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HomeMy WebLinkAbout0016 GARDEN LANE LAQE ACTI AiN Wovs � r�. �_._a-_ ---- -- - _ 1 • � � _.- __.. - 1 i i I I � ; � ' � C � { i � i � . /7 - �y F T Town of Barnstable 0 Expires 6 months Jrom issue dale Regulatory Services Fee + awxrasrnsre, MASS. $ Richard V.Scali,Director 1639. �0 AjfO�,tp Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 Property Address 96 Residential Value of Work$ d Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4 E,f/yGI2D Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X PR.ES3 IrPE I'm MOT la . one: am a sole proprietor SEP 10 2014 I am the Homeowner ®n �+T 1� I have Worker's Compensation Insurance TOWN OF BARNSTABLE 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) L. Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #of doors: ❑ 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 requi d. SIGNATURE: - f Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ti Die Comyrr.ani eakh of�`assachusefts -Uepwtwwnt a fixdr strird 1 cciden& a rns;estigu6ans Betsfou,,MA 02 111 wry w mass�ganrdia W orkers' Cctmpensat€uxtlnsuraac fiidavit:Builders/CantractorsMettriciansiKumbers Apocznt hafarmafion Please Pyint Legibly Name Address- Cityfs tateizip: Phone -re you Mz employe-O Check the appxopriate bavz: T . of of ect :r Y. 4. ❑ l am a general.contractor and I tip New oons(�txorh - l_❑ ?zm a Io er with ❑ �avese {f11I1 andlor p - ZIDP # I7:34T�hiredtIlE SiZb011t�cf4rS_ 2. propaetor or partner Listed o±�the attached shl et Y- ❑Rempdeling shin zzd have no employes Ilese sub-coafractors have g_ ❑Demo1itina orl ia¢ me in any c c.± r emplr�)-eEs and have workers' Y � t5 4_ ❑Building addition moo•v o±k=' comp:rmqiranre cam3_ins¢rant 5_.❑ `,die are a corporatimaud its 10-❑Elecfxical repairs or additions 3_ €am a bnrm vrn doing all too officers haves exercised fh6r 1 t_.❑Plumbing repairs or additions. GL myself [2do worl�'�_ c-rig 15 of 1e:s(4 fan we Ivfen 1?.0 Roofrepaiis. rnanc?rqui�d_][ c- 152,§I( },and we fiss e no- employees [No workers' 1 _❑Other comp_msarwn required6l 'AyfJapgt:kY -mstssofll out the secuoubelow showing theirtaosken'eompssa.'ion policy infomaa¢tn- 9 go,�-�an�s rr�s�otnrt mis�dsv:t i�„r�trey sre iicing s���sy-+d tbm h�iE a�sidc cuftrscmrs most saT�suit a��a�darR mast-p'�sarlL -Co-,—ascmrs '*d et cb---k this brat must stiaclt2d sa ariaiuonsI sheet sho -—tbx-nmn--o+i dip sulf-omift3ctors and stsbe vrhetiec tcnni tbosz mmitieshaves emp u-s-eys_ pIoa r,the),must provide i s warkePs'comp-policy aumbez I a�'n arz E'Mp ^r that is prmidi zg fvor�rzrs cainpetur..&n xn5wraacer for my en -gas- BeZqty is fate policy arcd joh aitg it�fartrtatiar= . Las: trace Comp=yName: PoL.+yT Vr Self ins_Lit-tt Expiration Date: Job Site Address: Cifylsh:wzlp- Attach a-ccpy of the workers'compensation polio-deeLrstion page(sh-owing the policy it-amber And e zj i tion date). FailDze fx)se--cure coverage as Mq uned unCkT Sectioa 25A of MGL c- 152 can lead to the imposition ofcrimi al penalties of a fine up to 1571,501 Qa andlor one-year imprivortmMf-as well as civil penalties in fire form.of a STOP rQR�ORDER and a fine fi of up.to 50-00 a day against the violator_ $e advised that a copy of this statement maybe fGnvndt-d to tbe-Office of Investigations of Ilse DIA for insauance:coverage veriBcatiorl_ I dd h9re r c t ttdEt apons andpmatlties of. boi e i s lots nntf carrect: Simatuze: ]late_ Phone A.: �ciui uxe ant . Da trot sprig in this area, u be campteted by di�v or town off(ciaL City or Town: Pic-ndt1License;9 + Fssuing Antharity(drde ono): 1.Board of Health 1.Bu-MEng Department I Git y-frawn Clerk 4_Electrical Inspector S.Plumbing Iusspecfor 6.C-iher Cost;Trct Peron-. Phone 9__ 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute, an employee is defined as""_.every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation-orother legal entity, or any two or more of the foregoing engaged in a joint ente_rpnse,and including the Iegal 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 dwelLng 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 appu Tenant thereto shall not because of sucd employment be deemed to bean employer." MGL chapter 152, §25C(6 also stctts that"every state or local licensing agency shall with bold the issuance or renewal of a license or permit to operate a business or to constz-trot buildings in the commonrreaitb ',-r any applicant who has not produced acceptable evidence of compliance vrith the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the peiormance of-public work until acceptable evidence of comph.opce,,,zt`r the ins=, ,ac.e requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation arodavit completely,by chectii-_ng the boxes that.apply to your situa on and if necessary,supply sub-contracio_"(s)name(s), address(es)and phone n be,:(s)along with the r GerLi-Ecalt(s) of insurance. Limited Liabili Compaq es(LLC)or Limited Liability Pal uerships C_.LP)Vri-hno eir� loyees other han the members or partaers,are not rem ed to carry workers' compensation ins!?-ancc. If an LLC or LLP does have employees, a policy is required_ $e advised ghat this affidavit may be s::brTi.tted to the DepaTtmnent of indu_su;al Accidents for confirmation oft nce coverage. Also be sure to sign and date the of davit 'I1le affidavit should be returned to the city or town that he application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any quesuons regarding the laver or if you are required to obtain a workers' compensation policy,please call Department at he number listed belovr. Se,'.r:insured companies sa.oald enter their self-nci,rance license number on :e appropriate line. City or Town OffaciaLs i "c 1 , Please be score that the affidavit i.,cam .ete and tinted le -bl " The Deoar;ment has rovZderl a space at she bottom P P g Y P � of the affidavit for you to ill out he event the Office of Investigations has to contact you regarding the applicant" Please be sure to fill in the permit/hcease number which wi11 be used as a reference number" 1n addition,an.applicant that must submit multiple penrDjt/hcense applit;ations in any given year,need only submit one alladavit md:icaung current policy information (if necessary) and under"Job Site Address"the applicant should vrrite"all locatio- s in __(city or town)."A copy of the affidavit that has been officially stamped or marked by u le city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year"Where a home owner or citizen fie obtaining a license or permit not related to any business or commercial venture (he,a dog license or permit to burn leaves etc.)said person is NOT required to complete th s afdda,; t. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call" The Department's address,telephone and fax number- Thb� Conrrctnnw,-alttx of Massaclu sot Depazt.ezt of 1ndustda1 Accidrazts Gffl(�e oflmvest%gatl-GnS Gig washmgtoa Stri--� Boston_M&02111 Tot,9 6I7 727-4900 W 406 or 1-n77--%LkSS-ATE REvistd4-24-07 Fax'` 617-727- 74Q F�.znas�gnvF�da - I Town of Barnstable Regulatory Services ��oFixe roty� Richard V.ScaIi,Director ° Building Division * saaNSTAB Tom Perry,Building Commissioner r+sass. 200 Main Street, Hyannis,MA 02601 �Fb MA'S a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: /`' number shae village "HOMEOWNER": fi �/la �,��%J'o)s name home phone# work phone# CURRENT MAILING ADDRESS: ci y/to am 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- f anrily 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 i09.i.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The unde signed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection uirements and that he/she will comply with said procedures and requirements. gnat re o Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or Iarger 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 formJcertification for use in your community. Q.\ti)JPFILES\FORMS\building permit forms EXPRESS.doc Revised 061313 • 4L THE Tqy Town of Barnstable Z� } Regulatory Services MASS.�$ Richard V.Scali,Director 1639 .� ArEp µpl" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing A Builder 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) 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 of Applicant r Print Name Print Name Date QTORMS:O WNERPERMISSIONPOOLS Message Page 1 of 1 Anderson, Robin To: - Tanya Wichterman; 'Margo Pisacano'; 'wendi chesson' Cc: 'Kim Gomez' Subject: RE: 16 Garden inspection I reported to this site yesterday with local inspector Paul Roma. At the conclusion of this inspection we agreed and it was determined that there are three valid bedrooms on the first floor. It was also apparent that a bedroom was previously created in the basement. Subsequently, someone took care to make a 5' opening in keeping with our typical instructions when we encounter unsafe conditions and un-permitted sleeping areas. Just to reiterate so there is no misunderstanding and to state for the record, this property is a three bedroom home only and all valid bedrooms are located on the first level. In the event that additional bedrooms are sought, a proper building permit must be obtained. That process will require a sign off from Health and a review of the septic capacity prior to approval. Please let me know if you require additional information. Ro6in Robin C Anderson Zoning Enforcement Officer Tiown of Barnstable 200 34ain Street Hyannis, -%1A 026oi 508-862-4027 -----Original Message----- From: Tanya Wichterman [mailto:tanya@margosells.com] Sent: Wednesday, June 15, 2011 4:48'PM To: 'Margo Pisacano'; 'wendi chesson' Cc: 'Kim Gomez'; Anderson, Robin Subject: 16 Garden inspection Hi Kim & Robin, I just spoke to Geraldo, owner of Garden Lane, Hyannis. He said that the inspection done today said it is indeed a 3 bedroom. I just wanted to verify that is correct and we are moving forward for July 1st move in for Kyle Axtel& Nora Vermette. thanks so much,Tanya Tanya Wichterman Office Coordinator Seaport Village Realty, Inc. Osterville 9 Parker Rd.,Osterville, Ma 02655 www.SeaportVillageRE.com www.MargoSells.com www.MargoRents.com Tanya@margosells.com 508-428-4443 F 508-428-4493 fax 6/16/2011 Lane DATE 6/15/2011 TO . Building File FROM R Anderson, ZEO RE 16 Garden Lane, Hy • Reported to site with local inspector Paul Roma. • This is a ranch home with a handicapped ramp to the front door. • House is currently unoccupied. • Property owner, Geraldo Cardoso was performing cosmetic work on interior of structure (painting, carpeting, etc). • Entered dwelling into living room. • Found two bedrooms and one bath to the right. • Kitchen directly off living room. • Found annex area to left side of kitchen with segregated room (third bedroom). • This area was formerly identified as "office" on a plan contained in our file. • Confirmed septic capacity of 3 bedrooms with Health. • Found no egress issues on first floor. • Annex area contains an exterior door and a staircase to basement. • Found appliance and mechanical equipment in lower level on cement floor. • Found a paneled room with typical cellar window and carpeting; no door. • Obvious that someone deliberately removed the privacy from this area in order to disqualify it as a bedroom. • Advised owner to not allow sleeping in basement. • Advised BHA and realtor via email of findings on 6/16/2011. 06/13/2011 12:13 5087789312 BARNSHOUSAUTHORITY PAGE 01/01 ZONING VERIFICATION TO: Linda Edson FROM: Kim M. Gomez - Leased Dousing Coordinator RE: Legal Rental Unit Verification 14 .7D Date: ✓ d ' Address: / e11La. Village: Unit Type: � Bedroom Size: Map & Parcel No.: � D UU The ovvner of the above listed property is entering into a contract with u.5 for the rental of the property as listed above. Please verify by signing below that the unit is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: �•,-' 6 Th nlz,you for our assistance in this matter. Sig re Print name Rate V,I,A FAX: 790-6230 MRVP Section 8 Rev. 8/06 v �' c � � 8 � - w -.-ie y .,�. ` ..err "_ :v •5"'.: iy '"�" .,), P�:_.. .'k`"<r ...-+� *,�-''a, --f .r�„� s"•i ?a`; c"S "kk rw'� >:t .,.r�, t,.; _..;. s E Z Z i _ ��.. ✓ s... 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For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary- signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. _,. Fill in please: Date: (0 1 / t 9 1 r I APPLICANTS NAME: �,4,[ � � ot;eo-E YOUR HOME ADDRESS. s� BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION: FID # a NAME OF NEW BUSINESS ­C,")2�; -, Ea; TYPE OF BUSINESS RAC IS THIS A HOME OCCUPATION? x YE_ NO ADDRESS OF BUSINESS \(0 GAP2c_e k) MAP/PARCEL NUMBER / (Assessing) When starting a new business there .are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form-is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.'(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally opera a y�our usiness in town. 1. BUILDING COMMiSSIOER'S OFFICE i This individual h s. n.infor ee of ny per it requirements that pertain to this-type of busine44UST COMPLY WITH HOME OCCUPATOOf V3� �-►�-�. RUt� A l I OU��°ION& PAILURlt TO Auth ed ; n tire* I: - _�. COMMENTS: flyLu -AAA IN I As r 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type.of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: I Town of Barnstable �00HE to Regulatory.Services o Thomas F. Geiler,Director ]Building Division * BARNSTABLE, _ y MASS. � Tom Perry, Building Commissioner �rEo pWta 200 Main Street, Hyannis, MA 02601 www.town,barnstable.ma.us Office: 508-862-4038 x: 08-790-6230 Approved: . Permit#: c2o WQ a Z q Z_ HOME OCCUPATION REGISTRATION Pater 1 j ao i 1 Narrlc: - -k Phonc #: ? O R 1 01 O t Address: i(o G)*Q4ip-.0 L Al village:�4e A,A-J 5 Nan)e of Business: ON Type of Business: RAl A1� Map/Lot: 4:;� ;�' �D� ��� �✓ INTENT: It is the intent of this section to plow[lie, residents of the Town of Barnstable to operate a home oc'c'upation t�Rtllril$ItlJ,�le F)mily dcvelliugs,sllbfect 10 the[)rUV1Sl01)s Of SeCtl011�1-1.�1 oftlre`Goring ordinance, provided that the activity Shall not be discernible fi-oni outside the dwelling: there shall he no increase in noise or odor;uo visual alteration to the premises Which Would suggest ally(III[Ig other than a residential use; no increase in traffic above Normal residential volumes; alicl no increase in air or groundwater pollution. After registration with (lie Building Inspector,;.cliston):ily home occupation shall be permitted as of right subject to the following conditioi)s: • The activity is carried on by the perinauent resident of'a single f'a)tily residential dwelling unit, located within that dwelling unit.. • Such use occupies uo more than 400 squ�u-c feet of space. . • There are no exteriial alte.ratious to the dwelling rvlrich are not customary in residential buil(lings,`<ind there is . no outside evidence of'such use. + No traffic will be generated Hi excess of normal residential volun)es. • "tile use (toes not-involve the 1)roduction of offensive noise, Vibration,smoke, (lust or.other.partic•ular matter, odors, electrical disturbance, Beat,glare, hlln)idity or other olljectiona)le effects, There is no storage or use of toxic or llIZI'dOLIS materials, or flammable or explosive materials, in excess of no=d household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,�uul Trot ceitlrin the required f-ont yard. • "There is lio exterior storage Or display of n)aterials or edllipmeut. • There are no c•onunerclat vellicles related to the Custonlaly FIOI))e Occupation, other than one van or one pick-up truck not to exceed one toll capacity, and one trailer not to exceed 20 feet III length and not to exceed 4 times,patrked on the same lot containing the Customary Hone Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If tlle.Cust011iary Honle Occupation is listed or advertised as a business,the street address shall uol be include([. • No person shall be employed in the Custon)aly Home Occupation who is not a pern)aucnt resident of(IIe chvelling unit. I, the undersigned, have react and eLimee nail Ile above restrictions for n)}'horl)e occupation I anI registering. Applicant: Date:Q l / I g lr�e11 > TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. 00 Application # I S Health Division Date Issued Conservation Division ' -;-Application Feed Planning'Dept: Permit Fee Date Definitive'Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village Owner G 4 �S D Address 41e � Telephone Permit Request , Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project-Valuation• Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;0 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 0 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 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ c7ji . ' Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION r (BUILDER OR HOMEOWNER) dame•am ��,�GP�D lam` ��S'T� Qk �_�..,� — Tele�phoneTNu_- mber�50�`_ CAtld License # i Home Improvement Contractor# Worker's Compensation # ALL—CONSTRUC IT ON DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE` C—DATE/ 1 a a. FOR OFFICIAL USE ONLY APPLICATION# � DATEISSUED , MAP/PARCEL N0. ADDRESS VILLAGE r OWNER - f r DATE OF INSPECTION: FOUNDATION FRAME . INSULATION 'R FIREPLACE ELECTRICAL: ROUGH FINAL -PLUMBING: ROUGH FINAL r` * GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN.NO. Y } The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ,6"" r V Address: 7 ,DEL S'TT City/State/Zip: PhoneA • g2,e oo/ Are yo an employer? Check the appropriate box: Type of project(required): 1. am a employer with 4. I am a general contractor and I • employees(full and/or part tim.e). * have hired the slab-contractors 6. ❑New construction I am a soleprpprietor or'parttier listed on the'attached sheet. T. Q Remodeling shi d have no employees These sub-contractors have g,'WDemolition. orking for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance.$ required] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3 I am a homeowner doing all work officers have exercised their It.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we,have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicantthat 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. tContractors 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 havo employers,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.M Expiration Date: Job Site Address: City/State/Zip: _ 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. 152 can lead to the'imposition of crimiri4l penalties of a fine tip to$1,50D.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 DJA for insurance coverage verification. I do hereby certify under t e ains andpenalties ofperjury that the information provided above is true and correct. Si afore: Date: Phone 77 �� Official use only. Do not write in this area, tb be completed by city or town off1CW .City or Town: Permit/License#. Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation'for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees'. However the house having not more than three a astrrients and who resides therein,or the occupant of the owner of a dwelling g P 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, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until'acceptable evidence of compliance with the insur-ance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub conti•actor(s)narne(s),addresses)andpbone numbers) along with their certificate(s)of . insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions*regarding the law or if you are required to obtain a workers' compensation policy,please.call the Departiment at the number listed below. Self-insured companies should enter their self-incnranGe license number on the appropriate line. City or Towp Officials .Plea se 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 permrit/iicense number which will be used as a re erence number. In addition,an aFFt-'cant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the afd-rdavit that has been officially stamped'or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of ladustri 'i Accidents Office of Iavestigations- 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 ar 1-877-MASSAFE Fax# 617-727=770 .evised 11-22-06 ' www.mass.gov/dia Town of Barnstable Regulatory Services xwatvsruLF- Thomas F.Geiler,Director Mrs. • 16S9 . $g� Building Division PrED F Tom Perry,Bttilding Commissioner 200 Main-S.Ueet,_Hyatmis,MA 02601.. wwsv.t o wn.b arnstabl e.m a.us Office: 508-962-403 8 Fax: 508-790-6230 HOMMOWNER LICENSE EXEMPTION Please Print ,number stroct village "HOMFAWNE3t - name borne phone# work phone# C-URRENT MAILING ADDRESS: —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. DEMEMON OF BOMEOWNER 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 buildinZ 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 5i nature of Homeowner Approval of Budding 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 bomeowner perfom ing work for which a building perrrrit is required shall be exempt from the provisions of this section(Section I D9.1.1-Licensing of construction Supervisors);provided that if the homeowncr engages a persons)for hire to do ruch work,that such Homeowner shall ad as supervisor." Many homeowners wbo use this exemption an unaware that they an assurrang the nspmmbilities of a supervisor(sea Appendix Q. Rules&Regulations for Licensing Cmstruetion Supervisors,Section 2.15) This lack of swarzness bften results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board carmot proceed against the unlicensed person as it weiuld with a licensed Supervisor. The homeowner acting as Supervisor is ultimately.responsible. To arinm that the homeowner is fully aware of his/her responsibilities,many conununitics require,as part of the permit application. that the homeowner certify thathdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can t amend and adopt such a form./eertifieatian for use in your community. d Q:forms:homet cmpt T Town of Barnstable -' Regulatory Services . • �.RA2b"rARf� g Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 0 S Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by ding permit application for. S (Ad s qrJob) Signature of Owner ate Print Name If Pro eLer is applying for permit please complete.the Homeown rs License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISS ION �� � fl � � � �,� � ' � S1 Y Y Town of Barnstable Building Department ComplainOnquiry Report Date:. °l C0 Rec'd by: Assessor's No.: Complaint Name: e_ Location Address: lJ ii M/P 1�C� (4 A f7 a/� C)C) Originator Name: Street: A-e, dillage: State• Zip: Telephone: D/E b Complaint lD- < Description: i D t Inquiry Description: For Office Use Only Inspector's Action/Comments Date: �, "� �Q Inspector: Follow-up Action Additional Info. Attached Copy Distribution: White-Dcpaitrnent File Ycllow-Inspector Pink-Inspector(Return to Office Manager) go U_T E 2 8 r�r r r r r r r N a e c� N M m S 88.09'44'E • !09.B9' 44 21 't LOT 2 C /0/ /0 f S.F. 3 #l 4 �b MC. \ • PATIO h _ 14.00. ��•s N >S,ZO 2s.8, gl 35 S6 TOWN OF BARNSTABLE ZONING BY-LAW DATED SEPT. 14. 1987 ZONE RB I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SETBACKS KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING FRONT - 2o' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS SIDE - 10' OF THE ZONING BY-LAW FOR THE RB DISTRICT. REAR - /0' PROPERTY LINES SHOWN HEREON THE LOT SHOWN HEREON IS IN FLOOD HAZARD ZONE C WERE.COMP I LED FROM AVAILABLE AS SHOWN ON MAP 250001 0005 C. DATED AUG. I9. 1985. PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. THE DWELLING DEPICTED ON THIS PLOT PLAN PLAN WAS LOCATED ON THE GROUND _ " `-'`� ' hi BY SURVEY ON DUNE 23. /993 AND BARNSTABLL�', MASS`. EXISTS AS SHOWN AS OF THE DATE OF LOCATION. C SCALE: 1'-40' JUNE 24. 1993 THIS PLAN IS FOR PLOT PLAN /z��q3 , EACLE SOBYEYINC t ENCINEENINC.INC, PURPOSES ONLY AND NOT FOR 10 8e060ard Lane RECORDING. DEED DESCRIPTIONS. llyann1g, ya, 08601 ESTABLISHING PROPERTY LINES (608) y?'8-4488 OR FOR CONSTRUCTION PURPOSES. 0 20 40 80 PROJECT NO. 93-261 i - (Action: Exit I (Exit the RE Original Bill Screen. ( Year/Bill# [2001] [ 7931] Tax Year (s) [2001 ] Add' l Names? [NJ1 ( Parcel [292-082-002 ] Namel [DEZELLE, EST OF CHARLOTTE M ] I (Alt [ ] Name2 [oCARDOSO, GERALDO F ] 1 ( Street [ 16] [ ] Unit [ ] [ ] [ ] I [GARDEN LANE ] DBA[ ] Own [ ] I 1Juris [400 ] Class [1010] Status [A] [JAN 1 Owner: DEZELLE, CHARLOTTE M ] 1 ISubdiv [3 ] Zone [ ] List [ ] Lender [ ] Acct [ ] Sery [ ] I 1 # Fam [ ] SIC [62AC] Exempt [N] Legal description I (Acres [ . 190] SF [ 82761 [#LAND 1 18, 000 ] I IBk/Pg [10439/037 ] [10/17/19961 [#BLDG(S) -CARD-1 1 54, 400 ] I Values Prev Year This Year Tax/Exem Rate Amount Totals 1 ( Land Val [ 18, 000] [ 28, 400] [HYTAX ] [ 3. 250] [ 106600. 00] Taxes I ( Bldg Val [ 60, 300] [ 78, 200] [LANDBK] [ . 000] [ . 00] [ 213200 . 0011 IPers Val [ ] [ ] [TAX ] [ 12 . 310] [ 106600 . 00]Exempt/Abated I I Gross [ 78, 300] [ 106, 600] [ ] [ ] [ ] [ . 00] 1 ( Spec Assmnt Bal [ . 00] [ ] [ ] [ ]Net Taxes I I Curr Land Use [ ] [ ] [ ] [ ] [ ] [ 213200 . 00] 1 I Curr Val Exem[ ] [ ] [ ] [ ] [ ] 1 I Curr Taxable [ 106, 600] [ ] [ ] [ ] 1 I +------------------------------------------------------------------------------+ Property Location: 14 UNCLE JOES WAY MAP ID: 292/305/ Vision ID: 23154 Other ID: Bldg#. 1 Card 1 of 1 Print Date:03/09/2001 K' MA �"'fzrm r MVM-��Cr 7 ivLAK&J DescFzp—tzon Code Appraised Value Asse--iemanhviialue KES LA-ND "' N 29,00 P 0 BOX 437 RESEDNTL 1010 95,300 95,300 801 W HYANNISPORT,MA 02672 —RESEDNTL 1010 600 600 1 VE DATA-Barn.,MA ccouni ZU47YU Plan Ref. Tax Dist. 400 Land Ct# Per.Prop. #SR Life Estate #DL I LOT 2 Notes: VISION #DL 2 CIS ID.- ota11 124,9001 124,90 1 ;#Wk\, 7M4 2 'DATE'M ? f k.'I'77 Lv- 2& W. 80'000i5et LAJUVE,IMLA-KK J a I Yr. Code Assessed Value Yr. o e Assessed value Yr. Code Assessed value PARETCHANIAN,ERNEST 3658/231 01/15/1983 Q 1 50,000 -2m Tur(f 18,61JU rF9"9"9 15(3U01998 iuiu --18,60D BASSESTT9 ETALS9 TR 03/15/1981 Q V 12,000 20001010 68,6001999 1010 68,6001998 1 010 68,600 ta --Tr,70,—-Totar- 87,20U Total: 87970 iYa Ints signature a 1a ck4owledges a visit by a Data Co ector or Assessor Yea, lypelvescriplion Amount code Description Number v mount Comm.Int. 1"Tmo' K '"'W"T f7l 4 Appraised Bldg.Value(Card) 92,600 Appraised XF(B)Value(Bldg) 2,700 Total. Appraised OB(L)Value(Bldg) 600 7%VXW Appraised Land Value(Bldg) 29,000 Special Land Value A-A "'T Total Appraised Card Value 124,900 Total Appraised Parcel Value 124,900 Valuation Method: Cost/Market Valuation et Total Appraised Parcel Value 12499UO q. Permit ID Issue Date lype Description Amount Insp.Date %Comp. Date Comp. Comments Dat,e ID Gd. Purposel'MeAT 42105 ---rU729799-----NS—Siding -full— --79Tf5797-----NIU- 39808 7/16/99 AD New Addition 8,000 100 12 X 12 K' Y" use Code Description one D Irontage Depth units unit Price 1.tactor S.I. C.Eactor Nbhd. Aaj. Notes-Ad/1 eciat Pricing A Unit Price an alue I IWO Single Farn -RR--4- -V.n AU 270, UU.00 LOU 1.00-6-2A-C--U-.45 SFCL(.2j,Ul0)NoFe-s-.-TUTBL-DG---T26-�OUM --291-m I W6 Card an U.2 3 A-C Parcel 7 Wal an Area: ota an a ue29,U001 Property Location: 14 UNCLE JOES WAY MAP ID: 292/305/ Vision ID:23154 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 03/09/2001 Element Gd. Ch. Description CW—m—mercialuata Elements ty e ypeRanch Element Cd. Ch. Description Model 1 Residential Heat Grade Average Grade Frame Type FEP aths/Plumbing Stories 1 1 Story ccupancy 0Ceiling/Wall ooms/Prtns 12 Exterior Wall 1 5 Vinyl Siding /o Common Wall 2 Wall Height Roof Structure 3 able/Hip 12 Roof Cover 3 sph/F GIs/Cmp Interior Wall 1 05 Drywall - a MT 2 Element Gode Description Vactor Interior Floor 1 14 Carpet omp ex 2 Floor Adj Unit Location Heating Fuel 3 Gas eating Type 5 Hot Water Number of Units C Type H None Number of Levels /o Ownership 26 2 Bedrooms 3 3 Bedrooms Bathrooms 1.5 1 1/2 Bathrms lu >r 11 1 Full+1H na I.Base Rate 0.00 Total Rooms 5 5 Rooms ize Adj.Factor 1.09397 Grade(Q)Index .98 ath Type Adj.Base Rate 4.33 Kitchen Style Bldg.Value New 102,864 48 Year Built 1981 ff.Year Built G)1990 rml Physcl Dep 10 uncnl Obslnc con Obslnc pecl.Condo Code Code escri tion Percenta a Pecl Cond /o 0 mg a am verall%Cond. eprec.Bldg Value 92,600 f `. Code Description nits Unit Price Yr. Dp Rt %Cnd Apr. Value FJPLI irep ace , SHED Shed L 80 8.00 1990 1 100 600 Code Description —Living Area ross rea Eff.Area Unit Cost Undeprec. Vahie BAN First Floor TT49 , BMT Basement Area 0 19248 250 12.89 16,083 FEP Enclosed Porch 0 144 101 45.12 6,497 IM Uross LivlLease Area g a: IU2,864 Property Location: 16 GARDEN LANE MAP ID: 292/082/002/ Vision ID: 22953 Other ID: Bldg#: 1 Card 1 of 1 Print Date:03/09/2001 MNll'�� hb I Ur UnMKILU I]LE Description Code Appraised Value Assessed value %CARDOSO,GERALDO F RES-L-AND7— iuiu --79,-4W 28,40 67 DELTA ST RESIDNTL 1010 77,700 77,700 801 HYANNIS,MA 02601 -RESH)NTL 1010 500 500 IVE DATA-Barn.,MA ACcountfl LUL714 777075-&35W I Tax Dist. 400 Land Ct# Per.Prop. UP FY02 #SR Life Estate #DL I LOT 3 Notes: VISION #DL 2 GIS ID: lotall 0696uu 1 IU6,6uu t/C,NA A"` NA -41 1'1111 'IN A t-AKUq-)bqJ,kiLKALOU r 13412/IU5 IL/U-//LUUU 1 135,U rr. Code Assessed Value Yr. code Assessed Value Yr. code Assessed Value DEZELLE,EST OF CHARLOTTE M 10439/037 10/17/1996 U 1 1 IA -MW 1010 18,00D PJ98-TUW 18,00U DEZELLE,DAVID J&CHARLOTTE 4696/309 09/15/1985 U I I A 2000 1010 60,0001999 1010 60,0001998 1010 60,000 BALICKI,WILLIAM&PATRICIA 3599/ 67 11/15/1982 Q 1 50,000 2000 1010 3001999 1010 3001998 1010 300 BASSESTT,ET AL TRS 08/15/1981 Q V 6,000 '7ouu:j 78,j00j "tall 78,31 —7-0-taF 78,3UU This signature acknowledges a visit by Data Go llector or Assessor ' Year ypelDescription Amount Code Description Number Amount Comm.Int. Appraised Bldg.Value(Card) 74,500 Appraised XF(B)Value(Bldg) 3,200 Appraised OB(L)Value(Bldg) 500 lotald I Appraised Land Value(Bldg) 28,400 Special Land Value Total Appraised Card Value 106,600 Total Appraised Parcel Value 106,600 Valuation Method: Cost/Market Valuation NetTotal Appraised Parcel V-afu—e 106,600 V1 zC -4* A ?W'I T �k uil AM -6 PermitX'ID Issue Date ype Description Amount Insp.Date Yo Comp. Date Comp. Comments Date Purposelmesull --97r5797-- ML 441':�'-,�" IVL�LPV! 2. V B# Use Code Description one D rontage Depth Units Unit Price I.Pactor S. actor otes-AdjlSpectal ricing ni rice an a ue SFn g-Te--F-a-m KB 4 0.19 AC -3T6-,000-.U0- i.ou 5 1.UU OZ.AIU U.45SPUL(.19,UIU)N-oTe-s.--rUTBUDG 149,684.4U Total Card an Units M. A-C T.—I 1-.1 �andAr—ea:—".19 AC -o-1aTL-an-d-FaTu-e 28,4UU Property Location: 16 GARDEN LANE MAP ID: 292/082/002// Vision ID:22953 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 03/09/2001 VONSMUC as 7ON DETAIL - Element Ca. Ch. Description CommercuilData Elements Style ype ancElement Description Model 1 Residential Heat Grade Average Grade Frame Type PIU 14 aths/Plumbing Stories 1 1 Story Occupancy 0Ceiling/Wall ooms/Prtns 12 1. xterior Wall 1 14 ood Shingle /°Common Wall 2 Wall Height Roof Structure 03 able/Hip Roof Cover 3 sph/F GIs/Cmp 14 MT Interior Wall 1 5 Drywall U'' 2 Element Code Oescription t,actor Interior Floor 1 14 arpet Complex 2 Floor Adj Unit Location eating Fuel 03 Gas Heating Type 05 Hot Water Number of Units C Type 01 None Number of Levels /o Ownership 26. - 2626 2 Bedrooms 2 Bedrooms Bathrooms 1 1 Bathroom .10 1 Full �. ;. Total Rooms Size Rooms ze I.Base to Adj.Factor 1.20643 Grade(Q)Index 1.97 ath Type Adj.Base Rate 0.21 Kitchen Style Bldg.Value New 4,603 14 34 Year Built 1981 ff.Year Built A)1988 rml Physcl Dep 12 uncnl Obsinc con Obslnc Ir pecl.Cond.Code o e Description ercenta a 8 1010 Single Fam eprec.Bldg Value 74,500 Code Description LIB Units Unit Price Yr. Dp Rt Yocna Apr. Value FFLI prep ace , , BRR Bsmt Rec Room B 143 5.00 1988 1 100 600 SHED Shed L 64 8.00 1900 0 100 500 IF I` v... Code I Description Living Area Uross Area Ely.Area unit cost undeprec. value BAN First oor BMT Basement Area 0 884 177 14.06 12,427 GAR Attached Garage 0 364 127 24.50 8,917 PTO Patio 0 168 17 7.10 1,194 TtL Groks LivILease Area g a: 84,6031 Property Location: 9 UNCLE JOES WAY MAP ID: 292/082/001// Vision ID: 22952 Other ID: Bldg#: 1 Card 1 of 1 Print Date:03/09/2001 WAV RWVTVWNFfiFW- Description Code ppraise alue Assessed Value NELSON,DOROTHY W 'N LAND 1010 2 'OU0 27,UUU 801 276 CENTRAL ST SIDNTL 1010 63,500 63,500 SAUGUS,MA 01906 IVE DATA-Barn.,MA ms Accountg zuz-/W� Flan Ket. Tax Dist. 400 Land Ct# Per.Prop. #SR Life Estate #DL I LOT 1&2 Notes: VISION #DL 2 GIS ID ota 90,500 A -A, '�f�-! qlpgqw A NELSON, 445LIL55 ft"/15pbt U I 55,0U0 A Yr. Code Assessed Value Yr. Code Assessed value rr. Code Assessed Value NELSON9 MARJORIE M 4482/286 04/15/1985 U I I H '2UUU TOW 1 7,.3uu 1 VVY iulu 17,300199 1010 17'juu NELSON9 CARL E&MARJORIE M 1418/829 Q 0 2000 1010 51,300 1999 1010 51,3001998 1010 51,300 7—otaT- 68,6uo Total:1 6896OU -To—taT- 68,60U "S I This signature acknowledges a visit by a Data Cofiector or Assessor -, "i�� I A I-k L&AW&" 4 -a 'A , rear ypelvescription Amount Code Description number Amount Comm.Int. A Appraised Bldg.Value(Card) 61,200 Appraised XF(B)Value(Bldg) 2,300 Appraised OB(L)Value(Bldg) 0 JWald I Appraised Land Value(Bldg) 27,000 -1-Or 'It".1 S Special Land Value XHUTIS KI zz;... Total Appraised Card Value 90,500 Total Appraised Parcel Value 90,500 Valuation Method: Cost/Market Valuation I Appraised Parcel Value 90,500 IR -IXXHAIVUft -�."''MUIJMW INC%f T P 040ft It "r Permit ID Issue Date 1),pe Description Amount Insp.Date oComp. Date Comp. Comments ate ID Ca. urposelResult --W)5/87 ML MR- " MOMW W, ky A�A Utz B# Use Code Description Zone DProntage Depth viias Unit Price IPactor S. . actor Aaj. I Notes-AdjlSpecialracing A nit rice an value I—---YOTU--Single Fam 0.27 AC 1.Uu 0.90 62AC U.45SFUL(.27,UI0)Notes:10 IBLIJU 99,918.64 27,1 Total Card an Units l 0.27 AC' Parcel Total an Area:j I otm Property Location: 9 UNCLE JOES WAY MAP ID: 292/082/001// Vision ID:22952 Other ID: Bldg#: I Card 1 of 1 Print Date: 03/09/2001 U ION-DE NXETW at Element Cd. Description Commercial Data ements Style/I ype 11 Ra nc Element Description Model 1 esidential eat Grade Average Grade Frame Type Baths/Plumbing Stories 1 1 Story ccupancy 0Ceiling/Wall ooms/Prtns Exterior Wall 1 14 Wood Shingle /o Common Wall GAR 14 2 Wall Height Roof Structure 3 able/Hip Roof Cover 3 sph/F GIs/Cmp 12 Interior Wall l 5 Drywall " 2 2 Wall Brd/Wood Element Code Vescription tactor 2 2 8 Interior Floor 1 14 arpet Complex 2 11 Ceram Clay Til Floor Adj Unit Location 2 2 eating Fuel 2 Oil Heating Type 4 Hot Air Number of Units 14 C Type 1 None Number of Levels /o Ownership Bedrooms 2 Bedrooms 42 Bathrooms 1 1 Bathroom ,.r ,"� 10 1 Full Unadj. ase e Total Rooms 5 5 Rooms ize Adj.Factor 1.23119 ath Type Grade(Q)Index .93 YP Adj.Base Rate 8.70 Kitchen Style Bldg.Value New 8,524 Year Built 19 A 52 ff.Year Built )1978 rml Physcl Dep 2 "E' . uncnl Obslnc con Obslnc ... -. ,, Spec].Condo Code Code Description ercenta a peel Cond /o mg a am verall%Cond. 8 eprec.Bldg Value 61,200 LIA X S f o e Description nits Unit Price Yr. Dp Rt xo(,na Apr. value trLI Fireplace , ,:. .✓ :.e... i , ': Code Description LivingArea ross rea Ejj.Area Unit Cost Undeprec. a ue - First oor63,479 BMT Basement Area 0 462 92 13.68 6,320 FOP Open Porch 0 96 19 13.60 1,305 GAR Attached Garage 0 308 108 24.09 7,420 TtL Gro-ss LiVII ease Area 9241 1,790ig Val. , e ` s Q t G � cat _ o, � v.• 0 v i ov�i. C �{ �� . ar 9 y►y °1 s, y ott ��as w I J SZ• F 2• w1s' ° �/t s d «aa 4 14 G ss V< a F 8S£ , tsi •7 �Y a�i�. r cci �. v fs oy +.rgg,� a �` ��F• v e� MTI0,3 ., wM. .AFZ• o' 'ebZ. oo, A Z•'8 egg` OY,i tr ee 1 " r tsa �'F o f • I2 a.F s � � riJ suet, I 1 , n o a t tiss. '� A ar big q so,sea Va. rj F, 2g a o �,t• / .w"• °v �• P O II ' �_t �fi •(g a s.. ! frLs o ,.o al ev e ►1f. ofR a p �"1Z. 1852 p'Y vaog 1 `� Wilt ` o eft Ee \8 �! i 0 Q ° ;' r S 2 g �i ,�, � S �• se` GIA zit l�s llG 1 '14• ©soG - o T etes 1 l gof r' ram. v ,.M : - I t © 76 71 G1' J cat oe Ls�s• '�r��.� a fas M 15q ' saoss3ssa. 1 '318V1SNUVO JO NMOJL k: y i +------------------------------------------------------------------------------+ (Action: Exit 1 (Exit the RE Original Bill Screen. 1 ( Year/Bill# [2001] [ 7931] Tax Year (s) [2001 ] Add' l Names? [N] 1 ( Parcel [292-082-002 ] Namel [DEZELLE, EST OF CHARLOTTE M ] I (Alt [ J Name2 [oCARDOSO, GERALDO F ] I ( Street [ 16] [ ] Unit [ ] [ ] [ ] 1 [GARDEN LANE ] DBA[ ] Own [ ] 1 IJuris [400 ] Class [1010] Status [A] [JAN 1 Owner: DEZELLE, . CHARLOTTE M ] 1 ISubdiv [3 ' ] Zone [ ] List [ ] Lender [ ] Acct [ ] Sery [ JI 1 # Fam [ ] SIC [62AC] Exempt [N] Legal description I (Acres [ . 190] SF [ 82761 [#LAND 1 18, 000 ] I IBk/Pg [10439/037 ] [10/17/19§61 [#BLDG (S) -CARD-1 1 54, 400 ] I I Values Prev Year This Year Tax/Exem Rate Amount Totals I ( Land Val [ 18, 000] [ 28, 400] [HYTAX ] [ 3 . 250] [ 106600 . 00] Taxes I ( Bldg Val [ 60, 300] [ 78, 200] [LANDBK] [ . 000] [ . 00] [ 213200 . 001 1 IPers Val [ ] [ ] [TAX ] [ 12 . 310] [ 106600 . 00] Exempt/Abated I I Gross [ 78, 300] [ 106, 600] [ ] [ ] [ ] [ . 00] 1 ( Spec Assmnt Bal [ . 00] [ ] [ ] [ ]Net Taxes I I Curr Land Use [ ] [ ] [ ] [ ] [ ] [ 213200 . 00] 1 I Curr Val Exem[ ] [ ] [ ] [ ] [ ] 1 I Curr Taxable [ 106, 600] [ ] [ ] [ ] I I I +------------------------------------------------------------------------------+ �- - - __ , y `\� . '�� �' � v1� y. �Q " � � A � r o � �' , _ � � �.. " � � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel—"? Permit# Health Division ?C06 ZS-6 /z �° "�� ? Date Issued t Conservation Division Fee Tax Collector .. +NO'l t.u► Treasurer'` ✓` ®r� lz00 t SEPTIC SYSTEM M�B�T ICE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE S ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Addressi2D i✓ i✓� Village V 4 Al Al".J \ Owner Address Ic '✓'1//A. Telephone 77/ 7��' Gi-'Lc 7'`Ii71✓� ,s 7 '7 - 7,9- -T-- Permit Request ZA, Ii-k_E C i�d"�`/Ei� s � o;✓ 7t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 51-, Valuation _ ��= 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 / V)c.5 Historic House: ❑Yes C�No On Old King's Highway: ❑Yes O'60 Basement Type: & tu"Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) A/O�� Basement Unfinished Area(sq.ft) _ X'3 g flio s F Number of Baths: Full: existing 1 new Half: existing new tNumber of Bedrooms: existing_ new 1 Total Room Count(not including baths): existing new First Floor Room Count �) Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes RI(No Fireplaces: Existing S New Existing wood/coal stove: ❑Yes wl o Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:Elexisting ❑new size Attached garage:M/existing ❑new size 0 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use G L C BUILDER INFORMATION Name y' ' Telephone Number Address c L 4 i License# i c 3 Home Improvement Contractor# � - Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 2 ,y SIGNATURE DATE 111Q1a i -s F j Al FOR OFFICIAL USE ONLY PERMIT NO. J v DATE ISSUED , 'r MAP/PARCEL NO. • � - - • ADDRESS VILLAGE OWNER f DATE OF INSEECTION ' } FOUNDATION FRAME '•�2 L��S ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ' FINAL a GAS: ROUGH. FINAL FINAL BUILDING E� DATE CLOSED OUT "�. ASSOCIATION+PLAN NO."` 15, =; TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION Map J Parcel b$ 0 Permit# ' j `Z5 Health Division 2 00 0 �-� ' Date Issued � a Conservation Division T; Tit 2,// 0y Fee -f Tax Collector " ; EPBC SYSTEM MUST INSTALLED IN COMPLIANC: Treasurer. - ► WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AI'0 Date Definitive Plan Approved by Planning Board TOWN REGULATION& Historic-"OKH Preservation/Hyannis Project Street Address %/�/� /L DE A/ Z,4 I F Village l� �/,�1�✓i✓� Owner �T ,� 4L-Do e,f ,00S0 Address 4,11W's' •4, Telephone 7 71 - 7 U 4 S 7 7 - 7 Y k Permit Request TO FJ20 A/T h o o /Z Square feet: 1st floor: existing l .�� proposed 6 2nd floor: existing Nr� proposed �✓p Total new O ��oo g y Valuation tL. Zoning District Flood Plain Groundwater Overlay Construction Type WDOD FP-,4m E Lot Size Grandfathered: Cl Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes t�No On Old King's Highway: ❑Yes )d No Basement Type: $Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) F4 q Number of Baths: Full: existing / new 6 Half; existing a new a Number of Bedrooms: existing z, new o Total Room Count(not including baths): existing new O First Floor Room Count 1 Heat Type and Fuel: > Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes % No Fireplaces: Existing I New a .Existing wood/coal stove: ❑Yes No Detached garage:❑existing ❑new size U Pool:❑existing ❑new size O Barn:❑existing ❑new size O Attached'garage:❑existing ❑new size 0 Shed:$existing ❑new size D Other: - Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes $No If yes, site plan review# Current Use D c--,N i A- L Proposed Use r,5 i >)jEAL"r-/ ia- t p 4)Al1:-r 4 BUILDER INFORMATION Name D6 e 4 2 D D 5 6 Telephone Number 77/ - Address 4e-7 License# ��l �?-/�i✓i�Sdy55 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 48 SIGNATURE X DATE " a� ��Z e) S FOR OFFICIAL USE ONLY PERMIT NO. i DATE ISSUED MAP/PARCEL NO. ' 141 ADDRESS VILLAGE OWNER _ A DATE OF INSPECTION:` w FOUNDATION FRAME INSULATION FIREPLACE -� ELECTRICAL: ROUGH, '` _ FINAL C PLUMBING: ROUGH_ : s_ FINAL GAS: ROUGH 4 FINAL FINAL BUILDING 44 P v DATE CLOSED OUT J l!} ASSOCIATION PLAN NO. ' Y is r ■■■8 ■■■NOON VISION M MEN ■■■■ i■ - - ■■■®■ MEN EM ME Elm IN M .., ■ ■ ■■ � � � � 1 1111�11 Ili ill[1111 � 1�1 I��o� �■■■■■ i■ ■■ ■■■ I 1 1 1 11 1 ! 11 111IS ■ ■ 1 1 �1� 111� IL11 1 1� ■1111� � °�� i �■ ■■■ ■■■ ■ ■■■ ■■■ ■■■■ls■■■■■■■■■■■■ ■■ ' ■N■■■■ ■©■ ■■ ■■■ ■■■■■ M■■ ■■ ■ ■■I ■■■ I ■■■■■■■®■ ■■ �■ M■■I IN MM IS IN ■ ■ ■■ iiri'■.: �s�1�11■■ i' I IN NMI IS ■■ ■■ 1 ■ ■ ..�.-- �I■®■ ■■■■■I ■� i■N■■■ i 1■■■■■■■■1111■■� I ■■■■■ I ■ ■ ■■■■■ 1■■■0 ■�11 ■■■ 1 ■■ ■■ 1 ■ ■■ ■■■■ ■■■■ ii ; ■■■ - ■■ ■■ ■: ■■■ ■ ■■ ■■ ■■■■■■ ®■�H� ■■■■■■I i■ ■■■■■■ ■■I r i ' f L � �t - -� 4, J q t � • �e � � � (� 4 -� � � ' f � � ? � Y � 1 w� 1'� w v� T � � � � � � �J � � � O � � � � . � � �� � Q � � � x � � X �. � . ,�, � �� � . � M CU&Appadit J Table4L21b(eombued) • h an prim Psckga for Ono-and Two-family Red&=W BoOdlap Sated with Fang Fotb MAXIMUM ME"MUM CH g Glazing. Ceiling wall Floor SAS= ns Slab Hmaag/Cooliag Ana ('A) U-valrr� R valml R-mbe' Xvaltol wall aimoter 6grdpmrsrt Flfid=cY' p ERrvalne' 5101 to 6500 Headna Degm Dart' Q 1 127. 1 0.40 3E 1 13 1 19 10 6 Nonnni R 129A OJ2 . 30 1 19 19 10 6 Normal S IZ•/. 0.50 3E 13 19 10 6 U AFUE T 13% 036 3E 13 .23 WA WA Normal u IS•A OA6 3E 19 19 10 6 Normal V IS'/. 0,44 3E 13 2S N/A WA ES AFUE w 15% U32 1 30 19 19 10 6 S AFUE X 18% 032 1 3E 13 25 WA WA Normal Y Ism. 042 1 3E 19 2S WA WA Normal Z 13% 6.42 3E 13 19 10 6 96 AFUE AA IE•/. 0.50 30 1 19 19 10 6 1 90AFUE 1. ADDRESS OF PROPERTY. /� 6�4-i2r£Al ,4 Al d 9-A/r✓/ b 1224--43 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-t98M03a 780 CMR Appendix J Footnotes to Table J5.11b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. , For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R 38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include sheathing,and interior . For example,an R-19 requirement could be met EITHER exterior siding,structural g, �� P l by R 1! cavity insulation OR �13 cavity insulation plus R•6 insulating as sheathing. Wall q apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. 'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned N, basements must be included with the other glazing. Basement doors must meet the door U-vaIue requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). . The Town of Barnstable 9 • ■AMSrABLA MAS& �m Regulatory Services 'OrEp Mp'�A Thomas F. Geiler, Director 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. ,,l Type of Work: I�EF_L Cy4l eL 4 4M/° Estimated Cost 4`/.So Address of Work: �W � ✓ /✓ 441JE ZL,4Al A/I S Owner's Name: Date of Application: a / 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. kw�l OR / Date Owner's Name q:forms:Affidav CF THE 1p� The Town of Barnstable r r r • BAMSPABLE, + 9�AMASS. Regulatory Services lFn Iu1D•t° 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: �G Crl�f✓�D /✓ LEI N E h'�L��✓/�' -s number street village/ "HOMEOWNER": (3 MAL,D0 C-412Do 6o J d k-- 77/ 7eJ-,�4 CCGL 77- 7�4aa name home phone# work phone# CURRENT MAILING ADDRESS: zz1/g-wj✓1�5 !�224- Do2 6,0 city/t 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 of 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 proc and requirements. X ed x of Signature of ome r 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. y` 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. Q:FORMS:EXEMPTN - ESTIMA TED PROJECT COST WORKSHEET LIVING SPACE Value .(high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet XF$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER W ,4 f-9 L 614l41 e � l S square feet X$ /sq. foot Total Estimated Project Value W o r— 4�.- The Commonwealth of Massachusetts 4-- Department of Industrial Accidents -_ �e •==•'�� . •=3 , Ol�ce ollatnstlgatloos 600 Washington Street Boston,Mass. 02111 Workkeers' Com ensation Insurance Afrida /viiittt wan name: location: city phone# 7 7/- MP-*li ❑ I am a homeowner perf rming all work myself ❑ I am a sole etor and have no one in aavc2pacity ❑ I am an employer providing workers'compensation for my employees worlang . ....:.:...:. .. :.:::,....,. ....,.::: .....:::.::..... :::::.. ........ :.........:..:......-.....:.:. cam any name:: ;':..;.;'-::.;;; .;;:.;;;•.;.::;.:.;::... ::•i::viy:::::::::}:::Y:>}:?Gi Ti?}:• ?}:+ii}::(:;:}v: �vi::i::iiiriii:4�v:•Li}::;i:.:;:;:;'.'+.;:.,i:;:i;:<ti::ti: L'siJ:•i:•''•�L::''ii}'i:};';:.}:ii:;:;:}}:i:':ijY:%ij:::}::..:i :::ii?:?;i:.:j�:;::!:tiii::`:.':'C:<C:{-"•:•::i:'�iit.Jjiii:::ii:i'r:::';'.�:. .......... v-a.....,::.a ,w.v}:+ty:.{•.4::.4:?�;.�::.t-:,v:•.w::::.v:w::v::v.v::::...:v::w.v:::w.::.:......::•:•i:i.:�:::-::.....M'::::i'.�:::.':...... w•r::.::.;::y:.:•:{OX:::.:::::.v:•:..-.::r:.;:.::::::rL ::::::.:::.�:{:{.;.:Y{;.:.�....; .. ..,. �...... ....x:::.;.. ....-.....•.v::.:..-,......-:.:...............::v...:........,.:.v::::•nw....:.;;...;n ............... ....,,...:::.�.<;:-::�::•;:.:-;:+::::,..}:::.�.�::..:.::�...._::::d>::;•:::_:...................... ..{..;^.:}.;�,;�:t;•N:ve�};::::;,:;-.;,:{<•}:?2a}:?�::�:i;�:;�;;:;:•>�;<5;ii:�:;-f>:L�::�:i•:�:i;•2>�:>:`:::;;:;.; i{:?::t:{::iri>:::?:ii:ice}}:{i;3;•:i•:;-:ii->: ' .�:.�:.v:.v:•{i}•r{.::J:;::{{..}•rr+,;.;;•::^::i}}}}•-:.;:.;{.:.):...::v:::•::.v::.........::::•.::::v}{.:.:hr.:�v:.:v:}}:.•:•}:Yfi:{{;{•%:Siii:C:v. •::::::•>:'.:::•.::..�:::•:::::.-..... .......mi l:::;:::•?:...... nx•:•: ................... ...... .:::::.s: insm�amrt.Q:..::.:.... . ......:.::...:..:•:::::... ...:.::..;. ,..::.:. ..... .... .....%:•• ,,..,:::i:::;:z:;>:::.:;: oiicv#.... ::...... . ,...... :... ...:•;::�:. •._;;}:;:.r::..;::>;<.:;.:;::::::�••::;:.:;z:::;:;::: ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'Compensation polies.• :•..,:.:.:::;.;..:...}::.::.::.:,:.ti:.:.:::{%.::.:'.:.:'.,..;.}'.}:::.::::;::: 4.\k..:i}}i':::. +`Y.4::v:•}}:•}}:::?ti�ii?T`.�iiii:{ti;::{•:Si�}}i{:i•:�::{r}. %::.�...iv:}:•iiti:::�:ii.....:.:...:::::.i'S�:�•i�:i;:v:'rii>i::::::i:.::�w: :.;:{;:;}.:}:i{4:{•;y}:.}::�•}:%::•>}}:-:•:':.:•>:;:•}:4:}::•::•:}:.;r':::::G:;.;:;;;>:;;;_.;::+v::•:vr:;>:i;.}:...........:........................... ...............,...-......a :.•........w ry x.:....:.v.-x........... ...... vv.U::v:•.v:.v::.w:,v,� ....... :v.v............:: r:r:v:?•:^:w:�•}}iiY.}:.:%•=}%.•-w.v::::.v:::w:i4::?::n}'.}-.v.:v.v.::Y::::::::::::::::i<i+:'rii'ri'i}iji:viiji}R�;R:v:?i::: .................. .-................ ............. ............................. ........................t......... :.:v}::4i:%•'+i'v:•}}:•:?ti•}i}}}}'•}i:•}i'.}•::::::::.;::.:6:{i:ii:•i::CLi:t;•Y..i:. .....::::•..............hwvv::v.v::/...:.::..................................:•:••:4 .........-r..x::.v:r. t•., .::•:::::•.....: :.;... .....::.v:::Mw•{}::.:.`:•}h:\'Xhv:$?{iv:i}:??•}:•}::fi:�ji":i�i:�:::i>i::�?: .addny�>:.... :,.......:.........:...::.:.,.,.,.;r,.,::{,.>,..5.}.,{...,::•.:::.},.:•::::;;a�.4r{?:.;;......,r. ..;Y;±C::.}}:;i?%h,::}'•}}'•}}}•:.v:.v::$::::}::;.v::: ........;}};{{?:C;x.}:?f..-.}v:.v''i":'•:-,:v r;r.,.........•.v::v::::::{:•;;;r;-r.,4.,v.;.-::,,v r.+......�a ......., x a{ Y 44 .........:.,..t..,.....:....:•..:.......t,:.................:.:.....::::.,•.,,,...h......r, , •r:...,T. , ..., .. tiv{....#:"m•'}°•{t�:•.::'.;:ut?K :r::#;. .:::•:R:�S: I.M. 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O�iC{r�........,....:.,•:.,•:,-.: .::: ,-::••,:....... ................ .:........:.::.::.......:....... FaDur,to seeme coverage as regmred under Section ZSA of MGL 152 can lead to the imposidou of crhnbW penalties of a An up to S1.MOo and/or one years'imprisonment as well as eivII penalties in the form of a STOP WORK ORDER and a tine of SI00.00 a day against me. I mtdentand that s copy of thin statement maybe forwarded to the Mee of Investigations of the DIA for coverage wer eadm I do hmby certify / the pacts and penalties of perjury that the tnfonnadon pm ided above is tare artd correct Signatmt Date o I Print name �Fi�l/� D a l..AIZ d,0 3 D Phm e# 50�'— 7-7/ - 7 Y ------------- otncial use only do not write in this area to be completed by city or town official city or town: permit/lleense M ❑Building D=I 13Llccnsingcheckifinu nediate response is required ❑SelectmenOHeaM Decontact person: phone#; - ❑Other (lrAud 9195 PJAj 1Alf 4 :11 1 . . .1 . �111 • . . . . . - . • .111•.11 .0 •11 . 1 / • • • • -• • •11 / 1 . • • •11�• . .1 11 1 - - . 1. 1 1/..1 1 .11• . / . . 11111 -• • . . 1./1 • t � • - • 1�• • 11• • • •• 1 • •M • •1 • •• • •II • • 1� - r q11• • 1 • • U• • 1 ' • • • 1 • :11 • • 1• • III qw4fjfwtj• 1 •a 11 • 1_ 1 1 t • • 1 /• • • •/ p • •M • •II • • 1 'Y. �111• .1//1• • 1• • �/•U• • • • •1 - • • 1-/ • p • 1 • 1 • 1 11 • 1 • 11 • 1 .11 11 •U 111 w11•. 1 • " 1 • tiY • - 1 - �111 • 1 • •.111 • / • • wi 11 • 1 • • . 1• 1 i1 • 1 • :1111• • • •11 • • • Ilk il111.6/1 1 V' •11 • 1 M• •II •1 • 1 • • •, •11 1 • • 1 11 • 1 • • •11 tl •1 • 111 • •) • • 1 • • • .1• 11 1.) • 1 I 1 • • M: • 1 .1111• • 11-111 • •�w11�• • • 1 .1111• • 1 • M • •II • Y,1 1 •1 / 1 1 1 ' 1 ( : ' 1 1 1 1 1 I r 1 1 p / / 1 11 1 1 1 • 1 + � 1 1 1 1 1 1 1 1 1 J. 1 1 / 11 11 1 1 1 1 1 • 1 1 1 1 1 1 t / 1 1 • • : / 1 1 1 1 11 / Wil 1 11 11 1 1 1 1 1 • •• i• •11 I /=11 1-1 1 •It111•1 • 1 1 • / • 1►. •• 1• w. ••1 Y •11 1 NIIIH Illt• .11 •I11• • 1 • • 11 1 • • • • • •• 1/1• • • •�1/V- • •11.11 1 111 11 - 11 It .1/ Y �• 111 w111w 11•. • 1 1 .1• 1.,1 1 1�.1• • �111 �• • 1 - •111• ••1 • to ems. •1 11 1/ •••11.�� •11111�11 W,1• •11 •• • • 1 M•1111• �11 • 1 • 1� ,�/1 • 11 •• •/ .1 .1• • 1• • Y1/1 .1• •II ,11 • 1 •• 11 • •1111• •11 1 ,111 • •1 wY. .11 folk• 1 •II em III I w •11 ita".1 11 1/. 11 • p • �• • 1 1 • •11 w11 •1 1 •11 • V•q •wlis, O)JEroll1111.1 Y,1 Biel 1 • 11LI11 .11 V V• �l '1 1 1 1 11 'JI 1 1 1 • 1 •• • • 1 1 • • I a 11/11 _•took 11 MI v •1 1• " 1 1 .1 11 •1• • ✓.1• •II • 1 •�/•1111 • -$ is �• w. /�• 1 1 1/ / I •••�'lll •1 1 •11 •• M •../11. 11 • 1 1 • • 1 1 .11 • 1 ..� • •II •J: 1111 • 1 •1 • I �• • • • Y,111 '•I/.•wAffV•11111�+• w,l• •11 • • 1 V: I 1 1 • .1 •11•�/1 .1 1/ 11111• •�1 1�• 1 / .• 1 I. • • •1 y/ •• • • 1 •I.111 �1/ .11 • •1 1111�• �J I 1 � • •11 w11 1 - • • •�• • •1 11 1 • • •I/1 • • ,•• • • • :1I • 11 11 11 w11 /I � i1 •• • 1 ti 1 !Y.11 III 1 1• v•111 Y. •• 1 wTY. 11 • 1 - • • •%111 �: • • II /1 •�1.1III Vw1 1111/1 •�/ • 1 I I 1 Vim♦ - wlw w/ V 111111 I w 1 •• • It. 1/ • /1111�• " • •11;.16 • to • 11 • /1••1 .1� ./1 • w11 w11♦ 1 •�w1 11 • , i• • / • J: • •II •n•I n, • • - 1 • 11 • 1 • • •• •.64 •t• •1• 1• / • • • 1 •11 ' •• 1• 1 � ,1 • J W, I 1 1 11 11 1 1 ' 111 1 1 I I 11 r 1 I 1 1 I I . i I go, 1 1 1 1 . 1 I11 • ' ll 1 1 ' R' 'i Yja� •` rt� s � L �'s �'a �1 _ f I, tr a y K S m� fit, 17 ,. F �T MAR 0 9 2001 �. k 8 r � r ff4a'3k' 'k 1 f / 6e2 t �4. r. AR 0 M 9 2001 p 44 -4 . Y✓/ �y� 333 C"�i RiA��@ 1 a1 IN � f y A M1 r, Tva e � MAR 0 9 2001 r z s ti F r yt •..��5 3: Ek:.. Lw % 7 � Rl 741 a g MAR 0 9 2001 .e. t ooz l+ala s(�'p7 Wax\ 6 ® Ii�YO a I g a —am own yoy4: 170 . s w xa .. � .a+t.. p' aa.,gq,¢i,� Fa` art:i'�u>'...s✓. t � � � r:, i �3 1 � ��, ' 1 � � 1 � � � E _ _ .. � .._ �' � p I � � � 1 1 i s � i ` k � ' ` ,�� ' ;�; 1 � . I I t ° � 1 i � ' i I 1 1� ' 1 � � � t _ � } � � � � � * { � I � - t 1 '�. �� 1 ' t � ` 1 1 f �• ( 1 f � . i � ! , � � '� f 1 # � x :� , - �, ,, � . ' 1 � I � � � ' 1 t 1 � .� . � � � . f 1 .� , , 1 � � _ i � 1 � 1 1 � � 1 � S � � } 1 ' - 1 1 � i 1 ,N- is . 74 IR7 m Al w o m r s o No. co fit, ,,._�.�..,.._.�,_..._..�,..,,..:,�.�,.,�...��._....,,�.•�.�.. .,.+��._.._.,.:.p._ � I or e v. Y �J I , I ; o o C'e� I a < F 4q p r , i 1 k I i ' The Commonwealth of Massachusetts Department of Industrial Accidents _P ; Olflca ollarestlgatloos _ — 600 Washington Street Boston,Mass 02111 Workers'% Compensation Insurance Affidavit name: location. �a D city /4`N n!/.j 14-6 6 phonef ❑ I am a ho cr performing all worts myself ❑ I am a sole vroprictor and have no one working in any tacity or 1 workin on this 'ob. tmsatloa f workers g J 1 �employees an c�P Ism � m amwname.: ::.::....::.:..::<:::»::>:::::»::>::>::»:::»;;:;::;::«::;::.:< ..bane t) I am a sole proprietor,general contractor, homeownle one)and have hired the contractors listed below who have the following workers' compensationpolices: cum se ream ........... ....:t{.}:. . •.....................::r:...............................................,................r.,..:..:..t :...:......... .......... ............................ ............................... ...:........:.......,........... ,•:.�.�:::::::•:::::::::-:::,.:....:.,}..,:.w..,-::.,•.,....mot.;:.:;,:,.,•::;:.-:::: ... ..... .......... ......... ....vvv.....................:. ..... ........ ...... ...............r.w::{;....v:::.r ..... ..................,.....,..... .r�.......{.n...r................. ........ ................... ...........................,. ...r....�:.... w:3}.}}}}:Sh... .r.Y...............r .. rr}}}}}:nw::::•.:w:.v::w: t •. {ti} ........:..::.:,. .. .. .::.........,..::::..:.:...:....::........}:>}:;•}:}:•;:•}}:::::•:.::::•.::::,•::::•::............................-...... bear ....................................:::ry.-i:4:3}}}�{{fi:;•: ......................::::::.: fi::.::i:.•:•:..}:?i�i:}:.v::::.;:w{?4iiY::Cy::tni�i;::::_:.}i}i:•}ii}:;�i>:6i: .... t{;a:•}:t•}::r:{{SY}:Y}}}::t•}}}}::::,:,••,-:��::::t•;}}}}:.;•:::::::::::::::••:::::•::.:::::••:•-::•:}:::.::.:•:•:::::::::..... ...... �.::•.:..::.:.:::::3;;:•:.>:•r:;r:;;�:.�,.;•.::;:::�r::}r:�:::ri::;-2.:;•:•: ,............ ........... o 1 Falbue to scans coverage as required under Section 25A of MGL 152 an lead to the hnposftiaa of criminal penalties of a 6ne rep to 51,500.00 and/or am yam,imprisonment as well as dvil pities in the form of a STOP WORK ORDER and a line of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the OIDee of Investigations of the DU for coverage verinatilm I do hereby certify under the pairs and penalties of pedury that tlu information provided above is true and coned slgaatore x' Date i �E ���� Print name GAY�'L /I- L D D C 14-6 D 06 o Phone# 7 7 / — 7�� Fdtyortown: .oniy do not write in this area to be completed by city or town oiMdai permit!lleerue# - :C]Other__--- ontactpartmentoardf inmtediate response is required Of toartmadrson• phone#; Qeraed 9195 PJA) • 1 J / % • - • /�• 1 r 1lit1W11 • II 1 • •M ■ •1 • •• ••1 • • 1 - • I • / • • • /1• 1 ' • • • 1 • :1• X • • 1 • 11 11 � • 1 • 1 • 1 • 1 - - �1: - • wnY, • �, • 1 - -• :111 • • • •" . • 1 11 • /1 • •1 A / • • • •/ • • 1�•1 - J: i111• i1l n• • 1/ • i111 • • �:♦. • • / - • • •�1 • / • 1 • 1 • 1 1 • 1 • 11 • 1 1 1 • 111�1/1 1 / 1 • ... •�.. 1 .11• • 1/ - • .. 11 • 1 - I • 1• 1• • 1• 1�/ 1 • :dnl• • •A •11 • •• 11 I I lif000 b.be •11 • • •II • - • • •, •II 1 / • • • • • • • 1 1 y • n• • faii1l. • • be gv40:611 do - • 1 1*1 • 1 :1/119 • 1 • :1 • •II • Y.1 :� It .1 1 1 / 1 ' 1 ( 1 1 1 / 1 : 1 1 - • 1 1 1 I 11 1 1 1 1 1 1 1 1 1 • M"NIP11 1 1 1 1 1 1 1 : 1 1 1 1 1 11 1I P.1 101 1 / 1 1 1 / 1/ 11 •11 1�11//:1 1 " •I11111 •11 • �': / 1 •) 1 • IA •• 1• •1 Y •1! 1 :1t1 �1 111 • ,11 V•I11• - • 1 • • /1 1 • . 1 • • •• 1.1■ • Y. • •:♦1 • V•Illn 1 V' /1 11 1/Lie1 v1/IM' �• 11 wl/�111•. • II / • �1 1 •will • �•. N11 �• • 1 •111• •II ��jjjj/���j/----- i I 11 1/ •11. �/ •1111.111 w.n •11 i1 1 1 •Inn 1 • 1 .,G11 • 11 •• 11 .1 .1• • • • Y1/1 .1■ •11 ,1/1 111 1 11 • •11111 .11 r .111� 1 n �., ,11 • • r •11 /IIIn •�/ •II ' 11 ti •II •%1 - • 1/ 1 1 I i1 • A 1/ • 1 •1111111�• /• II , 1 111♦•'11 11 1 •11 • V« 1..•IA •1 V•1111111/ .1• •11 • 1 11 .11 V' • :i 1 1 1 1 �1 1 / 1 /1 •I 1 1 iI / ' 1 1 • 1 • t UIII-• 1• tl «1 v' • • •• 1 1 .1 /1 .n • KU •I/ • II I♦•II1111 U :1t 1�111 • _. / 1�• 1 1 11 It . 11/�11 •1 1 111 .. « .�111. 11 . 1 . • 1 1 1 .11 • 1 :.� . .I/ fY. 1 u • 1 �• 111 �1 1• • I Y. 11 "•n. -1 •V•I1111-11 V:11 •11 • • • r .'% I 11 - 1 • •11-•11 .1 f11 111111 /-1 a,1,11�• • • ' �: • 11 11 .1 11 II • 1 •1111• /- .11 1 1 t11/�• �.J 1 / ' • tll M11 1 . • •�• • •1 11 ••• •111 • •• • • 1 •1 •• • III • 11 1/ 11 - :.tl 11 11 • 1 r / 'Y•1• •11 1 1• •IIIY. •• •Y. • 11 • 11 ,11 • W.111 1 r 1• III ITT1 •a•1111 tit 1III$1 •-1 ' 1 1 Jwt•It/1►• 1/ 1 1 •11 �♦11 • ♦ 11 •1 11 � 1 1 - •.;:..1 11 kit 1 , II • 1 w • •Y•1• •11 • 1 • 11 ,11 • 11 • • .t/ V- • • ••• .II •II 1 • ! • • • 1 •11 1 w ••1 1 1 •,1, • 1 •11 bill Y• 11 11/ •N 1 1 11 11 1 1 I 0 11 74A 1 I I 11 1 1 1 it 11 I . 1 111 1 ' III II ' I11 ESTIMA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= `t (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet Xy$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHERS�� "l��'� °"� a L13 square feet X$2sq. foot= v o -# / Y, Total Estimated Project Value s MCURi Table JS31b(amd nmQ • prneriptire PaekaM for One and Two-Facody RnWmtlN BuiMbW Saud with Faaarl Fueh MAXIMUM MINIMUM caing Well Flo Bauman Slab Hked* fiat �) U val uue or lt value) R valum' R-vaiu2 Wag Farimew �a R.vabd &value 5701 to 6500 HeatioR Degree Daw Q 12% 0.40 31 13 1 19 1 10 6 Normal R 12% 032 30 19 19 10 6 Normal S IZ•A 0.30 31 13 19 10 6 13 AFUE T 15% 036 31 13 23 WA WA Normal U 13% 046 31 19 19 10 6 Normal V 1S•A 0.44 31 13 2S WA WA 13 AFUE W 13% 0.32 30 19 19 10 6 83 AFUE X 18% 032 31 13 23 WA WA Normal Y 12% 0.42 31 19 2S WA WA Normal Z 11•/. 0.42 31 13 19 10 6 90 AFUE AA Im 0.50 30 19 19 10 6 90AFUE 1. ADDRESS OF PROPERTY: 4 '�r7 �� °�/j✓ ��-- 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:. 3. SQUARE FOOTAGE OF ALL GLAZING: 3 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms080303a 780 CMR Append ix : Footnotes to Table 35.2.1b: ' 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 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions, but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. "' `"" •If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available,'include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- ' value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). Al iaF�T� The Town of Barnstable 9q, " : Regulatory Services Thomas F. Geiler, Director 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: ��'� ���✓��s �'�% Estimated Cost - 9 Address of Work: 14 Owner's Name: �� 14-L,0 U 14-,Oe 0 o s a Date of Application: //kz o/ 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. J , ti� oi R Date Owner's Name q:forms:Affidav The, Town of Barnstable _. • t3r►snrsrre UZ • 10� Regulatory Services Eo►��' Building Division 367 Main Stint,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print DATE:- JOB LOCATION: 1 Sy c D1_Al 14"fW� number street village rJ"HOMEOWNER": �T/ �4 LiJo �/��1�Osc 7 Ze f -f ( S 7 7 — 7 Y4,�— name home phone# work phone# CURRENT MAILING ADDRESS: >�r L Tip •S ciryftown 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 parce sand 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 state that: "Any homeowner performing work for which a building perntit 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,Rule&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/certifmcation for use in your community. Q:FOAMS:EXEMPTN • 1 r A� , r� ..._ +� n t o yY'k3 ,f. � #' ^ T ., .w.. r'wwr'.Mrtw•r.ww+Y•+•r.r��wYr��.w ` ... 'V R, Co y o 6 IN a�v 'A � c 14 �. u . S. Ise r Al o t 4 tmo 3 it s , S i r A oo � �. ........... (y field ... S a► v' St: .......... Ali y �1► � , v �. VA z • ;.:ate` ``�y;t {4 + �::. w c `.�'!r � � IS. ,y/•' v `�, � � , t ` r1j� � �j •, K f , to 14 .ylY Y e`` r, �,. ;> L3 .. � r ,�,., m ..__,.....�..�-....,_.�--- � .............�.�..,..,.�W��,�.,��m �`�� � . �? �`� �. � �q .� h ` ` ' � �� �� T� j; � � �� � . i !� � �� � __, �.,. .. 3 .,.., ,.,_ . .. . .. __._ .._�,_ - - _._r._,._�. _. 1 .. _.. '+� � _ � �� � � � � -�r,. ��, � � x F� �:: � ,. T � � N � �, � G m� �x � i � N . , � t � -` � �;o '� � i n '� (� p 1P � i P 'eC. f, �yq' � � ^err r J � .... .......... �.�..... ..vr..�..r....�... J ' � � r -; ` �. ._�� � 94G � (� N . 1 UzAi t. ;mod #a Ai kk �h j I bock ,� 3 n � 13t !•- r Al Al ti }� •� ,�i'1 �`4. g, r� � � S � � 1,dye � ! j 7 b � TEA �Y. Sol o Al ; $ G Gr T� N f t � rvmc*& GX e A p:L � i r...a..v♦._.. .».+...u.0 u.n..auv.u:vu.uev.a � ..r..l...•.u.u.m .urwv�.uxu»u,u _ __ ___ —____ 1 . � 1• 'o�TMr TOWN. OF BARNSTABLE Permit No.._--__-?15 3 91 »n..ti Building Inspector - Cash ` OCCUPANCY PERMIT '1, /Q Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged' use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to J• A. Ba.s t, Address Lot f3, .1.6 Garden Lane, Hyannis -7 Wiring Inspector -,,,r' �,rA - Inspection date Plumbing IYLspegtbr 1 Inspection date - .�y.., Gras Inspector / :Ux f,46� K i Inspection date y�. fix" Engineering Department , ` _� �, , Inspection date,/ 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. 1 `r Building Inspector (r Lessor's ma and lot number �� 1 ems,. p ........................................... , Q�oF toy 1'tewage Permit number .... •..-. �............................ gs ® .g+ �+ �yg f S I�TIC S°Yy-4�" Ded1 aas dYDLB, i ` House number _ INSTALLED CO � -1' 9r•00 WITH TITLE 5 TOWN OF B:A R N S rf VU NTAL CODE ANO GUL ATION.Ij BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ........ .... ........d................................................................................................ TYPE OF CONSTRUCTION ............. ...... ................................................... ................. ................19... , TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a perrmitaaacccordi`n o the followi1n information: Location . r �:Y�"':1... ..S!. ..� �a.. . .1... �� ........... ..... .. �. . ProposedUse .................... 1 I ....................................................................................................... .................. Zoning District ................ . . ... ................ .................Fire District Name of Owner ....... ,....lit. ... ... Address '�.�.... ?1. t�P... .V.P... U . Nameof Builder ............1� ...................................Address .................................................................................... Name of Architect ........\1 '�},/'✓ble�..................................Address .................................................................................... Number of Rooms ............. ................................................Foundation .......... ........ ..... � � QExterior Yl pRoofing �)�,� Q lN. .................................Interior ............b.Floors t/x•vc.U• .. ..... . �. Heat ' . ...... �.Cst. .. Plumbing .. qtlm"71 GP7 ...........................Approximate Cost �.(..V...KV Fireplace ........ 'f!.1`f✓4 h(}........ Apjp Definitive Plan Approved by Planning Board _____________ _rCi---19___ /• Area ...... ��....�.\ ...�..... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH0�� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . Name ............... .. 3ASSETT, J. A. A X_ f . x >r Nof Z`'5 13 Permit fo One S cory ` Single Family..Dwelling............... ..... ........ Lot #'.•3 16 Gardeii L ; t _ Jr Location ....................................................� �,�..... -, \' �t ............... ivannis .......... .% Owner ..Ji....:�t...Bas.set:t......................... .. ��_ ✓� � ��' .� Type of Construcan ...'rame.......................... C, T •r _Plot .. .................... .. Lot ............................... ► � , Permit Granted ,September '30 , !19 I f f Date o Inspection Q:.;Z7—sf. 1�9 �` � P � .. Dates Completed ./ Z^:.......:,19 PERMIT REFUSED .' _ ................................................:............... 19 ............. ........:.................:..... ......................%...... .................................................. ly l t, • r ` roved::...`........................................... 19 PP I ' f ............................................................................... _ ' ` . . � TOWN OF BARNSTABLE ` BUILDING INSPECTOR ' �� NNNN-�� N ���� N �����=��N° 0NN �� �� �� � ���� � �� �� � �� ��� ���� � �� �� APPLICATION FOR PERMIT TO -. -------.----.----.--.---------~.. TYPE OF CONSTRUCTION ---.... 9A.14./9,=^-------------..--------.-------... �� .....' l .... -._- ���nn- .�--- , /^ TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for a permit according a the following information: V7 Name of Ovyner .........)�...... 1,.......................Address ......9.0............ - Name of Builder ........... ---..--.--..'--A66rexu ------.--.-..-----..---.--.-.--. ' Noma of Architect --- -----------A66nss -------.----.---.-.--.-..-----__ Number of Rooms .............�% Foundation l' \�-N,R .�� ........................................Roofing .............QzIn.l."Al. ~ / Floors ��]�6�|-----------..|nterior --- __ ................ Heating -. ��-. ..Plumbing ........ _. ......... _____ Fireplace ....... ............................Approximate Cost ....... � Definitive Plan Planning onn|ng lV-~��' Area -------------- ' �/ Diagram of Lot and Building with Dimensions Fee ........................................... SUBJECT TO APPROVAL OF BOARD Of HEALTH ' , - ^ .`. ` . �l o\ ~/ - ` � 7 . | / / ~ ` - ' | hereby' ` nee to conform to all thdoRules and Regulotiono of the Town of Barnstable regarding the above � construction. Name .~..._...��,��.//r . -`--.,-.~ " / � BASSETT, J. A. ' 23518 One Story No ................. Permit for ................. ................. _�Sg�e .io �IpanxiIy Dwelling _ _____. Bvaozzio -----..^-------.--------. ............ J. A. Bassett Owner ................. ________________ Type of Construction ....F.raoue......................... ` ..........................................'''...................'.............. ' � Plot ..- Lot - ' ;'-------- ----------' Permit Granted --Se �teob r 30[.]g8l — —..�---' - � Date of Inspection ....................................lV � Dote Completed ------------..l9 � / - ` . . . . ^ PERMIT 11iFUSED � ` .................................. lg � ' . ' - ------'' -------------^--' ' � � --------7-------'----------' ^- — ----' ' ---^^—'----- «�~« .----f/A�-------r—'' v . � .Approved rove ----------------. lg \----------------~..---------. ' ............... ............................................................... � _ ~ �