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HomeMy WebLinkAbout0204 SEAPUIT ROAD y t I a 44 a r I tl i O y O "r Y 1' i': ,. � � _ f _ � �` f, _ �. _ ,� a 3 } �. _ 4; � _ _ _ - �� ,p f` -. ..N _ _ .. - � .. --c _ � � to - 7 - _ _ '� _ - - 1 '� - _ _ c - 4 o c [ _ - _ _ _ f. o - _ __ op E', a _ _ _ _ .._ _ _ c ...y r_. -. _. ... _ - . 11el &44 Town of Barnstable OF WE , Building Department Services Brian Florence,CBO • r aAexsresM Building Commissioner ass. $ i679• 200 Main Street, Hyannis,MA 02601 CEO Mfd www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# 35.0 FEE:_I G 1 $ O p SHED REGISTRATION .Z RESIDENTIAL ONLY 200 square feet or less �'- ! LL'e � n Location of shed(address)V Village `u p Property owner's name Telephone number Size of Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) 2y� Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg j r REV:08i6i17 /#�2 /t J ,vn f�S soGr 47'£SCG (off sT i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION x Map Parcel V y` Application# 0v -76 0 Health Division Conservation Division _ Permit# Tax Collector Date Issued (62 1 0-7 Treasurer Application Fee Planning Dept. Permit Fee ? Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village 0� /r--7zlv I Owner Poor z Address Telephone S e7 # Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new,2405 4= Zoning District Flood Plain Groundwater Overlay Project Valuation ®®EV Construction Type �°.� 5'�4A-?'Y kv-3r d 4 •Pa=f2_49167 Lot Size qq. 3eo Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure /-4o4 • Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other A^.4-• Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing /V`1A new Half:existing new Number of Bedrooms: existing mil+" new Total Room Count(not including baths):existing I"'1A new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other /tt'/ol- Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑% ❑No Detached garage:❑existing O new size° Pool:❑existing ❑new size Barn:❑existin ❑nesize Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: 21 C Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review# r� N Current Use Proposed Use cn rn BUILDER INFORMATION Nam es Q�0001-M-70';% phone Numbe-r-70t '7 4� Address74.44C- r�L � License# Home Improvement Contractor# Worker's Compensations# 4,zooN-7-7e oA2-2 56® ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO MAi-f, SIGNATURE - �- ATE S7r45 /©�-9 a _ $~ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER y DATE OF INSPECTION: FOUNDATION FRAME INSULATION 'FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING '- DATE CLOSED OUT ASSOCIATION PLAN NO. r ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' + d 600 Washington Street Boston,MA 02111' www.mass.gov/dia ' Workers"Compensation Insurance Mfiddvit: lBuUders/Contractors/Electricians/Plumbers Aplplicant Information Please Print Le ibl Name(Business/Organization/Individual) Ad _dress: 1V s, City/State/Zip' Z b A Phon Are you an employer? Check the appropriate box: :Type of project(required):. 1;09 I am a e loy er with 4. I am a general contractor and I 6. ElNew construction . •employees (full and/or part-time),* • • have hired•the sLtb-contractors 2.❑ I am a'sole pioprietor or partner- listed onhe'attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity employees and have workers' [No workers' comp.Insurance comp,insurance. $• 9. []Building addition 5. ❑We are a corporation and its 10. Electricalrepairs or additions required.] officers have exercised their 11•❑Plumbing repairs or additions ' '3.❑ I am a homeowner doing all-work . myself.[No workers' comp.Z right of exemption per MGL 12•❑Roof repairs insurance,required.]t c. 152, §1(4), and we have no o workers' 13.❑ Other employees,. �r. comp,insurance required,] *Any applicant that checks bon#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractor send state whether or nottbose.entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site* information. Insurance Company Policy#or Self-ins.Lic,# 01,zzo - � Expiration Date: 6>77 ?ob Site Address: _ _ City/State/Zip: Attach a copy of the workers' compensation policy.declaration page'(showing the policy number and expiration date). Failure.to secu.e coverage as requured under Section 25A of MGL c. 152 can lead to the imposition of criminal penal ies of a Lne 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 Tne of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the.Office of Lvestiaations of the DIA.for insurance coverage verification. ' I d2M. 1- certify under the pains-and penalties of perjury that the in fortration provided above is true and correct. Si Date: -% 7 �-7 4 . i �! Official use only. Do not write in this area, robe completed by.city or town afjicial + City or Town: .Perr�t/License F IIi 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#: l Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to+ statute, an employee is defined as"...every person in the service of another under any contract of hi1e, express or implied, oral or written." An employer is defined as "an individual,partners'nip,'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,paitriership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three aparhnents 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." Mbf 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 comnontivealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable ma denee-of•complmce.yit -'flie insLance- 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-contlactor(s)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-hmiranwlicense number on the appropriate'line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Departnent 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 necessity)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 future permits or licenses. •A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related 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:. . - ���€�zr .a��e�lt�€�f�Iass�c�t�s�tts • D-,Partment of Inc strial kr-ddeats Qface of Invest galtaus 60G Washingto iStreet Bo4ca,.1A 02111 TO.#617-727-4 e)d 406 or 1-377 MASSAFE Fax#617-727- 749 Revised 11-22-06 WWW.mampv1dia . 1 Town-of Barnstable yP °� Regulatory Services ' Baxr�sTnere, II � .MASS F.Geiler,Director � g, 16.59..,a`` Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION i MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modemization,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: ® � Estimated Cost f Address of Work: Owner's Name: Date of Application: �<FJ1 0 -7 • ,,. . . . .. . Ihereby certify`that: . . . . Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name QAnns:homeaffidav Town of Barnstable. Regulatory Services t B' au sew'$ Thomas F.GeRer,Director �AIFn 59. A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www-town.barnstIWe.maxs - Office: 5 08-862-403 8 Fax: 5 08-790-62 3 0 I Property OwY er Must Complete and Sigh This Section If Using A Builder i as owner of the subject property hereby authorize �/1✓L �Z act on my behalf, in all matters relative to work authorized bythis building permit application for: . (Address of job) `ignature of Owner ' Date 1 Print Name I i I QFORiY?S:0'ddNZR?ERMISSTON, i RightFax Norcross 12/5/2006 1 :24 PAGE 004/004 Fax Server F233 :: ., . OAT \DD E(MM ) IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE STERN INS GROUP LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST CENTRAL ST COMPANIES AFFORDING COVERAGE NATICK MA 01760 COMPANY A INSURED COMPANY HOMESTEAD PROPERTIES INC B 764 PLAIN STREET COMPANY MARSHFIELD MA 02050 C COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTA DATE(MM\DD\YY) DATE(MWDD\YY) GENERAL LIABILITY GENERAL AGGREGATE g i COMMERCIAL GENERAL LIABILITY PRODUClS•COMP/OP AGG. g CLAIMS MADE F—�OCCUR. PERSONAL 6 ADV.INJURY g " OWNER'S 8 CONTRACTOR'S PRO7. EACH OCCURRENCE g FIRE DAMAGE(Any one fire) g MED.EXPENSE(Any one person) g AUTOMOBILE LIABILITY COMBINED SINGLE g LIMIT ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) g HIREDAUTOS BODILY INJURY g NON•OWNEO AU70S (Per Accident) PROPERTY DAMAGE g GARAGE LIABILITY AUTO ONLY-EA ACCIO ENT g ANY AUTO OTHER THAN AU70 ONLY: ............. EACH ACCIDENT g AGGREGATE g EXCESS LIABILITY EACH OCCURRENCE 5 UMBRELLA FORM AGGREGATE g OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND STATUTORY A `.ti EMPLOY ER'SLIABILITY (UB-778OA22-5-06) 07-01-06 07-01-07 EACH ACCIDENT g..... THE PROPRIETOR/ INCL DISEASE—POLICY LIMIT g PARTNERS/EXECUTIVEROFFICERS ARE: EXCL DISEASE—EACH EMPLOYEE g500, OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIRESTRICTIONSBPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ;A C£�TrA 0 'stC �l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ATTN: BUILDING DEPT LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR MAIN STREET LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. BARNSTABLE MA 02630 AUTHORIZED REPRESENTATIVE ADO .7 ,. . ...._.... ......... :......,. ..,..:.,:.... ....... ........:.:.... { � N 1 BOARD OF BUILAINo�EGU� r License: CONSTRUCTION SUPERVI SOR Number:�ES, 006689 • Birthdate,Qfi%ZA-M,940 EXpire§�OQ21/pp �$ Tr.no, 28344 Re 'tric.CeQ p DAVID T GREGOn. t PO BOX 1063 I OSTERVILLE, MA 02655 �/..e` G` Commissioner Board f Bomvin°'zu`e �✓ p�z . of Building Regulations and 3tandar�ig. ! NOMs IMPROVEMENT CONTRACTOR Registration g21066 Expiration - "=TYPe -41 Pcia e Corporation STEAD PRppERIESaIN_(' i�: I P.AViD GF EGORY 764fv'ARSHFIELD• MA 0205`0 DeputvAdminish: for TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map�g Parcel Application Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer - Application Fee s� Planning Dept. Permit Fee U Date Definitive Plan Approved by Planning Board 1 7 10-7 Historic-OKH Preservation/Hyannis Project Street Address Sew_Ftii ATE Village7'Z`�� Owner � lZ 'r"oFZ7 Address Telephone Permit Request 4 G d!/T> (o yr Odl �X_� ,rX�Vdat. ��t�t _ Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2 We Construction Type e//_C--00 � z 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 ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) j Number of Baths: Full:existing new Half:existing i new Number of Bedrooms: existing new , Total Room Count(not including baths):existing new First Floor Room:Count 'r E > Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: Q;Yes r'❑No Detached garage:❑existing ❑new size Pool:�ng ❑new size/ Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: rZoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# 'Current Us_e�c9 Dc*7,*t � �y n Proposed Use 54 Alv A9we SF--,W/ BUILDER INFORMATION Name SO4T* S[100C Uk j pUU�s Telephone Number 6220 Address 7 �/1dli.C�SS �y'� License# Home Improvement Contractor# _ �Ar,0 Worker's Compensation# I l d J 2 ALL CO U,,TION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��E55 !/G i � ifr ems SIGNATURE DATE A FOR OFFICIAL USE ONLY Y PERMIT NO. r J {� DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER J ; DATE OF INSPECTION: 'FOUNDATION J ;. FRAME P60L -STeCL Ca d 1 d& r' y _ , r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 1 �. { :PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING Q ? 11?11 Z - r' DATE CLOSED OUT ASSOCIATION PLAN NO. ol t 1 I The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations. 600 Washington Street Boston,MA 02111 ° . °, �•J www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly .Name (Business/organization/In&vidual): Address: City/State/Zip WM.r FOyi-) ftA- 602 q Phone#: �Gyy' �GgIS Are you an employer? Check the-appropriate box:. Type of pr 'ect(required):- 1.LT 1 am a employer with �� 4. ❑ I am a general contractor and I 6. ew 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. x 7• ❑ 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 10.❑ Electrical repairs or.additions required.] officers have exercised their 3.❑ 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' . 13.❑ Other s 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 anew 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'compen Wion insurance for my employees.'Below is the policy and job site information. Insurance Company Name: 7i &f—t eA LTA Policy#or Self-ins.Lie..#: Expiration Date: Job Site Address:npy E74'��� T�i�l£ 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$1,50Q.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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under a penalties of perjury that the information provided above is true and correct: Si atnre:. Dater - �7 Phon Official use only. Do not write in this area,to be completed by city,or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. f 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 individuat.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. Howe-yer 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 woik-on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152;§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence.of compliance with the 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 retuned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. 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 permitllicense 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.future permits or-licenses..A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office.of Investigations would hire 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'WashingEon Slreet4 . . r Boston,MA 02111 r Tel. #617-727-4900 ext 406 or I-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/dia r ftf1E, Town of Barnstable Regulatory Services S anruvs-r,►Bi E ' Thomas F.Geiler,Director y asnss. � 1639.la`0 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 Permit no. i Date I 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; �W1 &$A ►� L Pl G ��` Estimated Cost 2S �� Address of Work: 2� Owner's Name: �� Date of Application: 3 ��'--— 07 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied []Owner pulling own permit j 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. i SIGNED UNDER PENAL S OF PERJURY j I hereby apply for a permit as the agent of o er: Date ontractor Signature Registration No. OR Date Owner's Signature i Q:wpfiles.forms:homeaffid av Rev: 060606 I Town of Barnstable �P�aFt�'Owti { Regulatory Services • BABNSTABM ss, �,, Thomas F.Geiler,Director s6;9• �0 �'"rEo w►�.+° Building Division; Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , f r I i Vyt2o , as !Owner of the subject property hereby authorize 5e3"rtl 5 tl0 V-£ C-4k(T�-- Rk e►voeT to act on my behalf, in all matters relative to work authorized by this buildingpermit application for: (Address of Job) Signature of Owner Date Print Name r I j r I Q:FORM&OWNERPERMISSION ' i 7 License or registration valid for individul use only ✓0fie �io��irnu�ziuea/l/ a��ac/auaett before the expiration date. If found return to: Board of Building Regulations and Standards Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR One Ashburton Place Rm 1301 Registration: 105485 Boston,Ma.02108 Expiration: 7/17/2008 Type: Supplement Card SOUTH SHORE GUNITE POOL& PR -AkD BENOIT 7 Progress Ave. Not lid i t signature _ — Chelmsford,MA 01824 Administrator T�-.»omvnzahuieall��,�oaac/u�aelta Board of Building Regulations and Standards Construction Supervisor License License: CS 56174 Birthdate: 3/16/1945 Expiration:. 3/16/2009 Tr# 10990 Restriction: .00-' RICHARD E BENOIT 54 CUSHING HILL RDA- ''�`" NORWELL,MA 02061 Commissioner r At-UtU t.tK 111-1t.A 1 t Ur LIAbILI 1 T IIVJUKAIV%..c 04/02/2007 P+RooucER (603)432-3666 FAX (603)432-6076 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lakhside Ihsurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR One Nall Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Windham, NH 03087 INSURERS AFFORDING COVERAGE NAIC 8 BMSURED South Shore Gunite Pool & Spa, Inc. m FtmA. Acadia Insurance 31325 7 Progress Avenue INwFERB: Technology Ins Co Chelmsford, MA 01824-3606 INSURMC: INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE:8'EEN 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. MSRADM TYPE OF 04SLMANCE• POLICY NUMBER POLICY EFFECTIVE POLICY E04RAMN LMITS GENERAL LIABILITY CPA014582511 04/01/2007 04/01/2008 EACH OOCURRENCE $ 1,000, X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 2 S0,00 aAMi MADE a OCCUR MED EXP(Any are person)- $ 5100( Alf:� PBtSONAL&AM INJURY S 11000 GENERAL ACXM;EGATE S 2,000,00( GENL AGGREGATE LIMIT APPLES PER PRODUCTS-COMPIOP ACC'' S 2,000,00( POLICY JPROT LOC AUTOYOBRF LIABILITY PM017724810 64/01/2007 04/01/2008 COMBINED SINGLE LIMIT s ANY AUTO (Ea Cockles) 11000,000 ALL OWNED AUTOS BODILY aiIURY X SCHEDULED AUTOS (P-Peen) S A X HIRED AUTO I BODILY IN.IURY X NON-OWNED AUTOS (� ) $ PROPERTY DAMAGE S (Per 8-dat) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AM S EXCESSIUMBRELI A LIABIJTY CUA017913810 04/01/2007 -04/01/2008 EAcH ocamw&NcE s 11000,00( x OCCUR CLAMS MADE , AGGREGATE $ 1,000,00( A $ DEDUCTIBLE s RETENTION $ s WfORI ERS COMPENSATION AND TBA 04/01/2007 04/01/2008 we s A, OER TH- emPLOYERs LIABILITY E.L.EACH ACCDENT $ 11 000, B ANY PROPRETORIPARTNERExEaR1VE OFFICER/hEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 1,ON,00( ayes,des«M)e ewer SPECIAL PROVISIONS babes EL DISEASE-POLICY JMI7 S l,000, OTHER BE9CRETIDN OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Covering the installation of swimming pools and related operations of insured during the policy period. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DOXIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS wwrm NOTwE To THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FARIIRE TO VML SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER.ITS AGENTS OR REPFE..EN ITATMES. AUTHORG"REPRESEN(ATM loseph Rossetti/GARGA ACORD 25(2001M) QACORD CORPORATION 1988 I y 1 TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 095 021 GEOBASE ID 4473 ADDRESS 204 SEAPUIT ROAD PHONE OSTERVILLE ZIP — I' LOT 14 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO t PERMIT 85316 DESCRIPTION SIN FAM/5 BDRM/ATT GAR/#721.05 PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS:ARCHITECTS: Department of Regulatory Services TOTAL FEES: $25.00 BOND .00 CONSTRUCTION COSTS $.00 J f 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE * ■ARNSTABLE, : t P MASS. r � 03 �FD MA'S A BU ISION BY P DATE ISSUED 07/08/2005 EXPIRATION DATE-,- o...� _----------- ------- - - -- ---- ' TOWN OF BARNSTABLE PERMIT EXTENSION GRANTED - EXPIRES 10/07/2004 - I PARCEL ID 095 021 . GEOBASE ID 4473 ADDRESS 204 SEAPUIT ROAD 4 PHONE OSTERVILLE ZIP _ LOT 14 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 72105 DESCRIPTION SIN FAM/5BDRM/ATT GAR PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT CONTRACTORS: DAVID T. ' GREGORY De artm ARCHITECTS: . ; PERMIT EXTENSION GRANTED p entof Regulatory Services TOTAL FEES.:. . $1,816.44 BOND $.00 �tME CONSTRUCTION COSTS $542,400.00 101 SINGLE FAM..HOME DETACHED 1 PRIVATE 0 * BARN9TABLE, w I ! KAM 39. BU ON BY DATE ISSUED 10/08/2003 EXPIRATION DATE . i - 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 i PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU ELECTRICAL,PLUMBING AND MECH- G (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. b . � , . � - e - BUILDING INSPECTION APPR VALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 z-Z [ 2 �...dZ1� 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I � j 2. .57 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 i 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. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map © < Parcel= 0I;;� Permit# U . Health Division 2�3" b�, 9 2y o3 8D.04 �'�L y Date Issued Conservation Division e-79e Fe 141 .4 Tax Collector 4/f9/o,;� 4/ C� M MUST BE' Treasurer I `5� � WSTALLED IN COMPLIANOS Planning Dept. NlA WITH TITLE 5 EWRONfMENTAL CODE ANt Date Definitive Plan Approved by Planning Board Now• I TOMM REGUUTIONS i 111 ' 1 +I Q 5E Historic-OKH Preservation/Hyannis 9/2 SW, Project Street Address 226 ' Village Owner �' (Address 7 1� rvqfo�!ry Telephone I , Permit Request ►q lfu s-.• z- ( �R VV1 (, r Square feet: 1 st floor: existing proposed� nd floor: existing proposed ��' O Total ew �0 I rrj Valuation Zoning District Flood Plain Groundwater Ovrz"lay Construction Type %� z Lot Size '72.2 ACV-CS !L! Grandfathered: Cl Yes ❑ No If yes, attach supporting do( umentafion. N) (- Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) M M Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes XNo Basement Type: KFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new 7- Number of Bedrooms: existing _ new G Total Room Count(not including baths): existing `—` new First Floor Room Count Heat Type and Fuel: O Gas ❑Oil ❑ Electric ❑Other Central Air: Yes ❑No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes V No Detached garage:❑existing ❑new size Pool:❑existing O new size Barn:❑existing ❑new size Attached garage:❑existing new size ghed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes K-No- If yes, site plan review# ' Current Use Proposed Use �1 BUILDER INFORMATION a Name Q Telephone Number'- 0 �� Address 10 � -1N License# AV 1� Home Improvement Contractor# 16_1?/Dui/% Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTIN FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ti r FOR OFFICIAL USE ONLY PERMIT NO. x DAUB-ISSUED MAP/PARCEL NO. Hr ' ADDRESS VILLAGE OWNER. , $ DATE OF INSPECTION: ` FOUNDATION mo 3, FRAME INSULATION �� �'�'Z1241,64 � FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL } . GAS: ROUGH FINAL ?' FINAL BUILDING�)� �" d to ., DATE CLOSED OUT = ASSOCIATION PLAN NO - e ' d i } The Commonwealth of Massachusetts Department of Industrial Accidents t' 0xce 9110YCStiffaff DS —' 600 Washington Street Boston,Mass. 02111 Workers'ICom ensation Insurance Affidavit name: I - location: ' t3hane it city ❑ I am a homeowner performing all work myself.' ❑ I am a sole rietor and have no one worlds is anv capacity din workers' easatioa for my employees working on this job.:: X. "'v n am n a�com ..::::::....... :..... ......::::... .................... ::i;} '' :;.r:>:?:teas?»}>s:<:.?• ..... ....::::...:::... :.:...... • :::'.:::.:;>:::<:::>•:::>:>:::<:::; ;>:.}} Bane :.... ��-�•;'#�:isi:;:ii'/.>::? ?.isf:S:�iij;vi:i�ii:�:�i:''iY,:!:;;is i':::}i};^:i:'�ii:i$:ii ii`:;'r:2::;:;:;:j;:;:::�i:;iii::� •����'�t.Q:;:'�':-:.�.�',:'•:',';..i:Ji}:;i:: f:;:;ii.j:,;:;jG:i`i'i:i::�iiii'�i:;�ii?'�ii: n�iirani:e I am a ,generak contractor, (��orse)sad have hired the contractors lid who dmdghming offers'co msation polives: ..........:.. .. .. ..ti:.;:::: ..::.:........ :.. .::: . :.<: cum an < :: :di{Te •i:•a 3:.........:.... ......................................................... ...:w:•.............. .............. ,,. }.w.:•}}vv::;....n...... :: :: is ..:. , ...... ............ .................::.::::•::::::}:.}:-i:-;:.}. .. .::.;}:.;:.;:.:?:..:::.:......:::.:::::.::::::.. lion :: ....,::::::.....:::::.... ............. • iw� ::::::::::::.......... :... •:;;•ii... .......4:•iyy::;::::r::..::... n...... ................... ::4?:isi>ii::iiiiii•'.'•t.::•i:?-is4:i�:T: :ii:4`S:.S.}y:::::::::.::::.1:::.y:::::::::.�:.y::::n............... ::t::::S::w:......::::::::......:............................... w::::::iri::.i.:.:}ii::Qi:}:CF}j?:;}ii>:ti t}ii i•ii}t}:•l:;v: ::.::::.i'.. .................................:.,:w:::::::::::.� w:::..v::.....:::::::::::::::::w::nv:i:::::::::::•. x:.v..... ...:.. ..............:::w:::::::•i:;ryiii::::::::.�n�:::::.^:::::•nd.v::::}%vim.....::::::::: -::::'r'•it}vC;:::n;{•tit::.. ....::::::<::::v::;;;.::n....;....n.:..::.,;.:::... ....: ....... ..... ::.:........... ...i}itti:•ti :;:!vr:iiti}i}}}i}`::::::::.....::w: i:: w::4iiA-:::::::.:..}...,..............::•:...:...........::...:.., n am a difiei ry:::.i. ....T.?^ii:':�i::i;::i:::<ii:Ci?:vii:;i�ii:''<:ij:;;:'ii:fj;<:ij;::;i:;:;i:!:iJi:i:C%.;..S�: .'' -.':::v: ..... :::..::.::::?.i;.}:.�:.;;.::::''.i:::::.:iiii::::i s iiiii r::;4i:::iiriiiiiii::^%::ii:iiii:iiiii:lii:ii:-:ii v'}:............ .......::::::::::.�::.tit::::::::::::;•:::::::: ... ..n.:•}}i}ii: :;:j;;}w:::}............}4%...... :::.::::::.�:.............w:.............. v::3:v}'i}:;•:•it.:::::::::;•ttiti:•t;.}:}.•:•wn t.w:x .......vjt^t:4iii...........�... ......................................................... .............r.uzxw::::::: .ti'4'fiiiti:L�ti$i}$ilY::;:;;;{:;4::.....• ............ ::. ................ .............................................................................................. ::.f:•'::vttt}:;}}t':.t':n-:-:::i::::.v.vn..::•?•;;:.....:..:....... ..,:v: ..........................'v ` iiiii$iiiiiii:'viivi:L;:;:::ii:v......v:::ti;i:;iti :-iii:i'.;4iikL}}}::..�::•1 a.'•':.•.:'.••:'.-...:'-}SD:?-0:Cilt:::!}:'.... hw.....::-y:r.......v:-•:v'^h:'t.:..:.v:.•r:v.......•.:....................... .. .:::n:.::::w::::v..X.n.a:G.?.:n.:tt.:::t.. .:•..................... ^. .. iiii:�?F;iiii: ::: ::i::.;'.5....::ii:k}v>::?i+{:;:;�:::i::::i::}iy:;•i::i:.}itii}i'y`yi}}:t::•5:::..•:v. II]IITaIICe:CO. der Section Failure to seems coverage as requited en ZSA of MGL 152 ran lead to the impt a of criminal penalties of a Sae up to si em.o0 and/or one yam,haprhoruncat as well as civil penalties in the form of a STOP WORK ORDER and a roe Of 5100.00 a day agaia+t me. I tmdetstand that copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage vetifleatlna I do hereby certify under the pairs mid penaltiet of pedury that the utfornsadon provided above it tnu and correct O Signature Dam d A 6" Print name ,� � Phone d"M q�'l G- otnCW toe only do not write in this area to be completed by city or town official t peratitilicense 0 • 3Btdlding Depart city or town: ❑Livening Board 0s l conen's Office. ❑cheek if immediate response is required ` ❑Health Department contact person• phoney; _ ❑Other �rnam 9M PIA) ' I 1 I i I Information and Instructions ` + for th�ir Massachusetts General Laws chapter 152 section 25 requires all employe�to Pm the service workers of another under any ca= employees. As quoted from the"law", an employee is defined as every person of hire. express or implied. oral or written. An emplot�er is defined as an individual, partnership, association, corporation or other legal entity, or any two or more : c the foregoing engaged in a joint enterprise, and including the legal representatives o to e let the owner of a` trustee of an individual, partnership, association or other legal entity, employingaf! Yees Howe dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who emplovs persons to do maintenance,construction or repair work on such dwelling house or on the grounds 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 isasu nce o r renew truct buildings in the commonwealth for any who h of a license or permit to operate a business or to cons pp 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 urm, have been presented to the cO11U,�;n_ acceptable evidence of compliance with the insurance requirements of this chapter authority. //%///////%////%//%/%%%/%/O/%�%�%///%/ IN Applicants - Please fill in the Workers',compensation affidavit completely,by checking the box that applies to your situation and all affidavits may supplying company names,address and phone numbers along with a certificate'of insurance as Accidents for ccmfirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial . or town that the application for the permit or license is date Ehe affidavit. The affidavit should be returned to the city have an ors being requested,not the Department regarding the"law"or if c of Industrial Accidents. Should you at number listed below. are required to obtain a workers' compens ation policy,Please call the Department �.., City or Towns printed legibly. The Department has provided a space at the bottom of Please be sure that the affidavit is complete and p ors has to contact you regarding the applicant. PIe:se affidavit for you to fill out is the event the Office of Investigate num_ber. The affidavits may be r=jci a 1^ be sure to fill in the permit/license number which will be been made the Department by mail or FAX unless other arrang 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. FEE The Department's address,telephone and fax number. The Commonwealth Of Massachusetts : Department of Industrial Accidents Office of Inyesugatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 717-7749 ` phone #: (617) 727-4900 eat. 406, 409 or 375 r a, RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 ' Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= 2 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.ft. >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 building permit: square feet x$96/sq.foot= x .0031= STAND ALONE PERMITS Open Porch x$30.00= p (number) Deck _I x$30.00= U (number) 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) / .2 4 , 4 i( Permit Fee 'T projcost t .Affidavit of Substantial Financial Inte st of on oath depose and state as folio S. / '" ' . C � caip0,9 �� �s1) 1. 1 am an applicant for a building permit for the property located at M � arch e The address of the property is 20 2. 1 have 0 o %.legal or equitable interest in the real property which is the : �, subject of the building permit application which is identified in paragraph 1 above. ' �' o� ° , 3. Within in the last twelve months from today's date, which is the following individuals or entities have had a 1% or greater legal or equitable interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above: Name Address. 4. Within the last twelve months, from today's date, which is �/° ` I have had. a 1% or greater legal or equitable interest in the following properties which have been the subject of a building permit application: Map/Parcel Address. 5. Within this calendar year, I have submitted building permit applications for property in which I have a 1% or greater legal or equitable interest. 6.. Within the last ten days, I have submitted building permit applications for property in which I have a 1% or greater legal or equitable interest. 7. Within this month, I have submitted building permit applications for property in. which I have a 1% legal-or equitable interest. 8. Within this month, I have received building permits for property in which I have a 1% legal or equitable interest. Signed under the pains and penalties of perjury, this _ day of Ste, 200_. 1 . 2001-0050/affin Q/LOTTERY/AFFIDAVIT P�tME Tp��� The Town of Barnstable SARMASS. a, l. MASS. , Department of Health Safety and:Environmental Services 9 eS �p $659. �0 Tfo►��' Building Division 367 Main Street,Hyannis,MA 02601 office: 508-862-4038 Fax: 508-790-6230 ,1. PLAN REVIEW Owner. 4Y u S� Map/Parcel: O� S - 0 2 ( A'`-'� Project Address: 20 4 S Q4 U Builder: The following items were noted on reviewing: 1�r� vn �r � o _ Y J�6U ,iv � e r { Reviewed by: Date: q:bu it ding:forms:review ' A I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code' I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 9-23-2003 DATE OF PLANS: 9-10-03 PROJECT INFORMATION: 204 Seapuit Rd Osterville, MA COMPANY INFORMATION: Homestead Properties Inc. COMPLIANCE: PASSES Required UA = 1248 Your Home = 1168 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 5710 30.0 0.0 201 WALLS: Wood Frame, 16" O.C. 5286 13.0 0.0 435 GLAZING: Windows or Doors 500 0.360 180 GLAZING: Windows or Doors 192 0.410 79 DOORS 53 0.360 19 DOORS 20 0.270 5 FLOORS: Over Unconditioned Space 5230 19.0 0.0 248 HVAC EQUIPMENT: Boiler, 85.0 AFUE HVAC EQUIPMENT: Air Conditioner, 12.0 SEER ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code, The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 9-23-2003 Bldg. 1 Dept. 1 I Use I I I CEILINGS: [ J I 1, R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] ( 1. U-value: 0.36 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location [ ] 1 2. U-value: 0.41 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ j Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U-value: 0.36 I Comments/Location [ ] 1 2. U-value: 0.27 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned "Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Boiler, 85.0 AFUE or higher I Make and Model Number [ ] 1 2. Air Conditioner, 12.0 SEER or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I 1I VAPOh RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, 'and floors. I I MATERIALS IDENTIFICATION: [ J I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating and I cooling equipment efficiency must be clearly marked on the building I plans or specifications. DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions, Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I ' I HVAC EQUIPMENT SIZING: [ l I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I ( ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I ' [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : I , I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-l" 1.25-2" 2.5-4" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ l I CIRCULATING HOT WATER SYSTEMS: 1 I Insulate circulating hot water pipes to the following levels (in.) : I PIPE SIZES (in.) I LION-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 1 100-130 0.5 1 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- 0 j y BOARD,QF BUILDING REGULATIONS i i cense CONSTRUCTION SUPERVISOR < ' Numbe 006689 ;►i. da4—��6721T'9.4.Q Tr.no: 252 Resit e. DAVID.T GREGO ' PO BOX W63 OSTERV , MA OZ ILLE 6 5r'" Admtnidrat-or �. - . . .. . . . .. ... Board of Building Regulations and Standards HOME IlV?ROVEMENT CONTRACTOR Re ista 21066 — —rt =4/ 0:6 a - _ ,.;04 ate Corporation HOMESTEAD,P DXVID REGO 764 PLAIN ST " --<. MsltI�VA,0.�� - Adm nt' 't r ®, 6 IWestern Suret ' Com an n �• d r � d 6 d p d LICENSE AND PERMIT BOND o , e F For County, City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, ; 6 Performance,Maintenance,Subdivision,Agent to Sell Hunting and'Fishing Licenses or Utility Guarantee Bond. d 6 I d KNOW ALL MEN BY THESE PRESENTS: ! BOND No. L&P- 4 3 O 3 9 3 O 1 That we David Gregory I Ai I& G of the Town of Osterville State Qf Massachusetts , as Principal, d and WESTERN SURETY COMPANY, a corporations duly licensed to do business in the State of Massachusetts , as Surety, are held and firmly bound unto the Tftwila of Barnstable , State of Massachusetts , Obligee, in the amount (Valid only when a County,City,Town or Village is named as Obligee) of Five Thousand DOLLARS ($ 5,000.00 ) (NOT VALID FOR MORE THAN$25,000) lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives; jointly and severally. THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has been licensed street permit bond 204 Cotuit Road Cotuit, MA 02635 by the Obligee. NQW ,pTEFORE, if the Principal shall faithfully.,perform the duties and comply with the laws and ord is ces,,(kicludi-67g all amendments), pertaining to the license or permit, then this obligation to be void, h othMw se to rematti sin full force and effect for a period commencing on the 24th day of � ft`t�►� ��►':�,� September 2003 and ending on the 24th day =W �- ep: e per 2004 ' , unless renewed by continuation certificate. � hi bon ay,berterminated at any time by the Surety upon sending notice in writing to the Obligee and to thp�Principal, 1h,ca{se�oof the Obligee or at such other address as the Surety deems reasonable, and at the expira- �p �tl ty,� ' (315) days from the mailing of notice or as soon thereafter as permitted by applicable law, whichetserdisj�ate-r,this bond shall terminate and the Surety shall be relieved from any liability for any subsequent acts or omissions of the Principal. I Dated this 24th day of September + , 2003 • � Principe David Gregory Principal Couiktersigned. W E S T E R SURETY CO A N Y f By By , o 6 esident Agent - ` President p ° c A KNOWLEDGMENT OF SURETY STATE OF SOUTH DAKOTA 1 (Corporate Officer) F County of Minnehaha f ss s G On this 24th day of September , �003 ,before me, the undersigned officer,personally p appeared Stephen T.Pate ,who acknowledged himself to be the aforesaid officer of WESTERN u SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing instrument for the purpose therein contained,by signing the name of the corpo ion by himself as such officer. ; IN WITNESS WHEREOF, I have hereunto set my handl and officials ; 6 ' J. RHONE NOTARY PUBLIC �� s$"n SOUTH DAKOTA sL cIY4otary Public, South Dakota My Commission Expires 6-12-2004 Western Surety Company • 101 S. Phillips Ave. r Form 849.A—12.97 SiouxlFalls, SD 57104 • 1-605-336-0850 it I i 6 ACKNOWLEDGMENT OF PRINCIPAL 6 i F (Individual or Partners) STATE OF ' •{ 6 'J 6 J 6 ss ° Y County of ° R ° a On this day of ,before me personally appeared n ° 6 I 9 l n ° P , F , Y 6 6 known to me to be the individual_ described in and who executed the foregoing instrument and n G 6 acknowledged to me that_he_ executed the same. y My commission expires Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) STATE OF ss County of On this day of ,before me, personally appeared , who acknowledged himself to be the of , a corporation, and that he as such officer being authorized so to do, executed the foregoing instrument for the pur- poses therein contained by signing the name of the corporation by himself as such officer.. My commission expires Notary Public ti n T p P 1 Q n p f P a P 4� 1 p n v Cd 6 v U a P v n P O p FM P z z z 0 f• c� a _ Nce d L O ' F-1 Y n ^` W 9 > w o U R a a o G4 -� P , r� "A,.$BP-24-0.3 10:47am From-BARNSTABLE REGISTRY 5083625065 T-039 P.01/04 F-932 �:•c:698. 7,95 t�: �]w�..''✓Ta:I�L �...1� t..JJ�►- a,ii,•i�fc 1 NATHANAEL V. DAVIS, THOMAS H. P. WHITNEY, JR., and JANiES HOWARD DOW DAVIS, TRUSTEES OF NAVIDA TRUST, under a Declaration of Trust dared December 30, 1976 recorded as Document 224,837 in the Barnstable Registry District of the Land Court, of Osterville, Massachusetts, for consideration paid and in consideration of SIX HUNDRED SEVENTY-FIVE THOUSAND AND 001100 ($675,000.00) DOLLARS, grant to DAVID T. GREGORY, TRUSTEE HOMESTEAD REALTY TRUST under a declaration of trust dated December 31, 1997 registered in the Dwnstable Registry District of the Lend Court a Document No. 841205, of 1343 Main Street, Onerville, Massachusetts 02655, with QLXrCLAIM COVENANTS, a certain `! parcel of land situated at 204 Seapuit Road in the Village of Osterville in the Town and 1 County of Barnstable,Massachusetts and shown as Lot 14 on Land Court Plan 5725-2. °i No fee in Bunker Hill Road is hereby conveyed. Said land is subject to and has the benefit of the rights,easements,privileges, :i restrictions and agreements set forth or rcf r ed to in Certificate of Title No. 1858 so far as the same are in force and applicabie. Said land is also subject to and bas the benefit of the rights, reservations casement, agreements and restrictions set forth in Document No. 76,823 said agreements and restrictions unless released,modified,amended or waived,shall remain in force for a period of fifty(50)years from January 1, 1960. Saud land is subject to and has the benefit of the tights and resmctions set forth in Document No. 188,976_ For title see Certificate of Title 70178 issued by the Barnstable Registry District of this Land Court. THE UNDERSIGNED TRUSTEES HEREBY WARRANT AND REPRESENT .� THAT THE NAVLDA TRUST SET FORTH ABOVE IS STILL IN FULL FORCE AND EFFECT,HAS NOT BEEN AMENDED IN ANY WAY,THAT THE BENEFICIARIES ARE OF FULL AGE AND ARE NOT UNDER DISABILITY, AND THAT THE TRUSTEES HAVE BEEN AUTHORIZED BY THE BENEFICIARIES OF SAID TRUST TO EXECUTE AND DELIVER THIS DEED. Sea=24-03 '10:47am From-BARNSTABLE REGISTRY i 5083625065 T-039 P.02/04 F-932 i WI-MESS our hands and seals this 4_ y of 2002. NAVIDA TRUST NAVIDA TRUST ATIiANAEL V.DAVIS>Trustee TH MAS H-P.WIfITNF Trustee Y>3R. VTVIDA RST O ARD DOW DAMS,'i5rustee STATE OF Ala COUNTY OF DATE: eared the above-named NathanseI V.Davis,Trustee as aforesaid, and Thca pet5ona11Y aPP the same as their,$ea act made oath that the foregoing statemcuts are true and they signed I and dwd.before me LIC i•+. My Commission Expires: STATE OF HATE: COUNTY OF Then personally appeared the above-named Thomas M P. Whitney, Jr., Trustee. as 1 aforesaid, and made oath that the foregoing stawrnoats are true and they signed the sOMP•;•- '! their free act and deed,before me OTARY PUBLIC t: My Commission Expires: i CARKSTABLE REGISTRY OF DEE_:o 5725--2 SUBDIVISION PLAN OF LAND IN BARNSTABLE T. H. Stegmaier, Surveyor April 27, 1962 N . C.B. O Wo e e�,o 2Z� 99 C•O W • d i � 1 lam••DM? \ Q :o, 0 'sar \ 0 d V) , 6 ` ` O ('s 1 O% •, s 2• 1 WAY stit ic 0. $4 n 0 4`0 P � 1> ; Ao sr c'�!gz ^ I CH 8SZ 'i �G aA60N0 $Ge16 , W /� >7� (33.0 wade)Y Subdivision of Part of Lot J Shown on Plan 5725 Sheet 1 Filed with, Cert. of ,Title No. 1858 Registry District of Barnstable County ae r ereer es al es t title may to issued for land By the Court. -- • C°?''fo l.pf man LAND RMSTRAT/ON MWE r�qv z;��6s Jolt of this plan 106ferttoantnch �,ria.w_e,AaAnC.MAnderaa►,E�ptxen5rlburt✓ 1HIOMIES •IEAD i l Architects•Builders•Developers i f 1 I Town of Barnstable Building Department j 367 Main Street Hyannis, MA02601 { RE: Foundation Permit for 204 Seapuit Road, Osterville, #72105 To: Inspector of Buildings I Due to a severe winter season, the foundation for 204 Seapuit Road has been delayed. I expect to have the foundation started within several weeks. Therefore, request that the Foundation Permit be extended for 6 months. Thank you for your consideration and understanding. incer - David T. Gregory Homestead Properties, Inc. i I 1 f , I i 764 Plain Street, Marshfield, MA 02050 Bus.781-837-6745 Fax 781-834-1522 TOWN 01' BARNSTABLE BUILDING PERMIT PARCEL ID 095 021 GEOBASE ID 4473 ADDRESS 204 SEAPUIT ROAD R PHONE OSTERVILLE `' ZIP - LOT 14 BLOCK LOT SIZE DSA DEVELOPMENT DISTRICT CO t� PERMIT 72105 DESCRIPTION SIN FAM/5BDRM/ATT GARS PERMIT TYPE BUILD TITLE Ngl,$ESIDENTIAL BLDG PMT CONTRACTORS: DAVID T. GREGORY Department of ARCHITECTS: p Regulatory Services 4 TOTAL FEES: . $1,791.44 BOND .;-CONSTRUCTION COSTS $542,400.00 * TME 101 SINGLE FAM HOME DETACHED 1 PRIVATE . ► s�xsraB�, • Mass. RFD MAr A BU NG ISION BY r DATE ISSUED 10/0 EXPIRATI DATE TOWN CIF BARNSTABLI, n BUILDING PERMIT i ... �. . / Io" PARCEL ID 095 021 ,GEOBASE ID 4473 ADDRESS 204 SEAPUIT ROAD + PHONE OSTERVILLE; r ZIP - r , LOTr 14 . BLOCK LOT SIZE DBA �,_ DEVELOPMENT DISTRICT CO v N% PERMIT 72105 DESCRIPTION SIN FAM/5BDRM/ATT GAR PERMIT TYPE BUILDZ,,,,j�LE NEW RESIDENTIAL BLDG PMT CONTRACTORS: DAVID T. GREGORY - Department of ARCHITECTS: Regulatory Services TOTAL FEES:` $1,791-44 BOND $.00 p1fr ' .'CONSTRUCTION COSTS $542,400.00 101 SINGLE FAM HOME DETACHED 1 '` II PRIVATE 0- '� 1 BMWSTABII.B, 039. >Kass. � u FD MAr BUILDING DIVISION s DATE ISSUED 10/08/2003' EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLV OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PE UNDER THE BUILDIN E,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS AY BE OBTAINED O T DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIO ANY APPLICABL UB ISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED NS MUST BE RETAINE N JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CA KE T POSTED UNTIL AL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN .WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUI ED, SUCH BUILDIN LL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED U F; AL ICH- NSPECTION AS B MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. 1 BUILDING INSPECTION APPROVALS PLUMBING INSPEVV APPROVALS > ELECTRICAL INSPECTION APPROVALS 2 2 2 i 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 f 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. BUILDING PERMIT i _ 4 90 \ N. ^ s n ce- c• /i 7 I. it t� ►� IO `i• I I -�I to L_ T fHc IN, IL ,Qe�ct=r'.: . r ,� r � 2�z"fir r�Nc. •%. .� ` \,O� _ ^\ -2x - L - . - • _:� � •.. cam. _ , I a - SMOKE DETECTORS O.K. -.:: ouNL�T ioN p NST BLE BUILDING DEPT. f a I • ,O. t. q,.mgl4. ST -r. 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I j • - I ELEELA gig 1 r _ . : i zP LO - - , 17 `... 7 17 x --- Z — '=---- --- S¶ kff N it bL c { a R Al o I �• h - ' � ALL Sl1.iti�AGE NWTE.P.fiKfLL - -- PER JrArz-ammo am 1!Q aM/N ANSIY/GIE�M RILiG DETFRAOM" 8r MUL lflfWY V-4r.fBA.4-- w 82ND a6AIAI ._L E�E1!Dr0' �sr�ci,iE^ I M0 OF DO W QE.IM— MAX YER.:w4u ..T_ 3f .kc;,N�JP raves J•Atu.• 3 /Y.LS7FR EJi/Y/Rc' Aaa� C-A 7 NSY7lON RovNT i • i AOA� 3 a•r.a nI".oar.,;V�YS . � 11 GROlJNO SafETY i�ac/ � 6�T AMA/ G•Q t 4CY1T a=a OFF�tLT�T_- �PEOO O r CY3v.N , '— — b� I mac_<v *3 FLEI! S �iWofi S•.�YG[.L \ CY/r Of AS :=ED "4/N DRAW CGW 16CrD/RF.Cr 771 AIMP REIJEF 111WE ` �'T k ICU O�7S a RE5100kMAL? Cb Ri^JAL f" A r r uFAP ELF 71-9 wan s[ar eS 6"Mrn[ryp /f OE�1Rrrg� �/• �h b R'QSR AlFiar. —3 MRS� ,STA/VD.4R0 WALL SEr'T/DIV CONSTRUCTlm NOTFS -•e ;. t •• , • 6EMERAL RE/NFdRC//� STEL�L •COA57 MUN STALL Q7M RAWAO' A! C/TY DEFT REINFORC4W& s7ZZ;L _ ..: ;:e •�;. :OF.AW6 (SdFE7r 1�7QE� S7a0JVQARQS. �P��.4L�BE A ifJ/�/�M�7X! `• - • !DN//YG BOXRD /Wl i_Y/ffITFA_OA AXESJaM DI.4MEre" QR 1 -WNZRE SPL/GFS •�: •. /Q' '( • j1E33'. P7f/,IT BGNRD. OGG1/iP •. , ' d, ' Quit dWCAM AE7J.Jll 7Y.(C U/RFD J�P; _/;��N/TE CD/KSTIPI,CTIO/Y ALL. ���M 61tN/TE S.K41:1 LEALOGVI.t/E.M/12°D •AND • . • • .! A//X S�tLQ[1 QE • •• .� D� ... %%� ,arPum P.vEr/�IuriGOLLY •,L_ . -- : ( w 74N/S D S.S''%Q/V C??KFdRAfS m LOGtL WW iN/D • i 84= U/ON A A!rA OJ~LY XPvXX -ME PA/PTS Jr4K0 /•-4�t !/LT. Q7A1P.t7R'EAOTiV c "t 4WLrE .• 6WWO CLAMP •;.wD.tP.•ROVF,D/J( A f 6ROUA/G W/1$(�!/t JGE�T v W�P-CEAIFVT A. 7;V .Wda AVT E� OF�TbP QF AND AF BFiaA•!,ANY E,tL'�PT/O/IC9 AUTOMATIC SURFACE mriAafER =* JVi[L .PEOU/RF -2W,0LF�XTRARY ZMWL e=4S/ . 3%z &A15 WAr.,V f W X CX or C.6wVT :• • FD1/CE - O CLIAr &/X/7F 6YA L/6.IT X,,aTF,P.?WY r*j s'"kr(EK) . o v roe JWAU 47WraE�raA6 4V m.WPL/,%•E 7/ >%�t l�/Y . IYArFX L.�,yT W1W !A& C/7 49W 7&W/V o.PQ�04A�CE MOTE GA713' AW SELF tlul/.K6 L.4TaV1h6. -2gr ,oTlr��=71.m'.21.V oR.(jYi�ks X7 7"fXw lXALL CONOVeA! 7?7 .frA7F - A•AM l` .' 44" LOrAl �P6i7!//�E.fIFN.Tf: p • SACS 46'O,G. e SOTM Nu t'9 o46rzw STANDARD SWuNM.WOr POOL f4� •' � - - .o. ,N�c/�,i vE i.�• A/•vMr: Tlt f. FL)lZ1 F-f S I P)Em 0-4— ;: ? (/F � = �•_ AIwx4isrs:'LU 4 ' �i vl Pj11 l 2l� s.Te �b l'''�� CpLLEL?iaN -!••': �r�` �. \ILLS Y- _. 3 ' lv�ttlr T//EF /FAw.D .'• ; tic s - SCALE- .✓ONE llovEn er - ' 0l�uvl+ sY /d�/drr4 £ „ - - w►�: - b 6-7. UCENSED Pit FES��[>iR XEll D ~ ^ ,r 6.Ci4✓lL.S7//4lSA 41 c `/a. 31_.b _ .. , �• T�r TIMOTHY WALKER - CONSULTING ENGINEER o s_`^'� �' -'19 WOOOSIOE AVE. WESTPORT CT 06880 IUSER MAIN OUTcLT ' ` ` CtIDR fvrrX j-,W?E 611,N/hr/�L "m 7 AX04CItEtS f�l/E. LT f "fitS. s .G 7 �` C'AlezAffFO.PD, A""q 0/8z�/ N ,A 00- �`IRiCA?!"I 1&&6-Cts - 1 1 a 17 !T goo- 6 y T- v zl Bo b..May Abod oo • , t .. N79 3p'12'yy .. 230.05' CIM S00oult.now.', ° z71 . 'I CD m I ov. � Z o a e Parcel .No 95-21 .: 99,380f Sq. Ft NOTES.' I _\..�- M/NL F JNUM LOT AREA. 43.560 S. . M//VIINUM WIDTH: 125' Ff. o�^. %o\ M/NI/11UM FRONTAGE' 20 FT. IWIPW 1IUM YARD SETBACKS: 'oa o FRONT.:: 30'. S1DE: 18.. ReAR 15' t. 77 AE LOCUS IS Lorww IN FLOOD ZONE G A5 �teii'Gr', i►IfFli> iL;FLwDI�YG' AS SHOWN '4` -X A4 Gam. F.LR:M; MAP N0. 250001-0018.0. A09AI77ED REV JULY 2. 1992 3. 77-+RE LOCUS IS LOCATED IN.A WELLHEAD.PROTECTION.DISTRICT . 's - J �\o��`, ` �-ca. . {.. PIItrH .PA710. 7Y7 DRAIN AWAY FROM WETLAND _ Ass SHOWN ON PLAN ENTITLED 'REVISED GROUNDWATER' — - P0eqL040TECTiON OVERLAY DISTRIC75' - APRIL, 1993 •\� \ �. . _ dt•1. t 5'u Pro a _,,... `--,� At-tOCA . E - . Deck 0 °1 8' X 4'DEEP D House # 204 RYWELL SET IN.3/4' 1-1/2'.STONE �! e FOR POOL RUN-OFF AND DRAW DOWN �_'� p cA o .. _ 100 911 35 . 1 CERTIFY 1iD HOMESTEAD PROPER11E5.AND THE TOWNhAA -3 OF BARNSTABLE THAT THE HOUSE LOCATION SHOWN ON 1N OF Ng8 I D r` THIS LAN IS BASED ON AN INSTRUMENT SURVEY: G) wriu V`t u JOSEPH McGOVeM No:3as �- 0 P� 82.26' 2 2.52 REGa7E/tm MTE �4�osuiN °Q N89'45'31"E R SC PP SCALE 1' = . 30� 7 i 0 15 30 . 60 90 120 DrawnB :DJD1CT STENBECK & TAYLOR, INC. . bran For ? Homestead Properties Revisions. t Location Plan I VS DBD RYWBLLc�PAT O NO Ti CheckedB :WMRegis rred Professional Engineersana Land Surveyors a`�� o scale:1 -30 844 Webster Street 9 Steeple Street Showing Proposed Pool Date:I115107 s1]Ire 3 P.O.avz 630 PARCEL NO. 95-21. Marshfield,Ma.OZOSO Job No.:6786 Mas ee Commons,Ma.02649 204 SEAPIIIT RD 781-834-8591 508-539-9300 Plan No.:6786 NOI Fax 781-837-8238 Fax:508-539-9301 OSTERYLUE, MA www.stenbeckandtaylar.com Email:sandt®gis.net .. 1 -"-`' . (f FE iILIJ IA p i fi 1 X fi ,.► _ �_ � -ra E► ► -MOST LIV fl , . t , x� M r 1 , r :� l / a f ��' r i ~s Ice Volley Rood '•• N79•30>>2 . 230 45 rt O C m C Seopuit Rood Pa 5 z a Parcel No. 95-21 99,380f Sq Ft o �• NOTES 1. ZONE- RF-1 4-1 MINIMUM LOT AREA: 43,560 S.F. � MINIMUM WIDTH: 125' FT. MINIMUM FRONTAGE: 20 FT. MINIMUM YARD SETBACKS: oa ' FRONT: 30' SIDE. 15' REAR: 15' 2, THE LOCUS IS LOCATED IN FLOOD ZONE CA (AREA OF MINIMAL FLOODING) AS SHOWN u :? X `I % ON F.I.R.M. MAP NO. 250001-0018 D DATED REV. JULY 2, 1992 3, THE LOCUS 1S LOCATED IN A WELLHEAD PROTECTION DISTRICT AS SHOWN ON PLAN ENTITLED "REVISED GROUNDWATER - / PROTECTION OVERLAY DISTRICTS APRIL, 1993 ' 4a } �. T peck porch 10 9 C.L) 4 <�. # 20 por House } ----- gyp• ,�{L V.y� parch L 3C11L7 �� •w iZ l V) eL c-c- TO 'FO n _ L pt'�e�oY I CERTIFY TO HOMESTEAD PROPERTIES AND THE TOWN � OF \1ktU cull C—,(-Vk R Cr \t(AQT (A 1 z--�`DIDkL-L 1D0 31 35 E OF BARNSTABL.E THAT THE HOUSE LOCATION SHOWN ON b LUAM ti — " 7-a UL- Lk N6$ THIS PLAN IS BASED UPON AN INSTRUMENT SURVEY. JOSEPH Mcf OVERN L✓�1 / 1 - �'U L< No.39M ��T e� � �F.'. (33' S�:LACr N I L 68:92 nnAIJ�.. J c,� 9"p sut ° 82.26' 01 2 1 ► T R v REGISTER !A SURVEYOR DATE N89'45'31 "E R AP V` �E SCALE 1" - 30' 0 15 30 60 90 120 Drawn For : Homestead Properties Revisions Drawn By:DJD/CT STENBECK & TA YLOR, INC. Checked By: VvrM Registered Professional Engineers and Land Surveyors Location Pan Scale: l —30 ShowingProposed Pool Date : 1115107 844 Webster Street 9 Steeple Street Suite 3 P.O. Box 630 PARCEL NO. 95-21 Job No. : 6786 Marshfield, Ma. 02050 Mashpee Commons,Ma, 02649 508-539-9300 204 SEAPUIT RD Plan No. : 6786 NOI y 4-8591 Fax.8 8 8 837 8238 Fax : 508-539-9301 OSTERVILLE, .MA www.stenbeekandtayfor.com Email:sandt@gis.net V \\ Y Lf ` C. U e O C 5 OWNER ° Novida Trust Nathaniel Davis Trustee ` N/F ;Wan I •o o ob R erfToyfor 6� ��, — -------- S Marys Trawled Woy 5_Wla J----------_``` � � / Island / i II •` Lot 70 (LCC 5.7 Aso�\� --�--------� ��`�/ _ _ 1725_2aJ \\ ,� a / LOCUS PLAN SCALE:1 =2000 / "/ \ I ASSESSORS REF A1,W ' \l\ //• --- __ _ __ - - o Map 95, Farce/ 21 NI , 1 A15� -- 11 1 1 �/ P.-/ OVERLAY DISTMICT.' I \ J/Al2 WP - Wellhead Protection District Isolated As Shown on Plan Entitled Vegetated I III "Revised Groundwater Protection Wetland i III I r Overlay Districts" - April, 1993 1 IN I I I I I\ All I I 1 \ Ffl.00®ZONE: AI � Community \ Zone C 'At 111 I II 14 / #250001 00181 D o Resource Limit ', I I / Jul 2, 1992 As Flagged by ENSR I I \ III \ y Date 12/Nov./2002 IN Al \\ RF-1 AD Area (min.) 43,560 SF I �'\ \ \ ',\ \\ \ \ \ \ \ \ Frontage (min) 20' //�/\ \\ \\ \ \••\�\ \ \ \ \ \ � \\/ I I \\\\ \\ S Width Sin) 125' a\ Front 30' Side 15' AI \ \ \\ \�\ \ '\ \\ \ \ \\\� \\ \ AJ ii/ /Y // j II 1 1 �o cs/rtlt Rear 15' \ '70 \ / 1 1 \ \ AID CB -10 / — — — i I ( _ �I A TP 13 \ \..\ ............ v.................... . .. . .......• . . .... ........ HQ), \ lG n\ 1 \ / A 1 ..........'Ed \ � \ Front�ord Setba k13bI.1 \ �\ Wp.d Fence T8M E1=22.58' NGVD'29 \\ — — — / / L=69 Top of C8 DH 82.3 ' R=202.52 / \ one /) Ed e of Pave ent Edge of Pavement /Q� L�/!V O� (33'�de) ROAD � y _ - -20 PLAN VIEW NOTE: Scale: III= 30' 1.) The property line information shown was compiled from available record information. 2.) The topographic information was obtained from an on the ground survey performed on or between 28/NOV/01 and 20/DEC/01. 3.) The datum used is NGVD '29, a fixed mean sea level datum. I I G Title: PREPARED FOR: PREPARED BY. • li SITE PLAN Sullivan Engineering, �nc. PROPOSED IMPROVEMENTS DAVI U GRE.GORY PO Box 659 7 Parker Road CD 91 GREAT BAY ROAD Osterville, MA 02655 Osterville MA 02655 AT OST ERV I LLE , MASS. (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 fax V 204 SEAPUIT ROAD PSuIIPEOcol.com capesurvCicapecod.net OSTERVILLE, MA ` 30 0 15 30 60 120 Field: MDH/WHK Draft: Date: Scale: Comp.: WHK Review: 16- December l0, 2002 As Shown Proj. # DraNing # C341 1 P k. VoNWRoad �R,ytt'• N793012, 2,30.05, ® JY sopult Rood � z . Q O_ O • Z \Z _ a Parcel No. 95-21 m � 0 �� ►� ' 99,'380± Sq Ft o . IV � N kc o kc o n NOTES N \ N ZONE: RF-1 MINIMUM LOT AREA: 43.560 S.F. MINIMUM WIDTH: 125' FT. MINIMUM FRONTAGE: 20 FF. MINIMUM YARD SETBACKS: ` o FRONT 30 SIDE: 15 REAR: 15 0 � 7 THE LOCUS IS LOCATED IN FLOOD ZONE C s`°� �% ' XA6 A5 (AREA OF MINIMAL FLOODING AS SHOWN 4 ON F.I.R.M. MAP NO. 250001-0018 D o� `� - �.S ` - -:- A DATED REV. JULY 2, 1992 — '' THE LOCUS IS LOCATED IN A WELLHEAD PROTECTION DISTRICT �s ;, ., :; ,n AS SHOWN ON PLAN ENTITLED IREVISED GROUNDWATER PROTECTION OVERLAY DISTRICTS" — APRIL. 1993 - �� �_.... - 1 64 \ r Y) _� Ret. Woll Pool Pumps & Fllters �' A i.., 2.35' Qeck bo• .3 6 porch 1.35' 10' • ` Q ��9 ovs pore it # 20`I / DEEP DRYWELL House FOR POOL RUN—OFF AND DRAW DOWN r porch 0 BARNSTABLE CONSERVATION b I CERTIFY TO PETER FORD AND THE TOWN OF BARNSTABLE 35 E THAT THE INFORMATION SHOWN ON THIS PLAN IS OF N68.31 BASED UPON A71NUMENT SURVEY. )WILLIAM � WIDE/ : JOSEPH P� (33 6892 REMMERM LAN `%� ,_ �r 82.26' L� 202 52 R 0 A I / WE .Y ,J sutw� N89'45'3I"E K EAP �� _ C/ S SCALE 1' 30 0 15 30 ,• 60 90 leo ?yawn For ,- Peter Ford Revisions Drawn By: CT/JM STENBECK & TA YLOR INC ' 1. 9/2/OS Added Shed Location Checked By: wM Registered Professional Engineers and Land Surveyors AS-Built Location Plan „�, Scale: 1 - g y XMMle. 30 844 Webster Street 9 Steeple Street PARCEL NO. 95-21 wlewmw Date:3131108 204 SEAPUIT RD Suite 3 P.O. Box 630 Job No. : 6786 Marshfield, Ma. 02050 Mashpee Commons, Ma. 02649 781-834-8591 508-539-9300 OSTER VILLE., MA Plan No. : 6786 FORD AB Fax: 781-837-8238 Fax : 508-539-9301 www.stenbeckandtaylor.com Email:sandt@gis.net Ice Volley Road 0 12 w ce Seapuft Road c— z -30 Parcel No. 95-21ci 411 tPl- CD O C) 1. ZONE. RF—1 MINIMUM LOT AREA: 43,560 S.F. MINIMUM WIDTH: 125' FT. 0 MINIMUM FRONTAGE: 20' FT. / v MINIMUM YARD SETBACKS: FRONT. 30 SIDE: 15' REAR: 15' 01 2. THE LOCUS IS LOCATED IN FLOOD ZONE C (AREA OF MINIMAL FLOODING) AS SHOWN ON F.i.R.M. MAP NO. 250001-0018 D DATED REV. JULY 2, 1992 3, THE LOCUS IS LOCATED IN A WELLHEAD PROTECTION DISTRICT AS SHOWN ON PLAN ENTITLED "REVISED GROUNDWATER ���io / `' �,� PROTECTION OVERLAY DISTRICTS' — APRIL, 1993 2.35 .1100 1 .35 oS, 4 '5r 114DAT�0`1' F0- 1 2' A� 0 ,ova�1 �5 0 F -4 1 CERTIFY TO HOMESTEAD PROPERTIES AND THE TOWN (33 wILLWA 92 OF OSTERV!LLE THAT THE HOUSE LOCATION SHOWN ON 68- jOSER� 0A THIS PLAN IS BASED UPON AN INSTRUMENT SURVEY. 2.52 82.26' 20 U N89*45'31 "E SEAP SCALE 1" = 30' 0 15 30 60 90 120 1 EWSIERED LAND SVPVEYt)R i a0kTE Drawn By:JJM A In, Op T Ltawn For : Homestead properli evs,siOns L Chocked By: VM Registffed Professional En oem and Land Suveyors A,'S-BUILT PLAN Scale: 1"—30 844 WebstwStred 9 Steeple Stred PARCEL NO. 95-21 Daft:&21/04 Suite 3 P.O. Box 630 Mxshfie]4 M& 02050 MAW CODMIK)M& 02649 Job No. 6786 204 SEAPUIT RD 781-83"591 508-539-9300 I At Am No. 6786 AB Fax: 781-837-8238 lax: 508-539-9301 11-lam;P0L.L �E, AAA. www.stmbwJ=ftykr-c= Enwfi:88n&@g&.nd