HomeMy WebLinkAbout0042 CROCKERS NECK ROAD z - --- - - . . . , _ _
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t. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map s Parcel 'Application# c06 &`7
«^ Health Division
Conservation Division Permit#
Tax Collector Date Issued ``4—/-,N tq
Treasurer Application Fee J
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address UMjL,"r'
Y -
Village II f"V
Owner J ok to i C. Address 42 Uxydcuz 1,(edL
Telephone ®' 4U"
Permit Request
` 81
J
Square feet: 1 st floor:existing pr posed 2nd floor:existing proposed Total new
Zoning District �r Flood Plain Groundwater Overlay
Project Valuation 21 660 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 Historic House: ❑Yes Cl No On Old King's Highway: ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full:existing new Half:existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Room�Count
N>
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: �O Yes� ❑No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exi ting & new Re f36
Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0_
WCommercial ❑Yes 4No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name Lk ✓1 < )/1XA&(fW VC'Z Telephone Number (4 2�O r 3� c
Address I *- e-c,C License#
�- Home Improvement Contractor#
Worker's Compensation# i r
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Vk
SIGNATURE DATE
FOR OFFICIAL USE ONLY
r
PERMIT NO. '
i '
DATE ISSUED J
MAP/PARCEL NO.
ADDRESS VILLAGE)
OWNER '
r
DATE OF INSPECTION,,: !!
FOUNDATION *qb QbK) 'l\ha O '
C.nswFi
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT -
ASSOCIATION PLAN NO. �%`�
, �a (7/�` 1/LG VVf/L/!LV/L7YGWL/.!i V,J lIlWOJW�.JLWU Gii.l
Department of Industrial Accidents
_ e Office of Investigations
e 600 Washington Street
;., Boston,MA 02111
www.massgov/dia '
Workers' Com*pensatioYn Insurance Affidavit .Builders/Contractors/lEldetricians/Plumbers
Applicant Information t Please Print LeziJbiv
Name(Business/Orgmization/Individual): . Vl✓1' ��,�• (j C Z
•Address: 4 Z C.✓L10__UC n/ CJL-: ' � C1 %5 '
City/State/Zip:_ C'o�IM 17 , MA 0205S Phone:#: 5b
Are you as employer? Check the'appropriate box: -Type of project(required):,
1.❑ I am a employer with 4. ❑ I am wgeneral contractor and I
employees(fall and/or part time).* have hired the sib-contractors 6..❑New construction .
2.❑ I am a'sole proprietor or partner- listed o t. e-attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g Q emolit,on '
working for me in any capacity. employees and have workers' 9...YBuilding addition
[No workers' comp.insurance comp.insurance.$'
equired] f ' S• ❑ 'We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their
I am a homeowner doing-in work 11.❑Plumbing repairs or additions •
myself [No workers' comp.; right of exemption per MGL` `
insurance required.]t c. 152,§1(4), and we have no
12.❑Roof repairs
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 affidaoit indicating they are doing all work and then hire outside contractors must submit a new ai'fidavitindicatng such.
$Contractors that check this box must attached an additional sheet showing the name of the'sub-contractors and state whether ornot those entities have
employees If the sub-contractors have employges,they must provide their workers'comp.polidynumber.
I ayn 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,#: 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
InvestiRations of the I?IA for insurance coverage verification.
I do hereby certify under the pains-and penalties of perjury that the information provided above is true an'd,correct,'
Si ature:. � Date:
Phone#: b—b " 3c1
Offdal use only,.Do not write,in this area, tb be completed by city or town ofcial
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 Inst tucti®ns
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 hiie,
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
re,ceiV=nT tru�t�eg•of an individual,partnership, association or other legal entity, einploying employees, However the
owner.of a dwellfng'house having not more than three apartrnmts 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."
MCiL 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.accdptable evidence of compliance with the insurance coverage required.'
Additionally,MGL oliapter 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 in.�sce
requirements of.this chapter have been presentedto the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, i�
necessary,supply sub-contractor(s)name(s),address(es) and phone numbers)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. B.e 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 require$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.cbpy 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 mot related to any business or commercial venture
(i.e.a(Ibg license or permit to bairn leaves-etc.)said person is NOT required to.complete this affidavit.
The Office of Investigations wound like to thank you in advance for your co operation and should you have any questio.
pleas a do not hesitate to give us a call.
The DepaFnient's address,telephone-and fax number;-
e,Comm•omw' aQih of Massa 1Uwtts
D-pa of ladusWal,Accidents'
Offlee¢f In-vestigat Ons
• ��(��ashim €� Street •
Bostm,ARIA 42111
Tel.#617-727-4944 ext406 ar 1-Q'77 MAS'SAFE
Fax* 617.727-7 749°
Revised I1-22-06
wt .inas .gQt� dl
S
�OFVE� Town of Barnstable
P� G
Regulatory Services
B"MASS Thomas F.Geller,Director.
y�A 1639 �*
�Ec Mpr 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. /1
T e of Work:
yP Estimated Cost
Address of Work: 4Z- ��1to k( ,, K( C'.Ll L 2c� (B� A
Owner's Name:,—A C7�,.V1 VL 0 W v C Z.
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
/❑ uilding 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:
Date Contractor Name Registration No.
R
Date O s Name
Q:forms:homeaffidav
THE p Town of Barnstable
Regulatory Services '
• r
w BARNSfABLE, Thomas F.Geiler,Director
y MASS.
�p i639. .0� Building Division
lfD MA'1 A
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: t
number 11 - street village
"HOMEOWNER". �6V` ✓� jl�/L/l Gr�i l C � �� r -E w
7
name home phone# work phone#
CURRENT MAILING ADDRESS: d
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-writh the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands thetTown of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
req 'ir�rx.en .
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.L I-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
N OF nr.q . �Lo v_ 2 3
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� CRICPiELE c ...y � w -1
No.3477 5
STRUCTURAL/ t !.
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2 r� FLOOR JOIST I CONTWUpUS NAILERS
ATTACHED V/(P)1/2' DIAr
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THRU-BOLTS I EV O.C,
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BOLTS LZ�__O.C. _
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1�MN (TYP)
STEEL COLUHN %A S ,, - '
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TO FOOTING-
OR CONTINU
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BASE PL _-- _
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M.
11.I. ALL WORKMANSHIP TO CONFORM WITH AMERICAN. INSTITUTE 'OF STEEL CONSTRUCTION AND
MASSACHUSETTS STATE BUILDING CODE-LATEST EDITION REQUIREMENTS.
2. STRUCTURAL STEEL: ASTM 572..(FY=50 KSI); 'Optional' SHOP PAINT WITH RUST -INHIBITIVE PAINT.
3. EXPANSION BOLTS: ASTM A510 3/4" DIA:xV EMBEDMENT IN CONCRETE;
THRU-BOLTS:ASTM A307 1/2". DIA:
4. PUNCHED HOLES IN PLATES = 9/16" DIAMETER.
5. ALL WELDS E70XX ELETRODES. SHOP .WELD-CAP AND BASE PLATES TO COLUMNS.
6. COORDINATE ALL DIMENSIONS W/ ARCHITECTURAL.DRAWINGS, AND FIELD VERIFY WHERE REQUIRED.
-7, A L7 �f L-V,L ,
STEEL BEAM CONNECTIONS TO WOOD FRAMING
MICHELE,S 1 UDIL0, P.E.Engineer
/ Consulting
Centerville, Massachusetts 02632
h2 Ck-c `I� �� Drawn By: MC Date: -7 /30 0: Drawln .
Scale: AS NOTED Rev.
COT U T/ M A S K
File Name: Project No.: ��a_
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TJ-Bearr@ 6.355 Serieri 7005107030
Serial Number
4 Pcs of 1 3/4" x 18" 1.9E Microllam® LVL
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Usec2 729l201070:59:17AM MEMBER IS INSUFFICIENT DUE TO LOAD
Page t Engine Version 6.35.0
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A 28�-
Product Diagram is Conceptual.
LOADS:
Analysis is for a Header(Flush Beam)Member. Tributary Load Width: 1Z
Primary Load Group-Residential-Living Areas(psf)a30-0Tive-at 100%duration, 12.0 Dead
SUPPORTS:
Input Bearing Vertical Reactions(Ibs) Detail Other
Width Length Live/Dead/Uplift/Total
1 Stud wall 3.50" 2.54" 5040/2503/0/7543 ' Al: Blocking '1 Ply 1 1/4"x 18"1.3E TimberStrand®LSL
2 Stud wall 3.50" 2.54" 5040/2503/0/7543 Al:Blocking 1 Ply 1 1/4"x 18"1.3E TimberStrandO LSL
-See iLevel®Specifier's/Builder's Guide for detail(s):Al: Blocking
DESIGN CONTROLS:
Maximum Design Control Result Location
Shear.(Ibs) 7453 -6578 23940 Passed(27%) Rt. end Span 1 under Floor loading
Moment(Ft-Lbs) 51553 51553 7 96-- sed-f .� MID Span 1 under Floor loading
Live Load Defl(in) 0.767 92 Faihed(L/433) MID Span 1 under Floor loading-
Total Load Defl(in) �1.1488p, 1..383 asSe MID Spa/n�1 under Floor loading
-Deflection Criteria: HIGH(LL:L/480,TL:L/240). L`r3 ® _
-Bracing(Lu):All compression edges(top and bottom)must be braced at 12'9"o c- detailed otherwise. Proper attachment and positioning of
lateral bracing is required to achieve member stability.
ADDITIONAL NOTES:
-IMPORTANT! The analysis presented is output from software developed by iLevel®. iLevel®warrants the sizing of its products by this software will
be accomplished in accordance with iLeveIS product design criteria and code accepted design vales. The specific product application, input design
u
loads, and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel®Associate.
-Not all products are readily available. Check with your supplier or iLevel®technical representative for product availability.
-THIS ANALYSIS FOR iLevel(b PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS.
-Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevel®Distribution product listed above.
-Note: See iLevel®Specifier's/Builder's Guide for multiple ply connection. u -
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ASH OF rdgS,
PROJECT INFORMATION: OPERATOR INFORMATION:
COTUIT o`' MICHELE tic,
Michele Cudilo
Michele Cudilo, P.E. o CUOILD
v No.34774
123 Cottonwood Lane STRUCTUR>1L- /
Centerville, MA 02632-1979 1
Phone : 5087717601 �'FGlaiEF`� �.
Fax : 5087717163 °Si7TSI E`er
mcudilo@comcast.neC
Olio t>}' 'Leve!.e, Federal. Way: WA. L `'
s a -=_cas radena .. -
�e'-- e. !Leve ldi.
i
l Town of Barnstable
Regulatory Services
MAS& Thomas F.Geller,Director
�rE p���`e� Building Division
Thomas Perry, CBO,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
'Office: 508-862-4038 Fax: 508-790-6230
PLAN REVIEW
Owner: NMENOW t Map/Parcel: D
Project Address lot Builder:
he following items were noted on reviewing:
ZOP
o s� -f7
/I. ktteellw�
J � / G I4-/'lI � �S C K E /��• L Lt'-S
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Reviewed by:
Date: o 7` 2 6-- b7
Q:Forms:Plnrvw
K�
Mckechnie, Robert
From: allianceny@libertymar.com
Sent: Sunday, July 29, 2007 6:18 PM
To: Mckechnie, Robert
Subject: 42 Crocker's Neck Rd Proposed Barn
Dear Mr. Mc Kechnie,
My wife has informed me that you have questions about the proposed barn that I
wish to build. I have to apologize for any omissions on the plans that I
submitted to your office. She had mentioned that there was a question about the
foundation. I plan to put in a 24 inch concrete footing and 4 foot deep 8 inch
wide frost wall. I can' t remember if I called for a 3" concrete slab on the
plans but it is my intention to have one poured. The height of the barn will be
25 ft 06 in which is within the town' s height restrictions.
When I had first planned this barn, I had spoken with Tom Perry about my plans
for using rough sawn pine from a Massachusetts saw mill. He had told me that it
would have to be from a Mass. certified sawmill and I indicated on the plans
that I would be using lumber from R.D. Williams sawmill in Carver, Mass. who is
a certified Mass. sawyer. It will be No. 2 pine sawn to full dimension that I
will be using for the framing.
I am currently working on board the ALLIANCE NEW YORK and we will be sailing
between ports on the US East Coast until early August after which we will be
heading across the Atlantic. I had called you on Friday afternoon and left a
couple of messages. I will be in Newport News, VA Monday morning and will call
you between 0800 and 1000 to answer any questions that you may have. My next
opportunity to call will be July 31.
I can also be reached at this e-mail address at any time if we cannot connect by
phone. Please put my name (John Janowicz) in the subject header so that it will
be forwarded to me. I will be happy to answer any questions that you may have.
Again, I am sorry for any omissions on my submitted plans.
John Janowicz
7A/0
4, el
�C
Page 1 of 1
Mckechnie, Robert
From: annabrigham@comcast.net
Sent: Sunday, July 29, 2007 9:45 AM
To: Mckechnie, Robert
Subject: Janowicz, 42 Crocker Neck Road, Cotuit-Barn
Good morning Bob,
My husband John Janowicz will be attempting to contact you on Monday to discuss his plans for
the barn. I did notice on the plans that John forgot to indicate some dimensions. The scale is
1/4 inch= 1 ft so I have scaled off the height for you (it is 26 ft). I would be happy to re-submit
any information you need after you and John speak on Monday.
Thank you for your time,
Anna Brigham-Janowicz
7/30/2007
Assessor's office(1st Floor):
Assessor's map and lot number
T'ALLED Ill C
Conservation(4th Floor): 'y1•j•HT
Board of Health(3rd floor): w
Sewage Permit number ONIWENT'A
Department 3rd floor):, ` + 5 + TOWN REGU .•
Engineering Dep ( ) . �.
9
House number,
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M..and 1:00'-2:60 P.M.only
;TOWN O;F BAR�N�STABLE
`BUILDING : INSPECTOR
APPLICATION FOR PERMIT Y �L��iO /�A'1/D/ S1-0
/J J
Rp{" !�®
TYPE OF CONSTRUCTION e `
r , 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: /
Location t�6�.d7-11/`� aa�
1
Proposed Use ` Ibc-OTAt
Zoning District J t / Fire District elm, L
Name of Owner S�Ly 1VJ s,/,!JA)0VJ G C Z Address-
Name of Builder LTf•(.i,i Address /b 1/'i WeLl 5a-,— /IAV�fi1`S
Name of Architect Address
Number of Rooms Foundation—4
Exterior
I/y/Utit-C, &6� Roofing 4sp
Floors amjAx9nd Interior �r�ll/i1L-
Heating Plumbing
Fireplace �.� �— Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all.the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Const/ctionSi ipervisor's License
CI
6
JANOWICZ , JOHN
No
361 /5 PermitFor
ADDITIONS & ALTERATIONS
Single Family Dwelling _
Location 42 Crocker Neck Road
Cotuit
Owner Tnhn' .Tanowi c7. i 'r
Type of Construction Frame
Plot Lot
f
Permit Granted Sept. 16, 9 9 3 r
Date of Inspection: ,t
Frame
S .f �` `
Insulation 1�R�D�0 9
Fireplace 19
Date Completed
,\ n
zw
J
- COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF 1010 COMMONWEALTH AVE.
MASSACHUSETTS BOSTON, MA 02215 '
L. [C E iJ S c i CAUTION
EXPIRATION DATE '+t:i T U PE k U.i S G R
0 6/3 0/1 9 94 '''4 4 I � FOR PROTECTION AGAINST
EFFECTIVE DATE LIC NO.
RESTRICTIONS i THEFT, PUT RIGHT THUMB
N U N E 6/30/1 9 9 Z r)> 14 7 PRINT IN APPROPRIATE
BOX ON LICENSE.
�Ji;H"J F GyLIIS
` : 1 '.) L E D A—ROSE LA n E # BLASTING OPERATORS
gSTGNS MILL' rA:A iJ264 � MUST INCLUDE PHOTO.
i
I PHOTO(BLASTING OPR ONLY) F�Ef•� F� - ' ��"-~ "� - ,.-� - --
I NOT VALID UNTIL SIGNED BY LICE NSE F`.AND OFFICIALLY
HEIGHT:
STAMPED OR SIGNATURF OF THE COMMISSIONER
i
j' """'j/I i A P R 2 81992,
THIS DOCUMENT MUST BED' «�- I SIGN NAME IN FULL ABOVE SIGNATURE LINE
CARRIED ON THE PERSON OF AGSIG MATURE OF LICENSEE
fHE HOLDER WHEN Eh _1.'Zq
OTHERS RIGHT THUMB PFI�NT GAGED IN THIS OCCUPA I ION' /j'� / l r.n COMMISSIONER
COMMONWEALTH OF MASSACHUSETTS
DErARTMENI' OF INDUSTRIAL-ACCIDENTS
600 WASHINGTON STREET
BOSTON, MASSACHUSETTS 02111
fames Gamcoei:
�oT-n:ss�one WORKERS' COMPENSATION INSURANCE AFFIDAVIT
,
(licensee/permittcc)
with a principal place of business/residence at:
(City/state/Zip)
do hereby certify, under the pains and penalties of per)ury, that:
[ ] i am an empioycr providing the foliowing work:.rs' coup :sacon coverage for my etnpioycc� working o ; ihi>
)ob.
Insurance Company Policy Number
[ ) I am a sole proprietor and have no one working for me.
[ I am a sole proprietor, general contractor Chom:c:o:wn�ccircic onc) and have hired the contractors listed below
N�
who have the following workers' compensation insurance policies:
Lo
Name of Contractor Insurance Company/Policy Number
?game of Contractor Insurance Company/Policy Number .
Name of Contractor insurance Company/Policy Number
Q 1 am a homeowner performing all the work myself.
NOTE: Please be aware that while bomcowners who employ persons to do maintenance,construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sea. 1(5)), application by a bomeowner for a license
or permit may evidence the legal status of an employer under the Workers' Compensation Act.
1 understand that a copy of this sutcmcnt will be fo,,-ardcd to the Dcparrmcnt of Industrial Accidents' Oftiee of Insurance for.eovcragc
verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition ofStimina) penaJ:ics
consisting of a fine of up to Sl 500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against me.
�t k�C�u day of , 19 --� --
Sipped this Y
L'censee/Fermi e Licensor/Permitter
f
ro�►.� r✓Ay.
74't
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LoT �Z3� I
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I certify .that this property is
located in Flood Hazard Zone' C (out-
side the 500 year flood) as identified
by the Department of Housing and Urban
Development (HUD) .
Date acT 2/ /J�yZ �, "`:' "`'�., CCR7IFILU PLOT PLAN
•yt' .+,: _._.__ �':a,.'•inn
LOCATION 4iI :C,Co7?v00,
iT�
SCALE . .'�.... DATE
R.eb .` ,-,., PLAN REFERENCE �'7!�!G .�r .. .7
<lp.44'' Surveybr p
I certify to its title-insurance company
that. there are no 'visible encroachments I C E R T I F Y THAT THE !ST!'!�G„ DWEL�!!vC.
or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
plan was prepared under m immediate AS SHOWN HEREON AND THAT IT CONFORMS TO ME
y SETBACK REQUIREMENTS OF THE TOWN OF
supervision BiJ•Q!vs'T�8.4E., , , . . .WHEN CONSTRUCTED.
DATE
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# � a
ITown of Barnstable *Permit# o�00710161 V�
Expires 6 months from issue date
1 r R 'egulatory Services Fee �
o S PERMThomas F. Geller,Director
APR 0 2 2007 Building Division
Tom Perry,CBO, Building Commissioner
TOWN OF BARNSTABLE200 Main Street,Hyannis,MA 02601
www.to-vm.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERAUT APPLICATION .- RESIDENTIAL ONLY
/ Not Valid without Red X-Press Imprint
[aP/PaTcel1,Tumber0?110
roperty Address 2 C�f OC-��¢-!i Ater" ??
lyiesidential Value of Wo2 / V 2D Minimum fee of$25.00 for work under$6000.00
iwner's Name&Address � '(7 yt K \& t4 y[N 1C 2
ontractor's Name
'Ur,6 ' Telephone Number
[ome Improvement Contracto-r License#(if applicable)
]Workman's Compensation Insurance
Check one:
❑ am a sole proprietor
[ I an the Homeowner
❑ I have Worker's Compensation Insurance
ssurance Company Name
Vorkman's Comp.Policy#
;opy of Insurance Compliance Certificate must be on file.
-ermit 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
[Replacement Windows/doors/sliders. U-Value °140 (maximum.44)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property.Owner.Letter of Permis�srstun. --
A copy of the ome Improvement Contractors License is required.
;IGNATURE:
I:Forms:expmtrg
.evise061306
IThe Commonwealth of Massachusetts
Department of Industrial Accidents
Office oflnvestigations•
' d 600 Washington Street
Boston,MA 02111
wivw.mass.gov/dia '
Workers' Compensation Ihsurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Letzibl
Name(Business/OrgauizationUdividual): . ('� !� (,il(�Zcm
Address: Z .12Q77 .(i,� kk Q- C
� �City/State/Zip:
Are you an employer? Check the'appropriate boa: Type of project(required):. .
1.❑ I am a employer with 4, ❑ I am a general contractor and I
* have hired the sub'contractors 6. ❑New construction .
employees (fall and/or part-time). .
2.❑ I am&'sole proprietor or listed on the'attached sheet. 7. ❑Remodeling
partner-
shipand have no employees These sub-contractors have
8. ❑Demolition .
working for me in any capacity. employees and have workers'
insurance.t 9 ❑Building' addition
• [No workers' comp.insurance comp.
equired] 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions
3. I am&homeowner doing.in work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per exercised.
12.❑Roof repairs
insurance required.]t c. 152, §1(4), and we have no 13:❑Other
employees. [No workers'
comp, insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that cheek 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.policynumber.
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.#: Expiration Date:
lob 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 OfF ce of
Investigations of the DLA_for insurance coverage verification
Ido hereby rtify,under the &ins andpenalties of
perjury that the information provided
`above is true and correct.'
rlSi ature: Date: `� 2 v
Phone#:
Official use only,. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
I;
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#:
Informlati®n and Instr°ucti®ns R=e,_�•
Massachusetts General Laws chapter 152 requires all employhs 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
s o a-deceased employer, or the
of the foregoing engaged in a joint enterprise,and including the legal representatives f
=ec.6YU or=tee of an individual partnership, association or other legal entity, employing employees. However the
w oner 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 insnrraance
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-conti:actor(s)name(s), address(m)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. Bp 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 hike 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:
Tie.Com ouwealth of Musar-h=tts
DTaztm:ent of I.dutrial A.oc,di mts
Office of Investigations
600 71ashingtozi Streut
E.oston,MA€.2111
Tel.#617-727-490.0 ext 4.06 ar 1-M-MASSAFE
Fax##G17-727-7749
Revised 11-22-06
w .mass.gaWdia
i
�t r Town of Barnstable
Regulatory Services
BAMSTABLE, : Thomas F.Geiler,Director o-
MAss.
039• .�� Building Division
RFD MA'I A
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
f���J� Please Print
DATE: 7 t V,;e y /
JOB LOCATION: Z �r�lGev ecp� Ce
nu^bberr,, street q village /�
"HOMEOWNER : f JVl y) �.�.tj0W tC Z AIZO — J 7 L,7 5MS—Z97 —l/0t d S
name home phone# work phone#
CURRENT MAILING ADDRESS: / Q &x V3
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
r e ents.
Si ature of Homeo
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
r
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
,
P' 7.
Map ' Parcel qV Permit# 7�
Health Divisionct CI I Date Iss
Conservation Division 30 g Fee
SEPTIC SYSTEM MUST BE
Tax Collector �5 INSTALLED IN COMPLIANCE
Q WITH TITLE 5
Treasurer ENVIRONMENTAL CODE AND
Planning Dept. TOWN REGULATfked in By
Date Definitive Plan Approved by Planning Board Approved By
Historic-OKH Preservation/Hyannis
Project Street Address 42 l` kuy� Q tcL
Village 0.n--k �ck.
Owner k V1 )l ANQ W ILZ Address
Telephone
Permit Req t t� f0U
Square f t: 1st floor: existing 2b proposed 2nd floor: existing I ��� proposed Total new
a
Valuation c�� Zoning District �- Flood Plain Groundwater Overly
Construction Type
Lot Size Grandfathered: 0 Yes ❑No If yes, attach supporting documentations
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) = -
�r
Age of Existing Structure 3 ' Historic House: Cl Yes 4o On Old King's Highwa Cl Yes.. o
Basement Type: &"Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �6
Number of Baths: Full: existing 2, new Half: existing new
Number of Bedrooms: existing new _
Total Room Count(not including baths): existing `0 new 1 First Floor Room Count
Heat Type and Fuel: INGas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes C!I/No Fireplaces: Existing 1 New Existing wood/coal stove: t9'Ies ❑ No
Detached garage:Ve'xisting ❑new size Pool: 0 existing ❑new size Barn: 0 existing ❑new size
Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial 0 Yes Or< If yes, site plan review#
Current Use Proposed Use
((,A BUILDER INFORMATION
Nam �V�'� fii l 0�1 CIL Aelephone Number
J Address A & License#
l)-l` _-xv.-Fi -Mk 021, 3J Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
SIGNATURE DATE fps
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS - VILLAGE
OWNER '
DATE OF INSPECTION:
FOUNDATION
FRAME a tr
INSULATION n
rr
FIREPLACE ! n
� :5- rn
ELECTRICAL: ROUGH ; FINAL ~
PLUMBING: m ROUGH FINAL
GAS: ROUGH ' �• / FINAL, '
FINAL BUILDING y� "Y✓
DATE CLOSED OUT
rQ _
ASSOCIATION PLAN NO.
rat I KA �t�•-Ect�u�v�.l S k..,�(.ti `"'� ,s .
3� IC1- t.u�•c pic.6aM-+�
o�,e.. i,;poc6 Kgar .
va,�ss
3.2x8 ,
I .
I' f
w' ,ems .1pWAIPI5 Ef 5 y
ti a-2,6 2�a P.+@ 16 — s' pr Laoy<a.
' �IASa ovGL
,s; y
f 1 '
Itl
11Ell
I .
-
0
EK/ST/N 7-4 I
- �,
Iry I.z. PO,zc .- /�(Z C.2v��c=reS /�lecic Xd
emu: —/40
QANOW IC"L <lL CrGvtJCavS Ncc.�G
AAA
n ..
vaa w.nms�n.mu.ouv.an. '
vj
7*'
N
. 1
ti
t
I certify .that this property is
located in Flood Hazard Zone c (out-
side the 500 year flood) as identified
by the D€partment of Housing and Urban
Development (HUD) .
PLOT PLAN
LocATION
�47, 4�?'. . ATE
SCALE . ,. • 4;rP Z37
PLAN REFERENCE
-..... �'.4..�c rv.c
d� The Commonwealth of Massachusetts
�\ Depariment of hidi2strial Accidents '
Office of Investigations'
600 Washington Street
Boston,MA 02111'
w www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaiis/Plui hers
licant Information Please Print Le 'bl
�1 Mlle(Buqiness(0rgaz»adon/I tMduan: dcn 0'1 C_ �
Address• �Z �,lDo�-r�Ge.�- 1� ��� (<� • ' - '
to/Zi �c�i .� .0 2f6 i Phone#: .
City/Stir p: °° . .. .. •.
kre you an employer? Check the appropriate box:. ;Type of project(required):•
❑ Z am a•employer with 4. ❑ I am a general contractor and I 6..❑New construction
full
employees and/or part-time).* have hired the sub-contractors
( listed on the attached sheet.$ 7. Remodeling
[] I am a sole pmprietor or pM-Iner-
andhaveno employees. These sub-contractors have 8. -❑ Demolition . .
ship workers' co insurance.
working for me in any'capac#y. comp. 9. ❑ Binding addition
[No workcis' comp.insurance 5• ❑ We are a corporation and its 10.❑ Electrical repairs or.additions
required.] officers have exercised their
t of ex lion er MGL 1I.❑ Plumbmg repairs or additions
3 I am a homeowner doing all.work . P p
myself.[No workers' comp. c. 152,§1(4),and we have no.. 12.❑ Roof repairs
t employees.[No workers"
insurance repaired.] 13:❑ Other
comp.insurance required.]
Any applicant that'checks box#1 must also fill out the section below showing their workers'compensation policy information
Homeowners who submit this amdavit indicating they are doing all-work sad 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 andtheir workers'•romp policy:nsfbTffMtion-
am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site,
information. '
[nsurance•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 e. 152 ca::Iead to the imposition of aiiminalpenalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as.civil penalties in le form of a STOP'WORK ORDER and a fine
of up to$250.00 a day against the violator. 13e advised that a copy of this statement maybe forwarded to.the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c u der the pains and penalties of perjury that the information provided above is true and correct:
Si at>lre: Date:' �•()��
Phone#:
Octal use only. Do not write in this area,to be completed by city.or Town official
City or Town: Permit/hicense#
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#•
Informat
ion and Instructions
ter 152 t wires all employers to provide workers' compensation for their employees.
MassachusettsGeneral Laws chap person in the service of another under any contract of hire,
Pmiant to this statute, an employee is defined as"...every
express or implied,oral or written." two or more
ration or other le al entity, any
sociati ,
. . err .as � f�P ..
An employer is defined Wk'sn=d'vi4aaL P 14' to er,or the'
of the foregoing engaged m a joint enterprise'and mchidmg the legal representatives of a deceased emp y
arm ,association or other legal entity, employing employes. HovsteVer: e
receiver or trustee of an individual,P er�P ant of the
owner of a dwelling house having not more than three apartments and who resides therein,or the o. I
elfin house of another who employs persons to do maintenance,construction or repair work-ou such dwelling house
dw g thereto shall not because of such emgloymentbe deemed to be an employer."
or on the grounds or budding aff
uTtenant
GL chapter 152,§25 CO)also stets that"every.state or local licensing agency shall withhold the issuance or.
M permit St t operate a business or to construct buildings inIhecommonwealth for arty
zenewal of a license or p P.
licant vrho�has not produced acceptable evidence•of compliance with the insurance coverage required."_ .
aPp states"Neither the commonwealth nor any of its'political subdivisions shall
Additionally,MGL chapter 152,§25C(�
�t�into any contract for the performance of public work until acceptable evidence of compliance with the insurance
iequiremems of-this chapter have been presented to the contracting authority.
Applicants
ensation affidavit completely,by checking the boxes that apply to your situation and,if.
Please fill out the workers' coal addresses)and phone numbers) along with.their certificates)of
necessary,supply sub-contractors)name(s), with no employees other than-the
=es or Limited Liability Partnerships(L•LP)
insurance. Limited Liability nip (LLC)
r partners, are not required to carry workers' compensation insurance. If an LLC or L�LP f Ina anal
embers o P submitted to the D artm
m aired. Be advised that this affidavit maybe e suborn ep
employees,a policy is req
Accidents for confirmation of insurance coverage., Also be sure to sign and date the affidavit. The affidavit rho
or town that the application for the permit.or license is being requested, not the DeparEment of
be returned to the city ustions re girding the law ar if you are required to om_aers'
Industrial Accidents. Should you have any q g
compensationpolicy,Pl ecan the Departmentat the number listed below Self-insuredcompanisshould�atertheir
self.insurance license number on the appropriate lime.
City or Town Officials
provided a space at the bottom
Please be sure that the affidavit is complete and printed legibly. The Department has pro lict you cant
of the affidavit for you to fill out in the event office� f Investigatioi�has to wM be used as a reference number-regarding In addition, an applicant
Please be sure*to fin in the peruut/hcense number
thataui a 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"'tlie applicant should write"all locations in_____(city or
P stamped or marked by the city or town may be provided to the
A copy of lhe•affidavit that has been officially
applicant as proof that.a valid affidavit is on file for;infuse p ermoit not elated to any businessor bmmercial venture
Dine owner or citizen is obtaining a license o p .t
year,Where a h
(le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
ti advance
for our coo eration and should you have any questions,
advan P
The Office of Investigations would Ike to than.-you m Y
please do nothesitate td give us a call. '
The Department's address,telephone and.faxmimber:
The Commonwealth of Massachusetts .
' Department of Jullstrial.Accidmts ..
. Office 9g Investigations
�.
f b00•washingtion StreetV Boston,MA 02111..
"Tel. #617-727-4900 ext 406 or I-877 MASSAFE
Fax#617-727r7749
Revised 5-2645 www,mass.gov/din
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
63
j°�En +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
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' Z EC50
Address of Work: 47— C�49_0 q(g & ,
Owner's Name: �v �VL a v C
Date of Application: �j - �� _0
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
❑ uilding not owner-occupied
LZOwner 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 he I by a ply for a p rmit as the agent of the owner:
Date Contractor Name Registration No.
` Z —v S. OR
Date Owner's Nan ie
Q:forms:homeaffidav
��i
�� �
��
s
Town of Barnstable
P� o� Regulatory Services
• Thomas F.Geiler,Director
KAM
L s�xK LE
i6,19. `0� Building Division
Tom Perry,Building Commissioner
200 Maier Street, Hyannis,MA 02601
www.town.b arnstable.ma.us
Mee: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EREMPTION
qPlease Print
JOB LOCATION
``�n � sheet
` village
"HOMEOWNER': V V)
name n e phone# work phone#
CURRENT MAILING ADDRESS: 4 Z �.f�fJTT J(C-e�
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
su eg rvisor.
DEFINITION OF HOMEOWNER
Persons)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
re ' e nts.
l Si ature of Home
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 EREMPTION
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 I o9.1.1.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.carmot 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.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Mapes —Parcel Permit# ! 1 l
1 Health Divisio k'03 9 3 5�1`!� Date Issued
/6103 f `
Conservation Division nn��-- �r^F •,-.� �-�' i�':`s #� �� Application Fee
Imo:. �,.. � PP
Tax Collector zo Permit Fee
Treasurer SEPTIC SYSTEM MUST SE
Planning Dept. INSTALLED IN COMPLIANC`
WITH TITLE 5
Date Definitive Plan Approved by Planning Board E"RONMENTAL CODE ANE
Historic-OKH Preservation/Hyannis T004 REGl1LA7I0tiS
Project Street Address 4 2— (11_CXJ(_P_r KVeA �ZoQc (
Village _00 c�
Owner �h1') �)C 1( 1 CZ— Address �o �� Q C 1
Telephone 420 14 ]
Permit Request _1Fn OE� ►)c;� roAJ C10I cyLar C)n � I cepr
Square feet: 1st floor: existin proposed 2nd floor: existing proposed L Total neW
Zoning District 9.E Flood Plain Groundwater Overlay
Project Valuation 4 161 S Construction Type I,` 14 JPcome
Lot Size 1 .03 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing StructureAa1r0)( SD qrS Historic House: ❑Yes �o On Old King's Highway: ❑Yes
Basement Type: Bull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) -- Basement Unfinished Area(sq.ft) ¢ (�
Number of Baths: Full: existing new — Half:existing ' new
Number of Bedrooms: existing_ new I
Total Room Count(not including baths): existing 0 new First Floor Room Count
Heat Type and Fuel: O Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes U-110 Fireplaces: Existing �_ New Existing wood/coal stove: �s ❑No
Detached garage:Vxisting ❑new size V745 Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial Cl Yes B<o If yes, site plan review#
`Current Use .n,6g:A -_ Proposed Use_ R Q S 1
BUILDER INFORMATION
l,Name Number�dfess d �Ah&A9,hJyt1_.PJ'6Ze
License#
d� Home Improvement Contractor#
Worker's Compensation# WC -33
ALL CO
�
NSTRU ION DEBRIS RESULTING,FROM THIS PROJECT WILL BETAKEN TO t
I �b�1S _"
SIGNATURE DATE 0
R �� l
FOR OFFICIAL USE ONLY
- PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS -~ VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION _
FRAME '!c
INSULATION
FIREPLACE '
i
' f S
ELECTRICAL: ROUGH FINAL +
1
PLUMBING: ROUGH FINAL
GAS: ROUGH 4 ° FINAL
FINAL BUILDINGi �dyi,.
ek
DATE CLOSED OUT
r � M •.( • ' ' t.. Ihif
ASSOCIATION PLAN NO.
The Conimon-wealth of Massachusetts '
-�- Department of Industrial Accidents
exce oflvyestigatiaas
600 Washington Street
- - Boston,Massa 02111
Workers' Com ensation Insurance Affidavit /
IN
name
JOB
.on:
hone#
ci I am a homeowner per£o S all work myself.
[] I am a sole rietor and have no one workin in ca aczty
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itsaraa¢e:co3::' }4r: QO and/or
osition of�t{�lpenslties of a Sae up to SI,S00.
W!!�verage as wired under Section 2s&o f MGL 15Z can lead to the Imp a Sae of S100.00 i day against me. I understand that a
one years'imprisonment wen as�penalties in the fora of a OsP WOPLK o f the DIA iRDr�erage verlitcatiom
copy of this statement may be forwarded f Ivti
the Office onesg
under the p ' and penalties of perjury that the information provided above is trcu and correct
I do hereby 7 f 9 0-
Date
Signature
\ Phone#
Print name �N
official use only do notynite in this area to be completed by city or town oi4dslUBuflAing❑ Department
peradt/license# Licensing$card
city or town: ❑Selectmea's Office
3 _ HealthDepartment
❑ checkif immedilte response is required Other
phone#;
contact person:
(cruised 9/95 NA) a
Information and Instructions
Massachusetts General Laws chapter�152 section 25 requires all employers to provide workers'of anothercompensation
for their
ract
employees. As quoted from the 'law", an employee is defined as every person in the service
of hire, express or implied, oral or written. -
ent to er is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
An p Y .
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 Iocal 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,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 ice requirements of this chapter have been presented to the contracting
authority.
Applicants
Please Min 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 in` urance as all affidavits may be
submitted to the ny ernes of Industrial Accidents for confrmation of inc��rance,.coverage. Also be sure to sign and
date the affidavit"The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the peirnitllicens0 number which will be used as a reference number. The affidavits may be retamn ed't
the D ep artment by mail or FAX unless other arrangements have been made.
d like to thank you in advance for you cooperation and should you have any questions.
The Office of Investigations woul
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
amce of lavesugatlons
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
oFtHE,o,,, Town of Barnstable ,
Regulatory Services
»xsr.+s Thomas F.Geiler,Director
WAM
9$ 1679. ��� Building Division
pjfD MA'S A
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:
(f1 ��ZX�t/u Estimated Cost
Address of Work:
Owner's Name: L Z
Date of Application: '
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
❑lob Under$1,000
OBuilding not owner-occupied
96wner pulling own permit
Notice is hereby given that:
OWNERS PULLING TEEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME MROVEMENT 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.
Q 0
Dirt wner's N
3 ` RESIDE NTIA L 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 ,
-W�! ' x.0031=
square feet x$96/sq.foot=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
x.0031=
>. square feet x$64/sq.foot= 3 3,33
plus from below(if applicable) 1 p?S Z
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 pest x,0031=
square feet x$96/sq.foot=
STAND ALONE PERMITS
x$30.00=
Open Porch (number)
x$30.00=
Deck (number)
Firepiace/Chimney ,x$25.00= -
(number)
Inground Swimming Pool $60.00 -
Above Ground Swimming Pool
$25.00
RelocationlMoving -
$150.00
(plus above if applicable) Pert Fee
r r
7 ja CMR Appendoa!
Table J3.Llb(continued)
F prcriptive packagm for ace and Two-FMW Resldend21 Buildings Heated with Ftrissl Fuels
ti
MAJttMUM MINIMUM
Wall Floor Easemaai Slab Heating/Cooling
Glazing Glazing Ceiling etu
R Equipment Eilicicncy'
Area'('/.) U-valuc, R-vaiuel R-value' R-valuar wa t �cr
package
3701 to 6500 Hating Degm Dalai Normal
13 I9 10
0.40 38 6
Q 12/. Nor
6 mal
g 12'/. OSZ 30 19 19 30 6 85 AFUE
S 12% 0.50 38 13 19 to N/A Normal
T 15% 036 38 13 ZS N/A 6 Nomal
U 15% 0.46 38 19 19 10 N/A 85 AFUE
�7 15'/4 0.44 38 13 25 NIA
6 85 AFUE
w 13% 0.52 30 19 19 10
13 25 N/A N!A Normal
}( 19% 032 38 N/A Normal
y 18% 0.42 38 19 25 N/A 90 AFUE
0.42 38 13 19 10 6
Z 18'/• 90 AFUE
AA 18'/. 0.50 30 19 19 10 6
1. ADDRESS OF PROPERTY: 91
UD LA,
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING:
4, %GLAZING AREA(#3 DIVIDED BY#2):
5. 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: J
YES: NO.
q-forms-580303a
780 CMR Appendix I
Footnotes to Table J8.2.Ib: Lass doors, skylights, and
i Glazing area is the ratio of the area of the glazing assemblies (including sliding-g
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 ft of decorative glass may be excluded from a building design with 300 f'of glazing area.
Z After January 1, 1999, glazing U-values must be tested and documented bythe manufacturer in accordance with r
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11,5.3a. U-values are for
whole units: center-of-glass 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, 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 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
wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction.
The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces, basements,
or garages).Floors over nutside air must meet the ceiling requirements.
The entire opaque portion of any individual basement wall with an average depth less than 50%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 in Note b.
'The R-vafue requirements are for unheated slabs.Add an additional R-2 far heated slabs.
' If the building utilizes elebtric 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,
'For Heating Degree Day requirements of the closest city or town see•Table J5.2.1a
NOTES:
a) Glazing areas 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
Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
Ta
� ermine compliance of the door.
glass area of the door with your windows and use the opaque door U-value to determ p
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 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)..
Town of Barnstable r �. �.
�p WETn. o , . . ,,` .t ti�('
o� RegulatoryServices�
f+ . AB Thomas F.Geiler,Director
y MAW.
�A 1639• Building Division
ren Mvr
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
r� Please Print
v DATE: V
JOB LOCATION:._ dtzk Mu.IL.._ ezO
nu ber street village
"HOMEOWNER":,,�_
name home
fphone# work phone#
CURRENT MAILING ADDRESS: b �C
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
4
um inspection rocedures and requ' ements and that he/she will comply with said procedures and
re ents.
Si ature of Homeowner
Approval of Building Official a
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:homeex emtP
3
Nv O»nip
t
r
Z3 �
4SO
afk
4 ems' p
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I certify .that this property is
located in Flood Hazard Zone C (out-
side the 500 year flood) as identified
by the Department of Housing and Urban
Development (HUD) . PLOY PLAN
rS�A
8 �
.ERENCE3 . . ... .... . . .. . . . . . .. .. .
b ° o
NEW SMOKE DETECTOR REQUIREMENTS
ARE NOW. LAW. EVEN THE ADDITION OF A
NEW BEDROOM WILL TRIGGER AN
UPGRADE OF THE SMOKE DETECTORS
FOR THE WHOLE 'HOUSE, YOU .MUST
PLAN ACCOR'D1NGL AND HAVE YOUR
; ELECTRICIAN TAKE;.OUT.THE APPROPRIATE
PERMIT
AT T
1 {r , HE FIFI DEPARTMENT.
"
:y
_
owl
- --Cal 1
-
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SMOKE DETECTORS O.Ke
.. -
"^"'-"_;'� T. _.,-.-.-,. �- '-S.t.-.�-"'t_?ter•.^.c.-�:T _'_—e _.____.._
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oFTME T The Town of Barnstable
Department of Health, Safety and Environmental Services
iB&AURNSTABLM& ' Building Division
� 1639. t►��� 367 Main Street,Hyannis MA 02601
ArFD MA't
Office: 508-790-6227 Ralph M.Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Re �stration
P �
Date: 5 0
Name: at��'g3"k"" Phone#•
Address: �,g ("A( (-�- �—K-L Village:
v
PO 60s--
Type of Business: 9L/ Map/Lot:
T
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4.1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and
there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: Date:
Homeochoc
�3 TOWN OF' BARNSTABLE
BUILDING PERMIT
PARCEL ID 026 094 GEOBASE ID 863
ADDRESS 42 GROCKERS NECK ROAD PHONE i
COTUIT ZIP -
i
LOT 237 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT CT
PERMIT`- ------338a4-_--_-DESCRIPTION RADIANT/UBED-FAM:RM.
PERMIT TYPE BSTOV TITLE STOVE PERMIT
CONTRACTORS: PROPERTY OWNER Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES: $25.00
BOND tME
CONSTRUCTION COSTS $300.00
434 RESID ADD/ALT/CONV 1 PRIVATE P,t 'E
* •ARNSTABLE,
039. A�0
Ep Mp►l
BUILD VI N
BY _
DATE ISSUED 10/06/1998 EXPIRATION DATE
t �► TOV14 OF BA,RNSTABLE
BUILDING PERMIT
PARCEL ID 020 094 GIMASE ID 86
ADDRESS 42 CROCKERS NECK ROAD ,- BI40NE
COTUIT ZIP
LOT 237 BWCK U)T SIZE;
DBA DEVELOPMENT DISTRICT CT
�• M
P)MIT 33864 DESCRIPTION RADIANT/USED P'AM, RM,
PERI.11T TYRE BSTOV`:�f' TITLE STOVE PFMIT .
CONTRACTORS: PROPERTY OWNER Department of Health, Safety
ARCHITECTS:
and Environmental Services
"TOTA.L FEES: 26,OO
BONI) $_00 '� DIME
..CONSTRUCTION COSTS $300-00 � "�•�
434 RESID ADD/ALT/CONV 1. RRIvA` B P
* BAMSI'ABM +
MASS.
f �i639.
ED MA'S A I
BVILDI IVT N
BY y�
t DATE ISSUED 10/06/1998 EXPIRATION DATE.
THIS.PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION:STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC.SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS:
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED I
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE .REQUIRED FOR
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.'
ANICAL INSTALLATIONS.
4.FINAL INSPECTION BEFORE OCCUPANCY.
VISIBLEPOST THIS CARD SO IT IS
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
LJ1 1 1 I
f I
I
2 2 2
I
I
I
I
I
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
I
I
I
2 BOARD OF HEALTH
i
OTHER: SITE PLAN REVIEW APPROVAL
I
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION.
BUILDING
PERMIT
i
. f
7
At
TOWN OF BARNSTABLE
BUILDING PERMIT
PARCEL ID 020 094 GEOBASE ID 863
ADDRESS 42 CROCKERS NECK ROAD PHONE
COTUIT ZIP -
LOT 237 ' BLOCK, LOT SIZE
DBA DEVELOPMENT DISTRICT CT
I�BRMIT R 3 855 DEsCATpTION" RE OLUTE/USEDrv--'IN CELLAR
PERMIT TYPE BSTOV TITLE STOVE PERMIT
CONTRACTORS: PROPERTY OWNER Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES: $25.00 9
BOND $.00 0�Tr
CONSTRUCTION COSTS $300.00
434 RESID ADD/ALT/CONV 1 PRIVATE P.
t * BARNSTABM +
f Ass.
ED MA'S A
BUIL �� IV N
BY
�
DATE ISSUED 10/06/1998. EXPIRATION DATE ;°°'
1 -- dam\ f. '
TOWN (IPAIF '�`AL E
.sv6l
- POILDINC PERMIT „
PARCEL ID 020 094 GEOBASE ID 863
AII'3R,ESS 42 CROCKERS NECK ROAD PHONE �.
"� COTUIT ZIP
LOT 237 ` BLOCK LCT 84IZE � w
DBA DEVELOPMENT DISTRICT. CT
PEItI` IT 33855 DESCRIPTION RESOLUTE/USED -_.: IN CELLAR
PERMIT TYPE BSTOV TITLE STOVE PERMIT
�
f _
CONTRACTORS-. PROPERTY OWNER Department of Health, Safety
ARCHITECTS
and Environmental Services
TOTAL D FEES: oxBON
t�
CONSTRUCTION COSTS $300.00
434 RESID :ADD/AL,TfC0NV I. PRIVA.IL P. ..E
s
. * iARN3I'ABLE. •
MA &
' g
ED MA'S
BUIL 1VJS N
B
?ATE ISSUED 10/06 1.998 EXPIRATION DATE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS,
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD. KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED. FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE EL C T ICAL, LATIONS.
CH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN.MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS s
1 1 i 1
2 2 2
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 BOARD OF HEALTH
I; OTHER: SITE PLAN REVIEW APPROVAL :I
I`
'I
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- LINSECTIONS INDICATED ON THIS I
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC-- MONTHS.OF DATE THE PERMIT IS ISSUED AS EOR'WRITTEN NOTIFICA-
TION. " NOTED ABOVE.
BUILDING
PERMIT
�yo� TO TOWN OF BARNSTABLE Permit#3385
MASSACHUSETTS date: - -9�
>ARMS ABLE. /4 6
MASS.
i659. 10� Fee:�o?S,
iOTEp •tA SOLID FUEL STOVE PERMIT
Owner: �Jnhn �E 01Aa-j�2MQ1(-;7Phone:
Address: Village: i �—
Approved by: Date:
Stove
A. New (ssDed
B.Type adiant Circulating QC)
C. Manufacturer ✓u(► onl C"b Lab No.
D. Model No.
Chimney
A. New Existing/if yes, date of last cleaning
B. Flue Sizc
C. Are other appliances attached to flue? /\JO
D. Pre- � d Manufacturer
E. asonry/lined Unlined
Hearth
A. Materials
B. Sub Floor construction Di ra-rocx—,
Installer , 1�, ,,
h►n �`cat cZ
• Address
Plione
Location of Installation
'Polaroid Moto Necessary
""This constitutes in ollicial stove permit after inspection and approval by Building Inspector
D'o
TOWN OF BARNSTABLE
o Permit#33,F-,5
MASSACHUSETTS
Date: /6
`• BARNSIABLE.
MAM
9� 9 s63 . �
SOLID FUEL STOVE PERMIT Fee:A?s,6z
Owner: �hh 40c, ](DI3 C z Phone: _ "7
Address: 0XQUOIC L Village:
Approved by: Date:
Stove
A. New sed
B. Type adiant Circulating NO -
C. Manufac urer u� + CaA Lab No.
D. Model No. (f n ,
Chimney
A. New Exisdng/if yes, date of last cleaning 9l,2—G3
B. Flue Sic -7 Y-1
C. Arc other appliances attached to flue? N o
D. Prc-Flabi-Nnr7md Manufacturer
C. asonry/lined Unlined
Hearth
A. Materials
B. Sub Floor construction pay
Installer �C�.-1'l,Ot,�IG� ,
• Address
Phone (2Z
Location of Installation
`Polaroid Photo Necessary
"'This constitutes an official stove pem2k,-fterinspection and approval hyBuildinglnspector
Anna&John Janowicz
42 Crocker Neck Road
Cotuit, MA 02635
Ralph Crossen, Building Commissioner
367 Main Street,Town Hall
Hyannis, MA 02601
August 12, 1998
Dear Mr. Crossen,
We would like to request our Building Permit be continued for an additional 6 months.
The work is continuing but the interior construction is not yet complete.
Thank you very much
Sincerely,
Anna Brigham Janowicz
� �
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,.
Town of Barnstable
Approved Regulatory Services
Fee Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Home Occupation Registration
Date:
Name: n - tG'Z_ Phone#: ,go J2
Address: � C C Village: ( "fi V1J l T
Name of Business: V LQ A4240d S tJ�TI�
Type of Business: Map/Lot: 6"-)O - 0 LL/
Zoning District CZE Zoning Districts RF and RC-1 require Special Permit from Zoning Board of Appeals.
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes; and no increase in air or groundwater pollution.
After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke, dust or other particular
matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the undersigned ave read and agree with the above r strictions for my home occupation I amViterinApplicant: !yl Date:
Homeoc.doc
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