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HomeMy WebLinkAbout0060 LINCOLN ROAD �� �� ----- - - - - -----��n� _ - - -- ---- - � � � -- - , , �,. a � i Town of Barnstable 9-c XlBuilding Post This CardgSoThat rtd�s.Uisible From-the Street Approvetl Plans Must,be Retamedon JoVb a'n:d#his,Card Mustnbe Kept x � A 'osted,Untl&Ftnal�lns ection Has Beena a >,� �' 5 • lb.=� ..+�..- eY'n11t � � P ear ° Where a�gCertificate of Occupancy Required,sucFiBuildmg shall Nob�Occ�ed ntil a Fina!Inspection had been made 'ga Permit NO. B-20-596 Applicant Name: William Callahan Approvals Date Issued: 02/26/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 08/26/2020 Foundation: Location: 60 LINCOLN ROAD,HYANNIS Map/Lot: 269-009 Zoning District: RB Sheathing: Owner on Record: KELLEY, KATHLEEN Contractor Name .EFFICIENT BUILDINGS iLC Framing: 1 � T g 3' Contractor License 169944 Address: 60 LINCOLN ROAD 2 HYANNIS, MA 02601 Est Project Cost: $4,500.00 Chimney: :. y: Description: Attic Insulation Permit Fee: $85.00 Insulation: Project Review Req: FeE Paid" $85.00 Date 2/26/2020 Final: Plumbing/Gas - r Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed'.by this permit is commenced within six months aftgr,issuance. All work authorized by this permit shall conform to the approved application andithe;approved construction documents for whic:Kthis permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be incompliance with the local zoning by lawsand codes. This permit shall be displayed in a location clearly visible from access streeto`F oad and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the B ndFir�e Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work £ X Service: 1.Foundation or Footing 2.Sheathing Inspection �` A a Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable Permit: o ,0/ 5-0 7V21 Regulatory Services Date: /f/a-1 S �T"E rq Richard V. Scali,Interim Director Fee: 35' Building Division ILUMSTABI ' Tom Perry, Building Commissioner MASS. 1639• `0� 200 Main Street, Hyannis,MA 02601 QED MA't A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: Kathleen Kelley Phone: 774-487-4195 Install at: 60 Lincoln Rd Village: Hyannis Map/Parcel: Date: 10/30/2015 Stove A. New/Used B. Type: Radiant/C1rCUlating Report:135-S-32-2,,ASTM E1509-12 • C. Manufacturer: Harman .Lab.No. ul c s6v-oow D. Model No.: Absolute 43 Chimney I_ A. New/Existing (If existing,please note date of last cleaning _ B. Flue Size 3" C. Are other appliances attached to Flue? none D. Pre-fab Type and Manufacturer Duravent Pellet Vent Pro E. Masonry: Lined/Unlined Hearth A. Materials: Hearth board B. Sub Floor Construction: wood Installer Name: The Stove Center Address: 1220 Rt 28A,Cataumet MA 02534 Phone: 508-564-7663 Location of Installation: living room H.I.0 Registration# 173250 Construction Supervisor# 106001 OR check_Homeowner Installing, no license required LICENSED INSTALLERS SIGN TURE: APPLICANTS SIGN RE: �Uu- R W APPROVED BY: — ! " Please make checks payable to the Town o Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 11/4/13 i s; The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Cod Pond Supplies/The Stove Center Address: 1220 Route 28A, PO Box 700 City/State/Zip: Cataumet, MA 02534 Phone#: 508-564-7663 Are you an employer?Check the appropriate box: Type of project(required): 1.7 I am a employer with 6 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑ 10 ❑Buildin I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition ldi g addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOF repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other pellet stove install 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AmGUARD Insurance Company Policy#or Self-ins.Lic.#: R2WC619865 Expiration Date: 01/01/2016 Job Site Address: 60 Lincoln Rd City/State/Zip: Hyannis MA 02601 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u r pains and penalt' o rjury th the information provided above is true and correct. Signature: • Date: 10/30/2015 Phone#: 508-564-7663 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -;, ����u'�+�.�`�qy u � y r�c,'''£'� �t ,s" +�,�`�"� z�- y'�^�"`.. �.�a �,�.7,y� Y�.�,. ,-t s.7 ;:"-N i¢' � 7'•"�'`{:'.1;,,r-,.c`�,. -�'�r�.,�"�t-?L�y �•� f°`,- '��y '�`..i���cc?.�rt a �.:�`•t.�'s"'n� p 5 �s3�� � n�2 �.; ?x '". -=;�; .::i i _ � __lµ .,`'; :.. A y.. A DiviMdn af'Cape Cod Pon`#Supplies, Inc. K; tilt OVAI-fiftfil to � to - y._ nn by gb , Mt8 Ti1e gm� Ce f r {{Case Cod PanS'ds Suppl��s aEt a a gi n , beh,I rrr 1'a T t to> he eve `ire to i�t�on for the pra er y Z T Fs y rr l d-e &r tc t.p.e .m ts, rns ctions., and® h; r d C� e fa sing to i afare,M.-er:tcort:eci rn-stall tbn ®n y been. i . Si' 1'e r �1 .4coaRD CERTIFICATE OF LIABILITY INSURANCE DATE 1/06201/2015 /YYYY) 0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is anADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: STARKWEATHER&SHEPLEY INSURANCE CORP OF MA PHONE pAX PO Box 549 c o AIC No Providence, RI 02901 ADDRESS: INSURERS AFFORDING COVERAGE NAIC C INSURER A: INSURED INSURERB: AmGUARD Insurance Company 42390 CAPE COD POND SUPPLIES INC INSURER C: P.O. BOX 700 INSURER D: Cataumet, MA 02534 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D SU R POLICY NUMBER MNWDIYY1 Y POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 0 COMMERCIAL GENERAL LIABILITY PREMISES a occurrence $ 0 CLAIMS-MADE OCCUR MED EXP An one person) $ 0 PERSONAL&ADV INJURY $ 0 GENERAL AGGREGATE $ 0 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 0 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea BIINdE� LI D SINGLE MIT ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY Peraxident AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N B OFFICERIME BEREXCLUDED?ANY ECECUTIVE� NIA R2WC619865 01/01/2015 01/01/2016 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 'DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additiorial Remarks Schedule,N more specaIs re4uired) ` CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE StarkWeather &Shepley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 University Drive Westwood, MA 02090 AUTHORIZED REP E -------------------------------- SENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Restricted To- C5S1,-SF-Solid Fuet.Burning[3evic€ �t,,�+cFcrsrr�n Su�er,:i�.rtr S.�ccraTct. License: OSSL_10=1 ROOT IKURPW, i�arss Fills 1� � - e ' -pi ration . Failure to possess a current edition of the MassachussM Commissioner 1 011 1120 1 7 State Building Code is cause for revocation of this license. For DPS UcerSing information visit. 'Marne 'OPS Offfe am$samer affairs 8c i s before the expiratiau dam- 1f faaasl rewrn tit E IMPROVEMENT CONTRACTOR Office of Consumer At`fairs and 1Susiness Itegi3latis� `-t-fRegistration: 173250 Type: 10 Park Plaza-Suite 5170 J Private Corporation 920/2016 Boston,MA 62116 ,Expiration: CAPE COD POND SUPPLIES,INC. I THE STOVE CENTER ROBERT HANFLIG 1220 RTE 2BA CATAUMET,MA 02534 Undtrsecretary Not valid without signature � e _ ay O w a , s w � J >o « � t �. to�,µ-- �• . µ •. r o R ,4 r Mw IE 11/ _. �.�_ _ •• s ,, 60 Lincoln Rd., Hyannis 11/19/2015 1XE, The Town of Barnstable BARNSTABLE.$ Department of Health Safety and Environmental Services MASS. i63q' �0 prFObU.�A Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location Permit Number Owner Builder ' One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 4-F C- G...r Please call: 508-790-6227 for reeinspection. Inspected by Date �S s The Town of Barnstable 7 BARNSTABLE.MAS o` Department of Health Safety and Environmental Services S. � �p tayq•as Building Division RFD MA'S 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection y ws' r Location Q L v-N CCU Permit Number J? Owner �� k4 Builder vo r One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: J i f � i Please call: 508-790-6�2-27 for reeinspection. Inspected by Date Town of Barnstable Building Department ComplainVInquiry Report Date: / //C$ Rec'd by: Assessor's No.: r Complaint Name: Location �o Address: rvvp- Originator Name: Street: VaLage; 7PP_ S(aLe: Zip: 4 Telephone: D/C Complaint Description: Inquiry Description: For Office Use Only Inspector's G Action/Comments Date: 7 " /c— Inspector. Follow up Action Additional Info.Attaclied Copy Disaihudon: %Wte-Department Me 3'ellow-Inspector f QUERY PROPERTY: QUERY END (QUERY PROPERTY PENTAMATION----------------------------------------------------------- 09/14/95 PARCEL ID 269 009 GEO ID 17315 LOT/BLOCK DBA PROPERTY ADDRESS OWNER KELLEY 60 LINCOLN ROAD ROBERT F & PATR 60 LINCOLN ROAD Hyannis HYANNIS MA 02601 PHONE DISTRICT HY DEVELOPMENT STATUS C ASSESSOR'S CODE CAPACITY(NOTES) ZONING DIST/ZOC RB SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 8276.4 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 (N)EXT / (P)REVIOUS / NO(T)ES / PER(M) ITS / (V) IOLATIONS / (G)EOBASE / (E)XIT R269 009. A P P R A I S A L D A T A KEY 173154 . KELLEY, ROBERT F & PATRICIA LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 24,000 26,300 1 A-COST 50,300 B-MKT 41,000 BY 00/ BY ML 7/90 C-INCOME PCA=1011 PCS=00 SIZE= 603 JUST-VAL 50,300 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 50AC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 50AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 10] 10 LAND-TYPE 24000] 102000 LAND-MEAN -76% 50300] 75048 IMPROVED-MEAN -65% 25% ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR]LAND LFT/IMP]ADJS/SB/FEAT STR]STRUCTURE ARR]AREA-MEASUREMENTS NOR]NOTES COM]MARKET INC]INCOME PMR]PERMITS GRR]GRAPHIC FUNCTION-[ ] STRUCTURE-CARD NO-[000] DATA-[ ] XMT[?] .-R269 009. P E R M I T [PMT] ACTION[R] CARD[000] KEY 173154 00000000] PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT [ ] [ l [ ] [ l l [ l [ ] [ ] [ ] [ ] [ J [? ] c To— Oa a WH LE YOU ERE OUT M of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTSTO SEEYOU URGENT RETURNED YOUR CALL Message Operator AMPAD 23-021-200 SETS �j'� EFFICIENCY® 23-421-400 SETS CARBONLESS I (Assessor's Office(1st floor) Map Lot Permit# jConservation Office(4th floor) ri j Date Issued — 9J / Board of Health(341flo _ (8:30-9:30/1:00-2:00) �5�. Fee -d7l Engineering Dept.(34 ) House#1 42a ; Planning Dept.(1st floor/School Admin.Bldg.) it ST BE Definiti*Plaedby a Board _19 � STALLE 6A� CE OWN OF BARNSTAB VIRL E'NTAL C00E t �� { G/�"" Building Permit Application TOT Project Village Owner /7::-- P�.�- Address e Z_1j.4/ Z� itJ 1� , Telephone 720 7 Permit Request 1f'X 5K �c�, / /c Al �"T�s,t/ / r(:VC t2:1 Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost Q$ /zoo Zoning District I\ U Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths f No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name (��/LIL%y�_ Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE (PUILDING PERMIT DENIED FOR THE FO LOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. #10448 DATE ISSUED Sept 19,' 1995 r MAP/PARCEL NO. 269'.009 ' i ADDRESS 60 Lincoln Avenue VILLAGE Hyannis, MA 02601 OWNER Robert F. Kelley DATE OF INSPECTION: J FOUNDATION FRAME, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' r PLUMBING: ROUGH FINAL GAS: I OUIG, 'FINAL ' FINAL BUILDING `r _ DATE CLOSED OUT : " ';> >'�. ASSOCIATION PLAN NO. U4-21-1':Y:�4 01:`•2PN FROM YR IKEE SUROE•r TO 3625542 P.01 , FN.0 t y C.t3 ` FND. I -1 ASS LOT 1 ASS LOT - 10 NOTE. PRE—EAYSTING NONCONFORAYING. Fr S ZOiVE- "PE" This MOR'I'G_AG-E INSPECTION Plan is For FLOOD ZONE. "C" Bank Use Only ?10WN: _..�-':}!L\1;4''1L — — REGISTRY OWNER: QA_RZAR_4,_j_. ALL -� DEED REF:, —BUYER: _RGR.ET__,&-_ P_AL'?1M DATE: ' 1t — PLAN REF: 1b'0 PLgf — — —SCALE:1 _20---FT1 I IWRI; Y CERTIFY TO 111n�c'TStT_.�I;tQ�i' �"L�GE�1�'' ---- H Qy yANI�EE SURVEY —�e -- --------T--------y�®�_ ---THAT' THE BUILDING $�4�� �q���, CONSULTANT'S �1Y}I ON THIS PLAN IS LOCATED ON THE GROUND AS � � o PAUL G SHOW ' AND THAT ITS POSITION DOES NQT CONFQRM A. r' 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OP TIE MER�Ew N 01111- OF R1lT "TABZE'___-----_ _--AND THAT ?098 INDUSTRY ROAD �T 1_ LIE T'iTiIIN THE SPECIAL FLOGI� iTAZARD M 11ARSTONS HILLS, CIA. O26 +E D)I;� 9ECrSTEk�� ��, SHOT INT ON THE H.U,D. MAP DATED �; 1��?r`R,S _ ``�so S�Q TEL: 428--0055 CCmt.11 t.�--r'al1PI 250001 0005 C FAY, 420-5553 4r'\.. A _ THIS PLAN NOT MADE FROM AN INSTRUMENT 14538 BJS -E ff I i T SURVEY NOT TO BE USED FOR FENCES ETC. TOWN OF BARNSTABLE ' BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . DATE JOB LOCATION 60 - Number Street address Section of town "HOMEOWNER" Air{" C��l �'� •7 Name Some phone Work phone---- PRESENT MAILING ADDRESS Z/AJ c1__D1,(j ''• City/toft State Zip code The current exemption for "homeowners" was extended to include owner-occupie dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess A license, provided that the owner acts as supervisor DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re, side, on which there is, or is intended to be, a one to six 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 Offic: on a form acceptable to the Building Official, that he/she shall be responsil: for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes " responsibility for compliance with the S�_ Building Code -and other applicable codes, ,by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirement: and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE 2d iz i APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. HOME OWNER'S EXEMPTION ,. The code state that: "Any Home Owner performing work for which,,w,a'buriding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that. if Home Owner engages a person (s) for hire to do such work, that such Home Owr shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 01 Rules and Regulations for .licensing Construction' Supervisors, Section 2. 15) . This lack of awaren often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed personas it would with licensed Supervisor. The Home "Owner- act as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities,. m, communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On ti last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. s r ' ��v_� ■ ��I� `•~�1 ��! lid �`�`.` r ��s IX � ter✓ � �� r . . �'�,A� � n 's NO- �-�_.• �- . , r Of 1 , r 99 The Town of Barnstable Department of Health Safety and Environmental Services MAM . 1 Building Division "9.�.� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Building Permit Procedure for Residential Additions 1. Plot plan or mortgage survey required for zoning compliance. 2. Old King's Highway Historic District Commission approval required prior to construction/demolition for any properties located in the Historic District (north of the Mid Cape Highway). 3. One set of plans, reduced to 8.5"x 11" or 8.5" x 14" is required. Plans must include a cross section and a framing schedule as well as proposed insulation. 4. Approval from the following departments must be obtained: Assessors Office(1st floor Town Hall) Conservation Department(4th floor Town Hall) Health Department (3rd floor Town Hall- 8:15-9:30 a.m. & 1:00-4:45 p.m.) Engineering Department(3rd floor Town Hall) 5. If the cost of the addition exceeds 50% of the assessed value of the house the Fire Department requires a smoke detector sign-off and the Building Division requires a certified (as built) foundation plan. The Building Commissioner will make this determination. 6. Workers Compensation Insurance Affidavit form must be submitted for any workers hired. In the event the homeowner takes out the permit, subcontractors hired must supply this.. 7. Home Improvement Contractor Affidavit must be submitted. 8. Copies of the following licenses are required: Construction Supervisors License& Home Improvement Specialist's License 9. Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. 10. Fee must be paid prior to issuance of permit. Note: No wall is to be covered before wiring, plumbing and frame inspections. PERMrr Rev 2/13/95 Rm N (( rr t I Q� ,� S u w/•e_ �,u o ,.0 de7-a/ � ' lr� 37Y1 XSl% --� PV+ �4P I At AJ- 7 ��/r bo�rdlS N ' Y ( N rj 1 I CoAe o, S>£ zxy's G' +P i� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -16q Parcel eno Permit# �f(O 9/��/Health Division _ � ,�9 Date Issued l Conservation Division -e `� Fee r Tax Collector- Treasurer q>�' SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE wrm 8 Bate ' a rd­ ENVIRONMENtAL CODE AND TOWN REGULATIONS istois- reservation/Hyannis Project Street Address w© L lti co%✓ Village /�YA-.U�y 1 S � '} o_z too' , Owner 70bf Aiel l `/ Addresseey�-- Telephone Permit Request 96,fsvy Square feet: 1 st floor: existing 11�4 t proposed 7:� 2nd floor: existing � proposed Total ne Estimated Project Cost. ate• V'o Zoning District (� C3 Flood Plain Groundwater,Overlay Construction Type �� fi�o•y Lot Size '::�%2 7 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure // r Historic House: ❑Yes Mr'No On Old King's Highway: ❑Yes �o Basement Type: El Full Qr( rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O/A Basement Unfinished Area(sq.ft) �/s¢ Number of Baths: Full: existing / new N 0- Half:existing .v new A4 Number of Bedrooms: existing / new .� A Total Room Count(not including baths):existing knew 5 First Floor Room Count Heat Type and Fuel: M Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Url o Fireplaces: Existing / New Existing wood/coal stove: ❑Yes 240 Detached garage:❑3 existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:C�existing ❑new size � Shed:C�(existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes M'�o If yes,site plan review# Current Use Proposed Use // BUILDER INFORMATION -blame 5?6t_e�-L � lee Ile" s- COWN a2�Telephone Number 5-e13' 79�a 17!!y ( Address CMG 9 .1AIC-61 y License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE FOR OFFICIAL USE ONLY - PE_kMIT NO. DATE ISSUED MAP/PARCEL NO.` ADDRESS -; .y+ r+- :.... VILLAGE ,+ ' OWNER s . F • .. R "` x _. DATE OF INSPECTIG;4:.--lll FOUNDATION FRAME 1621447 f • 1 -INSULATION FIREPLACE ELECTRICAL: ROUGH" FINAL ; PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING ; DATE CLOSED OUT ASSOCIATION PLAN N0:�,3 : 0 ` a61 ® ' as FROM Yk4KEE SUR.k)EY TO .352-554c P.01 Y C B FND. 17 r � O C.B. t� FND. ASS: LOT ~ 19 1p ov srF, —11SE' _ — tiff 0, j �^14? � ; J �� , t AS'S. LOT — 10 :V01 PRE.<EAYSTING NONCONFORMING. RES. Zo E. "RB" This MORTGAGE INSPECTION Plan is For FLOOD BONE. Bank Use Only TOWN_ Y NI _ _ REGISTRY OWNER: e? RBARA ,,d_ _LLL DEED REF- 1110 344 - — —BUYER.- -ROAF�T� RAT-RIM' K LLE DATE: • �1 -- PLAN REF: 1�'OA� — _SCALE:1"— 20---FT- I- HEiREB�' CERTIFY TO r YANI{EF SU"HVEY ___THAT THE BUILDING A��ZN �� �sqS'�� C C ULTA NTH SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS o�' . PAUL yG SH016-1 AND THAT ITS POSITION DOES A(2_Z CONFQRM A. 40B (SUITE 1) TO TPG ZONING LAW SETBACK; REQUIREMENTS OF THE MERITHEW H 1 ._---_------AND THAT No. 3"0s8 4 INDUSTRY ROAM �'o Q MARSTONS T4II?�. 'CIA. 026:� LIE WITHIN THE SPECIAL FLOOD HAZARD �J 9f�+tSt���`� Q�4• r =? A S: OIfN ON THE H.U.D. MAP DATED�`�:��RS_ sio S�� FA , 42 0—555a jai �AN� w� panel 250001 0005 C FAX 20-5553 �._.r__ THIS PLAN .NOT MADE FROM AN. INSTRUMENT 14538 BJS }„(;` A. blER:ori�`1 ,-� _ SURVEY NOT TO BE USED FOR ENCES• ETC. t / V� w 6 k Few, R16.14T Cleva'1/O� I 1 INSutAT�� 5 Z!/ c j abp 3 I 2h4l,S�i Toll I COX - ; 1'- 1 CD Serf/0 V�e fro A,)T i 1 i ' ' I 1 1 ( i } � i i I • 'f���l/ //Q�cJo' � ( !I! ! i j i j/= I `_f�,• ��a11, A",to 6kl�fnl w ��S I , I -I�G1 �• !! 1 Z Pt wood: 51r)IQ rpcl eeAr r1 i r 6 1 Ord , ! artj Z flfaNr ��lew s �� T INSucAT/ a i i b �pI LS` Ch '1� IOy1'L So,st rot oc 1 vj l S Y.�•1�5� I , ,',fr ' i i _ �._L_.'.eG--- ��c•�197 NdfN •(YC�V f A--Ir, Lei L I J ,�' I��� Ccv/.,G•i.� '^lU cfavb(�. y ! j S-ecf�o.J V , rcIT � � � I � � X /ia`� ���-�j°c�.s ` _l '.�I-�tgri/iQ'v � �o; ,/ � � i • i / i'✓ I YI7 i � � � l�6// J�Q;I! cico u?,n.-I�9 / � � i ' I � � + � ��y�,/S �irl� Q a�n�� i , Z L C i°�1 51�Q Yowl i 1 �reva�/off ' i ' Tr oa/ • ! 1 i i ! If ; J•f°O� • i i i bra ph�^'�1 I I , -3 �° N�f� ! � � i � I j y'I xc)'v J014'r I'✓OL !! i Cr- VIVO Na JL X eoA F>G �¢IN,7- i f �� D ZX 1t f A)r feji L S-2IT G//o� V�e 1 i ell f i7z4o I j 114 ` I Karel -r o oy i n+i y wo cA 5 ! rocl od i _— --------- _�I y vi,ov ,hw�le G- ff �. I j Z�2'rXQrr��ol� I V,- ! Rr6/aT 'tlPVC*'I/O.J INSuLA7� 601 1 7 r I i En,�_ I,, N ro 1,„xsI f r / zX lf" c c No '1 �x 1'G�bY� rnI r l � IT 777 ff 11 I I i i I i S'.e G�/O� 1/�e • t I I i 1 ! � i I � i i � i j � I I I i j 1 1,¢olo�D/ D,fj Iold�7 ' F/r� i c, , t IIILaV� �1"E l ,. o Deparme _ 3. ITie1ty and Environmental .w,} Building Division 367 Main Street,Hyannis MA 02601 MASS 059• ► Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: /' number street village W "HOMEONER":`rr-- , b. ��— name home phone# work phone# CURRENT MAILING ADDRESS: Iq 5-- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. . (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN e °F"E The Town of Barnstable BMNSTABIZMAM • 16 9. � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the-"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:6p!'X 7 WL4, Estimated Cost t1000, c-d Address of Work: O -Zi y cd A � AA o'2Loo/ Owner's Name: Date of Application: 49 �- I hereby certify that: Registration is not required for the following reason(s): rl i Work excluded by law Job Under$1,000 Building not owner-occupied �6"er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. — i Date Owner's Name q:forms:Affidav 780 CMR Appeoda • Table J&LIb(continued) Prescriptive Packages for One and Two-Fanuiy ResidentW Bukldlags Heated with Food Fuck MAXIMUM MINIMUM (}hang Glazing Ceiling Wall Floor Basement Slab Heating/Cooling U-value= lt-value' R-value' R value° Wall Perimeter Equipment Efficiency' Page R value° R value' 5701 to 6500 Hating Degree Days Q 12% 0.40 38 13 19 l0 6 Nomud R 12% 0.52 30 19 19 10 6 Nomal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 036 38 13 25 WA WA Nomtai U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A WA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 19% 0.32 38 13 25 WA N/A Normal Y 18% 0.42 38 19 25 WA WA Nomml Z 18% 0.42 38 13 19 1 10 6 90 AFUE AA 180% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: ?• 9 4. %GLAZING AREA(#3 DIVIDED BY#2): 05 7 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table J5.2.1b: ` 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 ft2 of decorative glass may be excluded from a building design with 300 ft2 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. 3 The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for 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. s 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. 7 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.la 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 J 1.5.3b. 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). f ceiling,wall floor,basement wall slab-edge,or crawls ace wall component includes two or more areas with c)I ace g, g , p P different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 4 The Commonwealth of Massachusetts - =- Department of Industrial Accidents -= -_- Office ofliirestloadems -_ r 600 Washington Street • --• G Boston,Mass. 02111 Workers' Cora ensation Insurance Affidavit name: o b-e r-�— I location: z,0 --)—/.c/"/.v ci ,4"f,, er 0 z be hone# ,VO V 7,P0 1,7 ee I am a hom weer po erforming allo wo ork mo yself. ty . '�i//❑////////////%��%%% %%%%%/%/%%%%%%/%��%%%��%%%%%%/% /%%//////%///O%%%%%/%%/%%%%%%//%%%%%%%%////%%%%%%//G%%%%%%//////%%%%////%%%/�%%// ❑ I am an employer providing workers' compensation for my employees working,on this job.:: :: :::::: :.:::::::.::::::::::. :::::::: ' 2 s `` �ii ..... -.... ><� ? ' '`' t i j""2 as sj2 >'s `2"`[ < 2 < > [j j>? c[ as j?%[ < ' ,.....i 2 % omaanv n m ������q#:::-::•:y:;:':* .:::*: :.:::::::: ::::{:::i'::::.... ::::::::i:::::::: �:::j::::::::::::i:._::�::::::�:�:�:�::��:'::::::;�:<:::i:J:<:$::'::':: �::::::�:%:: :::: vi:.::v::yiv:;:;:i:{:::`:::::::::::? ;:;i::i::vj.::�:+i:: i::::<::::::::iii?:.':::::?i.:i'ii :}:(ij::!i:iii v':`::i'i:i::.:...... : ra: e' `-bon # ': > >> ::::::<z > ><`<'<>`> ><�?<' < <<��<>><< <>>»» >�>: :•: :.::::::::::..::::.....:::::.:::.::::.:::.::... insurance co,... ... .. .. . ...:.. :>::::>:;:::»::< ?»>::::;:<: :;;;:::;:;<:;;... ❑ I am a sole proprietor, general contractor,or homeowne (circle one)and have hired the contractors listed below,who have thefollowing winker....compensation polices:..:::::::.::.::.:.::.:::::.:.:::::::::.:::::::::::.::::::::::::::::::.:::.:::.::::::::::::::::::::::::::::::::::::.::.._:::::::.:::.:::::::::.:::::.:.::;.;. >::>: tbmoanv name. ::>::1:.:;:-;::::..::.;;:.;::<::;::; ::>:: adze ..J....:C.' ::::::::::::: :::. .::::::::::::.�.�:::...:�:�;i::4i:i::is;:;::i;;::.--:...........:..:...........:..............:...:...:..................................:n....•:....::.:.....:...........:..:......;.,.......;..:..:::.......:...... .............................................. ..............:—.....::::...................................................................................... :::::::::::::::::.:.;'::::::::::::..i':::::::.....:..•.:................-.;.......................-•.�:::............;;.:.., ....:�::::::::::::n�::•.:w.�:::::...-..........::::::::-::v:::x:::.�:: :..:;:::::•.:::;::::::::::::::::.�.$ ...................................................:................ v...::. ...................................................... ............................................................. .................................. .... 4 ..:.t•:.„ ......: ............................................................ .. ...................................................t:•:::::......::.::::.:::::: .................y........................ :ii�'j'''::' .::2:: :.S..i;<`;:::::i ::i ::':. 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Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crhntmd penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verlflcatlon I do hereby certify under the pains and penalties of perjury that the information provided above is fte and correct • Date 9- /vim- eq Signature Print name �ogEw-7" F kSe-L�11 Phone#.SaS� 7`?© 17-1{9' official use only do not write in this area to be completed by city or town official city or town* permitdicense# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _ ❑Health Depardncnt contact person: phone#; ❑Other Owned 9195 PJA) Information and Instructions ' r Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retuned 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 Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided"a space at the bottom of flue 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 permitilicense number which will be used as a reference number. The affidavits may be wi nne`d fe the Department by"mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address,telephone and fax member. The Commonwealth Of Massachusetts Department of Industrial Accidents oftics of Iwasugadens 600 Washington street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 TOWN OF BARN STABLIa t BUILDING PERMIT- - r PARCEL ID 269 .009 GEOBASE ID 17015 r' ADDRESS . 60 LINCOLN ROAD PHONE ' Hyanxa s ZIP T � LO'T BLOCK LOT CI ZE , DBA t DEVELOPMENT DISTRICT HY � PERMIT 10448 DESCRIPTION 4 X 8 ADDITION TO FRONT ROOM I -PERMIT TYPE BADDI TITLE BUILDING PERMIT ADepuldnient of Health, Safety CONTRACTORS: PROPERTY, -OWNER and Environmental Services II ARCHITECTS TOTAL FEES; $50.00 Ox� BOND $.00 CONSTRUCTION :COSTS $i,200.00 11 4.14 ? RES I D AI D/ALT f CONV 1 PRIVATE P `,.E wt �STABLE, MAIM- �► r t n6gq. �0 OWNER KELLEY, ROBERT F & PATR ADDRESS . 60 LINCOLN ROAD � � I HXANNSfi MA BUILD" , V SLN j4 DATE ISSUED 09/19/1995 EXPIRATION DATE 'BY i t THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION-RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANIELECTRICAL,LNSTALPLUMBING TIO . AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 I 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 508-790-6227 I ' � I I C I rn - ao r _ v � _ _ z AND RAYS SHO 1s1V ARE THOSE OF PUBLIC .. , . °� LOT 1��' _ 0.22' OR WA YS ALREADY ESTABLISHED AND THAT �' r �Drsx) �oR le D ION OF Eh7STING OWNERSHIP OR FO� NE . R. T p C.9 p p6 _N7715 'L016g'33� ';^' S/ rAT �-2 p7p✓ 55 jY 95.14= S s83 otD LOT —0 37,2 5�, PA UL A. ME'RITHEW, P.L�S. DA T C � iR 55.2 1 — i 270. 79 i sa _� R 30. 7 ' I L Lor.19 I 9, 8 4 270. 7, c4 PART OF ,g 14 ' L h (4 LOT _ 0 0 0 C'i " LOT E = 270- 79, Q) o 71 61. PlAs�r LOT18 L " q 1 L Z �J LOT Li PREPAI a �— N7 40 00 _ o ° o B.,4 R-HA RZ 7 75 55 yy i '� '� QD F4 PLAN RE'F. , ►� GRAP I 9216358199 1 inc w w 0 94/9 4 w b YANKEE' S UR l-2 4 UNIT 1, 4 OB _ � f o w P. 0. 1 80. oe o o b AI ARSTOATS All A� BR TEL 428- 005� =w FORD A �E V � 180.00' � � - Qd L 5 I 4- %W, r} ` OLD LOT L I co o 70 79 I 1 I R 30. 70 h I L ( o N7715 55" P.IRT pF LOT J.9 270 7 , ti 136. 65'_. ;� R — 4. 84' CVP�r�pF LOT'g L OLD LOT LINL' , — 70 79 h o �i , — 2 e o00 � � w I? _ 6171 PLAN LOT1B 1 L J n h ° i r HJ 2— 31 �Sl� �LOT LLVE ~ q PREPAh ap ` 14Q 00' o co B-1-4 RJYA R2— N7715'S5" .� �\ o , 4 t`J PLAN REF. GRAPI �9,2 95 � � � .o o zo .o �z 92163 1 in cr 58199 ;� o w �� 941 , w ° ` , O 4 4 w b YA-ATAEE S UR I q UNIT 1, 4 OB y P. 0. 1 ao. oo' _ 5000, Al ARSTO-A'S_All tr l o ' TFL. 428— 005 5, ! I, BRAD w I FORD T S7715 S5 V I I 180.00' O _Y'�