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HomeMy WebLinkAbout0071 FAWCETT LANE 7l FAwee�/ 4,✓, ACTIVE I ,f r-- ��_---- r'�_------� ��- � _ I Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 _ Tel: 508-398-0398 Fag: 508-398-0399 „' z s.0 Q t 3-28-14 -" n Town of Barnstable Thomas Perry CBO -- Building Commissioner rp 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 71 Fawcett Lane has been inspected by a certified Building Performance Institute (BPI) Inspector. Ceiling: R-11 cellulose in main attic, knee wall attics and enclosed slopes Basement: 42 lineal feet of box sill with R-19 fiberglass blanket. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION sr Map 0 9 Parcel_- 5 Application #C U Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ' Village 14 A n is Owner Tose ��T� Address Sa.Neo Telephone SOB+3 il+ 0 85 �l Q Permit Request PTA a -�� an a, �- �� Ce��A� � � 6411C - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 34 0 o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ 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) t� Name o „�'� Telephone ���� 031? Address -WaAhn Rvr; License # �C `0D% YAT 0'�. r Home Improvement Contractor# Email Worker's Compensation # cT We 33 539 b 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 3 , ' l�l , r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. F r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Housing Assistance kin Corporation Cape Cad HOMEOWNER I RESIDENT WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM 1F YOU ARE THE APPLICANT HOME OWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation(herein after referred as "Agency")on the property located at: 4 The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls&basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: f. I give permission to the"Agency"its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) --� Date: ! Agent (signature)./ Date; HAC approved Weatherization Company: Adam T Incorporated All Cape Energy Altemadve Weatherization Building Performance Contracting LLC Cape Cod Insulation =CapeSave Froctier Energy Solutions Lohr Home Improvement Resolution Energy The Commonwealth of Massachusetts Department of Industrial Accidents 4 - Office of Investigations 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 Lep-Mv Name (Business/Organizadon/lndividual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth. MA 02664 Phone# 508-398-0.398. Are you an employer?Check the appropriate box: Type of project(required): 1.El 1 am a employer with 4. I am a general contractor and I p 6. ❑.New construction employees(full and/or part-time.).*- have hired the sub-contractors 2.0 I am a sole.proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have.no employees These sub-contractors have g Q.Demolition employees and have workers' working for me in any capacity. 9. Building addition [No workers'comp.insurance comp. insurance.{ required.] 5. We are a corporation and its lq.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LEI Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.[:1 Roof repairs insurancet required,] t c. 152, §1(4),and we have no employees; [No workers' 13.�✓ Other Insulation comp. insurance required:] "Any applicant that checks box#1 must also fill out the section:below shoeing their workers'coinpensation policy information. t Homeowners who submit this attidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit:indicating such. Contractors that check this box must attached an,additional sheet shoeing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'compi policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below:is the policy and job site information. Insurance Company Name:, Technology Insurance Company Policy#or Self:ins.Lic.#: . TWC335396a'__ ExpirationDate: 04/09/2014 Job Site Address: �p►w c 2 CitylState/Zip: I a n s 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. 15.2 can.lead to the imposition of criminal:penalties of a fine up to S1,500.00 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. L do hereb certify under the pains and Penalties o er' that the information provided above is true and correct. Si ature: Date 365 1 Phone.#: 508-398-0398 Official rise only.. Do not write in this area,to be completed by city 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#: .4co CERTIFICATE OF LIABILITY INSURANCE D0/22IDD013 10/22/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policypes)must be endorsed: If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on his certificate does not confer rights to the certificate holder in lieu of such endorsement s NT 1-7 r�le PRODUCER Na Colleen. Crowley Risk Strategies Company PHOI o , (781)986-4400 1 FAC No,:(791)963=4420 15 Pacella Park Drive E-MAIL ADDRESS- Suite 240 INSURE S)AFFORDINGCOVERAGE NAIC• Randolph MA 02368 INSURERA:SeleCtive Ins. OF America INSURED INSURERB:SafetY Insurance Company 3618 Cape Save, Inc INSURERC'.Technology Insurance Company 7 D Huntington Ave INSURER D:. INSURER E South Yarmouth M 02664 INSURER . COVERAGES CERTIFICATE NUMBERtCL131022.68490 REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE.INSURANCE.AFFORDED:BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID'CLAIMS.. L TYPE OF INSURANCE POLICY NUMBER. PNOILICY EFF PMI CY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE . . $ 1,000,000 DAMAGE T5-pm= $ COMMERCIAL GENERAL LIABILITY PREMISE S(Es occurrence) $..._ 100,000 A CLAIMS-MADE Q OCCUR SI1994490 0/16/2013 0/16/2014 :MED EXP(Any one person) $ 10,000 PERSONAL&ADV IN URY $ 1.,000,000 GENERALAGGREGATE. $, 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOPAGG $' 2,000,000 POLICY X PRO _ LOC $ AUTOMOBILE LIABILITY $a id nt 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X71 SCHEDULED 5.208.200 1/6/2013 .1/6/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS_ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident) X UMBRELLA LIAR $ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIA13 CLAIMS40DE AGGREGATE _. _ $ 1,000.,000 DIED I I RETENTION$ Nil, 1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included for WCSTATU-. OTH- AND EMPLOYERS'LIABILITY X O Y LIMIT$ _ ANY PROPRIETORIPARTNERIEXECUTIVE YIN Coverage E.L.EACH_ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? f 7N . NfA 3353968 /9/2013 /9/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yss,describe under . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 0.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101;Additional Remarks Schedule,If more space is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WO$., Per Proj Agg Per Loc. Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 'chael Christian/CLC - -rr ACORD 25(2010/05) ®1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD.name and logo are.reglstered,marks of ACORD ass achusP s epartme 30a C 8 ding L`c+n�tru�tii�n SuPe,rs i.ur S�seialti rise: cssL 402r6 WILLIAM J MC'`LUSKEY._ 37 NAUSET ROAD West Yarmouth NA 02613 06/28/2015 Office of Consider Affairs and 2usness Regulation s—"El El 10.Park Plaza- Suite 5170 Boston, Massachusetts 0211.6 . Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC: WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card,Mark reason for change., Address ?`.j'Renewal El Employment Lost Card DPS•CA1 0 50M-W04-G101216 ✓fe Tooivnzr�icuPaz a�.tsacfauaet2z Office of Consumer Affairs&Business Regulating License or registration valid for'individul use only before the expiration date. If found return to: T- HOME IMPROVEMENT CONTRACTOR. 121Registration 171386 Type: Office of Consumer Affairs and Business Regulation. , Expiration 3114/201'4 Corporation 0 Park Plaza-Suite 5170 s '/ Ems,, Boston,MA:02116 CAP€SAVE INC:: -.... WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE gam_ SOUTH YARMOUTH,-MA:02664 Undersecretary Not valid w�itd signs ' 41 Town of Barnstable �pt►iE 1pyY Regulatory Services Thomas F.Geiler,Director , ,:. , . " ' ' L + 1ARNSfABLE. • ;� p jj �r M 1% �t r: 9 MAC' BuildingDivision i639• �0 QED MAy Tom Perry,Building Commissioner j;U G 2 2 i 0 2 1 200 Main Street, Hyannis,MA 02601 www,town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-623( PERNHT# 49Z�p FEE. $ / SHED REGISTRATION 120 square feet or less 7/ hawc�-H—Ln Location of shed(address) Village use. C��as Property owner's name .Telephone number lox ;�(o d Size of Shed Map/Parcel# . _ as o Signature Date Hyannis Main Street Waterfront Historic District? NO Old King's Highway Historic District Commission jurisdiction? 00 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE.COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 f m 50 \ I IN, j a w o � 31� y �. -lJ d j: U "v rn p � rn �� a3t�S TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a CAI Parcel CABLE Permit# C 7 3 Health Division U �o� ' " ' Date Issued 6 Y Conservation Division ^ ;4 `°._.! .,.,� �:, Application Fee Tax Collector a ® p D Permit Fee r 0. 06 Treasurer Planning Dept. EARN WJMC SYSTEM= Date Definitive Plan Approved by Planning Board LIMITED TO_3.0OF BEDROOMS Historic-OKH Preservation/Hyannis Project Street Address `✓o 1,3 C Village A v k C.Owner c�SC> Address Telephone O Y - D:2 1 U� Permit Request FOr_ C Square feet: 1st floor: existing proposed `1 !SO 2nd floor: existing 9� proposed 73a Total new Zoning District Flood Plain Groundwater Overlay - Project Valuation Construction Type c Aqlvk IF- Lot Size \�CScs:_ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 114, Two Family ❑ Multi-Family(#units) Age of Existing Structure �J UN,(-- House: ❑Yes t/No On Old King's Highway: ❑Yes '�U(No Basement Type: 01 Uri, ❑Craw,I 0 Walkout ❑Other c� Basement Finished Area(sq.ft.) S Basement Unfinished Area(sq.ft) 3 d� Number of Baths: Full: existing new O Half:existing new Number of Bedrooms: existing new 0 Total Room Count(not including baths): existing (:', new First Floor Room Count Heat Type and Fuel: kGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes b4,No Fireplaces: Existing c 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 Cl Yes ❑No If yes, site plan review# Current Use Proposed Use - BUILDER INFORMATION 1 Name Telephone Number ��'— ��7�" YSD�? Address Gf�n ,, w ^^ License# Nv� v�-(o E>I Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Y FOR OFFICIAL USE ONLY rh c, PERMIT NO. DATE ISSUED ' .j MAP/PARCEL NO. ADDRESS VILLAGE a _ OWNER DATE OF INSPECTION: FOUNDATIONa FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH h _FINAL GAS: ROUGH I-- FINAL FINAL BUILDING + DATE CLOSED OUT w ASSOCIATION PLAN NO. The Commfinwealth of Massachusetts Department of Industrial Accidents' -1 — Oise Bfl�rsd�sdafts 600'Washington Street Boston,Mass. 02111'. Workers', Com ensation.Insurance Affidavit-General Businesses // , �• ���` ;:tiystrv,. .S+,t,r^''+'S:.•"r^.'.. .r. ` -"' .. .•�a' � •..;�,hdU1 '- / address.: A PC j �• p state: s a :6 work site location(full address): tI am.a sole proprietor and have no one Business T�'pe: []Retail[]RestaurantBar(Eating Establishment working in any capacity. ❑Office❑ sal'es(including•Real Estate,Autos etc.) ❑I am an em to er with employees ees(full& art tim�: ❑ Other /�%/%% ��%jam � %//////�%%%�� ////%//%//%%%/.%%%% � •,%%%%�%/G/%� , I am employer providingNprkers' compensation for my employees working on this job. an employer •''i.:,r'+ .S: •' :t' �'r •r •:-T•'i'•:Y:l'•.• ��l'•.+r: •�.' .'�r�: > Co an'.flame: ;[: '.r. }' ,'';c7 J'.r'i.:'t'•:,>i:;:. .: Yi ti•' cin ,.. -:,•• ':•�, `' t ` .. . •.+.: '''.' '4, .. �;'+..• ",•r•• ' , ��' ''i. '�� ,��+ ,tit. - , �'2 '; ;.'t.y�,�" ,�j'�_ '•'�' i f>:?i, '� .. address: 1:. •Ci ,, � <•I�a,jr' _• '.is � �p "`t : •>. '�'?yi �'i'+p.^t •insurallCe.C'U�' +r .•:,:..t^ .il;,�„ •p:' r�:y' •,i•It% RMIx (] I am a sole proprietor and have hired the iudependent contractors listed below who have fife following workers' . compensation polices: c� ,fir.+ ,,•.ai.^. .,• - ::1n:N .�.;' 'li r •r*''•''' .7. .>;:.±r: i.tS' .4'.•�' .': 'y�•.}..•:.'-iF'e;�I. ir� I r' •rj• ..i- �•ti'r., 1•'•r�• •ir�' _i,� Cl ..� '`k1:4``.' 's"f.i:•:' +.yam,:a:1.. f''r•.;is :.:,'=.i ��rh�::v•• 1:' .. ';,�' y`,,:r'.'�r :x''r :i= •Sa};;• >';:� .}.. .+:.'�'r'UZ1C a��•'.,e.�•i•.'•,:,�:<7`•' '':.i�i. '{.`a..=i• ,'. fu's�iirance'co. :•' -:ti,. .,•. •.. . .r: l/////%//G///%�/ :,: •+. r;•1it� .i�. ':,.. +c:; ,�? `t:� +'`'•'' :,•.�: :'off. •'•� •'�' Com aD• j►i1Z1je:.i J ''• i+ r. r' address: CI t - :i.s r +:'+.. 'A. .S y: 4.• 't;., a: Ir�: :'7:ir';�' ! )::�,. •i"•I •.1 r , ;:5:' ti3. ';fit: i 1'.•: t i• •'• ' ' ..>_• ,i::+�',. ;'Y:�.. r: ti,,,.'. w. ��.,i :'t! •r.;J.: ''i. +•. �i'.:. ':,t:•,t'. �•1"ri:Fr'.,st•.'�,�,;•r •t.:.'''�.••'•.,.�,•ti. ,�,�. '::' ';�'•r :t!:ij ,.u: •'OZICd':'#•i• insur"snce co: 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 simo0 a day against me.I understand that s ent maybe forwarded to the Office of investigations of the DIA.for coverage verification. COPY of this stytem . I do hereby certi and �t p nalties of perjury that the Information provided above is frMoil orrect:, E_.. -�� Date � ®So Phone# print name official use only do not write in this area to be completed by city or town official permit/ltcense []Building Department:, city or town: OLicensing Board immediate response is required ❑Selectmen's Office ❑check ifimm P []Health Department phone Y; ❑Other contact person• - : t (reused Sept 2403) I Information and Instructions. cha ter 152 section 25•requires all employers to provide workers' compensation for their. General Laws' p vlassachusetts. � , ;mployees: As quoted from the f`law", an employee is.defined as every person in the service'of another under arty contract �f hire, express or irrlied; oral or written An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoes engaged in a'joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or individu4 par trustee of an tnership,,association or other legal entity, employing employees. 'However the owner of a dwelling house `?mg not'inore than three apartments and-who resides therein, or the.oceupant of the dwelling house bf another who employs p�sbmis to do.mamtenance, cons or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such,employment.be deemed to be an employer. MGL chapter 152 section 25 also'states fhat'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.coinmonwealth for any applicI. ant who has i the not produced acceptable evidence of compliance shall eater into an Ath the e contract coverafor the performance of public e r�4idr&d. Additionally, work until coirnnonwealth nor.any.of its political subdivisions s Y acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. FIR 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',compensationpolicy,please call the Departm*t at the number listedbelow. AV City or Towns . Pleasebe 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 perrnit/license number.which wi11 be used as a reference number%. The.affidavits may,be.returned to. the Departmentby,r�or F?,X unless other:arrangements have been made. :. The Office of InvestiSations world like to thank you in advance for you cooperation and should you have any questions, please do nothesitate to give us a-call.- The Department's address,telephone and fax number: ' The Commonwealth Of Massachusetts Department of Industrial Accidents emce of Wesupbons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 �"ISE � �o�cl of Barnstable • �' "°� Reg-alatory Services . 1 g�Et ThomasZ Geller,Director �19. k Building Division • Tom ferry,Building Commissioner ' 200 Main;Street, Hyannis,MA 02601 Office; 508-862-4038 Fax; 508-790-6230 Permit no. l]ata AP'RIDAYZT )30ME 1M.PROYFMENT CONTRACTOR LAW SU PUMENT TO PERMIT APPLICATION MGL 0.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, •improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied budding 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: PC Estimated cost - Address of Work: , Owner's Name:. ® � Date of Application: ✓Oleo Z/ • ' . I hereby certify that: Registration is not required for the following reason(s); []Work excluded by law ' []lob Under$1,000 ' []Building not owner-occupied Owner pulling own permit ' Notice is hereby given that: • OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.iRMG•ISTERED CONTIaCTOM FORAPPLIC4,LE HOME IMPROVEMENT WOIKDO NOT ILWE I ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY BIM UNDER MGL c.142L SIGNED UNDERPENALTMS OF PERIURY ' 1 hereby apply foi a permit as the agent of the owner: Date Contractor Name RegisErationNo. OR 0 wne,r's Name Town of Barnstable Regulatory Services SF, Thomas F.Geiler,Director BAM Mass. . 03�. p,0 Building Division rFD 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 RATE JOB LOCATION: y� ✓'t ez rl 1 s number street village "HOMEOWNER"J�:Pnnpa�-� 7?/- ®� g g �3 V name // home phone# work phone# CURRENT MAILING ADDRESS: a 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. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a.one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official.on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section i09.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. in this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:bomeexempt MEMEMEMMEMENE ME MOMMOMMEMMEM MEE �EMMMM M ME ■ 11� S � ME ri ■ ■ � NON ■ ME I { rl all I - I y i I - -� J � I p 4. i11 , c", I I I I --4 11 , VI r s� �y it I � o 10 -�— 1-1---------717 1 1 1—, —TI FT— mom WE IN Elm MEMOMMEMMEMMOMMEME mommom ME ME NONE ME MMOMMEME MEN MEN No M ■■omom MMM ' iu � � iiME � MOMMMMMOMME mom MOMEMEMOMEM MEMO lmom ON so No No oom ON MEN mom MEMO so EMMEMOM ON SOMEONE ■�� MEN ME mom ME MEmom �Mm MOMME ON IN mom MOM NNE ME MEM M ME mom mom mom MMMEM MEMMEM so MEMNON EMMEM moomm MEMO momom � 1� oe- ol LV w i 11 rn 17. th o .� _ \ - ` a to n b -6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o Map �� Parcel 073- Permit# "Health-Division � r r Date Issued �-� Conservation Division f/3 Z�® Fee C� ('-Tax Collector '1�3(l0( U,, SEPTiC SYSTEM MUST! t -Treasurer c,cam,,---� I�ZlJ71J INSTLLE® IIV COMPL9 �y WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE Al;)n Date Definitive'Plan Approved by Planning Board TOWN REGULATIONS �w�W Historic-OKH Preservation/Hyannis - � s " y �� N Project Street Address Village ffMhl S Owner o,a.,e_ C Address r XOC f /Z4 �`�5 onl7 S, A Telephone Sb$' ?^7 ' �9 ©� � o _ -7 / 9 Permit Request -�✓ I o Square feet: 1 or: xisting �ai-/ proposed 9&;�2nd floor: existing proposed Total new /� m Valuatio6',, Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes )(No Basement Type: XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) rr Basement Unfinished Area(sq.ft) Number of Baths: Full: existing o! new Half: existing O new Number of Bedrooms: existing 0C new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes XNo Fireplaces: Existing I 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 ANo If yes, site plan review# Current Use Proposed Use (� BUILDER INFORMATION Name 05(. C Telephone Numberr,� 9_%�- a Address gLv License# t��a✓In ,,`M4 C)a;* )1 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r DATE, J1 161 r '7 1 FOR OFFICIAL USE ONLY PERMIT NO. _ DATE ISSUED 3• e h MAP/PARCEL NO. , ADDRESS VILLAGE` .•,� � 11 { l OWNER " , DATE OF INSPECTION: FOUNDATION FRAME INSULATION a/a a/a /,vs o P . fir' .•� .,� - FIREPLACE ELECTRICAL: ROUGH:- ". Yy FINAL PLUMBING: ROUGH;" 7% FINAL GAS: ROUGH FINAL _ FINAL BUILDING DATE CLOSED OUT .� ASSOCIATION PLAN NO. �, The Town of Barnstable o eAWNAB& RegulatoryServices 16,3�►��� Thomas F. Giler, Director s o Na Building Division Elbert Ulshoeffer, Building Commissioner 367 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: ClUL C Cwt e Estimated Cost �t�J C2 t J LA Ali h 1 S oa(o C) I Address of Work: --��� -� Owner's Name: 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 Oadding not owner-occupied wner 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- Contractor Name Registration No. Date OR Date Owner's Name q:forms:Affidav 780 CMR Appardit 1 Table JS.tlb(continued) Prescriptive Packages for One and Two-Famdy Residential Buildings heated with Fossil Fuck MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Hcating/Cooling Area'(%) U-value= R-value' R value R-values Wall Perimeter Equipment Efficiency Page R value' R value' 5701 to 6500 Hating Degrce Days' Q 12% 0.40 38 13 19 . 10 6 Nomud R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10' 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 38 13 2S N/A N/A Normal Y 19% 0.42 38 19 1:2119 5 N/A N/A Normal Z 19% 0.42 38 13 9 10 6 90 AFUE AA 19% 0.50 30 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: f-k n 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3 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 DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a I 780 CMR Appendix J i 4 Footnotes to Table J6.2.1b: ' 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 J1.5.3a. 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 met the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned bo-:Iements 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. s For Heating �' Y Degree Da 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 The Commonwealth of Massachusetts rir 7- Department- Department of Industrial Accidents office 911HYDs99068s — 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit � ��r�srrazf�.lti name: —3—OSe— �S® c--� location ci asN r)15 ©a(4© hone I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one workin in any capacity ......... dinX. workers' compensation for my employees working on this job. :. :. :: .:.;:.;: ❑ I am an employer prove g mp . .. com anv name:. :...:..;:::...... hone#: XXX insurance co.IF 0 ❑ I a10 m a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have ' compensation polices: the following workers' P .,, ....::.... .. .:. com an name: address. < ;. aw xhone# cl _. ..:::...:.:.... :::: ;.; n9uranee co .:. VO ICY: N MINIMUM, c in ::name: : . address. ci h6ne 41 Gi*#: ;entrance co:::: _ 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 yam,imprisonment as wella,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 D1A for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature C,-% Date — Phone# Print name official use only do not write in this area to be completed by city or town official city or town: pe�t/iicense# ❑Building Department ❑Licensing Board response i9 required ❑Selectrnen's Office ❑checkif immediate respo q ❑Health Department contact person: phone#; - ❑Other Ocyned 9/95 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 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 or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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.. btain 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 permit/ cnse 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 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 Office of Imlesduallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 BAMSrnatMASEL .s. e o ��� Regulatory Services 59. ° Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village -1 "HOMEOWNER": t�OS� (-- ��/OS� S /' /�� 5 �-7,90-9.237 �\ name / home phone# work phone# • �' CURRENT MAILING ADDRESS: UJCC Lid ,c?��5 � o oa, �ry/tow state up 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,vrovided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said \ procedures and requirements. 1 \ f Signature of Homeow er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION 'The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the ded provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provi that if the homeowner engages a person(s)for hire to do such work.that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q.Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems.particularly when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certifrcation for use in your community. Q:FORMS:EYEMPTN FE E VALUE WORKSHEET LIVING SPACE (2000 sq ft or greater) square feet x$115/sq.foot= s (less than 2000 sq ft) square feet x$96/sq.foot= (affordable housing) square feet x$57/sq.foot= (4013 or low income) / J� spare feet x$25/s foot= /To to o •�-GARAGE(UNFINISHED) ` 9 q -1 PORCH square feet x$20/sq.foot= DECK square feet x$15/sq. foot= ALTERATIONS/RENOVATIONS OF EXISTING SPACE cost '• Total Project Fee Value 900 Office Use Only Permit Fee projcost l �JJ - � � i ��� �i � j � �I� � h � h ��� �� j � �� �' � � � � � � �� � � L � � i 3 i i { i \ C� .`�� � - ._ _ G� -�_ -A _�- � M�. RANI I N G . SECT ION ALL DIMENSION LUmj3pt SNA $COLLgR TIE O G. 8E Kb SPF No. a OR 6EVE.M. •� x Qa 4E" 2 x I0RAPrER @ • ac. .� 2 It BCEILINS VaIgt ® •• O.C. SNINOLE W/IS I.B. FELT A•30 KRUT WEI) R0 PINE FA • gAit,9 p- �3UNFACl:f1 F6 8A1Ts SOFFIT vENr W/6•MIL POLY VApon 3ARRIEA 2N° FLoon) PINE SOFFIT 2x »FLOOR ToIST (!sr ; 2Nn FLOOa) C. 2� Y _ P, SILL SILL SEAL • RI aOLT 6'0• ®.C. 5•CONCRE7E POUN')ATIUN WALL • a rN rh r A m /q� I i N � i i 2