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HomeMy WebLinkAbout0012 HARBOR HILLS ROAD is i kr�= f '= Town of Barnstable *Permit Cg" Expires 6 months from issue date Regulatory Services Fe ' CK Thomas F.Geiler,Director ��� Building Division Tom Perry,CBO, Building Commissioner X-PRESS PERMIT 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us AUG r 2 200 oc. Office: 508-862-4038 T �wN6AKNS LE .EXPRESS PERMIT APPLICATION - RESIDENTIALCWI Not Valid without Red X-Press Imprint Map/parcel Number 2 / 2 q Z0 :1 Property Address - JP tjAk.60e 1 BLS Rd CWr,6 RVILL_C_ M RSS 0 26 3 2 ❑Residential Value of Work 7 �Jr-OC� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address J67 0 2,73 CaMAilldP9 iPoctd , Amn D1801 Contractor's Name JgUp, suls Telephone Number fql T`— �D�4 Home Improvement Contractor License#(if applicable) -Construction-Supervisor's-License-#(if-applicable)---- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) fQ Re-roof(stripping old shingles) All construction debris will be taken to B P-A/M 0Le- dam ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value. (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. �A co y of the Home Improvement Contractors License is required. SIGNATURE: J. . Q:Forms:expmtrg Revise061306 4 i ne uommonweacrn of lnuaraa.cnuawita� Y Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaris/Plumbers Applicant Information Please Print Le gib] Name (Business/organization/Individual): Address: �--7 City/State/Zip:_Vr6 bC4 9,.J M4 4 1 ' Phone#: Are you.an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors6. New construction 2.❑ I am a sole proprietor orpartner- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9, ❑ Budding addition' [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their eP 3.1 I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§IN,and we have no 12,a Roof repairs insurance required.] t . employees. (No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 rnust also fill out the section below showing their workers'compensation policy information.• t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infornwtion. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: p Job Site Address:_ 12 RAftwa1LLS �82City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secare coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to.$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperyury that the information provided above is true and correct _l Signature: . �i 1.�.�� Date: ZDps Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk e.Electrical Inspector 5.Plu,mbina Ijaspc_sior I 6. Other Contact Person: Phone#: and Instructions � Information 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 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 orbuilding appurtenant thereto shall not because of such employment be deemed to be as 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 evidence of compliance with the insurance requirements of this chapter have been-presented to the contracting authority.,' Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed 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 pcirnit/license number which willbe 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. i 617-727-4900 ext 406 0r 1-1877-MASSAFE rax t 617-727-7749 Revised 5-26-05 W—W-Vv.Mass.gov/dia PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS> MA 02601 DATE: •08/02/06 TIME: .13:02 --- -- rOrALs PERMIT $ PA'ID 25.00 AMT TENDERED: 25.00- AMT APPLIED: 25.00 CHANGE: :Do,- APPLICATION NUMBER: 20062246 PAYMENT METH: . CASH PAYMENT REF: �i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `� Parcel '7 Permit# -� Health Division Date Issued Conservation Division Fee Tax Collector ONA/ tr Treasurer Planning Dept. " Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address .Village - Owner YE ©me, E% Telephone Permit Request lie ' 01 v Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new q 9 P P _9 P P Estimated Project Cost- 5� �u Zoning District Flood Plairi Groundwater Overlay Oonstruction 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 ❑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 BUILDER INFORMATION Name 1 porne se,,IL" ; kkine2 'ffelephone Number �7 Address 2—Db meld AA`vim License# - fQh 1Cc�L` Y�' D 1 '� �� Home Improvement Contractor# /Z- 1 '3 Worker's Compensation# 6Px <Y_/R6150 c. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 2a ig No-0 do A-6k l4d d ?n 4 SIGNATURE DATE . FOR OFFICIAL USE ONLY vr• 3 1 � • art �•' ' ` - ' I , I ' • PERMIT NO. DATE ISSUED - ` r, t. MAP/PARCEL NO. f ADDRESS VILLAGE .' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE = ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL. GAS: 'ROUGH FINAL' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s „ e . 1 ne 1 own of Barnszapie Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 , Ralph Crossen Fax: 508-790-6230 Buiiding'Commissione. Permit no. 4 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. I ` Type of Work: e wi`C I av S Estimated Cost` Address of Work: 1^2, ,L: a214LLS L4 UJ Owner's Name: 914&t) ontio 14-,-) Date of Application: q I hereby certify that: Registration is not required for the following reason(s): [3Work excluded by law r]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. J7( Y Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav ie omm zj Department of Industrial Accidents ONCE nflayestigations � Q � 600 Washington Street � Boston,Mass. 02111 Workers Com-ensation Insurance davit j /// nIc�nFimfat location ,I Z � citV r hone# / boo ❑ I am a homeownir performin all work myself. ❑ I am a sole proprietor and have no one worldn in a V ca achy ❑ gg I am an employer providing tivorkers' compensation for my employees working on this job, carnnnnv name: address: city: phone#. insurance cn. golim# r ❑ 1 am a sole proprietorge�al ccontr or homeowner(circle one)and have hired the contractors listed below who have r� the folloning workers' compensation polices: comaanv name: lick 14a Ae address: -7�ZS Q2 1ekP C J d QV2 tom dtv: A-4 1CAIA A& .40>'7 z phone . insurnnce Co. �t/Ci' Oi1N#" `.GJ• ::' E ���� ................S%///////(///////G.i////////GGG/OG%O///////,U//////////%///.%///////G///////i(///GGi/////G�///////.//.////�i // camnanV name: address. dh- phone#i20 CV :. . .. insurance co. :.. ::... //", Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to s1.Sooxo and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and Correll Signature, Print name oincial use only do not mite in this area to be completed by city or town official city or town: permittlicense# QBuilding Department ❑Licensing Board ❑check if U tediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other_ w: ... . ([rnsea Y95 PJAI f 1�f 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 cow- of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other Iegal entity, or any two or more cr the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive: 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 c: 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 renewz 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 PIease 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 ins„ra ce 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 caul 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 permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have bees 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 Office of imlestloatfoas 600 Washington Street . Boston;Ma. 02111 fax#: (617) 727--7749 phone #: (617) 727-4900 ext. 406, 409 or 375 790 CU&AppuW&J Table JS=b(continued) ; Prescriptive Packages for One and Two4amdy Residential Buildings Heated with Fossil Faeb E MAXIMUM MINIMUM Olaang Olaang Ceiling Wall Floor Basement Slab Heating/Cooiing �'('A) U-value= R-value' R m value' R valuc$ Wall pa m Equipment EfEcie� Padcaae R value° R value' 3"1 to 6500 Heating Degree Dare' Qmvtu 0.40 38 13 19 10 6 Normal R0.52 30 19 19 10 6 Normal S0.50 38 13 19 10 6 U AFUE T 0.36 38 13 25 N/A N/A Normal U 150/4 0.46 38 19 19 t0 6 Normal V 150/4 0.44 38 13 25 WA WA 83 AFUE W ISY& 0.52 30 19 19 10 6 85 AFUE X 19% 032 38 13 23 1 N/A N/A Normal Y 19% 0.42 38 19 25 N/A WA Normal Z 1814 0.42 38 13 19 10 6 90 AFUE AA 19% o.50 30 19 1 19 10 6 90 AFUE I. ADDRESS OF PROPERTY: , Z k g ofL 14)* L!-S 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: '- 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 'Z S. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a 780 CMR Appendix J Footnotes to Table J5.2.1b: i Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft'of decorative glass may be excluded from a building design with 300 ft'of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or.mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages). Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement.doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a _ NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the - glass area of the door with 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 average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 f J �` V •v`� lJ �1./��'1��.i�i����2/I�Wr//`^i . , HOME IMPROVEMENT CONTRACTORS REGISTRATION and ndards Board of Building Regulations One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Reg6893 Piration 08/03/00 TyperPRIVATEon 2CORPORATION Type RMA HOME SERV/HOME DEPOT AT HOME SE MAr:I� S . ROBIDOUX 3200, COBB GALLERIA PARKWAY #260 ATLANTA GA 30339 I Installed , Siding and Windows Mark S. Robidoux = HOME IMPROVEMENT CONTRACTOR QLkvryAssurwceinsPeaa Registration 126893 Type - PRIVATE CORPORATION 1 Phone (5081 881-6394 Fax (8081 881-2908 E%Plrati0n 08/03/00 �+' 11877131-DEPOT Se�ic� AMA Home Services, Inc. RNA HOME SERV/HOME DEPOT AT H 200 Butterfield Drive. unit B � �sEW S. R08IDOUz Ashland. MA 01721 100010 ApMINISTRAroR 3200 COBS GALLERIA-PARKuay 12 ATLANTA GA 30339