or town ❑Licensing Board s ❑Selectmen's Office - ❑ check if immediate mQonse is required ❑Health Department ❑Other phone#; contact person: at s.� Information and Instructions chusetts General Laws chapter 152 section 25 requires all employers to provide workers' ensation for thei comp - Massa to ee is defined as every person in the service of another under any coat employees. As quoted from the "law",an emp y - i , of hire,,,express or implied, oral or written- association, corporation or other legal entity, or any two or more n An employer is defined as an individual,partnership, of a deceased employer, or the rec.�: g e: the foregoing engaged in a joint enterprise, and including the legal rep .•v - Io However the owner of a trustee of an individual,partnership, association or other legal entity, emp�ymg�P Yam• house of artmeats and who resides therein, or the occupant of the dwelling dwelling house having not more than three ap house or on the grounds , . - . - -`_won or rep air_work an such dwelling another who employs Persons-to do maintenance, building appurtenant thereto shall not because of such employment be deemed to be employer. • . .�.. . . ' .. ..._ � f: ` MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or rene� of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h not produced acceptable evidence of compliance with the insurance coveragerequired.n Additionally, ci work e _... oimcal suhdivisians _. r - - - shall esrtermto b urE coamaonwealth nor any of itsp _ _ _ ..�,_-._,�_.� r - _ _-chapter ha - - - the-c°ntrac�-'. e of compliance with the insurance regtnremeats g.: een presented to f acceptable evident comp ._ authority. Applicants - -� the box that applies to your sitnati ,tea Please Olin the workers' conapensatton affidavit completely,:by checking supplyingcompany �. - _ numbers aiamg with a CerafrCate of insurance as to affidavits may be = canfirmati of ins nice coverage _Also be sure to sign and.. submitted to the Department of bidUtlial Acculeats _ __� ar town that _application for the permit or license date the affidavit: 'I1ie affidavit should be ieturaed to crt3' 'law"or if not the D dustrial Aard�•�` .you have anyquestions being rEx�uested, eParMu t of Ia_ are required to obtain a workers' co�ensxum pohcy Please call the DePar�meat at the number listed ss City or Towns Complete and legibly. The Department has provided a space at the bottom of Please be sure that the affidavit is comp _ ._- _P �applies, Please to fill out�a the event the Office has-to you�� . affidavit for you -- _ .. be t^ be sure to fill in the p ermitllicease nnmberwhich wfil be used as a reference number. The affidavits may _ _ _ - have been made. _ the Department by maid or FAX unless other cooperation and should you have any questions. The Office of.Invcstigations would like to thank you is advance for you coop -- :_ please do not hesitate to give us a call. �/ /// The Department's address,telephone and fax mun er The Commonwealth Of Massachusetts Department of Industrial Accidents Office of fnYesagaatlons 600 Washington street - Boston;Ma. 02111 far#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 MCLULAWndisJ Sam w&Fow0Faeb psssaiPtt+'o Psi for aaa aad'TMsF�f Boitdtap MAXIIHUM Wall Roar Ham gF*M=saimL F4taea� S Wau mmm >1*vaiao P � 5701 to 690 Hndo;De Dam Noemai 19 lA 6 Q 12% 0.40 6 Mond R 1� tuZ 30 19 19 10 ES AkVE 19 10 6 Noeeasl 3 irb 030 13 2S NIA NIA Noemai T 15% 136 19 19 10 6 1S'lri. OA6 � tS AF�JE U ,a 13 NIM YI A6Z]E F is% aaa r 19 19 10MjW W 15% LU34onemix lE•/. 03Z39 t3 wAM=i19 2S NIAAFUE4 1E•/L OA2 3 19 l0y IVA M » 1 AEZJE M tE'J. 030 � 19 19 10 1. ADDRESS OF PROPERTY: n�d� /IS 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: �l 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF oRMATE G ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS . BUILDING INSPECTOR APPROVAL: NO: YES: q-forms-f980303a 780 CMR Appendix J Footnotes to TableJ5.11b: ass door.;. Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass � basement windows if located in walls that enclose conditioned space, but excluding opaque doors)t area, expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-valuE For example,3 fl of decorative glass may be excluded from a building design with 300 fl of glazing ai Z After January 1, 1999,glazing U-values must be tested and documented by the manufacturer in actor ,the National Fenestration Rating Council (NFRC) test procedi� e, or taken from Table J1.5.3a. U-valu. whole units: center-of-glass U-values cannot be used.. The ceiling R values do not assume a raised or oversized nnss construction. If the insulation achieves LL insulation thickness over the exterior walls.without compression, R-30 insulation may be substituted for h. insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R=values represent the sum of cavil, insulation plus insulating sheathing (if used). For ventilated ceilings,.insulating sheathing must be placed between . __.: i o.the-me die conditioned s . pn=nuts sic enuw.cd.Y 'Wall R values represent the snm of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R:I9'requirement could be met EITHER by R 19 cavity insulation OR R.13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-flame or mass(concrete,masonry,log)wall consirt:ctions,but do not apply to metal-flame 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._.- b The entire opaque portion o_f_any::individual:basement wall-with an-average depth less-than.50%below grade must meet the same R-value requirement as` above-gtade�walls:-WWdcws and=sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must-meet the door U-value requirement described in Note b. 'The R-value requirements-am for unheated-slabs.Add an additional R-Z for heated slabs. ' If the building utilize s.electric.resistarice lieatmg use complianc.&approach1 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 Deg=Day requireme:tts.ofthe closest city or town see Table J5Mla NOTES: --- a) Glazing arras 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 035. Door U-values must be tested and documented by the manufacturer in..accordance_with the..NFRC test procedure-or taken from the door U-value in.Table JI.5.3b. If a door contains glass and an aggmV to 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(Le.,may have a U-value than 035). c) If a ceiling,wall,floor,basement wall,-slab-edge,or crawl space wall component includes two or more arras with different insulation levels,the component complies-if the aiea-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 requirzmerrt(035 for doors). 43 fr c um A t-1 �' ,f, ,�, ►• ®'IV e 44.1 Al 4/ VL IV r � i1!!3 ' AM . r—AL � lk 11�1�A i�AMR M *0*N MAY WWI I NN WNW ci�n OA&M X* dra�sru 11 Roof C"torville � �r�•�wrw spa a.ret, o �e l 00110 Gedo 4227 Pop: 333 +��w1 M le N wNt IN'1MN1 . ' R b QM� 711 Q/9'! AtAe IWA Nm boa~wwR M dalA M an @MW 1"s 401 M�11 lr1�INa N YNd N.N1MA�A I b"W IM O RWOOd w wmwut met corporation (To ailnM�h►�ll Nren, Atleey Mvin mclem sw"y M Im lrr wow"~oN1 a NM Y�f poi f os rolff""dl by saM at "mWe Oka. AdMfft IAA 101 4464131 • ,1 L4 pl gr j f i - IT .__._.,._... -- _.---- 14 3 • � � �! if + ;i f< t t t — a _ o �, - 1 f-c ►'!1C i ns is � _ ell( , A3t A31 A3I [ r• - .. - �ar.cwwracwrrt. ��- - ,..was.. - •� K 1 i PQQ-L , 6/ 1 I to 01 .20 C) L7 ' � z U e"- dIL 1 4 a - • -- F - co if,6o cre4eI - t f 3 41 f 2oo Lu,� s it 15.12 Y 1xyrNer J o'� v r) Map Parcel Permit# 1 x, House# Date Issue d :30/.1:00 Fee : .1 -9:30/ 1:00-2:00) P dg.) tNe rq . rd 19 BARE. h MASS. TOWN OF BARNSTABLE Building Permit Application ; Project Street Address Village Owner Address Telephone ,Permit Request S' ` Le �� f� L�� tfb 5 First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House p Yes , o On Old King's Highway ❑Yes *0 Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing c — New Half: Existing -- New ~ No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas *il ❑Electric ❑Other Central Air ❑Yes KNO Fireplaces: Existing- New Existing.wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ?Attached(size) ❑Barn(size) ❑None -Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes;site plan review# - Current Use Proposed Use Builder Information - Name V.L �_® M"A Telephone Number Address TtE_ License# J .� L 7-0 T—, (%� Um `� Home Improvement Contractor# t �7?f Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6 1c,SIGNATURE DATE / 0 BUILDING PERMIT DENIE FOR THE LOWING REASON(S) FOR OFFICIAL USE ONLY r `: .�^ is �� � 1 ' t _ •' _ - ,� o � :_ � � PERMIT NO. DATE ISSUED MAP/PARCEL NO: ADDRESS ti VILLAGE++. -OWNER,-... • — _ J,,.n - i .,..+ n +, � � t mot_ w t r �•"`�; ,yt ,: �� F � DATE OFINSPECTION:' FOUNDATION f FRAME INSULATION ? FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH n FINAL FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN NO. i I r . e The Town of Barnstable, Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioae For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: ' `F �t Est.Cost —� Address of Work: f Owner's Name K&V I 64T t� Date of Permit Application: �� t I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a,permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owners Name v • The Commonwealth of Massachusetts � _���•'� Department of Industrial Accidents . ..._. €_ Office of/nyesti9inions _ 600 Washington Street Boston,Mass. 02111 workers' Compensation Insurance Affidavit name location C IV-c—e— city hone# ❑ I am a homeowner performing all work myself am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers compensation for my employees working on this job. com anv name: address: city phone# insurance co. olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: tom anv name: address: - ... dtr phone#•surnnce ca. _ cam anv name- addresr. hone#: ... city- . ..:. . . .:.........:,.;:<,.:::.:.::..:::>:::.,:. :. :• ;;: ..... inuarance co olicy# ::.: Failure to secure coverage as required under Section 15A of MCL 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and/or one years'imprisonment as well as civil Penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this Statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains an 41venalties of perjury that the information provided above is tru,and correct Si lure Date Print name U (� G Phone otIIdal use only do not wr:- dtyortown:— area to be compacted by city or town olIIdai permit/license it QBuilding Department Qldcensing Boardonced ❑Seieetrnen's Omce13 duck if immediate r ap ®Health Department contact person: phone th, ❑Other. (mvuea 9,95 PIA) ' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any 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 c trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewf of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of 1nsuance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pi number which will be used as a reference number. The affidavits may be wtua a io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts { Department of Industrial Accidents Once of Imlesuiations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 i • - ... ~ ,. ..y.., ✓fLCYJO7YV�IZO�IZClJCILGI/L d `�lfirvraclzuiPC DEPARTMENT OF PUBLIC SAFETY { CONSTRUCTION SUPERVISOR LICENSE . Number. Expires: Restricted 2"r PAUL K ROAR Wr 4 BOX�653 90 C11ER Y TREE RD ; ,,,;; ;, COTUIT� �� .✓It6 TpO�JViIl09f[4¢i6�IR o` dL[tdeab �. ml.,HOME IMPROVEMENT CONTRACTOR t.. • rzRegiStTation 115918 tTYpe' ;. - INDIVIDUAL 'bPirati0n 05/01/00. PAUL K. RONA `'PO BOX 653/ 90 CHERRY TREE RD f4k4kUIT MA 02136 ADMINISTRATOR QyoFTNEro�y TOWN OF BARNSTABLE • 33ARNS'TAIILE, MUG& 1639. 11 NO BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... 4 914 .. ..�.. ................ TYPE OF CONSTRUCTION .... ..... ........ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......W. r4p...... .......... Proposed Use ......Uqx—. ............................................. Zoning District ....ee...........................................................Fire District Name of Owner .......Address ............. 4 Name of Builder 4".e,"ft ............... ...... .............. Nameof Architect ...... % .............................................Address ... --* ,j-AA .......................................................... Number of Rooms ......(A........................................................FoundationC%VW...... .............. ...........................Roofing ....R.",5 Exterior ....................................................... Floors .. ..................................................................Interior tK t-1 Heatinge-74..F!. ...............................Plumbing ... ...... .. ................................................... Fireplace .....1.I.1. ...............................................................Approximatk- Cost e ................................. Difinitive Plan Approved by Planning Board --------------------------------19--------- 17 Diagram of Lot and Building with Dimensions 172, ON V) 0 < :C a. U) cn zCO Z < X 0r > .. ; M — 0 U- U- w h 0 0 V) x4 0 j Mo< Elf W z 0- Ld 00 LU -J ZD LJ-J I < V) U) LLJ Ly < LLJ V) Cr LLJ I.-: Mr < l 3: <VI-11 41, U) < I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name/ 7 Normest Development Corp. OTC 31 1970 13378 permit for one story, No ............. .................................... single family dwelling j .................�......................................................... Locatio Lumbert. ..M.i.11..Ro. ...ad .................. ................... .... .. . .... .. . .. Centerville Owner Nome st Development Corp............................. I Type of Construction frame t .................. l ................................................................................ r Plot ............................ Lot .........#16................ 1 Permit Granted .....September..2.$........19 70 Date of Inspection ....................................19 Date Completed ........//...:n....J.. ......19 �Q i PERMIT REFUSED r ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ..................... ......................................................... _