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0357 OLD STRAWBERRY HILL ROAD
�� � �� S�i� �err - -- ��� �� _ . � - -- - - ------J `, 'I �� cm 0, TOWN OF BARNSTABLE 33)ARNSTA63 IDIL NAB& 9- 1 0 M BUILDING -INSPECTOR APPLICATION FOR PERMIT TO ..................................................................................... TYPE OF CONSTRUCTION .... . .............................................................................. ........IV....../ ...............19.2 TO THE INSPECTOR OF BUILDINGS: The- undersigned hereby applies for a permit according to the following information: Location ....................... zz Proposed Use ...... ..................................................................... o " ZoningDistrict ....... ...............................................................Fire District ................................................................. Name of Owner ao" ....::f ...Address /P /I iji 'ej i ear Nameof Builder ....................................................................Address .................................................................................... h b I'l /1 1. 1r, # , .0 # Nameof Architect ..................................................................Address ................................................................................. Number of Rooms .........10 ...............................Foundation ... ..../Oyml Exterior 4.r..............Roofing ...... .w4e, 40 -.�. ............................................ Floors ...... ...................Interior ......................... Heating ..1.41-fe6w.....Plumbing .......00Z ........................................................................... Approximatt- Cost ............................................ Fireplace ............... ................................................................ .......... Difinitive Plan Approved by Planning Board 4A __19 Diagram of Lot and Building with Dimensions /65- 00" LLJ M z<C LU ma a- cn C-) Lu 0 _J C0 C C-) C-) 2:z 0) LU < < C/) P (3 LU W I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstableftegarding the above construction. Name ....... A.. .................................. Dacey, William E. Jr. 15887- one story No ................. Permit for ...................... .... ........ single family dwelling .............................................................. ... ............ Location Old Strawberry Hill ad ................................................................ Hyannis ................... ............................................................ William E. Dacey, Jr. Owner .................................................................. frame Type of Construction .......................................... ................................................................................ #65 Plot ............................ Lot ................................ Permit Granted ......February 12.........19 73 Date of Inspection ..............19 Date Completed ..... 19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................. ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... .............. 1-1-1........................................................ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ` Map Parcel Permit# �D �V Health Division Date Issued Conservation Division Application Fee Tax Collector ermit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis co Project Street Address 5 Old �,_ ui bets 4 i��d Village 4(A a n n is n Owner Adbor __Aker-}UTSY. Address 359 old S�Mui6►mtit Telephone Permit Request ��L)i-�i 4h) "6 Square feet: 1st 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 W Two Family ❑ Multi-Family(#units) Age of Existing Structure oQ Historic House: ❑Yes o On Old King's Highway: ❑Yes Dw� Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new ' First Floor Room Count Heat Type and Fuel: 6�OFireplaces: s it ❑Electric ❑Other Central Air: ❑Yes Existing S New Existing wood/coal stove: ❑Yes Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:D existing ew size �& Ahed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / ( 26 C L ` FOR OFFICIAL USE ONLY I PERMIT NO. 1 DATE ISSUED MAP/PARCEL NO. ADDRESS + VILLAGE OWNER DATE OF INSPECTION: f FOUNDATION FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH 'FINAL PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL FINAL BUILDING �1 DATE:CLOSED OUT ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION y� a `°`Map Parcel Permit# V Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Q G Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Q� Project Street Address DidG r r Village 4A60mc, 44 - ii '' Owner v t ho r (�h.Pr kl . `may. Address ` r � �(qc r R, .H Telephone Permit Request ��� i inn) -6 �pYlh�,�OiLy1L- ` ) (,Je —�-� 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: 0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi-Family(#units) Age of Existing Structure �^} / g g ca(�� u� Historic House: ❑Yes IVO On Old King's Highway: ❑Yes O Noo Basement Type: JaFull ❑Crawl ❑Walkout ❑Other `,-Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) y�c Number of Baths: Full: existing -.n-'ew-`- Half:existing , new Number of Bedrooms: existing J I nevEr Total.Room Count-(not including baths): existing new First Floor Room Count Heat Type and Fuel:v0 Gas O Oil 0 Electric ❑Other Central Air: 0 Yes PfNVo " Fireplaces: Existing New Existing wood/coal stove: 0 Yes E o Detached garage:O existing O new size Pool: ❑existing Q newt size Barn:0 existing ❑new size Attached garage:0 existing w size , Shed:0 existing 0 new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial 0 Yes ❑No If yes,,site plan review# Current Use Proposed Use BUILDER INFORMATION - Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE I DATE 1`. 2 t. 6 L FOR OFFICIAL USE ONLY r, PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of In Accidents -- — = Office ot/oyestigstians < 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit i name: Sr. location: '357 old Ia hone# N ft—m�ahote'o er performing all work myself. ❑ I am a sole ne worlds in rrietor and have no o ca aczty G%/%%%%%/O//G%%%/G%%%%%///%/%%%//G%/%/��%%%/%%/G//%///%/G%/%%�%//�%/%%%%%%% . workers' an era 1 er rovidmg • an <.naRi .TORT ..:........:....:.:.:}>}::�•:;•}}:•;::}:}::•}:•?:.}:;•}}.:>:}::•;-}?:}•}:•:}?:;;.;;.}:;:}:.::t•::�;:•:: ... :::•.:::::::::......................::::;::;:•::;;:.:................................ ±ri'{..':ijY$5i:%.ii:i:�{;:;:}}:;ii�{::�i?;%vv'�ii:•:•i?{:iS:S>::Jii:i{�iiii:�iiii?ii:;:is�i:;{:yi::::iiii::j}S;sisLi ::�:•:}<;'i:?j:;ti}:t:•i::;i:,r.•i}}}:tt;;?:;:}•}:.i:•i:;i?:t�;:�tv:•}:•i:•y:t•}:v:::::C::.}•:.ytT,4y,:,:t•}:•}:tb:;t4?:;^:t<f;fi:�fr•}::f:CS};•}$?f}i?:;?}:;:}}}:y'f�fff:;:%%JiY t^ff:;�'rff:::„}is;:t;:;;f;:v}??}:•}i:t•?.?•: .... .:v:::. •}}}:•}??::•}::tt{{•}}::tit.i:::f•?}::•?:?:•r:?;;::::•:;�}?is{•?:..?-........•::•}:!;t;t:•}:.;.:.:•:•:::::•::::.:..:..: ....::::::.�:::::::;�i:�i}}:?}?i:}:;;i4::::v::.w;::::}i:::::::n:�::.F.i}+:i}:.?:{;::::ji{i''�.`ii}i'•'.4'L'•:::}.vv:�:•.w:::::•:: t•:. ::::::...........::::•:::........,.......:.:::.::..................::•...................:•::.................:.:...::::.�....:. :::..........................:..................::.:.................:. hone . :.:.:::••:::,:.. ............. :'' {!}+`{$fi$�:}: i:•i::•,:•:�:;j:i'r,:.'-�:`:ii:+':?n5 is}.'Ci:i`:,:}:«'•;;:;:j.•t,•::{•t.?;Y+S:rjO:•:Y:?::}:?j.''':?;: ���•tilfi�'v ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have theo ensation olices; 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4............r.........r..... ......<.. .....................................n...... :tv......P.......x:::v:i. ..:.v...::i;........v........:.•;.:..::•.::t^::�:::::::............v.... }II83tCeC4:;:5::<::::;:;::}:;:.:r.::.::, :.}}:-:;;:.::t.}«.;::.::...t:;.}.}•.:::.::.:::....::.:::..::...,...:,:,..:::,.:.:...:...:,.. r:}.•rr ::: :==`•:t::a::"i:::::;:::: :2�: <<:<``t::':;::%5.;:<::: f:`:': :: St::;::`;;%:;%:;::}r:s'•:%'.•SSR;:x;::::5:'<t::<.}'•:.t MW ............. :. ............................................................ ....... .......... ........... ...... .........:::::............... :... .. ter:.;.:::.::: Xxx ...... ......... n�nranc "613 Foam to secure coverage a+required raider Section lSA of MGL 252 can lead to the imposition of eriadnal penallin of a fine up to s1,S00.00 and/or one yam,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a 8ne of 5100.00 a day against ma I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify the pains and en es of perjury that the information provided above is true and correct Date Signature Print name �d K e f � Phone# official use only do not write in this area to be completed by city or town official city or town: peradt/license# ❑��g Department ❑Licensing Board is required ❑Selectmen's Office checkif immediate responseq ❑Health Department contact person phone#; ❑Other (trc d 05 PJfq Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. NO Applicants x ation affidavit completely,by checking the box that applies to your situation and Please fill in the workers' compens 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 _ to the city or town that the application for the permit or license is date the affidavit. The affidavit should be returned 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. I ME - City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and.fax number: ` The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Intlestlgallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 SNE ip Town of Barnstable Regulatory Services r r + BMINSMBLE, 9 Mass, Thomas F.Geiler,Director rED 39. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR I I owner of located at property 357 0ld S , hereby certify that vl l G1lte6�2Q�P�S is no longer Construction Supervisor listed on the application for the project under construction as authorized by building permit# , issued on 2000 ._ I understand that the project under construction must cease.until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. PROPERTY OWNER 16ATZ q/forms/newcontr reference R-5 780 CMR rev:080102 Ile The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXENIPTION Please Print DATE: ¥?h2.et Q-11 .266 Z JOB LOCATION: 3aJQP?,0.)1*S nu er street llageC `HOMEOWNER": U 9— 7 / ,6V 6 name I ome phone# work phone# CURRENT MAI lNG ADDRESS: ��,5 7 fo L d 5 jMW bQ f tv Aj 1 I?Q ���lvi►�I� !mil � ��a cityAdwn 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 a111l req ' ments. Si ature 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 EXENIPTION 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. °FZHET°yti Town of Barnstable Regulatory Services " BAMSPABLE, ` Thomas F.Geiler,Director 1639. a`°� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date a- 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. f� Type of Work: G(1 / {"� Estimated Cost Address of Work: Did V Lj U e �-it( 6 S Owner's Name: aKAor P D6" , !Sv, Date of Application: JJ I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date er's Name Q:fortns:homeaffidav TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �. Map;_�� Parcel Permit# Health Division Qv�- Date Issued d Conservation Division, ,I I?.�0 Z' + H: Application Fee Tax Collector Doa b Ic a— IV(— 1 .bR Permit Fee Treasurer Planning Dept. �PCAN['MUSTOB CONNECTION I ERMIT.FM O ASE Date Definitive Plan Approved by Planning Board CONsUGD1yypNP$NO$1bTrIE Historic-OKH Preservation/Hyannis SON, Project Street Address _ 2.6-2 ©/Jys''i�eR,( ?,ee Village - _ Owner e7 lide Address Telephone e7 Permit Request C'A2*a e L',9/2- Square feet: 1st floor: existing proposed I' 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 000 ' Construction Type Gc�6olj j Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentations Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Hig@py: ❑Yews LkNo Basement Type: ,�O Full ❑Crawl ❑Walkout ❑Other co Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) `~' Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new 4 Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage: ❑existing new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing new size c-Vxo1,-)-Shed:❑existing ❑new size Other: v32ee2eW.9,-V ,. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# ,Current Use Proposed Use BUILDER INFORMATION Name/ iefigeC �6Cc,7_357 Telephone Number Address //0 0 go( License# G S o„��Pi1y���P /�cL G'd&3a Home Improvement Contractor# 16,111 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,/�c7lJaeN�. Lp�i SIGNATURE DATE r Y FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED. MAP/PARCEL NO: ADDRESS r VILLAGE y - OWNER s DATE OF INSPECTION- FOUNDATION FRAME r ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL R - 1 i FINAL BUILDING DATE CLOSED OUT,-- _ -, •_- - t ASSOCIATION PLAN NO. r _ _ w r FIKE l°� Town of Barnstable Regulatory Services t ` ASS.Mass. Thomas F.Geiler,Director ` y M $ E1639. &�0 Building Division Tom Perry,Building Commissioner 200 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 1 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: Akla-4/oN of f Estimated Cost -2�,ood Address of Work: Owner's Name: //C,2-7'"V Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a pe as the agent of the owner: Da re Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav The Commonwealth of Massachusetts Department of Industrial Accidents Office offnyestigadons.. - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit IGhAe �6e,�� nears: .. location: vI P - Q ❑ •I am a homeowner performing all work myself I am a sole ro rietor and have no one workin in ca a, com ensation for my y a,{r.,•.YF}.? ?:F. :?x ??.: :F: :...{.A ,M rr ;.}: din workers }:• : {J. G;:;{ :F:r???::rf:. >'::.'>.{ ::.h•;;•:?Rzrr :.>:, F':•r::^:;;:•::. +,?•F}:%•'`.; 1 eI_ ZOvl g .�.. •::F:'ct..::},i<;F:a.�F'•:�?;•.{...:...:•r:„::n..:>:4:.:+:::}:.:.:.:.;•rsi:2•.}•..:.:•:.a:...,... :.,, ,.4..:n....:..-,. ,a:}}? >?`.:::Y.+t.:•.Fr{.}t+4+}. 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FailurA M.e to secure eovera;e as required under Section 25A of MGL 152 cahlead to the imposition of eriinizsal penalties of a Snenp to 51,500.00 and/or one y. tors'imprisonment as well as civn penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. I mtdersfsmd that a' '• . copy of this statemeatmxy be forwarded to the Office of Investigations otthe DU for coverage verification —'ereb 'certi ndea-t a pains es-o perjury-that the-information-providedabave-is i=L-- id Idoh Y „�r3, Date Signature _ .,. ,. :".,,..• •• �G$j � 7 • Pr t name 1G�lAtL�'`��t�TS • ' .. - •'Phone# '�� ram` 7 �02. . Omcial us a only do not write in this area to be completed by city or town official "permltllicense# (3Building Department dty or town: ❑Licensing Board ❑selectmen's Office ❑checkif immediate response is required OnealthDepartment , phone#; ❑Other eontactperson: r r,.vi.e219195 P7N .Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from t1le"law", an employee is:defined as every person iri the Iservice of another under any contract 'express or implied, oral or written. .of hire,'exp .- associaii&i,'corporation or other.legal entity, or,any two or more of An employer is defined as;on individual, Partnership, in a joint enterprise, and including the legal-representatives of a deceased employer, or the receiver or the foregoing engaged association or other legal entity, employing employees. However the owner:of a ... dwelling house having not more thanthree apartments and who xesides therein;-or the occupant of the dwelling house of trustee of an individual,partnership, another who employs persons to do maintenance, construction or repair work on such dwelling house or o n the groinids or building appurtenant theretd 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 c aecaIdng te of insuran box that ce as lies all affid your a maybe supply4 company names, address and phone numbers along with submitted 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"orlf yQ d,to obtain a workers' campensatioitpolicy,please caZI he Depai#ia atthe number•lii tedbelow:.' are require - :.. - City or.Towns complete and printed legibly. The Depar ment has provided a space at the bottom ofihe Please be sure that the affidavit is affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please. ` umber Rrhieh QvilLbe'used a's a reference number. Tfie~affidavits rilay li'e'r�te a. be sure i6,6 inthe.pemutTlicense ii _ the DepartmentbYai1 of FAX unless other arrangements have be6nm e. ad ;• .,.1 i:•• The Office of Investigations would like to thank you in advance for you cooperation and should you have any9,uestions, . please do not hesitate to give us'a call. r The Department's address,telephone and fax number. :.y The•Commonwealth Of Massachusetts • Department of Industrial Accidents Office 01 Investigations 600 Washington Street Boston,Ma. 02111 fax ff: (617) 727-7749 . : phone#: (617) 727-4900 eat. 406, 409 or 375 _ r RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE 00 New Buildings,Additions $50.00 O �_ Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf S 35.00 >500 sf-750 sf 50.00 �'D ° --- >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (der) Deck Fireplace/Chimney x$25.00= (number) Inground Swimming Pool .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost ` ,ry S ndarAs �gttona ' B9a %TOIL "OR I 'EN T - - t a P.O.80 '4.6 Adtmst ' CENTE A O 3. , „ _ `..✓s.."^.��..-fit...-..-�-.-.�. '� '' fte-V011,11 anuseali o�, ac�iuoeQ` BOARD OF B'U""LLDI'NG.REG,ULATI:ONS License ONSTRUCTION SUPER<VISOR ! x IJumbeaA. 053861 4 ` B'Frt�� ® 1 ^�;� �^; Tr.no: 16541 --- _ R I tb MICHAEL J ROBBR =` f PO BOX 166 ,M CE'NTERVILLE, MA Administrator_ : r r MORTGAGE INSPECTION SKETCH OF PROPERTY . � vl�>oetr (3r w,rs puny tws, InL, Appl�aank�,nauv��.tea. es~n.�y���r P�.1►�5 t�9 ��a�, book- Papa t.,C,Cert-No, LI Y&+ dw 1 - ' e 40 / vita s 1 1 .C) a' i easional opinion the buildings are approximately located an the ground as Ao eon and Conformed to the applicable horizontal dimensional yard setback r !3E , MAW nts of the 2onln�8y-Laws of t11a '�► � Cf ►„"T�.1,t _at v oI construction,The of . as shown does not ton within to Special Flood '� t�COtMMd One as dslineated on the FEMA/FIA Notional Flood Insurance Program Mop. .�f+la• ity No, Panel F AWAUM Dated Zone e..rt.-...• �'s, o ,a�� arm#is*tee�e nwooesw�vweoaw eu.and rro+ro a nbe/daa r eoti+ as an Ma+ ++b>K . 1 Ta�i'tA9ba1 Far6l Drive "M Intl d in 1ablfwMen1 W"19 OWW"0 11180 V a OW able we w1u„e�ee(910~9 let oA f" P4oWm*.AMA 02343 C11�C110R A OU�a IIOOM1 O�RMCb'.�.nea►ab ae aowev er V4 mag"OrQW6 abraae4+1� Aft Fix!(0 t 7 7675073 1b WWItilt 767-1400 bebase,v.ernrn.et ore Ml-AMuded M 1W 8e-1nb M*11W*A 11 a ~ bbe's or*"bW"Imt iMAbl r �le -�o-�rirnonwea/� o�/�aaaac�ivae%ta � Board of Building Regulations and Standards HOME I10'RQVEMENT CONTRACTOR Repls2ra tan 1119 xprra 2004 rw'= -- ilividual MICHAEL ROBERT �.- ; Michael Roberts .:.Z7/; P.O.BOX 168 CENTERVILLE,MA 02632 Administrator Client#: 17718 2CMRCO ACC&D' CERTIFICATE OF LIABILITY INSURANCE 07/30/0z°°' ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O' Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE INSURED INSURERA:Travelers Insurance Company Michael Roberts D/B/A CMR Construction INSURER B: P. 0. BOX 168 INSURER C: Centerville, MA 02632 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE MM/DD/ A GENERAL LIABILITY BINDER196457 07/30/02 07/30/03 EACH OCCURRENCE $1 OOO O00 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone fire) $300 OOO CLAIMS MADE X OCCUR MED EXP(Anyone person) $5 000 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE s2,000,000 GEN'LACGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY JRCT LOC; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AN DLL EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EAEMPLOYEE $ E.L.DISEASE-POLICYLIMI $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. Re: 357 Old Strawberry Hill Road, Centerville, MA 02632. CERTIFICATE HOLDER ADomONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTOMAILI.ODAYSWRITTEN 367 Main Street NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUTFAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO 0 B LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S(7/97)1 Of 2 ' #27179 _ © ACORD CORPORATION 1988 E IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and,the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. r ACORD25-S(7/97)2 Of ' 2 #27179 j °FIME ro Town of Barnstable P Regulatory Services * BARNSTABLE, r MASS. Thomas F.Geiler,Director �p i639' � rED Ma's A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT �S Construction Supervisor License # , hereby certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit # &Y� 0142 issued to (property address) y gl l L on , 200 / I also certify that on d o? , 200 -1-, I notified the property owner, that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. I ENSE HOLDER DATE q/forms/newcontr reference R-5 780 CMR rev:080102 coot) Cqt-ew d Ul( $9�Tl cr �C✓� 'r 4 c � 1 , � r QQ9a mod Ea 5A. f ♦ <) rrj 8;,A 4 v 4� f y✓r -':.r g " L p r" y.•vi w n x y '4'_ �'' {` + 'C'i*,°y`'r�: r.J s g " a -- . . r� 5w' t�d {'`y i rru�E, ;� a ?�" � ;+���- a a a r� a `a�s• �r-�'S`!. r-.a,t�' r�rr�� '3 tft, . rN .p 4 ,� � �.a� � :5k� �r �, :. fi xFa• � , '• �ay rs� F .a1 ; �h�r3 �r€ f b � ;.y " L r c',a ,y� •� ># t � > E{{fr{� � ��tF c'tE& .+ :+""..a.. •#, ��F' iy�p �. v. �� r '� �s� . K d' 3 x rr y '4 n" a !�Y'i �; t;:. S 4 + i° Ef F' i A- ..D EEC c `,' ,G �.ya ,a�.ay! zF � ; ;t"'irt+ :» f,�E t: ,.�rtr„Y r .s�; ;.e 1 y'3.`�-;' l 1.k•�' E. ;t' ,,fiFr , z € 'i_ ' ,X' \.,, 4 1 -k ° IA y-'3 fir''. }. ui,.'t a q5. 1 I1 k Y.i �+ 1t3 rzJ '�C tt ',, '13 `C:ry' rika. }a' �E za &, dxE,.i s3, k' a u a yvfy,ryr r >E a , x r ' t'aa In I: } ���� : t"'' h. r4 :�'d �' i' � a!i°+.aa !',tf?S„7 �i� � +'�-J` 1 . ` ..� �°E Et - � '•a � d A� '{ �rr�� i >., `E�+a j+f :ti {[� t,rY}� .�,ti*<',s P. i,�r,.3-�d ��p,.4Li�J4 "'+S,t �`' y �:-A�.� r." 'a'�4E b,Y 1 (�+�; *: , Department:o }mot;: Ix.}` s . <, Regulatory Servsc�s T.nftt7 "^gar, 'r '�TSr) {• s, +' r} ,..�.-;J t* ...i"fi V.x! �J. r rr:°{C S A"` `S ��a E r ,� r� i : % S .r�En�,• b.� F _ �F w. a +.. A'A.fi/�`3-a� q. - � .k �-f'7x` C. Sa p � s( $• 3 �� & "� i � E ��T7{a ^r f, (h �"+yEG r 9 r i C'' --r l .:3' s _ a .✓ 1'i s..z..L 34..J .7•s j 5 .,�ja C•'s i�. tf `�' '`{���..g 1.� �S,17 r'I}iC {Y� I t.:�'�y��� - � + � � a"e gf� + ��.i:'i 7 Y C!.�t�1C #r''i£ !F' �A iF :a ' 1(17 �� �Tl��'� r� d 4.� y�• Fa i '� G ,,, � .�.ii//��6�uAw_ ,,� �,r;1 4 e r • S - ' x >; r BUILDING DIVISION F � jjv 17, ��r '� ♦4 1 ry f r+ + i F t ,ty '+A ":5•� .a,'. :.y`��y {�.�.}3 r '�,.t�/ '{�-�7 r 1�\1��+ �.;yt ll�`� if f"S{" �'.wl�� �r 6 h"",^` '* .• s 'tej '1 s; a.1 �W LA' S! L1.1`!ti3A_ li.t ' t*; �1:� 34, , ,! . r 13t1�LDiG YI? RII�� Yb L e let Y 06 q,r { ` 7FaE.O. r y 1 ,6'2 7 7 a PARCEL yV q ; " RLS8 Y3g5+?ppy��}{y4pLT3�� MkAWB VAY HILL f r k'HQi�E i�tYY.J.1111..t 4 tTF N {n^i� , �l i p`� .. zip 1Y ? f S 1 P k `�' � t �f` `�� L€ � � " LOT SIZE D A ',: .. DEVELQPME T "" 'DISTRICT .HY 1 PERMIT `� s y62805- -.'DESCRIPTION ADD-�20X2.2 'SAPAGE/12Xf3 B1 EZWAY:— Yk PERMIT<, TYPE BADI7I ;� 1TTLE ' °• Bt��LDINQ PERMIT ADDITION, . . f - ` 00 TRACTORS- ROBERTS MICfIAEL �` ' Ac; xTCT ,.� , , Department of x a R �f-iogulatory Services TOTAL -FEES: $ 7._'50 -00 cON9TWCTION COM $25,000.00 434 RE-SID ADD/AL'T/CONV ] PRj,ttAtF` +► 11R11ARNSTABLE, • MAM BUILDING DIMS N. BY DA-TEw ISSUED : 08/01/2002 EXPIRATIO'k `r fE • - ' � '' Lam. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY I_T`ANY STRE ALLEY."OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICA)LY PERMITTED UNDER THE BUILDING CODE,MUST-BE-,APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC'SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS:THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM.THE'CONDITIONS OF ANY APPLICABLE SUBDIVISION.RESTRICTIONS. MIN'MUM'OF FOUR CALL INSPECTIONS REQUIRED - FOR ALL CONSTRUCTION WORK: APPROVED PLANS MOST BE RETAINED ON JOB AND THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE I I.FOUNDATIONS OR FOOTINGS •*':' PERMITS ARE REQUIRED FOR 2.PRIOR TO'COVERING STRUCTURAL MEMBERS• HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PANCY IS.REQUIRED, SUCH BUILDING SHALL N T BE ELECTRICAL,PLUMBING AND MECH- (READY TO LATH).' K Q ' ANICAL INSTALLATIONS.- 3.INSULATION. : OCCUPIED UNTIL FINAL.INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING.INSPECTI N`APPROVALS•. 'PLUMBING,INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 \ I , 2 2 lie 3 1 HEATING INSPECTION APPROVALS' ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER:*' SITE PLAN REVIEW APPROVAL ' WORK,.SHALL NOT PROCEED UNTIL PERMIT WILL"BECOME NULL AND VOID IF CON". INSPECTIONS INDICATED ON.THIS j THE INSPECTOR HAS AP,PROVE'DTHE` `STRUCTION WORK IS NOT:-STARTED WITHIN SIX#s CARD CAN BE ARRANGED FOR BY _. VARIOUS STAGES OF'TCONSTRUC MONTHS GDff�DATE THE PERM�`IS.ISSU°ED;AS TELEPWONE OR"WRIFFEN NOTIFICA s� TIQN'k, NOTED ABOVE .�`•.', .',.'` t er Aa a a 11 W14. ' 6 fk 44 r B ,Ul I PE'R, .1 T AL I- f' -k4`76 *if"'d . •F # Yi-t5r ,� 5 .. F�., i=� y �'^1' 'A .1 �" * •' 'r _. ,� ',a �.�$ Yc�. -`. : r 3 f 4+x �s .' '. +. :4 - •�`° , t •rtir t a � � f z �;;, s• :t�< r „! �w�y;. `r \ � � 7 s v rY a.. d ¢ � _:{�s a ?Y, ' �.s��n �SY,�y a,�' F ** S�'F m �y5/ �r!• L r� 5 ;�',.v t^,'?�:'.7. �,..E" ;f- ;r,�•'�1-� ,a� sR-��Y' .GT't4..-.Id L� ..-}S r A ...<�Si. _ ..... t.....��—�...w�•,';�.•l ._ �X\3•4Y•. 'P°i'� _._ ^_'rP'... .� r�� � K C4 V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �J�l Parcel HD PerU _ Health Division �" Date Issued Issued Conservation Division r �� AppiiCationn fee a 00 Tax Collector 6D �� t—"�1/ /�O� Permit Fee TreasureraDcoa — 31-0N Planning Dept. Date Definitive Plan Approved by Planning Board ''' +' sr PTA,' r Historic-OKH Preservation/Hyannis Project Street Address 351 OLD 1111-4 Ri) Village A1Y,4e1,v/1 J Owner,aR7NyIZ, 2Ac c r.>QNe-try Address _35] 01-b S'7722ut,G,G-ez/' ,146 Telephone _6-0k Permit Request ADD IV`X/11` /�.�Tl� ✓i OON 729 adekC OF Uouji5 //J P44-445� aic Gi.C_ Square feet: 1 st floor: existing proposed 176 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation aq,sD0,O0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. . Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 4 No On Old King's Highway: ❑Yes N(No Basement Type: ❑Full ❑Crawl ❑Walkout D Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name S7' )a&Z V:-&,X— Telephone Number .S'O� Address Jtllekyl� 1,4T/1 License# es e6 75791 SC yz�grei�l�is Home Improvement Contractor# /c?7g69.3 Worker's Compensation# 23c LAC 0306l� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO X7 SIGNATURE ����-- — DATE ��' /`- FOR OFFICIAL USE ONLY h PERMIT NO. DATE ISSUED N'IAP%PARCEL NO. ADDRESS{ `; - �' '. .VILLAGE OWNER _ } DATE OF INSPECTION: 1 ' FOUNDATION -T tg I-1 ,0 FRAME INSULATION l FIREPLACE ELECTRICAL: ROUGH FINAL- � PLUMBING: ROUGH FINAL i GAS: ' ROUGH FINAL r FINAL BUILDING b t ' DATE CLOSED OUT + t ASSOCIATION PLAN NO. _J A.M. FOR DATE TIME P.M. Irm c/ (" NOW PHONE � � BALL ARE CODE NUIVIBE E MSION 'i MESSAG '' x �, .�: Qr � G niversal" 48003 A.M. FOR DATE TIME P.M. M OF PHONE. allYtJIR BALL' A CO � BER EXT NS �N PLI A CAliL.j, MESSAG S>w1rt YOLf':: . S I N �rilV2rSat" 48003 NOTES = j ti r / NOTES r .: r T T 1s j�y' ��` y����(yt♦�,A��"L``+ � � ,��t .. QL' �7 A lIalet anc� ��iro e>hta" SeYces T e a BijJY �� I>�Lo } 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 APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: 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 ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLEFROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 ! 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL I 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. BEST FIT Window&Door Co.,Inc. Specializing In Customer Service" ! 8 Huntington Ave.-South Yarmouth,Ma. 02664 AL BELANGER <, www.bestfitwindow.com Ph:(508)398-9704x13 Toll Free:(888)385-3201 Fax:(508)398-9744 Email:bestfit@earthlink.net I, THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ..... , TOWN (IF r;AF2N�`Z'ABL,E BUILDIN(: PE RMTT Ayyy}��'��.C1����,[�L ID eta - , iJ1:7�U;s7 s7 ' GEOBAaJf=�, .l,.T� �I',r_."., I I COLD CTRAWSJ� RRY FFILL 1.6,E r J FiYAN,�TTS � <: P140DT ZIP i� I TUI u1'RZ Cl if i)k9 C',PI:PT 1:s:.7N AUl7 1 X 1-4 ,PATIn ?C`C3i�A a.rr' F•J.Y I ST. 1,L7 P,k,L�.EII�GTCHITECIPS 'R ,�' ; ADD DFEC K IK Department of Health, Safety TA1:, FEES; . - and 'Environmental Services 9STRUCTIOR COS 'S. $ 0o YMIF$24,600..0(' p� 1 P - VATx MAO BUILDII G,DIV 6� ' _. B The Commonwealth of Massachusetts _= Department of Industrial Accidents office offnvestioations . 600 Washington Street r` Boston,Mass. 02111 Work Censation Insurance ������������������������������������������������ name: location: city phone# - ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one workiil in ca acity I am an em Toyer roviding workers' compensation for my employees working on this job. com an :name; <> <<»> sittX. ers :::: :< ' .:::. •<:::.:/. . It ri � ..:.. ..;:::<:<;<::::::::f::;t:';': ::;::::;i::i 1711,V117117ZI1111111111111111111IIIIIIIIIIIIIIIIVIIIIIIIIIIIIA 0 WA WA VA WA Q I.am a sole proprietor eneral contractor or homeowner(circle one)and have hired the contractors listed below who have n polices:compensation �: ::..... the... ...n workers comp p.............................:...::::::::::.::::::.:::::::.:::.:::.::::::::::::::::::. ;::;:.;:<.;;:.;.;:«.:;.;;:.;:.;:.;:;.:;.;:.;:.;;:.}::.}:.;}:<.;:.;;:;.;:.;:.:.::.:::,:...,..}�.:::::.:. g.......................::::::::::::::::::::.::.....:...::.::.:::::::::::::::.:::.:::..............:...:::.:::::.:::.:::::.:::::::::::::.:::..:.:...................:..:.:.:::::::::::.:.::::::::::::.::::::::::::::::.::..::.:. an name �� � �� � � �L? :::::>.,� >.>:>::>:�:::� �x. COml1 P :.:.:...::::.. :3...... ;p L .. v:o >4' ................... j4:...'::Si'} ........:.'{{:<: '';::!ivy �:�'::i:i:::i::•'i ........'•iiii:ii::%•}iiii: .................. ;c an imam :: isiii::isv: :;ii:i,lv::},: ;:F`:<::?;<::;isisi:%^:i::'. }:2{Y::J:.::::i:ii ::<i:%«?i::: ::::iiii:.:.:{ i:<i%ii< iv:Ji:i;i:?!>iii:BJ}Y:;;^:4:}%;^i ess. ....:.:.....:..:....::':::..... :. on `C h -: >< •::. ie±iuraa. ' li Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine 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 Offlce of Investigations of the DIA for coverage verification I do hereby.certify under the pains and penalties of perjury that the information provided above is true and correct Signature ' —� '"�— Date Print named � G; if��r t��--' Phone# c��� official use only do not write in this area to be completed by city or town official city or town: pernut/license# C]Buflding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office _❑Health Department contact person: phone#; ❑Other (devised 9/95 PW r r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal . of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the' commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is _ being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law or if.you are required to obtain a workers' compensation policy,please call the Department at the number listed below:. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please.. be sure to fill in the penmitllicense number which will be used as a reference number..The affidavits maye returned;ti? the Department by mail'or FAX unless other arrangements have been made The Office of Investigations would like to thank you in advance for you cooperation and should you have any_questions. . please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: 617. 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 Table JL=b( � sd wits Ft�.aD F.0 aa prscriptfre P:eksLa fur ana d Twa~f zlay Rs""dml S� um 1► EYQ41iJM ' . W� Floor Haaemmt •� � O wi ng g . Glariag Ceilias Rrvslo� P (•/.) U-value' R-value' R vzlua' R Rww Psdcaar 5701 to 6500 Hash;Demos+17=1� 1 6 Nw=5l 9 10 Q I2, 0.40 3E 13 19 30 6 N=a l g 12Y. 032 30 19 6 95 AFUE 19 to, Norte g 12:4 . 0.50 3t 13 .Pi/A N!t T 15% 0-.1 3E 13 25 6 Normal U .15'/. 0.46 3f 19 14 10 NIA E5 AFUE 0.44 33 13 25 1VA ES AFUE ' y iS/. 10 6 W 15'/. M2 30 19 19 Normal 13 25 NIA N!A X 18% 0.32 3E NIA Norma! y 1 E'%. 0.42 3E 19 21 MA 90 AFUE 13 19 10 6 y lE•/. 0:41 32 19 I9 i0 6 40 AFLJE AA IE% OSO 30 1 ADDRESS OF PROPERTY: 0 L y y ���� - Q 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: `3 D 3. SQUARE FOOTAGE OF ALL GLAZING. o #3 DIVIDED BY#2): � 4, /a GLAZING AREA( • 5: SELECT PACKAGE(Q—AA-see chart move): NOTE: OTHER MORE INVOLVED METHODS OF DzrERNSII`I NG ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: g4orms-f980303a t 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. expresspd 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 arcs. z After January 1, 1990,. glazing U-values-must be tested and documented by the manufacturer in accordance with the Nadcnal Fenestration Rating Council (NFRC) test procedure, or taken'from Table 11.5.3a. 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 exteriai walls without compression; R 30 inuulation may be substituted for R 8 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. use Do not include Wall R-values represent the sum of the wall cavity.iantlatioa plus insulating sheathing (� d)• exterior siding, structural Aheathing, and interior drywalL For example,an R-19 requirement could be met EITHER insulation plus K-6 insulating sheathing. Nail requirements apply to by R-19 cavity insulation OR R-13-cavity wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to met1l4ame construction. The floor re,q apply uirements 1 to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside*must meet the ceiling requirements. •Tl a entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mc_t the same R-value requirement.as above-grade wails. Windows and sliding glass.doors of conditioned b r..,ements must be included with the other glazing. Basement doors must meet the door U-value requirement d-scribed in Note b. The R-value requirements are for unheated slabs,Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or S. If you plan to install more e 'ere of cooling eat, the equipment with the lowest piece of he equipment ar more`thars on pt g equipment,than one pt g e. efficiency must meet or exceed the efficiency required by the selected packag . For Heating Degree Day requirements of the closest city ortown see Table 35.2.1a. NOTES: a) Glazing areas and U-values are maximum acceptable.levels.Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include strucnural components. b) Opaque doors in the building envelope must have.a U-value no greater than 03-5.Door U-values must be tested and documented by the manufacturer is.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'(l.e.,may have a U-value greater than 0.35). c) if a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the.component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted.average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). ._ 43 I - ZHE r, Town of Barnstable Regulatory Services 9B..STABLZ�" Thomas F.Geiler,Director �A s63q• �� rEp,�,prA Building Division Tom Perry,Building Commissioner 200 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: /2,4710 E�VeZpSVyZ.C_ Estimated Cost 9 y/lsw'0 Address of Work: 3S7 .0i-b S)'°MW a -►rLAJ U14-L RZt , Owner's Name: 4127 VIL e c Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Qhrms:homeaffidav RESIDENTIAL BUILDING PERMIT FEES .' APPLICATION FEE New Buildings,Additions $50.00 AlterationvIkenovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING*SPACE 96/s .foot 1 b'00 x.0031= s feet x$ q plus from below-(if applicable) ALTERATIONSWNOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x.0031= plus ro below(if applicable) ACCESSORY STRUCTURE>120 sq.f� >120 sf-500 sf $35.00 ' >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf Same as new binding permit: square feet x$96/sq. foot= x.0031_ STAND ALONE PERMITS open Porch __x$30.00= (number) Deck , ____--x$30.00= (number) Fireplace/Chimney (number)x$25.00= ( ) Inground Swimming Pool $60.00 ; Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 . (plus above if applicable) permit Fee S�f 33 3 projcost MORTGAGE INSPECTION EK&CH 4F PROPERTY � In ��-re i/f a�r�C ►a,�+-raise i�� •t3 ouny,VA AQpiit:anY d'�1g�e. Lso�.�.�.�-•'C®���..�� t3o®tc Pago L,C.Cer4 No. X6 700 i Q Scale:.., L*reo1+ epj NW I jAe -L7Stlq• ` W a ' _ 1 ' 9 feulonal opinion the buildirgs are approximately located on the Ground as a 4to con and contormad to the applicable horiaontai dmensionai and setback • Y �r Mis of the Zonlnp By-Laws O),tha of 3ktRhfiXh lk at i K. pf Construction,The Ibt ati Shown does not fail within a$pe",Flood ��,� pAQriCtrlAtV I ' as delineated on the FFI AINA National Mood Insurance'rogram Map: it No.lrEL92L Parcel A Dated ll J ZoM 11 YI Pant DriveIglu ate,„ q� ,� �eni,yea K roQ ro M ram,ee®aaarw+wrA u u+��> wrn �n Motbrooa,MA 02343 v oe tMt d�n,APtlylRMa•uro�y w�ue1 IMfQ 01 a!uigt 46li w�wA nqf a>,�>toon�aw�tw�e�r 9111�It Pax 17 767-6873 ehe�oelaenpM1+�uwe IE6a#+tad rue\afY+ai�a alagO�IKa xr MaYraBuawttf Maven oa tong (6(!1) n shae. MMe w�+�ft p0mi''t 17 8�•1� 0%New MA*M* a eew.,w j..I�MIIN not.nnl MA11/dM � f BEST FIT B YY WINDOW & DOOR CO., INC. "Specializing in Customer Service " Phone: 508-398-9704 28 WHITES PATH—S.YARMOUTK MA-. 02664 Fax: 508-398-9744 r �.e"� .J�ie 'C�1ar�vnza-rert�ea� o�.fltcziou.J�u �t �'iFe�nnzo�aur+,ll�i o�.i��imaaclueselzs BOARD OF BUILDING REGULATIONS HOME IMPROVEMENT CONTRACTOR `L License: CONSTRUCTION SUPERVISOR f Registration: 127601 Number. CS 067991 Ez iratian. il/1212002 P $�rthdate 12l30(1951 '^ Type: Private COrpOrati9 - F pj 12l;}0/2003 Tr.no: 10253 BEST FIT WINDOWS DOOR CO Restricted: 00 ALFRED BELANGER ALFRED M BELANGER is c o 8'WHITES PATH 28 WHITES PATH ADMINISTRAMR S. YARMOUTH MA 02664 SO YARMOUTH, MA 02664 Administrator fI4?1.,v!GVQ rJ.rJ7 :Jw vQ.4L jJ IL__tJ� I I-r AC9M. CERTIFICATE OF LIABILITY IINSIJRe4NC�z�t�� H1aTE(MW1DD/1q 04/30/02 30 ONLY AND CONFMS ND RIGH79 UPON rHE CeRTIFICATE N 567 South ridg�aSt. Agy, , Inc. HOLDER.This CaKTIFICATE DOES NOT AMEND,EXTEND OR u Auburn HA 02�1 gt, ALTER THE COVERAGE AIPORDED BY THE FOLiC1E8 BELOW. Aubuaza 861 O150i , Phornm:30B-632-0404 Pax:509-832-9565 0� URERSAFFORDINGCOO�ERAGE ReD INSURERA: Guard Insstxance Group 113g =Q� 1 suR:9vs: Merch"ta and Bnsinaas Mess at i $�+ 6 Dour Ca NsuRERc: a y&=oa.tl� r�`�2664 j ilvauPl&R 17: COVERAGES Wit e, T14E I'M CIM&OF INSURANOE NOTED BELOW NAV9 SUN 4MED To TH$INSURED NAME0 AeCVE,FOR THE POLICY PikiOD INotCATED,NaTWTTHa7RF57iMQ ANY R1VA11RE1 W.T9w ORCCIloriON Of ANY CONTRACT OR OTHER DOCULIG'T WITH RflBPECT TO AHICH TW4i CERTIFICATE MAN,SE ISEUGD OR 1 MAY FlRTAW,THE INWItANCC AFFQRDED 0Y THE POLICIES 06SCRI5H:o wEREW IS SUBJECT r0 ALL THri TgRIJ5,ZXCLt)SC;N AND v�NpITIUNS 0�StJCH POUC!08 A03R6GATE LIMITS 6FPOWN Mki'KAVC 09EN gEDUCEb BY FAID;.LAIM•S tTR77 rft_cF POLICYNIUMBER A LATE Larrr8 OENERALIJABIL7Y i I i EACtI OCCURRENC I SE 500000 8 I X 0 0 Ma16RCALfii�lERALL'.49ILIT1' j 0020349593 j 06/03/01 06/03/02 FIRE OAVAGr.(Amy ono Are) ,:50000 CLAfMIS MADE L X J orccuR I r-r— �^�It� I Meii MCP(Any one Person) IS3000 1 •PERSO'JAL a is I I GE+USAAL AG6REGAT6 i ; 111000000 I GEk'L AcraAEOATE l kAlr APPLIGS PEIi; PRooUCTs-wmvl0P A06's 10000 0 0 ►Oucy i �-A�V-•r�OM01962 UAVL" T 1 I ANY AUTD � j I�tr3+dFYCMShU^aLG LIMITr7 a ALL OWNED AUTOS I` P SCHEDULED AL1TD8 i j +> tJtLYNrntUkY I S f NM AM$ NCW.OY�LNIDaUT49 ' I � (ae, c:l�n — j PRODBRTYOAMAGE t GARAOE VAWTY I j AUTO OPJLY•EA ACC106NT {S ANY AUTO I OTI�THAN enACc AUTOONLY: AOG S LSO tIA1MLJTY 6ACHaOCCLIRRENCt i i acCUR L_j CLAI MS MADE I ! }A30REGATE s I I I I t GL'DUBTIi�E I I 1 I '6 RBTiNT10N r I ; '$ i WOM=COMPINSATIONAND A �E°PLaY�'LtAelLmr nai 03o611 10/23/01 i 10/23/02 I6ir .GCWACCIUNT L .I9100000 I E.L.DISEASE•EASIUPI ISt 00m IEfDlSeAft-PO>IOY . L!MlT 2S00000 I RiPTtOMQROPERA'fWN1A.00ATIONOJy@�,LEgIBIf�„1$IONgApDSDB t�DOR86i1EtiTlSP@C1A6PROVISION CERTIIFICATE HOLDER N 'ADDITIONAL INSURW;!NSURER LETTER: CANCELLATION ,1'CIPATOI:B ONOVLDA%Y Of T vE DEY /OU010 09 CA14CELLBp IWORE TNI OUVArDN OATH TY"", E NO IR VIHILL BND0AV0R.70 MAIL .Z *Ay$WWTTR% T*vn o t Hama table NOTICE To TH ICA 01%R NAalED TO THE LET,OUT RAJUJM TO DO SO MOU 200 Main Street impose N00 oN TY OP ANY#Owo rra Af lir9OR Eyassasi s NA 02601 I H k"MmBENTA va AUrHO I B- t r b4 4COR0 Z0.6 0197) DACORD CORPORATION 1988 IMPORTANT if the 0e11l 2to holder is an ADDI'•IONAL INSURED.mb poliey(tes)met be endorsed.A st umen+. on d%cert3floate does not Confer rights to the certificate hoiclw in lieu of such endorsement(@), If 3U8R+OGATION 16 WAIVED,subject to the farms and oondltiona of the policy,certain palsied may require an andorsoment A ststement on wa cervcgta coos not confer rights to the certificate hoider in Neu of su&endoraemom(s). DISCLAIMER The Cerftwe of Inevrence on the reverse side of mis form dose not consttute a contraoi between tha Isauing 1nsurer(s), or producer,and tote aetvtloste hoidar,nor doge it aMmrstively or nswilvely amend,dutend or slier the coverage afforded ty the policies listed thereon. 4COR0 Z4$(7f97) nivcrnurM-nyrn ORWWMI.S NR�O00h " vawvs a us a ?Stater uildingCo Q. �npen m.. _ echo 1)' .� -;`- -- The Massachusetts State Building Code(�80 CAM) includes pr ovisi ons to ensure that houses and house additions meet energy efficiency standards. This supplemental L CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall,seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR, Appendix J, Section J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size,configuration,orientation,foam of construction or percent glazing,but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/mstallation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a"sunroom".It is recommended that consumers carefully review these options with their designer,.builder, or contractor, in order to minimize potential_ energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" ' • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation-Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.12.3.1,requires that the actual poverty owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions.to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. ZL2 Z?, Signature of ActuaPtuilding Owner Date 267 01-y s x9ez:'wy f//I112)lfy'wv1 Print Name Address of Permitted Project Owner Address(if different than project location) Owner's telephone number t _ z - d c PATIO § t Pmn o Da tom' f � No To sc(N�T f � f i f }f} 11 i t y3y f 1 g i L f a a U j WALL t r r l 16W7" WALL1107- To CA u-C J SLtzaN6r LvatjD D tO (AFL WlNDVul,f-,2 Lt-r-6 sc.iDIM4,-j _ t t � ! RIM - " € r . � 1 0 0 Lxpand yu--% ur lg.'Utng space. . . {fir !1 t _ .� l �. " 77 _ r IIN atl air * . n .,,- ,S,u, res,,,, �I gtL e• • _ 3 e 'a •Ny'*R a: ,�"V„, 7 w '�i«�k ,; �« �'� " " �` � ' % � 1Irn' wy �"� ,� . • - • . i� 5 ace j • n just days,your seldom used deck,patio G :' • or porch area can be transformed into s - - - • extraordinary living space at a fraction of - , • -4 the cost of conventional construction. j r • . , g4 • •• • - • • •e N, "* � a u. Transform your backyard into a beautiful and comfortable"dream space"by incorporating-both a Dreamspace Enclosure and Dream®Deck vinyl decking system. Pe x FF t r f �. IJe peatio tsesroie1a nevi area for family ADreamspace Enclosure witha cath�dralr of,adds neght f r # . 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I Best Fit Window & Door Co., Inc. _ o/00 0R "Specializing in Customer Service" ©2000 Thermal Industries,Inc. Y 28 Whites Path- South Yarmouth, MA. 02664 Pitt PittsbburgurghroAAvenue + h,PA 15221-2168 Phone: (508)398-9704 Dreamspace,Euroweld,Peak Performance,DreamGlas and Circle Sash are registered trademarks of Thermal Industries,Inc.PPG Intercept is a registered trademark of PPG Industries.a Visit Us Online! a www.bestfitwindow.com Glass Technology I. Ask about the Energy Star,, Qualified Products Program. ti s r ,r , •a 4 W M1 4 e .,. g f , rn I ONOWill kal iw ME it VO wgiId x IL s y r " s PATIO : DOORS � , r ZZJ Beauty & Security For Your Home's Largest Window . . eautiful, elegantIF ? s and secure are_just a few words to describe the new standard x in Patio Doors. . . the Mid" Legance'll II Patio Door �� � � from Thermal Industries. i With the Legance 11 Patio Door, �d tft homeowners like you will no E d_. longer sacrifice strength and efficiency for the largest window in your home. The fully welded construction, aluminum 1 reinforcement and superior s wedging interlock provide a tight ' seal between the sashes, keeping winter's chill and su iner's heat { at bay. In addition, the Legance w* 11's exclusive monorail track 'I �, - � tea. design allows for smooth, easy n � - a operation. l B ' +: s Maiw 3 s. w aI Legance a Patio Door with Sunshine Border DrearnGlasa. Inset:Optional Style French Door Panels. " ,.w NN ` V III p� = hermal Industries offers a wide range of patio I _ doors to complement your home and your : A 1 lifestyle. Choose from two or three panel . , z door styles, decorative gridaccents and classic hard- , ware options.You can also opt for astained-glass look 6 j in your Legance II by selecting from the elegant glass p d patterns in the DreamGlas°Gallery-Collection. �. ® ® e m a , ' r t Contoured exterior glazing. t, _, � e ecurit y is a definite �:' :' ^ "� �� . ' White* , priority in they design of the f Legance II Patio Door. °;t Earthtone Keyed dual-point locks are I y ri, standard on`all�door handles .�, - ��. at an beupg'ra edio iSafari ,� r t` keyed,multi point locks ,l ` Laminate ' AW with4our locking points. "l ` t '� •' h = Above: Plus, a recessed security Heavy duty A E y *,,,Monorail Track DesignAV &Anti-Racking System Accu-Track R , boltIds mounted on the`trail- screen withM ' hanging "� ��^ � ;Or_-Hanging "Accu-Track"Ensures k.£ mg edge ofEtlie!operating Anti-Racking � ' c ' Smooth Operation a, ., System. _ sash, keeping intri�ers O 'Superior Wedging Interlock For Increased r i n Security&Reduced'Weather Infiltration „� 1 away from-ptecious family • � , RemO 'Fully-Welded Construction For Rigid,:Long andpossesstons. Lasting Performance 1 r ® White,low profile External Key Lock � handle with keyed lock. O E Standard Dual-Grappling Hook Lock Pattern a Increases S y9v s ecurit ; Draws the Door Tight a � Left:Exclusive monorail track and O Recessed Security Bolt Acts as an Extra01 r *. y sill. 4 ,3Lock or A11ows�For,Secure Partial Veritiltation Rib Products with the ENERGY STARS O Grooved Aluminum Walking Plate Provides Label save energy.Saving energy a reduces air pollution and lovers Place to Scrape Off-Dirt&Soil,Keeping Your utility bills. Home,ClcanIt l_ c t_ O 13/16"Insulating Glass With'PPG Warm l Edge Technology i ' ® r" *Printed colors may vary from actual product. m .. PATIO DOORS 0, Aft legant Brass Door Handle Y $ O e Multi-Point Lock With Key Locke Oak* ° �O ,Color Matched Door Handles O Natural WoodGrain Pamtable/Stainable ' Interior; Oak or Pine 4 Pine* O ,`DreamGlas'Gallery Collection; Jewel`Cut, 1 _ .. I. Color& Cam *S 10 t••White,Earthtone or'Safari Brown(Laminate) . a .Exterior Colors, £ .,, •,. r Custom Shaped�Accent Windows' Peak Pehormanc6l'Insulating Glss 1 O '''Super Peak Perfortiiance "'Insulating Gla s O 2 or 3 Panel Configurattons I Elegant Brass Door Handle with Key Lock. O';Decorative Grid Designs in'a Variety of 1 . Patternsx&Styles-r n I Glass Technology � ., *Print d' fA At may vary from actual product' s i N C e t s s !�Fa` FlainB CAunpl lw_W Visit our web site: www.thermalindustries.com ©2001 Thermal Industries, Inc. XL 125B Legance, DreamGlas and Peak Performance are trademarks of Thermal Industries, Inc. 01/01 50K l" Best Fit Window & Door Co., Inc. ' - ThermalIndustriesjIncb4w� "Specializing in Customer Service" 28 Whites Path"- South Yarmouth, MA. 02664 301 Brushto Avenue a t ,-Phone: (508)398-9704 Pittsburgh, .Pennsylvania15221 Visit Us ®minel s www.bestfitwindow.com . E� . �I N, s. a t � r ' _ 1 RIC d �" � - i r A e _ ::. tz F-R-1 ed. 14, 1"KP Coort.m 17 r� E Enclosure with the DreamGlas®Sunshine ' ? Border pattern. 3 elect from a variety of options to add beauty and comfort tc . your Dreamspace. Options include marquee or cathedral roof designs, DreamGlas® Gall=ry Collection gIIass accents, and a variety of interior wallcovering styles and colors tha_will personalize your Dreamspace while adding to the beauty and value of your home. urn your backyard into a family I r�.creation area. TP z� J Y $ _ e � P -ANN i P < '*a} m w rc Enclose ane x�stmg pc ch with a Dreamspace A marquee style roof on this Dreamspace Enclosure complements the exstir.g Posch,Enclosure �' �� - • s architecture. ^ � r { x�I2 • , '� €tea � 81 " ��" ar F 1 k AM • M' ' y Ao- ipp H , y m .1 xI�r, ^: f -,!,M- M-g s l vin m h �� id, 1 "� �' `an ', f�b 00 �1t{3{�..r>��rdw ,..x.���a� .�` ��sar�� , � ar�!{`�". �ar�°��a��' � 9 n m� est-g-fiede -!o, W147 1," W X_T� ¢ JAI i Enclosures ach Dreamsp.ace Patios Enclosure has over 40 �OR t _ i F years of design and manufacturing experience by =� Thermal Industries, Inc. Custom designed to comple- ment your lifestyle and your f `w home's architectural features, your Dreamspace will add to both the aesthetic and resale value of vour home. Envision your Dreamspace... an affordable addition that f3 lets g our living space Y P blossom, and enhances your w . quality of life. Complete your-enclosure package with the Drea-r��Deck,Rail anc.Stair systems. National &F Sunroom Association Charter Member t � xt 't >. A Dreamspace y Enclosure with � Legance Patio Doors, M glass transoms above, t n and a cathedral roof 1 b rings the great -,,outdoors in! AV g m F s s LL. fil KI _ ., , � �4F riM r ti"=i 401 q paic, ms Y ,tF Panel dol f �°at o s . Windows only Windows with glass above • a � • y� � i�'rq ., . • • Windows with glass below Windows with glass above and below Or Options Thermo-Dek,an optional foundation on which to build a Dreams ace' Enclosure,has an insulating R-Value ; of 17.0.It is resistant to heat and cold F ;k and extra strong.Thermo-dek is also available with insulating values up toR-45. Stargazer Skylight,an added source of light and ventilation for any enclosure, �� f • • • provides superior strength and insu- • • lating qualities.Features Peak k x in PerformanceTM tempered glass with Low-E and Argon.Stargazer is also * _ available as a fixed unit.Skylights are b factory installed. / • ciassrechouiusr Thermal Industries, Inc. NSutti'nroom Association 1111 MEMO! Charter Member ©2000 Thermal Industries,Inc. Best Fit Window &Door Co.,InC. Dreamspace,Dream Deck,Dream Rail,Dream Stairs,DreamGlas,Legance and Peak 28 Whites Pa. S.Yarmouth,MA 02664 Performance are registered trademarks of Thermal Industries,Inc. Phone: (508)398-9704 XL 117A 05/00 50K Toll Free: (888)385-3201 Ask about ENERGY STAR Qualified Products. www.bestritwindow.com Visit ourAweb site: www.thermalindustries.com ' a o- ""Al � �. ., a Jr .. . w:.«�,.. _. rr .. . r - .� Ali t .1n1� A�N 7000.S' L+ vi,�GerJL—.•J"..^—'�_ Ewe ' I1 Ru.C-da-Ti; 1JAY� F� W�Tti '�Iq 1 Polt6�S� 1 lln Jrkl.IW,4L 7 tl� Co'Aa j ' I VI - -------- ---"—' /Y��T_: Oe)r' ✓I1i6�C�_C.J[,S��i I •;sti+S�� cox ------------- � c �.n •vim ��7wlc.(.,,�'kir� rG . �-i/�oP�l4:�•'-�. _'`�JX�CT;i iiTif' � - � �. i'I30 �'L6 a �..fir.•r /.ch j, n ' .3/"eSocea .4•4 ai4' 4,s/. irl�o n'aan AD rig S -.T.tTs t`— Arai I _axe Bcems _�) — -- -— — 65 arm r3aC4 cr, 1 - Y •. . � �•' ... BGI.E:"_ nRpROVED eY: - DR�WR eY