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Home My WebLink About0139 POPONESSETT ROAD f39 � %' � I�� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l �( Parcel Application #A010 Health Division Date Issued Z(0 Z� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village ( ,o'Ty l Owner_ Address �� Telephone Permit Request �tL t7,d a7 PLco;;� K(T E2cEoc2 ODQED 1Z l 1w:1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _ ew Total Room Count (not including baths): existing new First Floor Ro® Count C Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other 3° -n Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodfcoal stov&'_❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing oa�ew¢ ize_ 1-0 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name TC-,P->- i-� �L.D Telephone Number �'� Zr aq Address c5 7 M,6 r ?' License # (0 i N— 3 S Home Improvement Contractor# —ok-0 3� , Worker's Compensation # �oa37g`-f©l �1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO NATURE--- ,��:ft5?z DATE l� FOR OFFICIAL USE ONLY u APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: r FOUNDATION FRAME x i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r ' i - The Comfnonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t F: Boston, MA 02111 ,. www.mass.gov/dia . .r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le i bly Name (Business/Organization/Individual): 't L� '/ �� Address: �5 7 /vl �� ^� S City/State/Zip: Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 4. ❑ I am a general contractor and I 6 New construction * have hired the sub-contractors employees (full and/or'part-time). �7 emodelin 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ? g These sub-contractors have g, ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. $ 9. ❑ Building addition' [No workers' comp. insurance comp,insurance. 5. ❑ We'are a corporation and its 10.E Electrical repairs or additions required.) 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL 12. Roof repairs om : ❑ m self. o workers c ' y P C. 152, 1 4 ,and we have no insurance required.]t § O 13:❑ Other employees. [No workers' comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. nal sheet showing the name of the sub-contractors and state whether or not those entities have tContractors that check this box must attached an additio employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: `7f7�—�i7 ''�Y� a � Expiration Date:. J� !v / Job Site Address: l�ol �D(�OI�F��Z r<. City/State/Zil:i 6CU i M&0 T7 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. k I do hereby certify under�l �' enaIties perjury that the information provided above is true and correct Signature: Date: 1. Phone# Official use only. Do not write in this area,.to be completed by city or town,official City or Town: Permit/License#' Issuing Authority(circle one): r 1.Board of Health 2. Building Department 3."City/Town Clerk 4.Electrical Inspector 5.{Plumbing Inspector 6.Other t Phone Contact Person: # �� f , Information and nstr11 ctio' ' n' S Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees... em ployee!o ee is defined as "...every person."�in the service of another under any contract of hire, Pursuant to this statute, an p ) , 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 three apartments and who resides therein, or the occupant of the owner of a dwelling house having not more than dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any, applicant who has not produced acceptable evidence of compliance,with the insurance coverage required." •Additionally,MGL chapter 152, §25C(7) states"Neither the conunonwealth nor any of its political subdivisions shall crier into any contract for the per, 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 numbers)along with their certificates) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,apolicy is required. Be advised that this affidavit may be submitted to the Department of lndustriaJ Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The Affidavit should be re3urned 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 workersr compensation policy,please call the Department at the number listed below.-Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a.space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit license number which will be.used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."-A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the e for future permits or licenses. A new affidavit must be filled out each applicant as proof that a valid affidavit on fit p year.. Where a home owner or citizen is obtaining a license or permit,not related to any business or CO xlmercial venture (i.e. a dog license or permit to burn leave$etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like.to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us..:a.call. The Department's'address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations 600 Washington Street Boston, MA 02111 .Tel. # 617-727-4900 ext 406 or 1-87.7-MASSA FE Fax # 617-727-7749 Revised 4-24-07 www.mass.t;ov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETAC ED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site'Address: lct � � print Town: . ' Applicant Phone: �e - Applicant Signature: e of Application: NEW.CONSTRUCTION: choose ONE of the followin two`o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND-TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab ption 1: Basement O Fenestration exposed Wall Floor ,Wall Perimeter AI'UE. HSPF SEER U-factor floors R-Value R-Value R-Value R-Value , R-Value and Depth National Appliance Energy. R-10* Conservation Act(NAECA)of .35 R-38 R-19 R-19 R-10 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not.required if you choose either of the two versions of REScheck as listed below, ❑` Option 2: REScheck Version 4.1.2 or latervariant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http://www.energycodes.gov/r6scheck/.' -77777-7 OR:ALTER.AT)iONS,TO EXIS TING BUILDINGS.OVER.5 YEAR S . . . ADDITIONS *Buildings under 5 years old must use option#1 or 42 in New.Construction section above. Complete the following formula to determine the% of glazing: . (a) Gross Wall & Ceiling Area equ4ls Formula; (1 OO x b= a) SF 100 x — _ % of glazing b a (b) Glazing area equals SF If glazing is:<40% use the chart below. If glazing is >40.0/6 proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS T.O EXISTING LOW-RISE RESIDENTIAL BUILDINGS ` MAXIMUM MINIMUM,_ Ceiling and Slab.Perimeter Fenestration Exposed floors' ,Wall Flom Basement Wall R-Value U=factor -Value -value R=Value and Depth . R-Value 3 9 R-3 7 a R-13 R-19 R. 10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if th ation achieves the full R-value over the,entire ceiling area(i.e.not com ressed over exterior walls, and including any access o enin s SUNROOM=An addition or alteration to an existing building/dwelling unit where,the total glazing area of said addition exceeds:40% of the combined gross wall and ceiling area of the addition.. Note: Owner to fill out Consumer Information Form (found in Appendix endix 120T) T Town of Barnstable Regulatory Services ELAMSTAR9 c.E.� Thomas F.Geiler,Director 16.19. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section' If Using A Builder. I, 4-4� N-1 Lc� ( b as Owner of the sub ect ro e J P P rtS' hereby authorizes^ -{-� (� to act on my behalf, in all matters relative to work authorized by this building permit application for. (Ad Tess of Job) Signature of Owner Date Print Name If Property Owner is applying for_permit„please complete the Homeowners License Exemption Form on the reverse side Q'FORMS:OWNERPERMISSTON s. 4 Town of Barnstable ,*'THE tp� o Regulatory Services • Thomas F.Geiler,Director aAxxsr"t.E 9qp a Building Division rEn � Tom Perry,Building uildin Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# ' work phone i1 CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than-one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit: (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities.of a supervisor(see Appendix Q,. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board.cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC DATE(MMIDD/YY) �«� x w p . :z 8 6/30/2009 °FBIATEOF} 1L I= I� SU RANGE aTM ;CERTI- TY� N � � HI r. THIS CERTIFICATE IS ISSUED-AS A MATTER OF INFORMATION = cER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 908 MAIN STREET COMPANIES AFFORDING COVERAGE OSTERVILLE, MA-02655 COMPANY .• AIM MUTUAL INSURANCE COMPANY A . . INSURED _ COMPANY - - PETER D. FIELD e DBA PETER FIELD BUILDING& RESTORATION COMPANY PO BOX 16 C COTUIT,MA 02635 COMPANY D M= ^u ` ad�at,. - COVERAGES F ` IN- �. 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 B Y 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. POLICY EFFECTIVE POLICY EXPIRATION - LIMITS LT TYPE OF INSURANCE POLICY NUMBER- DATE(MM/DD/YY) DATE(MM/DDlYY) LT R - - GENERAL AGGREGATE $ . GENERAL LIABILITY - - PRODUCTS-COMP/OP AGG $ COMMERCIAL GENERAL LIABILITY — - PERSONAL&ADV INJURY $ CLAIMS'MADE ❑OCCUR - - .EACH OCCURRENCE $ OWNER'S&CONTRACTOR'S PROT - - - - - FIRE DAMAGE (Any one fire) $ MED EXP (Anyone person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OW NED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS - BODILY INJURY $ - (Per accident) NON-OWNED AUTOS PROPERTYDAMAGE $ - _ =OTHER IDENT $ GARAGE LIABILITY NLY:ANY AUTO - IDENT $EGATE. $A $ :. EXCESS LIABILITY AGGREGATE - $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM we sTAru- OTH- 05/16/2009 05/16/2010 TORY LIMITS ER A WORKER'S COMPENSATION AND AWC 7023784012009 EL EACH ACCIDENT $ 1.00,000 EMPLOYERS'LIABILITY - - EL DISEASE-POLICY LIMIT $ 500,000 - THE PROPRIETOR/ INCL - PARTNERS/EXECIITIVE EL DISEASE-EA.EMPLOYEE $ 100,000 OFFICERS ARE: e EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ' I u,P'.asas CERTtICA�TEHOED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1 p EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T0. MAIL. JARED KELLE� IE(1 10 DAYS WRITTEN NOTICE TO THE.CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION.OR LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHO PRE TATIVrA CU„A t "' - .R- , ;'�// ,iNow- ICQRD�CQRPO�AT10N r ACORD25 S 1795 s ""• � .. l� f.z 7 Board of Building Regina ons and Stan ards One Ashburton Place'- Room 1301 Boston. Massachusetts"02108 ' Home Improvement Contractor Registration Registration: 120362 Type: DBA Expiration: �1/30/2009 Tr# 261156 PETER FIELD BUILDING & RESTORATION .. . PETER FIELD P. O. BOX 16 COTUIT, MA 02635 Update Address and return card.Mark reason for change. Address R Renewal Employment Lost Card DPS-CAI t5 SOM-07107-PC8490 Massachusetts- Department of Public SafetN Board of Buildin�u Re-ulations.�nd Standards Construction Supervisor License License: CS 65638 Restricted to: 1G PETER D FIELD „ PO BOX 16 COTU IT, MA 02635 Expiration: M5/2011 ('umtnisiunrr Tr#: 19280 44 F / �� / - - ' . I ( � . ' 3.��i �� ._ .- - ICI �� . r: `� .. .�= y_ . r , a. ,t r . i l.Vll11J1atu1.J r0.�'G 1 Vl 1 �t �The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home> Consumer> Housing Information> Home Improvement Contractor Program> _................................._.,............._...._...._._.........._._.._......_...............................................__.................._......................_.................................................._._.................:.....................::.......:. HIC Registration Complaints Registration# 120362 Registrant PETER FIELD BUILDING&RESTORATION Name PETER FIELD Address P.0.BOX 16 City,State,Zip COTUIT,MA,02635 Expiration Date 11/30/2011 Status Current No complaints found for this registrant. You can also view arbitration and"Guaranty Fund history. 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