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0075 FURLONG WAY
° Q �J 3 o- ' � v) 4 S 2 © 4z 2 d �� 2S'< <c� c,�� 3 ��' o c� PT B � ( l R5e-e. c,k«eQ UQ-, cmti�.���' " S 'I p((,,A r-D - 110. lk-- eL- y/?,cKk sex a a�(q i Z r f q �1 g 27'T� v� So �t D 5.e i E c� C,p(S) c�PS"cLoA, Lffk 0 u—r .�S �j Ta A-( art x T41.P 2 J A 2 9- �T T ( e -�- � � c cmo 4- 44 -4A-c iC a-K,� 6�T (C-f o-p / © G2 2 r o. l .. -�O �c vQ � •r— CA-((ecQ 2 v /C7-i Pt, vv'JD R I S E Division of Thielsch Engineering,Inc. 2T3 MAY 10 AM If: 11 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 DIVISIOq May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 75 Furlong Way has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerely Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 401-784-3700 •800-422-5365 •Fax 401-784-3710 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1u Map �� Parcel Application # 05 (0�� Health Division Date Issued Conservation Division -.Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis W Project Street Address Village Lfi I J+ ii DD Ownerm Address Telephoned 0 42--b- 2 / Permit Request inga LaAam ",b 'r t aha Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay J -i o Project Valuation ! Construction Type ,......E �.�, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docQnent-abion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) —I a Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Hig!way: ❑2-78s d)No a p Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other m Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � �i'1 n Telephone Number d 1� 194- 3166 tX SO Address l V f� J�{�l�)��)(T �Q ,� License # D a %16 Home Improvement Contractor# I Worker's Compensation # -Z[ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE 2 ty 1 FOR OFFICIAL USE ONLY `APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 4 INSULATION d. i1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO: w RISE EEgE RING Y: NG Federal ID#05-0405629 Y RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 OC o CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston, i0c. (401)784-3700 FAX(401)784-3710 _ _ ,._ �INT CT I Page q L THIS CONTRACT IS ENTERED INTO BETWEEN RISE �,+ �a ENGINEERING AND THE CUSTOMER FOR WORK AS ,G.141'�i�I1C R8l��i o a DESCRIBED BELOW CUSTOMER PHONE'- -, DATE Client# Michelle Rojee (508)120-2179 10/09/2009; 104968 SERVICE STREET - BILLING STREET - - 75 Furlong Way 75 Furlong Way SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP ' Cotuit,MA 02635 - ' Cotuit,MA 02635 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air, r exchange and indoor air quality.Materials to be used to seal your home can nclude caulks,foams,weatherstripping and other products. '' t Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and tesiing. 9.5 man hours. " $627.00 RISE Engineering will provide labor and materials to install a 8"layer of R-30 Class I Cellulose added to 1100 square feet of open attic space. $1,210.00 RISE Engineering will provide labor and materials to install an easily moved,rigid foam insulating cover for the attic access folding stair..The' cover has integral weatherstripp ing to restrict air leakage. _ $160.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for households where total income is less than or equal to 80%of median income, the Cape Light Compact offers 100%incentive toward eligible measures(not to exceed$2,000 total incentive.). - s -$1,997.00 NO 1 WE AGREE HEREBY TO FURNISH SERVICES-.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF **"00/6019aes - $0e00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATURi-RISE ENGINEERING - CUSTOMER ACCEPTANCE '3 WE) \ � NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN - DATE OF ACCEPTANCE y - F GG ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE ✓_5 - + SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK '� DAYS. _ - i AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE 15 , L icensee Details Page 1 of 1 71ie Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home : Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 f. Restriction WS,IC Name Erik Nerstheimer 'City,State,Zip North Scituate, RI,02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search f Board of Building Regulations and Staiida6N License or registration valid for individul use only _ HOME IMPROVEMENT CONTRACTOR i. before the expiration date. If found return to: - Registration, 120979. Board of Building Regulations and Standards Exiratton One Ashburton Place Rm 1301 _ P 3/25/2010 aTYPe :Supplement Card T�istoi},. ja.0210$ THIELSCH ENGWEERINGS ERIK NERSTHEIMEW- 1341 ELMWOOD AVE.t f CRANSTON, RI 02910 � - ------ Admmistn itor Not valid without signatere http://db.state.ma.us/dps/licdetails:asp?txtSearchLN=CSL100459 a/�n i�nnn I f AC®RD CERTIFICATE OF L�IAMU 9Y INSURANCE OP ID NBC. DATE(MM/DDIYYYY) THIEL-1 11 05 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite.303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW East .Greenwich RI 02818-0810 Phones 401-886-8000 Faxs401-885-1700 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Hartford Underwriters Ina. Co Thielsch Engineering, Inc INSURER B: Hartford Casualty Insurance Co Thielsch Group Inc. INSURER Liberty Mutual Insurance Group Hi Tech Realty Inc. y P 195 Frances Avenue INSURERD: North American,Ca acit Cranston RI 02910 INSURER E: COVERAGES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY E POLICY EXPIRATION DD Tf N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIALGENERALLIABILITY 02UUNTD5678 04/01/09 '04/01/10 PREMISES(Eaoccurence) $300,000 CLAIMS MADE ®OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY- $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X PRCOT LOC Em Ben. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B X ANY AUTO 02UEHM4850 04/01/09 04/01/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) i GARAGE LIABILITY AUTO ONLY-EA ACCIDENT -$ ANY AUTO OTHER THAN EA ACC' $ AUTO ONLY: AGG $, EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,0 0 0,0 0 0 B X I OCCUR CLAIMS MADE 02XHUUF6573 04/01/09, 04/01/10 AGGREGATE $ 10,000,000 ' $ DEDUCTIBLE $ X RETENTION $10,0 0 0 $ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY C ANYPROPRIETOR/PARTNER/EXECUTIVE Tn]C2-Z11-259874-019 04/01/09 04/01/10 E.L.EACH ACCIDENT $ 500+,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If es,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER D Professional Liab DVL000025902 04/13/09 04/01/10 Prof Liab 2,000,000 A Leased/Rented Egp 02UUNTD5678 04/01/09 04/01/10 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION _ TOWN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Division 200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis MA 02601 REPRESENTATIVES. AUTHORIZED EPRES ACORD 25(2001/08) ©ACORD CORPORATION 1 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 . www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RISE Engineering; A Division of Thielsch, Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, ,RI 02910 Phone #: 401-784-3700 or 1-800-422-5365 Are you an employer?Check the appropriate box: Type of project(required) 1.® I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired.the sub-contractors 2.❑ I am a sole proprietor or partner- listed on'the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have h 8. ❑ Demolition working for me in any capacity workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their - 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs I ,,'insurance required.]t employees. [No workers' 13.© Others LEA 1��MMM 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 their,workers'comp.policy infonnation.' I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins. Lic. #: Vat—ZI I L y I� G Expiration Date: 04/01/ 10 _ Job Site Address: G� `1� City/State/Zip:Li r ~ Attach a copy of the workers' compensation policy decl ration 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 herebycerti un r the ins an. :penalties of perjury that the information provided above.is true and correct Si nature: Dater Erik Nerstheimer for RISE Engineering Phone#: 40-1-784-3700 or 1-800-422-5365 Ext. 133 ~ 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): s. 1.Board of Health 2. Building Department 3.City/Town'Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: IrI` 7/11/00 Took in permit app. from wife. Later husband called questioning what wife had been told by Angela and me about setbacks and about when permit could be issued. He wanted permit immediately and said he had pool people coming Thurs.a.m. I explained our procedures and suggested he call Tom Perry, 3-4:30. He was extremely verbally abusive and insulting about town employees...he is taxpayer,town employees are no good,and he wanted his permit. He ranted for some time. I calmly attempted to give him informatiop. Finally I told him I had given him all the information I could and again suggested he call :yr Town of Barnstable Permit: Regulatory Services Date: Thomas F.Geiler,Director '�18 Building Division Fee: aA M�BLE, Tom Perry, Building Commissioner - q��039. p�ro� =F 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ma.us Office: 508-862-4038 ` `'` Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: I"l )�L �-� a K:Cd Phone:!SM'q Z D 02 179 Install at: S Village: . Map/Parcel: Date: Stove A. New Used B. Type:'� diant/Circulating C. Manufacturer: ��LO61!N Lab.No. D. Model No.: Chimney �� A. New/Existing (If existing,please note date of last cleaning)f&I�1K,r B. Flue Size C. "Are-other appliances attached to Flue? a D: Pre=°fab Type and Manufacturer E.,Masonry: Lined/Unlined Hearth .- A. Materials: rick B. Sub Floor Construction: Installer n Name:. Address: Phone: Location of Installation: C1 H.I.0 Registration# �- Construction upervisor# OR check Homeowner Installing,no license requiredLn APPLICANTS SIGNATURE :3a _ APPROVED BY: o- o _ 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 Rev103107 �. Town of Barnstable Regulatory Services >aatsrts-rn$t Thomas F.Geiler,Director b9. ,�� Building Division `b�fo rMa�a. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ' Please Print DATE: 1 a_n 2-L E LUd v O '^ JOB LOCATION: l S �LC.✓�I UI I G W N y�number street e, T�7 village / I "HOMEOWNER": M �i rKot�� �jL+ZV A7A name _ •_ home phones# _ work phone# r CURRENT MAILING ADDRESS: 77C �d� M �"`"'! l.tJ /✓1�0 �� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less . and to allow homeowners to engage an individual for.hire who does not possess a license,provided that the owner acts as su en rvisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re uirements. 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:homeexempt AsseN®r's map and lot num Via.-.. f�. ... .�-a ) �G d! _ -/-3 �7 o�THEtO _ i iC-' YST_€ Q Sewage Permit number .... ........�..`.�.9............................... :.oT. ' ` "%`+k AN MUST E ` ,� li �PIISTATE MPLIAN '{Z BAHHSTODLE,House number s V- H ART r "6 a ................... ................................................. SAP�ITAR'�(%CODE�AND TO tiN oo�E0MAYlr�9 TOWN OF BAR.Nsr TW "LE BUILDING INSPECTOR _ h APPLICATION FOR PERMIT TO �� '"��'i ................................:.......... .........." ........ ........... .... . TYPE OF CONSTRUCTION ......... ' .................................................... .................. . .A../ ........., ?9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informationn:/� Location ...1Q .......1 ......... '....... .............WAN..............e e.. ......�... ............... r4" ProposedUse ... ............. . 1. .l.. .��/ . ....................................................................................................... ZoningDistrict ..k��............................................................Fire District ... il....................................................... Name of Owner d! L..... D.t�.€.1�1?:��.....AlI .fEL. -G..Address JS....1 K e-1-Z. UI a..y.......�U,t... !;• f Nameof Builder .....&Pr 1,r ...........................................Address ..... . ............................................................... 1 P .•..�- Name of Architect ...... . ss.6.�',.E ...5...••....•••.. —' ...............Address ..........cac. ..........t' ........��!1!/�� .5... Number of Rooms .. ..0 .�q.l............................................Foundation .r....... � 1.4 �.. { Exterior .......C� �..... :g.........................Roofing � ........ ..........................1p ..Floors ��... Dd...'t'.v.N�,P.C.�e-...... ............ nterior ..` ... Qf �.......-sue.......� T �� ...... Heating 1�, .w......P.J......................................................Plumbing ........a.. .................................................................. pp ...........Approximate Cost ....." ......Fireplace .111•!.�.. ... �:�:.'�............................... pp � y p.aC.>.�....................��..//.....�.t............. Definitive Plan Approved by Planning Board ---------------__ S --------------�9--------. Area ....... .......... .. .. :., Diagram of Lot and Building with Dimensions Fee &�...................- .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ( Q• 00 4� 3� a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................. ' MaoPbee, John CourtIaud ' � ~ � � �� � D— Permit —..---.��o��--.. [ ..................... . Location ---��.���:�Q��.]���.-------.. ^ � � . ........................<lotui±......................................... . � � Owner .......i-ohm..CourtJazd..Mar.Pb.(P.q.......... -- | ' � Type ofConstruction ..........frame..................... ^ ' --------------------------. - | Plot Lot -----.#��---� ---------' - i PermitGranted --. 'I8..............lg ?9 . ' � Date of Inspection ........ ..........................lA / Dote Completed .............................. —..lg . . � � � &hot PmRnano REFUSED ' -- — ' - ---------------------' lV ' | . ` ~ .. `~. ~ ... - � - —.. ......r..o . ------' ^ ------..-----~...--..,—.~—.—.- � .. , Approved ^ ................................................ lQ ' ' " --------..-------.—.--------.. -----------^---------^—^^^—'- � | ' 7 Assessor's map an� lot number ......- .. .......... _7 7 0*1 E Sewage Permit number ...�� z................................... .......... House,number ............4/__ 76� PARNSTAMLE, MU& 1639- MAY of* TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........................ ..................................................................................................... TYPE OF CONSTRUCTION ............................................................e.t,r.................................................................... ................... .........192�_ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ...........E ��............. V Location ... ...................... ....... ....................... ................................... ... . ... . . .. .............................................................................................................. Proposed Use ... ............... trict ............. ...................Fire District ... Zoning Dis ........................... ...............:T.................................................... Name of Owner (":��.Axlx.J..... ..Address J r (k) ...... ............................................. Name of Builder ..... ............................................Address ......�"Xz X��.r.............................................................. Name of Architect ...... ?......................................Address R ^. ......... .............................................. .......... ............. Number of Rooms ................... ...........................................Foundation ................... ....................... Exterior kA C..... ....... .......................Roofing ......... ........................... ................ .............. k"1w Floors .......I ......... ........ ...................... ...4k............Interior . .. ... ot I --Heating ..................................................................................Plumbing........ .................................. Fireplace .01m�' ...................Approximate Cost ........ ........................ ................................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area ............................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4 Name ...... .................. ... ...... ................... UL V/ ' 2I200� Permit for ' o' �e' �-to-^' -.No | i f�miI dweIIi _--� ... .�ou��--...����.------.. Location ......75..FurI���..�Way _________. ,___,__.Ootuit________.______.. � ' Job� CoortI��d Owner .---.-----~--..�������~.-_. Type of Co.mnvc"v,. . - Perm' Granted ./A p.r.i.1 1.8.................19 79 Date of Inspection ' uora Completed � | � PERMIT)REFUS lV--. -� - ...................... ~-._----�--- J� ! ............................... ....................... } _- ___.. _.w-~~-. _________ ----^'--'---''~^'--'^^'-^^---^---'- Approved __________------ lQ -.-------.----.--~~....---~---. � ----------^'--------^''^---^-' | ' ! | ' | . low% TOWN OF BARNSTABLE Permit No. ----------_-.-----__--------- 1 Building Inspector ,�n.0 ...� Cash ------------- -- 00 �° Ito YPv►\ OCCUPANCY PERMIT Bond ------------ �L No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to John Cortland MacPhep Address ? r, Tnirzas E r-, 1^Y:ne_nnis� lot #214 75 Furlong Way, 't Wiring Inspector i �'� !,i4 Inspection date '-7 T Plumbing Inspector - Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ........................................ ........................._........................................ ._ IL= Building Inspector t' re��tGN b�4TA c,.to GAtz��� Grit�ro�-cz. 4 'LS l>.dt LN( FLOV./ = l to eC `,7eT-r(G `f"A11C = SSC3,e ISO % 4_q P.D. � US lOOp GAL-. SPOSAL PIT usE loco GpL. aq Ss�. X 1 .o SO 6.P D: �`�... ,�` yk a Prr t. TOTAL �ESlGtJ = 42S 4,:P.D. 4 -f-OTA L UA t L--( Ft w _ 330 6.PD. 4111 Paw poi oS P�r-1ZGU4&T1©t,,l t2ATa4 ; CtL! 2Ar(iu 02 LE ��. t�" v'-&2AG.S tv A. fi:'tXXEF ion- i`y k G 1 r__ST "s/15 70g' Fyt> t 100.p +O- :•Y LoAtkf G"Poe tuv:- ITO r�P� looc� 1w ;i S,�t3 4 vise tw. GA.L. i(P '� So►6. iaty r'�x 16. ; Sepnc l 000 4 1 tov. TAtitK > i� GAL. ��V' LAN R1. o qG z FIT '• M eD .I ff - - SSA it> wAs�t � ` � ' — - LOCATIot4 C,lL)I pub. 4. GGtZTl t=-{ T&4AT Tt4C-. t"OL)Wj>t'nOQ 5Uotivu ..l�.►.J iZr i=C� E t-I�.>?rt�l.,1 Cr�lt�L�(5 W t'I� -t'i-1:=_ �ID�.t_t►-.tE: r.ur> rJ�7c _7 f Y, � t2EGt5[ttZi=D I�utJ 5uev��oes �, ,Tt4tS C71,Aw t eJoT A J O5"cEfLV1ELT o �t�C��Ste,. 1 tiJSt�;�►.Ivt Cry.[ ;u cl�/��� ;� 't•+-t�: I.a�_�'}�F"!i �`s•tcrrut.:� AF�t�L i �A.t~_1 T /' AcPaes S1L4GL� FAMtU4 - S 73tEDZOOAA two GAtzs�� 6,PI , 25 ?'fit L% F LOw _ 1Ib 3 2 33b G.p•D. Sr--F' is T/ lk = 3S0v (SG % _ 419S 6.PD. SMGWALL AV-EA (5o s.t='. i A4�p" TTO/c/t Q1Zt=L�r C� ST-. � Sri. x l .o So C•�.PD. � yP� ' '�� �� '�`r TOTAL T>ES(6Q = •425 6.PD. �fiZGDI-QTloc.l CZl�T� : tL,! Zhcl u O2 RICHAM A. £ 55r o0 � ter-. , TZLO ueST OL,Er- f ., .,. . 1 o4M PPE Iuv.• 41/0 + ,Pow y 1 voo Iuv. ;� SU$Spt(, 4 blsr" IW. 6AL. !mot �(�$ '2. • fox 'fib. - Sepric I o — IAIN.I5 T�LaNK GAO �� INS. IL,iy. , /`�� L�H •,e ,g'YJ PIT Met:> goo, Od SA�� WA5I.IED STor.IE. �q,� CEtZ�'tFtEt7 pLo�-' P_L./�l�3 P�.OT='t t✓� �v�, 1-aC/�Tlot� Et.=SS lit� � zv �o tivQ't'�'TL' o oSu``� Pe P I <Gtz-rtP^4 `t" 4AT- TNIr VW6- A., 5Wc,,AJ 1 A TZ�_i=�cZE�.1GE eC:AAPLVG W i`t k T14L"c AW6 51=`reACtG �[q�t�E�t�tit uTs o� -r►+t : �' 2� �r n , a � 5ra ' -- B A XTCtZ- QeG(5rc-:rz�� 'i..ti►�1� ,u�vL��fo�s T1415 M—Aw t5 wo-r ot-4 Aw oS•TEevtt"�_ 1lJSt•'� J.�tE:t.t; ✓,Uc-,�/t��L' ;� -t.+lr� c:F�,�["�, SI•IUt��.a LeLim- ! 44(,POM _� •- .. ....,, ,...•,-...-, ,., .t:. ...., -..-.��-.ao F-•,,..•,-�.Mp,+�+e•���--.,--,'i-t.....�t�.,.,.=�-�r�-�s•--,-r.-R,,-�.,f.,.---"--r- -.� .. __. _.... ...�ti.ve.},.d-- , OPINE�O The Town of Barnstable A. BARNSTABLE. Department of Health Safety and Environmental Services " - 7 MASS. �A �p i67q. �0 rFUMA'�p Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice I Type of Inspection RK VV\ Location K TU I Permit Number 7 3a Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ro Pow 4Ye uQtf 90M J-0 U6;14-- VMS ov e�- v V � Please call: 508-862-4038 for re-inspection. Inspected by Date 0 6 r i MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING .SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 10-27-2000 DATE OF PLANS : TITLE: COMPLIANCE : PASSES Required UA = 157 Your Home = 152 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 624 30 . 0 0 . 0 22 WALLS : Wood Frame, 16" O.C. 800 11 . 0 0 . 0 71 GLAZING: Windows or Doors 73 0 . 400 29 FLOORS : Over Unconditioned Space 624 19 . 0 30 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE: 10-27-2000 Bldg. Dept . Use CEILINGS : [ ] 1 . R-30 Comments/Location WALLS : [ ] 1 . Wood Frame, 16" O.C. , R-11 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value : 0 .40 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3 " clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape . Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel :, Permit# 7� � Health Division ' s Date.Issued j Conservation.Division `, Fee �y%f U. ZG Tax Collector ` ` ' SEPTIC SYSTEM MUST BE � �� INSTALLED IN COMPLIANCE. Treasurer 4"$ WITH TITLES y ENVIRONMENTAL CODE AND Planning Dept. TOWN REGULATIONS Date DefinitivpPl pproved by Planning Board f ; Historic-OKH fi Preservation/Hyannis Project Street Address L Cpt5U '(,M," a Village C,0:j J 1 7— Owner HP--�/-- Hy ) I,) I��TJ Address SPA M -Telephone f gA0 Permit Request 7D ADD I 10&4 52At L 65-L GAa ,:: 1 cr-5,S 7-0 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuati Zoning District Flood Plain Groundwater Overlay Construction Type 1ZeItoj:Gj_7) (:940�6C% 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:AFull ❑Crawl ❑Walkout` ❑Other Basement Finished Area(sq.ft.) % Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing - new Number of Bedrooms: existing new _ Total Room Count(not including baths): existing f new First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: j Yes ❑No Fireplaces: Existing New Existing wood/coal stove: Yes ❑ No Detached garage: ❑existing ❑new size Pool:❑existing ❑new size Barn: ❑existing ❑new size Attached garage.Aexisting ❑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 (Sl Name Telephone Number 4c). ? 1 Address P• p S'63 License# h8sit A14 � `� Horne Improvement Contractor# ® ' Worker's Compensation# LU ,3 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO t_�: Cam' ' , SIGNATURE DATE L FOR OFFICIAL USE ONLY 6,1 PERMIT NO. -41 DATE ISSUEDm MAP/PARCEL NO. djR• + - ` c` ADDRESS. • VILLAGE OWNER j DATE OF INSPECTION: - 4 FOUNDATION FRAME �Or� ti _ INSULATION i Ia�lr�o i ,r FIREPLACE ELECTRICAL: ROUGH - t FINAL t tF PLUMBING: RCUGLN � FINAL ` "- � I f-= � • - -. .' 4 � ;w GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT Z ob r ASSOCIATION PLAN NO. + �•' ' I S ' EST/MA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= 3�po (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot= PORCH x square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Value 351 5'96 k For-Off ce Use Inclusionary Affordable Housing Fee Fj Residential [] Commercial" Property Owner's Name Project Location Project Value Permit Number "Existing Sq. Ft. "Proposed New Sq. Ft... Fee $ IAHFORM 1/3/00 r . •• TablodSZlb( prou7ptim psaugn for ana and Twa}FamdY Rid BaUhw Hand with Fad Faela MAXIMUM IYIDVIMUM ceirmgWaU Floor .Bateme� Stab oolia0 �) ttrvalu� &Vahwr &vaht2 wall icsaxy' Paclwee R42f a 5"1 to 6300 Hnda;De�eea DAW Q 12% GAO 31 13 19 10 6 Normal 1 It, IrA 032 30 19 19 -10 6 N0"� S 129A 030 39 13 19 to . 6 13 AFUE T 13% 035 31 13 23 WA WA Normal U 13% 0A6 31 19 19 to 6 Nonaal r 1�7i YG44 jO 13 ryM ui tS AFTJ1r a 13% 0 SZ 30 19 19 to . 6 U AM x IV/. 0.32 33 13 25 WA WA Now Y IVA 0A2 38 1 19 2S WA WA Narmai Z IVA 0.42 31 13 19 t0 6 90AFUE AA 180/4 030 30 19 19 10 6 "AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: (Q — 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. - BUILDING INSPECTOR APPROVAL: YES: . NO: v Ni q-forms-f980303a 780 CMR Appendix J Footnotes to Table J5.11b: and ` Glaring area is the ratio of the area of the glaring assemblies (including sliding-glass doors, skylights, 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 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for 1" whole units:center-of-glass U-values cannot be used ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the fu11 insulation thickness over the exterior walls without compression,--R-30 insulation. may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between . . � ula;ed po uvn:of the roa: the conaiuonea spacc nuts u,c vcu '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. Nall requirements apply to wood-frame or mass.(concrete,masonry,log)wall conswctions,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 500/a 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 glaring. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements-are for unheated slabs.Add an additional R 2 for heated slabs. 3 If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. if you plan t0 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. F 'For Heating Degree Day requirements of the closest city or town see Table J52-la 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 greaw than 035.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 JL53b. 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(Le.,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 differ ent'E"sulation Ieve-ls 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(035 for doors). 43 Ovlto v A �u� , r �f ..•ucaaq��QP,f�b r . BOARD OF BUILDING REGULATIONS Uaensec;�, ONSTRUCTION SUPERVISOR 1 . N'n t �'CS'Blrft -057122 p < � 21f19,65 , 06112/2601 Tr.no: 10042 !r ��stricxed"To: 00 THOMAS S COHEN 160 HIGHLAND AVE COTUIT, MA 02635 ! '. Administrator �p THE rpm The Town of Barnstable ► &UMSfABLE, 9� "9. Regulatory Services prFD Ma+A Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax:` 508-790-6230 Permit no. Date — qk 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 0J Address of Work: ���i.CCotG L ° Owner's Name: � J 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 PENALT Y I hereby' pply for a permit as the agent of th e of Date Contr r Name Registration No. OR Date Owner's Name q:forms:Affidav I The Commonwealth of Massachusetts s' =: Department of Industrial Accidents �'=-=�` OfT1CC Ofl/IYBSIfgBt%OIJS - � � 600 Washington Street y Boston,Mass. 02111 workers' Compensation Insurance Affidavit , name location: hone# city ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in anv capacity ❑ I am an emplover providing workers'�c)ompensation for my employees working on this fob company name �',� L' ✓ Z`� (/ �'ti► fin' --?—' address ? r t city:. dal hone.# insurance co. F1117111,7/ / ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the.following workers' compensation polices: ' co a name: y . ad dress- ...... ess: n. city: insurance co. .. ....... :::•::.............. conlnanv name: :. address . olicv insurance co. as required under Section tion 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 andior Failure to secure coveragein the form of a well a,civil penalties STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a one yeah'Imprisonment copy of this statement maybe forwarded to the Office of Investigations of the flIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is truo and correct Date — - -Signature Phone# Print name omcial use only do not write in this area to be completed by city or town official perntit/license is ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required ❑health Department contact person: phone#; _. ❑Other__ (remea 9195 PJA) Information and Instructions Massachusetts Generai 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 comr.:: of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or_other legal entity a r, or the ny two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of deceased However the owner of av� trustee of an individual,partnership, association or other legal entity, employing employees. dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who Persons to do maintenance, construction or repair work on such dwelling house or on the grounds c employs em t P Y PP building appurtenant thereto shall not because of such employment be deemed to be an employer. :. .:.._ .. _.. . . . o states that every state or local licensing agency shall withhold the issuance or rene� MGL chapter 152 section ZS also who h. P o construct buildings in the commonwealth for any applicant o operate a business or t g of a license or permit t p not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor an of its political subdivisions shall enter into any c A act for the performance of public work until Y P acceptable evidence of compliance with the insurance requirements,of this chapter have been presented to the co" r''n 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 forr confirmation of insurance coverage. Also be sure to sign and davit. The:affidavit should be returned to the city or town that the application for the permit or license is ---date - - date the-iffi being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if yc are required to obtain a workers' compensation policy,please call the Department at the number listed below. //, City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided space tthe bottom Please f affidavit for you to fill out in the event the Office of Investigations has to contact you regarding applicant. be sure to fill in the pemut/license number which will be used as a reference member. The affidavits may be 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. 01, The Department's address,telephone and fax number. . The Commonwealth Of Massachusetts Department of Industrial Accidents office of Inllestl0allons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 ze•d Idi01 ° TOM COHEN 00 CARPENTRY UNLIMITEE) FAX#420-7266 _ 75 FURLONG WAY,OOTUiT T SECOMID FLOOR OvKR GARAGE - 81 Prepared by.Jibe Date:8/29100 BaamChek 2.2 Choiw I •"14x 30 A36 Wide Flange Stem Lateral Support at: Lc 7,1 ft max. Conditions Actual Size is 6.3/4 x 13-7/8 in., - Min Bearing Length R1s 0.9 in. R2=0,9 in. Beam Span 24.0 ft Reaction 1 8180# Beam Wit per tt 30.0# Reaction 2 8160# Seam Weight 720# Maximum V 8160# Max Moment 48960 # Max V(Reduced) N/A TL Max dell L 1240 TL Actual Deft L 1480 Attributes Section i Shear cn' TL Deft inj_ Actual 42,00 3.74 0.60 Critical 24.73 0.57 1.20 Status OK OK OK Ratio Fb(psi) Fv(psi) E(psi x mil) .. values Base Value Fy 36M 38000 29.0 Base Adjusted 23760 14400 29.0 Adiustments YP Factor,Le 0.60 0.40 BearnChek has automatically added the beam self-weight into the calculations. Loads Uniform TL: 650 A Uniform Load Aw R1 $160 R Swo SPAN-24.FT Uniform and partial uniform loads are ibs per lineal ft. F-O'd ET09 z98 83S QO�ld Q00M A3-ld3HS Tz:Oi OOOZ—GE—unu 7L t L .a W to � R , ,• r IILI � i � iill � � I , III ax�t i III I II I i .-7 -'S • ti� 43 r q r x r t. • J/ t. C' G 5 5t log D C. "i RIDGE VENT 1 X 8 LEDGER BOARD -�J COLLAR 11ES 0 49 O.C. _ AsRMT SHME5 OVER VI CaX PLYWOOD 2 X 8 CELING JOISTS 1s OJC. i --�� SOFMVW ,o RM I'W LA" 1X4SM 01EO.C. 7 4'HIGH VE WHITE SIiI R.WA TO PA 0 S TO D R.19 INSULATION WEATHER OVER VI COX i I IPLY#/=WPM IYVEK -- _.-1 ..1-I 1_ - _ - HMSEWRAP (LEFT CABLE TO HAVE R®CEAAR CLAPBOARDS) G. . � , 1 2 a. �� _� I 4 + k e { I i 5 �. � __ i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map_� Parcel :-Permit# - Health Division Date Issued Conservation Division , e7 I-VIA&) �l FeeZ7 ✓�� Tax Collector ` , 7 Treasure I6���TALLED IN COMPLIANCE t WITH;TITLE 5 Planning Dept.. i . ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board .TO". 7GULATIONS Historic=OKH Preservation/Hiannis ' v ' P roject Street Address Village Owner d� 1 Add ss l Telephone Permit Request t Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost CCO Zoning District Flood Plain Groundwater Overlay t` Construction Type 'Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 1 279 Historic House: ❑Yes OXo` On Old King's Highway: ❑Yes No Basement Type: EFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: -Full: existing new Half: existing new Number of Bedrooms: existing new ry , Total Room Count(not including baths):existing 15�_ „ new First Floor Room Count S Heat Type and Fuel: ❑Gas ; Oil ❑Electric ' ❑Other Central Air: VtYes ❑No Fireplaces:.Existing _ New Existing wood/coal stove: O Yes ❑No Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:0 existing ❑new size Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization., 0 Appeal# Recorded❑ 90 - �b r Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use ���T ♦ fin/ BUILDER INFORMATION Name- Telephone Telephone Number Address License# / Home.lmprovement Contractor# \, Worker's Compensation# 4F c2 t R _ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO sT�_Q c_Tco� S SIGNATURE DATE _�Zl//Ioo - FOR OFFICIAL USE ONLY •A t PERMIT NO. a DATE ISSUED `-. • ..� i .. 1 . � � ,. _ y r _ . MAP/PARCEL NO. ADDRESS . - ' VILLAGE , OWNER DATE OF INSP ECT - y FOUNDATION FRAME1: w / INSULATION f s • f 1 FIREPLACE - - J ELECTRICAL: ROUGH FINAL r ' PLUMBING: ROUGH, t:=v a FINAL GAS: ROUGH' FINAL . M i FINAL BUILDING X Mt - j r j . f R DATE CLOSED OUT 0 ASSOCIATION PLAN NO. K.� .y.. �s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `0 Z 2 - Parcel 7 �� Permit# Health Division ;Ft'`� /al'` ! g `'1 /'ll l�°i/°) Date Issued r Conservation Division�0`°: e Fee Tax Collector Treasurera.,af 1 I Planning Dept. - - Date Definitive Plan Approved by Planning Board fX Historic-OKH Preservation/Hyannis Project Street Address t75- RXL /UY1 Village. �,_o n Owner 56c i) f �(>t,��- .� /C�t,c.�� AdIss lnam� / Telephone 44ck)- �Permit Request rJ Square feet: 1st floor:existing I proposed 2nd floor:existing proposed Total-new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay a Construction Type ; ; Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwellinglype,,Single Family .' Two Family ❑ Multi-Family(#units) Age of Existing Structure ,q'7 9 Historic House: ❑Yes ON On Old King's Highway: ❑Yes X No Basement Type: C�Tull � ❑Crawl O Walkout ❑Other " Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing N new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not'including baths): existing �57 new First Floor Room Count S x l i Heat Type and Fuel-% ❑Gas' XOil ❑ Electric ❑Other Central Air: `AYes OTNo� Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size. "M: Shed:❑existing ❑new size Other: 'Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# @ �-� Current Use Proposed Use } f BUILDER INFORMATION' Name �c-{ ` Telephone Number Address . � 1 ��`:' � �, License# 114A Home Improvement Contractor# 41, Worker's Compensation# P-P a ., V ; 1, � ALL•CONSTRUCTIO1nN1.D l RIS RESULTING FR®M'�H���PROJECT WILL BE TAKEN TO 1.n1S'T2 (k C_`('O-J SIGNATURE Zt �-t -� � DATE r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL T, GAS: ROUGH FINAL FINAL BUILDING e DATE CLOSED OUT ASSOCIATION PLAN NO. � --t The Commonwealth of Massachusetts --- Department of Industrial Accidents .��=�.�. �-- � pfJlceallmrestigatioQs 600 Wasl:ington Street w�� �. . �-. _. Boston,Mass OZIll Workers' Com ensation Insurance davit fC�'1Vl U location' ` ^ . - • hone Al city (/�/CJ p all work . 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Y{F:.;.;{:::•rx;-$:}'r.:;:}:L:}i}•:.}}�r•:?;i5�'}:ii.}::;6:;<�:+.�?:i:!;:::rir::....: ............................................... .......................... of aimiaal penalties of a One up to S2 �00 aad�or I,Q ears lead to tba that a ganure to secure coverage as r'eR��� STOP WD�OVER�a ftc of S100.00 a day against tne. I understand one years'imptvomnent as well as etvli p of Ste DIA for eovelage vedSeatloa. copy of this statement maybe forwarded to the OIDoe of certi under the partu�P �eI P���inf°m�n p�ded above it Mal mid corred. I do hereby fy Date do 0 - h Slffiamre plan# `7i�`� / / / Print name in this arsa to be completed by city or town official E omdalweonly do not write - ❑BafldingDepari cense# ❑Licensing Board city or town: ❑5electmen's Office once is required ❑Health Department ❑check if immediate reap — ❑Others phone#' contact Person: .—_.r o:oc D1Al I Information and Instructions ;viassachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their. Iv is defined as every person in the service of another wader any come employees. As quoted from the"law",an emp y of hire- express or implied, oral or written. er is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of An emplov representatives of a deceased employer, or the receiv�,- or the foregoing engaged in a joint enterprise, and including the legal association or other legal entity, employing employees. However the owner of a trustee of an individual,partnership, who resides therein, or the occupant of the dwelling house of dwelling house having not more than three apartments grounds or to persons to do maintenance , Construction or repair work°II dwelling house or on the another who =p ys P be deemedtabe an employer. building appurtenant thereto shall not because of such employment that every state or local licensing agency shall withhold the issuance or renewal MGL chapter 152 section 25 also states the commonwealth for, any applicant who has of a license or permit to operate a business or to construct buildings neither the not produced acceptable evidence of compliance with the insurance cove required. e{oAdditionally, ce o public work until P of its political subdivisions shall.eater into any P commonweaith nor any P of this chapter have been presented to the contain_° acceptable evidence of compliance with the msuranee � authority. - -- EE Applicants - checking the box that applies to your situation and campensatton affidavit canzp Please fill in the workers' letelY,by along with a certificate of insurance ash o be sure tom mas�and supplying company address and phone numbers Department of Industrial Accidents for cam of insurance coverage submitted to the be widened to� tY Or toov .that the application for the permit or license is date the affidavit. The affidavit should Should Y�have any questions regarding the"law"or if v ou being requested,not the Department of Industrial aU the Department at the member listed below. are to obtain a workers cempemsationpolicy,P� . , required ggs City or Towns . The Department has provided a space at the bottom of e Please be sure that the affidavit is camplete dad pig fly cant. Please affidavit for you to fiIl out in the event the Office of d has to contact you regarding the applicant. The affidavits maybe returned t^ be sure to fill in the pcimitlliceose number whiahwabe used as a reference the Department by marl or FAX unless other arrangements have been made.' The Office of Investigations world I$ce to thank You inadvance for you cooperation and should you have any questions. please do not hesitate to give us a call. �%�/% The Department's address,telephone and fax member. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 �pF THE A� The Town of Barnstable • Services MAM " g Department of Health Safety and Environmental a 5 �, Building Division 367 Main Street.Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Far: 508-790-6230 Permit no. Date ,, AFFIDAVIT HOME IMPROWMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MM c. 142A requires that the"reconstruction.alterations,renovation,repair.modernization,conversion, improvement,removal,de of an addition to any pre-existing owner-occupied demolition,or construction units or to structures which are adjacent to building containing at least one but not more than four dwelling th certain exceptions.along with other such residence or building be done by registered conu'acoors.wi requirements. Cab Estimated Cost 6W Type of Work: i�l'��-� Address of Work: -7 S 0�01 Owner's Name' -' U Date of Application: --I// I hereby certify that: , Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 Building not owner-occnpi� Owner pulling own permit Notice is hereby given that: . OR DEALING WITH UNREGISTERED OWNERS PULLING TFI;OWN PEItNIIT WORK DO NOT HAVE CONTRACTORS FOR APPLICABLE HOME I1VIPROVEMENT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL a 142A. SIGNED UNDER PENALTIES OF PER MY I hereby apply for a permit as the agent of the owner: Contractor Name Registration No. Date , R Owner's Name Date 1jL '"E'O`!ti Department of Health Safety and Environmental Services Building Division 7 Main Street,H ,uttvsrneie. 36 � annis MA 02601 Y MASS. 9 039. Office: 508-862-4038 Ralph Crosser . Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: —7/II /U0 JOB LOCATION: t r r � G village number street 1-f�-a -2q . U� "HOMEOWNER": (y�t.lrl Ro home phone# work phone# U. 0 CURRENT MAILING ADDRESS:-a 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, mp vided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and. other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,06b 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 unlicc=d 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 thelast page of this issue is a form currently used by several towns. you may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN ..'m :3/10/09 ".ID VjMS W-.CS nr DMIAf—M MIGIM SIGYI p 1ME I.LIR[v 6 LLCOID Al1P YI M1I—IZU + +.IAT `TJK lD A(USED F"uT—0 1- . anGpNAL,�� \- PLANS FOR LOCATIONS' 1 O O F1'0 �2v B AC ER ROTS M� 2• 9- NMI- BRACE) ,11 NCA.GALVSTEEL S I FANEL T-FAIRICATED 3-iR••11AC✓ _ DIAGON4L BRACE �2 WkSH'EP�L BwO N�tl1 AND _ 20 YLT"IC104ES5' IL IC*b12G4Ca4LV.L. TYPIUL _ (CRE-FABRICATED VINYL LINER ISEE I3/SECT 2 AND- FLAMS FOR LOCATIONS 5-YEA M-BOUS I�B OTHER REA6N BRACE STAIR LINE STNR ASSEY6Y NITS AND 111A.v1�R5, �++ PRE-P#BRICATFD 20 MIL-THICKNESS20 YLTKJ065' AIR ASSEMBLY I� VNYL SANER .. VINYL LINER . STIR GA.GALX STEEL STAR LIK �m Y1LBa75 COfeER RANFl FAND AME END yr . m SERIES 550 6 650 STAIR CORNER SERIES 750 STAIR CORNER n SERIES 850,950& 1050 STAIR CORNER /s1 •� PIMP AO R 3 RAO ape. SNMWR 3 MOTOR �— MOTOR ON ♦ —►— — 1 'A'FR1YE ASSEMBLY a 7 Y•e) 1 = + LTYFKJIL MERE sHoWw ' • FLYER �. —� 2 �Er- ETVRN PERMANENTLY'A'FRAME -u�' 1ED� 1 w z V 3 ASSEMBLY WHERqArnPE •^- g I rr l I T t SAFETY LIE I gyy ISPPA0ED.0R,10>� y SE>� J¢ r CD 2 & � 0 �F'L PORTIONS Z I AT AREAS PUMP AND I s .. co vP;�. FLA APEA A a _ MOTOR RHADED ' PRESENTSAREAS - m m T 1 € I O m.a STARS.RE L--►---� °" Iw - ION pBE IY•2t 2RA sF AIRF AEAe Z242GLL.UB LOCarED AT -I I A1CT H m SIZE 9gR'N'-�16A3Z 50B..SF SURFAREA6.15flQQGAL-CiP M36 E9i SF SUTWAREA L 2O4➢-GALCAP 'X'Y OEYZ' t RETIHN • - 1 q A —m 20440'.796 SF SU FAREA 6 20$QQGAL-CAP Afl Do 3 SERIES 2000 9 2050 INGROUND •A FRAME ASSEMBLY a TYPICAL WHERE SHOWN O O ?��. - sRE SHOWN•aw4478s SFSURFAREA&24800 GAL-CAP TEROR PERMAIORLY ATTrJWe57711R5 ARE OPTIO SAFETY PERMANENTLY —_. r .-MEN+ TtsaH SERIES 2100 a 2150 W GROUND SIZE SHOWN 1Ba26.sa 90•EL e22 SF SURF AREA -I T 6 26WS GAL-CAP L-I.PT;GN t. SER IES 2000 8 2050 INGROUND °` ® ♦ PEfeYPEMMY - ATTACHED SAFETY LAW y '.z{'LL:: FLR AREAS fir. ���5 Misr 9 I - RETURN I I _ 'A'FRAME ASSEMBLY TYPICAL WHERE SHHOWN. 'C ♦♦a1.� SIZE SHWN:19-3r ZbT SF 9RF AREA. 20MO SAL CAP 4+' ALSO un P-IBIAI'713 SFSURFAREAL24955 GAL.CAP 20a1Y ess -F SURF AREAL 29223 GAL CAP SERIES 2100 @ 2150 INGROUND 66666666 - Mamurit 111 • • • x 32 RADIUS � 32' 2'W/STEP 2'K 2'K 8 8 a 4 RT# DESCRIPTION 2`K 2'K 102 8' Plain Panel CENTER 2 104 8' Skimmer Panel g NTER LIGHT 8 8 108 8' Return Panel PANEL l 23 ' Plain Panel 129 2' Plain Panel THERMOPLASTIC 51EP 161 2' Radius Panel 188 A-Frame 4. 2 1 t 2 4P2 —dSNR 4 Tread Step-N-Res2K 2K _ 2'K g 8 B 4 T A-FKAME BRACE 16' 32' 40" 40 7kf.1 the gmm�d water table is a minimum of 4'6" E __ the height of backfill arcuecdtheheightofill 6y more than 6".um 8"Jeep.f I/i"lu I' -SAFETY NOTE 2•M1NIMUM All dimensions are finished dimensions. PREPARED t)O1TOMJPoolrbul earth. for illustrative purposes Only. d+n,hall'+w 7Te Configuration shown wn- 4' 8' .,,{,.._ 4' J L 4' f I formswith curn:nt N.S.P.I sug- 14' 1 8' -� nmounl. }gemed minimum standards for 6n illu,uarive pur- ptwls approved for use with 'Ii,:InmJ by pan"u., manufactured diving equip- +,m,pou+JiiG�l ul the m"L If diving equipment is +niaa pen.. installed,fullow the equipment +tai�,and a"ni 6uiIJ- mane fact+ucr's installation, s - use and safety instruclions. POOLS If located in okh,fence only requires Certificate of Appropriateness If located in Hyannis Historic Waterfront District,pool & fence need certificate of appropriateness. Map&Parcel# Sign-offs from: l a Health Conservation Tax Collector Treasurer ©/ Dimensions Estimated Cost Owner's name&address Complete dwelling information for the Assessor's dept. Applicant's telephone number Signature Construction drawings or factory brochures& specifications (� Certified Plot Plan �Workman's Comp. form Fee + In-Ground pools Home Improvement Specialist's License OR Homeowner's license exemption Check expiration date&attach photocopy of license(s). Home Improvement Contractor Affidavit Above-Ground pools No license required. Any pool equal to or greater than 2' deep, or a minimum of 250 sq. ft. (18' diameter for round),needs a building permit. NOTE: INGROUND POOLS MUST BE FENCED WITH A 4' HIGH,NON-CLIMBABLE FENCE WITH A SELF-CLOSING,SELF-LATCHING GATE. FISH PONDS: Any pond or pool equal to or more than 24"deep MUST BE FENCED WITH A MINIMUM 41,NON- CLIMBABLE FENCE WITH A SELF-LATCHING GATE q-fortm:permits l rev.04/25/00 J Engineering Dept.(3rd floor) Map Parcel_ �" Permit# House# S� • � Date Issued mAff �i Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) — ? Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 16 �tME r 19 . MRNMBLE. �TFD Mpi a��g TOWN OF BARNSTABLE Buildink'Permit Application Project Street Address r?,S` ='LIp�j� [ tq- 11 DO L a Village, Qjw bT 00A ' ;-:4. Owner -el -e. �[�.1't'. Address 9^M f Telephone % a yl�to ,�I`�C/ jj Permit Request -71 PU �OA) 0Ll k �La T ��rAq��-- rAT ,CA square feet Second Floor square feet Construction Type ) Estimated Project Cost $ 01000. 00 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑Noa. Dwelling Type: Single Family 5d Two Family ❑ Multi-Family(#units) Age of Existing Structure S Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: 1(Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1144 ak i=i Number of Baths: Full: Existing _ New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing eg- New First Floor Room Count Heat Type and Fuel: ❑Gas ] 'Oil ❑Electric ❑Other Central Air ❑Yes 4rNo Fireplaces: Existing I_New Existing wood/coal stove [&'Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None ❑Shed(size) JD ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name U-)Jb -cc Telephone Number Address License# Home Improvement Contractor# - Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO alt SIGNATURE DATE lD BUILDING PERMIT ENIED FOR THE FOLLOWING REASON(S) " FOR OFFICIAL USE ONLY i i PERMIT NO. O ' DATE ISSUED MAP/PARCEL NO. t. ADDRESS VILLAGE '. j OWNER a DATE OF INSPECTION,: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH }, —FIN AL GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT " . � 1 ASSOCIATION PLAN NO. _ A Dcpurtnrcrrt of Industrial Accidents 011tceallavestfgatloas 60(1 liirchia'tl;tnn Strect 4i•` 'i`= Bostltn.Mms. (12111 MS26on Insurance Affidavit �-'- Workers' Comp ----. name t_ location5us1d��_ 1 am a homeowner performing all work myself. Q I am a sole,proprietor and have no one working in any capacityR �__�,_ L..ter... I am an emplover providing workers' compensation for my employees working on this job. comniny E a ldr en nhone#• insnrstnc co lieu JY I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: " :r - cnmrinny name, atidre ttn phone b: policy iY insurance en -..r- -==�-�--g•� -�- —� __ � _. . _. ,.cn •ewes---+_'r• �cT«c. -.ram--.�s.�-ti-n`•.r�'""'ri " - - ..:..:i rnm an•name• addre s• rip phone fly policy 0 i %urnn c _ Attach additional sheet if necessa i4= t ^:}•r.iPRa<re�f :•a:.�. p .• ...r..v. ��+�� �,_q� J� `wr� Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 andru, oneyears'imprisonment as.well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that cop%-of this statement may be forwarded to the Office of Investigations of the DIA for coverage verificatiou. 1 do hereb certifi•J(nd• tlJe pains and penalties of pedur►•that the information prorided above is true and comet i Si_anaturc iAA Date I o Print name i in Phone# 'official use only do not write in this area to be completed by city or town official ' permit/license 0 riBuilding Department cite or town: C3uccnsing Board Selectmen's Meecheck if.immediate response is required C311ealth Department phoneW: nOther contact person: .a cn+ucd i.•15 PJAI r ='4 - information and Instructions . Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation.for employees. As quoted from the "la++",an emplimee is defined as even,person in the service of another under an% contract of hire, express or implied, oral or written. An ernplurer is defined as an individual. partnership, association. corporation or other legal entity, or any two or r the foreaoin�_enuaged 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. Howeve _ owner of a dwelling_ house haying not more than three apartments and who resides therein, or the occupant of the dwc1ling house of another who employs persons to do maintenance, construction or repair work on such dwelling_ or on the arounds or building appurtenant thereto shall not because of such employment be deemed to be an empic MGL chapter 152 section 25 also states that even•state or local licensing ngency shall withhold the issuance of renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant++•ho 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 chaps, been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation ar supplying company names. address and phone numbers 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. Tite affidavit should be returned to the city or town that,thp application for the permit or license is being requested. not the Department of Industrial Accidents. Should ydtt have any questions regarding the `law"or if you are requi to obtain a workers' compensation policy, please call the Department at the number listed below. Cin• or,ro++•ns . and printed legibly. The Department has provided a space at the bottotr Please be sure that the affidavit is complete p � p p p the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne 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 quest, 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 fit i LA r i % c Uzi i, � I. cw � - ,^E t The Town of Barnstable U �' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing our owner occupied building containing residence or buast one ulding be done by t not more than (registered Icongractors with units or to structures which are adjacent to s certain exceptions,along with other requirements. Type of Work: Est.Cost Address of Work: Owner's Name Date of Permit Application: 4 ' I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. wilding not owner-occupied — Owner pulling own permit Notice is hereby given that: WffH gEGySTERED OWNERS PULLINGFOR THEIR �LICABI E HOME MOROVEMENTERMIT OR G WORK DO NOT HAVE CONTRACTORS FO 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. Contractor Name Registration No. .Date c OR _ o ID A--re 16 , g� • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION - Number Street ad ess Section of town "HOMEOWNER" Name Home phone Work phone - PRESENT 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj 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 Officia= 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 Stat Building Code and other applicable codes, by-laws, 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 comp y with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be to comply with State Building Code Section 127. 0, ConstructionControlquired t F HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which abuilding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Ownez shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner- actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, mar. communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. 14. O� LOT 25 - LOT ,23 5A / / POOL p,�i SHED / o K ' w_ PATIOs HSE. #75 4.3 0 /G a / CD LC'T 24 CD AREA- 0,160-:1-S. F. c-a A. \ I.= � zo j / COTUIT `0�, T FURTOXG WA Y a o LOT 23 LO 7' 'L'S OLDNI LOCUS MAP U' POOL, \ CB 1 SHED -�Y PLAN REF 26814 RES. ZONE.- "RF" v PATIO ' FLOOD ZONE.- "C" IV ASSESSORS MAP 22 HSE, (75 14 0 (77% 6 PLO PLAN OF LAND \ i LOCH TED IN- "O T UIT 4IA. PRI-7 RED FOR. JOHN & MIS HELLE ROJEE LOT 24 SEPTEMBER 30, 1996 AREA 20,160_f S. F. \ \ c9. Y � GRAPHIC SCALE --4(l V 20 0 10 20 40 80 {ii I�_/rw�� AV ( IN FEET ) 1 inch 20 ft. I YANKE'E' SURVEY CONSULTANTS i' UNIT 1, 40 INDUSTRY ROAD ! I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE P. 0. BOX 265 IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL MARSTONS MILLS, MASS. 0,2648 STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN TEL: 428--- 0055 FAX 420-5553 � THE MONW'EALTH OF MASSACHUSETTS. 01 ALAA. MERITHEW, P.L.S. DA T ,1#51060 GM