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HomeMy WebLinkAbout0123 SCHOOL STREET �� , � 5 �. i, l`` 1 1, `l I 1 iI i1 1 } f / Commonwealth of Massachusetts � Map Parseq( Sheet Metal Permit �) ✓v�J Date: Permit# s � Estimated Job Cost: $ CRESS PERMIT Permit Fee: $ 8 S . Plans Submitted: YES NOJUfQ4 2913 Plans Reviewed: YES NO ?` Business License# 4 3 q 0,,)-S 3,G Applicant License n i Business Information: TOWN OF 8ARN'T' raE Owner/Job Location Information: - Name: A a.e_ (A Name: Street: -f�. ,.� v-�_ Street: JiMIR, '3 S&V-e e)) Slv --t' I City/Town: City/Town: Ce �xjN' ' Telephone: 5 06 -3 "A Z S' Telephone: Photo I.D. required/Copy of Photo I.D. attached: 'FS ?c NO _ no;tw d-1 M-I- restricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft.-/2-stories or less Residential: 1-2 family _ Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational o Fire Dept.Approval Institutional_ Other ��,. � C> Square Footage: under, 10,000 sq. ft. over 10,000 sq. ft. Number of St pries: Sheet medal work to be completed: New Work: Renovation: -�- - NVAC J Metal Watershed Roofing - Kitchen Exhaust System e J Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: i INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes�&10 ❑ If you have checked Yes.Indicate the type of coverage by checking the appropriate bolt below: A liability insurance policy 2P Other type of indemnity ❑ Bond ❑ I OWNER'S INSURANCE WAIVER:I am aware that the licensee d2CE not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that rely signature on this permit application ymiyes this requiremnent. Check One Only Owner ❑ Agent ❑ ; I Signature of Owner or Owner's Agent By checking this bo I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the bestbf rmay knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance wM all pertinent provision of the Massachusetts Sullding Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections I Date Comments I Final Insnection Date Comments Type of License: i 3y A Master Pile ❑ Master-Restricted I atyliown ❑Journeyperson Signature of licensee I 'errnit# y ❑Joumeyperson-Restricted license Number. :ee ❑ Check at www.mass.govIdol • i nspector Signature of Permit Approval Technology Insurance Company i i A Stock Insurance Company i 20 Trafalgar Square,Suite 459 Nashua, NH 03063 WORKERS COMPENSATION WC 99 00 01 B AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Ncci Code: 39071 1. Insured: Policy Number: TWC3333710 Cape Cod Mechanical Systems Inc 8 Fruean Avenue South Yarmouth,MA 02664 Individual Partnership Other workplaces not shown above: X Corporation or See Extension of Information Page Federal Tax ID: 043402526 Producer: Risk ID: AmTrust North America, Inc. Renewal of: New c/o PMC Insurance Agency,Inc. 50 Cabot St Needham, MA 02494-2819 2. The policy period is from 9/21/2012 to 9/21/2013 12:01 a.m. at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: Massachusetts B. Employers Liability Insurance: Part Two of the policy applies to work in each stated listed in item 3.A.The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit ' Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND,OH,WA,WY and State(s)Designated in Item 3A. D. This policy includes these endorsements and schedules: See attached endorsement schedule. 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. See Extension of Information Page TOTAL ESTIMATED ANNUAL PREMIUM 6,320 STATE ASSESSMENT 257 TOTAL ESTIMATED COST 6,577 Minimum Premium 500 Deposit Premium 889 Issue Date: 10/3/2012 Countersigned By: �^ uthorized epresentative : The Commonwealth ofMassachuseft Department of In&atrld Accidents ®ffwe of Investigations 600 Washington,street Boston,MA 02111 ww>a.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Wormation Please Print LeRbla Name(Business!OrganizationamdividuC:. tl 12 r (IL14 • c e,��-v� `Cc� Address: :L'1 �-►'Ver�,. f�V e_ City/State/Zip. �;X LIL o-Ob^, IOW Phone-fr: 2 ro, Are you an employer?Check the appropriate box: 1.I am a l with _ -4. ❑ I am a general contractor and I 6.-Type❑New construction eco t��ti(required):. 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. Oa=odeling ship and have no'en:ployees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance COMP• ' required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c.152, §1(4),and we have no employs.[No workers' 13.❑Other comp.insurance required.] *Any applicant tbat arks box K must also M oil @te section below showing th.4 workers'compensation policy inforna$on. t Ilou=wnm who submit this affidavit indicating they are doing all work aid then hire outside contractors anut submit a new affidavit indicating su& l ontrac tors that chxk this box mmA attached an additional shce,showing the of the sub-contractors and state%lod r or not thou entities have employees. If the sub-cintcactor nave emp:oyees,they must provide their worieeis'comp.policy number. I am an employer that hr`.mviding workers'compensation insurance for my employees Below is the policy and job site information. ' Ins o Company I ticc.V�s�� �l ws - / Policy#or Self-ins. � L 3 j Expiration Date: r LC 1 %`•3 l .rob Site A(idress:_. 's` �d SC:�v y` S�- CityfState/Zip: Attach a copy of tht . rers'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$250.00 a day against the violator. Be advised that a copy of this statemmit maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under eFis and penalties'of perjury that the information provided above is true and correct Signature: �Gi /10 Date: ! �� Phone fr Official use only. Do not write in this area,to be completed by crty or town official City or Town: PermitfLicense# .Issuing Authority(circle one): ' 1.Board of Health 2.Building Departmeut 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • COMMONWEALTH OF MASSCHUSETTS SHEET R" IWORK:ERS ISSUES THE .FOLLOWING .1TENSE AS A B.US:I`NES$ IW: I¢. S);DNEY:-K H0RT0N rt I CAPE COD MEGHANI'.CAL SYS gy 8 'FRUEAN AVE. Z W . YARMOUTH MA. 02664_ 'J ` :` V v� ol �a 'ffrf�•�ACM,`1 f 1_,vr..:�. • AS E f �L:,T11L W(�RE. S A TER-U ISSUES TliFS�RICTEQ;' E ABOVE LICENSE TO. SILI:NEY K � NO R T(iN ?I I G !. 8 FRU�piV: WAY wl s YARMourH ►rA 5�2I D� 664 1G ,D D7:/%t3Jlif , -: 2119:y4 a Jgoarb of Regi!9tratiou of *beet Aleut V96rher.5 30abiug 15ati!9fieb t�a requiremeutsS of JRa!9!5acbu!6ettq Oeueraf labs Cbapter 112, �bectiou 237 tbrouglj 251 a7ape .Cob 41erbant" cat ,* io berebp grauteb tl)i5 certificate no. 584 ae ebibeuce to practice as; a lireu.qeb eel eta on tbt!6 1711) bap of A.ap 2013 In Teotinionp IVYjereof, io bereunto affixeb the name of tije (Executibe director of the Woarb Cxecutibe Director Date Town of Barnstable Regulatory Services Thomas F.Geiler,Director i6gq. 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, 1P [AJc CA S , as-GPw4ior-of the subject property hereby authorize- St C>&AJ !g- Qto act on my behalf, in all matters relative to work authorized by this building permit. l a 3 5-&;60l (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. "fl Sign Lure of 0 L,,lc..mv- Signature of Applicant Print Name Print Name if g) Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 �tH Town of Barnstable °^ Regulatory Services MAS& E Thomas F..Geiler,Director �E 039. � 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Ou[look\QRE6ZUBN\EXPRESS.doc Revised 053012 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map clu Parcel Application # Health Division Date Issued Conservation Division Application Fee Jk �I �< Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board c/�1l1�3 Historic - OKH _ Preservation / Hyannis 01— Project Street Address Village Owner�'a� \� 1.V� �� Address Z 3 �/�`C Telephone �-�� Permit Reque t ���Ma��i't.- �`5C 114 Gam- _11�UL -6)zt�i S O h 1�,St ll 2 Nc 1st lv , , *Sw D6W5 law Square feet: 1 st floor: existing�� proposed 950 2nd floor: existin � proposed�� Total new Zoning District Flood Plain ` Groundwater Overlay Project Valuation"kS Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# ::nits) Age of Existing Structure �S Historic House: ❑Yes W'No On Old King's Highway: ❑Yes �CNo Basement Type: WFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new _ Half: existing 011 new Number of Bedrooms: -?> existing new Total Room Count (not including bath,,): existing _ & new First Floor Room Count Heat Type and Fuel: ❑ Gas >dOil ❑ Electric ❑ Other Central Air: ❑Yes 4 No Fireplaces: Existing / New _� Existing wood/coal..stove: ❑Yes WNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ ing ❑ R.13w size .Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: `nZli ,ate Z Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �v Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name� � ' -�'V"� `` t Telephone Number -72 7 .5(0 70 Address > License # C-S 10 3 '50 Y p L A Home Improvement Contractor# J 7 V Y 5 D Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO wic SIGNATURE ��/�//Z/ DATE 3 ✓ �� � � � ppp— — — — FOR OFFICIAL USE ONLY •_ "�5. APPLICATION# 'DATE ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE _r OWNER DATE OF INSPECTION: E -FOUNDATION FRAME ®� l "h t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING bdlI6K DATE CLOSED OUT ASSOCIATION PLAN NO. _ The Commonwealth,ofMassachusetts _ Department of Industrial Accidents Office of Investigations .600 Washington Street Boston,MA 02111 www.massgov/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2iblY Name(Business/organizaiion/ludividual): i`^ •:���l Y'^S Address: d `I 0ZG9 1 -767 Phone.#: Are you an employer? Check the appropriate box: -Type of project'(required):. 1.❑ I am a e to er with 4. ❑,I am a general contractor and I mp Y 6. C1 New construction . t timel* have wed the stab-contractors 2.�I am a'sole proprietor employees(full and/or par or partner listed on the-attached sheet 7: ©Remodeling ship and have no employees These sub-contractors have '8: ❑Demolition employees and have workers' working for me in'any .capacity9.• Building addition [No workers' comp.insurance comp.iner,rance, - required-] S. ❑ We are a corporation-and its '" 10.❑Electrical repairs or additions -3e❑ I am a homeowner doing all work: - officers have exercised their ,.11.❑Plumbing repairs or additions . ` myself [No workers' comp. right of exemption per MGL , 12.❑Roof repairs insurance required-]t c. 152,§1(4),and we have no employees.[No workers'" 13.❑Other comp.insurance required] *Any applicant that checks box#1 must also fiU out the section beiow 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. .. tcmtractors that check this box must attached an additional sheet showing the name of the sub-mutractors and state whether or not those entities have employees. if the sub-contractors have employees,they must providb their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job,site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Dater' Job Site Address: City/State/Zip: Attach a copy of the workers'-camp ensationpolicy declaration page'(shovdng the policy number and expiration dafe). 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 thq 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 under the pains•and allies.pf perju t the information provided above is true and correct Si tare: Date: Phone# -7 -7 q 5 6 `' L � 7 . Official use only. Do not write in this area,to be completed by city or town official City Town: Permit/License# Issuing Authority(circle one): .-L Board of Health 2.Building-Department`3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . f EVE Town of Barnstable ti , Regulatory Services � NAM $ Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstablemi.us Office: 508-862-403 8 Fax: 508-790-6230 �Y ProP e Owner Must = Co lete and Sign This Section P g If Using A Builder I, DAvTb c- c-U9N-6-K` , as Owner of the subject property herebyauthorize S to'act on inYbehalf in all matters relative to work authorized by this building permit 123 56600L 81, eOTurr, ► A- .0263 (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.' e of Owner Signature of Applicant Print Name Print,Narne - Date Q;FORMS:OWNERPERMISSIONPOOLS 6/2012 Town of Barnstable Regulatory Services RAMSraBLE, : Thomas F.Geiler,Director rsnss. 16 9• g .�� Buildin Division . Argo�,t a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.toWn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or les' 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 y, when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt License or registration "before the a valid for individ Office ex date. If fou ul us only of Consumer Affairs and B d recur 10 Park PI n to: Boston aza-Suite 5170 usin 'M 02116 ess Regulation a. / r _ o i \` itho tgna Ur Office of Consumer Affairs 8 B mess Regulation I. HOME IMPROVEMENT CONTRACTOR _} Registration: .1,72458 Type: Expiration: 612712014 DBA J L SILLIAMS COIV.rTRUC, [OWCO). JEFF WILLIAMS \ T 10 WEEKS POND DR.`- t _ g a s- x ` FORESTDALE, Undersecretary `gOar-�ii'hittctt�-'-pclj��� Const�wid�ri Rerulatiot W �° 4ctici S nS and Stand., Lice.,se. CS � erVi atd.� Restricted 10351q sor License to: Op 1.0 yyE WILLIAMS FKS,.POND F�RESTDAL DR E MA 02644 , .: &. _ f ornmissf�aier ExPiratio _..._ n: 12/14/2013 Tom: 103504 File No.2008-1157 FP age-#AZ Building Sketch BOrwer Chent DAVID C.LUBNER Pro AddMJS 123 SCHOOL STREET City COTUIT CoUrb BARNSTABLE State MA Zi Code 026W3= Lender CAPE COD FIVE CENTS SAVINGS BANK LARGE WOOD DECK 2NO FLOOR AREA KITCHEN BEDROOM BATH BEDROOM ® _ BATH b DINING b b AREA BEDROOM b FPL LIVING ROOM DEN 2&V 14.W LARGE.GOV.PCH >�oYN.aro'° Comments: AREA CALCtJLATiONS SUMMARY .LIVING AREA BREAKDOWN GLAl First Floor 850.0 850.0 First Floor GLA2 Second Floor $78.0 578.0 25.0 s 34.0 850.0 Second Floor 110 x 22.0 242.0 14..0 x 24.0 336.0 Net LIVABLE Area (Rounded) 1428 3 Items (Rounded) 1428 I ( i _ I !. 1. l.... i i - Ir I ' 64I ' , 1 5N ' kw i : � 1 I 1 ... I I I I ' i I f (. 1 , � � � t�• I. ( I , 1 ; r ; Lf I I � � ✓ �, f i 1 I I r i II , I I f , , 1. . l I i I I t I 1 �• I a .... � � E�Fr I x r ' I I 1 !! : • I r rr I � i j { 1 I ; G : : : l 2/7/2013 CONTRACTOR WAS IN TO PULL A BUILDING PERMIT AND INFORMED THE BUILDING DEPT., THAT THERE WAS A FINISHED ROOM IN BASEMENT WITH NO EGRESS WINDOWS, JUST A BULK HEAD DOOR. a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 020 Parcel 6 . Application# 62067.002?o Health Division Conservation Division Permit# Tax Collector Date Issued d Treasurer Application Fee ®� Y/f'7 Planning Dept. Permit Fee . 06 Date Definitive Plan Approv anning Board �V �' Historic-OKH f' rl" reservation/Hyannis Project Street Address Village -f Owner �40 Address Telephoner.C!��tfl 4� d'= Re"Ce Permit Request .,va4ze 42n,�> Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay . Project Valuation aoo Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑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 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other J N Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal sto e: ❑ Flo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exi g ❑net size`' Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: co Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ -` Commercial ❑Yes ❑No.. -1f:yes,-site-plan review# Current Use Proposed Use BUILDER INFORMATION / Name �l�/���1 n�� Telephone Number Address ,3' 5 ��J License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � SIGNATURE DATE � ��� FOR OFFICIAL USE ONLY: PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS. VILLAGE r _ OWNERi ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ; b` Boston,MA 02111' www.mass.gov/dia ' Workers"Compensation lgsurance.4-Midavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gib Name(Business/Organization/Individual): • f' - �i Address' !2 S SL City/State/Zip: ® Phone-P Are you an employer?Check the appropriate bog: :Type of project(required):, " 4. I am a general contractor and I 1,❑ I am a employer with g 6, ❑New construction . employees{full and/or part-time).* • have hired the sub-contractors 2.❑ I am a'sole proprietor or partaer- listed on tbe'attiched sheet. 7. ❑Remodeling ship and have no employees These sub-contactors have 8. Demolition i�vorkin for me in an capacity, employees and have workers' g Y p ty t. 9. ❑Building addition [No workers' comp.insurance comp,insurance, equned.] 5. [] We are a corporation and its 10:❑E1ectrical repairs of additions 3 I am a homeowner doing ill-work . officers have exercised their l l.[]Plumbing repairs or additions ' myself.[No workers'comp. , bf exemption per MGL 12,0 Roof repairs insurance.required.]t c, 152, §1(4),and we have no •Other /v� 4_ - employees, [No workers' 13 ( comp,insurance required,] e �'�%�. ' *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 anew affidavit indicating such $Contractors that check this box must attached an additional sheet showing the name of the yub-contractors and state whether ornot those entities have employees, If the sub-contactors have employees,they must provide their workers'comp.policy number. T qm an employer that is providing workers'compensativn insurance for my employees. Below is.the policy and job site• information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: - Job Site Address City/State/Zip: Attach a copy of the workers' compensation policy deelaradon 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 tip 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 maybe forwarded to the-Office of Investigations of the CIA fat insurance coverage verification I do hereby certify nder the�ainsnd penalties of perjury that the information provided above is true and correct Si tore: Date: _ Phone-k Official use only. Do not write in this area, fo,be completed by,city or town afficiaL City or Town: ' .Permit/License# Issuing Authority(circle one): :1.Board of Health 2.Building Department 3. City/TownClerk 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 in the service of another under any contract of hue, 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 of more than three apartments and who resides therein;or,the occupant owner of a dwelling house having n p of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced,acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter-152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public-work until acceptable evidenee-of cornpliaace v,+ithtlie insurance- requirements of this chapter have been presenteddto the contracting authority.'• Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability'Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that ibis affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents., Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate'line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information•(if necessary)and under"Job Site Address"the applicant should write"all-locations in � (city'or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone•and fax number:. T.o Commollwwi&of Mwarhusetr s Dtpadmwt of ladutdal.Acdd(mts • Office of Javestigaflow 600:Waabingtori Stet Boston,.MA 0.2111 . . TO.#617-727-4900 ext 405 or 1477 MASSAFE Revised 11-22-06 Fax#617-7274749 www'.r a1mgovIdia l i °FVE� Town of Barnstable Regulatory Services " saFMASS .E Thomas F.Geiler,Director 059. y Mnss. $ , . MA+p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax; 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations renovation,repair,modernization conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �' .Type of Work:��/' �— /�//�"" �`' Estimated Cost Address of Work: �t l�a / sx Owner's Name: l�� Date of Application: I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law ❑Job Under$1,000 QBuilding not owner-occupied SQwnei pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. O Date Owner's Name QIonw-.homeaffidav I i OF 4HE tp� Town of Barnstable " Regulatory Services yBARNSTABLE, e � ' o� Thomas F.Geiler,Director * * 9 MASS. g 1639. p,� Building Division rFD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number sssttre._etC village "HOMEOWNER": ua�Pi/ 1Z ✓0<77l�lOr l`T'D[!7 CAS �� Y��—��,�"� � i�1�� name home phone# work phone CURRENT MAILING ADDRESS:_ _ C/ ,t� 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 nd requirements and that he/she will comply with said procedures and re it ments. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner.shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction-Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly _ when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt �I 123 School St. Cotuit yr4 F yx� yxL T /fir � �� • Go�cr��� Go�crelte aC�hG�r�� 1 " • r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division Date Issued Conservation Division / Zi �Z Application Fee Tax Collector Ifl K. }'Yl. on Permit Fee '41 2 J Treasurer 6 ryl Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address k Z-3 Village C-6 \ J Owner L0.(-�AQ.� �'�W Address V Z:3 Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,60o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ 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 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ o SU Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size N Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: a~ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ -� Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use _ BUILDER INFORMATION Name C-,�Sa C Telephone Number J`—�a V--7 " 3 2- Address C:I _ License# 6 5 KL ® A� Home Improvement Contractor# 1 9 1 � F� Worker's Compensation# C, _Q�,(D 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE �� Z 8 ` O 2 x FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED MAP/PARCEL NO. E - ice• t , I ADDRESS VILLAGE OWNER J DATE OF INSPECTION: i- } FOUNDATION'( C 4� I , t 1-3 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL R GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT , ASSOCIATION PLAN NO. -ram 1-f L-fOpTHE T Town of Barnstable Regulatory Services HAMSrAaLE. ' Thomas F.Geiler,Director . OS Building Division fD Ma's 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 I;AW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal,demolition, or constriction 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: ' VI k __cb V� ('l� l Estimated Cost Address of Work: 5L�6 W Clf 7 vmd oZ6 3S� Owner's Name: �U e 1 ow Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date " Contractor Name Registration No OR Date Owner's Name Q:forms:bomeaffidav The Commonwealth of Massachusetts - ` - Department of Industrial Accidents == = Office 911HY8502M RS 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit Co name - �-- C L owl location: <t.S /v �Z �O 1 city �� phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workii m' ca acity a sole% %% ///VI%/O/O�/G%////////%. an emP 1 er rovidin workers' compensation for my employees working,on this job. o3' P.................................:::::.::::::::................:.::::..::.::.:::::.:........::: :::::::::::.:...............:......::::::::.::::::..::::::.:.::........:::.::::::...........::.:.:::::::.:::.:....... co m an .name. .......... . . . . . .. »> . . ;:.: .. ::::::{Ci•::•: , .. .. v:::. .. ::.�.�.:.................... .:.... ii.... ... :. :•r:::. :.:::. :.:......:::..:.::. :. .........:. .:::::.;:.;:.. .. , :.. ::::...,.:.::::.::.,.:.....::: hone#:>;::':;:.ti'�':. :,.;::�;'<::..:,:,.;,.<...,,,:::::..,:.. ...............::::.:•...:.:::...... �riseirarceci :: ,,:�: a"'94 :;<>::>:}<:;.�:<::.,;:. .. •;':;s�:�::::: >;:. . :«.:. ,.:... hcv I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have win workers' co ensation olices. llo P e fo ::.....,....................................:..........:.....:...............,.,,....,•.•,,.. ::,::•:::::•::. ;:::;::e>' 'is?i3i'y °;asi<i ? ? < i <i>:::;:isfin `; :;;: ;<i;i; i<i''`'ii:i:'•asi ':@2ii< ` <' :`;}::'' `:':;``>:»: >' `:`. :>`:` :<:s'c<: :::: 'i 'co `' :nam M ;5% `s� ±?` h ^C l:L:ii?iiii�::':J`?:4};:::iiii^ii:;�:;::{is5y}:;:j}}i:;�::;ii%;:;{:;C'ri:4ii;:%:,'ii:;}:{i;:ii`::jiT??:>.:ii ri:::?:i'iii:::Jii'^:+:`irij:{;{:i i':i:!:i`:iiiii:^i}iii}isri'i::}:{{{•}:;i:^::{tK.•;•.r}Y:}•}:•.{+.•::::::::::::v:::•.�:::::••.::::?:•, iyi i::{;i:ii:•':i iv'.i':�•}:•}:4:,v;'.•}r:;:jjir:4:•}}}:{ f:+L:ii i:i:iii:? iii ilii:}.:ii::: 4:y:j::;%{ :i$i::ii:::J::;r:;:::i:!;:;{.'•:$::::i>�:}.:i:C:�:'. t .M �.. OI�CP :?:::iS.:i:;:i:}x:;:.'•:�:?:>:`:iii:;c`•SiiY•%::�:::'�;i:';>fi;#?%;;::;:%;:;�:{::::%:i:}.';�:`:i:%;:a :�::%}}:::<:;:�::::�:{::�;:'::::•?.i4i:o:::::¢:�:-i:::�::::::•};:i.;`.ax; �};{:•::....,:>::::-.�:. � � ' :: flue:>�::%::%;i%Si:`+::%::;:::[;:%:iii:�:::;:<;;r;:i;::;':;:;:%5:�:i i<•:;;:;::};;';:�:•. ... . .. ....... .. .... ' 4 ::;i:}:i::iiiii:�if.i::v :`:::::i'r:•i}:::i:':•ri'-ii:::vi• :;::i:':j}:�:{;i':<2:�':::':?::i;}i:ti'v:::t%}•':}`v;'tiv} ::vv:{:::::::'rii}::::::}::::i::i:�}L:i:. ` : :"v;:: :is i:': ::'ii::ii(:}�:: .... �:��. �. .: ....... ...... OIIt!W. ................ ...............................:. n�nrance:co >>'_ ::: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification 1 do hereby certify under the pains and penalties of perjury that the information provided above is tw•and correct Signature Date — c Print name Sp�,r Phone# -3 Z b 531 official use only do not write in this area to be completed by city or town official city or town: peradt/license# ❑Building Department ❑Licensing Board checkif immediate response is required (3Selectmen's Office ❑Health Department contact person: phone#; _ ❑Other 0vm*d 9/95 PJt) Information and Instructions r Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any coact of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a 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,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 along with a certificate of insurance as all affidavits maybe :. 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 the D artment of Industrial Accidents. Should you have any questions regarding the"law"or if you being requested, not ep rnp are required to obtain a low. workers' co ensatioa policy,please call the Department at the Al number listed be 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'in the Department by mail or FAX unless other arrangements have been made. .The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Ottiee of Inaestlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �+ _Tk ��/� o� aaaaclivart7a BOARD OF BUILDING REGULATIONS ;i Lice nse- , 1 e. CONSTRUCTION SUPERVISOR I Numb er,-CS\ 065640 I! I YFac�res' 1?004 Tr.no: 13514 Restric _ JOHN P CLANCY�� 8 JASPER LN — - FORESTDALE, Administrator i - Assessor's offioe (1st floor): Assessor's map and lot number L... <?4.(�. "..1Jyf....... X' �oiTNETO� Boag"rd of Health (3rd floor): Sewage Permit number .......... ..:. �-.......,M.(. ............. Z BA]USTGDLE• Engineering Department (3rd floor): M"0I Mouse number '' f G� t639 •� APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only • t TOWN , OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �U/C. u ' !R!i / &C41-1A)6 .............................................. ..... ...... .............. ............. TYPE OF CONSTRUCTION ................."'�'`�N ..£.... �f!N1l41 .................... ............ ...---..�?.......19.9.. TO THE INSPECTOR OF BUILDINGS: .The undersigned hereby applies for 0 permit according toto the following information: Location ` ...�.�3 o1 Q.!......+:...'......`� .T..l�l. Proposed Use .........Azx)..�.44z ............................ Zoning District ...................1,/,,,,/,,,,..,,...................:................Fire District r-,-497z--�z 77— ...............................I.......... Lac .real. C, 3rowh Name of Owner `' ............ ..........Address ... .,........................................... . . C�!e n. . C Lou h �" C TP�� ) Name of Builder ................ .......... .......g....................Address �°�9...........✓.�.//�....... " Nameof Architect ... .............................................................Address .................................................................................... .Number of Rooms ............................................................:.....Foundation ...../!��.......................^....................I..................... Exterior .......(wOQ. .............,1.G. /?..............................Roofin ��-/g .......... .. . ..... ................................................. Floors ............................................................Interior .......... ......V................................................................ Heating �/V ...........................Plumbing ../ ..........��..... .................................................... ........................................................ Fireplace ........N1✓. .............................................................Approximate Cost—..<........OF 0L-)��.� C/ . Definitive Plan Approved by Planning Board 19 Area / .1 : ' ..... Diagram of Lot and Building with Dimensions Fee . �............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH r � v � , a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above �r construction. Name .....�// -Y•�-:.. .....C/ .✓/.././.. .. Construction Supervisor's License BROWN, LAUREL C. A=020-041 i J r No ....30365. Permit for .. Build Dormer .. .......... ................................. Sin le Fam i.nq.l.e.... ..Dwellin.................9........... Location ...1.23..School Street .............................................. Cotuit ............................................................................... Owner .....Laurel. . ...C......B.rown. ... .. .. .. . .. . .. .......................... Type of Construction .....Frame........................ ....................................................................... FPlot ............................ Lot ................................ Permit Granted .......January 9 , .19 87 Date of Inspection ....................................19 Date Completed ......................................19 �:x.; ..a,..., i.0..'r2".✓:e..,.S:--+ _..... .«.y: a:z::r.;t"9;ii,r...yx,:Y>„C'Sr•v.cy.E:vni^.k." .,::si4'i"�rw+c+ Yi,yr. ,�•yry!..;se. , . .. •tar-a+....x., r_N Assessor's office (1st floor): THE T Assessor's map and lot number � .—.�.'...... of o Board of Health (3rd floor): fO�Q ♦� Sewage Permit number .0...................... i 33,Hd9T&BLE. . Engineering Department (3rd floor): /Z 3 vo rb 9• House number 3 0 . ... ...... ................ ........................ CEO YPY d' Definitive Plan Approved by Planning Board ________________________________19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. !!✓.�^�.....��c'�, ce t// ........................................................................................................ TYPE OF CONSTRUCTION .....�"©.0.......� "'' .........` _...y.....................19.)0� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �' 17U .ST l_ 0G /................................ '.. ...../........ ................................. .................................................................. ProposedUse ........ Wed. ..4........................................................................................................... ............................... .� 7- ZoningDistrict ........................................................................Fire District ....... ............................................................. Name of Owner 14 .A Address ... :!7......SC ,dQ.......5 ...... .1 ?,�c��l .......... Name of Builder .(r/N�,r......l /0U'.�..�........��. xr`. � / V Address i..... v.... Nameof Architect ...................................Address .................................................................................... Numberof Rooms .......... -..............................................Foundation .............................................................................. Exlerior ......................... ^...................................................Roofing Floors ................ ...........................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace pp �...................................................................Approximate Cost ...............�..ao Area .... ..�l�.�r..`:...... Diagram of Lot and Building with Dimensions Fee ...... ......: ............... ......... 1 , � N, t ♦/F r.-� I y!V ,10 q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above I construction. � I Name . :!,f��'ic .. .. a'�►- � ............... ..... Construction Supervisor's License ... 0.1�'S��« BROWN, LAUREL - a A=020-041 No ..317 7 3 Permit for ..ADD DECK .................. Single Family_.Dwelling Location ..123._Schoo_l Street . .......................... Cotuit ............................................................................... Owner .Laurel.._Brown... ................................... Type of Construction ...Frame.......................„ .............................................................I................. Plot ............................ Lot ................................ April 4, 88 Permit Granted ........... ...........................19 Date of Inspection ....................................19 Date Completed ......................................19 C4 t ! Assessor's offioe (1st floor): T pTIC SYSTEM MUST BE nn nn TALI.ED IN COMPLIANC cF THE>� Assessor's map and lot number .......�1. A( ".. �. . * K� Board of Health (3rd floor): WITH IME S E Sewage •Permit number ......:. /...... :.......,....f.l ...:............ NYIRpNMENTAL COD = BAB39fADLL• Engineering Department (3rd floor): TpWN REGULATIONS ,,o NAM . House number ............................... ....),a.3...... !�`� 'F0MAIale { APPLICATIONS PROCESSED ,8:30.-9:30 A.M. and 1:00-2:00'P.M. only TOWN. OF - B�ARNSTABLE BUILDIKG INSIPECTOR . APPLICATIONFOR PERMIT TO /L•o................. ............................................... .... ................................................... TYPE OF CONSTRUCTION r L . ��V L.................... ......... 19.p .. � - TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ppeermit according (_to the following information: Location ..: .z3....... I1S2o.�......r� :...:...:.1 OTS ...............:...:.......................................... ... .... Proposed Use ......... ...................:.............................................. . .................. Zoning District ............Fire District .. • Name of Owner L.a...u,u-e (...Ci..-I-�r,OWA...........Address rnOl�l/Yl S�. ...............................,................ . . ... Name of Builder �I�Y1.h.....4-.l.Q.ugh.................Address ........ C"!�/..f'�'`.:il/.1r..................................:........... ................ Name of Architect ...................................................................Address ...................... Number of Rooms :.................................................................Foundation ...../0.'................. ..... Exterior . �.�W.a.C!...... �i. .!�!:. 1..P.............:.................Roofin <.. g .......... .. . //� .........:.......................... Floors .................:��..............................................................Interior N//:� ........... ... ... ....................................................... Heatin ................Plumb g / ........................................... g ........../Vd/..... ................................................... Fireplace ......../V/w.............................................:...............Approximate Cost .. ........V:.® .. .. ................... Definitive Plan Approved by Planning Board ---------------=------------ --19-------- Area 4. c_.?i �CK ... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH F OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to-all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ••......C47 ............ Construction Supervisor's License .Ff... C?:�a../.. �.... BROWN, LAUREL C. No ..3.0365.. Permit for .....B..U...I..L..D......D..O...R..M...ER .. Single Family Dwellinc ......... ............................................................ 1'3. School Street . Location ......... ..................................................... Cotui't ............................................................................... Owner Laurel C. Brown .................................................................1. Type of Construction ..F...r.....am.e............................ .. .. ............................................................................... Plot ............................ Lot ................................. Permit Granted ..............................january 9.,.........19 87 Date of Inspection,/-,—.:.:z ..............19 Date Completed .........]� �...............19 r a 0 M X 14 Assessor's office (1st floor): , SEP-m aysTEm MUST BE Assessor's map 'and lot -number � ..... Z. ....... ) v a L.E 5 e�Q Board of Health•(3rd floor): Sewage Permit number ... . � ,.. ,. ...... ...Ei�.T ,kr,Mti� at� �tf$L. CODS ® i BaaasTsnte, i engineering Department (3rd floor): TOWN REGULATIONS MA & . 7p0 i639: ♦� House number . /.�.°� .. aye 16(r _ 011?Y Definitive Plan: Approved by Planning Boar ________________________________19-------- . APPLICATIONS PROCESSED 8:30.-'9:30`A.M, and 1:00.2:00 P.M; ,only 1 TOWN OF . BARNSTABLE ' ULLDIHG . INS.PECTOR APPLICATION FOR PERMIT TO ..!C y/.��...:.......... .....�.. ../C.........................................:......:.........:.: ................ k TYPE•OF CONSTRUCTION ....:P.0: �.. ed %j1.e�.r .................................. .. .y .............. TO THE INSPECTOR. OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information: Location .....Ca . .J� Proposed Use• ...... U.�... 4.5;—r 14......: ...... ... ....... .....5 ..: ............... .. ..................Fire District :.:.......� Zoning Distr.ict. ......::.'.::�....,. .. ... .... ............ . •.. .......... ......... / Address ... Name of Owner .A..U.1? L......a?OG!h......:.............. �c7 ..... C..�!007 ... .. ..LQfl; E� 7/ l `` ''� Address .... .. P/...... /�(j C' /�N 0Ph . Name of. Builder ..(J�!Py! ��....5.!....... .Y...... ...... � ......,.. .. ✓... J {!�...:. . .. Name of Architect ............... ...............................................Address. .:;......:::...... :: : Number of Rooms .......Foundation............. r ........ .. . Exterior . .....Roofing Floors :............ ....... ............ .....:.............Interior ........... W Heating ......................................... .................. ,:..... .Plumbing . .... Firepp -_. :....'....:..........:..........Approximate Cost .... .... ........00........................ lace ............................ . ......... / ` Area`. .. .. ......... Diagram of .Lot and Building:•with Dimensions Fee '...... ................ 1 w C. irnk�� r : rpru OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS" -V� t I'hereby' agree to conform to all the Rules .and Regulations of the Town of Barnstable regarding the above construction. Name ........................... Construction. Supervisor,'s License Q. ...... ......... BROWN, LAUREL. - No Permit for. ..ADD...DECK............. - �Fam. .y....A.Wll .??.g.......... location ~ 123 School Street ► A ........ ................................ ....... Co'tuit ' s .....................a- urb 1 ....µ.......... � � • .. < _ - - . . Owner ................... .......................................... , Type of=Construction" ^Frame K Plot .................... Lot •. , - 'Permit Granted ...p'Prla .4.!.......:....19 8 8 Date of Inspection .'.... ................... .....19 - CDote Completed ..a: !.'.......:19 s C. all 17 cr r-7 •p w Z ;r TOWN.OF BARNSTABLE'BUILDING PERMIT.APPLICATION Map DAD Parcel '`// �`� ����.���SYSTE �'N�s Permit# Health Division I ..�1;5=�S�g Ly�y���COMPLIAA CLssued 7'60NAAEN AL Tax Collector+ Treasurer Planning Dept. _ — Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis . P Project Street Address 123 .-School Street Village Cotui t7. Owner t Laurel Brown Address c/o 619 Main St- , Centerville ' ' 442 - Telephone 775-1 i-==r 4� D f. Z L, � 1%`� i S,M.— '1 ,Permit Request_ -Remove existing ( 1 ) window unit and replace'with larger unit Replace kitchen cabinets~, replace front steps Square feet: 1 st floor:existing proposed '_ 2nd floor: existing: proposed - Total new N/A Estimated Project Cost $15, 0 0 0. 0 OZoning District Flood Plain Groundwater Overlay Construction Type blood Frame Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation., Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure 70 years Historic House: O Yes -UNo On Old King's Highway: ❑Yes W No Basement Type: X3 Full ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Y Number of Baths: Full: existing 2 new — Half:existing — new — Number.of Bedrooms: existing 3 new — Total Room Count(not including baths): existing 6 new — First Floor Room Count 4 Heat Type and Fuel: ❑Gas -NM Oil ❑ Electric' ❑Other Central Air:4 ❑Yes UNo Fireplaces: Existing 1 New — Existing wood/coal stove: ❑Yes 43 No Detached garage:❑existing ❑new sized Pool:0 existing ❑new size '0 Barn:❑existing 0 new size 0 Attached garage:❑existing' ❑new size 0 Shed:0 existing 0 new size 0 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes, site plan review# A- - 'Current Use Single Family Proposed Use Same Ronald J. .,Silvia BUILDER INFORMATION Name Silvia & Silvia Associates, Inc. Telephone Number 775-1 442 Address '61 9 Main Street License# '01 6932 ' Centerville, 'MA 02632 Home Improvement Contractor# 101627 Worker's Compensation# TC 9 9 8 3 61 9 4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN by Private Contractor ' SIGNATU E DATEci Sr FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i . -MAP/PARCEL NO. ADDRESS VILLAGE - OWNER - ` DATE OF INSPECTION: FOUNDATION 0TIZ �, t _ a FRAME- INSULATIONS FIREPLACE { ELECTRICAL: ROUGH FINAL M1 - '{ PLUMBING ROUGH FINAL GAS: 'ROUGH FINAL - 9 FINAL BUILDING , t� Kk DATE CLOSED OUT ASSOCIATION PLAN NO. <.� Workers' Compensation Insurance AMdavit J 2jogin—t Inforntation• F' e� nsr hRlh('Ifieri y _..- ' = ers:esaseao:ae.s s r�i�ee:ems name: 'Incntion: '" city nhone 9 of am a homeowner performing all work:myself. I.❑._ I am a sole proprietor and have no one working in any capacity ., .•T»...T.. ,,..,,_ 1 am an employer providing workers compensation for my employees working on this job. canlnnny name• Silvia & Silvia Associates, Inc. A((l tress• 619 Main Street city- Centerville, MA 02632 nhone ff, (506) 775-1442' - insurance co. Maryland Casualty Rorixf1 T 9983F194 ❑ 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: somnant•name- address.• citt•: phone H• Insurance-co. nolicr# 1 - .. �..M.rs�e'r,+''� f'st?'!�T53"S.n-Fly r•�S L�r����'J''`7�S} ,*e.sY"�^iS ctimnam•_name: st1dress: dh� phone 0- Insurance co. voila 9 _ ,t�lttaeb addltlatiafsbcet Ua`etessa •+.:.x,r r.. r: •wya« • �-';�,� fattiire to secare corer:�e is rcQatred tsadtxSt ctioa ISA oltilGL iS2 txa lad to the Itapositioa oftximlati ptxtaltia of a fine ap to SiS00A0 tadlac oac years. Impcisaameat at troll is d peaaltta(a the farm of a STOP\\'ORI:ORDt1i tad t floe of S'100A0 t city tgtttnst ma 1 aaderstand that a copy of this statetneat mar be fotwtrded to the ORice of laratt�ttions of the DIA for t:orera�e trccificttioa 14 hereby ccrtl er f ai d p ojp rjurr rat file Information prodded above Is trite and correct. SIC-nature Date Print name Ron Silvia, President Phone>~ (508) 775-1442 omclal use only do not write in this area to be completed by city or town official city or town: permitAiccusc/( ntiulldiat:Department QUcensiag Board p check If Immediate response is required Q5eleetmea's Office ; t]itealth Department contact person: phone q;_- nether f ................................ ------ ........................... ......................... ......................... ......... ISSUE DATE(MM/DD/YY) ......................... .. ....................... ...... ............... ...... ...... . .................... 12 01/98 ........... ............................ ................. ........................ ........ ...... ................ .......................... . ..................... ........ .......... ......................... PRODUCER;.;:.; RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE [he Fair Insurance Agency, Inc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P.O. Box 430 619 Main Street POLICIES BELOW. Centerville, Ma 02632 COMPANIES AFFORDING COVERAGE (508) 775-3131 COMPANY LETTER A MARYLAND CASUALTY COMPANY B INSURED LETTER Silvia / Silvia Associates Inc COMPANY c 619 Main Street LETTER COMPANY D Centerville MA 02632 LETTER COMPANY E LETTER ........... .......... ............ ................... ..................................................................................... .......... .............. , : .:.: . ..... .. .................... ... .... .......... ........... ..... .................... .................. ..................... ........... ............ ..................... ........ ................... ......... ................... .0.0 ...***,*...*....*­... ........ ................... - V ... .................. ........ ........... ................... X ........... .............................................................. . ......... .................................**... ................... THIS IS TO CERii�`T***H`*'E 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTA DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE s2MIL X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $2MIL CLAIMS MADE rX ]OCCUR. RGP27336966 08/01/98 08/01/99 PERSONAL&ADV.INJURY $1MIL ....... OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $1MIL FIRE DAMAGE(Any one fire) $50000 MED.E)(PENSE(Anyoneperson) $5000 AUTOMOBILE LIABILITY • COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $500000 HIRED AUTOS CA90517244 08/01/98 08/01/99 BODILY INJURY NON-OWNED AUTOS (Per accident) $1MIL GARAGE LIABILITY PROPERTY DAMAGE $500000 EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM ....... .......... .............. ......... .......... ................. ............................. STATUTORY LIMITS_TSTA ....... WORKER'S COMPENSATION TC99836194 04/01/98 04/01/99 EACH ACCIDENT I$5_0,0,0 0"0 ......... AND DISEASE—POUCY LIMIT 1$500000 EMPLOYERS'LIABILITY DISEASE—EACH EMPLOYEE 1$500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ............. ................................ ............ .............. ........ ....................................... ..........• .............. ............ ...... ........... ... ...................................................................... ........ .................................... .I . . ............................................. . .......... ................................ ....................... ... .......... ............. ..................... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE rown Of Barnstable EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO- wilding Inspector MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 3outh Street LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Ayannis MA 02601 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE . .... ..................... ........ ............. ............................................................... ... . ................................... .......................................................................................... ...... ............... ......... .......................................................... P. .. . ........... . ............................................................ ... ... .............. ........................................ DEPARTMENT OF PUBLIC SAFETY 141571 ONE ASHBURTON PLACE. RM 1301 + BOSTON�M,A @Z1@8=1618. . .f CONSTRUCTION SUPERVISOR LICENSE Number: Expires: ::::_:...::. CS 016932 11/18/1999 Restricted To: 00 RONALO J SILVIA `: 619 MAIN ST t r"���-�.•� CENTERVILLE, MA 02632 - Keep top for receipt and change of address notification. 1.41571 Y. OEPART EMT OF PUBLIC SAFETY Restricted To: 11 CONSTRU d "SUPERVISOR LICENSE 11 - None Nun Expires. 16 - 1 6 2 Family Homes Failure to possess a current edition of the Massachusetts State lWilding Code ROliA4. IVIA is cause for revocation of this license. 619 AATN•ST CEKTERVILLE, NA 12632 I fie set / ae HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards One Ashburton Place — Room 1301 I Boston , Massachusetts 02108 I -L-------------------------------- HOME IMPROVEMENT CONTRACTOR Registration 101627 Expiration 06/26/00 Type — PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR oil Registration 101627 Type - PRIVATE CORPORATIOI SILVIA & SILVIA ASSOCIATES , INC . — Ronald J . Silvia I ,Ezpiration O6'26L00?_ I 619 Main Street I SILVIA 8 SILVIA ASSOCIATES Centerville MA 02632 ! 1?4%%ld J. Silvia ADMINISTRATOR 19 Main Street Centerville MA 02632 L The Town of Barnstable BUM ffiTASLE. ` Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 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. cc 11 Type of Work: �'v!d V E:� Estimated Cost r Address of Work: 1 23 Sc ttDo L S T Owner's Name: L.-WV 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: lkk� !�I L�) I lft= *qp"am% 109! Date Contractor N e Registration No. OR Date Owner's Name 9 :forms:Affidav Summary Report �r ar TM - INDOOR AIR QUALITY SPECIALISTS Test Date: 7/30/2013 Technician Name: FILL IN TECHNICIAN NA Test Performed by: cape cod mechanical systems Customer:, jell williams 8 fruean ave 123 school st� so.yarmouth ma 02664 -- 508-394-7501 cotuit ma 02635 Enter Email Address Test Results: Measured Duct Leakage 43 CFM Equivalent Leakage Area 8 Square Inches Duct Leakage as a Percent of Total Conditioned Space 2.6 Duct Leakage as a Percent of Total system Flow 3.6 % Pressurization/Depressurazation Depressurization Duct Test Pressure Tested at 25Pa Type of Test TYPE OF TEST Protocol PROTOCOL Property Info: Total System Airflow 1200 CFM Total Conditioned Floor Area : 1650 Square Feet Equipment Info: DLT-5 Firmware 1.2.0.3 DLT-5 Serial Number 1) Estimated Efficiency Loss from Duct Leakage: 3.6 % Comments: :E Wid GE 1 y, E110 l jcuvis�rmw ':ilo 00i TOWN OF BARNS' ORE 'Ail-It€`C OIULSjo BASEMENT BASEMENT WINDOW WINDOW 2'8'DOOR ~ I � � BASEMENT — — WINDOW _ — _ I 2'6"DOOR W — i — BASEMENT Y 7 I TWINDOW D 2'6"DOOR MECH. 1 2'0"DOOR ff—UP T-0' CLOS. 3'0"DOOR I 4 1 -.BASEMENT 4 WINDOW REMOVE PIN POST& BASEMENT c� © INSTALL NEW LALLY WINDOW COLUMN W/1/2'STEEL cn Q I PLATE ON BOTH SIDES OF GIRT WHERE SPLIT . � s 1 REMOD. GAMEROOM I 1 BASEMENT WINDOW ot NEW 2 x 4 WALLS W/3 1/2" p BATT INSULATION(R13) I o LEAVE 1/2'AIRSPACE BETWEEN NEW WALL&FOUNDATION. 1 P.T.2 x 4 SILL ANCHORED INTO SLAB&TOP PLATE I ONTO JOISTS ELECTRIC 1 PANEL raw r t � 25'-0" - l SEM E,NTPLANBA LEGEND: © SMOKE DETECTOR C_] EXISTING WALLS © CARBON MONOXIDE DETEC �- CONSTRUCTION TO BE REMOVED NEW CONSTRUCTION . COTUIT .BAY DESIGN LLC NEW- REMODELING.43 BREWSTER ROAD F0f MASH.PEE ,MA., 02649 LUBNER RESIDENCEPH. (508) 274-11FR