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1758 FALMOUTH ROAD/RTE 28
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CAPE COD INSULATION /ISIN GIA>f StAMt[31 SPSAS IOAAI SYSPSNGtY - ' SAIf3 GVIt333 INSNAl10N C3141gt3i - ' 1-80Q-696-6611 . l'own of Barnstable Regulatory Services Building Division 200 Main St l-tyannis, NIA. 02601 ; Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed &: completed the Insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on-the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State RequirR nts. , z.. Property Owner Property Address Villa "- a o S50A 4 6lI z-4 LC4L PALL+0 1�S 4 l,vl b� � 64141 1 l 0-- Insulation Installed: Fiberglass Cellulose R-Value Restricted . Unrestri ted W r- tv- rn Ceilings ) (X ) (31 ) ) (X) Slopes Floors ( ) ( ) ) ( ) ( ) V✓ ills ( c X t i3. ) Air Sta to - Sincerely - Ile y E C sidy J , President Cape Cod nsulation, Inca 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` OP rcel Application o Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �3�g�13 Historic - OKH _Preservation/ Hyannis Project Street Address AA 5 Village �'�'UZ' Owner IZ�it ��• �((�(,f� Address Telephone Permit Request �Q �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay / Project Valuation ' Construction Type�� W �— 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' ighway:�:V Yes+❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other -_ C Basement Finished Area(sq.ft.) Basement Unfinished Area(sgglp Number of Baths: Full: existing new Half: existing nqa Cn Number of Bedrooms: existing —new co �.� Total Room Count (not including bathe): existing new First Floor Root i Count c�.} Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes &No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number '✓�g� �7�`1 Z�� Address �� ����� �u-Qi License# 16,0 a� `''t Home Improvement Contractor# �J 3 Sty 7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WI L BE TAKEN TO q4r&&X SIGNATURE DATE 8w'l t� r FOR OFFICIAL USE ONLY s s APPLICATION# a DATE ISSUED - v MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL — r FINAL BUILDING t r DATE CLOSED OUT ASSOCIATION PLAN NO.. - NiAssachusetts Department of Public Safet\ Bo4u•tf of Building Regulations antl Standards. ® construption Supervisor License Licen .? CS 100988 y. HENRY CASSIDY 8 SHED ROW WEStT 'JARMOUTH, MA 02673 Expiration: 11/11/2013 ( unuuissi4ntel. -- Tr#: 7620 pQ1~YGQ1)2'(ClPI•l."f('f�l� Office of Consumer Affairs and Business Regulation ��,-:--- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2t14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card.Marls reason for change. (� Address --� Renewal t.niployinent ( Lost yard SGA t - .4\ Office of C:ousumer Affairs& Business Regulation License or registration valid for individul use only Ffl{OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:- egistration; 153567 Type: Office of Consumer Affairs and Business Regulation expiration: 12115/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION,;)NC: HENRY CASSIDY 18 REARDON CIRCLE SO YARMOUTH, MA 02664 Aotvalfi Undersecretary witho t nat re The Commonwealth of Massachusetts Print Form } Department of Industrial Accidents `=�� ``'�_��� Office o Investigations ( .� ff f g I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/:Plumbers Applicant Information Please Print Le ibl Naive (Business/Organization/Individual): I at Address:_l - City/Swe/Lip:_ F}_ V V/ IM ' Phone #: -r-2_0� I Z [ L Are you an employer? Check tt e appropriate box: Type of project(required): I. I am a employer with 210 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2-❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' insurance.$ 9 ❑ Building addition comp. (No workers' comp. insurance p• required.] 5. We are a corporation and its 10.0 Electrical repairs or additions I ElI am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof re a•rs insurance required.] f c. 152, §1(4), and we have no �j ofIbo / employees. [No workers' 11, Other W rk h D comp. insurance required.] "Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Iiomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such. 'Convectors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inforrnation. r insurance Company Name: Actohc, Policy #or Self-ins. Lic. #: WGA o0z�Zh 01 Expiration Date Job Site Address: �G�%' t'��/�/ / _ City/State/Zip:.!�� r►'rr/'� 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 tine 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 nine oi'ttp to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify ''tiler the painsand ertalties of er'ury that the in ormation provided above is true and correct. -Si ,halure: / — Date: i I Phone ki: j� 1 Ufficial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: :, ro Ghent#-: 4507 G�. c`cIN:SUL. _ _ I CERTIFICATE OF LjABILITY IN$I�R�ILNCE — - THI>',CPkI N ICA1 H 1 I�:iUL::L1 A A IYtgTT N OF INFOIiMA"IIUN cnvL1'ANR CGNFLR9 NO RI(dI1T9 UI'UN TI1H(?kRTII 1CATE HULI)(?It,'fFUS' CERTIFICATE UOE$ NC1I'AFF'JItN1AI'IVELY qF(NEGAIIVkLY ANiR:.hla,EXTEND ORALTER'hIIE COV22ACL AFFQRpCf] 11Y TIIG POL.ICIIS (cI::L.UVV.'1IIIS CERTIFICAT[OF INSURANCE DOES NOTCUNSIitIlIE ACON1-"CTBEIWEEN-I'IiC ItiyUING INSUI�I_,R(t;),A I INQK14LLI REr'R[:iI:N IA I)VE., ---- r'rr(:Ir)uct k ANn TIiR CFRTII=ICATE I it ri Ilt r� __,_..__...._ \Nl: III" r;¢IrtlflG Mtn IluWur 1G (n AbL1il(UNALIN;iUIM1I U thrlu)licy(les)uluSl b(.wIdpraecl.If SULII�(1(:Al'ION 1.1 WAIVLI'1 �utll,.11a to uI, utto c(/nLNtlon n al'tl,c olley N c nrt,ln 11011 ns May l4,(„„„wt urlciuranutnnL A atalawenl un this col tll'i(:ula(Ilaa:r nul confer nUltl,to the '-ntlllc,.lu Ju,lGlc,r LAI I;II f fity CI1(IGIJ4'IIICIII r II,!ylcf , I (.f;lY III:i. - �(1. LIt1l"Irll2: NAhlt WtI 'llC1 YIJun I -. .. IJI l;uticv Is I s�'c Nofm 508 760-46U2 FAh- _-..-... :)mold Uuunn::, Nl!\ l{t'GIiU 'I liU l E-NAIL .--._-___.--,-------__._--_-----.,__.....__�..I:�/i_•.NaJ:.l�/l•II I11 A'-IJ11 ALICIHF it........ ' —,---,--___.,- IIVCW Itf1tilUl nrFl!Nt!INU C(!VLN/\Rt: NsweLl:/L,Pe4rlt,s Intiurartt u l'.r{)e'. CuU 111.;ulG�t(L:)n Iris wsukearl E.v UI�tC)n U1eu1 In(:L1 L'G)u r1,r;.uly . ' `.'I 1'dlnwG.t[II huuil INSI1fiCRt:,Admilic 1.f1211tG( Ir18Llrrfnce i Ily(uulia, IVIA O:liQ'I � IN9ukcNU CorI11lli:rGfa lll(iUi'1911C4 C:iltllplll.0 :317a•I --- _.___.,.--,-,-_.....__,_...._.-...._.._._-_._.------ ....._ uaauner.r LI�IIF1(AIL NUMUER Ftt.VISION IVl11VIUL It - 11w. { I I I i�l:i I!1' 11(A I I i lt- I�'OL(L I[ Or IN11J --^_ _. --------.—......_. "--- RgNCc I h I I n uu,u II,ANE BEEN ISSOELI 10 _JE INSUKL•D ly\h AIAI)l)VI_ 1-OI I 1 IIL. F)i)t It l'I'Lrfli)(i IJU I VVI I I l',I ANOIIV(; ANY Nt_QLIIRIF(vII=N1, 1�Rh1 QR CONF i'101`I OF AIVY CONTRACTOR OI FIE-R UOGUMEN I WITI-I ftl SNt(.I 1 l') 4YI IIl;hl II 0 '.`W i10N' NO ISI I;.S;l1C.0 OIt MAY P't_li1"AIN, 1TIE INSURAN(•l nrriu DEu BY TNI= POI_ICILS DESCRIBED IIL:REIN IS SU(T,IEO'I 10 AI..L. IIIF ra;.LU51�!I`d:i AIVO Ci:)Nl.)IDON=> OF SUCH POLICIES. Llmn'S SHpwN lyd•,•r�(�l, .0 ...._...--.----_-__._----•-.--.._._..___,.._ ._ _ _ t�GGN hEL1UCEC1 by PAIL-1 CLAIMS.tr; t ti IYPt tIt IIV:IURANt:l ADOL$UDR_ PpLICY CFF HC,I ICY SKI'""'"'��"---"------'-- _.. 1 __—FOCI ,fiVn"�II�T—inlnllhOnril'L . j'( ..LR�f,.{l LIHLllllll CBP8263061, 410112012 0410111U1• t.) "cJcC;utftLlr(CP r 1000 000 . nI t:'Jh1hIL"Ptl,hll l LNI'.I'tAl l IALIILIIY -----._ .—.._ qG ( Lrn"ru y'1UN DUII (Lylr:,,1,4AUt f xl L.(=1JJ2 _.. nu_u rxla Innv oiw parannl w:i4llO0 1'kli:lllMAl,tt AGV IN JL4 tY L I ---- l)urvI r ALA(iIiNLUAtI:: h2 UU(I UULI I•L'+ Ituul L I hwl I APr LILtI NGH� —_--._ .-_.__ ,_..._ • ._. 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X untwu,-Lnunu --_ _-.___„__.--- ..- Lki'lIR XQNJ(iSd5l.: 141t{'1i2U'12 04/U'112U1 L-:,4CIfOL'QUrtl(l;NC13-",_--, .41,O110 at)D .GLLUUULUUU L..X.l,iu u"LI t t UMI LNrJAIION ' — -- U 5 J Ar,urnu+IutLr(s Linl.nuly VVGAO 2;i U1 WW2U'12 UGI3U12U'I X wcsl"ATiJ, ulli; ' LL-Jn,u (:u:rl�;ur,'ync1ill,/P,4tY'•L:f;/_qY:i;1,-IIVk.YI� `t• `.•^•C� ulrr•�Itlnit:-J:i k.r;6,((,:�,(�O�I�h NIA r,L.eHcll Ac:Gliarcr+l' I UULI UUU ,,,NFII NJ I 'd;�:auc�.nhu,nnlo, _ L.l..DISI_ASG..,u,LrYd�1.4YLC, '4"I Ull l{U411 Jr i,'rUP rlOrl(.1F OPi71�A r10N5 Iloluw I �----.--__._._._.__._,-�,_......,,.•____,_,_.__._.__.�----- h.I_ DIi;L:n,h"Poui:vl_InuT y'I ODU LIUU �'�J'.IIII'lal(/UI'1)1�1-ff Al li)Nti/LOC:A I'IL1NS I VLNIC L.ES(AGlauh ACORO L01,AdJan,�„,,.,,,��,1.C�h uul,1 v v 1 ww.aPecu la rnyuU�Ul •�4lbrILG:15 CLrnil) Irrfurrntttlurt •''` liuyu(Ivll OfticCJ'U G1 I'rGI)r1(7t01'S - I �nlrlcacc:Ii ildar i_ti 1ncILlLlvct ZIP un acl(titianal inaura(t un(Iul (:)Luwral LiaUility wllpfl rO(JUIro(I by written t:Unloo Jr'd41rcvrllC'.Ilt. - ---- _ .. _......—__-- CANCELLAT40N GOO iA16ul;a14gn,IrlC SHOULD A14YOF THE A00VGDEtit:RIOLVIF'(JLI(;IEiuE4ANI:I;hLI:IIl11 OIL THE EXPIRATION DATE THEREOF, Nl'1'r'IC.L WILL 8L7 UftlI k:keLi IN ACCORDANCE WITH THE POLICY PROVI:1I0N5. IAl1IM0012LD kEMVS01Al IVE (�'190 -20 1)AC014D G_UHP'ORAI ION,All 0ghb Ihaarnoll. �I:lltt(, (-U 1QM) 1 Qr'I 1 he A.CCIRLI 11,iino:ind lop;iru nigh,'crud marks OAGORD li;id3J4UlmH3t)4lll may OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located.at � 74 :(Property Address) ZG 3z (Property,Address). hereb authorize t 0 Y � . (Subcontra r) IN an authorized subcontractor for RISE Engineering,to act on:my behalf'to obtain a building permit and to perform work on my.property.. Owner's Signature Date n _ Town of Barnstable 1HE r Regulatory Services Thomas F.Geiler,Director P 35 9B B Building Division ,* piFp µpi A Tom Perry Building Commissioner1�� 200 Main Street, Hyannis,MA 02601 .R Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY,REPORT Date: Rec'd by: Complaint Name: /11,V,977YY _W2�Map/Parcel �c3 Location Address: ` /W14QU7161 0A9/ Originator Name: //"! Street: Villa e: nl& yil ,,c--State: ASS zip: 3 Telephone' D /TOME —761 ��0„��75 CP�0 3 Complaint Description: 611ei6-�_ - -of /9 z uJ !lW 67 % 07 JYI - CS EL<ve'' /Z4 44tme"77,e ,PAS /e9-/3,2 i 1tE 11_001di, S i 6 o _:Z_ M ,Oc Tf/A� W Y�.f' `7—ilC- .li9ST TE•,1 i4:.e E Iq7 Aa C6 7�-lt /,93dd��,5f '-�9 FOR OFFICE USE ONLY AU1 T 7-1767 _-7� 9S Z 0 C,d re IS �.Aj 1-2 �E=fll��eJ%�e�G OoY Inspector's Action/Comments Date: Inspector: Additional Info.Attached I , ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � ry Map r 9 ParceP_0 Permit# Health Division (9k 9M No4c, Date Issued 0 17 10 Conservation Division 4Application Fe r y 'Tax Collector r_,-� ot_=n Permit Fee 121 , 1 d Treasurer 6 EXISTI!!t7 Planning Dept. LIMITEp TO Date Definitive Plan Approved by Planning Board 8mR00�$ Historic-OKH Preservation/Hyannis Project Street Address j i lm -M 7 ,2 Village t C'`�n �v c ► le Owner l i010 4 H Mc Ae IC!, Address /75T lallwg744 /fd Telephone Permit Request fiPwau-e ao" / s"$"` .,5;L61e ee d 4, wel i ld �Vew ear ek[S11VJ &Cl&A f lOals %t mocl e goo— S bil i lc`, 0Al 0,1 _A ?e �Ous e,0%c-f vectl, 6yi1d .2o x ly'& vec-A wi*16 14& d&cA(*o9 Square feet: 1st floor: existing Proposed 5,401-e 2nd floor:existing wU proposed A106V Total new Zoning District Flood Plain . Groundwater Overlay Project Valuation Construction Type Sig ! ;f' W 04 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi Family(#units) 1 " � � r Age of Existing Structure Historic House: ❑Yes -9'No On Old King's Highway: El Yes El No Basement Type: k ull ❑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 Z new Total Room Count(not including baths): existing new First Floor Room Count 599 k Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal'stove: fl'Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑ew size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: -° Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ - � m Commercial ❑Yes UF1 o If yes,site plan review# Current Use Srw l� � w Proposed Use, 5,Oot -e-1 r BUILDER INFORMATION Name tri'C V �u&U0.N 0 Telephone Number 50� 39 a3`'AK5�08 yzo`S$65- Address p 0 130x IT F Fc,10r0ce lti 061 License# C"S 06'0K 61 Home Improvement Contractor# /,�Y�Y7 Worker's Compensation,#tea ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 70'W . Nld SIGNATURE DATE FOR OFFICIAL USE ONLY R PERMIT NO. DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER` ' DATE OF INSPECTION: < FOUNDATION FRAME I¢ 17 INSULATION / ? '°4 L v T FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGHr ?, FINAL GAS: ROUGH) FINAL ' FINAL BUILDING 4 • 24L C. d 1/-, co DATE CLOSED OUT ASSOCIATION PLAN NO. 9 °FZHE T°y, Town of Barnstable Regulatory Services ' snaxsrasLE,MAM Thomas F.Geiler,Director ' 9`viOTE 6 1 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. t Type of Work: RPolD / Estimated Cost ,3 110OQ Address of W ork: l 7 S Y 1 F0/*mcc-14 Rt� C&we rVd 1// , Owner's Name: N(ACGe� Date of Application: V1z_? O Y 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: 2-7110 IfrriC L e6L O lI �'at Dat Contractor Name Registration No. Da e Owner's Name Q:forms:homeaffidav The Commonwealth of Massachusetts T- . uA - - -- � n(_-� Department of Industrial Accidents F J` 600 JEashineton Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit-General Businesses name: address• city state: zip: phone# work site location(full address): ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I an em loyer with t m to ees(full& art time). ❑Other I am an tmz to er rovidin workers' compensation for my employees worlti:ng on this job. I B Y P g ,�d' company IIeM V - address: WOW city: bone# insurance.cot..' ,_ d�t"Ig.:. .. .C, �..;:.,:;.i. . oli'c'.#.: : .:: ... ., ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: cOmpanY name• -, ?.... .. ,• :; .... ;.., . .., ,.,, .. I addregSe�:.... ` .., .. city phone# instirance co. olic" # company name: address: - instiranc=so. to]icv Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$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 DlAfor coverage verification. I do hereby certi rider the pai s and penalties of perjury that the inform ation provided above is true a d eoZree, - Signature '/ / Date Z � - Print name %'OC I/ if 0 Arza 0 C7 Phone# $ official use only do not write in this area to be completed by city or town official cityor town: ermit/Ucense# p ❑Building Department � .. ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department g3 contact person: phone#; ❑Other (revered Sept 2003) - ��,� -��.s:3�.a,,�'�'".�r�ce"�"`'-••- a: �'.'�`�' 5�': 'ere,'s�^�r...�ar" �>�,�s...,�a�.s,�..+,a��oe. - -. ,. - Information and Instructions 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 contract of hire, express or implied, oral or written. corporation or other legal entity, or an two or more of association, co or , An employer is defined as an individual,partnership, ssoc n, rp g ty Y 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 m 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. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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 pernrit/license number which will-be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents WIN of levestlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 1'70 square feet x$96/sq.foot ® x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= 36 ,C (number) P.4- x$25.00= 0a (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) W Permit Fee d Projcost Rev:063004 710 0A R Appada i Table d5.Z1b(continued) prescriptive Packages for One and Two-Family Raideutial Buildings Heated with Fossil Fuels MA.16MUM MIMMIJM Hearin Coolie Glazing (hazing Ceiling. Wall Floor Basement Stab Areal(Yo) U.value= R-valued R-value' R-value° Wats perimeter Equipment E'1'icien aY' R-vaiue° R-value' Package 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 30 6 � ` R 12% 0.52 30 19 19 10 6 Normal g 121/1a 0.50 38 13 19 10 6 85 AFUE T 15% 036 38 13 25 N/A NIA Normal Normal U 15% 0.46 3819 19 10 - 6 �I 15% 0.44 38 13 25 NIA N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE x 19% 032 38 13 25 NIA NIA - Nom�al Y 19% 0.42 38 19 25 NIA N/A Nomal Z 18% 0.42 38 13 19 10 6 90 AFUE . AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 7 D I �l V R d C Cps�t'or�d V� ' a 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3 S 3. SQUARE FOOTAGE OF ALL GLAZING: 360 4. %GLAZING AREA(#3 DIVIDED BY#2): 0 5: SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS. ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table AM b: r Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall e.Up to 1%.of the total glazing area may be excluded from the U-value requirement. area,expressed as a percentag decorative glass may be excluded from a building design with 300 fl of glazing area. For example,3 ft of Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. 3 The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R values represent the sum of cavity insulation plus insulating sheathing ( )if used). For ventilated ceilings, insulating sheathing must be placed between , the conditioned space and the ventilated portion of the roof. o not include 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). D exterior siding,structural sheathing, and interior drywall.For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. S The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. •The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as .above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes elet:tric resistance heating use compliance approach 3,4, or.5. If you plan to install more than one puce of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U.value in Table J1.5.3b: If a door contains glass and an aggregate U-value rating for that door is not available,.include the glass area of the door with your windows and use the.opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if.the area-weighted.averag e.U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 r Town of Barnstable Re ulato Services BAMU. - g rY ABL% ` Thomas F.Geiler,Director 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, rIH /< �c'e ,as.Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for sg a [MOLA RAP, Ceo—1 yrk (Address of Job) n �2q 0 Signature of er Da /l � "e e Print Name :FORMS:OWNERPERMISSION s f ✓� of Building ati ns and Stand rds ` Boardd CTOR lug, HOME IMPROVEMENT CONTRA Registration: 114047 Expiration: 7/29/2005 Type: DBA ERIC V.LUBRANO BLDG.&REMOD. ERIC LUBRANO � 85 BLUE CASTLE DR Administrator MASHPEE,MA 02649 a " p ✓LIL BOARD OF BUILD11d REG. LA�ONS ' Ucens® C©NSTRUCfIONSUP€RVISOR # CS Wgi4" Psi a Number 4 Berthdafe 0.....1959 �r x tOQ32 � Expires 04/29%2 0d5Tr no estri00, 00 ' I ERIC V LUgttANO r '� PO BOX 185 E FALMOUTH, MA 02536 Adminis#ratbr' j '1 ill Vj�,M I UP tlflc y' BEE -Year Type Bill Ii Cust # Bill Hame Ph Parcel ID 189-"036N 1758FRLMOUTHu3"'Al) ww �z Alt Parc � CENTERU i LLE AMA 02632 € ` Ire BAN PropLoc 1758FRLMOUTH �ROAD/RTE 28o,- Miry r �kanT11 Int Dt Billed Abt/Add ' Pmt/Crd Interest Unpaid ba'1 ems00T465498'; 94 153...58: 545 3611 XKO00 5 00 00 0� 5 00 Fees/Pen 5 i n � . s Totals la 2025€ 5�00,. 565; 65 44 34 "' 703 94 OTH Due 09/29/2004 7039u4 . Per Diem rER S w2« 2�04 Int Paid 44 :47 �Pwefewe� es .. TOWN F BARNSTABLE PGA ka 8T0R 5F NCEs i -of 1 C < < Vk fA • U �X 1��e wH��iiaaa/�1�6j Year Type Baal # Cunt # Bill- Name Ph F_ Pare e-1 ID ;,1$9 0363P 5g,FALMOUTH Rl1 1 A It Pare, 3 s` .. >CENTERUI LLE MR2632 ' ,. Pro Loc i?58FALMOLITH RUA3DIRTE2$ p Act' Eff. Date: Receipt ,_ Rmount Meth Check%Ref# : 'Paid By PMTF 04/�21'1N204', 1 6807680' SSI � "V � 61012 ` 7ELIaSFRRG _,. _ _.._ : 1,of 1 _ a I - 1 COLLECTORQF TAXES �( TOWN OF BARNSTABLE ,, Issue Date: 08/2412004 f1 MAUREEN J. MCPHEE FISCAL YEAR 2004 REAL ESTATE TAX BILL Due Date: 09/07/2004 Commitment: 2004-01D P.O. BOX 1360 TC Bill Number: 18248 _ HYANNIS, MA 02601-1360 Parcel ID: 189-036 2-483 "Please,r6t6in'thil is"section of the°Bill witFi payment (� Fire District: COMM Demand Notice �b IIL��r�I�LllrrrJlr�rI�L�II�r��II�II��LI��rI�I�I�JrJrlrl�� ool�� -Amount Due:: � �yX�� ,td$694:90 MCGEE,TIMOTHY E 1758 FALMOUTH ROAD !/1� / Voluntary Scholarship Payment: CENTERVILLE MA 02632-3169 Total Amount Paid: i 02082062004000018248500000694901 - ----- --- - - ---- -- Please tear along the perforation and iriC'Ude the above section with payment. - It It Tax Rate Per$1000 FISCAL YEAR 2004 REAL ESTATE TAX BILL Issue Date: 08/24/2004 Class 1 Class 2 Class 3 class 4 Due Date: 09/07/2004 Residential Open Space Commercial Industrial Demand Notice of Real Estate Tax for Fiscal Year 2004 Bill Number: 18248 General $6.61 $6.61 $6.61 $6.61 As required by law,demand is made upon you for payment of your fiscal year 2004 Real Estate Taxes as follows: Parcel ID: 189-036 District 1.10 1.10 1.10 1.10 Fire District: COMM Qenrne[nfortrnaat'I n Pr�op_e.,ttj�",ln#Qnmat�orrc.¢` .. MCGEE,TIMOTHY E Parcel ID: 189-036 1758 FALMOUTH ROAD Location: 1758 FALMOUTH ROAD/RTE 28 CENTERVILLE MA 02632-3169 Class: 1010 Acres: 0.430 valuations ' S�pectal Asses entsG(.S/A) a°�� Taxlnformation _ Land Value for Class 1: 70,400 S/A 1: 0.00 �� General Tax: 1,019.92 Land Value for Class 2: 0 S/A 2: 0.00 �� District Tax: 169.73 Land Value for Class 3: 0 S/A 3: 0.00 Land Value for Class 4: 0 Land Bank Tax:" 30.60 - Total Value for-Land.. - -7-0.;400 S/A 4: 0.005: 0.00 Total Tax:- "' 1 220.25S/A Bldg.Value for Class 1: 83,900 Total S/A Int: 0.0.0 Total S/A: 0.00 Bldg.Value for Class 2: 0 Total S/A: 0.00 Total Tax+S/A: 1,220.25 Bldg.Value for Class 3: 0 � Previously Paid: 565.65 Bldg.Value for Class 4: 0 l4(JUStmnty Total Value for Bldgs: 83,900, � � � Adjustments: 0.00 Adjustment 1: 0.00 Fees Charged: 0.00 Total Bldg./Land Value: 154,300 Adjustment 2: 0.00 Residential Exemption: 0 Adjustment 3: 0.00 Demand Fee: 5.00 l Adjustment 4: 0.00 Interest on Overdue Bal: 35.30 Adjusted Total: 154,300 Adjustment 5: 0.00 Total Taxable Valuation: 154,300 Total Adjustments: 0.00 Am011llt Due $694.90 Please put your Bill Number on your check. To obtain a receipted bill,enclose a self- addressed,stamped envelope and both sections of the bill with your payment. Mail Payments to: Office Hours: If no receipt is desired,please DETACH TOP SECTION and forward with remittance. Town of Barnstable 8:30 AM to 4:30 PM Collector of Taxes Monday through Friday Interest at the rate of 14% per annum will accrue on overdue P.O.Box 1360 60 Hy Main Street Hyannis, MA 02601-1360 Hyannis,MA payments until payment is made. 508-862-4054 SEE REVERSE SIDE OF BILL FOR IMPORTANT INFORMATION! x � x ._ -_.... --------- .._.- . _.. __ .. __ _______ ______.... .. ----- _ ---- ..... DEMAND FOR PAYMENT OF FISCAL YEAR 2004 TAX This notice shows the amount of your fiscal year 2004 real estate tax, including betterments, special assessments and other charges, that is unpaid and overdue. In addition to the amount of overdue taxes shown in this notice, you also'owe accrued interest and a demand charge of$5.00. Interest will continue to accrue on overdue taxes until your payment is made:Your payment w`ill'be considered made -when received by the Collector. If the total amount you owe is not paid within 14 days of the date of this demand, the Collector will proceed to collect the amount owed in accordance with law. i 1✓Y ,f ......,. ., ., ., may, -.. '-`;5, �,^-..."`�,,.. ... ti,.... ``i''•,,. ... :'� A ,.,. `�,, .. ,v`. .. ..,......',''^, .. .�T+ "�. v +., 3. . ,...a„ ,., n L.h,�a�: e u;, ,.1.. . „YtiY ��w- 4 tir. iy-.�, i.` ,,.»ti. .:4„ t .dw •1` ySab.KT`+h - SCALE t Z000 Q �i N82 \ 10 73 37 105.00 F, T ` 4i : g STIN ,. . �. Z� F s:a d INC A a O -49 AREA- 523 S.F. , 9 • ,. 4 ,. 19 9UF02D W.GOIAIS 'O 3 � O r c TwATsoW ' a 1 71.3•Sf h LOT � QD v CqEORICt6.A CAMERON n ,N1361631.v... At AREAS 13� - LOT + .� 918tsF. .Ir. C, 81'�!9 ZC E J° 81'3iaoC N212 E a :o N l.7.42 .I 2a00 .E _ It a �"� l«J � 81°39'Z� 68.23 S300 uar39'L0'E I1 LOT 7B a Tr:LE Q�£FEItE t lCES 35.F. �t ' !y K SL4 at2 . :, ,. ' e7 ec�. 0Q1E 5T02Y COIJC.BLOCK a S a00 f r AJDB21CK BUILD BOOK 97 IF±3FAQA� AEF �75Z_SF r, AO PLAkI REFEREE"1ES• EXISTINCt DWELLIN_ CT v PLAN BOOK 316 Pg. ' 3 �d PLAM BOOK 169 . 13T : "� _ LOTs3 Pt1. _ _ _ $ AREA-f�0�0'SF. ti O W I.fTA?ACTE O MOBIL OIL CO2PO12ATIOiJ 3 , h ncot a o , Qs4785.86 L-34041 A-04°04'32 1?=47953 L-8Z.15. Qs4785.56 L=840d Q-4785.sa L-5000 2=4783.5a L-61.00 _ a03 2d3T L=219k15 IZ-4785.6ID - C ' i t ht STATE HICtNWAY (PuawC 86.60 WIDE QTf�: 28 APPQONAL. UNDER THE. SUBMISIOIJ LAW NOT UIQ 7 DATE, 1 .[- t i �i � Jam`+ l��• 1�- PQODE2TY IS SHOWN ON ASSESSOQS . QWNEQS : APPLICANT 1 CERTIFY THAT -THIS PLAID AS PI?EPAPED MAP 189 AS PLOTS 34,13Z AND 13!5 LOT51.2,3 PLOTS 3fo MOBIL OIL CORPORATION CON'ORMS TO TNE. 1Zl'LES_ AN REC�ULAT10N5. ZONING DIST21CT--RESIPENCE G 44( �� OF THE QE+Gr15TEQ5 OF DEEDS { 13ZASSESsoes 5►18AT 189) 91 MONTVALE AVENUE 8UFOQD W CEO I NS. 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