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0153 TANBARK ROAD
� , a THE TOWN OF BARNSTABLE Permit No. 3 4....... .�.-... f TO BUILDING DEPARTMENT .Y� I TOWN OFFICE BUILDING Cash ................ i6)0• ,To iuT HYANNIS.MASS.02501 Bond CERTIFICATE OF USE AND OCCUPANCY i Issued to Greenbrier Corp. Address Lot #123, 153 Tanbark Road Marstons Mills, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Apr . il . 21 89 .... .. , 19........9....... ................. Buil,ing Inspector r TOWN OF BARNSTABLE, MASSACHUSETTS B U I L D I N G ' IiT' ' t=10'i)/�`U25 & 02G DATE February L)_ 19 .fig PERMIT No. ����3 N 32�5�� APPL�CANT_ OwnPY ADDRESS 001397".'�;'.:-�� I NO.1 (STREET) (CONTR'S 110E NS:E 1,'.'' ':;. PERMIT TO build dwelling ( 1�) STORY Single famlly dwP_1liTlgNUMBNG UNITS ER OF ]'(TYPE OF IMPROVEMENT( NO. (PROPOSED USE) AT (LOCATION) lot #123 153 Tanbark Road, Harstons :dills ZONING RF INO.1 (STREET) DISTRICT— ( BETWEEN AND ' (CROSS STREET) (CROSS STREET) '• j;. SUBD.IV IS ION LOT ' BLOCK LOT SIZE i BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION''d-:; TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) } Sewage I;SEs•-50 REMARKS: n/A AREA OR VOLUME 768 sq. f t. 45,000 PERMIT. 6 L!6 ESTIMATED COST $ I. (CUBIC/SQUARE FEET) FEE a j . OWNER Greenbrier Corp. {4 ADDRESS BOX 510 Centerville, MA BUILDING DEPT. �•!`"���' BY +I Ir i (i . -"'�--- blur-'1"'rit•-t) •F''A-FtY'l.'ft-IVT'17T-,_a(jt7-L'.C-WOKFC'S'�'TH'E-f5Sl7X'F!'C `�jF'T}i'YS'PE•Ft'Nfl'Y'U'C7E'S''N'O-r--7'I�L"E-'ASE`'7'FI'E•�S'P'P'L'IC .I'..:FROM-7'fi'E`CiYN(7F'�'TOTIS..". OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. A.TJ MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING LATH).STRUCTURAL QUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL MINAL INSPECTION TI 70 LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE •:!•-.� OCCUPANCY. POST THIS CARD SO IT` IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS i 1 ` HEATING,INSPECTION APPROVALS ENGI EFRING DEPARIMFN'I OTHER -'— BOARD 01-HEAL IH OILCy�.3U�� WORK SHALL NOT PROCEED UNTIL THL INSPEC- ?ERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION FOR HAS APPROVED THE VARIODUS SIAGLS OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE AIMANGLDS INDIBY TELEPHONE ON THIS CARD CAN BE CONSTRUCTION. tl NOTIFICATION. FOR BY TELEPHONE OR WRITTEN PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. n o K PLal ,6047_�,;�_-�-,), Assessor's office (1st floor): , ., rem MUST `AssessoKs map and lot number ..' . ...... lJ ...... O a s Oat O`� 'd�'�� CQ(�� toy` Board of Health (3rd floor): �s. ',-LED eW � Swage Permit number ......................... ... ............... �.Ci Engineering Department (3rd floor): �"6}9- House number ............................... ...............�.... ITT N REGU 0MAI a\ Definitive Plan Approved by Planning Board ______---- --_��-_•_.___.___19_�. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... .........�LuELL�iJ�i........................._........................... TYPE OF CONSTRUCTION ...... C.�......��J'X"f Z :. .........14 DD ....... /ZP�F............................. ............................la TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location dT j/,"Vq/J2K 40.,06 HqA-S�d ........ S -ItCCS ................................................................... ......I............................. ...................................................... Proposed Use t .... ........................................../I............................I............................ CC R_�* .......... . . ....................................................... Zoning District ..... ............................. ....................Fire District GiZf�n//S�3E� (�OR� Q, Df( S/d �FlovrcTvztc(" Name of Owner .. ........................................... ......................Address ../............. .. ............. -5 Nameof Builder ....................................................................Address .........S.`..................................................................... Nameof Architect ...................................................................Address .................................................................................... Number of Rooms f/IZ F1� ca-vu-c-re f..........................................................Foundation ... ..... ............................................................... Exterior ....C,CA�S../ .....5?✓In�C .-..... rE. A�Z..Roofing ...........4- ..��/4 ....-7 Floors ................ P.........../ y........../ .......................................Interior .......SN. / �dCGC Heating ....�W.1..........g.�............G .......................Plumbing .......1..........BA rN .......... Fireplace ..........N�p Approximate Cost .........y ...................,./..............t Area ... � ..............�. Diagram of Lot and Building with Dimensions Fee .....l� 3C/ �3a x ate/ e,�pF � �N1sN Ups;�12s ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of th Town of Barnstable regarding the above' construction. Nam ........ .......... .................................... - Q01397 Construction Supervisor's License .................................... GREENBRIER CORP. 0 ................. f 11 story ��"2654 Permit or .................................... Single Family Dwelling ...................................................................... Lot #123 , 153 Tanbark Road Location ...................................:............................ Marstons Mills ............................................................................... Owner ...Greenbrier Corp................................................................ Type of Construction ....Fr........ame.......................... .... ............................................................................... Plot ............................ Lot ................................ February 21 89 Permit Granled ......................................11.19 Date of Inspection ....................................19 Date�`Complgtecl. ...... ................ .........19 alwyo; we �� IL . —�. -.- �. _ .L` �}_.� �� R .0_�. r4""i x.�ti.,. ��'•—ti„ iSliO�. � .�'�� „i ¢:.1' ��i�__ o ��� � �. f 1 t'�'.�... Y r `_ �.... Ir Assessor's office. Ust floor): 1 �0 •0` � Oa e' TNE Asses and lot number ...:/! ........ Board` of Health (3rd floor):� Seiwage Permit number :.................................................:..... � Z B8Bd9?oDLE, 2 Engineering Department (3rd, floor): " �yj ,/.9 �o rasa House number ............................ ............................ 0 MAI '~Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-'2:00 P.M. only TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......t'�/^!:�.'Z R.V�. .........hF r�. 1.vr : ........................................... TYPE OF CONSTRUCTION ......S '.G d K /�/'�1� II,,, Gu401.. ...... .......... rd ...........................`.. ......................................... ................................................ 9 a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............................................................................................•_.......................................................................................... �� ProposedUse .....................r... ...........;......1.............................................�.���........................................................ Zoning District ......k;;,...... ................................................1.........Fire District ....... .1/!!/........................................................ � T Q Name of Owner ...tL.at �R°�1C'� �t1t ....................Address ( ....: �d FtiT ,YV.��....t'............... /...:.... ........... Name of Builder 5 ....................................................................Address ..................................................................................... iName of Architect .................................................................Address .................................................................................. Number of Rooms .......................................:..........................Foundation Uat. o a Exterior ... .�... ... .> .���^r.F�.C....`.....�.�..�. .�.Z..Roofing ' :>��.C7 i �.... r ....... ............................................................ Floors /d�� i �°� •NYG�t �f�C"F edC,a .......................�............... ....................................Interior ......................... ............................................................. �° .Plumbin Heating .....�!(%�'?...............�'��.:............�..t.......................... g ....... (...........................................: - . - ............................ ..............Approximate Cost .......r. 5�� ; '(ftJ Fireplace :.......:........................................................... ..�.............. Area .......................................... Diagram of Lot and Building with Dimensions Fee C` �N l'NJ.S/Jc`�) o (/�75 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS " l"hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i Name ........ .. .... Construction Supervisor's License ...:.................................. GREENBRIER CORP. A=100-025 & 02-6 too - -1 c, No PeyTit for ....I.i...StOry........... $,in.glQ...FAMily...Dw.e.11ing........ Location ... .......1.53 Tanbark,..Road .....................Ma.r.s.t.o.ns...Mills...................... Owner .....Greenbrier Corp. .....................................Corp. Type of Construction .....Frame......................... .... ....... ............................................................................... Plot ............................ 'Lot ................................ Permit Granted February 21 ,.........................................19 89 Date of Inspection ....................................19 Date Completed ......................................19 /o : 111tCk i ul co 0D co LOT 123 \ 24'f 28,967 SF \ 1 �PN0 PFt ,�e •� �9°a� LOT 122 i 1 2-17-89 INITIAL ISSUE CF NO. DATE DESCRIPTION I By AS—BUILT FOUNDATION PLAN—LOT 123 MARSTONS MIIJ WOODLANDS M i BARNSTABLE, MASSACHUSETTS --� WOODLANDS ASSOCIATES REALTY TRUST �p�4�o� ` •ot :\ SCALE 1' = 50' J08 No. law/dam= I CERTIFY THAT THE FOUNDATION SHOWN ON THIS PLAN IS LOCATED PAUL A. 0 50 100 LEVY ON THE GROU AS INDICA D v` No. I0617 IM &IDF= k TAGNU ASSOC= INC. A REGI RED LAND SURVEYOR M W" MAW Slat M CINT RUMS WA 02M The Commonwealth of Massachusetts 02 y, Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,AM 02111 s�•� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 10/ QA Address: 143 --i—fl ry b.� City/State/Zip: 14-K r olug Mi LZS AM Phone#: 7 N/ ;>3 Are you an employer? Check the-appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 . New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.�Electrical repairs or-additions required.] officers have exercised their 3 i ,I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. C. 152, §1(4),and we have no 12. Roof repairs insurance required.]t employees. [No workers, ❑ 1 comp. insurance required.] - Other Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: *� Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 7ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nformation. asurance Company Name: -olicy#or Self-ins.Lie. #: Expiration Dater :)b Site Address: City/State/Zip: .ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a he up to$.1,500..06 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine f up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of . ivestigations of the DIA for insurance coverage verification. do hereby certify nder the pains and penvlfi—el of perjury that the information provided above is true and correct v ' ature:. hone#: 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): I.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• I Information and Instructions Y Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as``an divi ,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. Howev.,er: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 woikvn such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary;supply.sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . 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 permiVlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof thata valid affidavit is on file for.fixture permits.or licenses..A new affidavit.must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of Industrial.Accidents ..Office of,Investigations s 600-Washington-Street . Boston, MA 0211 L 4 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www,mass.gov/dia- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. ©—Parcel ® Permit# 2547q HealO,Divisson Date Issued a)OS 1 p` Conservation Division �¢ J s 7 1 S 0� fee - Tax Collector 1 1 Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 1 �3 _ "1 A 1IDA RFG Q6 Village J r 4m '� Owner s�� A& L 5®A Address 1 f9 LiAlCoL/V Telephone 50's Permit Request O 2 eMA CMAWA tm*( J_#rn up nk. . - 'kny6[firiU kkbm a _ IV i Square feet: 1 st existi proposed� 2nd floor: existing propo d T Tal neon" Valuation Zoning District Flood Plain Groundwater OFverlay�. Construction Type k E dNO < Lot Size Grandfathered: 0 Yes No If yes, attach supporting.-documentafion. G, w � .. m Dwelling Type: Single Family Two Family 0 Multi-Family(#units) rr,, Age of Existing Structure at Historic House: O Yes 1%No On Old King's High ay: ❑Yes XNo Basement Type: gd Full 0 Crawl ❑Walkout O Other Basement Finished Area(sq.ft.) i Basement Unfinished Area(sq.ft) —7 Number of Baths: Full: existing R new Half:existing new Number of Bedrooms: existing Z new Total Room Count(not including baths): existing 1 new First Floor Room Count Heat Type and Fuel: - Gas ❑Oil ❑ Electric 0 Other Central Air: ❑Yes 4No Fireplaces: Existing _W!ft_ New Existing wood/coal stove: %Yes ® No Detached garage:O existing ❑new size ` Pool:O existing ❑new size Barn:O existing ❑new size Attached garage:0 existing ❑new size Shed:O existing Cl new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes l4 No If yes, site plan review# Currerit Use Proposed Use BUILDER INFORMATION Name C _4 4-1<C Telephone Number �i4 Address ly /y hAck l�> License# f �lpt 10AI-5 M/L Zs Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO p IGNATURE DATE J� FOR OFFICIAL USE ONLY PERMIT,NO. DATE ISSUED a MAP/PARCEL''NO. A ADDRESS VILLAGE OWNER DATE OF INSPECTION: T FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL GAS: ROUGH FINALF� FINAL BUILDING y: DATE CLOSED OUT ASSOCIATION PLAN NO. — �u� ��FtHE 1p� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Mnas. 1639. & Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 7 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: k(— -MO '1.1N(� Estimated Cos 4.10-0.0 L,Q' Address of Work: s, J A A/9 A r D_ Owner's Name: ��L 0,4 �IQES Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 [luilding 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 ! ►3 Date Owner's Name QIorms:homeaffidav The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 .. ' _ www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/orp=ation/Individual): Address: City/State/Zip: 1114K i�oN9 M(LZ_!1I A Phone#: Are you an employer? Check the appropriate box:. Type of project(required): ` 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• temodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions equired] officers have exercised their right of exe lion per MGL 11.❑ Plumbing repairs or additions 3. I am a homeowner doing all workexemption myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13 ❑ Other 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 tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date. Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 der the pains and iahies of perjury that the information provided above is true and correct. c Si afore: Date: Phone#: i r[citly l use only. Do not write in this area,to be completed by city.or town official. r 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#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides theiein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair workton.such dwelling house or on the grounds or building appurtenant thereto shall not because of such.employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state'or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with-the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in . (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or.town may be provided to the applicant as proof that a valid affidavit is on file for fixture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www,mass.gov/dia I Town of Barnstable FTME 1p�_ Regulatory Services ' Thomas F.Geiler,Director nAWMBLF t'�: ��� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION r Please Print DATE: D 25 c JOB LOCATION: 1 /"►4 if 1-0/us /"l 1�� numer /� , street village / "HOMEOWNER": / 5 A lam- 6a+ga V 8 a 51#/S 2 2-? '73 G3t�? name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 pr dures and requirements and that he/she will comply with said procedures and requir eats. 1 of H,Inecwner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fomu:homeexempt I 'y /VD�-Mo v/niq r _ / Ll I� 3 (Ex� S�/� � �OVd -er 12r ��uT 51i� Me, L 57o 4Kyy _.__.._ ......... ._ 1 FKom t. �2� f o f i Of. L ! L.16yr ,9.0/ SS L `ODT ti s J. :! Fiat f�``'�� G� ��'� �A, �r �' ,�, � � I � --� ®� a. ..�_�..._........P..._.a...... .. _ .. —_.._.._..�_. �. !�r°��T 5ii�� - 1 i 4K Y I � I I I Rom N i Azl Li Q G Sj 1 z _ L.r�yr �._.r. .. ... ,...._. 9g0cc- .... .. wd Y ;SccpNt� rLooq� Town of Barnstable r `�`' �` sL Regulatory Services L �4R -3 F e Thomas F.Geiler,Director snnxsrnsi.E, M'S Building Division � - 1639. �0 ptED MA'1 a Tom Perry,Building Commissioner L' V1 200 Main street, Hyannis,MA 02601 Office: 508-862-4038 3161060-, Fax: 508-790-6230 PERMIT# q O(P3'7 FEE: $ 15,00 SHED REGISTRATION 120 square feet or less 3 i.A.,vbARk RD Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# � 3/03/0 a Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) 315 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MIDST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 CATION OF PROPERTY LANES MAY NOT B E •AC <U E STANDARD LEGEiND ❑ \ / F �' i NOTE:not all symbols will appear on a map 79 . 0 / \ ' �"� GOLF COURSE FAIRWAY •� '" EDGE OF DECIDUOUS TREES EDGE OF BRUSH .' ORCHARD OR NURSERY MAPV---T-V-V EDGE OF CONIFEROUS TREES _.. MARSH AREA 0 EDGE OF WATER / DIRT ROAD # 79 - �'/ ���/ DRIVEWAY �-PARKING LOT PAVED ROAD ' DRAINAGE DITCH ----- PATH/TRAIL [ 'IAP I00 PARCEL LINE** ��^^ �� 1MAP326 �—MAP# 25 - 0 \ #02 367 —PARCEL NUMBER #367 � HOUSE NUMBER 7 ° # 15 3 \ /• ���� �� 2 FOOT CONTOUR LINE / \ t 0 ❑ 0 %y / \ (� ° (� —t— 10 FOOT CONTOUR LINE / J J Elevation based on NGVD29 4.9 SPOT ELEVATION 1 I lz_ x STONE WALL 1 I 1 I -X—X- FENCE MA� I RETAINING WALL 0 RAIL ROAD TRACK -� STONE JETTY I00SWIMMING POOL } PORCH/DECK ... f0 BUILDING/STRUCTURE 8 t- DOCK/PIER \ / � HYDRANT 7 0 ° j E) VALVE O MANHOLE m4pJl o POST 0" FLAG POLE\100 T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T o SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This ma is an enlargement of a **NOTE:The parcel lines are on p� ro p N graphic representations DATA SOURCES: Planimefiia(man-made features)were interpreted from 1995 aerial photographs by The lames � UTILITY POLE ° TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 oerial photographs by GEOD w -` e 0 20 40 Natonal Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimefia,topography,and vegetation were mapped to meet National Map Accuracy Standards s I INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessor's tax maps. ¢ LIGHT POLE O ELECTRIC BOX „ . mat SHEET 7 OF 7 yeas ,b NARSTONS HILLS LOT 130 »�for a Rocs f p i LOT 129 LOCATION MAP 11 lil ry �� LOT ua lopL01 31 � �-' \ IT 137 -lit9\\ •• LOT 124 got r db too 3 S f rip —60 LOT 123 r' �. 1i t s I \ LOT 120 Al .. , (� u 14.4 i i I �' Lot 13 i lw �/ OW \ . ► LOT 149 l ` - \� - tuw OF LOT.136 ! - - lot \ LOT 122 i \\ _ LOT lu tf L t. \/ LOT 2 I >, ' \ •�sLot 107 ,r JLOT 14e � I�k �a ,,, � 11 LOT 119 \\ � /�• � � 1f'4 > 'LOT t41 \\ �/ ,•• �11\'a taw� � wt Of 11i� LOkt4! �! a 11OT Is, i. t`� � LOT 1� _ \ 'f t 11.1 1 i LOT 117 IL taw s M LOT)143%\ _ ..�,:"\ Ipw w �' f ` - fell .I.ewe *~r 7A °/:7 fvK- Sail, vas Aw4b 7 LOT 11Sf1�•T 7A ew w FvA_ •LsaMc: `•► COT 146 an w ` TEST. AOWt+ra /s Lot • ll` - \ LOT 11e 7 4 \ ff to I Lot 11b t� � � tam w 6 lei Ir ' ►I - k LOT 11 Lp .LOT 11 ,4s� 1 s 114 lot 11 29 as .FINAL BLDG AND SEPTIC LOCATIONS PAL 1118/68— BUILDING LOCATION KM A 1 �I• L - 1 10 2 Ba INITIAL I ELK NO. DATE DESCaPn BY BUILDING LOCATION PLAN \ I.1 LOT 110 MARSTONS MILLS WOODLANDS \” •: w \\\ LOT 109 IU-w 1 BARNSTABLE, MASS CHUSETTS \\\ WOODLANDS ASSOCIATES um \\ SCALE: 1• — 50' JOB NO. 1338 43n-46 no so 0 • IBvr, �a®cB � ��c�s u� Raft m" pjm me 111im!