HomeMy WebLinkAbout0006 YEARLING LANE �71Lc� e—
..��: Pf309 Tr O
Assessor's offioe (1st floor): , j-�, / ,
°�TWE
TO'Assessor's map and lot number .."5• a"/3.............: E
:SEPTIC SYSTEM MUST BE �Q ;
Board of gealth '(4d floor):' rta43TALLED IN COMPLIANCE = Baaa9TADLE,
Sewage Permit number ....... ,7::�.y..............
WITH TITLE 5 SA &
Engineering Department (3rd floor): , , ''fir �aIB90NMENTAL C®®E e1��° °o�039.a\e�
House number ..................................:...%........
...........E.,.....
a.Yc c YPI
`SOWN REGULATICMIS
APPLICATIONS PROCESSED 8:30.9:30 A.M, and 1:00-2:00 P.M. only -
TOWN OF - '- BARNSTABLE
BUILDING'-. JNSPECTOR
APPLICATION FOR PERMIT TO ..........Bui.ld 1 11 2...Story.......................................
TYPE OF CONSTRUCTION .......Wo.od..Fraine...................................................................................................
.............. .............19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location Lot `y2. Y,ecir..... ...n.9......L..�!..'....�......................................�..............H..v-.
Proposed Use ......Dwellinq.........................................................
...........................
.Fire District ........0 Zoning District ....R.. .F............................................................ „� .........................................................
Name of Owner ....SLS...Tr'ust ...........................Address .......Ilyannis.,....MA................................................
Name of Builder ...Le.be1.-Sollows.. . ..•........•..........••......Address .......RyallniS.,....M.A................................................
.. .... ..
Name of Architect ...Norths.ide.,Des. c n•.•..•,.,,,.•,.,,,,,.Address ..X.d]CI110.uthp.Qx.t:,...MA........................................
Number of Rooms ...6............................................................Foundation ....P.Qured..0 naret.e...................................
Exlerior .....Cedar...Shingle.S..........................................Roofing ......... As.phal.t.......................................:................
Floors 3.�4...T&9..Plywood..........:.................................Interior ..She.e.tr.oGk..........................................................
Heating ...Ga.s..........�H.A..............................................Plumbing .....P.VC...and...Copper..Baths........................
• Fireplace ........NIaS.OI.1X'.y........................................................Approximate Cost ....b.0.,.O.0D.................................................
Definitive Plan Approved by Planning Board --------------------------------19-------- • Area ..... ��?..�.?.v... �.
Diagram of Lot and Building with Dimensions .See Fee /!..........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
vo�
U I-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barns ble regarding the above
construction.
Name ..... ......... ............................................
Construction Supervisor's License .....0.4.3.41.5................
r S L S TRUST '
P
all
No" 30846... Permit for ....121...Stor3...........
!ZZ,ing1e...Familv...Dwellin.g...........
Location ...Lot #�9 2� 9 . 'ea .J,i ilg...I�.c ne
......:.. . ...e..........rf
Owner .....S..L.....S..Trust.............................
Type of',Construction .....F.Xame........................
:......................................... ............................ t
Plot ............................ Lot ...:............................
Permit Granted .........June..�...................19 87
t .
Date of Inspection ................'5.. ...:........19
Date Compl to ...f?.70` 19
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�oB 85-309
CERTIFIED PLOT PLAN
LOCATION: YEARLING LANE W . BARN . PREPARED FOR:
SCALE. 1=40 DATE: 6/9/87
REFERENCE:
LOT 92 PB 420 PG 100 LEBEL / SOLLOWS
I HEREBY CERTIFY THAT THE BUILDING
SHOWN ON THIS PLAN. IS LOCATED ON THE
GROUND AS SHOWN HEREON.
BUILDING CONFORMS TO SETBACK REQUIREMENTS
OF THE TOWN WHEN CONSTRUCTED. `tH OF
g� ARNE a
I,
down cape engineering wALA N
CIVIL ENGINEERS
LAND SURVEYORS
ROUTE 6A YARMOUTH MA DATE D SURVEYOR
o
TOWN OF BARNSTABLE, MASSACHUSE'TTS " BUILD•ING 4 PERMIT°" ,
A-i50-U13 V Ju:l> 1•l. 3'1 �.�-
DA'7E 19 PERMIT
APPLICANT Ll:•D�''1"'SOl�.i)W i ADDRESS 13.1. V1.0 Route 132,, 0434".5
IN0.) I (STREET) (CONTR'S LICENSEI
PERMIT To Build dwelling. ( 1'�1 STORY :7•IT1p,�.Fj �:fLFai 1.y dwelling DWEBLRNO UNITS •L
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
lot #92 9 Yearling Ltani( �.le �� ZONING R
AT (LOCATION) DISTRICT
(NO.) (STREET) .
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE `
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS' Sewage #877 ei54
AREA OR hO�:J
VOLUME 1550 `q. fc. ESTIMATED COST $ 60,000 PERFEE
� 111 00 .
(CUBIC/SQUARE FEET) '
.%5 1, 5 Trust
OWNER � ` �, BUILDING DE PT. i • �"�
.L Q [coif S i"lll i
ADDRESS BY
r
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED,�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 THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
1. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL '
MEMBERS(READY TO LATH). FINAL INSPECTION HAS SEEN MADE.
3. FINAL INSPECTION BEFORE I
OCCUPANCY.
POST THIS CAR® SO IT IS VISI13LE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL-INSPECTION APPROVALS
2 2 2
�' Yr
3 as H NG INSPECTIOWAPPRO ALS ENGINEERING DEPARTMENT
1 '
ER 2
3S� �jPPT�_Q 9 6 7 BOARD OF HEALTH
WORK SHALL NOT PROCEED UNTIL THE INSPEC-
PERMIT W!LL BECOME NULL AND VOID IF, CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE '
TOR HAS-APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTE.Q WITF IN SIX MONIHNF DATE THE ARRANGED FOR BY TELEPHONE.#R WRITTEN '
CONSTRUCTION. I`PERMIT 1S ISSUED AS N#TEbfABOVE. NOTIFICATION.
�o
TOWN OF BARNSTABLE Permit No. ..30846....
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash /.
°'tcuvR` HYANNIS,MASS.02601 Bond X.�.l���
CERTIFICATE OF USE AND OCCUPANCY
Issued to S L S Trust
Address Lot #92, 9 Yearling Lane
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.
Seotember 10.�, I9.....0�................................ .......� ..�
Buil ing Inspector
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
sssaar = TOWN OFFICE BUILDING
rua
i6J9• � HYANNIS, MASS. 02601
�OIIAY�'
MEMO TO: Town Clerk
FROM: Building Department
DATE:
An Occupancy Permit has been issued for the,,,11 lding,authorized by
BuildingPermit #.... DE». ....................................................................................._..........» ....»»...... .......».»». ..».»w
issuedto ....v.. .. .............................._ ......................................................................»_..»...»»
Please release the performance bond.
OF Town of Barnstable *Permit#
Lrpires 6 monde jion,issue dare
Regulatory Services Fee —
' 13ARNSTAB LE,
Y MASS.
039. �e� Ttiornas F. Geiler, Director
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnsiable.ma.us
Off-ice: 508-862-=10:8 Fax: 508-790-62 0
EXPRESS PERNTIT APPLICATION - RESIDENTIAL ONLY
/Vol Valid without Red X-Press Imprint
�l+prparce! \�u:,:ber � I
V Po r
liResidcr.iial i'al ,e o'1Y'ork �3� JGG Minimum fee ofS35.00 for work under$6000.00
Cf
nira.iur s Nam _Telephone Number
lmpr(%1-;. ,.nt Contractor License (if applicable) —j
oiistruci;or. Sut;c„ s,?r'_ I iccr,j. =(ifapplicable) [ ® 2� --
°z1�C?;i1JCilj�.tvn Insurance
Check one: MAR 18 201
12ri-.- a sole proprietor 4
LJ I am ;he Horn,-owner T®��
® 1 havc '.Y
orker's s Compensation Insurance / Vf-, 0
:Lurance Compan_; `;ante kssi cef✓� �d'7(�GcACd2 A S�A&J`E
:r n's Comp. poii"-,
-'W of Insurance Comphiiice Certificate must accompany each permit.
:! Rc;uejt (chcCk box)
r—,
Rc-ruof (stripping'old shingles) All construction debris will be taken to
7 Re-rco'(not sir;pping. Going over - existing layers ofroot)
Re-side
t, of doors
Replacement Windows/doors/sliders. U-Value (maximum .44) # of windows
'lvhcrc rcqui-i i_suancc or this permit dots not exempt eon?pilaricc x•itn other town dcpanmcnt regulations,i.e. Historic,Conservation,eic.
"'.\ate: Property Owner must sign Property Owner Letter of Permission.
A copy of the Horne linprovernent Contractors License & Construction Supervisors License is
required.
:0PURE: Q,
E.ES'FO (�ISibu cd rig ocnnn Ibrrt?s1EXPRFSS.doc
i
.i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
►vww.mass.gov/dia
ctors/Electricians/Plumbers
Workers' Compensation Insurance Affidavit: Builders/Contra please Print Le�'ibl
A licant Information (.
Name (Business/Organizatior/lndividual):
Address: En `t'��+�-<<
P CG �� COS.
Phone
City/State/Zip:Gyy_ P y����— �� ' aat� _
F
y6[] New
f project (required):
Are you an employer? Check the appropriate box: construction
er with�_ 4. ❑ 1 am a general contractor and 1
I.❑ I am a employ * have hired the sub-contractors
employees (full and/or part-time). ❑ Remodeling
listed on the attached sheet. j Demolition
2.g—I am a sole proprietor or partner- These sub-contractors have 8
ship and have no employees workers' comp. insurance. 9. ❑ Building addition
working for me in any capacity.
workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
[No
officers have exercised their
required.) right of exemption per MGL I I.❑ Plumbing repairs or additions
3.❑ 1 am a homeowner doing all work c. 152, §1(4), and we have no 12.❑ Roof repairs
myself. [No workers' comp. N employees. t o workers'
insurance required.] t 13.0 Other Stk�ec��{�
comp. insurance required.]
s'compensation
icy
*Any applicant that checks box this s affdavitainsdi altingt the they aretion below showing their doing all work and then hire rourtside contractors mulst submit anew affidavit indicating such.
t Homeowners who sub p
[Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' policy information.
I am an employer that is providing workers'compensation insurance jor my employees. Below is the policy and job site
information.
insurance Company Name:y
Expiration Date: I
Policy #or Self-ins. Lic. #: ���� �a
City/State/Zip:\.9-� 1
Job Site Address: �
' com a sation policy declaration page (showing the policy number and expiration date). U
Attach a copy of the workers
es
Failure to secure coverage as required under Section 25A ofMG�LIc'en Itices in an lead thetfothe impositi6n of rm f a STOP WO criminal
a
RKORDER nd of fine
fine up to$1,500.00 and/or one-year imprisonment, as well a p
of up to$250.00 a day against the violator. Be advised
that
copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage
1 do her by certi a der the pains and penalties of perjury that the information provided above is true and correct
�� Date:
Si atu
Phone #:
official use only. Do not write in this area, to be completed by city or town of tciaL
Permit/License#
City or Town:
Issuing Authority (circle one):
ent 3. City/Town Clerk 4. Electrical inspector S. Plumbing Inspector
1. Board of Health 2. Building Departm
6. Other
Phone#:
(-nntnrt Pvrcnn-
THE r, Town of Barnstable
Regulatory Services
MASSws Richard V.Scali,Interim Director
i6;q. 10
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete.and Sign This Section
If Using A Builder
I, �J c- CArrC--1I r^& ,as Owner of the subject property
hereby authorizer- , ,vim_ to act on mp behalf,
in all matters relative to work authorized by this building permit
( ddress of Job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or.utilized before fence is installed and all final
inspections are performed and accepted.
S' �� tune of Owner �S' tore of Applicant
Print Name Print Name
Date
Town of Barnstable -.
Regulatory Services
oFtt Tod Richard V.Scali,Interim Director
Building.Division
II nwawcr►nr.F ; Tom Perry,Building Commissioner
9� 1163 ��� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6250
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB.LOCATIOPtI
number street village
"HOMEOWNER":
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
procedures and requirements and that he/she will comply with said procedures and requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any.homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness_often
results in serious problems',particularly when the homeowner hires unlicensed persons. In this case;our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q MP17MEMPORMS\building permit formslE PRESS.doc .
Massachusetts I.)eparttnent of Public Safety
Board of Buildu,g Regul atlon5 and Standards �� .'��• w�moistmu.rie�,/� Ni aNrcl(<eiiaeaa
.m.h u,li„n tiui,t r%,—t ofi ice of Consumer Affairs& Business Regulation
t u:ense CS-014007 (d HOME IMPROVEMENT CONTRACTOR
Registration: 101149 Type:
JOHN P DUNN fi E Expiration: e/2512014 Individual
BOX 924/80 MARIE JOHN P. DUNN
Ccnten-ille MA 03632 I
John Dunn
80 MARIE ANN TERR.
: nnnu��u tnt•� 05/25/2014 CENTERVILLE,MA 02632
Undersecretary
Unrestricted - Buildings of any use group which
contain less than 35.000 cubic feet (991 m)of License or registration valid for individul use only
enclosed space. before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Licensing information visit: www.Mass.Gov/DPS N valid without signature
I�
Assessor's offioe Ost floorh P1909 r � O
l OF TM E t0
Assessors map and lot number ..� t0�.".�.. ...................
Board of Health (3rd floorh
Sewage Permit number ....... r.9LX
. ........................... Z BAMSTADLE, i
Engineering Department (3 r d floor): 'oc rb c
House number 3 lip
�e
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 .........�uild 1 1/2 Stork'.••••••.••••••••••••••••••••••••..................•••
TYPEOF CONSTRUCTION .......WQ.nd..FmQ................................:..............................................................t...
I Z?- 8)7
.................. .... . ................19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according.to the following information:
Location Lot �1 ye-a r^ / , ., c1 L- �`.'t.. .......C..e.'�.t.Lr'.✓!.�.�.e....:...H. ^. r..f-/i// 1
......................................................................./...............
Proposed Use DW! 4Aling ................................................................................................................ '
........... ..................................
Zoning District R F...........................................................Fire District ........G 0
Name of Owner ....SLS...Trust... ......................................Address HVanni� XA..
....... ,z .............G.........................................................
Name of Builder ..rebel-S011oWs ' ._••••.•••••.•••••••••.••Address .......Hyanna, .,...NiA.
.......... ..............................................
Name of Architect ...N.orthSlde.• DeAin.Q••••..•.••••••.•.•,..Address Aary.nouthport.,.AA.........................................
Number of Rooms .:.15.................,..........................................Foundation ...POUT!'d...CO22GxgtP...................................
Exlerior .....Cedar Shingles
.......................................Roofing .........AaPhalt.........................................................
Floors 3/4 T. ... Y.
&G 1 Wood. ....:.......................................Interior .Sheeta pq%..................................:........................
:. .... ... .. .......
lh�Heating ...�.S..........�.H.�"......................................:.......Plumbing ....k?�+'f;.'....:s'.l7Ct.c.�...C ?�.,;..cv0. .�"...Rat
............�..........................
Fireplace MaSOnrV ...........Approxima.te Cost ....6.0. OQO
Definitive Plan Approved by Planning Board ________________________________19-------- . Area ...........................................
Diagram of Lot and Building with Dimensions Aedt Fee .............................................
•5. ;t Jon
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town-of Barnstable regarding the above
construction.
Name !.`..., �.. . ............................ .
Construction Supervisor's License ....0.43415
S L S TRUST A=150-013
Permit for .:.l.i...S.tO..Ky.............
........S.ing.le.: 7.-ng.......
Location ........LQ.t...#.92.........9.'..X.earli.ng...Lane
..............:.......... ....:....................
Owner .........S...L. S Trust
Type of ConstructionFrame
Plot ..........................:. Lot ......................
Permit Granted ........June................................11 ,
19 8 7
Date of Inspection ................................:..:19
Date Completed ......................................19
OF THE Tgt, Town of Barnstable *Permit#
� Lrpirrs 6 nro !hs j onr ist�µ-durr
Regulatory Services Fee
MA.SS.
1639. ,�5 Thomas F. Geiler, Director
alEo MAC a
Building Division
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstab le.ma.us
Office: 508-862-4038
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ax: 508 790-6230
51 Not Valid wit/rout Red X-Press imprint
Map/parcel Number ' Q
Property Addressla� �� �y`jc�- � t
esidential Value of Work Minimum fee of$35.00 for work under$6000.00
Uwner's Name & Address ,_�,�-t��-
,nirac[or's Name �h��U Q • +�it�{ �`
Telephone Number JV!?"
1-iorne Improvement Contractor License#(if applicable)_ d ��
'onstruction Supervisor's License #(if applicable) L(Cor
PER
-Workman's Compensation Insurance IT
Check o
am a sole proprietor OCT 15 2012
❑ 1 -the Homeowner
have Worker's Compensation Insurance
tsurance Company Name Sri C IAD i TOWN OF BARNSTABLE
rkman's Comp. Policy F VL°
.)NY of Insurance Compliance Certificate must accompany each permit.
Request (check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not s(ripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/doors/sliders. U-Value # of doors
(maximum .44)# of windows
Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
"'Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License & Construction Supervisors License is
required.
ATURE: �—
iLESIFORti %buildi permit fUrmAEXPRESS.doc
4�
The Commonwealth of Massachusetts
^t 1 Department of Industrial Accidents
Office of Investigations
1 t� 600 Washington Street
j, Boston, MA 02111
wivw.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Organization/lndividual): ��1 `r J Jt�1►�J
Address: So ): tht ( c- iJ k :Eaa
City/State/Zip: T.1�>n''a\/11-1..� �A LA%�Phone A: 5708-q-) 1_44 s ei s
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees(full and/or part-time).* have hired the subcontractors
2.�I am a sole proprietor or partner-
listed on the attached sheet. t Remodeling
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
officers have exercised their 10.❑ Electrical repairs or additions
required.] of
3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ 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' 11[5—OtherkAlt 1l0 'tc
COMP. insurance required.)
'Any applicant that checks box it I 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. n _
Insurance Company Name: soc4 ri, cRS
Policy#or Self-ins. Lic. #:w jWuur,-0_0 (cgc)t l Expiration Date: q
Job Site Address: City/State/Zip: M(�s HA—
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date)P;I�D4
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 D1A for insurance coverage verification.
1 do hereby ertify unde the pains and penalties of perjury that the information provided above is true and correct.
Si azure- Date:
Phone
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
( "n.l r-u�ti��n tiulicri i. r Offcce of Consumer Affairs&Business Regulation
l icense CS-014007 HOME IMPROVEMENT CONTRACTOR
Registration: 101149 _
vt ,..V�
Expiration: e/25/2014 TYPe
JOHN P DUNN = Individual
BOX 924180 MARIE W',
Centerville MA 0'2632 JOHN P. DUNN
John Dunn
c x pj lion 80 MARIE ANN TERR.
(:.r 05/25/2014 CENTERVILLE.MA 02632
Undersecretary
Unrestricted - Buildings of any use group %vhich
contain less than 35.000 cubic feet (991 m)of License or registration valid for individul use only
enclosed Space. before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Licensing information visit: www.Mass.Gov/DPS N valid without signature
I
I •
JHE Town of Barnstable
o
Regulatory Services
RAYNSTA B LE.
v MIS& � Thomas F. Geiler,Director
fob 16 Building Division
Tom Perry, Building Commissioner —
200 Main Street, Hyannis, MA 02601
war-w.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-623C
Property Owner Must
Complete and Sign This Section
If Using A Builder
L• Cf9�G��Z.ID, as Owner of the subject.property
hereby authorize�ct-h., (;),\,.Sj"�.-� to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
Signature of Own Date �0�1
J v�l �/ � • C'�rQ��loe� ,
Print Name
If Pro pea Owner is applying forpemzitplease complete the
Homeowners License Exemption .Dorm on "the reverse side.
1-,-4 yz--)z i BENCH MARK : S E-tF F_ 13 L JD
4_1 I- <Z /,:�4 'R
TEST HOLE RESULTS P#e ��
C2 Z- c C),)12__s -E .� 41/ 1("
DATE :
-X C_1-? _77/ rJ -7—V �i ;',x=Z_ 7.,F-jD 40 WITNESSED BY IV) c KtF-�,,v 3,4it,4- 43 . 0. 11
7- 0
Q
TEST HOLE TEST HOLE 7
TOP
21 s'j 13 's c3
-.4f n 03
E-4 C?
.s
cr _S7#49 -VIC>
7 Z, 10\/0 7 2"
-7 boo /y)
/,S 7-0,VR
\0 I 1 .S 7-CO
/ 000 -r-R
15 A!F;e V IF 4
,4
.49)Z 40
"OGROUND WATER &_QGROUND WATER
2. 4 ENCOUNTERED ENCOUNTERED
0
10 S NTO BUILT
0, ELEV. TOP OF MANHOL
W I T H IE A2"D
N COVER OF FINISHEDBE GRADE TO
FOUNDATION
FINISHED A GRADE MIN, 2 % SLOPE
4
4 D I A., 4 D I A." m�. . -r- 'i a - ,
PIPE FIRS 2" 1
7 MIN . 2" LAYER OF
PIPE : MIN. PITCH FT. 2' LEVE
20 ,
P E A S T 0 N E3 MlPITCH •0 ea.
J INVERT '/4/ INVERT
GALLON INVERT cn 03
7.6`0 / 07 14 w : D I A,
EPTIC TA D I S T
K INVERT BOX 07 0 u
FOOTING TO BE PLACED
INVER M-o WASHED STONE
w
INVERT
PL A C E 0 N k
ON A MINIMUM OF18" OF ALL AROUND
f -''" �---- cr&J�*vr_ tq VIRGIN OR COMPACTED FI RM BASEEDA
BOTTOM AT ELEV.
0,3.6
SAND 10 M I N.)
0 GARBAGE 2 0' MIN.) 4 (01
_J0 Z- ,L.-
GRINDER
�� 4" D I A. PERFORATED /r_/-/v/ 17 ELEV. Z. 0
DRAIN PIPE WITH 3/4" 1
TO IV2 ' DIA . STONE PROF LE OF GROUND WATER TABLE t3-mr4 'vv`
DIRECT FLOW TO SANITA.Ry DISPOSAL SYSTEM
( NOT TO SCALE ) D E S I G N DATA
9 CONSTRUCTION OF SANITARY DISPOSAL 3 - BEDROOMS
SYSTEM SHALL CONFORM TO THE MASS. DESIGN FLOW 3 3 2 GAL./lDAY
ENVIRONMENTAL CODE TITLE St' LEACH RATE !!f- 2- MIN./INCH
(REVISED 7- 1-77 ) AND THE TOWN
HEALTH DEPARTMENT REGULATIONS REQUIRED LEACHING CAPACITY : 330
0 SEPTIC TANK, DISTRIBUTION BOX AND LEACH- PROPOSED GA L/D A Y
ING UNIT TO BE OF REINFORCED CONCRETE , 2,,S- (3,,5- 7Y I •f)
MIN. CONCRETE STRENGTH a 3000PS.I. REQUIRED SEPTIC TANK /000 GAL.
MIN. STEEL STRENGTH a 20, 000 PS. 1,
MIN. DESIGN LOADING : 'H- 10 PROPOSED SEPTIC TANK : /000 GAL,
0 DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM
UNLESS H2O DESIGN LOADING IS USED
0 ALL PIPES AND FITTINGS TO BE WATERTIGHT -
AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE
SITE PLAN SHOWING PROPOSED CONSTRUCTION
ZONING DATA L E G E N D LOCATION : '23,,:4 je^1.5 7;,9.8 4 E_ 7-E 9 Viar) M AS S.
Z 0 N E : 0—SA-14 PA—r-Ar—/ _1?Ar Z 0"5- 2A TEST HOLE LOCATION 4- FOR : LEBEL- SOLLOWS DEV. CORP. DATE : :�Z-2 Zle-2
1431-S(00 REFERENCE . LOT AS SHOWN ON - REVISIONS :
REQUIRED AREA ' A /0,8 9,0'0' EXISTING SPOT ELEVATION 17.6 yA Of 'ac> PAGE /c7o
REQUIRED FRONTAGE OfO) 376 EXISTING CONTOUR _ _ 16— vxass -PLAN BOOK -4
CRAGREQUIRED FRONT SETBACK : PROPOSED CONTOUR 16 SHORT
ALE :
=
REQUIRED SIDE SETBACK : 7S" PROPOSED WATER SERVICE —W— CIV
. 2
REQUIRED REAR SETBACK ' PROPOSED GAS SERVICE G_ IST
011AL
PROPOSED ELEC. a TELE —E BT �fZz/��— C RAI G Re S HO R T , P. E .
PROFESSIONAL C IVIL ENGINEER
BUILDING INSPECTOR APPROVAL DATE- 131 OLD ROUTE 132 , HYANN IS , MA. 02601 FILENO. 1 - 617