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Home My WebLink About0574 SOUTH MAIN STREET INN" NOW" TE mew", MAIN gun, toll, P., Awns 64" R%A Wk W- U IS w-WIN �r'Xi 'r "Al-I 11�� ., """ 11 W MAU ing R qmg r7i T? �C 'UO�'jkQ"'Alf 1"T Wit 19 Oil Igo '0 1 IVA' 4 1k QN191 iT T�11 �j,I,fg)a 114510-11bI 74 ip AD ,al Tv g F .44 A�v"41 fflilkikA�41 , i W' MIR, WE INH ru,"v%rn.v-, -I sip w wall �w CAM— RIP ski JIMA MAIN WIN IN I 40 MINORlmt_qj�I MAR., 'lip (�;)f gi UK Pit 117mv T, Nt iq Z- ew A, , In "Pr 'Y 1A- �1 U-1, i i, "1 _ IV jump DIV, Alum A,Im li OEM 11 NON i IS W1 MT 1pl-3 ell iWA;A_ 1 r, i.i, 40 �kj Him" 1,41 W 201 f 14 I, 01 M\,A NA ' IV a 03,ir, ON t INV It I wt Til w i) oil; g A got If"q mph N1 cAk AW I WO � I, I MIRA! 405"'M31- WIM WWO jj�t, ilia' /XIL W.c 1 Ic lbi" _ W.C..SIAWOMS . W.C.SIR40CA-Es . r \AI EST. _-i!LCVRTIEN <�:.. C.: _ �«� �� i . ti. I -71 19'o" 'max t 1 4 is QP C� �,( w , i� �� ` �� r y � u o t O� ell VIAesA , Jc , r + a a ` _ 1` v r ,c . o I� C�vl c! CiD Ow, L o°<i J f,• .. d I` ul ®a t r - _ l�, IV ! _ J J j\�Z? 1>,,�r;��v �� t c`�1 _�.•�.�urns„�, ., R � . lAulaG wkm '-15�sr W f , NO o ®`f y'o BpPxa�lk?�: + SEC(1oa� a °Ft r Town of Barnstabl *Permit# e Expires 6 months rom rssue date Regulatory Services Fee v MASS. Thomas F.Geiler,Director1639. &//� 0 4'AIFn w►p't'•� Building Division •P E SS PERMIT Tom Perry,CBO, Bnilding Commissioner NOV 200 Main Street,Hyannis,MA 02601 �� www.town.barnstable.ma.us TOWN OF BARNS ��L�, Office: 508-862-4038a9 ° 5-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid.without Red X-Press Imprint Map/parcel Number Property Address S -1 s t1 5 Cs �`l� 1�t TC'E`C M Residential Value of Work J066) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1'1 A*Rj Contractor's Name &_5AJ Telephone Number Home Improvement Contractor License#(if applicable) 6 �'Kb Construction Supervisor's License#(if applicable) 1 p ❑Workman's Compensation Insurance Chec one: LA�yl am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over' existing layers of roof) . ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: Q:\WPFILES\FORMS\building permit forms EXPRESS.doC Revised 090809 --��nn d. mm. / or registration va.:d for individul use only HOME IMPROVEMENT CONTRACTOR :'the expiration date. If found return to: i Registration 136386' 0 ie Ashburton Pl= Pm 1301- g Expiration 7/22/2010 Tr# 0 Beard of Bt:iWin Regulations and StandardsJ Ul stop,Ma.02108 ` Type1 Idividual BRIAN T. POWERS BRIAN PO�NERS i C 32 Hemeon way �� HYANNIS,MA 02601 -- Administrator Not valid without signature = � Massachusetts- Department of Public S.IfetN Board of Building Re;Iulations and"Standards w 4r�icVor,-Supervisor L . .�fl License:.CS' 79418• + Restricted to 00 BRIAN T POWERS a , a 32 HEMEON'RD HYANNIS, MA 02601 r. 1 Expiration: 8/1/2010 ('irmmissiorie Tr#: 1190 i T a The Commonwealth of Massachusetts Department of Industrial A ecidents 1 Lr Office of Investigations h 600 Washington Street c Boston, MA 02111 wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Q �J Id"'1r�� Address:' City/State/Zip: �� . r7a60 Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction p16yees(full and/or part-time).* have hired the sub-contractors 2. I am a sole ro rietor or artner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp.insurance.# 5.'❑ We are a corporation and its 10_❑ Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work officers have exercised their- 11.0 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.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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 andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert" ender th ains and penalties ofperjury that the information provided above is true and correct Signature. Date: 4 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 4 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 tinder any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia • J7 THE Town of Barnstable Tp� _ ti0 Regulatory Services HAMSrABL.E, " . Maes Thomas F. Geiler,Director 6 q; Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 0260.1 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must' Complete and Sign This.Section -If Using A Builder as Owner of the-subject property hereb authorize . . :Fd `�%-►�5 to act on my behalf, Y - m all matters relative to work authorized by this building permit application for. (Address of Job) _! ignavdwe of Owner ate. G C t-, L t✓ Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. , Q:FORMS:OWNERPERMISSION Town of Barnstable o Regulatory Services snxxsrnst a Thomas F.Geiler,Director tKass. 059. ,�� Building Division ATED MA'1 h Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790=6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: ' number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or 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:\WPFILES\FORM S\homeex empt.DOC iNETpy_o� The Town of Barnstable BARN STABLE. Department of Health Safety and Environmental Services 39,• Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection- ►�, Location ��' \�lt rC (ly � � Permit Number `L.q Owner Builder rx� One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: C Dz- n I'6 av�.�a 1-t-�...t, �;{�y ��P�"frf�-�l Q r'1 a) — HO z IC3 6 LT n t�&- 6efL v\, C, Please call: 508-790-6227 for re-inspection.PICA.��. Inspected by Q-4- Date 4 Engineering Dept:(3rd floor) Map Parcel OY�o + a4 it#- s . House# `jP D e Issued = ( 2 ,Board of Health,(3rd floor)(8:15 -'9:30/,1:00-4:30) C 4th fl IT '1 BE ` olrib�) �EpTIC SY CB 19 II�I$yA1.1-E wAW TOWN OF'BARNSTABL VIRON . OMP RE Building Permit A plication ; Projecf'StreetAddress coo .•"AA qLo..- Villag6 ,, v `' Ownerr' L��N 10A$ Address 1 o z (Fv � Z-)�oo- > `Telephone }a8 $ S^ (O g 4( Permit Request t -4. CL. vu I Z rSol%IV. 2cJ 6,"k- e-S `2 X Sa &A� Lti� �� L/ — 111� ti �va2��ovyt (� :First Floor �CXI 5S '� � square feet Second Floor 4&$ h%UZ Zg 21 square feet t Construction Type -Astimated Project Cost $ $p Zoning District Flood Plain Water Protection Lot Size Grandfathered &(es ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family( units) Age of Existing Structure ! Historic House ❑Yes o On Old King's Highway ❑Yes [iro Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other 'tA e tag. s d� yLcta.�c Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing. New Half: Existing New No.of Bedrooms: Existing 1. New.cLkk � Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing%&A Q7 New .Existing wood/coal stove ❑Yes kil o Garage: ❑Detached(size) tt14 Other Detached Structures: ❑Pool(size) ❑Attached(size) V* ❑Barn(size) [done ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use ` \SP I Aemc g; Proposed Use V0..cL n v►c_Q— Builder Information , xName�& AU t L dr1AQy\S Telephone Number r� 3 4 Address License# C)5�ka Home Improvement Contractor-#- Worker's Compensation# ~ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU a !DATE �1 I DING PERMIT DENIED FOR O NG REASON(S) /c`- / -� FOR OFFICIAL USE ONLY _ PERMIT NO. L y DATE ISSUED" MAP/PARCEL-NO. ,9 •* - ' .. s ae f, 9 j., ADDLLADRESS ; *_, IV1 y I . OWNER - � ._ � � � ,. • .". - ._ ' .� " t •-i .. s �` - � ,�.f;, rz DATE OF-INSPECTION: - - FOUNDATION 4, FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH ' 3 FINAL' PLUMBING: R-06GH FINAL ri l c ' F - ' GAS:-` i :RIJ114- . GH C �` FINAL.i - A t FINAL BUILDINGy�. cy DATE CLOSED a , ASSOCIATION IN , i I - Z o ��E2s �� • t „ `; , \Z�y !� C�'`o. 5v�►a akaz S Ltklok 'r C-p- e�2 Lv % of pit' tiy� st�c-. C36.� / I , r SCALE: APPROVED BY DRAWN BY }r DATE: 1 �� VLe U\ova N�aKc�l 5 DRAWING NUMBER f; V� � 4�1 I � �-� 2�1b f1�►c�E�S R Al` <uvw�.®t�s �''�� ` tp 2 � tip' ,�x� �J O�i �J 2^� q` s YL�\C-W� h0\ST"i! Q4cl ML Ok-svt8 I hD 1S� �J -----��1►�V(� ��s�t 1ODri oUti� �YV�tl�ti �L� 'SE�1,mA \��X�K� „" �� o�►u�: ti� st�� I � . Lut.) eve sin ow% Res�"-14C-E : �C—oM NI'�LS �I wvtcv— t SCALE: p' APPROVED BY DRAWN BY b DATE• 1.1 -yy� C l :S u vt.t a r DRAWING NUMBER TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel `+'w Permit# ,"Health Division c -z �(a d i es�� G' Date Iss ed v6onservation Division �a� � � Fee Tax Collector - Treasurer-1- i) o qbmq Planning Dept , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village C04e3-o,d P_, �� w �, 02,._ 3 Owner LDcl CD �" Address Telephone rr CO LU L (0.Z_ 02-00 ac* Permit Request Z r4: 2 O �- 5 Square feet: 1 st floor:existing proposed 1400 nd floor:existing proposed 80 Total new 9-0 s Estimated Project Cost ? .I 000 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family..0", Two Family ❑ Multi-Family(#units) - Age of Existing Structure Historic House: ❑Yes CNQo On Old King's Highway:• ❑Yes ZNo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other N f Basement Finished Area(sq.ft.) J Basement Unfinished Area(sq.ft) r Number of Baths: Full: existing 'oZ new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: "as ❑Oil ❑ Electric . ❑Other Central Air: ❑Yes ff'No Fireplaces: Existing New Existing wood/coal stove: ❑Yes eNo LIZo Detached garage:❑existing J2rnew size Pool:❑existing ❑new size_ Barn:m existing ❑new size pf Attached garage:(J existing ❑new size Shed:❑existing ❑new size Other: i 1 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ i Commercial ❑Yes ONo If yes,site plan review# Current Use Proposed Use --. BUILDER INFORMATION Name - c) Telephone Number Address l License# e Improvement Contractor# 3 Z --Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTI G FROM THIS PROJECT WILL BETAKEN TO I SIGNATURE 1 DATE �� - - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ' MAP/PARCEL NO.'- ' ._ } VILLAGE ADDRESS , OWNER DATE OF INSPECTIOI+I; FOUNDATION- FRAME INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL -- GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED,OUT 9 + ' ASSOCIATION PLAN NO. r t .�2g 47't 41 xtr.1S�� - Fr ag�sPr �s.� �-"�,s a�b � 5 -.p r t-,..:, rv. �s �.i � ,.A• - r r#� e�'ba �S'+r, ''- 2'F#^�uu yy��r-•�'kw 'rF,,. ` yam,; "ss •^,'F a-Yt. +5.'-;�as:u, s.t _' �.n ,e,� -� M`m.��.�- a � �.�,..:.""`•� ��,.,�.� '�.5 rt z�n sa_... � .r ' '+,. 'A - � 7�«x ,Y.�„ t',Si,.J' x"�e` -�c'�•� "� .� Y'yeR �� . � tee -� - o�� x � 3�. ��Y' , 400 sri � 'i'��•Y� k r`� t'� � "F fix.«-,� #!. fi i ��6�'�• P'A.: fix''." ;• 4 t r � w .i K i s A_ S Mar-31-00 15 : 19 BARNSTABLE HEALTH DEPT 5087906304 P.01 03/31/1-600 13:_7 5087764483 VIM-z1MOM TOWN OF BARNSTABLE S-10 ING PEIRMPT-MVL'CA'FEON , 10�131ALLED IN COMPLIA1000# Map Parcel C,`� WITH TITLE 5 Issued ENVIRONMENTAL CODE� D Mara Health Division , - - TOWN REGULATIONSFee Conservation Division Tax Collector Treasurer Plarming Dept• - Date Dowitive Plan Approyed by Planing Board Ffwtor c.-QKH iV 0 Preservationhiyannis Proje�Street Address 3 ; . - t}- C ( Address Owner 2- 0400 Telephone Permit Re4uest z- Square feet 1 st floor.existing proposed p0 flOot:existing ropos d 28� Total new f,Q M--% Estimated Project Cost o00 Zoning District ._.� Plain ----- Groundwatet 0vert3y Constnidon Type Lot Size Grandlalh9red: Oyes ONO if yes,attach supporting documentation. DweiiingType: Single Family Two Family O multi•Fv*(s units) Age of Existing Structure h. Historic House: ayes O� On Old Ying's Highway: O YeS eNO easement Type: E3 Full O Crawl O W'dkout O Other ®aseement Finished Area(eq.ft.� �. A Basement Unfinished Area(sq.ft) Number of:Baths: FUN:existing _ — '-- --- Half:existing new Number.of Bedrooms: exiling new Total Room Count(not Including baths) ti7 existing new First Floor Room Count Heat Type and Fuel: Gras C300. O ElWric O Other Central Air. ❑Yes 340 Fireplaces:Exists __v,,¢�__ New Existing wroodloodl stove: O Yes ertlo `+2 Detached garage:O axisting Knew size Pool:O existing O new size jq!� _Sam:®oxmng C1 new size Attached garage:®existing C]new size Shed:O existing ®new size-70--Other. Zoning Board or Appeals ALOOrization 0 `Appeal# Reowded O Commercial ®Yes �fo ff.yes,site plan review# Current Use _ Proposed Use �r � saasr�srasr�. _ - �o�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Tlz Estimated Cost 2.0, oe�C7 Address of Work: 5 -4- 4 S ,<, S"� l _. � � �u-(L-rv-:� L Q2-rc3�— Owner's Name: L 0-�r7tC Z Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT R DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MOROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. ? SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. ^ OR Date Owner's Name q:fb ms:Affidav >mCUR;, . : i pmeripeNe Paekaw for One and Two•FSU*Rudeadd BW14110p Sated with Fo"o Foah t l SUM NIWIMUM Gtaaag �8 �g WWII Floor 9a== Eftb CaoOr$ '(K) Uwaluer ltrvaiueJ R value` w"lue Will P=b Brvdue' 5"1 to 690 HeadaR DeOree Dow i Q 121E 0.40 3E 13 19 t0 6 Normal R 12% 032 30 19 19 10 6 Normal S 129A 0.50 38 13 19 10 6 U AFUE T 13% 036 38 13 2S MIA WA Normal U 15% OA6 39 19 19 10 6 Normal 1/ 15% u. �e 1+ �+ iiin v�.. !S AF[JE W 15% IBM 30 19 19 10. 6 U AFUE x la•/. 0.32 38 13 23 WA WA Normal Y IBOA OA2 38 19 2S WA WA Normal t la•/fi aaz 38 13 19 10 6 1 "AM AA Ir/. WO30 19 19 10 6 �A F PROPERTY: O J �` I. ADD SS O ` 2 S UARE. FOOTAGE OF ALL EXTERIOR WALLS: .Q 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GL XCAZINGAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. } BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-690303a I � 780 CMR Appendix J y Footnotes to Table J5.1l b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall ° of the total glazing area may be excluded from the U-value requirement. U to 1/o g g are reseed as apercentage. p . a,expressed For example,3 fl of decorative glass may be excluded from a building design with 300 fl of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by,the manufacturer in accordance with die National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole emits:center-of-glass U-values cannot be used. 11 The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between -�-the conditioned spacx rwu cur. vcuum- -- +---d pa u:,r.:,f the roof. 'Wall R values represent the sum of the wall;cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall. For example,an R 19'requirement could be met EITHER by R 19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-fame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-flame constriction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 501/16 below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described ire Note b. 'The R-value requirements.-are for unheated slabs.Add an additional R-2 for heated slabs. . If the buildng utilizes electric resistance heating'use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. r 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a J NOTES: r Ar i a)Glazing area and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels'. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available,include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wail component includes two or more areas with different insulation levels, the component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 -=• �- , -=• . - Olflce o/lmrestigatioQs 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit ^1 name: LrD r► c�- location- O i�— .n .P�t"�� L lC� r-I - o2Co 2- q city phone ❑ I am a homeowner performing all work myself ❑ I am a sole proprietor and have no one workin 1n anv capacity � �i4�y''/,0////.��r//�� .�i�i�//�//O�i�. /'/,��'////////�'�,�O ❑ I am an employer.providing workers'compensation for my employees working on this job. .:.:..:...::.. ::::.........................................:.:::.... .:. .....:.:.:.::..;:.;:.:;.:;;::..::.;::.:::..;;:......::....:.;:.;::::.;;:.:;:..:...::::._ ::::..: :::.::..:::. :.. : . '.i. i.i.i.:.. . %yii [22? ?�< f. i..' 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VB//,V 11-1,11gW-111e1,WA= a I am a sole proprietor,general contractor, r homeowner( cle one)and have hired the contractors listed below who have the following workers' compensation,polices: ................... co ........ ....... . . ....... ..... .... .. . ....... . ............ .::.::.:.:. . ............ address. ...` x1.i.,.1.�.1: %........... . ...................................'. {. ...................................: . .. . .......... ....... .. ............ ..... . ................................. ......... .. . .............. ... cit � phone.#........ .... '��. :': .:-.. --:•:.:';. .. y ' ..� :::%ti •4i1:::}•{:i' :;:::y;}:?:ii::iii}i'{{Siiif�iii 'ii1i:'�:ii?ii::ii:.i'jii:::!i:'�i:is>.i'r::�' iii?: riY. is i'r':vii'-:•,: ;: !vi:::.�:::�.:�::: ...:.................... .......... .. :tii: �::::::.:::::::•::::::::.:........ •,•..... ....................... .. 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' ?` `'?i'it.?i.S i as . ''<i? 'yj` isr r+< city: ::..::::::...:;..::..:..... .....: . .;{;..;{:..;.:.:::::::..;;,:nhoee.#•.. '< .07 nsuranceco.:..:: . . ..::::...::..:.:::::,,:,,::,,.::::.....::..:.::,::.:,....::..::::. :,:..,...:..,::,::,:..:::.::::.:::....::::.::,,.. oii�r#:::.;..-.:...:.::.::.:.:............................:::...::,::,...... i:po Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civII penalties in the form of a STOP WORK ORDER and a thus of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the OiBce of Investigations of the DIA for coverage verification. I do hereby certify e p ' and en ,of perjury that the information provided above is&w.and correct 1 Signature Date C) 6'7�v Pont name O c► rt - r �to L one Ph # '� Cmntact nly do not write in this area to he completed by city or town oincial town: permit/license 0 QBuilding Department ❑Idcensfng Board checkmmediate response is required ❑Selectmen's OIDce OHealth Department on• phone#; — ❑Other (tensed 9/93 P1A) i i r aYxxUIk1AUUUU ancu aXAQa / Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for thee' employees. As quoted from the"law",an employee is defined as every person in the service of another under any c4�ram of hire, express or implied, oral or written. f 4 y 1 An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other'legal entity, employing employees.. However the owner of a dwelling house having not more than three apartments and who resides therein, or'the occupant of the dwelling house of another who employs persons to do mainumance, construction or repair work on such dwelling house or an the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance ar renewal of a license or permit to operate a business or to "Instruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting.,�{, authority. 111111171111111 111111171111,, Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies.to your situation and supplying company names, address.and panne numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial,Accidents for confirmation of hmrm=coverage, AL-to be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or,license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event tb-.Office of Investigations has to contact you regau'dmg the applicant. Please be sure to fill in the peamnllicense number which will,be used as a reference rmmber. The affidavits may be retaaied io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address;aelephone and fax number. It I The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invesdoadoex 600 Washington Street Boston, Aa. 02111 fax#: (6171 727-7749. phone#: (617) 727-4900 ext. 406, 409 or 375 I + 48 AI 2.4 - 42. 1 _-M f �- 1 -. X 2.6 � 1 A At AL - - - \` / 13. - 50 4.8 \� - -------- - - - - ------ ----- fr! 4. � 12. >/11.2 , - A63 °� Building Division HARNS'AW-L ' 367 Main Street,Hyannis MA 02601 .. � tb=9. ♦0 �ArEO MA'S 6 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building COMMIS: HOMEOWNER LICENSE EXEMPTION Please Print DATE: G 1� 3-a0 JOB LOCATION: 5_4 SC)ok" 'r, `S number I street village ..HOMEOWNER": 1 �- tV-'bcr�1 r- g `1C�'-JCJ�S G g - O-1-U C) name hoV16 pho}n(e# work phone# CURRENT MAILING ADDRESS: city/town state up 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 suyervisor. 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 verformed 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 proce�d/urres�and requir ents. C!l � 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 EIM�WTION . 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 l09.1.1-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 arc unaware that they are assuming the responsibilities of a supervisor tsee 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/lter responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:F0Rh1S:EXENlMN I .� he Town ®f Barnstable Department of Henith Safety and EnvironmeIItai Services BuiIding Division 367 Main Street,Hyannis MA 02601 Ralph Crosser. Office: 508 90-6227 BuiIding Coin.__ Fax: 508-►90-6230 For office use only Permit no. Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT'APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation,'repair, modernizztion, conversion, improvement, removai, demolition, or construction,of an addition to any pre-existing owner occupied building containing at feast 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 requirementL Type of Work -d ¢ ,�� Est.Cost Address of Work: G ,� C. Owner's Name �— auk a �� Date of Permit Appiication: ` I hereby certify that: Registration is not required for the following renson(s): Work excluded by law _Job under S1,000. Building not owner-occupied S Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR D WORK DEALING WITH ORNOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL a. 142A SIGNED UNDER PENALTIES OF PERJURY i hereby apply for a permit as the agent of the owner. Contractor Ma Registration No. Date ui 6-��..�.... Tlrc• C111111rrutrtf-cult/! of:)firsruchuscttr pe- tirt»rc•Jr1 of ludrrstrial.4ccidetrts . 1 Offfmoflnyesrfgat/a V•:\1=+i:1 _� :�, I 608 !1 uslri,r;;tu» Street •�-; � �:• Bti.�-tair. .91uai: (I?lll Workcrs' Compcnsntion Insurmncc ARda-i•it , iic'—:"n—T-1—n forma i inn: ..- Inc inn ��'T lib (YUw\'(t �� %��G � r�•� t 0 t rC � nht,n• 1 am a homeowner performing all work myself, I am a sole proprietor and have no one working in an. capacity I am an enipiover providing workers' compensation for my empiovees working on this job. cnmwin,' n rmt •ttirirr<c• — cin nhnne tt• incur^nrr n nnlict•0 [ 1 am a soic proprietor. -eneral contractor. or homeowner(circie a»e; and have hired the contractors listed beio« ai e the .oilowin_ workers' compensation polices: cmm��tn� n:,rnr• atirirr«• cir • nhnnc a• incur-nrr rn nlict =3 _ .�._._.. :,tirlrr<<• rirc hone it• nniic•+� ��__ incnr..ncr rn. _ A zch additional shcet if necessary -�_�. �.: .:%.--: ... _�...•.... •.......,- . ..r..- — F:,,iurr n,�ccurr co,eras a :a required nucr�ectron_°A of 111G:- 1S=ran lead to the tmposuton of crtmtnat penaittes of a tine up to SIZOU.UU anus:.: unc carp imorr.nnmcnt ::. %%01 :is civil pcnaities in the form of a STOP WORK ORDER and a fine ofS100.00 a dad•against me. I undcntand to=t co{,� ref uri. ,t:rtcmcnr mad tic fun,arded to the Once of Im-estit;ations of the 01A for corerarc vcrifieation. 1 do i,erent• ccrtiit•un«rr rite gains mid penaities of perjurr that the information prorided above is true uttd correct. Datc Prix„ ^W-nc �VLR►rk. Phone* SOS 3�� -1b89 • •I,l7iciai u�c uni, do not ,rite in this area to be completer! b� citti or totrn oClicial t city or tn„n: permitiliccnsc 0 r tluildin_Department C:Uccnsinc hoard f t.. _ cneci; irimm Offtcr euiate respunse is required Q�eteeimen's �- (_•iticaith ocpartmcnt . phone 0- - ._ • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE l j Dili JOB LOCATION _ 9 \} S o_ �a�*-+. S�"�' o v►,+� v�.u� ��tr i V 1 Number. Street address Section of town— "HOMEOWNER" �tuk t'�- I E ®M� N..� ��$ 3 fa,S' �b g� •-----. Name Home phone Work phone . - PRESENT MAILING ADDRESS I OZ ek 9'i '' Z_a A L4 City town L4tate Zip code The current exemption for "homeowners" was extended to. include owner-occupi dwellings of six units or less and to allow such homeowners to engage an in dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides . or -intends to r side, on which there is, or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structure: 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 Of_i; on a form acceptable to the Building Official, that he/she shall be respons: for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations.. The unders_-pad "homeowner" certifies tnat he/she understands the Town of arnstable Building Department minimum inspection procedures and requireme.^.t nd that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE 1L of u L PROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be required 0 comply with State Building Code Section 127. 0 , Construction Control. t HOME OWNER'S EXEMPTION 4 The code state that: "Any Home Owner performing work for which. &-�building permit is required shall be exempt from the provisions of this section (Section 109.1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a persons) for hire to do such work, that such Home Ow;. shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules . and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awaren: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the :.nlicensed person as it would with licensed Supervisor. The Home "Owner act_ as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On t last page of this issue is a form currently used by several towns. You may pare to amend and adopt such a form/certification for use in your community. Y rx ,.