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0255 BEARSE'S WAY
as-� (&arse-.S Map Parcel 4 F=J3 Permit# OIL f House# ;� �`�� - Date Issu d Board of Health(3rd floor)(8:15 -j9:30/1:00-43�) .�(� , ��,,� Fee 9:30/1:00-2:00) - A� ®,� � min. Bldg.) 0yNc A r _ efi rd 19 Aft J. - • BAkATABLE .5L'���F MASS...46 � , TOWN OF'BARNSTABLE' Building Permit Application Project Street Address C`�c►� �7 Village Owner Address ' Telepho — / K Permit Request 17 01 s ' First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ /J?ry Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family p�Two Family ❑ Multi-Family(#units) Age of Existing Structu �j Historic House ❑Yes On Old King's Highway ❑Yes d-Ido Basement Type: ❑ ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New — ::7 Total Room Count(not incl ing baths): Existing New First Floor Room Count Heat Type and Fuel: Ga ❑Oil ❑Electric ❑Other Central Air ❑Yes l��O' Fireplaces: Existing New Existi g wood al stove Yes ❑No Garage: =Attached (size) Other Detached Structures: ❑Pool(size) (size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PE ft�ENIE0Aj)MIE FOLLOWING REASON(S) � � /a1)�� 1 FOR OFFICIAL USE ONLY _ PERMIT NO. BATE ISSUED:. MAP/PARCEL NO. - ADDRESS VILLAGE OWNER _ DATE OFINSPECTION: FOUNDATION FRAME , INSULATION - FIREPLACE , ELECTRICAL: ROUGH < FINAL - PLUMBING: ROUGH FINAL Y GAS: . ''�i"# ROUGH FINAL FINAL BUILDING DATE CLOSED OUTr + ASSOCIATION PLAN NO. :DEC K-IV C, /" E-p - e),P� /y 6 C E RS fi7- ��©© R . t)(o sT FtVDS eP©s i S M-X 7 ' ©,C. 141, = 1000 Iasi E = 1.,300,000 psi 1 yl�ic�.il v�ilues for SODUICHI Yellow Pine #2 (Pressure 71'reated) Exterior use (e.g. decl(s) Joist Size - .1 o is l ---- --�-- Spaciiig i 2x6 2x8 WO U 2x.1.2 12" 8-6 11 14-3 17-4 1611 7:4 .1 U-U - 12-4 15-0 20" 6-7 �-1 1 -U 13-5 IL 24" G-U 8-2 :lU-1. 12-3 (,MIEN Oi5'c t-�C IS 01-P crrE, -FE-7 ov:;= p1 N Soho /I �® �� �. t�� •tom `�i � � •, • � �` • - :.. �� �- - .. � .�, �``� 1 �,I 1 � ' ► ref v 1 1 I i c • r. e . e♦ e i-e. tee.• 'e t• e•G-,:"♦to I � . r , r r pig r j r r AM1,111 ark r r ' r , ` l r 1w, d °FTME Tom_ • "�. The Town of Barnstable 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 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. ` `' Type of Wor CfJ 1 Estimated Cost dress of Work: �� r Owner's Name: / Date of Applica?n.: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [3Job Under$1,000 Building not owner-occupied )E6wner 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. Date Ow ame 16_T� q:fonns:Affidav 180mtR Appwwft 1 Tab1eJSZ1b(eondaned) pmeriptive Pw*aM for One and Two-Family Residential Buildings Heated with FOW Fade MAXIMUM MINIMUM Glazing (3Iazing Ceiling Wall Floor I arem= Slab HestingtCooiiag Meat(%) U value= R vaioe� R value' Wvaiud Wall ftim m EgniPmcot F.ffic mq' page Rrvalue' R-valuo' 9701 to 6500 Heating Degree D&W Q 12% 0.40 38 13 19 10 6 Normal R IZ% 032 30 19 19 to 6 Normal S 12•A 0.50 38 13 19 l0 6 85 AFUE T 15% C 36 38 13 23 N/A WA Normal U 15% 0.46 38 19 19 10 6 Normal V 150A 0.4: 38 13 25 WA WA 85 AFUE W 15% 0.52 30 19 19 10 6 tS AFUE X 18% 0.32 38 13 23 N/A WA Normal Y I BOA 0.42 38 19 25 WA WA Normal 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: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMININ ENER Y REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-11orms-080303a 780 CMR Appendix J Footnotes to Table J5.2.1 b: 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 W of glazing area. =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. '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 musf 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 J5.2.1a 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 average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 1 - The Commonwealtll of Massaclluseds • r; :-- ~•` Department of Industrial Accidents fiffer al/nyestiffadoos AM - 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Afridavit , Z�e: c io Rv yhone 0 — I am homeowner performing all work myself am a sole propnetor and have no one working in any a acity ❑ I am an employer providing workers; compensation for my employees working on this job. company name: - address: tit,. phone#� insurance en. 2011cv# ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo%ving tivorkers' compensation polices: .... .. cam anv name: address- Mr. phone#• w c.A •...... Insurance ce. fmifcv# comp anv name- '..... address: dty phone A ....MiG.:.:.::.. ••+,y:$i(,:.... •. , .. ::..,:.yp({:s:':�•' .:.:0.�•;... ,may.:"<:•. ,K<L OiiG. Insurance co. lies# FaOnre to secure coverage as required under Section 2SA of MGL 152 can lead to the Imposition of uimivat penalties of a One cop to S1.500.00 and/or etc years'Imprisonment as well as eivd penaldel in the torte of a STOP WORK ORDER and a One o[3100.00 a day against me. I understand that a copy of a is statement may be forwarded to the Oldee of Investigation of the DIA for coverage vertileation. 1 do hereby txrtify under the pains and penalties of pedury that the information provided above is uw tend eo sigaa 1 - . IV Print name Phme# . C we only do not write in this aces to be completed by city or town o0lcial town* peemiWeense# C3Buildhtg Department ULtcetsing Board ckifI Immediate respomse b required (]Seleetnm's Ocoee (]Het"Department tperson• phone#. ❑Other (tense 9193 PJA) 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 coarr- 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 sore of die foregoing engaged in a joint enterprise, and including the Iegal representatives of a deceased employer, or the recenv. nistee 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 a.""Intm-nPvvn,c to do maintenance , construction or repair work on such dwelling house or on the grounds o: 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha 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 ConII { authority. E 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 being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if imu are required to obtain a workers' compensation poIrcy,please call the Department at the number hated below. --------------------------- City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the battom 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 pmnlivUcense number which will be used as a reference number. The affidavits may be rearmed is 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 :o not hesitate to give us a call. /' and fax number. The Deps�aeat's address,telephone .r._ �.. ..,.. .... _ The Commonwealth Of Massachusetts Department of Industrial Accidents 011Ice of imrestfoations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . , DATE- JOB LOCATION �j _ Number Street addr s ction of town "HOMEOWNER" N e (� / Home phone Work phone - PRESENt MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupies dwellings of six units or less and to allow such homeowners to engage an in- dividual 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 re- side, 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 Officia on a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Sta- Building Code and other applicable codes, by-laws, 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. HOMEOWNER'S SIGNATURE _,,,--�Ak- APPROVAL OF BUILDING OF IAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control HOME OWNER' S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owne. shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for .licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner acti. as supervisor' is ultimately responsible. To ensure that the Home Owner is fully aware of his/5er responsibilities, ma: communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. :