Loading...
HomeMy WebLinkAbout0015 ELMWOOD CIRCLE �S �L•s-►wooer ��ex� ��:.. _ � PAD Town of BarnstablePermit: _ Regulatory Services ate: oF�"E roiyti Richard V. Scali,Interim Director > o Fee: 2 Building-Division J " IARNRrABLE. ` Tom Perry, Building Commissioner MASS. , 1639• ,0� 200 Main Street Hyannis,MA 02601 A www.town.barnstabl BUILDING DEFT. e.ma.us Office: 508-862-4038 11 I V5 864nn 16130 TOWN OF BARNSTABLE ARNSTPBLE SOLID FUEL STOVE PERMIT TOWN OF� Owner. i3 SSA C�y� 1 t` y Phone. 7�1 qN Z Install at: C_ `e Village: Co-tu i Map/Parcel: u 1 ®� / (�d�— Date: 7f# S e Ne /Used UL# I(-i cS2-Z6kI B. Type: adian /Circulating r C. Manufacturer: e,©�s tric(C Sbve C c�. Lab.No. i D. Model No.: 7tae--.� 5 Chimney A. New Existing If existing,please note date of last cleaning) ''`7 l B. Flue Size C. Are other appliances attached to Flue? N d ~ D. Pre-fab Type and MAaufacturer E. Masonry: S s ine nlined Hearth A. Materials: B. Sub Floor Construction: V,.�P�LCAce c`P;Slnm Installer Name: Address: Phone: Location of Installation: H.LC Registration# Construction S!,upervisor# OR check V. Homeowner Installing, no license require LICENSED INSTALLERS SIGNA APPLICANTS SIGNATURE: APPROVED BY: Please make checks payable to the Town o Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev I1/4/13 Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner 200 Main Street, Hyannis,MA 02601 sARNSTABM »sAsa www.town.barnstable.ma.us i639. &� n �p MM Office: 508-862-403 8 Fax: 509-790-6230 HOMEOWNER LICENSE MMMPTION Please Print DATE: ' JOB LOCATION: I C.�M `U�' C;�C C�_. CO _ t V 1 number street Village "HOMMWNER �s . 7 74-�5ZI -L- I q 2 Sov►� name / home phone# work phone# CURRENT MAILING ADDRESS: cityhown 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. DEFINMON 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- un ly 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 build] erm (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 p e s d re eats and that he/she will comply with said procedures and requirements. ign 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:IWPFILES\FORMS\building permit fonnsEXPRESSADc 08/16/17 S Town of Barnstable Building Department Services Bryn Florence,CBO �`� Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 i Property Owner Must Complete and Sign This Section If Using A Builder I ,as Own of the subject property hereby authorize to act on my behalf, in all matters relative to work auth ed by this boil ' permit application for. I ' (Address 0 0 **Pool fences and alarms are the espo ibility of the applicant Pools are not to be filled or utilize before fen a is installed and all final inspections are performed d accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOLS Rev:09/16/17 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM.02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): Address: /i^'�rin)o fl cwc(�2 '�:p fiy `1 �- (J 3 City/State/Zip:. C /1 n Phone#: 7 LY_!3Z( - L4/q Z Are you an employer?Check the.appropriate box: Type of project(required): 1.❑ I am a employer with. 4. ❑ I am a general contractor and I 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 g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers'comp.insurance comp.insurance. quired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No.workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no. employees. [No workers' .13. Other � comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. ' Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c-152 can lead to the imposition of criminal penalties'of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP,WORK ORDER and a fine of up to$250.00 a day against the violator.,Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c der ai rallies ofperjury that the information.providied above /is tru P/and correct Signature: Date: Phone Official use only. `Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions t Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.##617-727-4900 ext 406 or 1-877-MASSAFE Fax#61.7-727-7749 Revised 4-24-07 wvrw,mass.gov/dia Assessor's office Ust floor):. As essor's�ma and lot number' .......`...D I a ,.....0.�-�� - S SEFMC S' M M INSTALLED IN COM Board of Health (3rd floor): Sewage Permit number +� 2v . WITH TITLE B 9TODLE i Engineering, Department (3rd floor): ENVIRONMENTAL C AND House number ........................................................:.I............... ` TOWN REGULATI „aY a� Definitive Plan Approved by Planning Board y 4 __f _2.2----19 APPLICATIONS PROCESSED 8:30-'9:30 A.M. and 1':00.2.00 P.M only TOWN,' - *OF BAR NSTABLE BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO .....!JJ...`.. `� S L. $Q ) TYPE OF CONSTRUCTION .... J� t i .. ........... . .. . ..... ................. ............................... .......... ...........l.."."`...2g...................19.. 9.. TO THE INSPECTOR OF, BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lc;'f K..1`tr� r.. l..�.. Z"............................�..� . .1............G.. ....... ..... ProposedUse ......5 ................ M�1 ........... ...... ...................................................... Zoning District .......... ............. •'• l . Fire District l�ct:f` ...................aIs......... DX Name ofAOwner ' ..::... Address :......._.........:.. ........... Name of Builder � .. .. 1. 9�... G( T...... s C..... ( .. A� Name of Architect .............'....... I � �• GI Address ; .. .. . Number of Rooms ...:...1. ....... ......... ...........Foundation .... ................... ........ ................. .......:....... Exterior ......... ................................................................:...Roofing Floors ...................................... ...............................:..............Interior .......................................... . s r Heating 6.`.`�........:.........:....: ..............Plumbing R.,...l�lZ„ ......... Fireplace ............... ...?...... .................... ......... ........'A-pproximate Cost .'..T.' e........................................................... Are .....T .f/..... . ..... Diagram of Lot and Building •with Dimensions F OCCUPANCY _PERMITS-REQUIRED-FOR NEW DWELLINGS I hereby agree to<conform to all the Rules and Regulations of the Town of Barn a re ardi t bo construction.' Name ....... ....... Construction' Supervisor's License . .... ... ....:,.......:......... 1 , GAUIHIER, DENNIS Permit for l. ...Story..............N o _ r k a Single Famil Dwel ng,.,,,--„ �.. ' Location Lot 2 15 Cotuit y ......................'.. ......................... ..... ........... ......... , It r, ,l Owner Dennis ,Gauthier Type of Construction. .....:Fr'.aMQ...................... . ........................ ..... .................. • _ - `Plot ............................. i- Lot" f.... ,• 1 ___w z<~ Permit Granted .....DE'Ce? .b.er...19-f....19 88 - Date of Inspection .7-.../..g— .19 r Date Completed ..! ..� '"� 19 -....;....... , '. ,.; All a -1 2 - M R r tr-10 0 - � r.-.�- . ;...} ..,fit+• ,....�`.,,.9T.-.,.; Ryr -r +six w .144,,Y ... r:.R�-4 Assessor's office (1st floor): t (-J '�' � Assessor's map and lot number ...........'�...r/�.�.... �..��0... �``)S FtME rot Board of Health Ord floor): r e�Q ♦� T- .Sewage Permit number ........... ..... .............. 2 BaBa9T1►DLE, ! .j ...................... .... �! Engineering Department (3rd floor): 'oo rb 9. Housenumber .............................................................:.i...:.... �'oYara' Definitive Plan Approved by Planning Board __:T/ _' _____2.1____19 _____ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....'�. S .....................�. ..............i...........!.................................................... TYPE OF CONSTRUCTION .... `!t,J f . .......t 1 On��... ....................191F. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location t-rJ . 2 `K.� C-d.2C.\ T A C G l// j ..,...................................................................... . ...................................................... Proposed Use ...... +'�'�. �' " Zoning District .........:.f•..........................................................Fire District ......:.`'� l .1 .................................................................... Name of Owner .�./.:�?.(!•'j....... �.�..'...!. .................Address .�.�........L....-`��c9 t���.Xr `ra T ,t ................... ............................................................... Name of Builder /Ili t-- ....�.......�:�............................................Address ............. ................................................................... t Name of Architect ..........................Address .................................................................................... ........................................ . tt Number of Rooms ....... .......................................................Foundation .....�J�1 . .............................................................. Exlerior .... .\..................................................................Roofing ........8 .,P�t�� ....... ............................................................. Floors ..............................................................................Interior ...............V. .............................................. Heating. . :-..... g . p S Plumbin ..................'.................................................... •X Fireplace ..... ....... ..................................Approximate Cost i c/21a . Area .......................................... Diagram of Lot and Building with Dimensions Fee .............r............................... eo i' r f 1 PCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable le regarding the above construction. Name ...... p ... . ... Construction Supervisor's Licensezj-�./- -- �" '.. GAUTHIER, DENNIS A=-010-030.06 No .3..2.5.16... Permit for .... ...Story........... ........... Single F.E-AiRily.. Dwelling............ ..... ........ . Location ....... .........................C9:tqi.t....................................... Owner ..........Dennis Gauthier .............................................. Type of Construction ....F.Ra.me.......................... ............................................................................... Plot ............................ Lot ................................ December 19, 88 Permit Gran*ed ........ ...I...........................19 Date of Inspection ...................................:19 Date Completed ......................................19 160A .NW�"�'"' 2'-1 1/2.-I.! i_ __ I--8._s•-6._i ._.G_, I_G - 110•-__ -r—r- Y72 --1_--'�2•-3� 2'-1.1/2" R 1 E - I A a � A � E i %6 G%6 ��)��Buaa�'-t�X6 -- -76X� _T 8%6eUPAr6'UP 1 11 l ' IAASIER BATH WALK-IN - _S' - 11 BEDRODt/.82 '1 ttOSET 'BEDROOM @3 - __-�� 9•-6"%i5•-6' I � 1. I 16•-1 1 16•-1 1/Y I 9'-6'X75--6� L �1 �• up I � I 6%6 6%G•- 6%6 ;-----__--6%6 I - I _______ _ A -/' \ ! I ' MASTER BEDROOM it OPEN i I TO BELO 5 - - j I 16•-1 1/2' I SKYV�NOOlY 1 �SICYY.1NDOv' !I i 6Kl^diNDp I ,/RAISED 16•-1 1/2- - 13•-101/2" I I I I � I I I ---� ! LL I , NOD S dNDI1 — SECOND FLOOR PLAN w SCALE 1/4"=1'-0" ICLIENT BUILDING TYPE �- APPROVALS REVISIONS �ffRAWAN BY: OFFlCE NO. - CAVALLINI /GAUTHIER RESIDENCE 32'X4O'CUSTOM CAPE W/DORMER caJENr coNsc cusral DESIGNsiNCCOTUIT. MA. 4X32' GARAGE CONNECTOR '��(ARj E POST & sEAN - SHEET NO.- . AND SUNROOM -- `.-1V1 oar CAPE coa------- --- -- ----- --G--- BeYCOIANY SY81'QL9, IIiC. OCfoBER 26,1988 I • ( X I ' j i I A I !A i ,/2 9A7N �o I T - ..� - D"4G.SEAT l/c- a - _. I _ - . I IT-e'X15-6• ,6 16 - —y—� ! CL O ,ate—.'b•-----r- - - _-la_—__�r_ --14• - — A - PAN1Rb(6 e'noee'_xo` _ x��r6•:a+Etv9+e---� - --- ---bx9 1 r. �- i I � 6X6 6A'.cry,(Y tiKE I � RAL6X6 1 iI, Ir r S7UDT _ Ii . 16' i sirvnNoox' i i ;sKrvnNuow; nrrlaraoo's I (] i 8-0:.R.O. 6X9 L GREAT ROW. !r I_5_6-R -8 _ I S— 5 6X6., r 8X6 40 066---[}6-%6' 6%6 6X6 . . a70 IR j I 1n .Ir 'ice Sj_ {-V C• _ Sulawom 1 w eXo I i SKYWNN w' — . •.� FARMERS POROI I , .. j CH P.T.DECK ! g '`_—_-J 6X9 . P_7.DECK :4 6X6 , 6X6 _ S' �' I e'er' / .•� `� _ t FIRST FLOOR PLAN SCALE 1/4"-1' 0" 1" - \ Q( '•J,...:-:r•: .,- a_'••:� .. ., _`._ ..__ ._.___ APPROVALS REVISIONS - DRANM B -- —..— •;;. __a„ 'y�,.�.�� ;.,`..-.• � Y: OFFCE NO. WAl17V CUSTOM NS INC DESItlIS - COT --.. • _ A P ' $C B-E�:S I I GATE �SNEET NO. ,. -_ .:.. .. .ri caOS r con �.• i � oc7o9ER zs 966 t .. L F n I FULL BAL ELEV.- .111-(CpJ6,$ey_ - DRO PT.W WAERS FALL N L0.WALL E7.EV.� Ur(A5411DD) - - i DROP FOUND.WALL FULL NOT. - T.0.MOST MALL ELEV.--7•-10' t T.O. MOST WALL FM ELEV.e-11' 10' ... L0. TC F ElEYrY-tO- . L0.SLAB ELEV.--Y-e (ALLY Ql/PADS s-D'In'-0'tr DEEP - - W ( 7m D� . : I I a. H S._L-5'-1 B' L—S 1. S•_ 1 7 1 Y - s 12'DEW Ir Yl({-PL NAHLFRS EA SIDE � - I DROP FOUND.WALL FULL 1-19T• 16-MOr DEEP 10.YED FOOTING"CAL) i K 3C-Y DROP wA1 a' T 120 .g 12'. 5-7 3/4' R7 - •. tNOIES• � � _ FOUNDATION PLAN 1.F1IUNDATIGN WALL io eE Y-tlrlm W/ta-xlor DEEP WY D FODIIN "- cRa6r WALS TO eE K-0 XY W/tNH-YID'oEElP REM FOO7M0. SCALE 1/4"=1�—O - - 7 AE EEVATIONS Fitt RFSEAB+cE ONLY.ACR/AL EEV.oET.W/STIE ElNDEtffR - S ACCESS NCFS FOR HATER AND SEWm TO RE o0OHa01NAlED W/41E EZN��EFJt 4 PROVIDE ANCHOR I.75 t'-O'FRCR EL CORNER ACID REPEAT EA W-d_OC 4 FOOM ORI14F TO BE COORONAIED W/PR01 IIT1R. - (r PERF.PVC PPF T RU FLORM4 TO 1)itAM UNDE7R SLAB 2.PER SIDE)IF FM 0. MS FRENCH DRAM AS REQUIRED BY SOIL CQHWTM - . 7.FE641ED GRADE TO BE WL tO-BELOW TOP OF WALL. - a DROP FOODNCS*am SLSo S0.FOUND.FlROW 2M7 INLLADECLAIE FROST PROIEC7101a BY.FOUND.CONiRACiCR CLIENT BUO.OMC'TYPE APPROVALS RENSIONS DRAWN 9Y: OFFICE NO.CAVAUJN/GAU1flER RESIDENCE CUSTOMCAPE w/DORMER NxIH7RT DATE D EM- S MC COTUIT.MA. 4'A3X GARAGENiD CONST. SHEET Na HCRM oA &. MAND SUNROOM tle - .. f y a , TOWN OF BARNSTABLE BUILDING DEPARTMENT , HOMEOWNER LICENSE EXEMPTION Please print. ` DATE May 5, 1988 JOB LOCATION Tot #2 15 Klimm Circle ` Cotuit um er treet a ress ection o town "HOMEOWNER" John Klimm ame Home p one or one p PRESENT MAILING ADDRESS 20 Elmwood Circle Cotuit MA 02635 ity town - - tate Zip co e The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less7an to allow such homeowners to engage an in- _ivi ua for hire who does not possess a licehse, provided that the owner acts as supervisor. (State Building Code Section . :DEFINITION OF HOMEOWNER: " . Person(s-) who owns a parcel of land on which he/she resides or intends to re- side,=on which there is, or is intended to be, a one to six 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. ection :The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstab1e6i.'ilding Department.Aminimum inspection procedures and requirements °and that he/ he will.- comply with said pro c es and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three fa mily dwellings 35,000 be re to comply with State Building Code Section 127.t0,oConstrructionlConntrolquired s 8 I HOME OWNERS EXEMPTION The Code state that : Any Home Owner Permit is required shall be exempt frromintheork for which a building (Section 109. 1 . 1 — Licensing of Construction Supervlsor°s)s; provided v Ions of ithat cIf�a Home Owner engages a Person(s) for hire to do such work, that such Home shall act as supervisor , " e Owner Many Home Owners who use this exemption are unaware that the r the responsibilities of a supervisor (see A y are assuming for Llcensin Appendix Q, Rules and Regulations. g Construction Supervisors, Section 2.15) ., . This lack of awareness often results In serious problems, unlicensed persons. In this case rtour laBoard rly hecannotproceedn the Home Owner hires unlicensed person as it Would with licensed Supervisor.. The HomeOwgernst the as. supervisor Is ultimately responsible. To ensure that the Home Owner is fully aware `of his/her responsibilities, communities require, as part of the p sibilitles, many certify that he/she understands the responsibilities iof �a suaervhe Home Owner last ,page of this Issue is a form current ) . towns.ISO On the care to amend and adopt such a form/certiflcateon bforeusealnour You may Y community. f N of Aj GOT 2 F• o �F J� 47, 620 S. A 1 t� }ti�J� � ` g►y ~ S 60.57#32"w r PLOT PL-A N OF LAND "TO THE BEST OF MY KNOWLEDGE, THE FOUNDA TION, COCA TED IN SHOWN ON THIS .PLAN IS AS IT ACTUALLY EXISTS AND BARNS TABL E- — MA SS. .THAT IT CONFORMS TO THE TOWN OF BARNS TABLE ZONING - REGULATIONS. REGARDING YARD SETBACKS" PREPARED .FOR H Of Mqs� DATE DEC. 15. 1988 _ ��� DAVID �y� D. GA U THIE Y: CA VA L L INI P CHARLES �^ R.L.S. SANICKI v DA TE.•DEC. 15. 1988 SCALE.- i"-50 FT. 28085 CAPE 6 ISLANDS SURVEYING FLOOD ZONE C (NON—HAZARD) FCISTERS D-30 FALMOUTH — MASS. sS�O i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) 1111 -F I M F^ DATA ivwn Uf BARNSTABLE, MASSACHUSETTS now .�, �, -77 ' Dt..TE_ ,! ! � r 19 `j � PERMIT NO. APPLICANT f'•'•` - - i.l�l..: '.�ij?iT7 �,}'�:T1�;[ ,_. ADDRESS " (NO.) (STREET) (C0NT R'S LICENSEI PERMIT TO {PROPOSED USE) (TYPE OF IMPROVEMENT) N0. STORY ,.:.. i':i,l .1:�,: ...«•,' ,_?(:''._;..1..Zi'i�bU EBER OF W LLING UNITS _ AT (LOCATION) ZONING f:�.i.• .'(NO.) a (STREET) DISTRICT BETWEEN . AND (CROSS STREET) - (CROSS.STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY..... FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCT c TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR !.i V IJ S.)i) L.'a .L i.2 / VOLUME ESTIMATED COST FEE MIT (CUBIC/SO UARE FEET) OWNER i.,_. .... _....-. ..I ADDRESS 1 : .. J , .!- �... BUILDING DEPT. BY pop. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY C PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY !`PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES .AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINE FROM THE DEPARTMENT OF PUBLIC WORKS. .THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOI OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD :PT POSTED UNTIL. FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE, WHERE A CERTIFICATE OF OCCUPANCY IS RE— MECHANICAL INSTALLATIONS D 2. PRIOR TO COVERING STRUCTURAL QUIRE;),SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL. :IJSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFOREE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS — PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 7 -T �, 2 — ?;F. 2 HEATING INSPECTION APPROVALS ENGINEERINO�"EPARTMENT OTHER -- -- BOARD OF HEALTH, Y 6/z /py WORK SHALL NOT PROCEED UNTIL THE INSPEC— -El-?MIT ''A'!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CONSTRUCTION. IT ARRANGED FOR BY TELEPHONE OR WRITi PERM IS ISSUED AS NOTED ABOVE. NOTIFICATION. __ SI CG.J I INUAT ION Or ROA0 FOND BUILDING PE,`-'-!IT The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering Section of the Department of Public Works. loam and seejshoulders as soon as Breather permits. �o other (explain) - ��J S 7 1Y .l�trl l ZZMWOOD �OCATIC', ; l s� l C� �� r t� 6,)T � .� r/Contractor) E EERII U ;, HCPILZATICi� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma 0- Par el Permit# Health Division J` ��`5' l Y Date Issued Conservation Division ��� - ' ' F f' - Application Fee Tax Collector 67,0 Permit FeeS� Treasurer SEPTIC SYSTEEA MUST EE Planning Dept. INSTALLED IN COPAPLIANCE LE S Date Definitive Plan Approved by Planning Board Ew u'o W n �1 TIITT CQC`LNG Historic-OKH Preservation/Hyannis T '`•"i rE_ LA.71cN, Project Street Address ' VY1 (A) 9A Village CcO+v 1 �Owner� ffla�i q M eAA_ Address L EA i d Ci r , CGh; i3 Telephone 5U Permit Request �' t Dec t0&& alw Yams Q,b-C3 S b Arc A ` i 0&e Square feet: 1st floor: existing _ proposed Z I& 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio ("?9 =:2 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )i( Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �(No On Old King's Highway: ❑Yes JKNo Basement Type: i❑Full ❑Crawl ❑Walkout Other Basement Finished Area(sq.ft.) Basement Unfinished Area(so ft) �(qo --r 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 Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air: ❑Yes X No Fireplaces: Existing New_0 Existing wood/coal stove: ❑Yes )Q No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ®new size Attached garage: existing ❑new size Shed:❑existing ❑new size Other: /C Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name _LCAn 4A444 Telephone,N umber Address 5 414&+.JCx7cS �� ;9— License# Jt - VIAA Q?L:31 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE t FOR OFFICIAL USE ONLY " PERMIT NO. a_DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE t OWNER -' r - d ' DATE OF INSPECTION: FOUNDATION- FRAME sC_ 311�5 � $s i INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH . ' FINAL GAS: ROUGH FINAL FINAL BUILDING uy p,- r6 ?,7�®;S ; DATE CLOSED OUT ASSOCIATION PLAN NO. t I�OFt E,�" .. . ;r. The Town of Barnstable BARNSTA. MASS. Department of Health Safety and Environmental Services Y 0a i639. �0 prFDMA+� Building Division 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 0 Inspection Correction Notice Type of Inspection ' '' Yk'\ Location ( 1 I4t,. ��4 a C rz I-f Permit Number '-7) Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 4 { `ram koS 1 1C4 e9lU44 tt �G�T l Al J r s Please call: 508-862-403-8..for re-inspection. Inspected by Date OF'HE' � The Town of Barnstable BARNSTABLE. ' Department of Health Safety and Environmental Services Y MASS. 0p t679. �0 prEDMP�� Building.Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection r M Location 15 C r, J e Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: c r e'� 5S eve✓ C P ate tl, JP� `Z 1" k Pr r f�nc `� ppp' 5 G(�C�r jr6L1G 1 5/")a, � I ��<., n� Yli Poff C.Le /111-a4-e oeCC� 01V /N I > (I `-G 'f CiP� � � ;G( ✓ l Ja y �M P1J1 na J r�o3y Please call: 508-862-�4038-for re-inspection. Inspected by Date C The Town of Barnstable Department of Health Safety axed Environmental.Services MOO. BuildingDivision 367 Main Street,Hyannis,MA 02601 18-862403$ )8.790.6230 PLAN REVIEW >wner: 'TVoeY,cu —Arrn"4'� Map/Parcel: '030 00 Z u roject Address: Y�two ti �C �e Builder• W 1J Che following items were noted on reviewing: �C dr 1 Y\�ere Tsb1+3S3.Xh( osdt rasa far 6-sad Tw-•-F"ss��'R B'd1d1`g 8 y�eripth•e pxekstct . QLang . G1E Cjslin� Will ' iL-v�� W� R•�L18 Pa O ST01 to 6500 HesthM D�Srtt D 6 T�ostiasl 1g ►o . Tt� Q IZ.4 0,4a 3n 19 I9 10 6 a AFt7E IZY: W2 10 ' --Q�a-- 3 i T 15'/. 0.36 . 19 19 IC lSAFVE u .15'/. 0.4.6 3= 13 23 • tilA WA25 AFVE 0.44 31 l4 1p i NSA W 15Y, U1 30 l9 tllA tilA 13 Hcrima1 R lay/. 0.3Z . 31 19 u TVA �A go AFVE :. Y 1E'%. ' 0.42 3Y IQ 6 gQ AFLT� Z 1EY. 0:4Z 30 l9 19 l0 6 M 1 EY, 030 30 . RE55 OF PROPERTY' •.�/ L, ADD uOR wALL�: 3'6 2 2, SQUARE FOOTAGE OF ALL , GE OF ALL CiLANG' S 3. SQUARE FOO'i'A 7 4 °/a GLAZING AREA(#3 DIVIDED BY#Z): ,• — AA-sec chart abGve):' SELECT'PACKAGE(Q .' • . ' INVOLVE D IySETHOD S OF I? G�'ERGY REQUL�?E?'�TS . NOTE: OTHER.MORE ARE AVAILABLE. ASK U5 FOR THIS MOgMATION. S' nLDING INSPECTOR APPROVAL, NO: YES: gdorms•P380303a , Footnotes to Table'JS.Z.lb:' Glazing area is the iatio of the area of the glazing asscmblics (including�-sling"gue doors) to thelgrass� and basement windows ff located In walls that enclose conditioned al gzig space, babe excluded.frorrt the U-value requirement. area. expresi;d as a'percentage. Up-to 1% of ttie total glazing art:a may g area. For example;3 ft1 gf•decorative glass rhay be excluded from a building design with.300 fr of lazing 2 After January 1, 1999, glazing U-values'must be tested and doeumez►ted b3'the manufacturer in accordance with the Na�ional' Fenestzatran Rating Council (NFRC) test procedur=+ or takca:frota Table .11.5.3a. U-values are for whole units:'center-ofglass U-values cannot be used. if • .11 ' The ceiling R-values de dot assume a raised or oversized tItt55 R3 pm�asumlatian may be substituted for t R�8 insulation thickness, over the Exterior walls without comptzss n, itmsulatian and R-38 insulation may be substitute'd'far R49 hulatlon. Calling R-�val�nrepresent t pia d 6 cween insulation plus insulating sheathing (tcavity f.used). Far,vt:ntilaicd t:engs,.iasuia ►g. the conditioned space and'tne ventilated portion of the.mof. sbexthing (if used). Do not include Wall R-values rtpresett the sum pf the wall cavity.iasvlatio��l R-19 requirmmcnt could be met EITHER exterior siding, Structural sheathing, and interior'drywall. sheathinF, Wall rc u' ments 'apply to by R-19 cavity' insulation'OR R-13'cavity Insulation plus R-6 inst g wood=fcanie or mass (concrete*masonry,lag)wall.oenstrucxidns,but do not apply to metal=frame construction. e The floor•'requirements apply to floors ever uncenditiotied spaccs (stun,as unconditioned crawlspaces,basements, or garages). ;`loors over outside air must meet the ceiling requirements. must TF e entire opaque portion of any individual basement wall with as average depth Less thandcor below conditioned mc_t the same R-value requirement-as above-grade Ba�•ent ndo�rs mws � =��the U-value requirement bz,emnts must be included with the other glazing. d_scribed in Note b. ' The R-value requirements are for unheated slabs,Add an additional R far heated slabs. If the building utilizes elettric resistance heating use compliance app, arh 3;4, or S. If you plan to install more than one piece.of heating equipment or.more'than one pieta of copling equipment, the equipment with the lowest' efficiency must meet or exceed the efficiency required by the selected Package. Far'Heating'Degrce Day requiremdnts of the closest city or town see Table 15-2.1a. ' n OTES: a) Glazing areas and U-values are maximum acuptable.levels.Insulation cmpcn= minimum acceptable levels. R-value requirements are for insulation only aad do nqt include situ: =-al th a 035. Dear U-values must be tested b) Opaque doors in the building envelope must have a U-va7uc no cedure or taken from the door U-Value and docuinertted by the manufacturer um.accordance wit U-NFR C procedure door is not available, include the in Table J1.5.3b. If a door contains glass and an use t aggregate to determine glass area of the door with your windows and use �em°a aye a U-valueue door uegreater than 035).mpll cc of the dear.' Ono door may be excluded from this requirement(r.e., y c) If a ceiling,wall, floor,basement wall,slab-edge,or craw w i Wall htedcomponenta yaluedis greater than or equales two or more areas s o different insulation levels, the component complies ifth 8h 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 far doors)..' _ 43 The CoMmonwealth of Massachusetts Department of Industrial Accidents oxce onflyesaffatioos 600 Washington'Street - Boston Mass. 02111 -- Workers Compensation insura nce Affidavit � name t 1 �C.e/lVt/�C`ea^� Cyr Ley city ® I am a homeowner performing all work myself. ❑ r rietor and have no one works in ca achy I am a sole /%%%c7a7%i/% workers co 1 ensation for mY employees working on this job.::::::::.:,:::::.:r::•:::-.}:;:::G:::}.}:.:.:,::,.::.::::..::.:::rovidin :::.:::.........:.::.:::::.:::.:...........:.:..:..r.r..........:... ...... ;:.:::.:::::::::::::::.:: aman em g :...............:.:.::.:.................:.......:.............:....... can ;. .. ::•.v:::::nv::. i� ..:....::....:.:...::.:.:.v::::.::::..::..::.:�:::is n:..... .............................::............{;•:G•:4'•}:;a}}is4:^%r}}:v}}ri:-0G•}}:�:�$:>5...::::., 4}un.......:.. :;•;'o liar`;?: i?�<:`�>:' i'}'i ?i;�::;;i'�'3:YirSE�i: :�;:5>fiasi ;:i'?�:>.:Sin;:t:<::?sS::::>::;::�':;:;.;.:.::: 1 `:�risranc ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have co ensation ohces; :....?:G:...;k•.>.:,;i'Nti•}}':•}};i}:-:{- ollowin wo mP ........P.............:.::•::.:,.............::::.::...............................:.....,..:................ the f ................ ............................................ ..................:.:.�:::.::::::..�::;:.>:.}:.}:;.}}$:.:;;:.}:.}:G•}?}:.>:.;;:;}:.};}::>:;<:$$:>;>':$:i:<$$::�:<:$;$::::::.:.:,..>...r... .........,........ i $$¢iv .. `n .$:Li$:>: ;>?i$:'$';4$$$'i j$:J$$$;:i::tt'(:$:v:iii$$:<($iriL$$:;:L$j$$:::$t:C+.4:�}:;;•::i;;;•::n ry;::};}':::::;.:;e'>`, }'" :<•: A}am `��n ... .. ..... ..':::...........• .............. ................:.:v::::;:. ......v.....\Aiik;L}'•}:4:.:.:5}:;;4:C ...................n•...............• ....,..................................:v::::::.............• :•:nv:::..........•::::.v.v:::.., ..:{$•}::::.. tires ................. .:.,.}•.;•.z;...w ...............................:wn...............::::..............::w:::.................-•w....... ,......,. .?F.in.•.v{:..... u..nra...w..Y......{. rv::. • ... .... ... .... ........................:.................................:.......::v..:.v::::::{•}}}.}:•}}}:;•....n....m .. r::?}:..xw:::.....,.........{....... ..N,•.v::.n)C,•;y.r;{:.:'r$:::::: .. .. .... ... .. r............................................. .....;... ..::::r::::.}•i•+•{i$$:•'�ir::::.v.::. :::r{:::%C}:;G•:yv {•:v.;{{r;;•i:::. ... .........n .. ....N...• v::•:::......::.. :..... N•,t- .... .......... ............ ...........n ............ ............. ...............:.a....::.nM1......;......... {.,, x{:nywiv"'::v'L•:,y Y.h,; ,,}{.L;.L;F+{{ii}}$i ............................ .......n.,..........:........... ............................................::w;::::::.......:::::::::::.v::::... ......is}::::':;$}:5::::.... ..r.........•::•:vv:.v:.:.n.........n;v:,:'•.;v3?a:i'?.:}�}:..}};i ....... ...... ....... ....... ........................:::.v::m:...., r...:::v::nv:.iv...,...••:•.v:::::.:: ........:::::,.;.}:.v,v:w;..r. ,. a'aattranceica.}<:}}::::<.}a.,:.,F.,:,:;.:;;.,,.}:,..>.:.::.:::.:..::.. ...... ..... ,✓,Uj%/////%%/ ....... ....... ...:r... ...:..... ............ ........ ......:•.:::::.v:::.v:.:.•::::::.:..v:;.::v'•:+.•}}}:};}......•v...r.n..v{:r..{...................:....{.... , v4....4'Gvi{•:L�:i:; :<Er. • - am :.vi:;•:.G:•::::..:.}};ii::::::::;•}}i:?}:;•:::::::::•.v i?}:w::::............. .....:::•:.v::x.x::{::}::::::::::::ii4:G;;i.,... ...... .............:................. ..... ..... :......... .... ..................:.............:::::::::::........ .:r......:: 4 Y{LL�k� vr............. -: ....... ...... .......:.... ......:... ..........::::.....::.v:.v.v:::v:::::i4:4:G::......................:...:•:i�i:::::::.$$$:..r..:.......... tiq}}j :tip${:$$}$$$$$$i$$:;::''v:•$::+:':y:`$$:'v:':�:?$':':;'�::}i:;{%;r:.$:•,:{.$i2}::;..v:;ti L;:G•:{$$''{Ci.}i}}i:•i}:;G{;•i}'r:}:;v'•}.:•::•..':::.'::::::::•i}};{•:i:-:i:4:;•}::v:::.::::::::.v:G•;:}:Gv'^i:•}:•}i::i:::::.. ...............:v:::::::;....,........'::}}:{•}:•}Y:}.....:.}.•}:•}:h:i:^'F:':'}}:•i......i:•}}}}:•i:;;•}::{4}}:G;;•}:;;4:}}:4:•}?}}y:}$$:;;•i}:::::;•}:•:i::}:4::•.y.}v:.::::::.v............... :}:;{;::::+ :..;tin{•.:::}:• ....::..:..:..:•.::::{•iY:}::ti;?}:G•ii}ii:{v:•}is•i:$$i:if:viS:v::i.v.vr.v. v:n:';{•:; <:v::::.}v:ii•..v w.:•••a' ........}............... ...... :.:.:...:.....:.:........:..:::::.: ,.... .......................:;... -.............�••:w.•.;.....•.:............'•..............................,w::::nv••w:::::::nv::::::::.v;....•:�.v:::x:.;•nv.:v::;:.vw.... ........ ....... ......... ...... ....... ........... ..................:•::::.v... •'v.:v:. t.}:.;•:':}'::•$i}:�:}i}:;:•}}•,�:G•k:•:C}�k;:ryn•G:i:••i}ir{,;${$:.;.. required requ�red under S es in the 25A of MGL im can lead to the imposition of criminal penalties of a flue up to S1,S00.00 and/or Failure to secure coverage a one years,imprisonment as s duff penaltihe form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is trw and correct Date 9��j n x signature 1 it Phone Print name l e3 4/ r/L official aye only do not write in this area to be completed by city or town otfidal city or town: perm{t/license# ❑Building Department ❑Licensing Board once is required ❑Selectrneres Office ❑checkif immediate rap 4 ❑Health Department contact person: phone k; _ ❑Other } Umsed 9195 PIN 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 Icense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the inC77rance 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 ins rance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of incnran�e coverage. Also be sure to sign and �:. date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you being requested, compensation policy,please call the Department at the number listed below. are required to obtain a workers' 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 permrt(license number which will be used as a reference number. The affidavits may be rearmed to the Department by mail or FAX unless other arrangements have been made.• The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Departments address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Otnce of Investigations 606 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 P�°FtHEl � Town of Barnstable Regulatory Services 9BARNSTABLF.g Thomas F.Geiler,Director �A 1639. �0 rFOMA'�a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: (� (%�W-LA )Cr 1 r��� Owner's Name:_ LAA MGA4 -[A Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied %Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No.Ax tor-s—_ ' OR . Date V Owner's Name QArms:homeaffidav ' �,Tia cksx Appa�d'a 1 'Table J5.11b(eontlaue M prsierlptrve Packages far daa sad Two-Fsasily Rtsideatisl Ha1ldIagg Hated f►ih Fossil Fuels MINIMUM MAXIMUM HeatinglCooling 0}lg Glaung Ceiling Wall Floor � .�wauctu Equigmmt Efficiatcy' Areal(•/4) U-valuz= R-value] R-values R-value1 R V t &vs•lud' FackaBe 3/01 to 6500 Hosting De"Daya� IO ,_6 Normal Q 12% 0.40 38 13 19 Normal R 30 19 I2/e 0.52 19 10 6 85 AFUE g 1No 0.50 38 13 19 10 Normal 13 25 NIA NIA T 15% 0.36 38 46 38 19 19 10 85 AFUE 6 Norm.4 U 15% 0. 13 25 N/A N/A V 15•/1 0.44 38 6 15 AFUE 4y 15% 0.52 30 19 14 10 Normal 13 25 NIA N/A LAZA 19% 032 38 NIA Non al 19% 0.42 38 19 25 NIA 90 AFUE 13 l4 l0 6 18% 0.42 38 6 90 AFUE 18% 0.30 30 19 14 10 1. ADDRESS OF PROPERTY: J -F -2, SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: ° 4, % GLAZING AREA(#3 DIVIDED BY#2): AA-see chart above): `l g, SELECT PACKAGE(Q-- • NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO,. q-forms-580303 a a 780 CMR Appendix J Footnotes to Table J4.2.Ib: lass doors, skylights, and d 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 fl of decorative glass may be excluded from a building design with 300 ft'of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with Council RC test procedure, or taken from Table 11.5.3a. U-values are for the National Fenestration Rating (NF ) . whole units: center-of-glass U-values cannot be used. 3 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 d for R-49 insulation. Ceiling R-values represent the sum of cavity insulation and R-38 insulation may be substitute 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. 4 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-die 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 outside 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. Baseme nt 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 for 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 seaTable 15.2.1a 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 in Table 11.5.3b.If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door, One door may be excluded from this requirement(i.e.,may have a U-value greater than 0,35). c)If a ceiling,wall,floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels,the component complies if 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). A'1 s RESIDENTIAL BUILDING PERMIT FEES .' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING PA x.0031= square feet x$96/sq.foot= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EMTING SPACE square feet x$64/sq.foot= x.0031= ------------ plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.f� >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$96/sq.foot= 769 X11-+ Is32J51. 571, X , 0031 = '7 �q STAND ALONE PERMITS , Open Porch _x$30.00= (number) Deck x$30.00= 3 o (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee �,�G S • D projcost Town of Barnstable t)F 114 Regulatory Services ,CAB Thomas F.Geiler,Director mass. Building Division ArED MA'1 a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: —1 Y JOB LOCATION:. y �' 'ZCV number street village . "HOMEOWNER': r ,&t j JlZ 1 $' '{G —� �`�o - i 7 5 ' 1300 name \pp home p one# work phone# CURRENT MAIIING ADDRESS: U5 F= "—a 2C X=C( f I V ft.2j I OAA ('3 c ty/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 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) t 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 . . requiremen t Signature' fHomeowner 1 -� 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 —J ME M ' m H.S. Iloilo ■n ::: e:i n■ w ■u ... ■■■ .......................... _ ' oilI"'I .....,..,, .......... Noun ,■ _ '�E.�a�1' 's,� ��' ICI � ����1 • • • • son .. ............... ........, .......:.......... ■■■ ■■■■ iii 7q1!11, tir. '-...�::::IIIII,, ...IIIIIIIIIILI,I�J�I��i�IIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIJIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII _ ..... .............. ..................... - 11�■I I I� III .III ♦ C III III ` 111 II II .ran .wammrww ............... .. ....... ...... .......... EFEW � L W b@ moo ramr.ow oou - eb..00 - 4 r.v .. s•.vr '.on o CMAf ROOM_ ># g 1j J J I/A2 vu vr,•o Rlldif 5117E ELEVATION 1 W O LU F O U w m.o.moo LAV. II I . [A J I 4 W O¢ W o�.m. mnma. O I 2 02 Q aew•:.o..wo� . I Z .•a,mm mmemm. .w - sumac I �.e ¢m t — Q AM - J'°U W PE4ROOM 2/A2 vc•vr•ro FR5f FLOOR PLAN o�. ------------- MOM a aaoea..c .•. CMqi ROOM vTmo.o a ra I 1 r D�Te� cum an mm.r��m wn,mm I 1 _ - rmsn vrwmmn DAWI I�YmOMB •vT svTmwwvrl ;, � � "• - �, ..acarmrxmrm 'e nc mto ..s w.srmr . (MJLE r.m raw � I - mm.mmuoo Immv �rra �+ mmmmwmm� F6£WIEr I I �.. •mm I I - mamas I I ' flEEt 1q. t � ..Lm.am.•e � �� - kmo.n...,m...mra � / \2 3/A2 swevr-�•o SrC110N 4/AZ xwxrs DECK FRAMINGf/EfM. a. o-. ww M .r - If I r r r rNo�z..r 1 , I i i I _ W c: 4 Z 'a EXISiPJ: �, Z -� c y .rn G°ROlE a, I I I I � - ..., ., .. ', � 0 U W O Q O mom O u m a,mwa mt ut {— a 0 LL a . I m.o.earau r♦ `1` � •1 q mn,e l enw¢rtwem.w� l , J µ n - /A3 FOUWATION PLPN 2/Ab min^-.•a FM FLOOR FRAMING P AN P.FAN7AilON5 ncmwro P. r 6 ` DAMIn f 3/A3 wuvrH•o 17CfWL 4/A3 wwvr-ro 17EfW1 5/A3 vr•-rq 17EfA1L b/A3 FOIBJDAiION NOTES i ♦ V! N ---- I I- 1 � z 1 W J U¢ a- 1ul V O 1 wm 1 1 �\ - N O — QO� U- zi. z r QLO W J U (A /A9 rAe:vF a o SECOW FLOM PLAN I 2/AA 1-4-1— 15ECOW MOOR FPAMING PLAN �/1�� �' - DAlE: CIECItED BY. �5 DAB om `4 1 pR 3 gr _1a . A2 - ♦ i. All a. f r £ - Z ' W J U¢ d ¢¢O m U LL V A5 —1 -ro• ROOF FRAMING FLAN � e • - u.nl Tel�p(m en ogre• n---- FLE M1U@� . S1QET ND. NO T )-0 SCALE TOP FDN. FINISH GRADE OVER EL . 9 I . SO FINISH GRADE �. S _ 6..°;',: FINISH GRADE OVER DIST. BOX 9 1 . C> FINISH GRADE OVER ;. :.o. SEPTIC TANK 90. C) .,.o.o..p \ . LEACHING PIT VARIES p .. � d:a' :a.'.°` •'0:'4; ''.o:�•:'o••.°.o:q:o �,••.•o••.,.o..¢:e.:�.'.a•: ..• :o'' e•'r: '•¢',;• � 3" OF 2/B" 1/2" 12" M'AX .. • °::b .... .' PRECAST CONC. 8R ASHED PEAS TONE BRICK 6 MORTAR OUTLET PIPE LEVEL 2" 66� -L i7 ;! GRADE a:6.. . 4 FOR 2 FT. MIN. b...�., xy:a:8:'O•'o.'+':..•o:' Ap o C. I. OR PVC TEES 0 . ✓. a: BSMT. FLR. ;�'p.° 1000 GAL L ON EL ., �� : :°.o :d �.: �"RIBUTION BOX INSTALL ON LEVEL BASE 3/4" TO 1-1/2" 6' RECA7' CONCRETEP °..•.a'..o: o: e WASHED S b':..0..'d',.•10: .. �- o REINFORCED CONCRETE .� 0 o CRUSf-)ED o d S TONE , b�:o. ood o:o c`.o;G o p o:�a�4'op°'d'o oP°'•o'v'•�o:60 oodaoa: j I :b :bf 6. R—� l 0 REIAIF. TANK ti ° o '' ° • '�•'•° C G:=e SEPT.� o. . ,•. . . . .� INSTALL ON LEVEL BASE o g d a e 4 ;•a o o. a o;o; NO EXCA VA TE TO ELEV. �? OR .o o a a;°'P:�_ �,• ',. ,o_ o o•. ,o `'.b L OYER TO REMO VE A L L IMPER VIOUS MA TERIA L BENEA TH THE L EA CHING AREA 2 '-0 " 2 '-0 " r . REPL ACE EXCA VA TED MA TE'RIAL WITH 6 .-0 " --^ CL EAN, CLA Y FREE SAND 10 ._0 „ EFFECTI VE DIAMETER o� ,+'� ,/'� L EA CR'..�"'NG PIT GF.yv. Rr m - NOTES S INSTALL ON LEVEL BASE } 1. ALL EL FVA T1`G��l� 'S"i IOJVN ARE BASED ON BY O T f-(EiZS m LOT I 2. ALL PIPES Il.t `� w- SYSTEM MUST BE CAST IRON � OR SCHEDUL 'C. 0 , 1`�VA T.1*10,E -. PIT r E BOARD O _1'YEAL TH MUST DE ,,, 07I IED - C) 3. TH P-6 903 WHEN CONS TRt/t, "TOE' IS COMPLETE PRIOR .. TO BAckpl;LLINta i PERCOLATION RATE.' Cl 4. ANY CHANCES '141 THIS PLAN MUST BE APPROVED 2 MIN./IN. BY THE BOARD 45F HEALTH AND CAPE 6 ISLANDS WITNESSED B Y.' If SURVEYING. CO'. INC" a s 78 5. MA TERIALS ANL'' INSTALLATION SHALL BE IN 74 82 �o �� `- �� COMPLIANCE WI�H THE" STATE SANLTARY ,SARNSTABLEBRO. OF HEAL TH „ TA CODE - TITLE ' - AND LOCAL APPLICABLE DATE.' 70 -T2 RULES AND AEGJL A TIONS ' NUMBER OF DEDR001�OS 3 6. NORTH ARRO�Y 1";�•FROM RECORD PLANS AND 0 " PIT"1 E 1 ,80.5' PIT*Z EL.8Z.0' IS NOT TO BE 1SED FOR SOLAR PURPOSES TOPSOIL 6 GA RE A GE DISPOSAL NO 7. FLOOD HAZ1iR0 �ONE C DAILY FLOW 330 GAL . SUBSOIL ". - TOWN WA TER 24" 1000 SAL . ' \ _ 8. WA TER SUPf�L Y _ � SEPTIC TANK REO D. 1000 GAL - - ►� — SEPTIC TA NK PRO VIDED _ �- LEACHING RE GJUIREDrp, 330 GPD S.F.SIDE'WALL AREA � 188 5 F .. , ......I 1BBS.F. X 2.'5 G/S. F. - 471 GPO 2WEL DOTTOM AREA 79 S. F. l i LEGEND _ 79 s. F.X 1 . 0 G/S. F. � 79 GPO - �' L EA CHINO' PRO VIDED 550 GPD j I V , l , L OT v- d _ �rl i POPOSED EL EVA TION � 47 Co 20y ° \ I EL. G85' 144` O #2 �t . 70.0' PRECAST CONCRETE N d BEACHING PIT ---ga ' c. 'IsrING CONTOUR SINGLE FA MIL Y RESIDENCE G Of-SERVA TI.ON PIT JOOO GALLON 0 DISTRIBUTION BOX , \s a ►— , ; ; PROPOSED SEWAGE DISPOSAL S YS TER PRECAST CONCRETE Q SSS I I S r, SEPTIC TANK ( I Cp ACHING PIT U \F� I � Pf� PAREO FOR o ;SEPTIC TANK � JN � DENNIS GAUTHIER 6 YVONNE M. CA VALL .�'NI IMM C RCL E n�; t � � � .-� � ,�,:. r ,_ •., LOT 2 KL I � s y� BA RNS TA BL E -- MA SS. 83.SO PIPE INVERT EL EVA TIO DA TE.' 4AP2. I 115 SB CAPE G ISLANDS SURVEYING, INC. ------ 7z -TO PLOT PLAN _ . �s�,. S� `,� SCALE AS NOTED i LAI_JD, / SCALE.' 1 +.,� 40' P. O. 80X 334 _ � - A ---- T T.._ - t• . PLAN NO 6�g � 7."rKFT