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Home My WebLink About0027 STONEY CLIFF ROAD 4t iF R. !' . Ap; q� -•=Y' .. . ,rsp" F. ,¢ y Y m- .�'`- ._... y., ,SF.si';-�,- , �..,.. -. � ..•..�. .;; -•v � :.9, a F,. �ate;..; .-.at-' e, i. � '�'�t ,�s y..�� ark,$ •,,� ,� ° �.f, fX 3.�' � -� .�. 3-, � t ... .. a : , w r . n p " r , 1' p r c 1 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parr�el w' Permit# 17343 Health Division a,a °�A.RNIN TABLE. Date Issued ( /1-7)0y Conservation Division �E K i ' 21 Application Fee 3400 Tax Collector ' Permit Fee C13 19 Treasurer D1VISi0N SEPTIC SYSTEM MUST BE ` Planning Dept. INS i-ALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 07 5aKEt Cu PE Village Owner fJ Address i Telephone o'2 Permit Request S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total newer I1R1 Zoning District Flood Plaint : Groundwater Overlay Project Valuation 0,(W Construction Type �16 • Lot Size 6a35 ACE Grandfathered: ❑Yes IQo If yes, attach supporting documentation. J _ %1 Dwelling Type: Single Family Two Family 0 .. Multi-Family(#units) Age of Existing Structure •Ito Historic House: ❑Yes <NITO On Old King's Highway: ❑Yes -N7No `} Basement Type: 'Full 0 Crawl O Walkout ❑Other tBasement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) lob Number of Baths: Full:.existing new ' Half: existing new �-- Number of Bedrooms: existing new.' Total Room Count(not including baths): existing fe new `� First Floor Room Count Heat Type and Fuel: �Gas 0 Oil ❑Electric ' ❑Other - Central Air: D Yes <#No Fireplaces: Existing. / • New ' Existing wood/coal stove: ®Yes 1N0 Detached garage:D existing D new size PooLD existing ®new size Barn:D existing D new size Attached garage4existing D new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization 0' Appeal#y Recorded Commercial Current Use Proposed Use - EbjC? �t12 + l� t *N Y BUILDER INFORMATION Name( Telephone.Number MiMI . 6M Address o2- OF �� License# q C Diu c- 6* du Home Improvement Contractor# ' - p Worker's Compensation# _ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'i� A-oilL. SIGNATURE z: DATE P 4 FOR OFFICIAL USE ONLY PERMIT NO. ;DATE ISSUED MAP/PARCEL NO. ` R- s ADDRESS VILLAGE OWNER DATE OF INSPECTION: p FOUNDATION 50Km g� 711 4 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH ? ,— FINAL FINAL BUILDING nr + DATE CLOSED OUT ASSOCIATION PLAN NO. = 1 s • � a r — The Commonwealth of Massachusetts Department of Industrial'Aecidents � _ use elJNnstsfl�►r� ' 660 Washington Street Boston,Mass. 02111 Workers'.Coin lens Affidavit-General Businesses - 7. TATTIe �o � t i address: ' , city_ State! MA- ziv' P � vho to work site location fat address : am a sole proprietor and have no one Business 7`ype: []Retail❑Restaurant/Bar/Eating Establishment 0 Office'[] Sales('including Real Estate,Autos etc.) working in any capacity [� Other ❑I am an em to er with .' etn 1 ees full& art time: .•::.�/%%/%//%% I am an;employer providin.,g vi.Orkers compensation for ni employees working on this job. com en'name:. ; ediireirse' ,,.� ,.•., • bone:.#.::' Ali uranci.6.." 'I am a sole proprietor and have hired the independent contractors listed below 'who have the following workers' .compensation polices: 71 coin en 'name : ... +.. 'oae".9 M FROM FIRMS 'f: insurance co..•.: x _ _ ••� :J '•`'j,',+':`' coin�aii. nandee.._ ..•.; addresss. •hone. ` Ci - }'.:• it r.4::. S •ir i.. :; +�•5•! ;5::•; •,•'. '. `. t'.,....,•W r ,,ram�••''. (•, _ - : >: insurance so' 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 foim of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that R copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify u i e i nd penalties of perjury that the information provided above is true nd correct Date Signature (� Print name l, phone# official use only do not write in this area to be completed by city or town official permitllicense# Building Department city or town: ElLicensing Board ❑selectmen's Office D check if immediate response is required ❑Health Department contact person• • phone#; ❑Other ' • (revised Sept 2003)• Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' ecrmpensatioa for their. employees, As quoted from the f`la ' an employee is.defined as every person m 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 ajoint enferprise, 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*niore than three apart to ments and who resides therein, or the occupant of the.dwelling house of to s ersons do.maintenance, construction or repair work on such dwelling house 6r on the grounds or another who.emp. y .! building appurtenant thereto shall not because of such.employment.be deemed to be an employer...,.:. :.... .. MGL chapter 152 section 25 also'siates 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 M the workers'�eonVensation 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 Departrnent-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 pplicy,please call the Department at the number liste�cl: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. y.mail or FAX.unless other'arrangements have been made. the Department b The Office of Investigations would like to thank ybu in advance for you cooperation and should you have airy questions, please do not hesitate to give us a call. The Depwtrrpt's address, telephone and'�faxnutnber. The Commonwealth Of Massachusetts Department.of Industrial Accidents emce of Wesfiggens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext:406 f 7V Ci14 Append& Toldca:stW�i ? `� q VIZZ11 'arlp XAd�.�a-Fua�Y FLaidetttiit Haudia�i ' p� trYe F'xekxltia iar�Aa IPtim% sub ,x %/Coaling m M C;elling Wall F1car 14 `a p�}mc�d me ci�nc ` R- R Y R Yc A Yx1ua Cr1 g xl Ara'V ) t1.Yalt� • Irmo 3/01 to 65tlo Hula&D px}•z' NammsI 15 Ia � 1Qarrs�xl � 1x'�, 0.5x 3a 13 19 1a N/A Ncrsc� 1rr� 0.5a � 13 N!A Narmal 19 19 to A 15 A M T 151/1 a.46 �g 13 25 NIA & • II Ake V 1574 o.44 3E 19 19 Ia 2dom-4 Y 15'/1 041 30 13 25 NIA NIA X NOM14 0.32 3� 19 2 NIA NSA po AM 1Sy, a,4Z 13 19 1a ga•t�Fcr Y 0.42 3a t9 1g 10 0,50 30 �� ADpRESS OF PROPERTY! FOOTAGE OF ALL TEgI,OR WALLS; ' S SQUARE FOOTAGE OF ALL GGAZGs 3, 54 GLAZIN G AREA C93 DZVMBD 8y 5 SL,EGr PACKAGE see apart ataav6)� , S 0�`AE�gZ�IT�G�RG'�REQ�NIEK'Z`s R.MDRE�yOLYEp METHOD TIO�t, t�0 ' OAgE AYA ALE, ASY, 8 FORTMS I 'ORMA S �D�G IrISPECTOR ApPROV t�L: ... YFIS. � q.tacm�•�$0303s . SHE r Town of Barnstable . ��oF °Esyo Regulatory Services • Thomas F.Geller,Director , p116.19. Ilk Building Division DMA Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office,- 508-862-4038 Permit no. Date AFMAVIT HOME IMPROVEMINT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 142A requires that the"reconstruction, on,o r onstracUon of an addition ooany preexisting modernization, cupied Ion, •improvement,removal,demolition,or c binding containing at least one but not more than four dwelling units or to strictures which are of scent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements, . Type of Work: " �I'f� Estimated Cost d Address of Work Owner's Name' ,• , Date of Application: 0 4 I hereby certify that: ge&tration is not required for the following reason(s): []Work excluded by law []job Under$1,000 []Building not owner-occupied �wner pulling own permit Notice I$hereby given that: EALING WITH UNREGTFIRED OyMRs PULLING THEIR OWN PERMIT OIlIZPROYEMENT WORKD�N�� CONTRA CTORS FOR APPLICABLE HOME ACCESS TO THE ARBIT�TION PRO GRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDERPENALTIES OF PERJURY Ihereby apply for apermit as the agent of the owner: Contractor Name Registrationl�Io. Date • OR • r_ Ownez'sName . RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 � '0 Alterations/Renovations $25.00 Building Permit Amendment FEE VALUE WORKSHEET NEW LIVING SPACE Q(S square feet x$96/sq.foot= 1�� x.0031= (.0 3,�g plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= 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.0031= STAND ALONE PERMITS Open Porch x$30.00= 30,W (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving- $150.00 (plus above if applicable) Permit Fee projcost oFtl ,° l. Town of Barnstable Regulatory Services BAJMWAI;M ; Thomas F.Geiler,Director MAss. 03ig. p.0� 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: S JOB LOCATION: G-1 -- �n number v street village "HOMEOWNER": ^ V. - name ,�.,//1�'� "" home phone# work phone# CURRENT MAU-ING ADDRESS: �4'fYVI�-- - - ` 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 workperformed 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. _>- Th e.un erstgne omeowner'';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 = - - re:�� Signature QWomeowner Approval of Building Official -- :: - Nate: Three-family ddwellings containing 35,000 cubic feet or larger will be required to comply witli the State Building Code Section.127.0 Construction Control - t �••. HOMEOWNER'S EXEMPTION .4 The Code states-that: ".Any homeowner performing work for which a.building permit is required shall be exemp�f&on'the protRisions - _;of.this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(`)for Hire-to 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 Itveral towns. You may care t amend and adopt such a fora/certification for use in your community. I � Q�� ok �lu�y 03 CJ �t- 2� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Zj�� Map )ECA Parcel �� '� Permit# 6 Health Division ✓ 7/ 0 0 C7v2 0 =L4tC Date Issued / ? p .2 Conservation Division ua0WIL Fee - Tax Collector 4.41 / Af p•FcF- 5D ' ®o Treasurer ck) / SEPTIC SYSTEM MUST DE Planning Dept. ,,"STALLED IN COMPL"CE Date Definitive Plan Approved by Planning Board ENHIROI VM TITLE S EWAL CODE'ANC Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address bz) \--1 F1_ Village ftMM Vl(-LE Owner _MHN UMLA•N Address i F_ Telephone 31_0�. Permit Request B\IO F— 6KEI!> -4 k�?ftb ,r.o? AEN Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Q15J 0 Valuation q0,Mp Zoning District Flood Plain W) Groundwater Overlay Construction Type 'kA)CO�. Lot Size 0135 Grandfathered: ❑Yes to If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure 40 Historic House: ❑Yes A-fto On Old King's Highway: ❑YesAlqo Basement Type;,'rull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ' Basement Unfinished Area(sq.ft) C� Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing (0 —new First Floor Room Count .S -� Heat Type and Fuel:< 'Gas 0 Oil ❑ Electric 0 Other 'f vv —; Central Air: ❑Yes lo Fireplaces: Existing New Existing wood/coal stove: ❑'Yesid"o Detached garage:0 existing ❑new size — Pool: 0 existing ❑new size Barn:O existrig ❑new-' size Attached garage existing ❑new size Shed:O existing ❑new size Other: CD Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ - rn - Commercial 0 Yes � o If yes, site plan review# Current Use 6H�Psj 6f(EE2& A�r Proposed Use R\JUU ,1 PLJ 1 Y��i0�} BUILDER INFORMATION Name NWRMK.bk Telephone Number Address �1 �f, Qll, License# (1 f l et;jkULLC 0 ( Home Improvement Contractor# Worker's Compensation# � fz ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I p" RN IS 11=, I*)PLC. SIGNATURE DATE f ♦� Y l> :T FOR OFFICIAL USE ONLY 3 c 5 PERMIT NO. , 5 '> DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r ' i DATE OF INSPECTION: 3 FOUNDATION `FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH '= FINAL " PLUMBING: ROUGH _ FINAL 4 GAS: ROUGH . - t; m FINAL FINAL BUILDING " 'M , �7 "DATE CLOSED OUT,, ASSOCIATION PLAN NO. 'IX i RESIDENTIAL BUILDING PERMIT FEES ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE wORKSHEET NEW LIVING SPACE cArI7 square feet x$96/sq foot x.0031= CO.�.C(SC_ plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EMSTTNG SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) 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.0031= STAND ALONE PERMITS Open Porch _x$30.00= Deck _x$30.00= (der) Fireplace/Chimney _x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 6 3 . projcost Tablo 432.1b(eeastasad) Fads Pracripttre Pacha;a for 0"and Twa aa Faiir Rsaddasdai Bad Hsatad with Fold b A=um lYImYIMUM Glaring Glaring Ceiling Wall r aw Baaemma Slab Aral(•h) U-valae' R.valud R-vaivai &vd+d Wa Rrvaltrst &val9or Padcaae 5"1 to 6500 Heating Deg:tet Dam N� Q 12!'• 0.40 3E 13 19 10 6 19 10 6 Narsaai R 12%. 0SZ 30 19 6 93 AFUE 3 12% OSO 3E 13 19 10 N/A Nord T 15% 016. 3E 13 2S .10 6 Normal U 15% 0.46 3E 19 19 WA ES AFUE V 151/0 0.44 3E 13 VA 25 10 6 85 AFUE W 15%. 0.52 30 19 19 N/A N� X 13% 032 3E 13 25 WA NIA Norte Y 18•/. 0.42 3E 19 I4IA 90AF;TE Z 18% 0.42 38 13 19 10 , 6 AA IE•/. OSO 30 19 19 10 A . 6 90 AFUE L ADDRESS OF PROPERTY: a� C i )v e ` LUPP. 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: IC�1 �5 4. %GLAZING AREA(#3 DIVIDED BY 42): o, r3 5. SELECT PACKAGE(Q—AA-see chart move): NOTE: OTHER MORE INVOLVED METHODS OF DE� G ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION- BUILDING BUILDING INSPECTOR APPROVAL: YES: NO: g4on=4980303a a Footnotes to Table J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall . area. expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example;3 ft'of decorative glass may be excluded from a building design with 300 ft of glazing area. 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 J1.5.31. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation 'thickness•over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used).For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall For example,an R.19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavityinsulation plus R-b insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-flame 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- 'TFe entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mczt the same R-value requirement as above-grade walls. Windows and sliding glass.doors of conditioned br..,ements must be included with.the other glazing. Basement doors must meet the door U-value requirement d_scribed 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 S. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels.Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components- b) Opaque doors in the building envelope must have a U-value no greater than � Do or or n from the door be tested and documented by the manufacturer in accordance with the NFRC test pro 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 The Commonwealth- of Massachusetts ' Department of Industrial Accidents '=-' _ 0197CC Of10YCSli�BUOdS � • 600 Washington Street Boston,Mass. 02111 Workers' Coen ensation Insurance Affidavit � �' • .. r' �Yi/r+t�/��r ij�jjjj///j�jj�j��jjjjj/j��_—_�_�/ /• I _—__/__r��/�j�j��jj��%jj�j�j�jjjj�j�j�j��jjjj��j�j Ine :cation: i Li lu hone# 7(1b 7� •`.O� 7 I am a homeowner performing all work myself. ; ] I e rietor and am a sol have no one worldi in ca aci � � � � iiiiiiii/iia�/�i/iiiraiiiiiaiiiiiiiiiaii�i�ii�/��/iii,�/ii�i�//ii/i/�ii I am an employer providing workers' compensation for my employees working on this job. 'OIDii817Y�219� '%'i%v+iiti+v%?:%ii:::ti?::•iii�:}i:?r?:ii+:r i�{�>: - .v:.v::::::..•::........:::y}�:}::_?:. :.v:::::::..:t :::::•.}1;:!n.}-i:::y::;;}i}:r h:?•}}}:.} •}:vi•: ............................rv:vn ... .: •-• }::::;r,.}Y^;•:vt•:�:;{vt3.v:.vv:::.::'::•}:;h.;;i}}.v• ..,....:::.....:..v:.....,.... ...........:•::�::vn.: .v....:.................. ..... ..r.n:::...:.................. r:::: :.?•:w•v:::::::.v::::}::+{:y:i4:•:•:::::::n}e?t:::}::.:v•::::•.. : n.... ::.:.. :... . tone I am a sole proprietor;general contracto ,or homeowner( cle one)and have hired the contractors listed below who the following workers' ensation polices+:.............:.... � ' ..................COS............... .......r.:...................:::::::::::.t,.::::.:::::.::::::..::::.::::::::::.::..,:.::..::::::::::::::::::::::...:.:..:;;:.,.:::::.::::::.t.::.,::•.,:•:.t,:..t,•:A,.:•...t•:::•:::.:. coast/pram iistj,:ir{::;:ir.:::n;.Cy::?i>?;`%J:%}`i{:+'•}:%::7:%:'i} :::::..}'.....::::}.v::::::nv;..•:.t:...' :}::r.}v.v::.}vr:..••v�.:...... ............................ ...}'+L}:}}:4}}}:?v}:}:•:Ct:}}::�v. ::r.•v.:.,::?:•.v•:.vnv::::.v:}}:•::}:j:}; 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I mderstand that a copy of this statoneat may be forwarded to the Oifiee of Investigations of the DIA for coverage verification I do hereby certify under the• bins and penalties of perjury that the information provided above is true and correct Signature Date �� V Print name �1n�r t b® I�� Ccheckif nly do not write in this area to be completed by city or town official town- persuit/license# ❑Building Department ❑Licensing Board mmediate response is required ❑Selectmen's Office Health Depattinent on: phone#; ❑der P] ([cussed 9195 /a q The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, 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:_it l( 1AW L V Sp Estimated Cost Address of Work: a� �t � ��+�F �� P�i�1 U(�l= RA X Owner's Name:' I npm Y,C? 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 Jw er 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 g1orms:Affidav :rev-122001 I The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: IO JOB LOCATION: number street �1 village "HOMEOWNER": , aOh[I� name , /home phone Q# work phone# CURRENT MAILING ADDRESS:_ CQ,7Ky1 1 NA r)M3a city/town state zip code The current exemption for homeowners was extended to include owner-occu ied dwellings of six units or mP P 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 Persons)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 an a S. . 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 pen-nit 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 forr /certification for use in your community. --- 12 I.r - 1 ELI � � D=-:JE1 AD N ® ® FRONT ELEVATION w SCALE: V4 = I -O Z w . 12 - --- =--- - - - —- - =-- - -- --- LLJ.. o W O - - — —- --- -- o - wN�7 b: _ r Q _ ., _ .. . SHEET ��/ �REAR EL ATION „ SCALE: VA" -" 'r0 - - JOB: 0206 . . DRAWN BY: KW w DATE: 3 13 02 KI GNE r COVERED BREEZEWAY ' CONCRETE LAB - w RESE 5 „. GARAGE " LIVIN' -j - EXISTING PLAN o. /4" 1'-0" r- ..SCALE. I _ 4' 2" 2' 10" . ao , I _ 2& AND. 2446.2 REF. I5 LIT i dip EN III SITTI G / KITCI-I . I BREA AST I I. D: .aD d1 — ILI /4" LV D _ (2)7 I L HEADER FLU t� AND: 243I0 I�TE AND 24310 _ - 2$.. o 9 L m . 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T ----- - - ------ - f i � I T � 1 7 t T_-�T-� ' i I _ f LE Y A7 1 U'&"% N SCALE: ifA" . = 1 '---01' DOUBLE UNDER. V4ALL P.T. 2X5 LIB ; P.T. 2X8 LEDGER BOARD -_ BOARD P.T. 2x8's 16"O.G P.T. 2x8's 16"4.G. GALV. METAL GALV. METAL i JOIST �4ANGERS JOIST" HANGERS - BLOCKI NG AT CENTER. SPAN - P.T. BLOCK TO EXISTING SLAB UNDER TRIPLE UNDER HALL — ------- —� -� - t I X' i' 4x4 P.T. POST C'oA LV. METAL POST ANCHOR 10 SONO 'TUBE PI ER TYP. - 4N r :n --- RIDGE VENT 12 .1 , - - F.G. INSULATION —� VENTILATED SOFFIT MATCH EXISTING TRIM -- THRU .... -- .�.�.. F.G. INSULATION KITCHEN 2x4's 0 iWO.C. / i/20 SHEATHING TYVEK OR Eta. / W.C. 544INGLLES MATCH EXISTING FLOOR ELEVATION � 5/81' P L.l'WC.1UD SUBFL.00R - 2xVr' S _ . ...._ P.T. PAN- BETWEEN LEDGERS 4" RIGID INSULATION 15TING CONCRETE PATIO SLAB � L ' CONC. "SON O" FOOTINGr7E , , i i aXr&,IgL .... alio 26 AND. 24,46--20 ll 15 LIT - SITTING 0 f l ISLAND loo - 1 2 9 LITE Cal AND.r-T4310 AND Z431 17 y LIVING FROFOSED LFA