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Home My WebLink About0021 DEWEY LANE l J�� -, � _ �� i N l r (( l i{ A i ��G� ice`"WSJ I ' fe"v�o I I. h no q F E =, C A 4 RUCTION jesi' afand Commercial Builder 33 � sd C T _I��yATTOIV SPECIALIST October 21,2014 Town of Barnstable Thomas Perry CBO " # Building Commissioner 200 Main Stret ry Hyannis, MA 02601 r 3 �n RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201404560 at 21 DEWEY*LANE has been inspected by a certified Building Performance Institute(BPI)inspector`All work performed meets or exceed Federal and State requirements Sincerely, f Michael McCarthy McCarthy Construction PROJECT NAME: ADDRESS: PERMIT#__( _� - � PERMIT DATE: Z Mrn: Z-Z 01g. 1 no . LARGE ROLLED PLANS ARE IN: BOX 1 SLOT' Data entered in MAPS program on: 71 BY: �- Town of Barnstabl • e *Permit# ®�20 FEB 2 1 ZUU� Expires 6 mq hsfro issue date Regulatory Services ((�f Thomas F.Geller,Director Fee 7'O�/►V ®��ARNS7'A�L� • Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www-town barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - "RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/parcel Number J®� Property Address f Residential Value of Work_ ! �(� _ Minimum fee of$25.00 for work under$600 0.00 Owner's Name&Address ) Ds ------------- Contractor's Name a Telephone Number_ L 2P—/) Home Improvement Contractor License#(if applicable) 0 3 ) q ' Construction Supervisor's License#(if applicable) �4%rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner 1I have Worker's Compensation Insurance (nsurance Company Name e)`P Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) b4 Re-roof(stripping old shingles) All construction debris will be taken to . ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum 44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation et c. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. 3IGNATURE: 2Torms:expmtrg Wse071405 k tf '4 , a l ti Town of Barnstable Regulatory Services. Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 4 200 Main Street, Hyannis,MA 02601 " www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property owner Must . ..-Complete ar..d S gn Thins Seet ors If U sing A Builder b yT ` D�/ ,as Owner of the subject property hereby authorize 1 LT l Aza)� &F'iLa AJ- to act on mY behaA in all mafters relative to work authorized by this building permit application for: 6 0 16 (Adds ss of Job)' ign.a e of Ovmer Date r, Print Name - - !,� •r�.G. �.ia$.}1+..G �;. tC Jim �.,� ,.e7 i.. �j.. p._ ' 1 Jw7�•t'�, 1L�*.7�r1 c.ty • y .._..,._....... . ............—.�_� __ .,w.—........»r 4S.:F�Tt :.1._ k.�.d..jq-• QTORWOWNMERMISSION 4J rcdv.of Building Regulat'ons an tan ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02109 Home Improvement':Contractor Registration Registration: 103714 Type: Private Corporation } f�r Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC.' Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for Chang E] Address Renewal Employment Lost Card DP8-CAI Cr 50M-04/04-G101216 ✓�cc omvr�w� i o _ &Z- Board or Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR l,iccuse or regi.%Iratiun valid for indMil,ll use uuh• Rogistradon:. 103714 before the eapiratiorl date. 11'found rcturu to: Expiration::7/9/2006 Board of Building Regulatious:uu1 5talidal ds alit: n AshhurU, Place Rill 1301 .':;;Typo:'Pnvato Corporation Boston,pia.02108 _ __.. PAUL J.CAZEAU,I,T;&.SONS,,I�IC: __.._.-- .,...._. _ Paul Cazeault 1031 MAIN ST ! °'� o�✓t '"I. I cz - . BOARD OF BUILDING REGULATIONS OSTERVILLE,MA 0265E1 Administrator License: CONSTRUCTION SUPERVISOR rl` Number;:,CS 026325 Blrthdate 10/20/1959 Expires 10/20/2007 Tr.no: 7696.0 Restricted, 00 PAUL J CAZEAULT 1031 MAIN ST '. OSTERVILLE, MA 02655 Commissioner , VJ 1 r-M V ILLC, IVIM ULUJD - _...Administrator_____: Board of Buildin egulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007 Restricted To: 00 PAULJ CAZEAULT 1031 MAIN ST s OSTERVILLE, MA 02655 Tr.no: 7696.0 DPS-CA7 G 50M-04/05-PC8698 Keep top for receipt and change of address notification. 1 Assessor's map and lot number /.--./ ............... � /76� 1`7 7G� � Sewage' Permit number 'T"ET°� TOWN OF BARNSTABLE �Q o , • • w/]c�^A if , ' Z BARNSTADLi, r6 9�`� BUILDING INSPECTOR . '' 0 war APPLICATION FOR, PERMIT TO TYPE OF CONSTRUCTIONM�� I 4 a� A of............19.6 y r' TO THE INSPECTOR,,OF BUILDINGS: The undersigned hereby applies fo r apermit according to the following information: Location ....... VII.�—e V....... .. .....�lJtU... ......................................................................................... c ' 11.!�l .......................L.. Proposed Use ........... .. . ,.,......... ... Zoning District .......................... '...Fire District ....4!.. ......!...I!.�.................................................. Name of Owner . �..�l.e...,�'/.r. G.. °Address ..��.f!d........MAIN........45. t.............................. Name of Builder ..fT�..... ` l.G.� �!C................Address �.....cal..vi�...... Name of Architect ..........�ddl r! 7..................................Address ............ O* .................................................. Number of Rooms ............../.................................................Foundation .. .tl /1� ..../�1.0`�( ,................... Exterior ................Alb/V4 5 ....................................................Roofng ........../ ...................................................... FloorsQ��=...................................................Interior ............. . .. /1�</. .......................................................... Heating / ...................................................Plumbing ............. eNl ..................................................... Fireplace ................!.X..�l.KC.................................................Approximate Cost ...��t��.�..................... ................ Definitive Plan Approved by Planning Board ________________________________19--------. Area ............. .�'!.5..... ................ Diagram of Lot and Building with Dimensions V — Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i C V lvv�J 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. e/ Name . ..1�..... ..................... Dewey, F. V. No .....17.062 Permit for ........... Lc�glioDn .. ... ........... ........................................................ Owner 174 Type of Construction ... .. ......... Plot ............................ Lot ...4;2. ...................... May 2 74 Permit Granted ..............................Oat ........19 Date of Inspection ...... 4-19 .......... Date Completed 51- PERMIT REFUSED.......................................................... i19 4") ............................................................... 4111 ..........................................................ei�................... ...................................................... ..................... ...................................................... ................... 1_7 Approved .......................................... i2i 9 AC ............................................................. .............. .......................................................................... - A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 019 001 Application # S (Ob Health Division Date Issued 12Y Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board -Historic - OKH Preservation/ Hyannis Project Street Address 0CUY k Kt_ Village �- Owner �� V��,Z-�= Address _T,n Telephone �� Permit Request 4Jr. r2_I,.., }. ... A kl Square feet: 1 st floor: existing—propose d 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - Kl Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;7--Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ 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 - ne� c—�4 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roo, Count a. Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other c Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood oal stovr;` ❑1 ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size Barn: ❑ existing 'EhevPsize_ Attached garage: ❑ existing ❑ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number /#Ike McCarthy Construction Address PO Box 52 License# West Dennis, MA 02670 Cell (508) 280-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 41Y11`' it FOR OFFICIAL USE ONLY 1�} APPLICATION# DATE ISSUED_ MAP/PARCEL NO. ADDRESS VILLAGE OWNER 44 ' DATE OF INSPECTION: y FRAME i IR INSULATION. ,Y r t FIREPLACE ELECTRICAL: ROUGH FINAL i? PLUMBING: ROUGH FINAL ,f . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT k ASSOCIATION PLAN NO. w A The Comnwnwealth ofMassachusetty Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1&a Workers' Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Le ib ' MtWe McCarthy Name(Business/Organization/Individual): I P.O Box 52 West Dennis,MA.02670 Address: 280-6964 CSL-58633 IIC-169393 City/State/Zip: Phone Are z employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1. employer with 0 g employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached,sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' con insurance. 9. El Buildingaddition [No workers'comp.insurance comp. required..] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner do' all work officers]rave`exercised their 11. Plumb'mg ❑ mg repairs or additions myself [No workers'comp. right of exemption per MGL 12 Roof r c. 152 ❑ repairs insurance required.]t , §1(4),and we have no I3,8'Uther employees. [No workers' comp.insurance required] . *Any applicant that checks box#1 must also fill out the section bclow showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicating thcy are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employers. If the sub-contractors have employers,they mist provide their workers'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is tFie policy and job site information. M_ Insurance Company Name:_ AT21— Policy#or Self-ins.Lic.#: 1�IN L-�a'-Cat a'�5G'�I Expiration Date: 7//7/,r Job Site Address:_ 1 � t,; ��, 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$1,50-0.00 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 r insurance coverage verification I do hereby certify p and penalties of perjury that the information provided ab is taste and correct Si ature: Date: / Phone#: OffccW use only. Do not write in this area to be completed by city or town of 7d4xL City or Town• PermitlLicense'# Issuuug Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• . Massachuse tts s -Department rtment of Pu blic Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 AH LJMC ,. C i PO BOX 52 , W DEN)`TIS MA 0267% i � —� Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston,.Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 x Type: `Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNI 0267 Update Address and return card.Mark reason for change. [� Address Renewal Employment.. Lost Card SCA 1 is 20M-OS/11 - v ac oO CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 1%_ �.• 10/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001, I NONTACT Bryden&Sullivan Ins Agcy of Dennis Inc (508)3 98-6060 a`c.No.: (508)394-2267 PO Box 1497 _ _..... ..:.� --- - --- ------- -..__ . Jh So Dennis,MA 02660 iooss: .- ___ _...___IN_rzLIRERA.: A.I.M.Mutual_Insurance Company - 33758 INSURED - --- ---- - Michael McCarthy Construction Inc �1`$4RR ` LIN-U ,9R1PJ-_------------ '- P 0 Box 52 1 LN-WRE3-P_`- — -- — - -- ._ West Dennis,MA 02670 �[�NSURER I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, gEXCLUSIONS AND CONDIT!CNS OF SUCH POL!,-:ES.LIMITS SHOWN MAY HAVE BEEN REDUCED CyB�Ypp PAID PCaLA:MS. ILTR' _ _ .,,.. TYPE OF INSURANCE - - PNSR i WVBD i - _POLICY NUMBER (MOLT 1 MM DD/`/`! ) -- - -- LIMITS - - --- _ rt - --C - _.. - I - ------ GENERAL LIABILITY I ! EACH OCCURRENCE L$ - - COMMERCIAL GENERAL LIABILITY - - - I - j DAMARETO RENTED ` S I CLAIMS-MADE I OCCUR ;MED EXP(Any one person) $ I, PERSONAL 8-A'D._V._I N J U R Y � S --. .-----'- - GENERAL AGGREGATE ---a GEN'L AGGREGATE LIMIT APPLIES PER: j PRODUCTS COMP/OP AGG '$ POLICY PE LOC ...... l ,._... - - ... ._ AUTOMOBILE LIABILITY -- --- - (COMBINED SINGLE LIMIT (Ea accidents $ _ ANY AUTO AUTOS _ AUTOS - - - -- I I BODILY INJURY(Per person) $ -- ALL OWNED I SCHEDULED i ~ j I BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE ...'AUTOS ( - --,-- ------- (Peraccidentl _ $._.._...... - .----- _ 1 $ UMBRELLA LIAR I OCCUR I LEACH OCCURRENCE F S - I ------ ---- —--- ---- EXCESS LIAR CLAIMS MADE i AGGREGATE $ ;DED RETENTION $ $ o_.KK_. gg oo. ..._..-qqT7��op-.- We g TU _ AND EMPLOYES�UABILIT! X `TORY LAMITS_ — A PR�PF ��R/P�f�TNEdF/�3CECUTIVEr��I I I E 1.EACH ACCIDENT Fi $ 500,000.00 A o�YrlcE M R X LU Y N/A! VWC-100-6017656-2013A 17/17/2013 7/17/2014 II(rrMandddatorybbin NH) -- 1 E.L.DISEASE-EA EMPLOYEES 500,000.00 UTCRil�'1'(ON V 9PERATIONS below I E.L.DISEASE-POLICY LIMIT$ 500,000.00 j i I L I i I DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,.i(more space Is required) i CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention: BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 :TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich, MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4 OWNER AUTHORIZATION FORM . (Owner's ame owner of the property located at I)e k/e , (Propefrty Address) 3 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Ow is Signature Date TOWN OF BARNSTABLE BUILD�NG PERMIT APPLICATION { 7 � Map ��,� Parcel �2��Q/ Permit# G Health Division 0� �l� �,,,re��f� yr �'A f'' g �a 6s�ued Q /6 d 2 / U i ,. 1 pp, Appltion Fee Conservation DivisionO C2 Tax Collector 02 Permit Fee �, 2 Treasurer 0Z -'k'tr' S1C ' fDZ- S PTIEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board VM TITLE S Historic-OKH Preservation/Hyannis ENVIRONMENTAL CODE ANDTOWN REOUI.;TRX13 Project Street Address - L= Village U (-1�-— (Q 0-v 1 '7- � - Z 2 _'7 J Owner Address • ,� 0 st ~ F W13o Telephone L l�)5) ) - (D a (1 Permit Request t to -9 Square feet: 1st floor: existing 00 proposed�� 2nd floor: existing -� proposed Total new ao Zoning District / Flood Plain Groundwater Overlay Project Valuation ,Q 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 ❑No On Old King's Highway: ❑Yes ❑No Basement Type: Full Crawl O Walkout ❑Other C12,4"L t)AA Elf? f/ o F L 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 t/ new First Floor Room Count 5� Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air: A Yes ❑No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes �No Detached garage:❑existing ❑new size AM Pool: ❑existing ❑new size Barn:0 existing ❑new size Attached garage:❑existing ❑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 BUILDER INFORMATION Name Lox. Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY 1� PERMIT NO. DATE ISSUED MAP/PARCEL NO. 1 f ADDRESS VILPLAGE t OWNER DATE OF INSPECTION: FOUNDATION - ' ft FRAME INSULATION FIREPLACE bC ELECTRICAL: ROUGH •.» FINAL t; PLUMBING: ROUGH . FINAL GAS: ROUGH^� ' £,. ,• FINAL FINAL BUILDING - F DATE CLOSED OUT e I v ASSOCIATIONPLAN NO. F ! ` ' r a~ o - t• e °FIHET° The Town of Barnstable '• BARNSTABLE. Department of Health Safety and Environmental Services 7 NASS. 0p 039. �0 M10 Building Division 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW ��1a a sr�tl�u ,�iS�'�li�� Owner: � Map/Parcel: Project Address: a�� w`y'i7 �R[- rlJ�-� Builder: e:5 " The following items wCere noted on reviewing: 0 Reviewed by: Date: q:building:forms:review The Commonwealth of Massachusetts Department of Industrial Accidents - Office aflnyestigatfans _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit //////////////////%//////////////////// AA name location: /� � vhone#cmi I am a homeowner performing all work myself. rl I am a sole r rietor and have no one worldn in ca acity %/%%/%%%%/%%%/G/% //%%%%%/%////%%%/l///%/////%% %��////%%%/%/%/%////%//////%/��% ' co ensation for em loyees working on this job.:::::}}:::;};:}}:•Y:4:«::;>i:::;::: ::>::;>.•«:«? ; :>:>?:>:':< .;; rovidin workers mP I am P .............. . ............. ............... .............. :.................:..:::::::::.�::.:::.::::::4Y:{?.;:;.Y:;.;}}Y:Y}}:.;:.,:.:�:.�.::...,...::.:::.......v.::.:.:.....,:.::.;...,.n..,.r....:. mP ...........:.:.:.....-......:.:.:........,..,:..,:::............::.::... ......::.::.................. <;[ x< �`raai {:a>; :'''tJ::<{;.:i::::?Sijl�i:{:i:::•j:"r'}:':::�i-v:ti:>i::::::}:::::::i:•.iii:Li$$:i�ii:ti?i:;:�$':j;:;is y• r:- i}i:!....... ::...:}:.:.. 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Oli or Bailm•e to secure coverage as required under Section 25A o[MGL 152 can lead to the imposition of criminal penalties o[a Sue np to$1,rstmi thatand 2 one years'imprisonment M well a,d-&penalties in the form of a STOP WORK ORDER and a Sue of S100.00 a day agshut me. I mmderstand that a copy of this statement may be forwarded to the Office of Invesligaiions of the DIA for coverage veriflcaHon I do hereby certi airs and penalties of perjury that the information provided above is ttrruo and correct Date /�� ® Z - Sigaature Print name�G% / GL� .1 r'-�°2�- - Phone# oineial use only do not write in this area to be completed by city or town official permit/license# � ❑BuUtng Department city or town: ❑Licensing Board re ❑Selectmen's Office ❑checkff immediate response is required Onealth Department contact Person: phone#; ❑Other Un wd 9195 PJp) 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,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 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 insurance as all affidavits 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.fo 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 number. The affidavits maybe returned 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. FBI The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesdUsUons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 I TAW.0 2 lb(oeasiar ) isi gosh grsscriptfre Psci�;ss for daa aad Tne Famf ¢ � MAXIMUM�$ Ceilla� Slab Wall Floor Hsaame� alaang , W Arse!('/.) U-raluc2 A-vilue� R-valua PEE,= rml to 6500 H D D Nas al 19 !D 6 Ncr=l Q 121'. 0.40 3i !3 6 19 !9 10 ES AFM A 12% 03Z 30 � N� 0-50 31 13 23 Ti/A W T ls'/. C06 Si 6 Noema! 19. 19 !D ES Am U .1SY. 0.46 3E 13 2S NIA }i/A 113 ARM y W/. 0.44 3d 6 19 14 10 19 ?3 NIA NIA Noressal X 1E�/. 032. 3E �A Ii/A N°r�! 19 25 6 90 APt7E y IE'/. ' 0:42' 32 13 34 6 90AFUE �, 1 gymOSO 30 19 t9 t0 1. A.D DRESS'OF PROPERTY: �L-'�vG'7' L ✓� uoR WALLS a 2. SQUARE FOOTAGE OF ALL '. . 3, SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA.(#3 DIVIDED BY'97 9: SELECT PACI{AGE(Q—AA-see chart move):' R MO P INVOLVED METHODS OF DETERMINING ENERGY REQUg�MENTS NOTE: ,OTHE ARE AVAILABLE. ASK US FOR TF�S INFORMATION BUILDING INSPECTOR APPROVAL: NO: YES: q4arms-f930303 a Footnotes to Table J5.2.1 b:' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,. Skylights, and basement windows if located in walls that enclose conditioned ipace, but excluding opaque doors) to the gross wall area. expressed as a percentage. Up to 1% of the total glazing arts may be egnxcluded.ftom the U-valua r quirement. For example;3 ft1 of'decorative glass may be excluded from a buiidiag deli with.300 fr of lazing = After January 1, 1999, glazing U-values'must be Cested and documented b'y the manufacturer in accordance with the National' Fenestration Rating Council (NFRC) test procedure, or takes'from Table 11.5.32. U-values arc for whole units:'center-of-glass U-values cannot be used. The ceiling R-values do riot assume a raised or oversized truss construetion. 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 substitumdfor R49 insulation- Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (1f.used). For,ventilated ceilings,.iasalatmg sheatidng•must be placed between the conditioned space wid-the ventilated portion of the.tvof. (if use Do not include Wall R-values represent the sum of the wall cavV' .insulation plus insulating sheathing n �• exterior siding, structural sheathing, and interior,drywall.For example, as R-19 requitzment could be met EITHER by R-19 cavity insulation OR R-13'cavity insula�on plus 1-6 insulating'sheathing- Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall construutrtida but do not apply to metal=#i-ame construction. 'The floor•'requirements apply to floors'over unconditioned spaces (such as unconditioned erawLspaccs,basemen, or garages). Floors over outside air must meet the ceiling requirrmeats. ' The entire opaque portion of any individual basement wall with as average depih Iess than 30%below grade must me_t the same R-value requirement-as above-grade walls. Windows and sliding glass.doors of conditioned br..,ema with the must be included w the other glazing. Hasemetrt doors must meet the door U-value requirtme.nt d-scribed in Note b. ' The R-value* requirements are for unheated slabs,Add as additional R 2 for heated slabs. ' If the building utilizes electric resistance healing use compliance approach 3;4, or S. If you plan to install more olim eat, the equipment with the lowest' one piece of ca. eq than one piece-of healing equipment or.aore•than r = Mm!= efficiency must meet or exceed the of ciency 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-value3 are minimum acceptable levels. R-value requirements are for insulation only sad do not include structural components. b) Opaque doors in the building envelope must have a U-value no grcz=than 035. Door U-values must be tested and docuinenred by the manufacturer im.accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and am aggrtgate U-value rig 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 regairement'(i.e.,may have a U-value grater than 035). c) if a ceiling,wall, floor,basement wall,slab-edge,or ciawl space wall component includes two or more areas with different insulation levels,the,campanent complies if the area-weighted average R value is greater than or equal to 'the R-vaIue requirement for that component. Glazing ar door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). . - 43 °pIKETpk'` Town of Barnstable Regulatory Services SARPISPABLE, ' Thomas F.Geiler,Director ' a Buildingg Division lED MPS 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: h__)1b?/4_ Estimated Cost `�EQ,QQ7Z) Address of Work: / QL2�JLn/ ��1't/l� .9 ^ Owner's Name:��y/��`' Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 []Building not owner-occupied Mowner 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. 0 Date Owner's Name Q:forms:homeaMdav � The Town of Barnstable _Regulator-y__Services -_ :-_- Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: O� D JOB LOCATION: LJ�VL'-' L i9'j't/� �lJ-T—U TiT numb �. V street village .HOMEOWNER"://I;U.PX.1�� /L1�S/7�P lrJ ( �o/7� S a s �q l 3 41j 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"ce ' es that he/she understands the Town of Barnstable Building Department um mspectio rocedures and requirements and that he/she will comply with said proc es requiremen Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN `•� RESIDENTIAL BUILDING PERMU FEES • APPLICATION FEE New Buildings,Additions $50.00 �' Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE • � l6 _square feet x$96/sq.foot= 3y x.0031= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE y square feet x$64/sq.foot= J 7, x.0031= / ° S plus from below(if applicable) ACCESSORY STRUCTURE>12.0 sq.1� , >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 ' >150 sf-1000 sf 75.00 >1000 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (der) Deck ___-,-1=_x$30.00= � D (mm3ber) Fireplace/Chimney (number) Inground Swimming Pool S60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost t Cal d /a CL Cvc)Ssa Club Med i 15 i ,9 t. �1 OD ' , :- ILE ff MIP 7131 CENSUS TRACT # 132 CLIENT: 'arman,Kirrane, & Terry DEED BOOK .680 PAGE 144 OWNER: cFinancial , Inc. _ PLAN BOOK PAGE L T - APPLICANT : Linda Thompson ASSESSORS PLAN PLOT MORTGAGE INSPECTION PLAN of LAND L0CATFD AT DEWEY LANE SALE : 1"= !}� � COTUIT, MASSACHUSETTS JULY 16, 1997 43 Z1211 s B RE I\J W AN ; 203.00 [LOT z LOT 3 LoT A '� w -- 140,00 I CERTIFY TO DUNNING, FORMAN, KIRRANE, & TERRY, SALEM FIVE MORTGAGE CORP „ A� ITS TITLE INSURANCE COMPANY, THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASE- MENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION . . THE LOCATION' OF DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BY—LAWS WITH RESPECT TO HORIZONTAL %=� KE DIMENSIONAL REQUIREMENTS , ': ( R THE DWELLING SHOWN HERE DOES NOT FALL WITHIN ^ '� CVO axis o�