HomeMy WebLinkAbout0059 LOVELL'S ROAD �ti• r�
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Bowers Edwin �✓
From: Paul Rhude <prhude@cotuitfire.org>
Sent: Friday, March 16, 2018 2:41 PM
To: Bowers, Edwin
Subject: Inspection
�5. Lovells Rd
'
4.Cotuit;MA 02635_
United States
Passed fire inspection 3/16/18
Paul Rhude
Chief Cotuit Fire
(508)274-6086 cell
(508)428-2210 -
prhude@cotuitfire.or
1
' T own of„Barnstable
200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: TB-17-2779 Date Recieved: 8/14/2017
Job Location: 59 LOVELL'S ROAD,COTUIT -
Permit For: Building-Sheet Metal-Residential
Contractor's Name: Balanced Hvac Inc State Lic. No: 143
Address: . 1.5 JAN SEBASTIAN DRIVE, SANDWICH, Applicant Phone: (608)428-0974
MA 02563 t
(Home)Owner's Name: COOPER,STEPHEN Phone: (774)238-6802
(Home)Owner s Address: 59 LOVELL S ROAD, COTUIT,MA 02635
Work Description: replacement of existing hvac system with bryant 96% efficient furnace and ac condenser and pflow:cccoil.
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rn
Total Value Of Work To Be Performed: $7,950.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this:application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and gants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Lincoln Stubbs 8/14/2017 (508)428-0474
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $7,950.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: .$85.00 8/14/2017 $85.00 X)M-XXXX-XXXX- Credit Card
0446
Total Permit Fee Paid: $85.00
tCa 132•-1q-y V7 T
TOWN OFf ARN,5TABLE BUILDING PERMIT APPLICATION
Parcel A lication # Iff
�iealth Division Date'Issued
Conservation Division Application Fee
Planning Dept. Permit fees /-j _ d
Date Definitive Plan Approved by Planning Board -em -
Historic - OKH _ Preservation / Hyannis <:
Project(Street Address L a ye llS 11-0'()-
-- _ "
�1 I
Village I—TU:?`
Owner- Address
Telephone 11 - 235it _t1o80,;Z
Permit:Request � �%7"!&,/,"g 0-1 pk�� �� 0.,- -&(S he.d` 5,0 1 ee 910 1"C (VS&
er
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project'Valuatiorol D, 00 Construction Type
BUILDING UB. T.
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) JAN 18 2017
Age of Existing Structure fct Historic House: ❑Yes No On Old Kins;High� y,A!S]�Yes_Elo
Basement Type: Full ❑ Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new _Z 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: XYes ❑ No Fireplaces: Existing 0 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)
Names e hem Telephone,Number 77-'1' -02,3S'Z9b--2
Address �oY'e§-s .+C License#
&k;4 IyA- oa Home Improvement Contractor#
E ail-Cc epdogo2- 0 qzm/' , Co-,P41 Worker's Compensation #
Yl cifALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DA E
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s ' FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
MAP/ PARCEL NO.
ADDRESS VILLAGE
(SCNNER
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DATE OF INSPECTION:
N" FOUNDATION
FRAME
INSULATION gr-011-1)
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FIREPLACE
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i ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
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FINAL BUILDING
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c DATE CLOSED OUT
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ASSOCIATION PLAN NO.
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fine up to$L50D OQ andfor one••yearsmpr isagmenk as weal as civil peua16es in the fozm of a STOOP WORK ORDERand a rme
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A WC Guide to Wood Construction in High Wind Ar�eas. 110 mph.Wind Zone
Massachusetts Checklist for CompHanke(780 ChIR 5301.11.1)'
Check
1.1 SCOPE Compliance
Wind Speed(3-sec.gust).
................110 mph
WindExposure Category....................................................................................................I......................B
1.2 APPLICABILITY
Number of Stories ........................................................... (Fig 2)............................ stories; :5 2 stories
RoofPitch .........................................................................(Fig 2)................ 5 12:12
MeanRoof Height ............................................................(Fig 2)_........._..._.....:.--------- ft 533'
BuildingWidth,W.............................................................(Fig 3)......................................I......
BuildingLength,L ..............................................................(Fig 3)...............................................—ft S80,
Building Aspect Ratio(L/W) ......*.......*....(Fig 4)................................................ 5 3:1
Nominal Height of Tallest Opening? ....................................(Fig 4)................................................_5 6'8*
1.3 FRAMING CONNECTIONS
General compliance with framing connections....................(Table 2)...............................................................
2.1 FOUNDATION
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete.
ConcreteMasonry...................................................................................................................................
2.2 ANCHORAGE TO FOUNDATION"
5/8'Anchor Baits imbedded or 5/8'Proprietary Mechanical Anchors as an alternative In concrete only
Bolt Spacing-general..........................................(Table 4)..............................................- in.
Bolt Spacing from endrjolnt of plate ............................(Fig 5).................*...***** in.!;6"-12"
Bolt Embedment—concrete.........................................(Fig 5)................................................. in.;-*r
Bolt Embedment-masonry.........................................(Fig 5).....................I..................... in.a 15"
PlateWasher...............................................................(Fig 5).................................................2t 3-x 3-x V4-
3.1 FLOORS
Floor framing member spans checked (per 780 CMR Chapter 55)....:...............................
Maximum Floor Opening Dimension.................................�.(Fig 6)............................_ft:5 12'or L.12 or W/2
Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..................................
Maximum Floor Joist Setbacks
Supporting Loadbearing Walls or Shearwall................(Fig 7).................................................... ft :5d
Maximum Cantilevered Floor Joists —
Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... ft 5d
Floor Bracing at Endwalls......................r
....................... (Fig 9)...................................................
Floor Sheathing Type ........................................................(per T80 CMR Chapter 55)......*.........................
Floor Sheathing Thickness.................................................(per 780 CMR Chapter 55)....................... in.
Floor Sheathing Fastening..................................................(Table 2).._d nails at—in edge in field
4.1 WALLS
Wall Height
Loadbearing walls.................................... .............(Flgi 10 and Table 5).........-*...........—ft 5 1.01
Non-Loadbearing walls................................................(Fig 10 and Table 5)...........................—� ft --5 20'
Wall Stud Spacing ........................................................(Fig 10 and Table 5)...................—in.-,q 24'o.c.
Wall Story Offsets ..................... ..........(Figs 7&8)......................................... It 5 d
4.2 EXTERIOR WALLS'
Wood Studs
Loadbearihg walls.......................................................(Table 5)..............................2x ft in.
Non-Loadbearing wails................................................(Table 5).............................. It in.
Gable End Wait Bracing'
Full Height Endwall Studs............................................(Fig 10).................................... ................
WSP Attic Floor Length ...(Fig 11)........................................ ft 2W/3
Gypsum Ceiling Length(if WSP not used)...................(Fig 11)............................................—ft 2:0.9w
2 x 4 Continuous Later-at Brace @ 6 ft.o.c...(Fig 11).............I..............................................
Double Top Plate
Splice Length ........................................................(Fig 13 and Table 6)..................................... it
Splice Connection(no.of 16d common nails)..............(Table 6).....................................................
AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone
Massachusetts Checklist for Compliance(780 CAMR 5301.2.1.1)t '
Loadbearing Wall Connections
Lateral(no.of endnafled 16d common nails)..._.........{Table 7)........................................................
Non-Loadbearing Wall Connections —
Lateral(no.ofendnailed 16d common nails).-_........:..(Table 8).....................................................
Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
Header Spans ...................................................:...(fable 9).................................. ft_in.511' _
Sill Plate Spans ..................................................(Table 9)................................_ft_in.511' _
Full Height Studs (no.of studs)................................(Table 9)..................................... ..... ..... _
Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
HeaderSpa ns.............._.............................................(Table 9)................................. ft_in.512' _
Sill Plate Spans....................:.......................................
(Table 9)............................... ft in.512'
Full Height Studs(no.of studs)........ ........ .............. ....(Table 9).................................................. ....
Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV '—
Minimum Building Dimension,W
Nominal Height of Tallest OpeningZ .................................... _
Sheathing T
Edge Nail Spacing.........................................(fable 10 or note 4 if less)........................ in.
Field Nail Spacing.........._..............................(Table 10)................................................. in.
Shear Connection(no.,of 16d common nails)(Table 10)........................................................
Percent Full-Height Sheathing........................(Table 10)_.................................................. %
5%Additional Sheathing for Wall with Opening>67(Design Concepts)..................... —
Maximum Building Dimension,L
Nominal Height of Tallest Opening2.....
............................................................_5 6'8' _
Sheathing Type...............................
._......._..(note 4)......................................................
Edge Nail Spacing...................._...................(Table 11 or note 4 if less)....................... in. _
Field Nail Spacing..........................................(Table 11)................................................. In.
Shear Connection(no,of 16d common nails)(Table 11)........................................................ r —_
Percent Full-Height Sheathing..............:........(Table 11)............................._...................._% _
5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).............. ...
Wail Cladding —
Ratedfor Wind Speed?.....................:........................................ ........................................._.....................
5.1 ROOFS
Roof framing member spans checked?..............._......(For Rafters use AWC Span Tool,see BBRS Website) _ -
Roof Overhang .................................................. (Figure 19)............. ft 5 smaller of 2'or L13
Truss or Rafter Connections at Loadbearing Walls
Proprietary Connectors
Uplift................................................(Table 12)............................................U= plf —
Lateral.............................................(Table 12).............................................L= Of _
Shear. (Table 12).............................................S= ptf _
Ridge Strap Connections,If collar ties not used per page 21.....(Table 13). ............................T= plf _
Gable.Rake Outlpoker................................. . (Figure 20)............ _ft 5 smaller of 2'or U2
Truss or Rafter Connections at Non-Loadbearing Walls —
Proprietary Connectors
Uplift................................................(Table 14).............._............................U= 16.
Lateral(no.of 16d common nails)...(fable 14)................................ ......L= lb. _
Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59)..................
Roof Sheathing Thickness....................................................
...................................._in.a 7/16'WSP —
Roof Sheathing Fastening..........................................(Table 2)........._ .. ....
Notes: ........................_..._....—
1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of
780 CMR 53012-1.1 Item 1.If the checklist is met in its entirety then the following metal straps and hold downs are not
required per ft WFCM 110 mph Guide:
a. Steel Straps per Figure 5
b. 20 Gage Straps per Figure 11
C. Uplift Straps per Figure 14
d. All Straps per Figure 17
e. Comer Stud Hold Downs per Figure 18a.
2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing
requirements shown in Tables 10 and 11.
3. The bottom sill plate in exterior walls shall be a,minimum 2•in.nominal thickness.pressure treated#2-grade.
r• AWC Guide to VOod Corrsfrucbio17 in F,t�h kP-u idArmtr<c-
_ IZD 11 F:PTF;xdZOaze
• Massa chus eta CheckHst for Cc mpam de pa rmi:R s �in i :i)r
gg • -
mot- -
m From Tables 1[t and 11 and locafim of WaU string and Building Aspectf2adia,determine Perc r7t Furl HHelght
Sheaf*g and Nail Spackig req*wmints -
b_ Wood Shialt ial Panels sW be mc*=thicknew of 7116'and be irked as fotlm-rc - -
L Panels WmU be instal♦ed VA s erigfh ass pars of to studs- ;
ii. 146 horimifial joints shall ar ewer and be nailed to fftn
a'L On single scaly mnsfruc5an,panels shall be afmched b bafinm plates and tnp.inember DFf a double
---------_._.--- ---JV Dn ivm.-.dn7�n + ten.-upperPmm-s.shaIIbe a"-dhed fiaAhe top membarDMa.tipper double top-- ----
plale and b band joist at bottom of panaL Upper affaci rant of lower pan'51 shag be made in band joist
and lowaraffac: m rt made to lowest plats at first fi6arframing.
v. Hoiimrtfa[nail spacing at double fop proles, band joists,and glides shalf-be a double raw of 6d .
staggered at 3 inches on center pEir figures below:VmIcal and Harimnfal Nor ing inr Panel Affachment
S. Glazing part a.)Tiew house or ficemnfat addMon—required if prnjert' ;i ram or closer'tg shore(genargy.south of
Rfe_23 or norM of lam.6)
b)verfir l addition—riot regLdfed rriless them b edixisive rarmatim fn Ihe first floor
rr)replaces nertiMdows—needs energy conservation camphoric;only(chap 93)
rL Wood Frame Cortsbu CHDn Manual(WFCM}for 1 ill MPH, lxpostnm-B may be obtained from the Amedctj Wood Council
(AWC)vim. V
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Town of Barnstable
_ Regulatory Services
dF try , Richard V.Scali, Director
Building Division
""'""'—�► « Paul Roma,Building Commissioner
��� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.maus
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: 1/q17 a^c&. /9� ', -RO / Q
JOB LOCATION: J / Zo yy,1`S /\OGi
number street village
_HOMEOWNER"a�"en s 7 7y-a 39-l 80-2 775/-3 8' eO.Z
nante q home phone# work phone#
'
CURRENT MAILING-ADDRESS: 3 / /B"l eks f d
O�Uil / fi-- O-a 3
cityhown state yip code
.The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A .
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum ' ction pro es and requirements and that he/she will comply with said procedures and
requireme
Sign f moo r
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 toL 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 to amend
and adopt such a form/certification for use in your community.
Town of Barnstable -
Regulatory Services
` s .PJAW ` Richard V.Scab,Director.
1"9.� Building Division
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.maus
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must 1
Complete and Sign This Section
If Using A Builder
L ,as Owner of the subject property
hereby authorize to act on my behalf
in all matters relative to work authorized by this building permit application for.
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final .
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
QTORMS:OWNERPERMISSIONPOOLS
t
EXISTING FIRST FLOOR PLAN SCALE 1/4"= 11
-1l 011
Gross Moor Area = 1288 Sq. Ft,
PROPOSED UPPER LEVEL FLOOR
FLAN SCALE 1/4"= 11-0"
Gross Floor Area = 775 So. Ft.
59 Lovell's Road
Cotait, MA 02635 m
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co
Map 025 Cr
CIO
Block 019 ® �+
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Lot 001
o
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Im �.
Uaper t® Lower Level patio:
Gross area - Lower Level i 1288 Sq. Ft.
" - Upper Level 775 Sq. Ft.
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775 = 60% - Ratio of proposed coverage
. 1288
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Shea, Sally
From: Shea, Sally
Sent: Wednesday,January 25, 2017 10:07 AM
To: coopdog24@gmail.com'
Subject: Permit/Application:TB-17-1.18 at 59 LOVELL'S ROAD, COTUIT for Building -Alteration
INTERIOR Work Only- Residential
Dear Mr. Cooper,
After reviewing your proposal, it.appears a dormer is being added. This must be included in your
permit description of work. As a result of your proposal you will also need to supply an engineered set
of elevations along with the gross floor area. .This is important as we must ensure this proposal
complies with the zoning.ordinance 240-13/14.
Sally Shea
Town of Barnstable
Assistant Zoning Admin/Lead Permit Tech.
508-862-4031
t
1 •
I ,
Shea, Sally
From: Shea, Sally
Sent: Wednesday,January 25,`2017 10:07 AM
To: .coopdog24@gmail.com'
Subject: Permit/Application:TB-17-118 at 59 LOVELL'S ROAD, COTUIT for Building -Alteration
INTERIOR Work Only- Residential
Dear Mr. Cooper,
After reviewing your proposal, it appears a dormer is being added. This must be included in your
permit description of work. As a result of your proposal you will also need to supply an engineered set
of elevations along with the gross floor area. This is important as we must ensure this proposal
complies with the zoning ordinance 240-13/14.
Sally Shea
Town of Barnstable •
P �
'Assistant Zoning Admin/Lead Permit Tech.
508-862-4031
,y
—'is � • -
1
Town of Barnstable *Permit# / 7
Tres 6 months from issue datJ
Regulatory Servicesee s
L snxivSrABLE.
Mass. $ . . Richard V.Scali,Director
Building Division Paul Roma,Building Commissioner MAR 17 2017
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us PONYN 01 A501 , I�
Office: 508-862-4038 Fax: 50 -
EXPRESS PERMIT APPLICATION - ,RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 0 2s/�j q
Property Address
❑Residential Value of Work$ 600 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 4 gn 49opo-r
144
Contractor's Name Telephone Number 771- 02 M o gG;
Home Improvement Contractor License#(if applicable) ~ Email: Do qcq 62 mct i�, com
Construction Supervisor's License#,(if applicable)4
❑Workman's Compensation Insurance:
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy# -
Copy of Insurance Compliance Certificate must accompany each,permit. "
Permit Request(check box) (
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to;�t/hs7�ci6� Xr,",S; i
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Wind_ows/doors/sliders..U-Value (maximum.32)#of windows
#of doors:
*Where required:Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: PropeS Owner must sign Property Owner Letter of Permission.
A c of the Home Improvement Contractors License&Construction Supervisors License is.
SIGNATURE:
QAWPFILESTORMS\building permit forms\EXPRESS.doc
01/25/17
Y
YIe tVDl3IwOIT veakh of Maysadi
Deparfaeut aflud-usftialAccidentr
600 Wash* ii Ells Pt
_ Boston,M4 02111
tVFn-v—vias&gaVMa
Wbrke& Cump2IISatmn Insurance Affidavit BuRdel--/C;on&actGrsMectriciSIIs/Phun ers
AppVc.-I i lufa matinII Please Print y.
'Nam U6M.- ant i3-xoltina ��(/c�li✓c-�
Addx o 1=Qve((s
phone�- ^,23 8' l 00 �itgf��tel ►
Axe you an employer?:Chee:kthe appropriate bow Type of project(required)—
I.❑ I am a employes wrth. 4. ❑I am a feral contractor and I 6. ❑Ides c on
employees(fall andfor par�fiitne)* havehired.the subLcuss
2.❑ I am a sale proprietm orpartuer- Tisted on.the attached sheet I`- ❑Remodeling.
ship and have no employees . , These sub-contractors have $. [:]Demolition
*odring far mein any employees and bane wodcers- -
[No wodmr 'Comp,fine ance CO P-imsuranc l 9..❑B,uildiag addifiou .
r I 5. ❑ We are a corpomfli .and its 10.❑Electrical repairs or additions
officers have exercised
1L
3X- 1 am a fiomeoumer do' all work Plumbed repairs or additions
ma s [No workers,camp_ of a man3pfion per MGL L_❑EI Roofr xirs
lr p
tF+celra,7t:P Iel�II11•Ed.]1 E
c.M §1{4h and we have no
employees.[No worms' 1�_❑dtherC
cam-msarance mquir ] a
'AayappHc=&steledsbosisl— almM out the section below dwving their wakes'compeasabaupoRgjrinffi=*ioL T
Smnemaerswba submit drir.affidavA i g&ey ate&ing allvra t Sn&dunhire outsidecomt artarss st salrmit anEW affidavit mdicabng Q,rfi
ICaut>acinas that check this b=mast sttnrly sa addili®al sheet sb=ing theasme of the add state whether or not those ea¢tiesl�e
employees.I€theavb-caa=u±oeshace employees,ifiey=stgxuviaer1e1r tisoaEes imp.golicg aumisez _ i
I am an ellipIayar fliatis prauidiltg il�ariiers'calrtlrertsaiialt ittsrirare cs�ar est}a P 3�e Beloev is thepa cy curd jell site
infarmalian. .
Insurance Company i'fame:
Policy-4'or Self-ins-Zic. _ § Expiration Date:
Job Rte Address: Cityl5tabuzip:
Attach a-mpf of the workers'compensationpolicf declaration page(she viug the policy number and expiration date).
Failure to securer coverage as required under Section 25A of MOL m 157 can lead to the imposition of criminal penalties of a
fine up to$UOD 00 and/or odeyearimptisonme nk as Well as civil penalties in Ste form of a STOP WORK ORDEiand a frr
of upto$250-00 a day against the violator_ Be a hised that a copy of this statement maybe fe warded fn the Office of
luvestigafic=ofthe DIA for insurance coverage verification-
Ida[WrRby eerbfy s andpsrral zs o, perjury tbattfis ilafbnaaff=prie*i&dabmv Z;bus and correct ;
Sionature: Date: 3/7" /
021cial um agy. Dap net wrRe in ffd3amae to be cmnpTeted by city artown qj0Zc&1
City or Town: PerndtUeense;9
Lwaing Auf1arity(drde one):
L Board of ReAM M g De tart meat 3.C dyMawn Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phi 9-
6
Laformation and 11astrueflous
M=s,arhmtcctfs Ge-n=alLEWS Cf38ter M requires all employeas to Irm&worfs'campensaf on fortheir employees.
P�-tD'E= ,an�Ioym is dcfm!ed as-¢.everyprasonin ffie s�vicc of under MY co�xact ofhne, ,
express or finpliocl,oral or Wrh=L"
c
�Tayer is defined as"an indrvid334 partnership,assocmizon,anporaion or other legal eutdy,or=7 two or more
A33.of�foregoing=gaged is a joint else,anal mclndmg the legal represeo�ves of a deceased emplayer,or fl=
rmeivr r or trustee of an in�al,partnership,associefion or other legal entity,employing effiployees. However the
owner of a.dweIl>ng house having not mare tbEm three apa dmenbg and who resides&=io,or the occupant ofthe -
dwelling house of ano&r who employs persons to do mainfe�ce,rr,nefmrr;on or repair Work.am such dwelling house
or on the grounds or bm"Idmg appurieaant$hereto shall not because of sash eurplopment be,deemed in be an employer."
MC3L chapter 152,§25C(6)also states that"every staff or local licensing agency shall withhold fhe issuance or
of a Beams.or ermittoo operate a business ofta construct buildings in the commonwealth for any
reaewat P P "
licant Who has not produced acceptable evidence of cdmpfian.ce with ins
urance..surance.coverage requirrecL
aPp the nor ' of its poIftcal subdivisions shall
AddildonaIly,MCsI.chapter I52,§25C(7}states�Feifher _ �Y
- Ie evidence of c ligacewith the m=znc;6..
Iic wozicu�il �P
enter m� any contract far the perfmman.c�ofpub �� .
efs of this chaptea have been presented to the contrardng M3fao3iiy:-
App4ca rb ,
leas' eusation affidavit completely.by checking the bones•(hat apply to your sift aiion and,if
oaf tee wo mP _
Please fiII comp
nmessaiL Supply sob-contracfor(s)name(s), addresses)and ph=mzmber(s) along with thew•certdacate(s)of
ice. Limited Lia1 MLY Companies(LLC)or Limited Liability Parfnessbips(LIP)withno employees other than the
mrrtjj>=or pis,are not requirmd to cry viorkc&campensafim insu a c-e- If an LLC or LT P does have
employees,apolicyisrequired. Be advised fast this affidayrtmaybesubmittedto the,Department of Indusfrial
Accidents for conEam afion of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to!he city or town laat the application for the permit or license is being regaeshA not the Department of
Tnrinsfrtal Accid.=tL Shouldyouhave nay questions regrading the law orifyon are to obtain a wogs
comp=sa±i .policy,please call tb a Deparimeut at the nmabea hstnd below. Self-insured companies onId enter their
sh
s elf-i i==ce license number on the appropriate line.
City or Town.Of
f -
Please be sine that the a$idavrtis complete andpritedlegibly. TheDepartmenthas provided a space a±fficbDtt=
of the affidavk for you to fill but in the event the Office ofluvmfgaiions has to contact yoaregmTUng the applicant:
Please be sm:a to fill in the pem rd ceuse rnnnber which will be used as a reface m=bea: In.addition,an applicant
fiat must submit m-ulfrple pemllicense appHzmfions in any given year,need only submit one affidavit 7ndic�g cunmt
policy infomzatibn(ff nwzssaiy)and uadea`Job Site Add rc+ the applicant should write"aII locations nr (ciLY
town)_$A copy of the-affidavit that has been officiany stamped or marked by the city or tovM maybe Provided to the -
applicant as proof faat a valid affidavit is on file for fine permits or licenses_ Anew affidavit must be filled out Cash.
year.Where a home owner or citizen is obtaining a license or peunitnot related in any business or commeaeial
Cie.a dog license or perm t to bum leaves etc_)said person.is NOT required to complete this affidavit
The Of of Invesfigations wouldhIm to taank you.m advance for your coopwt im and should you.have any goes ions,
please do not:hesiia±r.to give us a M L
The De Ran euf s.address,telephone and fax cumber:
tip of MASSRCh . -
_ Dew�flzidakA�+✓nt�
Of of IuVe&tgMtio=
6DG woman -- - - .
Ta 4 617 -4900 e�E 06 or 1477 MA'AM
Fax ff 617`27 7749
Revised 4.24-07
Ez
�"E Town of Barnstable
Regulatory Services
MAM • Richard V.Scali,Director -
wua Building Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
J. 4�. 7
f
Property�Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf'
in all matters relative to work authorized by this building permit application for:
(Address of Job)
**Pool fences and alarm are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
Signature-of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORMS:OWMMPEDMSIONPOOLS
Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
RAFJQrrAJ= = Paul Roma,Building Commissioner
MASS
��� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION.
J^� Please Print
DATE: 3^17—/ /q
4 JOB LOCATION: -S/ LD f/�/�S 0 t
number street village
"HOMEOWNER" / el 7 -.2 8=6 f)
nalne e�ly home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-ocMied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersi "h wner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
procedure ents and that he/she will comply with said procedures and requirements.
Si a omeowner
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:\WPFILES\FORMS\building permit fomis\EXPRESS.doc
06/20/16
s.
t TOWN OF BARNSTABLE
CERTIFICATE OF OCCUPANCY
PARCEL' D' 025 b19 001 - GEOBASE ID 1382
ADDRESS 59 LOVELL'S ROAD PHONE
COTUIT ZIP
LOT PARC 6 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT CT
PERMIT 24850 DESCRIPTION SINGLE FAMILY DWELLING (PMT.420425)
PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY
CONTRACTO' S: Department of Health, Safety
ARCHITECT and Environmental Services
TOTAL FEES:
BOND $.00 px tNE
CONSTRUCTION COSTS $.00 i
d Qi►
756 CERTIFICATE OF OCCUPANCY
* BARNSTABLE. •
BIAS&
OWNER FAY, PAULA E TR 039•
ADDRESS LOVELLS RD TRUST FD MI�►I /
52 LOVELLS RD r y
COTUIT MA BUILD DI
BV"
DATE ISSUED 08/06/1997 EXPIRATION DATE "
. .� TOWN OF BAktNSTABLE .. .$w
}' ,. WILDING PERMIT �I
PARCEL ID,,O? yr 9 00i . UEOBASE ID 1882
ADDRESS 59 LOVELL'S RD PHONE '
. Cotu ZIP F
LOT PARC 6s BLOCK 'LOT SIZE
DBA DEVELOPMENT ' 'DISTRICT CT
PERMIT 20425 DESCRIPTION SINGLE FAMILY DWELLING (SEW.PMT.497-12)
' PERMIT- TYPE BUILD. TITLE NEW RESIDENTIAL BLDG .PMT
CONTRACTORS. FIRES, DONALD .J.. Department of Health, Safety
ARCxTR 5: - - and Environmental Services .
, TOTAL FEES: $372.00 OxTNE
BOND $.Oct ti
CONSTRUCTION CONS $1.20,000.00'
f
101 SINGLE 'FAM HOME DETACHED 1 PRIVATE P .r*):
MA85. `
.OWNER, . ,FAY, PAULA" & DIANE
ADDRESS 52 LOVEL L-S Rn
BUILDING DIVISION.-r
C:OTU I T,MA. BY
DATE ISSUED. 01,/08/1997 -,-EXPIRAT.ION DATE—"`
` l I;:�. '_. r4.�.�:,�il:,Lr; •�� •''"'~""�«.� `.\ire
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,'ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOTAREq'F)CALLY,P..ERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET,OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF= S -
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDAT QNS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION
I, PERMITS ARE REQUIRED,FOR
2. PRIOR T COVERING STRUCTURAL M MBERS. HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU-
(READYT• LATH). FANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH-
ANICAL INSTALLATIONS.
3.INSULATI N. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSRECTION BEFORE OCCUPANgY. ;*!°
,,OST THIS
CARD
O IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS 4 ELECTRICAL INSPECTION APPROVALS
r A
2 2 06
w, yY
/'G i �s-rdL��Gi�ce7 I
3 1 EATING INSPECTION APPROVALS ENGINEERING DEPARTMENTg
r .
f" 2 �,. ] BOARD
/A',F H H
OTHER: SITE PLAN REVIEW APPROVAL
WORK SHALLAIoT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
' .VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION.
0
BUILD ING
PERMIT
,
Y
s p
i
0
r, t
t +
A
P�acz 601�s ck 1 ' t i eve, CT &;,C--0 YhA(4. op L Ox TD &6 MAS Anti
Engineering Dept.(3rd floor) Map a is Parcel 00 , 001 Permit# 7— S
House#- r"JS ' Date Issued
Board of Health rd floor 8:15.-.9:30/1:00-4:30 7 �� O Fee '
c� )( )
Conservation Office(4th floor)(8:30- 9:30/1:00-2:00)7/ I pin
Planning Dept.(1st floor/School Admin. Bldg.) �- -
efinitive Plan Approved by Planning Board
PcL i/N)No 2U--6ots F0y,.c0 ,
O OF BARNSTABLE s
,, 74c,f/�' 44 fl f,7"� i � �o wilding Permit Ap` lication
UN
Project'Sitreet Address ,
Village
Owner >� Address
Telephone
n. Permit Request
first Floor ,%G�L/Q - square feet §econd Floor _ C OO square feet
Construction Type«...
,AFIstimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size 00rD Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl f2<Valkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No. of Bedrooms: Existing New --
Total Room Count(not including baths): Existing New First Floor Room Count__
Heat Type and Fuel: Bias ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
fB'�Lttached(size) jy f J Q !/Zt/®1�X_ ❑'Barn(size)
❑None ❑Shed(size)
❑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 Telephone Number
Address % ,q/1^r jn! L�✓ License# 6 Le
Home Improvement Contractor#
Worker's Compensation#_ JqA S �—pyKoz?
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
SIGNATURE _J/4 DATE / /-1?-9
.44
BUILDING PERMIT DENIlvn FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED `
MAP/PARCEL NO. .
ADDRESS VILLAGE
OWNER
•
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: UGH FINAL
PLUMBIN H FINAL
GAS: FINAL
y
FINAL BU r
DATE CLO r
ASSOCIATI(a, N
n^./'`1-tY..-•.-....i'•a ,_ *•+ti.-rw f ~' .... . r, • rb., - �'-� .. . s.:1•- .•a '' . r �,''•..A-I'�yv+.•,.-.-.-.'—•,r-.,,r_ r i
THE' o� ::_ M .y� The Town of Barnstable
l'
BARE.MASS. Department
P y
De artment of Health Safety and Environmental Services
i63 `0�
�E9. Building Division
367 Main Street,Hyannis, MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection RLVA
Location 1_3 i �R Permit Number ��-
Owner Builder {
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
_�Ayzu pc�ect�� -1,Q
Q-7
z cy 2 v rZ fib �5 I R�r&ns'
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JZ ro 5,j Ut,
Please call: 508-790-6227 for re-inspection.
1
Inspect by t
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SHEET NUMBER,
FRONT ELEVATION RIGHT ELEVATION n
FILE NAME-
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__j«pROOM fi OrKRCHEN/LOFT EATNG
STORAGE
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Public Health Division SHEET NUMBER,
'own of Barnstable
P.O.Box 534 G�
Hyannis, Massachusetts 02601 PILE MANE
96161A2
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BEAM DETAIL 5 GARAGE
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SHEET NUMBER.
FOUNDATION_PLAN
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SE TI IN
FILE NAME.
96161A-1
HEALTH
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The Commonwealth of Alassuchusctts
Dt.nartmurt oJludustrial.9ccidurts
office of/nves#9211ons -
'�\ 600 11'as(iinrton Street
Boston, A1a.vs: 02111
Workers' Compensation Insurance Affidavit
d
me A �� 1 1�-rz- ,
location
cite PhoneiJ ��� I�O
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working to any capacity
... vsrAv{% ?r• •'�, _ :. ..f++•.r-.5;;am.r.r�+.�,se�s,R-SR+�a� j4�I':�.,r,"`�t!r...n-^r gip;..-v�+�ae�y1T?v�.�a• M."'!-.*9k .s..nn.. .«-s,•.rF.
glTamian emplover•providing workers' compensation for my employees working on this•job.
Q �.
contp•tny name D'/�/FS
address: �r�,CY1r7N l !1�
city: Phone
insurance co.Z�51!p policy# ,S`�/�00
i- .. ... ._..�,�_ •,�„ .•.,,,,. ,.m�.r,yyy. ...�•,,.-....ar, n.. ry��Ji,'-f`k *x•�e;'4#Ee»-h.,..-+snrnw.r^x,.•�
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:
company name
address:
city: phone#:
insurance co Policy#
_ .... :rs:,. ..... ^, -^_r^-���. ^,ti-Pa•r,t rvn•.ra.�T. -_ __ �' " lirwi•+�Y14i�iYY1-'i'r:.Llx::'.:JY.
�_.�. _...__..._._...�.�...�.._•____ .. .�l_at'.�.��_.a.....�:� �. jai v.:�d - -a�::i�►.i6V1t:.Y.� •a_ - -i.
company name:
address:
city: Phone#:
insurance co policy#
:Attach additional sheet if tiecessaty ,: t':il:. ;= TO m�;t •..,.a^ °�'"':`t11"`�-
Failure to secure coverage as required under Sectionf25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NyORK ORDER and a fine of S100.00 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.
I do herehr cie ij trnd t ains and penalties of perjuty that the information provided above is true and correct.
mnature Date %97
r
tint name Phone#
rofficial use only do not write in this area to be completed by city or town official °
city or town: permit/license# rIBuilding Department
Licensing Board
Cj check if immediate response is required oSclectmeWs Office r.
ollealth Department
contact person: phone#; rlOthcr :-
., :ram. -..,:,,,r .,.-�,- ^—+^•ra---�-r� _ ,�.,.-�..+x. s,•.�,..,,.--,,.
Ire%ised 319>NA)
Information and Instructions is
Massachusetts Gencral Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an einpinree is defined as every person in the service of another undz:r anv
contract of hire, express or implied, oral or written.
An emp/nrer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the forcgoin�� ena��cd 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 dwellin�� house having not more than three apartments and who resides therein, or the occupant of the
dwellino 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 vvithhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the common-svealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionaliv, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested,
not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
777777e._ 77
.sy�..r. .,-. ••, •m,.•�t'"•,n-----�'.-.•-..•. .,.mn.•-""--.,..c
pm-
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits 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 `ive us a call.
y. a►..�e..t+w. ....,.... ....e......^v ;:... :r.+�. t'tWrvF 1•.a..:w+F.;�'•S+.1r. s,......,.l...rxmnx.,!..!+�xa.v,�l,;'ssf)r..4nro+rrne.�Sf!�.'e'-•6 aN" i'A,i•.RA�Tii,Tb?'iR:F.11'T'-.T,�;Y1'�',1'lW)T�..-tw�yyisy•
Tile Department's address., telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 NVashington Street
Boston, Ma. 02111 aA..
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
"---, _ ' lie �o7ivmo�eusea��.Q�,��caQaac✓zuavlt
�. DEPARTMENT OF PUBLIC SAFETY 4
3,y CONSTRUCTION SUPERVISOR LICENSE
Nuoer: Expires:
.
Restricted To: 00
v
DONALD J PINES f
SEUNENET RD
CENTERVILLE, MA 02632
L
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-1 P-O{R N}T- UPGRADE REChJ# #
IRED
,
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_ ,
Y - _ M KE DETER NG-CGUE' REQUIR6S THE UPGRADING OF
-- _._ ___ .__}_ I ORS FOR THE EN RE,DWELLING WHEN
,
- 3 . +-- - NE OR MOR SLEEPING AREAS ARE ADDEO,OR CREATED. .
Laundry Room
OT :A_9E ABATE PERMIT IS REQUIRED FOR THE 1
MSlALLl,,JIOP OFSMOKE DETECTORS; THE-ELECTRICAL-
1 ® IERI 01T DOES NOT!SATISFY THIS REQUIREMENT.I
_-
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. , F_ . —� - DKTOIRS
# Existing Heat Detector 1.' f ,
, # t
t A
I11 ° f P
IiC tFp
I # DATE
B. JiLD
. ti f
} } MTMC'NT DATE
_- DEP i
-_t - ., • } .+...
bOTH SIGNATURES ARE REQU RED FOR PERMITTING_'._
i t i �`
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MPOR `�aNT
- - _ _ --
+ _._ # I ' 1 I I i � Existing Heat Detector - -+ - - - --- —�1 i fVY N RUCTION THAT 1NC" ^� �.`, -.; 5
� I 1 Existing Heat Detector � #
EYO 0 200 SQ,-'FT PER LEVEL MAY RE�UIRt-Tklf -I
° i i
° � - - _
1 I i i I STAL N .OF ADDITIONAL SMOKE DET °�TQRS
OTE A EPARATE PERMI} SEC FOR TFIt
i.
I i i t i I STALLA ION OF;SMOKE DEI EC I U11S -'EL ,.#:r,!CAL
_ __# ._ _; _ _ w ` _ e_. __ Basement ERMIT D. ES•NOT SATISFY-THIS �.I
T- i- t F ¢ , REQUIREMENT, I 3
j
#
t
1 AS
a
' ! =5 Lo Road -
►4- -t r4
9 yell'
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oturt, MA 02635 ,
Map 025
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_ _ _
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I I i # ( i Existing- ( _ �� _ ng Basement
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Bedroom
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( Road �-
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-- - -- Lot 001
� ,i�..._:�-
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I '' First o
k }}
T
,
9
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t �q t r6. q. s, i
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4
Existing double window to be removed,n apart - as(2)
Make and re installed i
}. � �. .... _ _ �_�. . ..-- -- - - �— ` -- separate windows in new Master Bedroom
,
+ j
- - - - - �`
{{ 1
Unfmished Area
_ _• _
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� Existing Smoke/CO.Combo
Existm
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_. Existing Window I
i
-
Below �� ll'S
�. - open to° {_' 59 Love Road .
C 02
b �' � �`l� ��~, 1 . � � OtUlt, MA
Map 025
I � � Block 019 �
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t Existing Second Floor
1 T ;
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1 _
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t
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-�- • --�° ster Bedroom
{ t
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` ad out existing 2x4 walls
°
to 5 ''/2 .All walls to have
R-21 Fiberglass insulation
t
14
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R-38 Fiberglas
insulation
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vell'
Lo Road
><t, MA
Cotu' 02635 ,
4 - t. ._ Map w �
025
Storage Storage Block_ — St r l0 019
t - Lot 001
t
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_
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New Second Floor.
i
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—
t #
New les Roof Shin Asphalt , i
p g _
Ridge
- - I Existing2 x12
Remove existing 2x10 Rafters and re use
on new 2x6 exterior wall
'
t a
— New Hardi-Plank clapboard
17
t ,
_
New 2x6 Exterior wall.
New 2x -
8 ceiling joists '
_ x ;
- + _.__Existing Rafters I_ 1 __
t
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( 111 t
--`- Existing 5f F or 1
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17 1
59 Lovell's Road _
f
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025
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