The URL can be used to link to this page

Home My WebLink About0212 PATRIOT WAY �, . � , r y �„ {� a_ .. .�.,, _ _ - . �, , ..� titi l � � �� 1 ` + � 0. � "d x :i�' �. _. ' r _. '�_ � �� 1 � .. e Y r i. Y B ... - A ,. .. - - ` >. r .. d i - � � ,. o e } .. ^: .. �- ., - �� a _ �� e c, .. .. .. �� ,.. .. C ,' Town of Barnstable o 1 g Po!dThis Card So That it is Visible From the Street-Approved Plans IVlust be Retained on'Job and this Card Must be Kept . M BA"''SrAISMM • + . " Posted Until Final Inspection Has Been Made '" „' # = f • "� Where a Certificate of Occupancy is Required,such Building shall Not be Occupied untU a Final Inspection has been made %639. It ry h _ n r�na _ - - Permit No. B-20-2309 Applicant Name: = Richard TupperApprovals Date Issued: 08/25/2020 Current Use '. Structure Permit Type Building,-Insulation-Residential Expiration Date: : 02/25/2021 Foundation: Location: 212 PATRIOT WAY,CENTERVILLE Map/Lot: 193-200 Zoning District: RC Sheathing. Owner on Record: POLIQUIN,CHARLENE S&NOWELL, KAREN F : Contractor Name: ,Richard S Tupper, framing: 1 Address: 212 PATRIOT WAY t ` Contra ctor.License CS-069058 2 CENTERVILLE, MA 02632 a Est. Project Cost: $5,148.bo Chimney: y Description: Install R-38 fiberglass and.R-37 cellulose to open attic space'. Install Permit Fee $85.00 soffit vents and propavents to maintain/increase airflow. Air seal Insulation:: home to restrict air leakage. Install R-19 fiberglass to basement Fee Paid $85.00 sills. Install 10 mI,poly to crawlspace floor and R'-10`rigid board'-to: Date 8/25/2020 Final crawlspace perimeter. > Plumbing/Gas Project Review Req: 4 Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and'invalid unless the work authorized by this permit is commenced within six months aIfter issuance. , All work authorized by this permit shall conform to the approved application and the approved construction documentsfor whiclithis permit has been granted. Rough Gas: All construction,alterations and.changes of use of any building and structures shall be in compliance with the local zoning by laws:and codes. This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. f , t, Electrical The Certificate of Occupancy will not 6e issued until all applicable signatures by the Building and Fire Officials are provided on this permit. F Minimum of Five Call Inspections Required for All Construction Work: Service:'. 1.Foundation or Footing " m Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed. _ Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection h 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final. Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site v . Final: . _ - All Permit Cards are the property of the APPLICANT ISSUED RECIPIENT /' � . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 312 Parcel Application# Health Division Conservation Division Permit# Tax Collector Date Issued c�:> , Treasurer Application Fee Planning Dept. Permit Fee 6b Date Definitive Plan Approved by Planning Board oK' 3W� Historic-OKH Preservation/Hyannis Project Street Address o l ` -_ f 1 rr,) -) -7--`--' ',`J Village CQI-n-f-ery 1�� Of Owner �V►. �` e� �` 6 n.) Address l Z elk�n �r—w-, �--- 1. Telephone S q Permit Request 1 �( �►• 9-1 Sep.��T(�-- :� .�•-„ �Q�a (A b D -et LA lei r L f (R< �D 4-- C.-n �—ge e Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation h 0 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 -161-73 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other 1♦S o� 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 +-f ►�,� r�-e �snew I �:J First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes >(No N 6 N<- N6 Ae— Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size PJ Attached garage:❑existing ❑new size N1 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ y -i ce Commercial El Yes ❑No If yes,,site plan review#— --- ° ------ -- �--- � - Current Use Proposed Use r BUILDER INFORMATION { b M1-.©w�t Name CAI -ems_.. -PQ)i 5 J j A Telephone Number Address License# C e -/I+,et v I P . .M14— Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `Z "1i`(i D: 7 FOR OFFICIAL USE ONLY PERMIT NO. D�TE ISSUED MflaP/PARCEL NO. a ADDRESS VILLAGE OWNER 'S DATE OF INSPECTION: { r: q FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ? FINAL BUILDING 3�3 U OR)-7-3 o-r i DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations ; d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers' Applicant Information i Please Print LeLyibly Name(Business/Organization/Individual): . Address \'� Y �T� v l/L/'�4 City/State/Zip: ��'�1 °l Phone.#: Are you an employer?Check the appropriate box: Type of project(required):_ ❑ I am a employer with ' 4. I am a general contractor and I 1. , 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the a 2.❑ I am a sole proprietor or partner- ttached sheet. 7. ❑.Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y P h'• , 9. ❑Building addition [No workers' comp.insurance comp. insurance.t 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 l l.❑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' 13.®Other1 N' comp. insurance required.] `t Se' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �r01 Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against,the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: �— L 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 Massachus General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant ths,statute,an employee is defined as"...every person in the service of another under any contract of hire, express or ' \ lied,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 ngaged in a joint enterprise,and including the legal representatives of a deceased emp eer,or the receive�oLtruste an individual partnership,association or other legal entity,employing employe s� However the owner of a dwellin house having not more than three apartments and who resides therein,or the ccupant of the dwelling house of a other who employs persons to do maintenance,construction or repair wo on such dwelling house or on the grounds or uilding appurtenant thereto shall not because of such e/enbe eemed to be an employer." MGL chapter 152, §2 (6)also states that"every state or local licensing awithhold the issuance or renewal of a license or ermit to operate a business or to construct buildcommonwealthforany applicant who has not p�oduced acceptable evidence of compliance withce coverage required." Additionally,MGL ahapt 152, §25C(7)states"Neither the commonwealthits political subdivisions shall enter into any contract for. a performance of public work until-acceptable eompliance with the insurance requirements of this chapter ave been presented to the contracting authority Applicants Please fill out the workers'co m ensation affidavit completely,by chec ' g the boxes that apply to your situation and, if necessary,supply sub-contractor( name(s),address(es)and phone n er(s)along with their certificate(s)of insurance. Limited Liability Comp es(LLC)or Limited Liability P erships(LLP)with no employees other than the members or partners,are not require to carry workers'compensatio insurance. If an LLC or LLP does have employees,a policy is required. Be ad 'sed that this affidavit may a submitted to the Department of Industrial Accidents for confirmation of insurance verage. Also be sure sign and date the affidavit. The affidavit should be returned to the city or town that the app ation for the permit r license is being requested,not the Department of Industrial Accidents. Should you have any q stions regarding e law or if you are required to obtain a workers' compensation policy,please call the Departure at the numbe listed below. Self-insured companies should enter their self-insurance license number on the appropriate ' e. City or Town Officials Please be sure that the affidavit is complete and printed gibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office Investigations has to contact you regarding the applicant. to fill in the permit/license number whic be used as a reference number. In addition an applicant Please be sure p pp that must submit multiple permit/license applications ' any g en year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" . e applicant should write"all locations in (city or town)."A copy of the affidavit that has been officia y stamped or ked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fixture permits o icenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining license or permit n related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)sa d person is NOT requ' d to complete this affidavit. The Office of Investigations would like to thank ou in advance for your coo eration and should you have any questions„- please do not hesitate to give us a call. The Department's address,telephone and fax mber: The, ommonwealth of Massachusetts \, De.artment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. ##617-727-4900 ext 406 or 1-877-NIASSAFE Fax##617-727-7749 Revised 11-22-06 www.mass.gov/dia /TME L v rr la vi Jv wi air 1."LIA1.0 IS Regulatory Services Ards ,$ Thomas T.Geiler,Director ��b,,l f p► '�• Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.,barnstable,ma.us dice: 508-862-4039 Fax; 508-190-6230 Permit no. Date AFFIDAVIT HOME IlVIPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c, 142A requites that the"reconstruction,alterations,renovation,repair,iuodernizatioq 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 ad}acent to such residence or building be done by registered contractors,with certzn exceptions,along vsdth other 4 r-M u� �98 requirements. r� .T�. T e of Work: � S�" fl,c �.5T d F Estimated Cost yP �. Address of Work: ` Z P{ (' 7,> rj-- L-V ---�-7 . Oymer's Date of Application: 2 - b I hereby certify that: Registration is not required for the following reason(s); Work excluded by law DJob Under$1,000 OBuilding not owner-occupied (Owner pulling own permit Notice is hereby given that: OytrnRS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATIONPROGRAM OR GUARANTY�'UND UNDERIYIGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner; Date Contractor Signature. RegistrationNo. ate Owner's Signature Qyrpfiles.forms:homeafUdxv Rev: 060606 �- Town of Barnstable yP��YTfiE Regulatory Services sAsrnaM Thomas F.Geiler,Director 9 MASS. s639. ,0 Building Division rED MAC a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstAble.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION —7 Please Print DATE: —D / JOB LOCATION: number Q street village "HOMEOWNER!': �1` �� i O. % y c v D�3' — I l 73 name ho phone# work phone# CURRENT MAILING ADDRESS: 2 i city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building"Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. Barnstabi UUUiLjr,1jrPMhF1 lit ——- - - . minimum inspection procedures and requirements and that he/she will comply with said procedures and requireme T Signature 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 cornmunity. Q:forms:homeexempt ;TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ")of 3 Parcel I ^ZCY) Application# d6O 42633� Health Division Conservation Division . ` . Permit# Tax Collector `y; r, Date Issued 3 Treasurer Application Fee *D Planning Dept. .' Permit Fee Date Definitive Plan Approved by Planning Board ti a ?/"/a 7 Historic-OKH Preservation/Hyannis Project Street Address Village e"CA .T u Ownerw � G ��t 1,r«tJ Address o /o �i4-a 'iG 7" iq L� Telephone d - �!/q-y !/6� 7 -5t:0 Y((0 M3� Permit Request Bof f1 s4 ��P x IG/�� .�l? 'c, D/T�.v iV 1,V=r AedL49Z %Zi tfaLlSr � /Qx V 0 /;;7 /��7lyT/CH 71&_ay/Sp%1_? IXI-f/2r2e Alp'2Ge44 ddwbl Td 4J 452Y Z?eXQ171's� ✓ �� ` 77� 10)*9:5A:K .2�0/�i Square feet: 1 st floor:existing 1AY proposed A5b 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation s Construction Type Wa9b)r4 ++N t' Lot Size� ,. �2 A fr Grandfathered: O Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure %,zZ5 .S. Historic House: ❑Yes o On Old King's Highway: ❑Yes 2'No _ Basement Type: fFull ❑Crawl ❑Walkout ❑Other PA Zn C-cn �04k5 W'N cooc%& meta Basement Finished Area(Aq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing_ new r, Total Room Count(not including baths):existing new First Floor Room Count / Heat Type and Fuel: ❑Gas 'Oil ElElectric ❑Other Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal stove: ❑Yes No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: E 1 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ " 4 Commercial ❑Yes 2Io If yes, site plan review# Current Use &�6D Proposed Use �- - BUILDER INFORMATION ? .._� Name /tea Telephone Number Address7,0 O r►C � License# --, Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE l—p 1 fi°�-�✓ FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE } OWNER DATE OF INSPECTION: FOUNDATION FRAME (0 6 f INSULATION 8w a? FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 1 FINAL BUILDING 62 DATE CLOSED OUT -- ASSOCIATION PLAN NO. i 1 } i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street . Boston,MA 02111, wtiOw.mass.gov/dia ' Workers-Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers• Applicant Information .Please Print Legibly Name(Business/Organizatiowlndividual): Address: 7_jD klawl, A18Av U City/State/Zip--:5;AAgoVM, ft4 OL6 Phonet t—727 7 Are you an employer? Check the appropriate bog: :Type of project(required):. am a employer with 4• ❑ I am a general contractor and I employees(full and/or part-time).* . have hired the stab-contractors 6. ❑New construction . 2.❑ I am a'sole.proprietor or partner- listed on lhe'attached sheet. 7.. ❑Remodeling ship.andhave no employees These sub-contractors have g, ❑Demolition yorking for me m any capacity, employees and have workers'l . 9. g addition . [No workers' comp,insurance comp, insurance.$' , required.] 5. ❑ We area corporation and its 10.❑Blectrical repairs or additions '3.❑ I am a homeowner doing all-work officers have exercised their 11.[1 Plumbing repairs or additions myself,[No workers'comp. right bf exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp,insurance required.] *Any applicant that checks box#1 must also fill Qut the section below showing their workers'compensation policy information. t Homeowaers,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the gub-contractors and state whether ornotthose entities have employees. If the sub-contractors have employees,they must provida them workers'comp.policy number. I am an employer.that is providing workers'compensation insurance far my employees. Below is.the policy and job site' information. Insurance Company Name: yl '1G�1 Policy#or Self-ins.Lic.#:_ JC ��Sr�i9�lD Expiration Date: Job Site Address.�2i r City/State/Zip; Attach a copy of the workers' compensation olicy declaration page•(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine. of up to$250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the-Office of Investigations of the DIA for insurance coverage verification. r do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct. Date; Phone#; �' TS-- 7 2;) Off cial use only. Do not write in this area,to be completed by city or town officiaL City or Town: ' Termit/License# Issuing Authority(circle one): .'1.Board of Health 2,Building Department 31 City/Town Clerk 44,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"..,every person in the service of another under any contract of hire, or express implied,oral or written." P An employer is defined as"an individual,partnership,association, corporation or other legal entity,or,any two or more of the foregoing engage m a joint enterprise,and including the legal representa' es of a deceased employer, or the receiver or trustee-of an' dividual,partnership,association or other legal entity,/employing employees. However the owner of a dwelling house ving not more than three apartments and who resides therein,or the occupant of the dwelling house of another wh, employs persons to do maintenance,construe n or repair work on such dwelling house or on the.grounds or building appurtenant thereto shall not because of such Jency loyment be deemed to be an employer." "every state or local licensing shallwithhold the issuance or IvLGL chapter 152, §25C(6)also statethat ev y f; • renewal of a license or permit to•ope to a business or to construct buil 'ngs in the commonwealth for any applicant who has not produced,accep ble evidence of compliance wi the insurance coverage required." . Additionally,MGL ehapter.152,§25C(7)s `es"Neither tfie commonwea1`th nor any of its political subdivisions shall enter into any contract for,the performance or" blic•.work until aceeptabj}�e evidEnee of compha ce Z*�ithtlie insurance requirements of this chapter have been presente to the contracting auth n'ty•." Applicants ,I Please fill out the workers'compensation affidavit con etely,by checking the boxes that apply to your situation and,it necessary,supply sub-confractor(s)name(s),address(es)an hone n mber(s)along with their certificate(s) of insurance. Limited Liability Companies'(LLC)or Limited Li, ility artnerships(LLP)with no employees other than the members*or partners,are not required to carry workers'compe ti n insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavitg may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure o s and date the affidavit. The affidavit should be returned to the city or town that the application for the pemit� . r licen is being requested,not the Department of Industrial Accidents. Should you have any questions regarding a law•or ou are requirea to obtain a workers' compensation policy,please call the Department at the number ted below. elf-insured companies should enter their . self-insurance license number onthe appropriate1ind. City or Towli Officials Please be sure that the affidavit is complete'and printed le y. The Departmeut h rovided a space at the bottom of the-affidavit for you to fill out in the event the Office of vestigations has to conta you regarding the applicant. Please be sure to fill in the permit/license number which be used as a reference n er. In addition,an applicant that must submit multiple permit/Hcense applications in y given year,need only submit one affidavit indicating cuu•ent policy information(ifnecessaty)and under"Job Sire A ess"the applicant should write`all•locations in__(city-or �, provided to the been officially t ed or marked b the city or tow .may be prom . town). A copy of the affidavit that has y tamped •. Y tY applicant as proof that a valid affidavit is on file for a permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a ' nse or permit not related fo any business commercial venture (i.e.a dog license or permit to bum leaves•etc.)said erson is NOT required to complete this affidavit. The Office of Investigations would like to thank yo in advance for.your cooperation and should you ha e any questions, please' o not hesitate to give us a call. The Depaztment's address,telephone•andfax nuriter:. ..The CaI�Monwedth of O=c-h 0tts• Dn"Ont of Tadusuial Accidents ()M"of luvesdgauans 600 waeingtoii Sheet B6:stanx AAA 02111 TO.#617-727 4900 ext 406 or 1'877-MASSAFE Fax 4 617-727-7749 Revised 11-22-06. www.ma;mg6v/dia 1 V Yr 11 V 1 1J at tla Lai✓l< yW °� Regulatory Services sAuvsrees.E. Thomas F,Geilen Director • `b 1619,19, �1�� Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.,barnstable.ma.us &ce: 508-862-4038 Fax: 508-190-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c, 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, irnprovement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but riot more than fom 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: '40,0171;0 Estimated Cost 92 Address ofVlorky��oZ owner's Name: 6�,e lJ.e /L-y � Date of Application I hereby certify that: Registration is not required for the following reason(s): 07ork excluded by law Fbob Under$1,000 OBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: oVnRS 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: r_ a e? Date Contractor Tignaue Registration No. OR Date Owner's Signature Q,wpMes.fbr=-.homeaffi d av Rev 060606 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE _- New Buildings $100.00 Residential Addition $50.00 ' Alterations/Renovations $ 50.00 - Building Permit Amendment $ 25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= ►, t plus from below(if applicable) ALTERATIONS/RENOVATIONS.OF EXISTING SPACE square feet x$64/.sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq,ft.= x.0041= 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.0041= 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 (plus above if applicable) Projcost Permit Fee Rr.v;063004 aJ"E 7. Town of Barnstable Regulatory Services } .. -. Thomas F. Gefler,Director . Building Division 'OIFD M1►i� TomPerry, BuDding Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-79076230 Office: 508-862-403 8 Property Owner Must Complete and'Sign This Section If.Using .A.Builder as Owner of the subject propertp hereb authoxize�ri C 0" n � `u�at to act on my behalf, Y in all matters relative to work authorized by this building p emit application for: �f0- (Address of Job) Signature of Owner Date print Name Q;FORM S;O W NERD ERMIS SIO N REScheck Software Version 4.0.1 x, Compliance Certificate 2'r7 pif ! Project Title: Poliquin 1 may- Report Date: 02/12/07 Data filename: Untitled.rck Energy Code: 2000 IECC V Location: Centerville(Barnstable),Massachusetts Construction Type: Single Family Glazing Area Percentage: 12% Heating Degree Days: 6137 Construction,Site: Owner/Agent: Designer/Contractor: LCentpe'iatriot Waylle,MA 02632 . . Your . .• Gross Cavity Cont. Glazing UA Assembly Area or R-Value R-Value or D.. Perimeter U-Factor Ceiling 1:Cathedral Ceiling(no attic): 320 30.0 0.0 11 Wall 1:Wood Frame, 16"o.c.: 424 15.0 0.0 29 Window 1:Wood Frame:Double Pane with Low-E: 23 0.330 8 Window 2:Wood Frame:Double Pane with Low-E: 15 0.330 5 Window 3:Wood Frame:Double Pane with Low-E: 13 0.330 4 Floor 1:All-Wood Joist/Truss: ver Unconditioned Space: 256 19.0 0.0 12 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2000 IECC requirements in REScheck Version 4.0.1 and to comply with the mandatory requirements listed in the check Inspection Checklist. Name-Title p A Gis- Signature Dat Poliquin Page 1 of 4 f b REScheck Software Version 4.0.1 Inspection Checklist Date:02/12/07 Ceilings: ❑ Ceiling 1:Cathedral Ceiling(no attic),R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame, 16"o.c.,R-15.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 2:Wood Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 3:Wood Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-19.0 cavity insulation Comments: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ Recessed lights are 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials.If non-IC rated,fixtures are installed with a 3"clearance from insulation. Vapor Retarder: ❑ Installed on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. ❑ Insulation is installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without compressing the insulation. Duct Insulation: ❑ Ducts in unconditioned spaces are insulated to R-5.Ducts outside the building are insulated to R-6.5. Duct Construction: Poliquin Page 2 of 4 r� Ll All joints,seams,and connections are securely fastened with welds,gaskets,mastics(adhesives),mastic-plus-embedded-fabric, or tapes.Tapes and mastics are rated UL 181A or UL 181 B. Exceptions: Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). Ej The HVAC system provides a means for balancing air and water systems. Temperature Controls: ❑ Thermostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor is provided. Service Water Heating: LI Water heaters with vertical pipe risers have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. Circulating hot water pipes are insulated to the levels in Table 1. Circulating Hot Water Systems: LI Circulating hot water pipes are insulated to the levels in Table 1. Swimming Pools: O All heated swimming pools have an on/off heater switch and a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps have a time clock. Heating and Cooling Piping Insulation: Lj _HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to the levels in Table 2. Poliquin Page 3 of 4 I Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in Inches by Pipe Sizes , Non-Circulating Runouts, Circulating Mains and Runouts Heated Water Temperature(7) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-169 0.5 0.5 1.0 1.5 100-139 0.5 0.5 0.5 1.0 Table 2:Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Rangeff) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.01 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD:(Building Department Use Only) i Poliquin Page 4 of 4 r{ Fill �• ✓�e La�rc�ncLirrueal�it a .'IGa.A;ac�u.:?l� i. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000671 I; Birthdate: 03/09/1955 Expires: 03/09/2008 Tr. no: 17920 Restricted: 00 THOMAS E DOWNEY 17 SPARROW WAY S YARNIOUTH, MA 02564 Commissioner • :. -r s - �12P �Q/�'j2�%CrQ/tZCILPCL�ifi�•C� Q� �/�' ��dd Board of Buildin Re ula ons and t g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 103926 'Type: Private Corporation Expiration: 7/10/2008 THERMCO, INC. WILLIAM MCCLUSKEY 7D Huntington Ave. -- ---- - — S. Yarmouth, MA 02664 ----------- -. ___.._ Update Address and return card. Mark reason for change. - Address Renewal .- Employment Lost Card -�_ P,oard of Pudding Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103926 Board of Building Regulations and Standards One Ashburton Place Rtn 1301 Expiration: 7/10/2008 Boston,Ma.02108 Type: Private Corporation -;EERMCO, INC. .'ILLIAM MCCLUSKEY Huntington Ave. Yarmouth, MA 02664 Deputy Administrator Not valid ithout signatt I � ACORD I DATE(MM/DD/YYYY! TM. CERTIFICATE OF LIABILITY INSURANCE j 04/12/2006 PRODUCER Phone: (781)986-4400 Fax: 781-963-4420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GATELY MORGAN&GILFOYLE INS.,AGCY.,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RISK STRATEGIES COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 400 NORTH MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RANDOLPH MA 02368 INSURERS AFFORDING COVERAGE NAIC# I I _ INSURED INSURER A: American Home Assurance THERMCO INC. INSURER B: 7 D HUNTINGTON AVENUE - -- -- SOUTH YARMOUTH MA 02664 INSURER C: INSURER D: )INSURER E: COVERAGES 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 CONTRACT OR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODlINSR INSR LTR 1 TYPE OF INSURANCE I POLICY NUMBER - POLICY EFFECTIVE POLICY EXPIRATION O DATE MM/DD/YY) DATE MM/DDlYY LIMITS GENERAL LIABILITY i S f EACH OCCURRENCE I COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED $ (-----I I PREMISES(Ea occurence) I _I CLAIMS MADE( I OCCUR I I MED.EXP(Any one person) is - PERSONAL&ADV INJURY 's I----- --- - — - I- ---- IGENERAL AGGREGATE s --- — GEN'L AGGREGATE LPROT APPLIES PER I - PRODUCTS-COMP/OP AGG. S i "--i POLICY 17JECT I LOC I , AUTOMOBILE LIABILITY I I I I COMBINED SINGLE LIMIT ANY AUTO j (Ea accident) S _j ALL OWNED AUTOS BODILY INJURY � I _I SCHEDULED AUTOS I (Per person) S HIRED AUTOS BODILY INJURY I NON-OWNED AUTOS I I I I(Per accident) S — I i 1 I PROPERTY DAMAGE tS I (Per accident) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT 'S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG Is i EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE IS OCCUR CLAIMS MADE rAGGREGATE s DEDUCTIBLE I S L-- - RETENTIONS S ' WORKERS COMPENSATION AND WC8958966 02/04/06 I 02/04/07 j W RYT IMITS( i OTHER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 500,000 A ANY PROPRIETORlPARTNER/EXECUTIVE I i OFFICER MEMBER ExcwoeD7 I E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT IS 500r0 0 0 OTHER: I I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ISSUED AS EVIDENCE OF INSURANCE. 4 CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE J. 15#erGately,Jr., President ACORD 25(2001108) Certificate# 11906 ©ACORD CORPORATION 1988 THERMCO HOME IMPROVEMENT 7-D Huntington Avenue South Yarmouth, MA 02664 (508) 398-7277 FAX (508) 398-7866 Sally Shea Town of Barnstable Regulatory Services Building Division January 19,2007 Ms. Shea: Mr. Thomas E. Downey is the head man in our remodeling division and has authority to act as an agent for Thermco in any and all matters. Sincerely, W.J. Mc key(Pre i ent Thermco Inc.) RIDGE BEAM AT NEW BEDROOM TJ-Beam 6.20 Serial Number:7005111359 User:2 1118/2007 11:27:48 AM 2 PCs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL Page 1 Engine Version:6.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:OM Roof Slope6M2 l Ell 2❑ All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width:8' Primary Load Group-Snow(psf):30.0 Live at 115%duration,20.0 Dead SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/UpliftlTotal 1 Wood column 3.50". 1.50" 1960/1555/0/3515 L1:Blocking 1 Ply 1 3/4"x 11 7/8"1.9E Microllam@ LVL 2 Wood column 3.50" 1.50" 1,960/1555/0/3515 L1:Blocking 1 Ply 1 3/4"x 11 7/8 1.9E Microllam@ LVL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):L1:Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 3443 -2963 9081 Passed(33%) Rt.end Span 1 under Snow loading Moment(Ft-Lbs) 13772 13772 20525 Passed(67%) MID Span 1 under Snow loading Live Load Defl(in) 0.404 0.800 Passed(L/476) MID Span 1 under Snow loading Total Load Defl(in) 0.724 1.067 Passed(L/265) MID Span 1 under Snow loading -Deflection Criteria:STAN DARD(LL:L/240,TL:L/1 80). -Bracing(Lu):All compression edges(top and bottom)must be braced at 9'2"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: SAL/THERMCO Bill Rubel PELIQUIN JOB Mid-Cape Home Centers 212 PATRIOT WAY PO Box 1418 CENTERVILLE MA 465 RTE 134 South Dennis,MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright C 2005 by Trus Joist, a Weyerhaeuser Business Microllam@ is a registered trademark of Trus Joist. H:\ORL BEAMS\BEAM JOBS\THERMCO-PELIQUIN-A.sms f r RIDGE BEAM 'A &,� AT NEW BEDROOM User:2TJ-Bearra6.20/2007ial Nurn27:48A:7005111359 2 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL User:2 1/18/2007 11:27:48 AM Paget Engine Version:6.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 16' 0.00" Max. Vertical Reaction Total (lbs) 3515 3515 Max. Vertical Reaction Live (lbs) 1960 1960 Required Bearing Length in 1.50(S) 1.50(S) Max. Unbraced Length (in) 110 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) -1311 -1311 Max Shear at Support (lbs) 1523 -1523 Member Reaction (lbs) 1523 1523 Support Reaction (lbs) 1555 1555 Moment (Ft-Lbs) 6092 Loading on all spans, LDF = 1.15 1.0 Dead + 1.0 Floor + 1.0 Snow Shear at Support (lbs) 2963 -2963 Max Shear at Support (lbs) 3443 -3443 Member Reaction (lbs) 3443 3443 Support Reaction (lbs) 3515 3515 , Moment (Ft-Lbs) 13772 Live Deflection (in) 0.404 Total Deflection (in) 0.724 PROJECT INFORMATION: OPERATOR INFORMATION: SAUTHERMCO Bill Rubel PELIQUIN JOB Mid-Cape Home Centers 212 PATRIOT WAY PO Box 1418 , CENTERV_ILLE MA 465 RTE 134 South Dennis,MA 02660 „ Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright ® 2005 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. H:\ORL BEAMS\BEAM JOBS\THERMCO-PELIQUIN-A.sms - I MULLION WINDOW HEADER B TJ-BeamCJ6.20 Serial Nu r:7 Bu 2 Pcs of 1 3/4" x 7 1/4" 1.9E Microllam® LVL Page Engine Version:620.6 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:OM Roof Slope6M2 f J _ - r • V 6'8.1 1 All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width: 1'4" Primary Load Group-Snow(psf):30.0 Live at 115%duration,20.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Point(lbs) Snow(1.15) 1960 1516 3'4" - SUPPORTS: Input Bearing Vertical Reactions(Ibs) 'Detail Other Width Length Live/Dead/Upliftrrotal 1 Wood column 3.50" 1.50" 1113/881 /0/1994 L1:Blocking 1 Ply 1 1/2"x 7 1/4"1.5E TimberStrand@ LSL 2 Wood column 3.50" 1.50" 1113/881 /0/1994 L1:Blocking 1 Ply 1 1/2"x 7 1/4"1.5E TimberStrand®LSL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):L1:Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 1981 -1925 5544 Passed(35%) Rt.end Span 1 under Snow loading Moment(Ft-Lbs) 5889 5889 8182 Passed(72%) MID Span 1 under Snow loading Live Load Dell(in) 0.108 0.317 Passed(U707) MID Span 1 under Snow loading Total Load Defl(in) 0.192 0.313 Passed(U396) MID Span 1 under Snow loading -Deflection Criteria:STANDARD(LL:U240,TL:U180).Additional checks follow. -TL:0.313" -Bracing(Lu):All compression edges(top and bottom)must be braced at 6 8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. i PROJECT INFORMATION: OPERATOR INFORMATION: SAUTHERMCO - Bill Rubel PELIQUIN JOB Mid-Cape Home Centers 212 PATRIOT WAY PO Box 1418 CENTERVILLE MA 465 RTE 134 South Dennis,MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright ® 2005 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. ®�e MULLION WINDOW HEADER B TJ-Bearr�6.20 Serial NuN. r:735g 2 Pcs of 1 3/4" x 7 1/4" 1.9E Microllam@ LVL User:2. 1/18/2007 11:25:51 AM Page Engine Version:6.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 6' 4.00" ^ Max. Vertical Reaction Total (lbs) 1994 1994 Max. Vertical Reaction Live (lbs) 1113 1113 Required Bearing Length in 1.50(S) 1.50(S) Max. Unbraced Length (in) 80 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 848 -848 Max Shear at Support (lbs) 875 -875 . Shear Within Span (lbs) 758 Member Reaction (lbs) 875 875 Support Reaction (lbs) 881 881 Moment (Ft-Lbs) 2585 f Loading on all spans, LDF = 1.15 1.0 Dead + 1.0 Floor + 1.0 Snow Shear at Support (lbs) 1925 -1925 Max Shear at Support (lbs) 1981 -1981 Shear Within Span (lbs) 1738 Member Reaction (lbs) 1981 1981 Support Reaction (lbs) 1994 1994 Moment (Ft-Lbs) 5889 Live Deflection (in) 0.108 Total Deflection (in) 0.192 PROJECT INFORMATION: OPERATOR INFORMATION: SAL/THERMCO Bill Rubel PELIQUIN JOB Mid-Cape Home Centers 212 PATRIOT WAY PO Box 1418 CENTERVILLE MA 465 RTE 134 South Dennis,MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright ® 2005 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist: J 6 i J � � 14``: \ � A CO I certify that this property is located CERTIFIED PLOT PLAN in flood hazard Zone C (outside the 500 year flood) 'as Identified by the Depart- LOCATION ment of Housing.and Urban Development(HUD) . SCALE . � . •moo DATE �?��•�. zti.'.'¢ Date A�lz�G Z Zov� � Os 7s PLAN REFERENCE••• �`?!`�.. C T"�7�. EOtPJA � Re aNc ury ,fir . l j-0 THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON , EITHER WAS IN COMPLIANCE Z certify to its title insurance company WITH THE LOCAL APPLICABLE ZONING BYLAWS that there are no visible encroachments IN EFFECT WHEN CONSTRUCTED {WITH r or easements e)cce t as shown and that this RESPECT TO HORIZONTAL ONL ) , EXEMPT FROM � REQUIREMENTS ONLY) ,OR OR EXEMPT FROM plan was prepared under my immediate VIOLATION ENFORCEMENT ACTION UNDER M.G.L• supervision. TITLE VII ,CHAPTER 40A, SECTION 7,UNLESS�3 'j,,, A10W�`u"/2�T OTHERWISE NOTED OR SHOWN HEREON.-;s I - R . • GaT Gor -' I 97.E 2d't /01 /p T fovvo. ,o, s.r o y,N y� 7 3a, 702 Exsr 9 •'�' O.c3. � ® j � I fd Ala ",OWAA i 7? . y3, 7 TES T DES u 7..(.) wnl TO VAJ TER.. 1-5 M / /,///"IU/7 .8UILDlNG 5E7-C3'19C1< Az?r0L/ PE /"IEA/TS U 2 / V E L./i9 Y A./ O 7- T O 13 E 4-d C y T..E D O I/E.i2 S E G,/E � .G7C SAS 7 �/"l U�/LESS N-20 DES / GAJ ' L0 /f? D / A-/G /S USED . , c r- n -T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel o Application 0 4`a 33 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owne Address _e Telephone Permit Request n / � Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) c Age of Existing Structure Historic House: ❑Yes ❑No On Old King's hway: (aYes �❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other ; Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) -� ci: Number of Baths: Full:existing new Half:existing rev ' �d r Number of Bedrooms: existing new --J M Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas Cl Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing O new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Co—mmercial U Yes O No If yes, site plan review# Curre t Use Proposed Use BUILDER INFORMATION ame /A,,-e 1,el 9 `! Telephone Numb r Address l C9.1 en r License# AA A Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKE eATU�RE �� E -'7--D� F o FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED I . s MAP/PARCEL NO. P' 5 ADDRESS VILLAGE OWNER r E t DATE OF INSPECTION: J s. FOUNDATION FRAME 7ld? INSULATION (() FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ?I3�1 DATE CLOSED OUT ASSOCIATION PLAN NO. of'WE T Town of Barnstable Regulatory Services , s,►xxA a M Thomas F.Geiler,Director 9�'ArEorp�`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR c Le iv , owner of property located at, oL 1f- , hereby certify that All'Inl is no longer Construction Supervisor listed on the application for the project under construction as authorized by building permit .33 issued on 200_7. , I understand that he project under constructi n un t p � o must cease until a successor licensed i Construction Supervisor, is submitted on'the records of the Building Division. i ' PROPERTY O DATE q/forms/newcontr reference R-5 780 CMR rev:080102 The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations 600 Washington Street �= Boston,M.A 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'blv Name(Business/Organization/Individual): . Address: O� la t-' J City/State/Zip: (f�l +-f-r- �t Phone.#: Are you an employer.? Check the appropriate bog: Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' Y P h' 9. Q Building addition [No workers' comp.insurance comp. insurance. $ 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 I l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MG r 12.❑Roof repairs insurance required.]t . c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are-doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site informatio . Insurance Company e: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy decla3ascivil age(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A ofL c. 15 ead to the�of position of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well penalties in rm 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 ma forwarded to the Office of Investi lions of the DIA for insurance coverage verification. I her ce an r the par nd penalties erjury that the information provided above is true and correct Si tore: / Date: d hone#: Official use only. Do not write in this area,to be completed by city or town ofj eciaL City or Town: Permit(License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is define a man individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engage ' a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an in 'vidual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house ha ' g not more than three apartments and who resides therein,or the occupant of the dwelling house of another who mploys persons to do maint Hance, construction or repair work on such dwelling house or on the grounds or building app enant thereto shall not b cause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states hat"every state or cal licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or t construct buildings in the commonwealth for any applicant who has not produced.accept 1ple evidence of ompliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither e commonwealth nor any of its political subdivisions shall enter into any contract for.the performance off b" wor until acceptable evidence of compliance with the insurance requirements of this chapter have been presented the c tracting authority." Applicants Please fill out the workers' compensation affidavit co lete by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses and pho number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limi d Liability artnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation urance. If an LLC or LLP does have employees, a policy is required. Be advised that this a idavit may be sub 'tted to the Department of Industrial Accidents for confirmation of insurance coverage. Al o be sure to sign an date the affidavit. -The affidavit should be returned to the city or town that the application for e permit or license is b ' g requested,not the Department of Industrial Accidents. Should you have any questions garding the law or if you a required to obtain a workers' compensation policy,please call the Department at th number listed below. Self- ured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and print legibly. The Department has provi d a space at the bottom of the affidavit for you to fill out in the event the Offi e of Investigations has to contact you r arding the applicant. Please be sure to fill in the permit/license number whi h will be used as a reference number. addition,an applicant that must submit multiple permit/license applications ' any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sile Address"the applicant should write"all locations in city-or town)."A copy of the affidavit that has been officially `tamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fdt�e permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a hcen a or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said pens is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. Th Commonwealth b .Mass chuse s e £ a tt Department of Industrial Accidents Office of Investigations 604'Washington Street Boston, MA 02111 Tel.4 617-727-4904 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.rnass.go-v/dia y°FSF1Elp�� Town of Birn►stable "P.�- Regulatory Services z sasxszAau�, Thomas F.Geiler,Director 9 MASS. 1639. DuRdincr Division MPI a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permitno. 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. I Type of Work, �S1 1z6 fi l �--Q 4u44 Estimated Cost- Address of Work: 6 C� ✓U�` (� �" 4 . owner's Name: { f ,J•�. Date of Application I hereby certify that: Registration is not required for the following reason(s): [Work excluded by law ❑lob Under$1,000 Building not owner-occupied ElGnerpulhng own perffiit Notice is hereby given that: oNMItS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FORAPPLICAI3LE HOMEIMPROVEI4�ENT WORK DO NOT HAVE ACCESS TO THE AR3I1RATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.0F PERMaY I hereby apply far a permit as the agent of the owner: Date Contractor Name Registrationly o. OR / C Date ame Q�orrshome�dav Town of Barnstable PROF THE rO''ti Regulatory Services IARNSPABL& : Thomas F.Geiler,Director y MASS. g 1639• Building Division rfn �p 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 �7 Please Print DATE: / JOB LOCATION: 2--l 2— / n G 1— !V^y `/ rtry/ number / street I c village "HOMEOWNER': I C n 6 0 1/V Q O— .2— name ho hone# work phone# CURRENT MAILING ADDRESS: ziT 2 i Or— f/lI`L +-grin f I.r _AA A— D 1,6 3 2 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The and igned"homeowner"certifies that he/she understands the Town of Barnstable Building Department inspection procedures and requirements and that he/she will comply with said procedures and re irements Signature of omeowner Approval of Building Official. Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that-if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ' Town of Barnstable *Permit# '8'S p� p� Expires 6 months from Issue date s Regulatory Services Fee Thomas F.Geiler;Director �Fo rAA`� Building Division Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 X'P ` ' a Office. 508-862-40$.8 JUN 8 2005 Fax-, 508-790-6230 kA EXPRESS PERMIT APPLICATION - RESEMMOMPOMMS Not Yalid without Red X Press Imprint dap/parcel Number• 1.5 3 U 'ropertyAddress � Residential Value of Work 1®D®off Minimum fee of•$25.00 for work under$6000.00 Jwner',s Name &Address P j gad erv�� 03 Contractor-'s-Nalne Ek �►'� Telephone Number ?0,97 37'aV Home Improvement Contractor License#(if applicable) ! �� Construction Supervisor's License#(if applicable) []Workmaes Compensation Insurance Check one: E3 I am a sole proprietor I am the Homeowner I have Worker's C nsation Insurance Name Y"' V&1 :r; (r9f10° as N Insurance Company WorkmaWs Comp.Policy# 3 7 Copy of Insurance Compliance Certificate must be on file. �y Permit Request(check box) Reroof(stripping old shingles) All construction debris will be taken to A�fqlt+jc— "6 a n cr []Re-roof(not stripping. Going over existing layers of roof) [] Re-side [] Replacement Windows. U Value (maximum.44)- *,Mere required: Issuance of this permit does not exempt compliance with other tows department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature QTM-Ms:exprntrg Revise063004 Boa d o Building Regula ions and Standards Onb',Ashburton Place Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration - Registrabon: 141078 Type: Individual Expiration: 1/6/2006 ERIC BARSNESS ERIC BARSNESS 54 ANGUS WAY CENTERVILLE, MA 02632 - Update Address and return card.Mark reason for chang Address Renewal Employment Lost Card �/re-i�.nvmoou�ed�c o�'✓�am«.�leuaelta , Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 141078 Board of Building Regulations and Standards Expiration: 1/62006 One Ashburton Place Rm 1301 Type: Individual Boston,Ma.02108 ERIC BARSNESS ERIC BARSNESS 54 ANGUS WAY GG.._. emu✓ 4 CENTERVILLE,AAA 02632 Administrator Not valid without signature `J The Commonwealth of Massachusetts s Department of Industrial Accidents Office of Investigations 600 Washington Street f Boston,MA 02111 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib� Name (Business/or¢a�atiowTndividuo): a\L 96W Ke.55 Address: City/State/Zip: rely\ 6r, t Phone#: Toy- Are you an employer?Check the appropriate box: Type of project(required): 1.91 am a employer with _ 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7• ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.El am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 120 Roof repairs insurance required.]t employees. [No workers 13.❑ Other, comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their worker;'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: v1 f 7� 6 &37-4-63Expiration Date: 'Oa_ �r, Job Site Address: 1 City/State/Zip: ►r, 4 Attach a copy of the workers' compensation po icy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 caii 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 certi under the nains and penalties of perjury that the information provided above • true and correct Signature: Date: Phone#-- Official use only. Do.not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts Ge neral Laws chapter 152 requires all employers to provide workers' compensation for their employees., Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling hous having not more than three apartments and who resides therein, or the occupant of the dwelling house of anothe who employs persons to do maintenance, construction or repair wor on such dwelling house or on the grounds or build g appurtenant thereto shall not because of such employment be de med to be an employer." MGL chapter 152, §25C(6) Is o states that"eve'ry state or local licensing agency shall wit old the issuance or renewal of a license or per 't to operate a b siness or to construct buildings in the co onwealth for any applicant who has not pro ced acceptable e�Pence of compliance with the insurance overage required." Additionally,MGL chapter 1 2, §25C(7)states"'Neither the commonwealth nor any of its olitical subdivisions shall enter into any contract for th performance of pub c work until acceptable evidence of co pliance with the insurance requirements of this chapter h ve been presented to the contracting authority." Applicants Please fill out the workers' co ensation affidavit co letely,by checking the boxes th t apply to our situation and,if necessary,supply sub-contracto s)name(s),address(es) d phone number(s)along wi their ce fic"ate(s) of insurance. Limited Liability Co anies(LLC)or Limited iability Partnerships(LLP) th no e loyees other than the members or partners; are not requ ed to carry workers' co nsation insurance. If LLC or LL does have employees,a policy is required. advised that this affidavit y be submitted to tlDepartmen of Industrial Accidents for confirmation of ins ace coverage. Also be sure o sign and date the affidavit. The affidavit should be returned to the city or town that a application for the permit or 'cease is being=requested, not the Department of Industrial Accidents. Should you h e any questions regarding the la or if you die required to obtain a workers' compensation policy,please call the eparmmeni at the number listed be w. Self-insured comp hies should enter their self-ins a license number on the propriate line. B City or Town O i ' s Please be sure that the affi vit is comple and printed legibly. The Depardnen as provid d a space at the bottom of the affidavit for you to fill t in the eve the Office of Investigations has to co ct you egarding the applicant n ber which will be used as a reference be . In addition, an applicant Please be sure to fill m the p cease ., that must submit multiple perim ense appii bons in any given year,iieed only sub t e affidavit indicating current policy information(if necessary)an under"Jo Site Address"th&,applicant should writ all locations in (city or town)."A copy of the affidavit that ha been offs 'ally stamped or naked by the city or may be provided to the applicant as proof that a valid affidavit 'on file fo future permits or licenses. A new affi a 't must be filled out each year.Where a homeowner or citizen is o " ining a 'cease or permit noelated to any bu ines or commercial venture (i.e. a dog license or permit to burn leaves a .)said p on is NOT requ to complete is a avit f The Office of Investigations would like to thank u in dvance`for your co ,peration and s ould yo have any questions, please do not hesitate to give us a call. / The Department's address,telephone and fax number: The Commonwea of Massachusetts Department of Ind trial Accidents Office of Ines 'gations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia f t . 4 °pVE r°y, Town of Barnstable Regulatory Services ` snxxAM s. # Thomas F.Geiler,Director 'prEp;A.�a 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 Property Owner Must Complete and Sign This Section If Using ABuilder I, 6deML (,l r ,as Owner of the subject property hereby authorize �r i C Rg a►1e2,2 to act on my behalf, in all matters relative to work authorized by this building permit application for. Pa4il 0-� (Address of Job) P Signature of Owner IC5ate Lug l�h� f (cl ICI _ Print Name Q:FORM&O WNERPEPWSSION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map' r '1 Parcel UU Permit# �© / , Health Division o ��7'� aD ou-3YI Date Issued 4 - 2 6, Conservation Divisio6 ' Application Fee Taz Collector il Permit Fees .I Treasurer • " . SEP'�tC SYSTEM MUST BE Planning Dept. AMMCOMPUANCE Date Definitive Plan Approved by Planning Board MN TITLE_5- &MRO ENTXL CODE AND Historic pL� .r OKH Preservation/Hyannis T R GULATIONS I '12 Ew r4 . Project Street Address t� `Z, �!'r '� w N Villages Owner Address Telephone Permit Request F_\"Ukbin (---Pr2� k 0 o rric� fwor -?DR4"lCrJ3� A-10 Square feet: 1st floor: existing t 59 proposed C 2 2nd floor: existing A-JA proposed IU.,A— Total new Zoning District Flood Plain Groundwater Overlay ' Project Valuation V Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2�, Two Family ❑ Multi-Family(#units) Age of Existing Structure 2-(a Historic House: ❑Yes Flo On Old King's Highway: ❑Yes Vo Basement7ype: Ofull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /5-ZS Number of Baths: Full: existing Z new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing 7 new I First Floor Room Count -7 Heat Type and Fuel: ❑Gas Oil ❑ Electric ElOther Central Air: ❑Yes Fireplaces: Existing l New er Existing wood/coal stove: ❑Yes M_No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Zxisting ❑new size Is"x23 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes,site plan review# Current Use Proposed Use II BUILDER INFORMATION Name Telephone Number Address License# W5 - 9 �( Home Improvement Contractor# I Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE U -..�_ �� DATE FOR OFFICIAL USE ONLY a PER#AIT NO DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER ' . l DATE OF INSPECTION: ' FOUNDATION �� i FRAME (!�C TFTi� 5/7)aY t INSULATION FIREPLACE s/ y ELECTRICAL: ROUGH �( (/2/Oy FINAL PLUMBING: ROUGV*g FINAL ��f 0', GAS: ROUGH O 0 FINAL 1 FINAL BUILDING J3 0-n ' gtrft.� o DATE CLOSED OUT S� `� ' ASSOCIATION PLAN NO. rn m 9 i S 7 A, RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE - New Buildings,Additions $50.00 Alterations/Renovations $25.00 2 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 �5—7 square feet x$64/sq.foot= 2 x.0031= (] plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft._ x.0031= 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= 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 (plus above if applicable) ?e�� Permit Fee projcost �h 'Coml�?an 'ealth 0 1Vlass4chusetts . e lit • ', - —= Department of.�ndustrial'.t�ceadents' . 60U Washington Street - �� • Boston;Mass..02111 • pvorliers'.0 m ensation.Snswrance�;ffidavlt-GeneralBusfnes'ses '//� � / .Ct '"�,5.�,::Rari'1• :tiTa,,,rrr'4tfip"+'w � ...• r ••. � ., ' �,:.t•Y^ • stale,• ' anf/Bafl�ating �' ablis�im�t ' site locate foil address : $lzsinep TnIe. []Retail[,Restate Antos etc.)' work a sole proprietor and have no orb Q pace[�sgte (including Real' ❑ ,orldug xa and caps 'lo ees full 8c' art time Ocher T any an am to er vn /%//%/%//%/////%%y/%%/�///%/�%%%/�///%///l%%//%/%%� /%%%/%%%///%%/%/////%%// � cb pensation for my emfloyees worlang ., leers' m 1 �onthis�ob�;,.. r '�,i, ,:,:ti{•x'�;.�t; /// loyespzM&gpap t \, �: _ :, t. , ':';'r' a'r.?:" ,?' . .;,•,1, a;. :\I,'�<j: am�•, .•.J •.{• '••,.i., ''.••.dry;•}. •�d.•\•tr'�ti•'„L:•':�.•t,'rfl•.fi.'�2•'•• •ft•S' '1' .'1'••"t•i•�yl:'y ir�r ,:•, - y••^' i,k' t.t°Vti• 4:ry;..••1 ,jai. , •t f\ i•:.1�' 'i•:, <i:;,: ale¢'t.'t b�l':?.': �' • d.: L(L� ,; 'sf �•�• ,,Zti•,.4 :1' ,. � .0 Y.1,• , ', ',1„}S I•�?la:•t;.i,'rl••.•,'\••'•• •t�'t•,rt. f t ~• S'�\'ii:4.5�•�� r .r••.�#;:�4 t! r�. reel. i'2 ;'t•.'.:'},is;.;•.�iii': 1 '{ lGilrbti<f•r.it. `i'�{'•y.r COIh•8n �,,. . •:NOirk•k;•,: ';t• i •, r • 'f 1 'V1 !:v •L'ry•.•' J J•••ri f�r.• !r•. A r ,• a �f ' , .1,4�i�• . t ' , , 1 s 'S' ! •;7.S ',<•�; f�5�:�•,. .. Jer..::�••4' , a L•:' >:•• ,!,• 't:• ar • •f. �. 5 5.•i.%t t I..w.i�.. r: ... •q •r•., a{:: •1 t •I�i �'.ii S.• �, ry •1' �.a , ' �,�;'v' , J'tl�i'yJ i' .r � 'i w',L S ff'' i 'L'•t�i�",,; 1 • , •. i f' r '�}','. +':f• r ,•• ttit'"'r �w9;.• .; ar ,;,d{1.t.7.}{• tr,;. .., '� 11 ;�•''..' ,,?'f••,•.r,Yl Eta�4':: •M• • {t• eN':': F..'S.,ar r• . ,., 4.. :,. .y. J,+ Pf i•.. ,l.• i �,,,'�i..y .� 1'' r S'.. a.+z Ir t;.•+ tt4'' + 'r y l.• 5,,��• 'a'•t'.�t�t.•4: ., .^ , f'..+•t rr:r. '•al '• t 1• ' 1 r ; �'y.f ,'xi•• tp�r f�1:,. �••'i 5•'t ti.•L '�;;',<' .\ ^'•?•,• • %' 'I, ,�\''a }.•'r''� r; ••} i .'y •a;t •,f w�.;• ,1 at•.,4;�y'n..' 'i S•'' �:.j'''�,:�.r{•.�IYr,.,.r •wf , ci f F ;?? ;f' •f t�'i., -'Sr; 11-4 • 2.•; 0�]Cr ,04•t.:} .r. ri. r'• •,•, •'••''L•r `+ Y,. •t•�.., •r:5 �•r1�1 •.el,'„r .'li•I+yp:.,x.'... , arkta's' asuYea�c'e.c031+ 1•�''t'"1•i f;;` ` ,Y f'` t contractors listed below who have the following.w rt eud en in T am a sole proprietor aud'have hexed tte eP a fi ' ' ,•',: `;'1\• _,:y; l]�ies: t. `r t•.rFr ti}•":tr�;yp,ti"�{h : }tt4t'4i ,.,. 'r peasation po . : ':i rr wi.t �.•l}:•.. .r.:.. a. '' ,. • r' y •s'••f.�;r�''1\A1;;,�1'r.}w ��.•,rr,Vo ' '';. ,r.•t. •l 7�a:i�•yiFt;,:P.Y• �,t i.p' •r'�. •.�•1 , .tCt; '',' Ihi,'t;l'1;P:�1 a,_•�.r.. '• .y,. Sry. .:.' ,! r SS•; :�:;':+ �':'fi�•�•3r+;;p,2•:'' ', ':, •r••' <• ' r'"' ii ''lisp ,• ''J d rf�.L'i;;'li;i t'( tfa', 661 �`I,'�:1•,:'•, . \. 'I'•'.v.l i�: �,,�.::'{.•iLi'.•.y :.• .•. •a r., Vi < t 1.+...f SJt... �•; .d; s• \ , f' n+• r r r: ' v a f ,�,. •a, { ct rt.. �':' S \.i :r,�•:', .t, C. .,,•ry.a{ i':r',.t• :'p.' i,:. a;n•u,.p.. ''1•'r •' r '., t11.' rt 1•m rt 1 "t., ' , r.C, �,4: 'f...•i•� �t•''• •� "t' 't ,1•�•";*?! ••: :••i, 't '•�'=1�7': a:lt• ''''.'`,t '•l''.,f=b;.:• a••,:ry•�;,•,yj,:+•t: r�+d'GCS'S:..f'' '� •r, •r s+{.'•a ,:'L C' r'• {"pr'IiIV,. i'ftl ry�t•••F; •�: •!• \ i�:r:. ,�...� 'j•�,'.:'1 '• �... 1:'..t{.r±. i'� , ate e,: ., i. '�':• erg#;. L;t'i•• a' L •; C,nrt ,y+i_• ;ryv$;' ;fi t1:',i'11 t '•:T',, r cyrfl.:t: f•';+r'' •:cirri. }'dti:=r.lta> E�f• f' f''}' �t a• at'• 1 ''••.•.tl •. ' SF I•,1 ••.. aT 2:';P .;1. f ,1 pp ri il:.l ♦ ��• 1p,t. '+:,f'•r:•' '• 1• ..1 r • ,,.' 1 t yi••y 1•'t fat•S^•' , 1• ,r i� till �.. {.I,1•�: ;:f. ,, F:ar,}r si S• f1 \ ,p,w f y,;ar 'a'tr '.•+r $.t't t 'r, F... R.N:1t r yMt'•r•.}t:.3. :. . .. :'':'� /��, VLL'(:''1• ••• !1 , •• , r''•, (l'1 1\h '•a lea.•L4.:'�b'4?r•:: },7•t:.•• •`'•' . , 1 '.. .i•rl. :�+.v1.:1.7:i+Fe•L,��'r r vr.fir:•.,�. r. / ..•J I;.,f': .'• '•. t t ' 111SArancec0. :t': r` ,.r .(;ti,, ;1 t.;1 ';t, :,' ,;'if s7`y11'w;.}F�,i't� f+/l %iyJ''�':•ft•':l+r+'vz y,t.. / ;,. + +., A ' , •�," = 1 ,�•, •v,i1,:•'• i 0:=� ' •, ,' \:,�•• t•(,' lLM„•I�j f�,�•5�� 11 r.in _ •,:. ••/ Ilfii4.y.�iti'•r1�hY •1 ••t•:' r is t'r'IM.t:r'� •1• ''t A.. '•t 5••« ,tJ\ ,t•.'r i• }.I f. , 2 • \. •w•j�„�•'j•,'•• y rt) ti.titi '2`., ,V, a•' ,T.t.;,ti��.'j tl ft :•y <S•'a tier....,.. �..v•r jt f •� to, 911• lime^�'r .,,.. i f. � f. ..•'t ly;l '� �•�i ' �;u fir'''•" •t•:}. •}.' :'\:tfL..t aad.1_ S: , • •, •, •. a•r ' :• •. .rd..'r .r:. "i;ll y:..22�� :+f.�1,��•j l:•I , •fir�,..':'�•'•:.:: ,t:•'•} ti reS 1� „ •+ .. .p,4 l,: •' •r M.•r.'t• ','' '�O11E•Tf.•{' :.. ,• .... , 'r ',r 1;':!�•1 elf:ti'S, i \. '..,+ .,• 1•,•• r,'�;�r.•7�•fr. J,1' '\r y? 'r:',' •,• A. r.• fit,''y.:71 f•r r«•.;r:rrr.'•'.'+P%.LS;•.f�.. .:i,i�' '� f• ,1, •,F '..'..'.'• r y, ,1„ry.�i .2.. > �i �+r ' Z a; :\�i.",�.5.,; t, ilf:'�.•;•f.�•,7•a,. I+j f �'`•'.yti ' + "• •' ,•� •: '• 'r. rat ,,�. • („ 1.{'r,,.'•� J'••YL! • •L.L , ' ' i•1''• 6ryr1 N. '!�'S:'f:rt.5f' .'1•4�i. Cif'',. \. • . .•. 'r. • �.•' , G'�.} t.y. 1i ft f. r,•p+ '{f,, t r ,�t,.. ,�•.lt i.yl' , tti 4 v:;+•.i '%' �I'•a',.+,'I:r,-.�y�•�, nY1•a''!r1 ';f t;i •'f9• fi.•• L'y 5� /. o11Cr'aYi •.,t�'e•.tt'.• ,.• r •,>;`rfp�F4''•f •. aR•.t:7' t'+'r\:.• ,•i". .a, �.'.��tei.,'J.�:Jl• �:', },y,rfi•- f.. .. 4•J�r•••''••'. ;t':+tr l 1;.it..1FF"y fi :..,. M.•. .,.::. ' 00.00 Sn Or SI2511T511C'irbAF a to$lr5 osition of crimfnal lsenaYties of a fin tip a sinst me, I understand that% Failure to aeeure coverage as required larder Section 73A of MGL I52 can lead toe Pend a fine of�100.04 a'day g . ent as Wtu as chdlpenalties In the foYm it 6 6TOY WORK ORD , risonln everificatlon. ' • oTte yeara'lisp eat maybe forwarded to the Office ofDivestigations of the DTAfor coYerag , copy of thu statrin ' un the psi d penalties°f'perJury that the inform provided above is Prue a>'t'��e� I do hereby certi Date y Print name 'h. 1 otTcialnse only de notate inthis area to be completed by city or iownoit CW O$WlaingDepartment • permitllicenae# ]Licensing$oard 4vn: ❑Selectmen's Offace city or to []Hea2thDepartment , []cbeekif immediate r�poase is required phone#; contact person' ' (fevaedSept7A03) —_ _ e2,1 Information and iistructions' r p}}� G eral Laws'efiapter J 52 section 25 requires employers to provide workers' compensation fcr .their. usett� f. Y ♦11, 5 Massach ed'fromthe f`law",, an employe is.defm d as every person m the sezvice of another under any contract enp'loyees= ,dos lip d . of hire;express or' e oral or written. ' artners ' , ass ciation, co oration or other legal entity, or any fwo or rmre of erttpla}►er is defused as an indivndual,p I4 the foregoing engage 'm a']oint enferprise,and iuciuding elegai zepresentatives of a deeeased,employer, or the receiver or artaershi association or other egai entity, employing employees. 'Howevei.the owner of a trustee of an individ P • P� of more than three apartments a�d'who resides therein, or the,occupant;othe dwelling�house bf dwelling house having' . lb sp sbris to do mainfeuznce,constrketibn or repair work on such dwelling house or on the grounds or another who emp. 3' . • . . errant th 'eto shall not b emus a 9f such loyment.be•deemed to be ari employer.•,,., building•gPP . , .. ., ,; . . :;. •.•, ' .. IGL chapter.152 section 5 also'siates fhat•every s• te'or local licensing shall withhold the lssuaneo or renewal t to o,erate a business or to nstruct buildings in the.coninnonwealth for anyuran applicant who has Of a licens6 or pe?•m?,. the Ins not pT oduced acce any.o 'e dolitic l compliance hall enter into any eoiatractgfor theerformance of yublic work untg cozrmoonWealthnor.any.ofits oliticaisubdzms� $ y acceptable evidence of compli' 'ce with the incur cc requirements of this chapter have been presentedT to the contracting AL1t110rlty: . %%�r��yrr�;�,'//�ry�r��/��r� • Applicants Please a Wor1Ce!S'•eoupensa ' a vit completely,by checking the box that applies to your situation.,Please s 1 company nhze=address andpho'a umbers along with a certificate of insurance as all affidavits maybe submitted y arErnerit of yndustrial Acciden or confirmation of insurance coverage. Also be sure to sign and'date the to the Dee affidavit. Taffihe should b e re e o the city or town that the application for the permit or license is b eing to not the Aepartment oxndus 'a1 A idents. Should you have any questions regarding the'"law"or if'you are reques a vrorkers',compens, 'vnpQli ,please call theAepartrnent at the nimmber list.AbRIOW- •t required to Otain h , , • ' FINE City or Towns P leasebe sure that the affidavit is c' lete anclprinted le , ly. The Depar6=t has provided a space at the bottom oft he affidavit for you to fiti out in'the ev t the Office of Tnvest�g. 'ons has to contact you xegardi�g the applicant Please >n the pemnt%license niwber t�rbich will be used a referbncb number. ,'Z'he.affidavits maybe xetuaned tq be;sure to , ' ••FAX gements have emmade.• • ` `': .:' , ` '. • . the T)epartment ess other:anan . 4 .•. •' ..:� 3 Office of Investigations would e t6 thank y'ou in advance for u cooperati6n and s310u16 you have any 4uestions, The • .. • 1 please do not-hesitate to give us a-c / arEmenes address,telephone and fax number: ' The Dep - The Commonwealth OfIVCassachu tts Aepartment.of Industrial Accident Bice 12 in�esuftns 600 Washington Street Boston,Ma. 0z111 fax#: (617)7z7-7749 Town of Barnstable ot,•rNe rok, Regulatory Servides Thomas F D .Geller, irector s a s -Bujiftng D'I'Vis10n 9� s6;9• k1 '°rae MPS Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 pax; 508-790-6230 Office: 508.862-4038 ' permit no• Date AFI+'IDAVI'I' IEOME ZIYIPROYEMENT CONTRACTOR LAW SjjppLEMENT TO PERMIT APPLICATION o atio repair,modernization,conversion, " aeonstruction,altezations,ren v n, er-accu led MGL c.142A requires that the r re-existing owr� P •ymprovement,removal,demolition,or construction of an additionto any p at least one but not more than four dwelling units or to structures which are adj scent to containing th other building be done by registered contractozs,with certain exceptions,along wi such residence or building requirements. � edCosttmt __S S Type of Work NtiSh Address of Work: Z U k � owaae s Name; Date of Appliaatiow I hereby certify that: F140tration is not required for the follovring reason(s): []Work excluded by law []lob Undez S 1,000 []Building not owner-occupied '40wner pulling own permit Notice is hereby given that,�OWN ER TOR DEALING WITH UNREGISTERED OWNE73S PTJLLING TEENot RM CTORS FOR APPLICABLE HOME MUROYEAME TX FUl�TD UNDER M L 142A. CONTRA ACCESS TO TEM ARBITRATION PRO GRAM OR G SIGNED UNOERPENALTIES OF PERMY Ihereby apply for&permit as the agent of the owner: S Q Registraloll110 Contractor Name Date OL ,.ter e ou/�V IKE Town of Barnstable Regulatory Services STABLE, « Thomas F.Geiler,Director SM �9p.•� Building Division ATFO�,i Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 4—k ka'U L' JOB LOCATION: number street village HOMEOWNER': � ��A az- 7y`� QUtti1 name home phone# work phone# CURRENT MAILING ADDRESS: 5�..., e_ �+ .46 a vim_ • 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 su ep 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 requirements. ^ - Signature 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:fonns:homeexempt NJ N_�,V S'1�OKE DETECTOR ��Ily-��-lIR.� E , sNTS — �r— ARE NOW LAN . EVEN THE A DII G C E R � J NEW BEDROOM WILL TRIGGER UPGRADE OF THE SMOKE Dt ! FOR THE WHOL � , . USE. YOU MUST R - OLrAND HAVE YOUR PLAN ACCO T THE APPROPRIATENi ELECTRICIAN E CEP TMENT. PERMIT ATE �`� �Z2 h w . soh' SMOKE DETECTORS O.K. A Z-&^ R ST y P + arc Dal, ��j M,.II laAj ,S fill. � w soy _ -G 2 4,1 Dal, may �, J J asX e�C��e�MJl1+oV � �� T� �r -?OUD — +� Cxi$+/Iq�i nn u i l a 6✓f s,cf v C �l�6 0�ipd " Permit No. -- �`Tr`'� TOWN OF BARNSTABLE - --- ""'r'" -- BuildingInspector Cash OCCUPANCY PERMIT Bond -------------------------------- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to uffolk Yeglty `.Crii9t Address ?X jnP, rar*ervil-lP. M4. Wiring Inspector Inspection date /'0" Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .....................................................1 19...... ...................................I............................................................................_ Building Inspector Assessor's map and lot'number ............................... oys-FEIW Toy INSTALLED 11,4 HE Sewage Permit number ................................................... C ...... WrrH ARTICLE 11 Z XANITARY 33A"WAME. House number ............................................... ......... ............... CODE 'RE 'LATIONS, 11 MAI TOWN . ,OF -BARNSTABLE BRUIN.- - INSPECTOR t APPLICATION FOR'PERMIT TO .......Suffolk,. ,Realty Trust ............................................. ................. ...................... ................... TYPE OF CONSTRUCTION single ........................ §i gle family, residential • September 26 Sept .. ...... TO THE INSPECTOR OF BUILDINGS: The undersigned 'hereby applies for a permit according to the following information: Location ............L.0t..#...7.4...P.a.trAo.t.s..W.ay.......C.ent.e.rvill.e.,..."A.........Q.2.6 3.2................................................... . .. ..... ... .. .. .. .. .... .... .. .. ... ... .. ....... .. ....... .... .. Proposed Use ..§.inge.l ...faro 1.y...r.e.sid.enlia.i............................................................................................................. .... .....• .... .. .... Zoning District single....f am.i q�§.i.d.en.t.i a.1......Fire Dist ..District .. .....0.5termille............... .... .... ....... .. . . .. .. .... .. Name of Owner Suffolk Realty Trust Addy ...P..0....Bo x..3.0..8. Cent.. ;.yjj.j. .Qess ................. Nameof Builder .......same...................................................Address ......................5.iAMe...................................................... .Name of Architect ...................................................................Address ..................................................................................... oured Number of Rooms ..........7.........I................................... .........Foundation ......p ...concrete..................................................... Exterior ...............cedar shincrles ....................... ...........................................Roofing .........i�k��p ..halt„ shingles ................................ Floors .Interior ......slim ................. ................ .............Inte ...coat... ..... ............. .......... Heating ..forced hot water ..oil ..................... ...........................Plumbing ............PMQ.............................................................. Fireplace ..........Pr..i.c.k .a n..d. b1 o.c..k................................Approximate Cost ......... ................................... Definitive Plan Approved by Planning Board -------------------------------19---------- Area ......IRIt...................... Diagram of Lot and Building with Dimensions Fee ....... ......................... I 1A SUBJECT TO APPROVAL. OF BOARD OF HEALTH /X/ I hereby agree to conform to' all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............... | Suffolk Realty Trust ' ' . . . ' 20824 Permit _.»ue_mt»ry____ � ~ --. ---- . . ' � single family dwelling � ................... 2I2 Patriot Way ' ----._ ---.----.-------.-----~ _,_,.,____Ceutarvill�~__�______.. . ` Owner ............S.u.f fn2k...Bealty...�ruot___. . . . . .. . Type of Construction ........frame-------- ^� ' . . .. —~. .. =` ^` — . . . --------.. ' ---------. Plot ...................... �t~�— .................... ` ' ` . . Permit Granted ` ' lq .................... . '~~'~ of Inspection^ . Dq*, Completed PERMIT REOUSED � -----_----.--------.--. lV � . � - � . � . . . ' .................................................�.~—.—.----- , ` . . —'--'—'---'^''r^.—^^^^''-----^^~^^^— .,—.~—.~—.~..—',—..--...~...—.~---.� � —~,----_-..~.~.-.—......'.—.----.... � . . ' ' . ------.�`—' lA ,r-'-- --.�— --- . _-----..'�------~----...-----, . � ---...��_—,.--.,..'------.--.—.....— - .- . . . . . . _ if v ry s� -- — -- : y�''� :. ^� � .• Qakesl F�.i3t�4,_:,�aeet-eSc�aS� - o� � - .-., .:Exams � I 'I,I:IL� • - _ - - :. . � - 3oPnrv.d Wuonw _I. ' 1 ✓;0 00t. II .,W.GS , I - ' V , — ___,�r„�,.t.�.L� *rya, I�ov y r - �.— —' Stfl r. S(Ale :: F1G n l 1 e" Vu cn 4 Ek9c FY&Qc T,1+Wn�h 3�4k� SW283f©5� N4, �lz)_\1 a/,G,R_c. �rs.M_..... ' - AceAtt _:9oU S?t eS p`,l� W,no??S _ - sanTal?4lnskno08 �tJ3o4ly- - �iqw vt ks _�t)•:�-a Au�sfRx�� Qi} •• van. 'an�,a\eQ l�iunn��__. �_... 3'2.�9.X9.�t4 v - - H ,: :.,.. .�_-,.'. i ;':'/- lz)4ty�.vLRePoeR__. Mr��t�cnsx�Fywst,os_kL_Cx, - _ ix • — i i H —r - -- -- =-yam—_l- I _ 11fesubl:A1�Wni��KA.:11eAl:.etFs__k Q rko_sxshncl - --- -- f --- -- -..- , • P. t .. .. t is \. �• 9___lam -'--- ofl � a ; Y . • . - '' -- �ors31��-s� ..� .. � .� :. -.; �• ... � ..:';�- �� -� ' � S�^yeR�Vo.;�U�,a�T` . - -,, � -E-�1 � , P ne Plea s,. _. f— is f�leke' " • 1 I�lt'�` 1 SCh IQ�,__ r 21'l — �j- 04411'S `�acMC40 3iz,so �Sz —b _ -----•---- -- . ku . 2riz w°o.c. I FmA�l� _2>1Z k 3csra - � j t z ConaelC Sawku�s �, r RorA Cb ON i jo-W a�a PIAR)()� W Pxc�n°�5 a• i�2.�V..+C4t�IC�f1R�-. � V 1 �C. \ i N.. ------..._- - 4 q w6tSI�T+ C �? n i caq v,ll c�n� . t` �xsi2 _� 1lDll�._54,S Rec�9:4��n .—_-------_�V_��.esw�co ' 9-D Hon'r�FvE So�{ger�eJl� C�'1R. 30 `` 11-l.�k5/v-5 / �-1Etin�U/`7 lor 0 (b 0 67X As T- /zv 00 G 7? ,13. 7 z T-E 5 7- HOLE A-DE5 ULT6 /-'[ k-1 7_c) 4,'A_l lEZ n Ile? CIE-C)1-7 8 !7)C V TO !,/A/ TES 1,5 8 L f /-I / A///-I U 1-7 LF_',U1LL) 1AJG 5ETBI-jCl< P E 0 U F `7,E A-1 T_5 /4-2 0/\1 7- zo , -5/D L:-- /0 ' R I. k, 0 7- 7-,o 3 E 4-0�2 0 V IE � 'S IE I-Ij IE lZ2, 1119 0 lar Z)E S / G/Q LOF-� Z) IAIG 15 USED . Pe c)F�O S D I-) F1 ,`)A,1 7 E. 57 S S E Aj V l 0 AJ 1N7 E AJ T-,--) 4 o DE D /19 7 EE.D JULL Y 6 7 7 6A/D TOiVAI OF DES UL TS 1-7 IAJ TOP 0,- 1-o U1\1.DP7_10AJ rC)Vl k 7'0 P9FVf_-^jT_ ,V1AJF�S 0,1:-- 1 -/L-7 R,19 7 YA/ /11 /Ahr 7-0 A-1 Ln 7-0112 (20VE,2!5 T)1-57- �Y Cc 4 tAl/A///,I UM _AW P/TCff —FLOW Aj E_ Aj/A/ P/ Ili 1. 1-1/A, P/ e5)0 0 Y4 /FO07- 14" Y4"IFO /--o 0 r Y. MIAJ z 0 2__9 -09 570A/IS L I" 0 (9 IQL L OA) RT SQL IL 0 UAJ Z-) /A/V,�kR7- Clq p/1:3 C /7- SE p 7- sa /qTE R 7-/,g 14 7-) A/VL-R 7 ' //V VEIC7- _� 4s "IV71) //V VER7- lvl,0G1--RR5,9GE GR1,,,JDE)e > _ 0 T PL 149 /V RONALD C 4? 7- ARTHUR 7-4---IT L) ,,�? GIFFORD -9 IZ- No.603 A./ L COT 74 �S SHOW/ AfoiSTER�� Q.� ' F� �� FAN Q /NVITA9\p' -r(-D 23 & F7 ^1 IAJ- /7� / 0' f-RO/`7 F-OLIA-ID,43 Z_ _T_ 0 AJ ZD / E /,-� 0 f/ T-D / 7"-S - e 0 e Z_ E A./ G P, 7--,13 7 0 73,F. f7 M/Aj 1-5 0 ✓ p r?C-) 7_A4E /-q N /7) 13 T".7 / C -7 H A,/A,' 0 A,1 TN -5 P S On/ 7-H E G k:;' 0 U/,J ZD s S f-4 0 Iq /\-/ Z) 7 % //-:)) -,,' - / 7' 7-Z-- 7 / I lE__ 7_70 7- 3 U / L D / /\-/G S E 7- u Z-F ze vE D E -7 B m) Co�y IMPORTANT -- lJPGRADE REQUIRED Sjp,TE BUILD1rIs: CQDE RTQU tiE ENTIRE oviELUNGWHM REVIEWED SMOKE DETECTOR, C-OR ONE OR MORE aLEEPING AREAS A'RE ADDED DR IREDF� WE t� Nam: p S;rt? ATE PERMIT 1S LF�7R1C�1- UEPT. DATE TECTOR INSTALIATI fSFY�THIS RE(YJIREMENT. PERMIT FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING CAR MONOXIDE ALARMS *AT� D PER INSTG CAE MMO n _(�Qc,��-.ice:�� ., . ;,-'"! �``� ,,% ./ �`'• __R ,_Q,a�S1MY r, 4 , YA , _ .w�..w..w.,www w..::.+w.rmwwmmm.w:M:n......_wwx:..++"m:mv,�w+m.aw««rw.nmr.,..:anvm:nv,...,ea,r.:u•v..am�nimnw w.r:.n.�ewnNaa+w.,x�aa'„Mdaw•rva•'s... n.rmevh.,n_ww,n.n,..r'.m.n.°, n wa'M�,+nn �..-. . ..:�sn.a...�wse.v—.:n.-rn.-.:,.._.w•:.+.....n+w_ �, ..v,. f ; LAI � l 4J.C„ rS ► t .. kk� Vo , , - t i , 1 r 4 \ r , t , ;: :� �c\��1�.vr�►�5_.. �`W�11 ��• � ....,v�ua , e _ a c �6 ► 1, Won Asa > �►.� -f- ))4 n��WM -W30kEa 6 ., I<�' �€ ( QA VI tier >i i t � `' 8 -!ft'A ? Z.�" ► " Gl� �..: �W I ,�.t 1-lf � "f►,�? � 3 2. � '� �, �. �y l�L A, f �"w�� , : ��.�w�. ��;,�� I ��. t� �.0 r�' , It _ -- , k C M+�I.F.,. ,... ,.. s .. .- ... ....._. .. _ ..._._. .. 1 i / f _ r ' - c � i ' • n `Ocean `t , RS ,. t , _ , • d ..r.:...........:..„..,,..,r�-,:..:.,w,.+.....::..r..,..,n...., ...... .,;..,,,..,.,..«....,:w,,..•......�. � to f . � R r r.w..n y R ` 2 s of + F j i Rya/ � Z k�X � `�.$ - _ X ----•----�---r 1/4 --- t , ca �,. ._ � `�eel` �u� -- `� - � �� ►��-e � �- x _ ,_ . 4 .. . , I t to — ,. r __C �_ PA . f; 4>,� A . , 14 t rz}�al V i 3�2,So i A J � Qv o ,Q o car _ �+»cw.awuwmw.a+.ww�e+awn...nw:er.a.+..xra9.apt'1rs«nwa.c+:aa.»+a+..nayia-m:n,. e,+w.x�..:M.-.-wavwmn aw..�x:.n,�,x.waverxraxw..+u.::':;m.. r.«.r«.m+err ,.e_...+,>.r,.r..«,t.a...v�wmsw-,.rn.,.,w>.w........„..,...n✓�-,......y,�,.-,+_«wand - '. �"" R+axgw�'+.wmM*++0.XWt�K^+*w� .. . nw .+.-.w-.+n+nwn.rn..+wwr,.w+.nn+T*..wrxwan,+_.�w.�rcs«..w.,w+»+..w+uwn+rxanrrew..,onv+nanax:�rmmw.weaansw+ 301 A ?s (�C ae Ii TA 11 V I r A .......•w�mn,_+..:.w+nm.r,+.n�u.�,mw,:,_,x:.n...ew a.,r.....,.s+��_-ns..,w.o•.a„r..n.nrt-.m..,wus�wve-r-�.-�v.+n+mrn. _n.a -. - _y A, CAN 16 3 r 4 A �A Ckt\ �t rng _ Y 1- ,1 y �., �_. � Y .,..p, h �-.�� L , :� � �� n � �� . '� x �� ,:�. > � -� `� �. - \'� ��1 ��- �� -�-� �` 1.�t � ��;. 1 � iE �� . -> � `� 6 �":� � ,�� ' ► ` /' � f z �„: � ' � � �� _ _ y �. . . �� l x � � X a- � �-, .,• l '`fa � •r„ _, ''* .q �Y P"' .a ,, • � � (�r�. � �,:�, �� , � --,� t /�E .- � r 4 ��e ~ �,, .r,._._.�_ _ __ a.w.. �_.. � _ ..� ..� ..�- .. �� _. �� G a `A-0 � o OAK i � /lei'✓. In t r ! Y r r 4:p rI!•- j{ t 1 1 , R t p w t TJ �.,. ,,,F 10) � 4 , OLR' Nj RZ i 1h ��o� � far'..r►►, , Rev 4. 1 3 kin e 1 .,