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0007 FERNWOOD AVENUE
7 �Ezniw o -�"✓ ACTIVE _ \ Town of BarnstableBuilding : . Post This Card So T.tat rt,is 1/is�ble From the Street Approved Plans.Must be Re in taed orrJ,ob and this Card Must>be Kept Posted Until Final Inspection Has Been Matle W.here.a Certificate"of Occuanc z.s Re 'used such Builds shall Not=,bye Occu red until a Final Inspect"�onhassb'e'en,made k e rmi p�,� Y.. .�. q ,...�g� ,.-;.p �.,.�,W.. . . _..w ,..,..x Permit No. B-18-3836 Applicant Name: RetroFit Insulation Approvals Date Issued: 11/26/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 05/26/2019 Foundation: Location: 7 FERNWOOD AVENUE, HYANNIS Map/Lot 288-079-004 Zoning District: RB Sheathing: Owner on Record: TURNER,DONALD&PATRICIA B Contractor 'Name:: ;RETROFIT INSULATION INC. Framing: 1 " Address: 11 BROOKSIDE DRIVE Contractor License: 160461 2 PITTSFIELD, MA 01201 Est Project Cost: $7,324.00 Chimney: Description: Air Sealing, Kneewall Slope: 2" rigid board,Attic Flat-14" Floored R- Permit Fee: $87.35 49 Dense Pack Cellulose, Kneewall Slope:6" Fiberglass R 19, Propa Insulation: Fee Paid $87.35 Vents,Attic Flat-6" Open R-22 Cellulose,4x16 Soffit Vents,;.Temp ¢ Final: Access,Attic Damming, Pull-Down Staircase:Therma""dome;Vent. ` Date. 11/26/2018 Bath Fan To Roof,Attic Hatch:Seal &Insulate f f-r Plumbing/Gas Project Review Req: Rough Plumbing: Building Official Final Plumbing: # s 4 Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized,by this,permit scommenced within siz months afterf issuance. Electrical �. „ , p All work authorized by this permit shall conform to the approved application and the approved Construction documents.for which:tNs permit has been granted. All construction,alterations and changes of use of any building and structures"shall bein compliance with:the local zoning by la�nis and codes. Service: This permit shall be displayed in a location clearly visible from access street or road and shall bemamtained open for pukil c,mspection for the entire duration of the work until the completion of the same. Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final: Minimum of Five Call Inspections Required for All Construction Work: Low Voltage Rough: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Health 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Final' 7.tiIenal Inspection before Occupancy Fire Department Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: WorA shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). E7Mha` - t Application number, Date Issued.................................... ..1...1.(0/! XAft sue. t ®//VG Building Inspectors Initials......... ......:................... ....... ... .. .. ... ... ... OV ® Map/Parcel........., .. .,....'.�.�1... .......... 1 ,7 NOV 21 201E TOWN-OF BA:RNSTABLE rp'IVA' Uk 8A Hiv EXPEDITED-PERNffT APPLICATION: ROOF�STDraj f4 /WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: /j �fj �✓ �ry /�'lCtrS�ti)'I.SS '`Z/LILS NUMBE STREET VILLAGE Owner's Name Phone Number dj o�a� ' ���� Email Address: Cell Phone Number Project cost$ �C/7y Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize &-, 7/� G to make application for a building permit in accordance with 780 CMR Owner Signature: !(x �� Date: TYPE OF WORK 0 Siding E3 Windows(no header change)#___p Insulation/Weatherization © Doors (no header change)# Commercial Doors require an inspector Isbreview 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOW...S INFORMATION Contractor's name Ue- - �c Home Improvement Contractors Registration(if applicable)# ?J�o " �, (attach copy) Construction Supervisor's License# .�r�J'�� (attach copy) � —rJ tW— Email of Contractor 1, Phone number —`7"N W V D ALL PROPERTIES THAT H VE STRUCTURES OVER 75 YEARS OLD OR 1F THE SUBJECT PROPERTY IS IN . A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER.......................................................�... r *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowners Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CAM the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP ICANT'S SIGNATURE Signature Date 44�� All permit applications are subject to a building official's approval prior to issuance. f — 004* Oft Yt a iaif6t3S FJ r� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma*chusetts 02116 Horne Improvement ontractor Registration Typo: Corporation ALTERNATIVE WEATHERIZ4TION, lNC Registration; 175883 2 LARK ST Expiration: 05/28/2019 FALL RIVER,MA 02721 Update Address and return carts. Mark reason for change. "4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only :~ 'TYPE:Comoration before the expiration date. If found return to: SmsilUatlor, is 'ration Office of Consumer Affairs and Susiness Regulation 17 05M/2019 10 Park Plaza-Suns 5170 ALTERNATIVE WEX iERi7}1TION,INC. n,MA 02116 TIMOTHY CABRAL - 2 LARK ST FALL RIVER,MA 02721 Undersecretary Ot V 0 Si litLtYE Y -s a� Town of Barnstable • s Building,Pepa.rlm nt Services Brim Florence,CBO a k`� Building Commissioner 200 Main Street,Hyamis,MA 02601 WWW.tovMbarnstable.ma us Office: 508-862-4038 Fax.: 508-790-6230 Property Owner bust Complete and Sign.This Section . If`sing_A Builder 11-e � e ,as Owner of the subject property hereby authorize / act on ray behalf in all matters relative to work authorized by this bui�d=in)g-�p4, PP (Address of Job) z **Pool fences and alarms are the responsibility,of the applicant. Pools are not to be filled or utilized before fence is installed and all final: inspections are performed and accepted. Signature of Owner Signature ofApp 'cant Print,Name Print Name Date Q:FORI -OWNERPERMISSIoNPOoLs Rev.09116117 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer:'Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. El Demolition' 4.F�I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ROOF repairs These sub-contractors have employees and have workers'comp.insurance.+ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must 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. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:' LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#: XWO(19)58867158 Expiration Date:6/8/19 Job Site Address: :5,A be If4- City/State/Zip:���'l/ 1. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration da(e). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a p lti s f perjury that the information provided above is true and correct. Si nature: Date: Phone#:508-567-4240 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 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . ACC) CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) L-� 06/11/18 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 INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may,require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER GUNIACT NAME: Anthony F.Cordeiro Insurance Agency (A/C,PHONNo Ext: 508-677-0407 alc,No): 508-677-0409 171 Pleasant Street ADORE Fall River,MA 02721 ss: HSouza@Cordeirolnsurance.com Fall INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St Fall River,MA 02721 INSURER o INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH 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. INSR AWL SUM POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 P_CLAIMS-MADE DAMAGE TO-RENTED�OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER I I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED AUTOS ONLY AUTOS Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) S X X HIRED �/ NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY Per accident $ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE s 1,000,000 DED RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? N/A XW058867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 :1 L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary&Noncontributory basis per the terms and conditions of form CG2001 (04113),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT 9 i/a._w �j � ....._............-_ f ©194�-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD l Town of Barnstable Bu�ildi�n r xs � # s ._3, ..� g M st tamed n,Job:.an his kacl M'sta. t �;f . . .. . Post This rd So That� �s V�slble,Frorrr�the Street A,..ro, ed Pia •S...,.0. be, ermit , _ 1, I t I Ha Been Ma e,.,-.�fi ,... .<. ,,. ,./„ ,�'�, ..: •, -: ,�. �, , :.P '..._:. ,h rewa-.Certifie teof.Occu an a:�is�Re aired `sueh�B.uild�n ,fshall Not�be Occu �ed�utitil-a.Finalans ect�orUhas:been made. ' Permit NO. B-17-1962- Applicant Name: TURNER, DONALD& PATRICIA B Approvals Date Issued: 07/05/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 01/05/2018 Foundation: Location: 7 FERNWOOD AVENUE, HYANNIS Map/Lot 288 079 004 Zoning District: RB Sheathing: Owner on Record: TURNER, DONALD&PATRICIA B � P Contractor IUame Framing: 1 Contractor License, Address: 11 BROOKSIDE DRIVE 2 PITTSFIELD, MA 01201 yEst�Project Cost: $3,500.00 Chimney : Description: Reframe screened porch to install 3 windowsand 2 slide m'to makePe�rmit Fee: $85.00 three season room Insulation: Fee Paid $85.00 Project Review Req: Reframe screened porch to install 3 windows and 2 sliders to �Dat", ,�e 7/5/2017 Final: make three season room r '< N Plumbing/Gas 41 6b _ . s Rough Plumbing:u mg: Building Official Final Plumbing: g This permit shall be deemed abandoned and invalid unless the work authonzeby�ths permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the'approved application and the approved construction documentsfor which th»%s permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zom�ng by laws'and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or oad and shall be maintained open for publicrospeetion for the entire duration of the work until the completion of the same. l Electrical kkl The Certificate of Occupancy will not be issued until all applicable signatures by the�Buildll R�ing and Fire Officials are;providedon this permit. Service: Minimum of Five Call Inspections Required for All Construction Work.; � y3 1.Foundation or Footing x ROu h: �,. . : g 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not-proceed until the Inspector has approved the various stages of construction Final .'Pe.rsons.contracting with.unregistered_contractors-do.not.have;access to the_guaranty.fund' (as'set.forth in MGL.c:.142A)'.` . Fire Department u. . Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT _TOWN OF BARNSTABLE BUILDING PERMIT APPLICXXION In Map 0? Parcel / 0 A Pp lication # �0_0 I `� 9 � Health Division A' Date Issued 7/s �/1 Conservation Division �1 .P ®G� `�Gy � Application Fee c� Planning Dept. ®:�, �j °�� Permit Fee �y5 Date Definitive Plan Approved by Planning Board �YA Historic - OKH _Preservation/ Hyannis E H-z L .S n roiect-Stree Ad ress 7 -ForflJmp Ave "Ow^- b-Z)N -1 j) ddress Pr V c !T;�6-00 -A 5,41 / cn-m, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay g'� 'Valua 5 Construction Type �e�edt �. � tbn 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) Dame . I !(�r4 1G 1 1V�' -�Telep.X1 �hon �lT ; �Adclress P gr�L� ��r`�c ��� If-� License# 0 126 Home Improvement Contractor# Worker's Compensation # ALL CON TRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Si i�4TlJRE °- DATE 4/ FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. r f ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION R FIREPLACE fY ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Pi RW q 44 R a aw _ � Q - oil" got ' P F-11 r n 44 ph M II:'•_— .11•l.�rw - ■�!_ r!1_■•[r �•■n:+ _1 �l■n ••rR l■ !1 r f- •••1.1rR r•1tn!r■I.Y:■■n■ Ifl i■.i■ rnlr ••�.. 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I t1_l ■. •�r1 • t•r1:1• .YIn1■it •! 1■.Ir.7�• r /1 rnt n •■•'l [■. r- r• •• •�I 1• n :■■. ..:.■e - n •• u.I _ • : n■:• I .1 i> Iu nn.! ■ti•n 1■, n ..I. ■' _ i■/.•t ■■u . :11 r■ •n �: -. �:■ •�t r ■•n •"t ■1 MI■ /rt ■■Ynn1■ rrl ■1 •rf■■1 ■• :1■�f l• .1■• ••Yt!`. • ►•It■t■�: rt_ •i!nn1 •■ rr• • t i1ft1 1 It •alrt ►■ v:■■ ■�:R•II �•■t! �• ■1 rnt/l• �[' ■111. ■{•: 1 ■ ■■ • ■ •wV■':I■■Il •'•■ • t.7- f■ ■t_I■ ■! tt t _II r. In ■■■ r1••�'. .If•n a1• ■•r ■ ••■ 1_ • a■ •■�+■n/ • w •■ ■• ■w■Ir_■r n 7• •I. •c 1 �• :•a n■rtt c•n .a r "■f■I■ _0 l r_► ■unl Wei -Ltint■• oil tit • la_■ ►a ' r. 1 er.� -•• • nr- THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA b . ,s Dv'- /u( Town of Barnstable09" Regulatory Services oFtl t \�� Richard V.Scali,Director Building Division * BMMSTABM *' �/1 Tom Perry,Building Commissioner ntnss. I 1639 200 Main Street, Hyannis,MA 02601 �FO ,t a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 6-20-2017 JOB LOCATION: FERNWOOD AVE. HYANNIS numGer street village "HOMEOWNER': DONALD TURNER 13-445-4745 13-441-7172 name home phone# work phone# CURRENT MAILING ADDRESS:111 BROOKSIDE DRIVE PITTSFIELD MA 01201 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 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 requiremen 1�1�w �,GG 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 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 form/certification for use in your community. m C3 MENOMONEE No MENEM MOMMEME 0 W MENEM MENOMONEE 0 0 Nommoom No 0 ONE so ME NOMEME MENNEN No 0 No MEN IMMEMN mom 0 00 sommoom M� mommomm NEI ONO limmo MEN ' mom �Mmmmmmmmm 0 ON 0 EMOMOMMOMM 0 0 NOON No NOON ONE MENEM M moloomosimm MONO No mmimomm NEI lM mmoom NOON oom mmmm� immommomom I moommomm 0 �mm mom MENEM M No NONE MENEM No 00 IMMENSE MENNEN MENEM ■■�ni■iiMEMO iinSOii■NSNEEMMEMEMEMIN ���� iii■�■iii�iii■�iiiiiiii�■iii�ii ................ ............... MiiiEiii■ii=i�i iedi OiMiiiiiii�i 06 Op1HE Town of Barnstable *Pei 130,F34 Expires 6 months from issue dote Regulatory Services Fee 3 _ (* BAHNSTABLE, y� MASS. Thomas F.Geiler,Director 039. ♦0 AIED IVIA't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Q 2.9 0 W Property Address71 FtJz-&/k., U O P t� 'n11 nGfl. S , �jResidential Value of Work$ r0 O 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address bd?U A t,9 --FV rt j 2,= I e- Contractor's Name —Telephone Number �� I Home Improvement Contractor License#(if applicable) Email: !'\- RESS PERMIT Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor TOWN OF BARNSTABLE 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows 9 #of doors:C_ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. *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 copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: F�'C— C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 OF THE Tp� * BARNSPABLE, 69. ,.� Towwof Barnstable AtFD MA'I A ., Regulatory Services Thomas F.Geiler,Director ` 'Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ;as Owner of the.subject.property.. . . hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner_ Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. .. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Out]ook\8R76BDVA\EXPRESS.doc Revised 061313 F iNE Town of Barnstable BARNSTABLE, : Regulatory Services. 9 MASS. $ r_ Qj 1639• A�0 -'°�Thomas_ _ F_Geiler,birector ; ACED MA'I y Building Division . Tom Perry, g Buildin Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: I i J Please Print t JOB LOCATION: number ssttreet �/ village „HOMEOWNER":�74ik o Tvr"e-r {L3 i��`t-7 q� (113 - It Y3 -20Go name home phone# work phone# CURRENT MAILING ADDRESS: << Lj�� I O l D 12 1 1J L N-t )m 1k- 6 126 1 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,accessoryao 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 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 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. t C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 v ..731e CoNlrttorrwetallh of Marsstxduusetts _.____....... Repay Item of Industrial Accide:rtts Offire of InvestigationsL161 600 W ashbigtorr Street �3 Boston,M4 02111 tr°tmrtaa.ssgorldia Workers' Compensation Insurance Affidavit: Builders/Conn-actors,JEieetiiciansJPlumbei-s Applicant Information Please Print Leh ly- None tsusmsitorganization;bd dualy D� 1,J kc]e —T-y T'N Address: \ 3-f-A9 i-r i cxR v Y— l 1 M(' le, C y�/Staten Zip: phone#: y 13 q t S— V 2 q - -Are you an employer?Check the appropriate box: Type of project(required) 1.❑ I am a employer with emP to 4- ❑ I am a general contractor and I 6- New constnmtion aehied the sub-contractors employees(full and or part-time)-*2.ElI am a sole proprietor or partner-- listed on.the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors'have S. ❑Demolition working for me in any capacity- employees and have,workers` : 9. ❑ Building addition [No workers'comp_insurance comp_insurancel required., 5. ❑ We ue a corporation and its 10.❑Electrical repairs or additions 3XI am a homeowner doing all w6ik officers have exercised their 11.❑Plumbing repairs or additions . m aelf: o woikers'txa right.of exemption per NMI, } [l�1 mp 1.2_❑Roof repairs._.__ c.I5:2,§1(4),.and we have,no etnployees.[No workers' l:3_IK Other comp-insurance.requixed.] ' ) PP the section below showing their workers':cotirpensation palicy infort ion.An=a t<snt that checks box#1 must alsn fill out >Flonmbwners who-subMi chic affidavit indicating they are doing 2Ll1 worn and then hue outside contractors must submit a new affidmit indicating such.. :Contractors that check:this box must attached anadditionsl.sheet showing the name of the sub-contractors and state whether ar not those entities have employees.If the sub-contractors hav e:emptasees,they mnst:provide their workers'comp.policy number. I alit art eirtpkyer that is providing workers'corrtpensation innirarrce for city employees. Beloit,is thepoligy and jab.site irlforart atiarL Insurance Company Name: Policy 4,,or Self=ins.Lic_ _. E pirationDate: Job Site Address_ CityfStatea'Zip. Attach a copy of the workers'compensation policy declaration page(shoving the:policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and`or one-year isxtgrrisomuent,as well as ci-.ail penalties in the form of a STOP'NORK ORDER and a fine of up to$250.00 a,day against the idc Wor. Be advised that a copy of this;statement may be,fbi aided to the Office of Investigations of the DIA for.insurance coverage,verification. I do hereby certify under the pains arm penalties of pei jurl;that the information provided abo/ve is trine and correct. Suture: Date i�1 G l o Phone# ` _.(?feral rise•sail . Do hof tt er to car ibis urea,to be cortupleted bl cat,nr trrrvir offi.ciaL t City,or Town. PermitfLicense# IIssuing:�luthont} (ria-cle Dire}: � - ' '1.Board of Health 2.Building Department 3. CitydTawnf C1erl: 4 Electrical Inspector 5.Plumbing h pectar° 's 6.Other' : Contact Person: Phone#-. - 6 Parcel Detail Pagel of 3 0/51 4 6AA.'ti4.•Erlfll.€' MASS r Ati-tln. ,rye' 'v'" Logged In As: Parcel Detail Tuesday, November 12 2013 Parcel Lookuu Parcel Info Parcel ID 128 0 98 77�004 � Developer Lot CLOT 25 l— Location 17 FERNWOOD AVENUE l Pri Frontage93 l Sec Road I SCUDDER AVENUE Sec 1 123 l Frontage village IHYANNISM Fire District HYANNIS _ I Town sewer exists at this address No l Road Index 10531 l I ; Interactive 7� Map x4t"W ikv�s� - Owner Info Owner�LAWLOR,THOMAS F Co-Owner RJURNER, DONALD&PATRICIA B Streets I11 BROOKSIDE DRIVE l Street2 -- - Lv City PITTSFIELD l state kviA Zip 01201 _ Country Land Info Acres 0.27 Use FSin6Fe Fa m MDL-01 l Zoning RB Nghbd 0106 Topography Level l Road rPaved l Utilities Public Water,Gas,Septic l Location —�— - Construction Info Building 1 of 1 Year i _ Roof Ext — --- Built{1984 l Struct Gable/Hip—" l wall Wood Shingle l Living Roof AC Area 1460 Cover sph/F GIs/Cmp l Type None — Int -- Bed Style f Cape Cod l WallDrywall l Rooms 13 Bedrooms l �* Model Residential Int Car et Bath 2 Full OP d l Floor - -p � 1 Rooms if g, ?fit ` Grade Average l Heat Hot Water Total Rooms l Type Rooms " Heat Found— stories�1/2 Stories Fuel Gas l anon(Poured Conc. Gross Area 13240 Permit History http:/'issgl2/intranet/propdata/ParcelDetail.aspx?ID=21829 11/12/2013 Town of Barnstable °FTMME r° Regulatory Services Thomas F.Geiler,Director • 3ARNSTABIX MAW. i639• Building Division ,0� .elEO MAC A Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINOUIRY REPORT Date: .07 Rec'd by:_ Complaint Name: 7 44t-1 Map/Parcel Location. Address: Originator Name: _7 Fe -7 4, Street: Village: State: Zip: Telephone: Complaint Description: FOR OFFICE USE ONLY Inspector' Action/Comments Date: Z- Inspector• -7/07 D� eeGCS Additional Info.Attached f Q:forms:complaint Town of Barnstable emit: pFIKE rqj, Regulatory Services ate: Thomas F.Geiler,Director saxxsraBLe, Building Division y mass. 1639: Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: Phone: Install at: 7 � �AlIz4on !f' if Village: o Map/Parcel: �C [ l (f Date: E D Stove A. ew Used B. Type: Radiant/ Circulatin C. Manufacturer: Lab. No. D. Model No.: a, O C,o-• U `� 'l C ' A New/Existing (If existing,please note date of last cleaning) B. e Size_ �o C. Are other appliances attached to Flue? 41 e) D. Pre-fab Type and Manufacturer •� E. Masonry: Lined/Unlined Hearth A. Materials: 3 v.--c B. Sub Floor Construction: lv/ Installer Name: 110, Address: Z Phone: _ - -- 0 Location of Installation: a� CJ f-C .APPROVED BY: i ` i`�/ `�' � el C;1, Please make checks payable to the Town of Barnstable =*Thistitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 n •�-jj'�" �,� V-Y C ,tip � '. ; r •� 4 10/08/02 7 Fernwood Rd., Hyannis -- , �- .z it, •� ��7r.�:sy .a2'te-... '."r.""a`.".... � � _ ..'«'� 'gyp �1#� ems` - y - - 10/08/02 7 Fernwood Rd. r* Hyannis u TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ® oo Permit# Health Division14161N 3 ate Issued 2 Conservation Division t' �A�� (O 3 roee N Tax Collector M 42RA4.. 1017-q✓O t (,A Treasurer M-v� ►��L fi �i�'U f / E �iC SYSTEM MUST �� 7 INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVI ONMENTAL CODE ANDTOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 77 Village M),y,LryJS�_I— Owner :7:VQ ",�125 l O u1 LA Address `J /�Xzy&/t',1 j &CL Telephone ,r,0 9- 7 9/1- 7 U . o, o Permit Request C 0/YVf__A f l� /�A)? ZaI7 7t) PAO-1 Y d O OM Square f 1 st floor: existing7L proposed r-' 2nd floor: existing proposed Total new Valuatio Oo Zoning District Q Flood Plain Groundwater Overlay Construction Type Wli dQ && l e Lot Size '7 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 3 Two Family ❑ Multi-Family(#units) Age of Existing Structure 62 Historic House: ❑Yes G<o On Old King's Highway: ❑Yes Z<o Basement Type: 0Fu11 ❑Crawl Nalkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing I new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing e new First Floor Room Count y Heat Type and Fuel: WGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ®No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes U No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: dexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use a&A. AC Proposed Use /:�21V BUILDER INFORMATION Name C2 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE S l DATE _b . - rl, e FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ` ADDRESS VILLAGE JET OWNER ' F DATE OF INSPECTION;, FOUNDATIONS ' FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL x � GAS: ROUGH " FINAL FINAL BUILDING DATE CLOSED OUT ± ASSOCIATION PLANNO. ` { f °F t►+E rpy� The Town of Barnstable ustvsrnst.E - �. g Regulatory Services 059' Thomas F. Geiler,Director, Building Division ' Comssioner Peter F. DiMatteo,Building mi 367 Main Street,Hyannis MA 02601 I Fax: 508-790-6230. Office: 508-862-4038 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION alterations•renovation,repair.modernization,conversion, MGL c. 142A requires that the"reconstruction, tion of an addition to any Pre-existing owner-occupiedimprovement,removal,demolition,or construc an four dwelling units or to structures which are adjacent to building containing at least one but not more th such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ' Type of Work: Av Estimated Cost Address of Work: ! � Owner's Name: L/r 1 y�J r' yes 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 ['Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APRATION PROGRAM OR GUARANTYICABLE HOME IMPROVEMENT WAD UNDER M 1ORK DO NOT � ACCESS TO THE ARBIT 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR / D Owner's Name Date q:forms:A ffidav:re v-070601 The Commonwealth of Massachusetts :==`; =•y Department of Industrial Accidents OlflCe o/lOYesdoodoOs 600 Washington Street Boston,Mass. 02111 Workers' Com ensadon Insurance Affidavit name: location �. city l S hone I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workin in anv acity I am an em 1 er roviding workers' compensation for my employees working on this job. ,:: : :: : :: _asxxxx : :: ::. comaanv name _ ,<;.. ,. 0. address ..::::.: :.:::..:::..:::::.:::..........:::..::::.:::: :>:<:::> :>:< : :.:::::;::>::, hone#: ;; .:.::..... ....... QtV• ......;. x. .;,.. •::• .......::.:....:.:..:.:::.:....:........ : insurance ca. ::. ❑ I am a sole proprietor,general contractor,o omeowner ' cle one)and have hired the contractors listed below who have the following workers' compensation polices: MEW com snv'name::.. _. address :::......:.::.:..:........:..:.............:..... ..::.:.:........ a .,..::::::...................... ::::. ..................... ... ................... ................................... y v:::::::::........:.:::v:.::::::............................. address city' ne ..............................................:::.�.. 70 ................... ::ni'::::::::.w::::::::::::.�::::::.�:::::.:�............::::::::...:::w. x. ntnrance co.:. Fame to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of erlmiasl penalties of a But up to S1,S00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a dne of 3100.00 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 p tharike information provided above is true mid correct Signature Date 2- _ z Print name.-0 a2 a S kNu 4/J Phone# -7 official use only do not write in this area to be completed by city or town official city or town: perndtilicense f1 ❑Building Department ❑ucen+ing Board ❑check if immediate response is required QSeuctmen's Office ❑Health Department contact person: phone 0; : QOther U uad 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, any o o orre�reo or the foregoing engaged in a�omt enterprise, and including the legal representatives of a deceased employer, of a g g to employees. However the owner trustee of an individual, partnership, association or other legal entity, emp ying 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 renewaa 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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage . Also be sure to sign and or town that the application.for the permit or license is date the affidavit. The affidavit should be returned to the city {law"or if you being requested,not the Department of Industrial Accidents. Should you have any questions regarding the are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bott--am 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 remoaied 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 lnyesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone# (617) 727-4900 eat. 406, 409 or 375 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 - Building Pemut Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE _square feet x$64/sq.foot=`C ©�' x.0031= O Z 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= (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 proicost 790 CAR Appa+aa J Table J=b(coatianad) . prescriptive Paeka;n for Oaa and TWO-Famil!Redd BoildlM anal With Food Facia MAXIMUM 1Ml fmum wall Floor BasemeW Hea�8/COOLng Glaring Glariag u+B SOab ,pmeat Effidr = Am:nn (,/.) U-value2 R-value' R vaiaeI R�valad P &vaivar P=kaae smI to 6500 Hntiatt DeSree Dada' Normal Q I2% 0.40 3813 19 10 6 6 Normal R 12% 0.52 30 19 19 t0 6 83 AM 9 12% 0.50 38 13 19 10 Normal T 15% 036 38 13 25 WA NIA 6 Normai U 15% 0.46 38 19 19 10 AFUE V IS% 0.44 38 13 2S WA WA 95 6 fS ARM a 15% 0.32 30 19 19 10 Normal X 19% 032 38 13 2S WA WA WA Norma! Y 19% 0.42 38 19 25 WA AFLJE :l Z t8•/. 0.42 38 13 19 10 6 AA 18% OJO 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: E R I1 11-2 O O DU e- y �✓ �' S N ' 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: �A0 3. SQUARE FOOTAGE OF ALL GLAZING:. 3 ` 4. %GLAZING AREA(#3 DIVIDED BY#2): /n 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J , Footnotes to Table J5.2.1b: o sk lights. and Glazing area is the ratio of the area of the glazing assemblies (including sliding-class doorso the gross wall basement windows if located in walls that enclose conditioned space,but excluding opaque doors) > 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 8 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. f used). Do not include 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing(i ent could be met EITHER exterior siding, structural sheathing,and interior drywall.For example,an R 19 requirem 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 crawispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. T�a entire opaque portion of any individual basement wall with an average depth less than 50%below grade must me=t 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 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 JS21a 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 snucuual components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35.Die frrom the door U ust be tested and documented by the manufacturer in accordance with the NFRC test procedure 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(Le.,may have a U-value greater than 0.35). ,ze wall component inc0des two or more areas with c)If a ceiling, vall,floor,basement wall,slab-edl;e,or crawl sp P ighted average R value is greater than or equal to different insulation levels,the component complies if the area-we 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 t ` , i 777�- I _ -VM l Ad { tw I 1 . , , 1 � I : b'S'fl ui oyoy, :1bvn0S 5 3111-IM U3101,03u OOZ GG£'2Y 3HV(1U55 IsVD- C131U/,03U OOL 2G£-2Y _ 3NVf1USS aSV3-3A3S13:1HS00'L GOE-2Y puelg��euopeN ,g 311Vf1USS lSV3-3A3 SI.331d$00 L M-2Y :iuvnoS 9®3SV3'3A3 S1.331110S L0£-2Y 9iuvnoSS H3TIJ'S133HSOOS 29L-El - 13-782 500SHEEIS,FILLER 58QUARE 42-381 50 SFIEETS EYE-EASE®5 SQUARE National°DB7and 42_ 389 200 St IEETS EYE-EASE°5 SOl1ARE 42-392 100 RECYCLED WHITE 5SQUARE ` 42-399 200RECYCI_ED WHITE 5SQUARE MnUa m U S.A. i 1 r � 1 i 1 , I i r 1 { . .. . - .._.. r { a 1' 1 i r I it r w 4 � a ' a S I � i, ...wu.'... ; .......w�ucro*+Me•mm+ ....i....w,. .....w,...\f _ ........,.. M...µ........-..u:w ar �..„.. .e.....r.. .�..,_........_...._. __�.r.e._...a.._.......,_._.._._....__�._.__. _ ___._ . i I � ,rr . r r , 1 ' I , 1 {. I I -ellI.�^ _ J j •�'$. t .ram �'�"� �/' i - ._._�_ E r ^ ' t j Y I ... o i i i iO rOooP6 ,i t � D 88oSoP KKm(-TS En('imT 1 J - • - T ANT m ra OCOGOO mmmnm�m The Town of Barnstable i MRNSTASM ' Recrulatory Services Thomas F. Geller, Director rE0►�`'` Building Division Peter F. DiMatteo, Building.Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 SOMEONVNER LICENSE p1TON Please Print r DATE: JOB LOCATION: street village number ' 1102 ell # "HOMEOWNER": home Phone tf., work name CURRENT MAILING ADDRESS: city/town sMdte up code The current exemption for"home_ o_ w'__v was extended to include O�+�+er-occupJed dwellings of six units or less an d to allow homeowners to engage an individual for hire who does not possess a license,aroviat the owner acts as supervisor. DEFIN TION OF HOMEOWNER Or is Persons)who owns a parcel of land on which he/she resides or intends o restures which such use•and�or intended to be,a one or two-family dwelling,attached or detached structures. A person who constructs more than one home in atwo-year period shall not be considered farm Official on a form acceptable to the a homeowner. Such"homeowner'shall submit to the Building Building official,that he/she shall be res onsible for all such work erfotmed under the building ermit. (Section 109.1.1) The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and gulations. other applicable codes,bylaws,rules and re "homeowner'certifies that he/she understands the Town shBwcobmPBuWdnsaid The undersigned Department minimum inspection procedures and requirements and that procedur and requiremepl. AL6�_� Signature of Homeown Approval of Building Official Note: Three-family dwellings containing 35.000 cubic feet or large will be required to comply q with the State Building Code Section 127.0 Construction HOMEOl. WNER'S EON eft is required shall be exempt from the homeowner performing work for which a building P The Code states that "Any Pe provided that if the homeowner engages a provisions of this section(Section 1og.I.1-Licensing of construction Suprv,sosrors):P supervisor(see persons)for hire to do such work.that such Homeowner shall act as supeat r an assuming the responsibilities of a Many homeowners who use this exemption are unaware s s.they 2.15) This lack of awareness often oresus�he Appendix Q,Rules&Regulations for Licensing Construction Supervi pets In this case.our Board cannot procoend`ble. ai serious problems.particularly when the homeowner hires unlicensed p as Supervisor is ultimately responsible. l the permit unlicensed personas it-would with a licensed supervisor. The homeowner acting ififies. communities require.as a of this issue is a To ensure that the homeown ii he/she understands thefully aware of histher esponsbbil ties of a Supervisor. On the last page unuy• application.that the homeowner certify care t amend and adopt such a form/certification for use in your comet form currentiv used by several towns. You may Q:FORMS:EXEMFTN _t i. 13-782 500 SHEETS,FILLER 5 SQUARE • • 42-381 50 SHEETS EYE-EASE 5SQ 423UARE ` O\�ONffiional®Bend 89 20000 SHEETS EYE-EASE 5 SQUARE 42-392 100 RECYCLED WHITE 5 SQUARE 42-399 200 RECYCLED WHITE 5 SQUARE Metla M U.S.A. • E 71 . I .�•'w. O . r - } 000000 ¢ttjruww �!g�n-33 ti GiwUV y wwwUU $j==Zww rIONpN p.. N88gg a ' �ovVvv 2 B G ` ,O Z in a y'4 O Aj y r/ i 10 n r 13-782 500 SHEETS,FILLER 5 SQUARE EYE-EASE' 42-381 50 SHEETS 5 SQUARE • �NatlOnel®Brand 42 382 89 20000 SHEETS EYE-EASE°5 SQUARE 42-392 100 RECYCLED WHITE 5SQUARE 42-399 200 RECYCLED WHITE 5 SQUARE Mace in U.S,A. yl a fit (ll l / I •p a i ro I►� 111 3 aVY �e d r r/ 3n w 7t1 M /r � d Z i Z' ro. s rf 3 r si i • 1-782 SHEETS �� • 42 382 5 SHE 00 ETS EYE-EASE°5 SQUARE • O�CNaBona! LLER 5 SQUARE ®Brand QUARE 42-3S9 200 SHEETS EYE-EASES TS EYE-EASE 5 SQUARE 42_392•100 RECYCLED WHITE 5 SQUARE 42-399 200 RECYCLED WHITE 5 SQUARE Mace in U.S.A. \1 ar y TOWN OF BARNSTABLE Permit No. _ 27306 l Building InspectorNAUMU cash _ -- OCCUPANCY PERMIT Bond -.—X- Issued to Lary, Nlckulas Address Lot 25 7 Fen wood Avenue H Wiring Inspector Inspection date Plumbing Inspec ,% Inspection date Gas Inspector Inspection date XEngineering DepartntNt Inspection date— Board of Health Inspection date2—/.Z-g Lf THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. . .... .. ....... Building Inspector FROM TOWN OF BARNSTABLE Mr. Francis Lahhteinz'--.• BUILDING DEPARTMENT Town Clerk . `. ^�.• � 67 MAIN STREET HYANNIS, MA a,eS4+N+aA:+v Tar a.9l•ce+Y'a"+r`A MS Y�ww,��, Phone: 775-1120 SUBJECT: ' FOLDHERE DATE` February 19, 1985 MESSAGE f*tf'•R'�k'aEa r!warr s•�i•+E•s:+s y. .. X7 Work .has been,0 t4 1e1-�ed�under�Penni t;#27306 .tIqrw Nickula ) y4 Please release Bond. • _ - 'r"s.?rw.rrnrar+.-rr•",.ss+rw�rrrk ru.w•+r arr+3-sa!'.xx•+Fc:tea ba'1s+e is a•�WTv d _ DATE - / t. - REPLY f t SIGNED � a Ne7•Rmi RECIPIENT: RETAIN,WHITE COPY,RETURN PINK COPY PRINTED INU.S.A. u SENDER: SNAP OUT YELLOW CORY ONLY.SEND WHITE AND PINK COPIES WITH CARBON.INTACT. _ n rn 40 on m c fq k OOi19 76 Im In Ll On O ®Oca Z Z _ z �DoozAnzi \\ Z ®Z 42 ;f p t fA8� v ®® ? ,Y f 7> tl CI rk-' Y��G- s Assessor's map and lot'numb ............ ............................. ' THE /Sewqge Permit number ......:....Ll-4:n... �...................... j�7 0 e)7...Ir 1 i C 4. i w _ • e House number .............. ,:.? i��! a! 4 l i+s ` ro asa ......................................•. M639• h 6 '°�l•p IIPY ems, t�A L'IE TOWN OF BA-RNSTA'fl ` ' RUILDIN'G INSPECTOR APPLICATION FOR'PERMIT TO .............. ............................................................. TYPE OF CONSTRUCTION ........ ..... ....... .U...D�.. ,,,��.............................................................: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accord the following information: Location .........GQ.. ....................... S............... ' l/14.0Q..C,/....... ...... ..... ......... ....... ,/....� ProposedUse / ......... .............................................................................................. ZoninDistrict ........, . /..... ................................Fire District .............................................. ........................ g ....... r�-t. -n x ..... ... . .c� .....................� 0 ... �1... ........................ ..... Name of Owner � ,,� � � r � Name of Builder ............:.......................................................Address ........................ � /1!t/�'1L..r. u ✓ Name of Architect ....................../.....................................Address .................................... Number of Rooms .................. . ........................................Foundation ............. Exierior ..................�./�.�...........................................Roofing ...............[.�� ...... .��....�-.f�. Floors .............+�� ..� .. <............................................Interior ............( , � • .. _ _ , ��. fir . r Heating ........... �. .......................Plumbing ......... ,,! i. Fireplace .......................... ..::..........Approximate. Cost ...................4.. ...... ............... . . .Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area .:......F..Q.1-74�.. . po Diagram of Lot and Building with Dimensions Fee �P�"�........... .. . .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH / , COI` Z U ' U OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na ......... .... ..... Construction Supervisor's License . :. 1 ""ICv.:LTLjM,, LARRY oft ,r " 27306 , permit for 12 story .........5j4g.,e..F Y..Dwellin5....................... 7 Fernwood Avenue , Location .�S?�...�.��........................................... , -Iiys�3 iE:)�? ...... ............................... t Owner ....Larr. .y Nickula. . ....... s ...... . . .. .......... . ......................... , r Type of Construction ......k:IMM..:..................... ....... ................................................................... y - 1 ! /. �i� 'R• ` ' Plot ............................ Lot ................................ i Permit Granted f ' December 5, 19 84 r. 'Date of Inspection ' Date CompletedT9 ' , l- ' �i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION j �,�EPTIC SYSTEM MUST S Map 8 Parcel Q79 �O STALLED IN COMPLIANC ,ermit# Health Division y P WITH TITLE 5 Date Issued EN,VIRON.MENTAL CODE AND Conservation Division 0�1�.- ' `"e .f °A�°IOaS Fee- �- Tax Collector ` � •- j'z✓31 Lono R Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -0 _ lJ 2 Village ay A Owner O 14S F O P, Address S��� Telephone ZW 7 �-- s Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new ? -Estimated Project Co� 'Zoning District ' Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. `f r Dwelling Type: Single Family 2/ Two Family'❑' Multi-Family(#units) Age of Existing Structure / Historic House: ❑.Yes 2Wo' On Old King's Highway: ❑Yes 31q-o- Basement Type: ❑Full ❑Crawl ❑Walkout Sher 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: O-Gas ❑Oil ❑Electric ❑Other Central Air: ❑.Yes CY16 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Oristing ❑new .size Pool:❑existing Q new size Barn:❑existing ❑new size Attached garage:fisting ❑new size Shed:0 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 Aa - Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE ' 3`a� FOR OFFICIAL USE ONLY t PERMIT NO. _ r DATE ISSUED- j F MAP/PARCEL NO. Y ADDRESS 4 - � � '` a'VILLAGE ` OWNER - DATE OF INSPECTION" FOUNDATION t , FRAME IN3ULATI01., " " T FIREPLAGE-i + ~• _ ELECI`RWA�: ROUGH FINAL ^• + '1 `' PLUMBING: ROUGH FINAL GAS: _ _ ROUGH FINAL FINAL BUILDING Z3' .6t 1 DATE CLOSED OUT IYD' ASSOCIATION PLAN NO. 4 ` —Zx8 C_. Kx 7 CON-TAX6 i_N_C�eNO_dSEB,F-j-Ot4D — STS =REMoV �I - GI 9X4 POSTS - - E1 - A. DE VT �e GocR - � sT--�n<A —� �S`COMPACTED FILL. _ _ 8€Loy,✓ __G_ ��x _ -EL.-F-VATION A T'- Lf - 00 FRON T -YA D- _ ti a -FX-IsTI N - - - _- At f_TI O-_I -CAA R I o I REAR - YARD . Building.Division t3�arrszesr.>:. 'x,►ss 367 Main Street,Hyannis MA 02601 tbs�. ,m� g'„rEo na+' Office: 508-862-4038 Ralph Crosse- Fax: 508-790-6230 Building Curnmis_ HOMEOWNER LICENSE EXEMPTION Please Print DATE:�r JOB LOCATION: O `, S number street. villa,e "HOMEOWNER":Z",WA ' d )/ 1_,J/A 327—75?&�'— 7�I a —� Dame home phone# work phone is CURRENT MAILINGADDRESS: l /t�/6Q��/D% �y o city/town ye 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 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 d requirei mpnts S' &cure of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger wiil 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 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 fast 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. Q:FORMS:EXENI MIN' " _ t 600 Washington.Street -' ;;, Boston,Mass. 02111 � ; Workers' Com ensation Insurance Affidavit name /) F L�9 u IL D locatio I 1�, Z> city hone# I am adoi6cowner pelfo g all work myself ❑ tv I am a sole "et'r and have no one any stir„�,�. ������/�� �����7%%///%%/%%/% I am an employer providing workers' compensation for my employees working on this job.:: ::: ::: ::;:;>;:;;;;;;:;::;:....... com ........ .. address::.: .:':;:;:::<:.:.;•:;:.;: :>::::::;:::;>:<;L:.:.:......:... ;.:;;;;;>:;;.;;;:<:::<;::;-::::•.:.;:;:.::......:-... .... ..:. ............ :.::. .. :._:::::.:::::... xd : ........ ................................::.:;:......::. Cltv' ••::. :::::•::•:::::........:..::.::::.:.................... insurance co: :,.::.:..::;::::::<,.::.::::.::::.:.. :::.:,.,.:....:..::..:.: Mmom ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the foll owmg workers' compensation polices: : :. :>;.>::.,:.:» :..- com aevname:.. ......:;::L:•;>;::;;.;.. addre .......... ...............................,:...,..:...:.::................................Lora......:.::•::::::.. ................................... .. . ............................................................................... ........-............ ...........,v.......... .... ., ....- ... .. L::•::�.:::ryii:.�.::Loy}':{-ii::•::-i::�::::�: .........::::::::...:.-......::.�.�:::.�::::.�::.�::.�:L:.:::,,:,.:::,::.:,::,..:.......,:...:.......................�:::::.,.:.::... hone.#.:'.>::.;:..::,,,�.;•:<;,:.;:,.;:>;:;.:, .L,::.:::.-;:::.... :.::.:.., ....,.:.a� v n ss. :.;. sddre . ..................................................................................................................................... , insurancele >co: ::,:. :.>:.:.:.:;.. :::..::<...:.;:..;:.::::.:.,.:;:,.::.,. Failure to secure coverage as required raider Section 25A of MGL 1M can lead to the imposition of criminal penalties of a fte up to s1,500.o0 and/or one years'imprisonment as well as civII penalties in the form of a STOP WORK ORDER and a flue of 3100.0o a day against me. I understand that a copy of this statement may be forwarded to the Olacce of Investigation of the DIIA for coverage veri8rsdms I do hcreby certify under the pains and penalties of pedury that the inform ion provided above is tru.and correct Signature Date Print name Tff/2 Md C- /` ' �/9 L���-.O� Phone# :za offidal use only do not write in this area to be completed by city or town official city or town• permitnicense ❑;ZIt �g Department ❑ using ❑check immediate response b required ❑ en's Office ❑ Department contact person: phone W, ❑ ��� (mvued 9/95 PLU °p THE 7. yw� The Town of Barnstable MASS: anxrrsrnei.E. 9�A Department of Health Safety and Environmental Services rFD ' 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 Work:�G�� e 2ire..c i���'C Estimated Costo� Address of Work: �x Al;t/n,51 :"3 Owner's Name: , C Date of Application / //1l/ I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law QJob Under$1,000 ❑Building not owner-occupied [f 6wner 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. vml Date Owner's Name q:forms:Affidav y -Engineering Dept.(3rd floor) Map 8 Parcel ermit# ZS'd Z House# ? Date Issued orf q'? oard of Health rd floor)(8:15 -9:30/1:00-4:30) 4e-V Fee e�,5-. ---2) Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 144 0 min. Bldg. SP' } M �USTSE _� � � MPl,�ANCE fintiPp�r�uBoard 19 J TOWN OF BARNSTABLEOw coDE AND vLA17ONS Building Permit Application Project Street Address r-d n/G/a a D iq l/E' " Dew LoT-0 2.\ Village � � e-S I. :f—: Owner Ttf a rY1 A s DiC/C A 1 N Address 7 Telephone Permit Request d r,T/g /i G D v ui 1 T& /YF L/ D gEC K -- SF�M� D//rl��YSiaNS o� x2��1 First Floor t7(� square feet Second Floor square feet Construction Type C - c t' Estimated Project Cost $ Zoning District g S Flood Plain /y Water Protection Lot Size • a- 19c R E Grandfathered ❑Yes ❑No Dwelling Type: Single Family �j Two Family ❑ Multi-Family(#units) Age of Existing Structure la XA I S. Historic House ❑Yes dNo On Old King's Highway ❑Yes U�No Basement Type: Q full ❑Crawl fJ�Walkout ❑Other Basement Finished Area(sq.ft.) '71D Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing oL. New Half. Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing( New First Floor Room Count Heat Type and Fuel: E(Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing / New Existing wood/coal stove ❑Yes d No - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ()'Attached(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# 'Imp rovement rovement 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 W4� 6�1 - -- DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 0 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. �. e atl ADDRESS _ Y� ' " VILLAGE' - tS - OWNER (' DATE OF INSPECTION: FOUNDATION FRAME - INSULATION ; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING:* ROUGH FINAL GAS: xU -z FINAL FINAL BUILDI r' A a DATE CLOSED QU;Tiol. ASSOCIATION PLtI`I ° w . •. 4 • The Town of Barnstable • e�axecesrE • Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission For office use only 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: A071YO097-/04✓ 01� dee/�/hta oC Est.Cost Address of Work: `7 ! oxn1 U/D o D AVE Owner's Name Date of Permit 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 =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: Date Contractor Name Registration No. OR OW�1ER w The Cottttttomi`ealth of:ltassachuscttt s i .•i •rr! ;--��j•�:- Departmettt of•Industrial Accidents ' ir oficeoflnyestigat/otts 600 !f a.v1ditgton Street �• Boston. Afan. 03111 �•' Workers' Compensation Insurance Affidavit _ I�nN tit 1nf6r6tati6n Plc�se PR(NTlebi i y_� �h t►o- AA1&1 d o o v P 1 a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ............ .—.�.s......--.....`-.---�+-•---•_-- [� I am an empiover providing workers' compensation for my employees working on this job. cnntnntty name- •tddre�t• city• nhnnc 1i• incornner co nnlirr tt [j I am a sole proprietor. general contractor. or homeownn�er(ct}cic one) and have hired the contractors listed below who n: the following workers' compensation polices: cnmmitty nninc• •itidreac• c11`117 nhnnc+�• in!znrnncc rn nniic� _ 77-7 cnm nnv mine: address in sin•• nhnnc it• policy A _ �arnnce cn - _ .Attach additional sheet if neces_sa_ev _.:•._. :% �;' -^'�""::L' - '`'�' `� ""-'' '" 'y"� ' "'I" "- w•'--- Failure io secure coveratte as required under Section:SA of NIGL 153 can lead to the imposition of criminai penalties of a tine up to S1S00.00 andiu. unc.'cars*imprisonment a.well as civil penaities in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that copy-of this matcnicut may be forivnrdcd to the Office of Investigations of the DIA for coverage verification. 1 do hCrelm cerrift• seder the pains and penalties of perjun'drat the information prorided above is true at correct. Signature -Date yr q Print name Phone# w - '�ofTiciai use only do not write in this area to be completed by city or town official �• citt•or town: permit/license># r7liuilding Department • C3l.icensing hoard 0 check if immediate response is required Oseleetmen s UMCC Men ► �•, aticnilh Department phone is: Cothcr contact per-son: . 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 empluree is defined as every person in the service of another under any contract of iiif express or implied. oral or'%trittett. An enrpinrer is defined as an individual. partnership. association. corporation or other legal entity. or any two or more the foregoing enuagcd in a Joint enterprise. and including the legal representatives of a deccascd emplover. or the rccciver or tnistee of an individual . partnership. association or other legal entity, employing employees. Ho%vever the nwner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the d\\•clliii�w house of another who employs persons to do maintenance , construction or repair work on such dwelling hour or on the -,rvunds or building appurtenant thereto shall not because of such employment be deemed to be an employer. v1GL chapter i 52 section 25 also states that even• 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 .rpplicant who has not produced acceptable evidence of compliance with the insurance coverabe required. -%dditionally.. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the )erformµnce of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha -)een presented to the contracting authority. .PPiicants lease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and sppiving company names. address and phone numbers as all affidavits may be submitted to the Department of idustrial Accidents for• confiirmation of insurance coverage. Also be sure to si-n and date the affidavit. The "tidavit should be returned to the city or town that the application for the permit or license is being requested. of the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required obtain a workers' cornpensation policy. please call the Department at the number listed below. - in• or 'rowns :use be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of affidavit for you to fill out in tite event the Office of Investigations has to contact you regarding the applicant. Pleas sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless other arrangements have been made. Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. ase do not hesitate to give us a =11. :e Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents office of Investigations " 600 Washinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (6I7) 7274900 ext. 406, 409 or 375 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE t//8 _ /JOB, LOCATION '7 U e Number Street address Section of town "HOMEOWNER" -Ll-loC1ds 7 90-706 Name Home phone Work phone - PRESENT MAILING ADDRESS p C) /gam X 7 9 /W City t wn State Zip code The current exemption for "homeowners" was extended to include owner-occupied 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: Person(s) 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 OfficiF_ on a form acce-ptable 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 comp y with said rocedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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 Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction. Supervisors, Section 2. 15) . This lack of awarenes 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 "Ciwner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/bier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the lazt 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. property lines shown on this pla t are for assessing purposes only t~nd do not represent actual rslG tk-inships to physical objects 00:Z£:£T L66T '8T ubp•88ZasPq/9sPgmau/sib/:o 6)v oi# LLZ 0 ]v K x � L# - lb# Z•0 ]v Z•Q. i Z• 9Z# 0 8 # - - x - i 1 R_ MAP SKETCH ADDENDUM Wmnver/client Tomas F. and Lorraine Lawlor Property Address 7 Fernwood Avenue City Hvannisuort County Barnstable State Ma. ZlaCode 02647 Lender South Boston Sayinas Bank BUILDING SKETCH 77 : � I - ... .... I ..... I ..j : i I I I 1 T _ T _ I - _ 600. { - L-AI • - -- - ! 1 • I a� - • r.. I ! : i • : ; - E._. . i_i.. I � I ZJ I I I i • -J -1. i _ i } ! .L Y I 4 / I i L I t _ 4 I I 1� LOCATION MAP [*SUBJECT PROPERTY] t .c z g � L: L a Me- rie 0 o A - - - - r_ .d d5 i'n a,0000 f s F6t�sc x �. ... p i .. f s, F k `. r • - r� V V x r'tf So ! __� ' ItT _ n G• ^� 3 i L 1 k V / 0 / kY �o e , r .. . ,, .i. -. . ..,• ..,, .. - .. `�''•� .. r.. Mkt 3 r. _ ; y k r ^z ( _ i F t Town of Barnstable *Permit P� G Expires 6 months from issue date Regulatory Services Fee 9 M"SS •°i Thomas F.Geiler,Director i639• pie - pTEo Mp' Building DivisionPPES " Tom Perry, Building Commissioner t� 200 Main Street, Hyannis,MA 02601 MA� 2 z �T 'x `'Office: 508-862-4038 ® 10Q3 T Fax: 508-790-6230 ��®F 8A& L EXPRESS PERNII Not Valid rhPL A IO Press IRE SIDENTIAL ONLY �ST�B nt Map/parcel Number 1 f r0 7400 y Proper &M44)V:6Address 'I tg Residential Value of Work 3 sM, o® y!. Owner's Name&Address Contractor's Name -& —, Telephone Number � Home Improvement Contractor License#(if applicable) j Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Ch one: Lg'I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance �L / Insurance Company Name Workman's Comp.Policy# Permit Request "heck box) � 4 Re-roof(stripping old shingles) All construction debris will be taken to az ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. .U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *** ote: Property Owns must sign Property Owner Letter of Permission. Signature. Q:Forms:expmtrg Ve :sA11l not " ': t �I . � ✓fie 1�am�mzdoicuea,�i a��/�aaacrc6auaelta. x Board of Building Regulations and Standards ` ...HOME IMPROVEMENT CONTRACTOR ,.". Registration:.133010 . Expiration: 4/3.0/2005 Type: Individual PETER J.SMITH PETER SMITH 3925 RT 6A CUMMAQUTA, MA 02637 Administrator x+ 4 •fr« - y r- t k.' k `k t �. OFTHE Tp Town of Barnstable Regulatory Services an �,MASS Thomas F.Geiler,Director ,►sa � OAT 039. A,� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I� Ir, as Owner of the subject property hereby authorize �����_� - to act on my behalf, in all matters relative to work authorized by this building permit application for: t2m /1 (Address of Job) signature of Owner Date Print Name Q:FORM&O W NERPERMIS S ION t639- ~. ~~ , , N OF ~~ ^ ~.R^ , ~~ ~. ^ ~~~. ~~E + BUILDING 0 ���� ���������� �� ��N0 N 0-�� N �� �� INSPECTOR ���=��0� � NN �� �� �� � ���� � �� �� � �� ��� ���� � �� �� ^�' � ~��_ APPLICATION FOR PERMIT TO .....................-_.���."._^-.'-...L----------.--.------.^--... TYPE OF CONSTRUCTION ............................... ----.------_---------- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for o permit accor6i the following information: Location --- ^�~- ��----�� '�~---- .«����7.��.~ ��--. —'........................... 1 ' ^ f ..P,opnsed Use ...............r;i�0� — — :� �l...................... ............................................................................ Zoning District ........ ..-----------Five District -------------------------- Name of Owner �—�,��=1��.������!��—/����.L.^��'�e�]dm��� ---.---.x� ��L..z�—�.�--.--�_ . Name of Builder ----. ^�~--------------A66rexs ----. ' . .. ^� Nome of Architect ----..-----.------'----.A66res ----------------------_.----. ~^ Number of Rooms -----. ,4z5 --------.FounJotion ............. -- ........................... Gwo,ior -----' .(..............................................Roofing .................. ..---- ��— —.— � Floors �//�� .����� .�-------------_|nte,iur ---'\ \' ��'.,�-C>� -----_ ^ Plumbing / Heohng ---'��'��/�=/------------------ ---�=��,—�.�"�����.x�..,��/�..,-------. ^� ^ Fireplace ----'�'��.����!�----------------Apprnximo�eCoo -----.!^_^�—L,� Definitive Plan Approved by Planning Board lV---- . Area --' l—.�. Diagram of Lot and Building with Dimensions Feu _.. ______ ,. SUBJECT TO APPROVAL OF BOARD OF HEALTH � 00 Li � � . \ , __— OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS � | hereby agree to conform to all the Rubs and Regulations of the Town of Barnstable regarding the a6ove construction. -� � -~�°~ _ mon��-'��—.. .. ~ ' ' Construction 3upervi License � + NICKUIAS, LARRY -A=28-8-79 No ...2.73.06... Permit for W]�Y................. 2 tQ:.........Slzgle..Z�y..DWWeplag....................... Location ...IAat..2 5.,...7..Fe-mwcad-Avneue ....................Hyaruiisport.................................. Owner .....lai=y-Nickulas.............................. Frame Type of Construction .......................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .........De.cembe.r..5.........19 84 Date of Inspection ....................................19 Date Completed ......................................19 1 I .o I 1 EXISTING HOUSE i I i o i f 1 t I NEW CONCRETE�R SLAB _ 10'SIDE YARD SETBACK 13'-2' 1 - 1 � _ 0 o _ PROPERTY LINE PROPOSED PORCH ADDITION SITE PLAN LAWLOR RESIDENCE 1/4" = 1'-0" 7 FERNWOOD AVENUE MARCH 20, 2000 , HYANNIS, Iv1A 02647 a , I a � ' ASPHALT SHINGLES CLAPBOARDS 4 I y, 4 y 4 M I 00 r SCREEN PANEL SCREEN PANEL 1 OdL a I NEW PORCH FLOOR EXIST GRADE I I 11 I I I I I 9'-Cr c I : 13'-2' 1 L-—————————————————————————— L--I---------------------------- —J REAR ELEVATION SIDE ELEVATION I PROPOSED PORCH ADDITION BUILDING ELEVATIONS LAWLOR RESIDENCE 1/4" = l'-0' 7 FERNWOOD AVENUE MARCH 20, 2000 HYANNIS, MA 02647 a