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1391 MAIN STREET (COTUIT)
� 3 q l I�a; Y, S$, �....^__ _ . r _ � . J .. �. �* � � i • D { e .. � [� a `r � � - ., 1 c � r n h .. m k 1 . 0 -- .:452S O� tttE Application umber... ....... .. .... ....Fee...........: ............................................................ AUG 0.8 2019 Building Inspectors Initials...... s634. A� -OWN 1 n n N �1���� r) ' AHNS _ . (I�BL Date Issued..................... `. ......................... Map/Parcel........ .�:.� .............1., .1......... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 3 9Z XCf,/a �_5yt t3 � NUMBER STREET VILLAGE Owner's Name: ,�� ,�` ��lgy� Of//,LS Phone Number L, Email Address: Cell Phone Number�� 3�o — 60W 6 Project cost$ , Check one `Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize ' to make application for; uil ing vorat in accordance with 7 0 CMR ' Owner Signatur : F Date: TYPE OF WORK Siding Windows (no header change)# 0 Insulation/Weatherization a Doors(no,header;change)# Commercial Doors require an inspector's review ED Roof(not applying more than I layer of shingles) Construction Debris will be going to /� f CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone n ber ALL PROPERTIES THAT HAVE STRUCTURES OVE 5 YEARS OLD OR IF THE SUBJECT PROPERTY/S IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are, ubjiecit to a building official's approval prior to issuance. Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Construction ,Sii* 1 & 2 Family CSFA-077754 I ; Lat<{iires: 11%2212019 6fr1rk pi 'f y CAREY C GROVER PO BOX 1080 COTUIT MA 02635 Commissioner I �e�ooiirxaitusea/l�a�C/flaaebc�u�nl,/i - r Office of Consumer Affairs&Business Regulation �. ' HOME IMPROVEMENT CONTRACTOR I Registration valid for Individual use only TYPE.,Individual }• before the expiration date..If found retum to: Reoistratlad�. Ex lrp ation Office of Consumer Affairs and Business Regulation 144322 09/22/2020 I 1000 Washington Street-Suite 710 Boston,MA 02118 CAREY GROVER D/B/A GROVER BUILDING+.REMODELING fit: • CAREY C.GROVER, �;' S• � � I 56 BOW DOIN RD Not V 1 without signature r. MASHPEE,MA 02649 Undersecretary. 1 1 . ACOR O' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD"YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD T CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.if SUBROGATION IS WAIVED,subject to the terms and conditions .of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX ftvlied Risk Insurance Services, ,Inc. (A/C,No,Ext): _ (A/C.No): _ 10825 Old Mill Rd E-MAIL Omaha, N8 68154 ADDRESS: PRODUCER CUSTOMER ID# (877)234-4420 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Grover Building and Remodeling Inc. INSURER B: dba Grover Building and Remodeling Inc. INSURER C: 444 Poponessett Rd Cotuit, NA 02635-3216 INSURER D: INSURER E: CTL 1273 1474912 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YY MM/D LIMITS GENERAL LIABILITY - COMMERCIALGENERALLIABILITY ❑ a DAMAGEToRENTE $ DAMAGE TO RENTED CLAIMS PREMISES(Eaoauaence $ MADE OCCUR MED EXP An one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO ❑ ❑ (Ea accident) $ ALLOWNEDAUTOS BODILY INJURY Perperson) $ SCHEDULED AUTOS BODILY INJURY Per accident $ HIRED AUTOS PROPERTY DAMAGE (Per accidem $ NON-OWNEDAUTOS $ $ UMBRELLA LIABi OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ❑ ❑ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION . x WC STATU• OTH- AND EMPLOYERS'LIABILfLY Y/N R ER ANY PROPRIETOR/PARTNER/ A EXECUTIVEOFFICER/MEMBER N/A 46-805700-02-02 A8/31/2018 08/31i2olsE.L.EACH ACCIDENT $ 100,000 EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POucvuMlT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,If more space Is required) r CERTIFICATE HOLDER CANCELLATION Grover Building and PAmodelini; nw. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 444 Ppm1essett Rd EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH T dotvit, D01 02635-3216 HE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attn: Project 14mager ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 01968-2009 ACORD CORPORATION.All rights reserved. AQk The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations 600 Washington Street . Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plnmbers Applicant Information Please Print Legibly Name(Business/OrganizatimIndividual)• t Address: � � --- -- -------- - � City/State/Zip: • Phone#: Are yo n employer?Check the appropriate bog: Type of project(required): I.R2 lam a employer with- 4. 0 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. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for mein any capacity. -employees and have workers' 9. ❑Building addition [No workers'comp.ftmzrance comp.insurance.: , id.] 5. ❑ We are a corporation and its- 10.❑Electrical repairs or additions 3.❑ I am a homeowner do' all work officers have exercised their I L Plumb' mg ❑ mg repairs or additions myself:[No workers'comp. right of exemption per MGL . 12.❑Roof repairs insurance reguh.A]t c. 152,§1(4),and we have no, employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sbeet showing the name of the'sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employeeL Below is the policy and job site information. /� Insurance Company Name:. Cam' Policy#or Self-ins.Lie.#: 4/C rigry AV -OPZov?. Expiration Date:,, Job Site Address: /�(Gt��l 51 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine . of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u e pains fperjury that the information provided above is true and correct: Si tore: Date: �;�Ie Phone#• Of,jMd use only. Do not write in this area,to be complded by city or town ofi al City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk, 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person hi the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of The foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another,who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not bemuse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the'commonwealth for any applicant who has not prodaced'acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation iro mee. If an LLC or UP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sire to sign and date the affidavit. The affidavit should . be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which will be used as a reference number. In addition,an applicant brat must submit multiple•permit/license applications in any given year,need onl'y`submit one affidavit indicating current policy information(if_necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation.and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. , Commonwealth of MMasssskc i eiW Department of Industrial Atxidents Office of Invesupdons 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 east 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia I� C�� , � �-�� -- -- --_ ____m _� �_ C6� i- z T �2u � � �� TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION Map Parcel Permit# 3�7 Health Division r71- �� ©0 ---� Date Issued ®� Conservation Division Fee W. Tax Collector J& cc— hPP` ®Q Treasurer — 2 ' INSTALLIED 6 J CorpUANC Planning Dept. U IWTH TITLE i C. Date Definitive Plan Approved by Planning Board EIMRONMENTAL 000E ME Historic-OKH Preservation/Hyanni TOWN REGULA►nON3s ` Project Street Address fw�. 'V� Village Owner ,� `,�� :��979c;$ Address/ Telephone ,� � Permit Rgpuest ��' •�`�% ��� o �� � � Square feet: 1st floor: existing proposed v> d 2nd floor: existing proposed -�744A2 Total new Valuation &.2. J Zoning District Flood Plain � Groundwater Overlay W-. Construction Type —rt Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docur entatior� is Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) N Age of Existing Structure �' ' �' Historic House: ❑Yes o On Old King's Highway: ❑Yet o Basement Type: ❑ Full IrCrawl ❑Walkout ❑Other '`-) Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) / �� Mr— Number of Baths: Full: existing new Half: existing J Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing 7S new First Floor Room Count Heat Type and Fuel: Clas Oil ❑ Electric ❑Other Central Air: es ❑No Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes Detached garage:�existing �exi 'ng ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑new size Shed: ❑existing ❑new size Other: Ol� ljalZ".�g g ��� Zoning Board of AppealXAthh 'nation ❑ Appeal# Recorded❑ Commercial ❑Yes If p ,es site Ian review# Y Current Use Proposed Use BUILDER INFORMATION Name Telephone Number._ Address x 6y License# / 022 ZZ — 1, �35r Home Improvement Contractor# �/ /v� o1-1� Worker's Compensation# 6.5 016 a3��c� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1 SIGNATURE DATE r t FOR OFFICIAL USE ONLY PERMIT NO. r x �. DATE ISSUED MAP/PARCEL.NO. ' ADDRESS VILLAGE �' { t OWNER DATE OF INSPECTION t' 7 FOUNDATIONS FRAME D) — INSULATION i FIREPLACE C ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH ', i FINAL ' GAS: ROUGH , . ._ «- FINAL FINAL BUILDING to + � 0 . DATE CLOSED OUT '4 ASSOCIATION PLAN NO. 1 1 " The Commonwealth of Massachusetts a =j— ^Z Department of Industrial Accidents -,i� �t •�-=•�� , -� ; 01llcsa/lasestlAatloos r 600 Washington Street - - Boston,Mass. 02111 Workers' Coro ensation Insurance davit TO name: locations city phone# ❑ I am a homeowner performing all work myself ❑ I am a so upidetor and have no one working,in aav ardiv ll�i� I am an employer providing workers' easdtion for my employees working on this job. 7 .....................�:::- .................. ........................r.. .x .................. .....:a......:rh,.a......:....:........a.:......r:.,rx...r........... .::;::.; . .:.: rv:. .�}.. •..,. .. ..v•.: r 3•.v::�.,:v.::w:}r , .. ... .,....... ....... v..{ ..........nw•:}i-n•.:•.f};::}•.,::.:..::::•}::??v:.}:{:�::v:•i:??•}):{vi:±C???•iii:':r?•:.i::^?iY??•`:::i?L. �ii::. ::. .. {.. ::: . ... . .�... insmaace�ty..:.;.,.::;.;:•..� '::::::: ��.: •: ::.:.,;;;:...::..::::.�.,,,,,::...:noiicv:#::.,�.:tYr. ,...�...•.,�` . . ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the cantractois listed below wh have the following workers' campensatian policx.. ,....::.:. ... .. r,.:::.::. ...::. v?•{•X:•.%•. x:x}}:}Y':;::::{{{-•;.:.:{•.•}}:,{.;{•i:•i:•}X•:r{{{•a}:}v.;}}::v��::.}.'Y... ..... .................x.v.......}:{.......h.:}. .}. ..X......r.:::v..}}: :.r....a .:...%v.•1ir...:}r}0.•:{vx::•.v v'4}}:•:{'•:S:{•% }}:{{Lv}}:L}r.�}i'4.�}::w}}h:�: ii}??:t-::.y::' Kwa.?:??.;.:}. ......x:::•.:::.<.>,, ;?.}y,:.r.,,?}.;??.,}::.r}::-:::}.:'{.;........................r. ..... ...... .,x. .. ...:r , r .......... :• r:.,;......vva;•.^::.v {•h,v.+.:•.w:::v:::{4"v::•::•:i::.v::v.�:.:v::::::.v.?•:::.a:•???•,•".}.............: ........:.; •;•.•.xa.......A x., .........,.rh{....hn,Mnt7G.x,.:.{N.h........YY[r.4?000C,Ni'.x:.:.:.:.........:v::w%:}:n.. sv^^r•Mw..................3...{•......:.............n..... .......: :rr.•x+wvh nllY.hv.:....................,,............7f. ...:..{................... 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M •• 1 �: •/If • /f .1• • ✓.111 • :.c • 11 1• i1i 11 /1 •�1.1111 «w1 IIIIee •w • / • I 1 1 v-• - .i•-0-01 fill•• •.t 41 bilmik 411141/�• of , • •Il w•1 • 1/ •1 of • 11 w .10 .11 •A-Ii Nel\ 1 •-w1 IIY. • � i/ • 1 -. ■ •rn •u • • f • f• If .0 • u • • .0 « 1•r • • 1 ••f w .0 m .If• 1• • • • .II • �.••1 1 1 11 11 1 1 1 � 1 A 1 ' • - o11 ' 1 1 1 1 • ' 1 1 I I 1 1 1 1 1 • � � / 1 11 1 1 1 . t 1 1 1 1 I C I � • I I • I I 1 �O 4 . TO•,� S61• ,fit' •• 08 • rTre Lot 1. • , t. �.`,} swt '7 ` . � I �.++ r ` `` ..r/� ".1,. •ram' ' ,.ter .r •� •� .�r n rb o rn os G. �r , . • - o �ea Q Beebe CERT. No 14 323 �. CER T. Na 28,664• 41 •.," 1` � 94 . 84 --`" 2 9 7 26 N1 ca e • '''IV 6J• 16. pt - ISI.4J rrlw )� -.-rJ 61• OS 4 rW-/39.J9 jr?-q�,1 .� : !,.+.-JV6l•'' yt gw�i1'-11�: I• y - i • - •_ ✓�ee�omynza�zu�e ✓ aaci�i Bd OFF AIR-Am PIP 57, ry GAS CUmg License CO - N 7777D4Numbb ,. 6csiTesri2��r�®3 irr.dry 77754 I • � est:wac d T�� r � � CAJR�&Y C GROU c iir r �.aDs a i.' ambnlr ri7sit � a � y n ` 2�W C0b � 3�fir(: ' l i - rf v x FZME r, Town of Barnstable Regulatory Services BMWSPABLE. ' Thomas F.Geiler,Director 1639. a`0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. / Type of Work: //�A�i�� _Estimated Cost Address of Work: Owner's Name: � � V�< Date of Application: r5-//-a I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as t ent of the own Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 - Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= o® x.0031= / 7 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE r square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf S 35.00 >500 sf-750 sf 50.00 ' >150 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (der) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool .$60.00 Above Ground Swimming Pool $25.00 RelocatiowMoving $150.00 - (plus above if applicable) Permit Fee f 730 CUR Appalls 1 TAU J=b(eoadaned) prescriptive Paei&M for Ono and Twa-F=Oilr Reaidm W Baildlap Sensed with FoWI Falb MAJi UM tyll?um ms . crag 01.2ins ceitlag wall Floor. gam Slab flca9iC0oiin$ Ann'('K) U valucz R value. R value' R-vaisid waII plesimew Eqwpm= EMd=cY' p�� R.vdge' &value' 5101 to 6S00 Heating Degree DzW" Q 12•/. 0.40 3E 13 1 19 10 6 Normal R 12%. 032 30 19 19 t0 6 Normal s 12% 0 3E . 13 19 . 10 6 iS AFJE T 15% WI 3S 13 WA WA Normal U 15% 0.46 3E 19 19 10 6 Normal V V% 0.44 3E 13 - 2S WA WA U AFTIE [wr.�S%I I O.S2 0 19 19 10 6 u AFUE X IE%. 0.32 1 31k, 13 • 2S WA WA Normal Y IV/. 0,42 3E 2S WA WA Normal Z 18% 0.42 3E 13 . 19 IO • 6 90 ACE . AAA IM 0.50 30 IX 19 1 19 10 - 6 90 AFZJE 1. ADDRESS OF PROPERTY. ` . "" —� / t 2. SQUARE FOOTAGE F ALL EXTERIOR WALLS: 3. SQUARE FOOTA OF ALL GLAZING: ' 4. %GLAZING A (#3 DIVIDED BY#2): D S. 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: q4orau-1980303a 780 CMR Appendix J . Footnotes to'Table J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 R2 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 whole units:center-of-glass U-values cannot be used ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R 38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum.of cavity insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R 19 requirement could be met EITHER by R-19 cavity.insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 7 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 to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with youurwindows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. 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'.1' i `�.t �'�"-lf,r-- ._ anrx -�r e, k• tio. E. _� - f J b.. .-rY� �-:r r -"r "x •_do-^.-�. Ea `.- -r P t{� �i r _ 100 -r, a .s•,: `r1N -- s9v G;..i - a i R- J f 3^t 4 i - - t ,-+ ,P'Y,x Yrt: �n � .1 e s x F;s�_ � •v � _ .:�."�� y.,,,. S h - M •'�. .,�cv.,,:t•r .t F..:r- - �/ r .-?- t�'Y'. '� ..�:� v - : ;1: - - 7 3 �. 4.s G. t*. �r '', 'r".-. _ ,rr:s �.ry d s. i- Z�• e-: �'f �rJ. } —""'i;fi_4 � _ _ :! .�-Ic f °'� sl :�.� u:SS`*.rA: _.�• X �t.,� jS�'i. •r�' a - - _ '�,. •At''-cr-y�'r? .�r_ P" _ �F,t- �`'1= y�f.'=� S?1Jalk'�{,IpS��,:r �< i -��F _ -..�..�: _ y S t'; � i ,� E''-i-t�- -r� ;-:r�` '.:°YbTn C�"3GS�;P-��-.'T•=�• r r.� 3' v : :V F1',z ys { F} . - '�'�- .rr• +�',.,._, �.v'Z?,sv"Z.a� -'%d. ti i 1,,;`a `engineering Dept.' (3rd floor) Map O/ Parcel 7 Permit# 2. ' House# 13 ,91 Date Iss ed Board of Health(3rd floor)(8:15 -9:30/1:00- 36�Pm - Fee / ��°16 W5 4 Conservation Office(4th floor)(00- 9:30/1:00 . 2:00) � IN C® � Planning Dept.(1st floor/School Admin. Bldg.) PA ,� t Definitive Plan Approved by Planning Board �s�'-."~ 19 m y gy� •.fr+, - • RARNSTABLE, ` ''''Jj�+t� MA TOWN OF,BARNSTABLE j-� Building,Permit Replication r ..., Project Stre ess 1 � ` / r/V `S'� :�O�r/f7 //%/►� Q� 3� Village�lZ��r Owner ,2/'X 4/ff//_a r y Address lyla/N )Telephone Permit Request 1 First Floor . S _square feet Second Floor square feet Construction Type Estimated Project Cost $ /J�� • O� Zoning District ,e,` Flood Plain �� Water Protection Lot Size R(,000 So Grandfathered Erles ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure A Historic House ❑Yes Q Ko' On Old King's Highway ❑Yes UIKO Basement Type: ❑Full Ueroawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) „2Q�2 Number of Baths: Full: Existing_ a New L Half: Existing o New d No. of Bedrooms: Existing New Total Room Count(not including baths): Existing $� New 0 First Floor Room Count Heat Type and Fuel: VC ❑Oil ❑Electric ❑Other Central Air &rles ❑No Fireplaces: Existing New _ Existing wood/coal stove ❑Yes Garage: U-15-etached(size) O '� Other Detached Structures: ❑Pool(size) ❑Attached(size) ©� ❑Barn(size) ❑None ❑Shed(size) .. ❑ ( Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes To _ If yes, site plan review# Current Use Proposed Use m LP ..,L��Af Builder Information iL�" � Name -,,�Z 'l-C s �! Telephone Number 500 -42c -1363 Address `60 4 1 0 9jt? License# b�4`7(A S A ®Z&S-S Home Improvement Contractor# 6 4 gS Worker's Compensation# 0 00 D -?,0O o�- 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 t- ) C I 95 SIGNATURE �"�""'' DATE BUILDING PEfMIT DENIED FOR THE FOLLO ING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. 1���✓ ~ � _ _ - r DATE ISSUED.. MAP/PARCEL NO. 5 • y tr , r - • s ADDRESS VILLAGE., _ OWNER DATE OFJNSPECTION: FOUNDATION ' '•�'/ Ao 4=4 �' ?�%✓T v r - FRAME INSULATION FIREPLACE r rf ELECTRICAL: ROUGH r r , FINAL' , PLUMBING_: ROUGH y FINAL , { GAS: '? - ROUGH FINAL+ FINAL BUILDING • - . ' r V DATE CLOSED OUT _ a 4 ASSOCIATION PLAN NO. . . °: The Town of Barnstable MAM• L►srisrnst,E, • 1� Department of Health Safety and Environmental Services 1659. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW 0 t8 Owner: Map/Parcel: Project Address: ,. q �` . Builder: �QD - Cr (G e C-0-T-U•t-T- The following items were noted on reviewing: lot) L C`C P KG u C-I�Ose- O's 11 17�jSuc (, cal C �FcyAL-DA�VtcDI--1 \I-J kU-S SVr3 ltk��lTto rJ - 1 Please call 508 862-4038 for re-inspection. by. Date: D q:building:forms:mview I Vim: The Commonwealth of Massachusetts Department of Industrial Accidents `' � � ; ��� Of�Jct aflmresd�atloos ' 600 Washington Street ' Boston,Mass. 02111 s Workers' Com ensation Insurance Affidavit nmne, location- citV ahone 0 ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any a am_,_------------ ' I am an employer providing workers' compensation for my employees working on this job. com nnv name: address- fYt 0, city- phoned• .���� ..... Insurance co. ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following Nvorkers' compensation polices: comoanv name! address: — insurance ce. oa:n anv name. address: dtv phone _- • ti•N •t:.P,ly w... V .. y'.w iR]tlTantT ctl. . "all # .�i :n i• ..: :' ;x.. Cs M:•. FaOnes co----ears eorera ge=- regmrad=der Section 26A of NIGL 152 can lead to the imposition of crbnimi penaWes*(a Me up to SLSOOAO and/or aoa yeas--'implinutnM ea well as eiril powides in the form of s hTOP WORK ORDER and a tine of SIOLOO a dy against me. I anderstand that s copy of this stataomm may be forwarded to the Omea of Investiptiosts of the DIA for eoraaSe vettacui=. 1 do hereby cad the party m d pen of perjury that the information provided above is gmp and correct Si�attuie17 Date hriat name - y� � Phmeit • ofncisl the only do not write in thb area to ba compieted by ally or town omtiai dtv or town: peemifllle�e# OBuliding Department . QLlcaa ins Board ❑chmkiflannediste response is repaired Osammewsonke OHeaith Depannom contact person: phone#: ❑Other_ mt.9/93 PIA! Information and Instructions V, Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation for tI employees. As quoted from the "law",an employee is defined as every person in the service of another under any C=—:- of hire, express or implied. oral or written. An employer is defined as an individual. partnership, association, corporation or other legal entity, or any two or sore of tie foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the rec.-n* . ===of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling horse cf ...�.v....h„o....,t...�"mvn"e rn do maintenance , construction or repair work an such dwelling house or on the grounds o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,nea 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 insair,ncc requirernerits of this chapter have been presented to the authority. ` Applicants :`.Please fill in the workers' compensation affidavit completely, by checking the box that applies to your 'sitmation and ,supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be , to the Department of bhist iai Accidents for confirmation of; ===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 imu are required to obtain a workers' compensation polkcv,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of has to contact you regarding the appkicau L Please be sure to fill in the pe=it/license number which will be used as a reference number. The affidavits may be remmed fo the Dep-%=cnt by mat or FAX unless other airangern have been made. The Office of Investigations would hike to thank you in advance for you cooperation and should you have any questions.. please-io not hesitate to give us a call. OF IN %.' The Der"Mment's address,telephone and fax number. ....... The Commonwealth Of Massachusetts Department of Industrial Accidents Once of Invesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 127-4900 eat. 406, 409 or 375 M CUR Appumftj Tab1eJ=b(eondsaed) • Pmoriptfre Packagm for One and Two-Family RaddentW Buudhw Hailed witb Fad Fuel MAXIMUM MINIMUM Glazing Glavin 8 Ceiling wall Floor Beam= Slab �g���g �'(%) U value= R values It value' &-values wall Pia �!� ElEdenc? >' &-value' &vdud 5/01 to 6500 Head ys' ng Degree Da Q 12m% 0.40 38 13 19 10 6 Normal It, 12% 032 30 19 19 10 6 Normal S IrA 030 38 13 19 10 6 85 AFUE T 15% 036 38 13 23 WA WA Normal U 15% 0.46 38 19 19 10 6 Normal V 1 SOA 0.44 38 13 23 WA WA 8S AFUE w IVA 0.32 30 19 19 10 6 85 AFUE X Iare 0.32 38 13 25 WA WA Normal Y 18% 0.42 38 19 2S WA WA Normal Z 181ye 0.42 38 13 19 10 6 90 AFUE AA 183A 0.50 30 19 19 10 6 90 AnM 1. ADDRESS OF PROPERTY: l Z 7f 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: yC,O 3. SQUARE FOOTAGE OF ALL GLAZING: 3� 4. %GLAZING AREA(#3 DIVIDED BY#2): S. 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: q-forms•f980303a 780 CMR Appendix J c Footnotes to Table J5.2.1 b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fl of decorative glass may be excluded from a building design with 300 ft of glazing area. =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 whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R 38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R values represent the stun of cavity insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall. For example,an R-19 requirement could be met EITHER by R 19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. !The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. 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. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with insulation levels the component complies if the area-weighted average R value is greater than or equal to different us P dr P the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 IMME . .� The Town of Barnstable • aniexsrasi.E, • 9� MAB& 1e�' Department of Health Safety and Environmental Services 'OrEo Nw�" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.Type of Work: 4 � AnI st Cost Address of Work: �� � 11Y� ( ��✓/ V� 14� ���`� Owner's Name: r5' Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Da ontractor Nam' e7 Registration No. OR Date Owner's Name q:forms:Affidav i 204. 7 To V .RuO�, �d `� body• ��. T < Lot 1. cowT• c '.; RM - CERT. NO. 14 323. CERT. No. 2B.g64, . • �' 1 r 1 •o Ilk I. o i •r. P 9 i Z 6 .�•t . •• PY -iai.41 lrh...�• -�Hs!• os ;se 1,9 hhrJ -1 !:: N6r- _ >\ o i - Dunning. -She :. .: « 3 LOT � ., *rat �..�a�',�.����rz�r r�• 6'.t 'a�tY', i t s DEPARTMENT,OF PUBLIC SAFETY ry , CONSTRUCTION SUPERVI ICENSE Numb el xpires: s_ Restr Red J6 ',� I6 •- ,'� ` '�'' r re; STEVEN P MCEINENV t, = PO BOX 282' COTUIT, MA 02635 .. 4 #41ry V" t �n �k i g sa t?} b f�N { y �t r' ��'� r'£�'�� k; a Y �-✓/E¢���Oo�tmt����s'7,it�' .r� �j._ \ Y - ;y ,C xHOMEIHPROVEMENTCONTRACTOR = T, ��Registratlont 110485�� yp INDIV B s ` st z = E'xp1rataron� ,�10/20/98TA-��r yY � t f 4 117 3s 6ROVER! `HCELHENY�BUILDERS � STEVEN�P i MCELIHENY � ,4 QoBOXa1056/5237MAIN,2ST ' OTUIT MA 02635 xz�T�y�ADMINISTF7ATOR �t r 2 �' h��r 'yx ,&,,g �`y ',ry'�� +- 's� z�r �,r<•,yt+ a - +1�iaG{L,!t"3,t - rt Y ._. .. . a .. ....• _r _ 41 77 ks) f. i; w - -S�. _4 i I,. i•; ,� j� i ..I ! I. i ,.wi,d I- j��+ I I j � I ��''} _ — U � � . iI 1. Y .. 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