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'i e . .. _ � _ .i r _ Town of Barnstable Permit: 66 CO&58 Regulatory Services ate: ' , pU Thomas F.Geiler,Director ' / Building Division vsrne� = Tom Perry, Building Commissioner 1639. 200 Main Street, Hyannis,MA 02601 D� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT C-Zz=� 774-�39�S�S Owner: Z/,c�/� ,,Cl. �T���� Phone: �CJ�' 71 Install at: 33 A-.4 Village: Map/Parcel: 1 I Date: Stove A.(�Used B. Type: adian Circulating C. Manufacturer: Lab.No. D. Model No.: 2$'-A,9 Ve -/ Chimney A. New/Existing (If existing,please note date of last cleaning B. Flue Size ELL T /C - L 4CK PIRZE C. Are other appliances attached to Flue? ' D. Pre-fab Type and Manufacturer Siyl�vs©/!JS ��/iZ/9 e YE/UT DELI� IjST.CoC�C`p/P�" E. Masonry: Lined/Unlined Hearth A. Materials: L p,, fjZd-72 B. Sub Floor Construction: CD �'eG-"T Installer Name: <</,0V1/ jdi9��,e /g Address: Phone: L Location of Installation: /yz= H.I.0 Registration# Construction Supervisor# OR check ZHomeowner Instal ' o license required APPLICANTS SIGAWE - APPROVED BY: 67 Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspec Nam,„,'_g Q:forms:stove 3 9600 Rev 103107 tI ' . Oj f Freestanding Pellet Installation Caution: Follow the pipe manufacturer's installation instructions and directions for passing through combustible walls and ceilings.Check local codes in your area. Illustration 1 . 1 , 1 , 1 - ;1 1 ' Our Part AC-3000 is i cceptable for Must have minimum ugh-the-wall, 3"adapter before tee ins lation. (A 3100 for 4000+ for longer run " ft.i tallations.) For shorter nm (such as Masonry Connection below)tee , ? sone is —� a mt installation should acceptable.. _ .__ 18�"'`` bmod by professional _ Use 3"metal pipe n 'clearance and coupler for Outside Combustion Air. Mnimum 3' g, clearance from ground to the Pellet Vent Exhaust Pipe. llabidettRl4 � _ � 1 brtlieailb P i..a Masonry Connection • 0 5. 1 1• � .� 1 1 i Zi fwy � y tea : x 1.If 3"flue pipe exceeds 15'in length,increase to 4"flue pipe for remaining flue connections. "� y 2.Total flue length should not exceed 35'. .: 3.Horizontal run not to exceed 4'. 4.Floor protector required: Min.size 31"x 32". Y 5.If the total run of outside air connection exceeds 6', if more than 2 elbows are used, or if a basement install,use 3"metal pipe(and coupler)instead. 6.OuWde Air is mandatory for proper safe operadon. FLOOR AND WALL PROTECTION r Floor Protection A If your floor is constructed of a non-combustible material such as brick or concrete, there i4- need for floor protection. If the floor is constructed of a combustible material such as ha linoleum, or carpet, then you will be required to use floor protection between the unit combustible. The protection should be.U.L. approved or equal, and should be large err provide a minimum of one inch (1") behind and four inches (4") on both sides of the st clearance in front of the stove should be at least six inches (6").This freestanding pellet unit a minimum 31"x 37 floor protector. ` a Wall Protection From the rear and the sides of this stove only six inches (6") of clearance is required t€ wallpaper or drywall. The pellet vent pipe would require the standard three inches (3") rAl b as recommended by the manufacturer. Normally additional wall protection is not regtt re€I type unit. �a� Town of Barnstable oFTME'or�, _ Regulatory Services �nBLe Thomas F.Geiler,Director SAMMASS. 16 Building Division 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 Q Please Print DATE: JOB LOCATION: �3 ! /�UTN�7 " ��i�• ��� �nnummbberr street /e}y village "HOMEOWNER":L/V/G�//4� C-f7V�• `�z T ! 774 name home phone## woFk-phone#GELL Ir-We z— CURRENT MAILING ADDRESS: -� C h`J�f�V�G L (_!J f��L r 4 3_1 __1 eW_ZiX.5' /yam city/town state zip code The current exemption for"homeowners"was extended to include owner-occuuied 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 su rvisor. 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 procedures and 57A�_ e s rgnature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a 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 312_9116 7 0�t Town of Barnstable *Permit# D6-7 6 I 0 y�- Expires 6 months from issue date Regulatory Services Fee 29-i 60 X-PRESS PERMIT Thomas F.Geiler,Director MAR 2 8 2007 Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 33 ` e CPII �rrville, " Residential Value of Work �/�J d6 -OU Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address h 111l-QrA at- ler 17, 4x 5�I ,ow Gz5 aZ -f/,rle &-o �(7& -a ff�o Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor II am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to�aAl�s ere ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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 Pro erty Owner Letter of Permission. A y of the e e nt Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston,11L4 02111 \www.mass.gov/dia Workers' Compensation lusurance Affidavit: Builders/C�o tractors/Electricians/Plumbers AlppUcant information r. Please Print Legibly Name(Business/Orgmization/Individual); . �l `Ptr v i Address: D _ S 3 _D t' Ca4,,T- -,57 r ! 7& City/State/Zip: �60 G , ( Phone :#: ( � Are you an employer?Check the appropriate bog: Type of project(required):, 1.❑ I am a employer with 4. E] I am a general contractor and I 6 New construction.. employees (full and/or part.time).* have hired the sub-contractors listed on the-attached sheet. 7. ❑Remodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp,insurance comp.insurance.# 5. We are a corporation and its 10.❑Electrical repairs or additions required.] 3.1a I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions ' myself. [No workers' comp. right bf exemption per MGL 12�Roof repairs insurance required.]t e. 152,�§1(4),and we have no 13.❑ Other employees. [No workers 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.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 isproviding workers'compensation insurance fo rmy employees. Below is.thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: ' Expiration Date: City/State/Zip: Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure,to secure coverage as required wider 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 he c r 1 u der the pains•and enal s of perjury that the information provided above is true and correct Si a Date: — { Phone#: d 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 orkers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the s ce of another under any contract of hiie, express or implied,oral or written." An employer is defined as"an individual,p ership,association,co oration or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal epresentatives of a deceased employer,or the reaeiv�or_tivs_tee-of an individual�partnershi association or other al enti employing employees. However the owner of a dwelling house having not more th three apartments a who resides therein,or the occupant of the dwelling house of another who employs persons o do maintenance construction or repair work on such dwelling house or on the grounds or building appurtenant thereto hall not becaus of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every tate or local 'ceasing agency shall withhold the issuance or renewal of a license or permit to operate a busin s or to co stract buildings in the commonwealth for any applicant who has not produced:acceptable evide a of co fiance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Nei er the nmonwealthnor any of its political subdivisions shall enter into any contract for.the performance of public w rek 'acceptable evidence of compliance with the insurance requirement'of this chapter have been presented'to the n acting authority." Applicants Please fill o ut the workers'compensation affidavAanne ete ,by checking the boxes that apply to your situation and, if necessary,supply sub-conti actors)name(s),addand p one number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)oed Liab 'ty Partnerships(LLP)with no employees other than the members or partners,are not required to carry woompens ion insurance. If an LLC or LLP does have employees,�a policy is required. Be advised that davit ma be submitted to the Department of Industrial Accidents for confirmation of insurance coverage be sure t sign and date the affidavit. The affidavit should be returnedto the city or town that the applicatio permit,or 'cease is being requested,not the Department of Industrial Accidents.. Should you have any questiarding the 1 w or if you arerequiredto obtain a workers.' compensation policy,please call the Departmentumnber listed elow. Self-insured companies should enter their self-insurance license number on the appropriate City or Town Officials Please be)a that the affidavit is complete'and rinted legibly. The Dep ent has provided a space at the bottom of the affidavit for you to fill out in the event Office of Investigations h to contact you regarding.the applicant. �' Please be sure to fill in the permit/license num er which will be used as a re rence number. In addition,an applicant thatmust submit multiple permitllicense appli ations in any given year,need y submit one affidavit indicating current policy information(if necessary)and under"J b Site Address"the applicant sh uld write"all locations in (city-or town)."A copy of the affidavit that has been f#icially stamped or marked by th city or town may be provided to the applicant as proof that a valid affidavit is on a for future permits or licenses. A ew affidavit must be filled out each year.Where a home owner or citizen is obta' ' g a license or permit not related to y business or commercial venture (i.e,a dog license or permit to burn leaves et )said person is NOT required to co ete this affidavit. The Office of Investigations would like to thE ak you in advance for your cooperation d should you have any questions. -- please do not hesitate to give us a call. The Department's address,telephone-and fax ber: The Co onweai of Massaehuse-s i�ep. . ont ofln strial A.eeic�ents cc of layestiga oas 6"0 Washington Street :.oston,MA 42111 Tel. #617-727-4900 ext 406 or 1-877-MA.SSAFE Fax##617-727-7749 Revised 11-22-06 vAv .mass.govldia t FEE — + cc° TOWN OF BARNSTABLE, MASS. Q 4.0 19 o 4 o•5 THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO PO0�0 CD 0 > .,4= ' »................................................................................................................................._»..»..»..»...»................... ............_.................................................................................. _ _ o A~ (PROPERTY OWNER) (ADDRESS) 0 b 9.a TO ........................................._........................................._........................._._._..._._._........._..........................................................................................._........_........._....._......_____ 2 b E(BUILD) (ALT ) (REPAIR) 61 A N ci Aa G C (TYPE OF BUILDING) (APPROXIMATE SIZE) op LOCATION .............._._......................................................................................_.... ..........»..............................................................................»..............._...-_ ._. (STREET AND NUMBER) (VILLAGE) 91 NAME OF BUILDER O R CONTRACTOR _._..... _._...........................—............._...._................. _...._..........__..............__..._... A d CA APPROXIMATE COST ........................ .......—..... _...._.............. eggs I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN y � OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. 3 ° _ _._................._....._........_................._...._...................u ........................_........ ........................_............................................................................................................................ N d (OWNER) (CONTRACTOR) � 0+ U BUILDING INSPECTOR j Subject.to Approval of Board of Health. :'i'� � e ;!o i d >_ ki r w Y � VW it^ EE F Y Y 114 Y '•Y'e t . f4 ] - T r Assess s map and lot number ' v C � ' T SE Sewage Permit number ..... �( ................................ WITH APTI0LE 11 STATE SKIT mil' C0 1 'a To RM 9TWt 7NETOWN OF BARNLE � t BARNSTABLE, i 90 mum BOUNLOHNC• INSPECTOR APPLICATION FOR PERMIT- TO ,,,construct one story dwelling wood framef TYPEOF CONSTRUCTION ......................................:.................................:....................................:....................... R Dec. 11 , 74 ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............Lot72 Nottingham Drive, Centerville Resoldential Proposeduse .......... .............................................................. ................................ . ...........................I......................... RDI -Osterville Zoning District Center ........................................................................Fire District ................... ........... .......................................... Name of owner .., Normest Homes Inc. Address ., Nottingha.�rive .Name of Builder same ....................................Address ................................ .................................................................................... Nameof Architect .........none...............................................Address .................................................................................... Number of Rooms concrete slab , .................................................................Foundation .............................................................................. • asphalt Exterior ......Sh1ri. le............................................................Roofing . ................P................................................................. Floors ................ . ............ car et..............................................................Interior drywall. . ..... .. ....... .. ........................................................ electric one bath Heating .................................................................................Plumbing .................................................................................. - Fireplace ....i19.........................................................................Approximate Cost ...14, 000.00 ............................... . .. .. Definitive Plan'Approved by Planning Board ________________________________19________. Area .........`P.. ®..-? ...... Diagram of Lot and Building with Dimensions Fee S�..'.a ................. SUBJECT APPROVAL OF BOARD OF HEALTH 41 r 9 I hereby agree to conform to all the. Rules and Regulations of the Town of Barnstable regarding the above construction. Name �'��f�'!N ............... 0mzzueot Homes, Inc. Y ^ ^ ` ( . ` No`J74gA—. Permit for .....914!�..�P?Db--- � . . --- .................... Nottingham Drive ----' .. ---------------------. ` - Centerville �. ----.---------------------- � Ovvne, .............Norzuaat..Bomaa�_Ioc.�___.. � frmooa Type of Construction .......................................... � r � . � ----'—^--------------------' #7� Plot ��--' ^ / . _ ------- -~. --. -------- � December 19 74 � - Permit Granted -------------]g --- of Inspection -- ' Dote Completed ' . � � PERMIT REFUSED � -----.--.------------- lV -------.-----------,-------. ` ^ ' . � ^—_-----.—.----..--..------.~.. —.----.--.----~-------~—.--`— . - ----.---,—.-----.---.—.-----.. Approved � . ` _--------------. lg ' ' ' -------.----------..--.~—.--- . - ---------------------~^---'' ' . ^ . ` � ^ | �