HomeMy WebLinkAbout0087 THOREAU DRIVE f V ////����
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Town of Barnstable Building
-� PostThis,Ca`rdSo That rt isUislble From.-the Steeet ,.A , rovedPlans,Musi be Retained onJobrand this Card Must berKept • F,f
• tAENt3'PABLE, ` t z �` ,,. �Y ,x, � *.P�„P a,,. -. r 4 # ', ,£� a'�,n� �.. ro y .�,�1
Permit
�ste"dUntil Final inspection Has Been Made e
s 1Vhe e a Certificate yof Occupancy is Requare�,such Buald=ng shall Not be Occup�edm n#il a Final Inspect onghas been made
Permit No. B-18-1811 Applicant Name: Stephen Dickinson Approvals
Date Issued: 06/08/2018 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/08/2018 Foundation:
Location: 87 THOREAU DRIVE,CENTERVILLE Map/Lot 191 226 _ Zoning District: RC Sheathing:
Owner on Record: LIPCHIN,ALEKSEY&NATALYA Cont actor Name STEPHEN T DICKINSON Framing: 1
Address: 57 SACO STREET UNIT 57 CoritractorLicerise CS-081843 2
NEWTON, MA 02464 Est Project Cost: $2,366.00 Chimney:
n
Description: Replacing 2 windows-Like for Like-No Change to Header Permit Fee: $35.00
Insulation:
Project Review Req: 1�ee�Paid $35.00
� � Date 6/8/2018 Final: -
� � -
z % — Plumbing/Gas
l Rough Plumbing:
- Building Official
� N Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work a&horized by this permit is commenced within six months after,issuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction documents for whichtthis permit has been granted.
It ' Final Gas:
All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws and codes.
This permit shall be displayed in a location clearly visible from access street or roatl and shall be maintained open for%public inspection for the entire duration of the
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable sign tur�es by the"Build n g and Fire utticla Isla rre�provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
."
1.Foundation or Footing µy z,„ ..i Rough:
2.Sheathing Inspection Final: T
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
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
t! -
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
r
Town of BarnstableREcEf �-r .
200 Main Street, Hyannis MA 02601 508-862-4038
163
Application for Building Permit
Application No: TB-18-1811 Date Recieved: 6/6/2018
Job Location: 87 THOREAU DRIVE,CENTERVILLE
Permit For: Building-Siding/Windows/Roof/Doors
Contractor's Name: STEPHEN T DICKINSON State Lic. No: CS-081843
Address: Plymouth, MA 02360 Applicant Phone: (508)676-6820
(Home)Owner's Name: LIPCHIN,ALEKSEY&NATALYA Phone: (617)953-9746
(Home)Owner's Address: 57 SACO STREET UNIT 57, NEWTON,MA 02464
Work Description: Replacing 2 windows-Like for Like-No Change to Header
C; O
U-)
` p
- C)" c7o
' A
Total Value Of Work To Be.Performed: $2,366.00
04.
Structure Size: 0.00. 0.00 0.0u- en .
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Stephen Dickinson 6/6/2018 (508)676-6820
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $2,366.00 Date Paid y Amount Paid ( Check#or CC# I Pay Type
Total Permit Fee: $35.00 6/6/2018 $35.00 mac- credit card
7597
...... ..... ...... ......... .........
Total Permit Fee Paid: $35.00
PLOT PLAN SHOWING LOCATION OF BUILDING
iN
CENTERVILLE BARN STABLE MASS.
FOR
ALAN E. SMALL INC.
SCALE ' 1 "= 60' DATE JULY 10,1975
CHARLES N SAlERY INC REG C E 9 L S 712 MAIN ST H iANNIS . MASS
4-4 4 S
100
i
81
15, 33 2 5.F:
80 0LO
82
9 15'+
Dwelling Gar, t
35
�pO. 88 '
oRp, U DRIVE
I her,,by certify that the wilding exists
on the 7round as sl°own on this IILn and r'e�•`--- ��`s�,
is in accarddnLF wish the
re irerlWtS Q; the Town ofBarn5tmble. �, ' v•+ r.
R-��Isicrc,d Land Surveyor
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE.
pG
XssessoYs' map and lot'number /.::.�" '....... , �'` s SEPTIC SY-TE 9 C f;:r�T :13E
INSTALLED
Sewage Permit number .................... .`........,........................ S�af ITAa:Y CODE, KiP. T.(3WN
TN E T04
TOWN OF BARNSTABLE . .`.
SS •.i B8$b9Td➢LE, i
039. .e�0 N BUILDING INSPECTOR
� PY p" ,
APPLICATIONFOR PERMIT TO ....Are-....................... ........... .....................................................................................
a /
TYPE OF CONSTRUCTION ....................................................
.. . ..........1.............192
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereb applies for a permit according to the following information:
Location ...,..... ... ..... .............`...........� ]!`�d.................... .......................................................................................
ProposedUse ......................... . ...................................................... ................................................................................
Zoning District ........... ... . . . ................. .... .............. .........Fire District ........ ...............
Name of Owner .... .:....................Address ..........
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ................................:.................................Address ....................................................................................
Number:of Room Foundation ... ......................................................
....... .Exterior ..........................................Roofing ................. .... .............................................................
Floors .......... ..........................................................................Interior ......1..` .. l/`'...G2"'1""'.............................
Heatingl...................................................................Plumbing .........ei...... ................................................
Fireplace ................. .............................................Approximate Cost . ,....................................... ..!1. .....
is�o s J.,.......
Definitive Plan Approved by Planning Board _______________________________19________ . Area .............. ...... ..
Diagram of Lot.and Building with Dimensions
Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg ing the above
construction.
Name ................................... ........................................
` p ,
. Small, Alan E.
y dwelling
Thoreau Drive
Centerville
Owner Alan E. Small
Date of Inspection 2,91
46
PERMIT REFUSEV-
� �� -----' ------------'^'—^—^--'/r
n f / ���.... .. . ....... 1 T
Aesso'r;V map and lot -number .
0 / r
Sewage Permit number .........................................,..,.,...........
Q�OFTNEt��y TOWN OF BARNSTABLE
BBflBSTA7lLE, i
"b 9 BUILDING INSPECTOR
�'0 MPY a•
APPLICATION. FOR PERMIT TO ......../� .................. . ...........r:...../..........................................................
TYPE OF CONSTRUCTION ......../ ../. ... �.../..... ...................................
r. !-.. :`'..'..
..........................................19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location . '......................................................:..................................... ......................................................................................
ProposedUse .............................................................................................................................................................................
Zoning District ........................................:...............................Fire District _. r-- •.._._,,._
Name of Owner ' '.. "�::'......................Address ..... 'r
.......................................... :.................................................................
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation .......:......................................................................
Exierior ................................r...................................................Roofing .. _...
.................... . . ..........................................................
/,' ;.
Floors
' .Interior .......p...I....................
Heating Plumbing
...................................................................................
r
Fireplace ................................: ..:.............................................Approximate Cost ... ,....................................................."?......
sf
Definitive Plan Approved by Planning Board ________________________________19________ . Area --r
._ r !
...................... ......:............
-)0�
Diagram of Lot and Building with Dimensions Fee .............'-' `- . .............~............. . ...
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ........................................!....:...................................
...� Small, Alan E. A=191-226
:- 0 17844 permit for , one story,
..................
siAgle family dwelling
:,. .........................................................................
Location 'Z-1 Thoreau Drive
.......................................................
Centerville
...............................................................................
Owner Alan E. Small
.................................................................
Type of Construction ...........frame
...............................
................................................................................
#81
Plot ............................ Lot ......:.......
i"
Permit Granted ..........suly.... 2..............19 75
Date of Inspection ....................................19
Date Completed ......................................19
1
PERMIT REFUSED
............................./ 19
.........../
...............................................................................
j t ///I�
ApproveU,........ ................................... 19
...............................................................................
PLOT PLAN SHOWING INLOCATION OF BUILDING
CENTERVILLE BARN STABLE MASS.
FOR
ALAN E. SMALL INC.
I SCALE: 1 "= 60' DATE: JURY 10,1975
CHARLES N SAVERY INC. REG. C E. a L S. 712 MAIN ST NYANNIS , MASS.
_ y
t
44 4s
7
Sf
15,.33 2 5.F-
60 0 0_ S2
9
t5
+ 60 —
Dwelling Geri Zzl`+ '
35
tpo.88 '
t
.p, U DRIVE.
I .
hereby certify fhat.the building exists .
on the ground as shown on this ,nlen and
HOAE>tT � G`•�
is in accordancE With the zoning e�= F.
re 1rements of the Town of Barnstable. �'�
u
No.t,,C20
1 °
Rgister�d Land Suryeyer ���
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED,FLOOD PLAIN ZONE.
r
0F1 r Town of Barnstable, Permit#
Expires 6 months front issue date.
Regulatory Services Fee
+ BARNSTABLE, ►'
1619.
� Thomas F. Geiler,Director
pTFD MP'I A - lv�J
Building Division
Tom Perry,CBO, Building Commissioner
200.Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press bnprint
Map/parcel Number ` Lo
Property Address o
Residential Value of Work n 0 G Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address e,<a e n, T' ijo
d u��
Contractor's Name �� �� Telephone Number,�(� —j�)
s 4-e,n
IV
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) XP R E S.IS E a M1T
❑Workman's Compensation Insurance FEB 2 4 2010
Chg&one:
am a sole proprietor TOWN OF BARNSTABL
Pam the Homeowner
have Worker's Compensation Insurance ;
Insurance Company Name �� -z r�Ytai.�w '
Workman's Comp.Policy# 41-C ? .3 I Jr 3 17 Z
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Reques (check box)
Re-roof(stripping old shingles) All construction debris will be to
Re-roof(notstripping. Going over existing layers of roof)
t .
❑ 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
r quired.
SIGNATURE:
Q MPFILESTORMSUilding permit forms\EXPRESS.doc
Revised 090809
The Commonwealth ofjlfassachusetts
—� Department of Industrial Accidents
Office oflnvestigations
►'_ 600 Washington Street
ti Boston, MA 02111
wwiv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): i 1,1 5 3 V 1n�'�✓t��_��h,�
Address: Z� �,� �u L^ , < t,C�City/State/zip: Phone M _V0 22 1
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/ 6. ❑ ew.construction
employees (full and/or part-time).* have hired the sub-contractors
2° XI am a sole proprietor or partner- listed on the attached 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 Y• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its ]0.❑ Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MOL 12,Fg"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 141 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 anew 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 and job site
information.
-Insurance Company Name: >G z /ti 0 i 1 /1114
Policy# or Self=ins.Lic.M td Z - 3 15 -3 I7 Z-I I Expiration Date: & 13 d
Job Site Address; D �-� a �r, City/State/Zip: �n'bt.rur l� /
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 MOL 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 certify 1r r the pains andpenalties ofperjury that the information provided above is true and correct. .
Si natiire: Date: Z'//9//) 0
Phone#: —0 Z -7-7 1 X 1 - -
Official use only. Do not write in this area, lobe 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
ram,, f—f Pare ,• Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an emplo},ee 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 house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §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(UP) 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 futtire 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 burn 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 I-877-MASSAFE
Fax # 617427-7749
Revised 4-24-07
www.mass.gov/dia
f -
�YHer Town of Barnstable
_^R'Sr^B
Regulatory Services
Thomas F. Geiler,Director
9 rinss. $'
1639.
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must.
Complete and Sign This Section
If Using A Builder
I, _ � �:w , as Owner of the subject property
hereby authorize 6/f-y, lie //1 /-1 to act on my behalf,
in all matters relative to work authorized by this building'permit application for.
(Address of Job) .
igna. e ate
Print Name
If. ProP er , applying Owner is 1 i for permit please complete the
- �
Homeowners License Exemption Form on the reverse side.
Town of Barnstable
Regulatory Services
' Thomas F. Geiler,Director.
1H ASS.
9� i679. ,m� Building Division
AlfDta 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 dQ 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 helshe 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\FO RM S\hom eex empt.DOC
- -
s
� a
Office of Consumer Affairs&Business Regulation License or registration valid for mdividul use only r
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration 1¢8588 10 Park Plaza-Suite 5170
ExpiratlbAng� 1 Tr# 291750
Type„i-- _- - Boston,MA 02116
=3W- -t sht
r _ r
MASS BUILDING SY�SERII
4
STEPHEN BOBOtF
24 ST.fARNCIS G1RCLf`
HYANNIS, MA 02601 Undersecretary
`Not valid without signature z
Massachusetts- Department Public Safety
Board of Building Rer=ulations'rid Standards
J
V ti,
Cbrstrucfion Supervisor'.License _
License: CS 58987
Restricted to 00 "
STEPHEN E BOBOLA -e,
24 ST FRANCIS CAR ,
HYANN IS,'MA'02601r � n
s:
Expiration: 2/4/2012'
I
`73
o -S
1'
i
tT)F fz
t TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION
Map �.:�' Parcel F_ Permit#
Health Division Ila) r^ �1� - Date Issued /-
Conservation Division I��l� Application Fe ,
Tax Collector I Permit Fee 4P .
Treasurer SEPTIC SYSTEM MUST EE
INSTALLED IN COMPLIANCE 94
Planning Dept. VM TITLE 6
Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANE
TOWN REGULATIONS
Historic-OKH Preservation/Hyannis
Project Street Address 2 2 %h o Q'-r_Q,,XA
Village C¢ 4-1 t 114 /Le
Owners ¢.Joan. S-6�,,,c Address S�- C— �r��s
Telephone :n 2 L/Z //f ?
Permit Request M e
Square feet: 1st floor: existing/SK proposed S""�e- 2nd floor: existing proposed Total new_
Zoning District Flood Plain Groundwater Overlay
Project Valuation -Z go Q Construction Type
Lot Size Grandfathered: Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family'' Two Family ❑ Multi-Family(#unit's��
Age of Existing Structure Z 9 )ev-- P Historic House: ❑Yes_,arNo On Old King's Highway: ❑Yes NO
Basement Type�Full ❑Crawl ❑Walkout ❑Other /
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) J`L-:!K S� _
Number of Baths: Full: existing new Half:existing / new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing S new First Floor Room Count
Heat Type and Fuel:/Gas ❑Oil ❑Electric ❑Other
Central Air: Yes ❑ No Fireplaces: Existing New —�� Existing wood/coal stove: ❑Ye
so
Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:❑existing 0 new size
Attached garageexisting ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use.
BUIILDER INFORMATION
Name / � -� y tRb, 1�t r ,,� !S�r{ jg Ym C Telephone Number �� 7 7 !t g e1 7 Q�
Address Z. �f ���,, .� ,, c , ����-r License# C :5 $—7
Home Improvement Contractor# / 3 O 6'11
Worker's Compensation# ✓G T-3/S-3/7Z// G L3
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE ,�/f./i', DATE /-L Z7 7 �� �„
9
1'
s FOR OFFICIAL USE ONLY
f
PER MIT NO.
DATE ISSUED
MAP/PARCEL NO. y
ADDRESS VILLAGE 1
t
f OWNER -
� 1
i DATE OF INSPECTION: 1
FOUNDATION
FRAME -1 3—O� f
INSULATION b —
FIREPLACE
ELECTRICAL: ROUGH FINAL
y PLUMBING: ROUGH FINAL ,
9
GAS: ROUGHS FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
i
The Commonwealth of Massachusetts
'-- Department of Industrial Accidents
Office VUHNS081 9JIS
600 Washington Street
Boston,Mass. `02111
Workers' ComiDensation Insurance Affidavit
name .��f�c r✓.� �. �"� /�`
I .ation.
_phone# 771 Q 17-J
ci
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I am a sole rietor and have no one worku in ca achy
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�••rita�4ce
Faimre to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crbntnal p o[a thie up to S1,500.00 and/or
one ye,,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against meo I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby certify under the pains and penalties of pelt'that the information provided above is trup.and eorred
Date J Z z �0 3
' ' Signature iv y �•—
. - Phone# 7-7,,' 2r 7 7
Print name J
official U9e only do not write in this area to be completed by city or town oMciai
city or town: permit/license# ❑Building Department'
❑Licensing Board
av ed ❑Selectmen's Office
❑checkif immediate response q []Health Department
contact person:
phone k; ❑Other
Uriised 9195 P!N
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
,An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver 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,construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or 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,neitherthe
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
Y4t
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
+` supplying company names, address and phone numbers along with a certificate of inciirn_ce as all affidavits maybe
. submitted to the Department of Industrial Accidents for confirmation of ins rance coverage. Also be sure to sign and
��.
j,: date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference numbe affidavits mar. The y be rewriiea to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Once of Investigations
600 Washington Street
Boston,Ma. 02111
fax 0: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
f
°FZHE l°� Town of Barnstable
Regulatory Services
�'' ' '�I'e� Thomas F.Geller,Director
s639.�A�� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost;A_ QG b
Address of Work:
Owner's Name:
Date of Application: /z 7
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑Job Under$1,000
❑Building not owner-occupied
❑Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner: r
Date Contractor Name Registration No.
OR
Date Owner's Name
Q:forms:homeaffidav
TLO CMR Appendix!
7tbk JS.Zlb(coatlaued) Foul!Fuels
.riptive Psckaga far aae s�zd Tr+a-p�d7' ideatiil HaildIag�Ham With
MINIMUM •Hwing/Coo(ing
MAXIMUM plait Floor 3&%=3 oat Slab
Glaring G(sang Ceiling pe imctet Equipment EtFiciate}�
Area'('/.) U-values R-valuer A-values A-valua� Awl i R-y4ur
Parksge 3701 to 6500 tlexting Dcgm Dips' Normal
6
12Y. 0.40 38 13 19 10 6 Norma
O SZ 30 19 10 19 6 15 AFUE
R 13 19 10
g 12/. 0.50 38 NIA Normal
T 15% 0.36 38 13 NIA a!
6 Norm
U IS'/. 0.46 38 19 19 1a NlA 15 AFUE
0.44 33 13 25 NIA 6 13 ARM
V 30 19 19 10
IS'/. O.SZ NIA Normal
18% 0.32 31 13 25 NIA NIA Normal
X 19 25 N/A
Y 1S•/. 0.42 38 19 l4 6 90 AFUE
042
38 13 6 90 AFUE
.
Z 30 19 19 10
AA 18% 0.30
1. ADDRESS OF PROPERTY:
- �h o r t r-L4, r
SQUARE FOOTAGE OF ALL EXTERIOR WALLS'
n
3, SQUARE FOOTAGE OF ALL GLAZING:
S�
4, a/a GLAZING AREA(03 DIVIDED BY
5, SELECT PACKAGE(Q--AA-see chart above):
ORE INVOLVED METHODS OF DETERMINING.ENERGY REQUIREMENTS
NOTE: OTHER M
ARE AVAILABLE, ASK US FOR THIS INFORMATION.
y
41
BUILDING INSPECTOR APPROVAL:
YES:
N0:
q•fa ms-580303a
780 CMR Appendix
Footnotes to Table d�.Mb: skylights, and
Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doers,
basement windows if located in walls that enclose conditioned space,but excluding opaque doors) to the gross wall
area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement.
For example=3 f of decorative glass may be excluded from a building design with 300 if of glazing area.
a After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council units: center-of-glass (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for
whole uni
• nter-of- lass U-values cannot be used.
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,iulatio R 30 CeilinguRv n may be aloes represent sum of cavity
insulation and R-38 insulation may be substituted for R-4
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
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
woad-frame or mass (concrete,masonry,log)wall constructions,but do not apply to metal-frame construction,
s 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 50%be owgrade must
doors conditioned
mezC the same R-value requirement as above-grade walls. Windows and sliding glass
basements must be included with the other glazing. Basement doors must meet the door U-value requirement
described in Note b,
'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes eleetric 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 roust meet or exceed the efficiency required by the selected package.
For Heating Degree Day requirements of the closest city or town see-Table 152.1a
NOTES:
a) Glazing area
s 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 11.5.3b.If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0,35).
c) If a ceiling,wall,floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with
different insulation levels, the component complies if or dooro mted average nents comply-Value is f the area-weight d averager thin or l to
-
the R-value requirement for that component. Glazing P
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
/q
I square feet x W/sq.foot= _�='� x.0031= �.
plus from below(if applicable)
ACCESSORY STRUCTURE>120 sq.1� ,
>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: x.003 1=
square feet x$96/sq.foot=
c
STAND ALONE PERMITS
Open Porch. x$30.00=
(number)
Deck _x$30.00
(number)
Fireplace/Chimney _x$25.00=
f. (number)
* Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable) permit Fee
projcost
°Ft► �°,,, Town of Barnstable
ti
P Regulatory Services
BAMSr"LE9 'MASS. $" Thomas F.Geiler,Director
ea 39. A`` Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, as Owner of the subject property
hereby authorize S?z y-L-_ ���p, 14.E to act on my behalf,/
in all matters relative to work authorized by this building permit application for:
2 :2 / ,fi o re 0,
(Address of Job)
a 3
Signature of Owner Date
Print Name
I
I
Q:FORMS:OWNERPERMISS ION
JC1
Board of Buildin Regulations
_ ations01 1
_ One Ashburton Place, r� 3
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 02/04/1967
Number: CS 058987 Expires:02/04/2004 Restricted To: 00
STEPHEN E BOBOLA
24 ST FRANCIS CIR
HYANNIS, MA 02601 -
Tr.no: 16123
Keep top for receipt and change of address notification.
IL
- 1 Board of Building Regulations and Standards
1301
One Ashburton Place - Room
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Reqlstration: 130611
Type: Individual
Expiration: 3/31/2004
CAROLYN BOBOLA
CAROLYN BOBOLA
24 ST. FRANCIS CIRCLE -
HYANNIS, MA 02601
Update Address and return card.Mark reason for change.
_ c...„1—MDnr 1.ost Card
C
�0 • qK,6 0A)6 OA4'� `�qA(m
b 7',5` oco
, .
NEW SMOKE DETECTOR REQUIREMENTS .
ARE NOW'L.XVk . EVEN THE ADDITION OF A
NEW BEDROOM WILL TRIGGER AN
UPGRADE OF THE SMOKE DETECTORS
FOR THE WHOLE HOUSE. YOU MUST
PLAN ACCORDINGLY AND HAVE YOUR
SMOKE DETECTORS O.K. ELECTRICIAN TAKE OUT THE APPROPRIATE
PERMIT AT THE FIRE DEPARTMENT.
NSTABLE BUILDING DEPT.
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