Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0120 SETH GOODSPEED'S WAY
izo JC7 �1 C��v�'t�� YLo�2�� � Vim' V ` y1.� I APPLICANT INFORMATION (B ILDER OR HOMEOWNER) ,! Name (( Telephone Number (�� 4, Address 9IJ� License # ' . Home Improvement Contractor# Worker's Compensation#"' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS JECT WILL BE TAKEN TO SIGNATUR DATE I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ®� l Application # I dj c.-07 Health Division Date Issued S Conservation Division -Application Fee Planning Dept. :' Permit Fee. Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 2� ���S ) W Village '0 S�� r v ► L Owner (IN e o 4 Address Telephone - C� Permit Request N Tr" C, clra00 t4,- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Ac Flood Plain C Groundwater Overlay P �� Project Valuation 11 Construction Type ojl�U i�j j► 0,}2i"f A Lot Size G Grandfathered: ❑Yes ❑ No If yes,*attach supporting documentation. --) C) Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) ; Age of Existing Structure S Historic House: ❑Yes ❑4lo On Old King's Highway: 'O Yes 2No 3 Basement Type: U Full ❑ Crawl ❑Walkout ElOther Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No . Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: M"'existing &(new size/411 ZBarn: ❑existing ❑ new size_ {Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes IYNo If yes, site plan review# Current Use ��S��C�. ,L ud Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name :BLe��� rr �CSC)� ��� \Q Telephone Number Address 33q VVa,•4-InaA @.I(S &)( J License # Jt957q:3a = w wq Home Improvement Contractor# Worker's Compensation # bk_V_Hq_ 45 r).G 9 12 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE SIN t FOR OFFICIAL USE ONLY APPLICATION# �. DATE ISSUED. f r MAP�:LPARCEL NO. F ' ADDRESS:- VILLAGE F OWNER If DATE OF INSPECTION: i S 'FOUNDATIONIr --OGL. s FRAME ;^.INSULATION; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GA.S 1 :- ^ROUGH, U,ilt �;`_L FINAL t:J FLNAL B;3:ILD.ING; :'s ` lz. s ASSOCIATION PLAN NO i The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �,� Please:Print Legibly Name(Business/Organization/Individual): �cl s_ L aA ecd 6) Address: ZO Qa r JrX `� � A V�( 1J U A `z City/State/Zip: Phone#: 22 ( Lo 5C Are ou an employer?Check the appropriate box: Type of project(required): 1.EJ I am a employer with_ J� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.] required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ oof repairs insurance required.]t c. 152, §1(4),and we have no f employees. [No workers' 13. Othe comp. insurance required.] -,«Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. J_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. m sz:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have :,,•�,errployees. If the sub-contractors have employees,they must provide then workers'comp.policy number. I.ani an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site r information. A Insurance Company Name: ( Ut :'S x P`} 1 Cl 1� �� I�1olicy#or Self-ins.Lic.#: �i�^�a� � Expiration P• ation Date: O3 .*r`Job Site Address: 1 C'a.0 k)(11...1 City/State/Zip: ()� X III,IVP . C0.le5S , . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a " fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 'of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa' an ' e !ties of perjury that the information provided abC/ve i rue and correct A" tj Si afore Date: ( �( Phone#: 2� 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 Persan• Lpbaae#�._ _ Client#:41537 2BACKYARDP01 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 04104/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERTACT E: Dowling&O'Neil Insurance PH�rE :508 775-1620 Agency a.MAI� M No): 5087781218 ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER 8 AFFORDING COVERAGE NAIC 8 Hyannis,MA 02601 INSURER A:CNA INSURED INSURERS: Backyard Pool Co.,Inc. 387 Nathan Ellis Highway,Unit#12 INSURER C: INSURER D: Mashpee,MA 02649 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMOIIDICY DI EFF MM DIDY EXP LIMITS A GENERAL LIABILITY B4024529866 3/03/2011 03/0312012 pEAACCHppOECCCURRRRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES EaE�rra.ce $300 000 CLAIMS-MADE �1 OCCUR MED EXP(Any one person) $10 000 PERSONAL 8 ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JECTPRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per..dent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ A WORKERS COMPENSATION WC424529918 D310312011 03/0312012 X wC STATU- oTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L_EACH ACCIDENT $500 000 OFFICERIMEMBER EXCLUDED? � N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If y.s,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Pinnacle Pools SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 28 Route 6A,Unit 4 ACCORDANCE WITH THE POLICY PROVISIONS. Sandwich,MA 02563 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S79644/M79643 LS1 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 �/� ,as Owner of the subject property hereby authorize \ 1On 0 to act on my behalf, in all matters relative to work authorized by this building permit application for: 2 y 5k-�h Coach , UJ 0-11 (Address of Job) e�— Z� Signature of e Date rint Name If Property Owner is applying for permit, ease complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\MicrosoR\Windows\Temporary Internet Files\Content.outlook\DDV87AAZ\EXPRESS.doc Revised 072110 b ' �ackyar�c� 'TJool moo_ P.O. Box 1473 Pocasset MA 02559 • Phone/Fax 877.836.9531 • info@backyardpoolco.com 6' Fence with self closing gates and self latching on ALL SIDES of the pool. i License or registration valid for individul use only before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation 10 Park Plata-Suite 5170 Boston,MA 02116 �Vot valid without signattA . �e �a»wiea-�eu�eall� a�,.'llu�;:ucfuae�3 Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR _ Registration: 165732 Expiration: 3/22/2012 Tr# 294875 Type: Private Corporation BACKYARD POOL CO,INC. SHAUN BRUMMERLOH 9 FIRST ST POCASSET,MA 02559 Undersecretary GA1C'h' '311,51V 1 inch = 20 ft. LOT 61 �a mapquest ozale i� Q..v. en�a.wzeao v a LOCUS MAP 5- PLAN REF 311-77 DEED REF- 13533-281 j NC -E. SEPTIC SYSTEM IS DRAWN PER ASSESSOR'S MAP.- 122-91 TC IN OF BARNSTABLE AS-BUILT CARD. ZONING: RC ' SHED 1 SETBACKS. 20'-10'-10' ;:> t FLOOD ZONE., C I o PANEL NUMBER. 250001 0015 41 CA ATED: 0811911985 i 5.6f� w cl \ 0 VERLA Y DIST, GP, RPOD �J CD "' SALT WATER ESTZ t LOT 60 i 20608.4 SQ. FT. m 0.47 ACRES PLOT PLAI N OF LAI LOCATED AT. i N 120 SE'TH GOODSPE'ED D E c K OSTER VILLE; MA �'REPAREI) FOR: Lo ARLrNE DOHERTY .NO VEMBER 18, 201000 � 1 _ ( E V REV -� ere Cti 1 REV. _ LA Co. INC L Steps Position Add A-frame at 6' 6 2'x2' panel joints as shown Skimmer 8 8' Inlet 2'x2' 2'x2' uIj I 3 " I I 6' 9 I I I I i s I I I I -+ I II I'MIN. 8 i 16 --t SAFETY ROPE ' I AND FLOAT 3 I 6' i i 6' 4' 2'x2' 2'x2' 2'x2' 6' Inlet Step Option 1 32' 3 4 -------------6„Waterline 1— --- ---- -- --- 8 ----- )2'x 4'-8" Deep � CII 4' —�-- 6' —- 14' - 8' _STEEL DIVING/SLIDING EQUIPMENT SHALL BE DESIGNED AND SHALOL BE INS AL ED IINR SWIMMING LS ACCORDANCE WITH THE DIVING/SLIDING EQUIPMENT DWG#: MANUFACTURER'S SPECIFICATIONS. KAR2S42-1632-8'H 08 AREA(SgFt): 509 PERIMETER: 92'-7" PLEASE CONTACT THE DIVINGISLIDING EQUIPMENT MANUFACTURER FOR VOLUME(US Gal): 18 300 LINER AREA(SgFt): 512 DATE: 01/Jan/2008 THEIR SPECIFICATIONS. VOLUME(Litres): 69 200 SAFETY COVER(SgFt): 612 SCALE: 1/8"=1' MEETS DEPTH AND SHAPE MINIMUM STANDARD ANSI/NSPI5-2003 Step Option 2 Bahama SHEET:1 OF 2 2008 32' Part number Description Qty Qty Qt —I 2' [H1 02-SP08 8'Plain 4 4 4 B C 02-SP06 6'Plain 5 3 3 3 ,, IS1 4 ,RZ 02-SS06 6'Skimmer 1 1 1 2 I 5 02-SI06 6'Inlet 2 2 2 r ,; i 02-SP03 3'Plain 2 - co I 02-SP02 2'Plain 2 I I 02-CB 2'x2' 4 4 4 3� 6'Straight Step - 1 - ----F--------I------- ------------------- 8'Kafko Straight Step - . 1 A-Frame A-Frame" "-,; 16 17 17 15-0632-9 Optiona 44 41 00 ---- --- J Z r`�i Q lw 6 W � o m e 00 m 8 _ S2 7 � Q W °' _ U A _I 2' I H2 P D Q y J U .Wc jo N U Q d 0 m `-=:3 yy � a = wly LLI0 H O 0 jo Q XW - 3: Wx0SIN W JF- N W W - LJ m W Cif ZU W J0 CL ME 0 ZJIU _ ate -0aa �� d Q 0 .-`app - v Q W a N N O B H1 C N F- Q � Ov ,n�uu S1 ~ t— Z_ pW � 0N 2 \ �) 0 J N Q 5 Q OI I A 0 � _ I I I - � cA -------� --- -----------------8 O I- W a z .A I 11 �` 1 ti' 1 2' 14' 34'-11 11 32'-0 3/4" p I I 2 14' 32'-0 3/4" 34'-11 1/4" L---- I 3 16'-1 1/2" c 30' 34' 4 34' 30' 2' 16'-1 1/2" 1 - 6 5 34'-11 1/4" 32'-0 3/4" 2' 14' IS2 7 6 32'-0 3/4" 34'-111/4" 14' 2' A H2 D 7 30' 34' 16-1 1/2" 2' 8 2' 16'-1 1/2" 34' 30' H1 18'-101/2" 10' 22' 27'-21/2" H2 10' 18'-101/2" 27'-21/2" 22' S11 28'-101/4" 24' 8' 17'-10 3/4" S21 24' 28'-101/4" 17'-10 3/4" 8' A 16' 35-91/4" 1 32' Bohomio 1 h' 3'' DWG : ViAR%c,l2-iG:i_'-o'N_b3 DATE. 01/J 20 THEE I 2 OF TYPICAL ADJUSTABLE BRACE INSTALLATION DETAIL i21—Ors. BRACE - ADJUSTING ANGLE BRACKET o /NUTS VINYL POOL LINER-- -THREADED ROD STEEL POOL PANEL— DEADMAN NON-EXPANSIVE PLATE BACKFILL S TWO PIECE BOLTED ANGLE BRACE CONCRETE FOOTER " DEPTH MINIMUM 2" POOL BASE UNDISTURBED �`( �I I � r SUBGRADE III�T�IT� �I I STAKE ?P0 (DT W_z)-T T cTZ0S S S� C'r1{JN STRUCTURAL P.E. REVIEW SEAL VOID WITHOUT SIGNATURE AND RAISED SEAL NOT FOR USE IN MASTER PERMIT APPLICATIONS ISSUE#:11-6593 DATE:4118/11 EXPIRATION DATE:06130/11 SEAL IS APPLICABLE FOR: Arline DOHERTY 120 Goodspeed Way Osterville,MA 02655 STRUCTURALLY COMPLIANT WITH THE BOCA(1999); NSPI-5(1995 thru 2005),MA BUILDING CODES(8th Edition),AND NATIONALLY ACCEPTED IBCIIRC(2000 thru 2009)CODES TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �. o'Z�. Parcel Application # Health Division Date Issued CA Conservation Division Application Fee '] 0 PlanningDept.p � Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address /Z® 0 fti -' .��: c�S'L✓41 y Village Owner Address—/ Telephone_ '7`7 y ?3 L Permit Request &i 4 ro Ji k e to cek ^etc --� Square feet: 1 st floor: existing proposed . 2nd floor: existing proposed ' Total new Zoning District Flood Plain Groundwater Overlay Project Valuation COQ,� Construction Type a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documeritation. 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) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT4, rME!0NER)D ATION (BUILDER OW Name / Itoez 0'",- r� Telephone Number -77Ll-k3 6— Address /2 U _S?A1S D1)-521 a Cv etc/ License # lr'lz' 011 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO fir SIGNATUR j -- DAT q FOR OFFICIAL USE ONLY Y APPLICATION# r DATE ISSUED MAP/PARCEL NO. r r ADDRESS r ! VILLAGE f OWNER DATE OF INSPECTION: FOUNDATION t4 - FRAME r INSULATION 3• i FIREPLACE IT t + ' ELECTRICAL: ROUGH FINAL 3 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OU.T to: ASSOCIATION PLAN•NO. n, r s. 1 The Commonwealth of Massachusetts Department of Industrial Accidents h - ` Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelribly Name (Business/Organization/Individual): h(jPw& /), A ' Address: 12,0 Sf �56clf (Va City/State/Zip: . r Phone #: 72 q0 Y03 Are you an employer? Check the appropriate box: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I employees(fill) and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- -listed on the attached sheet. 7. A 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 required] 5. ❑ We are a corporation and its _ 10.❑ Electrical repairs or additions 3AI am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. o workers' com right of exemption per MGL y � p• 12.❑ Roof repairs insurance required] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. !am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensatiett 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 S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigafions.ofAhe DIA for insurance coverage<,yeiification. do here`by�cer un r the ins and penalties of perjury that the information provided above is ue and correct Si ature'X - Date fill I I 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: I i Information and Instructions. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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-contractor(s)name(s),addresses) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the,permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permidlicense number which will be used as a reference number. In addition,an applicant y that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(ifrlecessary) 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 d6g 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'Rot hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TPAr#.617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia Ile /?Cmde,� Q 7-v6/ , SAO Wall rm ved LV . o , - f Town of Barnstaple Regulatory Services awr:xsTaaLe Thomas F. Geiler, Director "t` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION f // Please Print DATE: /L // / JOB LOCATION: Zff� 5 !—//� A41el/A number s ct village "HOMEOWNER": //l o " name home phone# wo k.phone# CURRENT MAILING ADDRESS: � `YJ p, G2 S ��LI�P✓ 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 m mu m it pection procedures and requirements and that he/she will comply wiEh•said procedures and re ement! Signature of Ho wncr 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.I A -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:forms:honreexempt - s oftisr r� f e 6ARNST'ABI.� f MAS& Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. CA Use rs\decoIIi IAA ppData\Local\Microsoft\Windowffemporary fntemet Files\Content.OutlooklDDV87AAZ\EXPRESS.doc Revised 072110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ParcelC�, ti Application # ` I Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Feeo I �� Date Definitive Plan Approved by Planning Board ' �-- Historic - OKH _ Preservation / Hyannis Project Street Address I a© .Se h cl-�-©o d S,-ee S wCA y Village 0;lr'eIr vi Me Owner keLeli1: D 0Aer/y Address /20 5el-4 Telephone � 7 7zE Permit Request 146 4 e IV 0- lM v ro 0A1 I-elm 0 )e � E 5% Square feet: 1 st floor: existing proposed 13 2nd floor: existing proposed Total new l� Zoning District Flood Plain Groundwater Overlay Project Valuation _4 011 0 01 0 64 Construction Type wood Fr. Me 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 ';dNo Basement Type: YFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new X Half: existing t)4- new X ZE Number of Bedrooms: 3 existing X new Total Room Count (not including baths): existing new First Floor Room Count- Heat Type and Fuel: ❑ Gas IN Oil ❑ Electric ❑ Other =� Central Air: ❑Yes X No Fireplaces: Existing New _>� Existing wood%coal stove: ❑Yves ❑ No i CD r— Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing U new' size_ Attached garage:] existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use 4� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Addre s 0 icense # US�t( V 1 l�, 1"I � (I,� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE'' DATE 'r g FOR OFFICIAL USE.-ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE CA - R a;? OWNER DATE OF INSPECTION: FOUNDATION FRAME .< INSULATION ra FIREPLACE ;.f ELECTRICAL: ROUGH FINAL 6 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ;., FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1. 16 MICHELE CUDILO, P.E. Consulting Structural Engineer Centerville,Massachusetts 02632-1979•(508)771-7601 •Fax(508)771-7163 mcudilo@comcast.net March 30,2011 Town of Barnstable Building Department 200 Main St. Hyannis,MA 02601 Attention: Mr.Thomas Perry Building Commissioner RE: PROPOSED MODIFICATIONS to Existing Roof Trusses 120 SETH GOODSPEED WAY,OSTERVILLE,MA Dear Mr.Perry, At the prior request of the Contractor,Dennis Glover,I went to the above captioned Site on this date,for the purpose of addressing the structural requirements of the above captioned project, in particular as related to the observed existing roof truss bearing and new header requirements of the opening into the Garage from the Living Room. I The existing structure,consisting of a one-story residence with attached garage has proposed scope of project inclusive of interior wall removal and a new enlarged opening into the Garage side. The existing 26' roof trusses were originally engineered as single span from exterior walls at front and rear;this is evidenced by the lack of a truss panel point at the location of the interior center wall. Therefore any portion of this center wall may be removed. The new enlarged Garage opening, 8.5' clear,requires a header, 1.75"x 9.25" 1.9E LVL(see attached calculation), attached with 2-timberloks to the gable end roof truss vertical studs,positioned flush to the Living Room side,with a single stud bearing at each end. Please call to discuss any of the above,as we continue to work together on this project. Sincerely, Achel Cudilo,P. 12011_ cc: D.Glover H OF,�� MICHELE tic O CUDILO m 0 Ho•34774 STRUCTURAL `� ■ 0 roof header by Weyerhaeuser 1 3/4" x 9 1/4" 1.9E Microllam@ LVL TJ-Beam®6.36 Serial Number:7005107030 User:2 3/30/2011 8:55:24 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page 1 Engine Version:6.35.0 CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:OM2 Roof Slope6M2 All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width:2' Primary Load Group-Snow(psf):30.0 Live at 115%duration, 15.0 Dead SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 1.50" 1.50" 263/166/0/429 L1: Blocking 1 Ply 1 1/2"x 9 1/4"1.5E TimberStrandS LSL 2 Stud wall 1.50" 1.50" 263/166/0/429 L1: Blocking 1 Ply 1 1/2"x 9 1/4"1.5E TimberStrandS LSL -See iLevele Specifier's/Builder's Guide for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Result Location Shear(Ibs) 429 -341 3537 Passed(10%) Rt.end Span 1 under Snow loading Moment(Ft-Lbs) 938 938 6442 Passed(15%) MID Span 1 under Snow loading Live Load Defl(in) 0.040 0.292 Passed(U999+) MID Span 1 under Snow loading Total Load Defl(in) 0.066 0.438 Passed(U999+) MID Span 1 under Snow loading -Deflection Criteria: HIGH(LL:U360,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 8'9"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevele. iLevele warrants the sizing of its products by this software will be accomplished in accordance with iLevele product design criteria and code accepted design values. The specific product application,input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevele Associate. -Not all products are readily available. Check with your supplier or iLevele technical representative for product availability. -THIS ANALYSIS FOR iLevele PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevele Distribution product listed above. tN OFssgc MICHELE y�N CUD ILO No,34774 v STRUCTURAL PROJECT INFORMATION: OPERATOR INFORMATION: ` 120 SETH GOODSPEED WAY Michele Cudilo OSTERVILLE,MA Michele Cudilo, P.E. Phone:5087717601 3�3 D 1I Fax :5087717163 mcudilo@comcast.net Copyright O 2009 by iLevel®, Federal way, WA. Microllam® is a registered trademark of iLevel®. i I The Commonwealth of Massachusetts , Department of Industrial Accidents , " Office of Investigations 600 Washington Street + Boston, MA 02111 � y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p� Please Print-Legibly Name (Business/Organization/individual): nre Address: S��"� C�-0o d Qr et City/State/Zip: d/YJ /4 6 Phone #: 77q 'Sj3 4 0 Q Y 3 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time):* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- -listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job.site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page-(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations the DIA for insurance coverage.yerifeation. I do hereby c rti u the an penalties of perjury that the information provid d ab is true and correct, Signature: Date: I I Phone#: -7 / 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. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,-or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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-contractor(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-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do'not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tei;.9:617-727-4900 ext 406 or 1-877-MASSAFE Fax #617-727-7749 Revised 4-24-07 www.mass.gov/dia i IKE Town of Barnstaple Regulatory Services + ' Thomas F.Geiler,Director BARNSTABLE, MASS Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ✓ I I _____SeM JOB LOCATION: V/ number street village "HOMEOWNER": Ayiwe f J r J 6 oqd name home phone# + vwerk-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 ndersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mirf rtum i pection procedures and requirements and that he/she will comply wi+-said procedures and en Signature of Hom wn 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$om 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 formIcertification for use in your community. i Q:forms:homeexempt of n+F r� • sAxxsz•,►atE ,' ,0� Town of Barnstable ArED MAC a Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us t L Office:'508=862-4038 ', ' 1 -�' i J ` ''i, Fax: 508-790-6230 t 04 Property Owner'.Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.OULlook\DDV87AAZ\EXPRESS.dDc Revised 072110 I 152 fbL- 24"- V 5 8 —24"-2�12"-9 24" C; IV 621, -60 L341, 1(117"-" 15 8" .'V —36" -,r---241"--f1 2' 36' 2436 BUTT 436 BU I 2UF CW243&R 2436 BUJ'A'1112UF 0 j A IS W ISHW B 615 a618 24.D 12R BSS3 Q) 7., LO 0 a) LJ CI) 20 Cf) in CID -n DB36 1TD BWBT1 84, 0 0) L Cl) C) M C) >1 �FP9634 GROI -rl I C) C14 iD x CO co C') 4'�--7 Ll 2'-� 22"--7 -14" V- /r-24" 12 1--36" All dimensions size designations given are This is an original design and must not be Designed:3/1/2011 subject to verification on job site and released orcopied unless applicable fee has Printed:3/1/2011 adjustment to fit job conditions. been paid or job order placed. DAC DOHERTY.kit JAll Drawin%z#: 1 f G � a f S f 4 t I t j E i { � I r 411 t e E FQ(t 1. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I Application I W� Health Division Date Issued Z-1 V4 ' Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board u/N/ll Historic - OKH Preservation/ Hyannis Project Street Address m lsoa-& �vinq Village V s u vtf I-c Owner h Address 1 2,0 Je�,� 660�I Telephone Permit Request - -1 _711,7 1/7 ellt IJod / Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay -4 Project Valuation Construction Type Lot Size A Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) ,��/ Age of Existing Structure Historic House: ❑Yes 0lo On Old King's Highway: ❑Yes 14'No Basement Type: lR Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) JWA?f6,g_&R,4 Basement Unfinished Area (sq.ft) Aff Number of Baths: Full: existing new A Half: existing newq Number of Bedrooms: existing jo new -- ca Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fue/existing Oil ❑ Electric ❑ Other . I = ire Central Air: ❑ Yes Fireplaces: Existing I—New Existing wood/coal stove:uU Y6-S fi16 Detached garage: ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ('existing ❑ new size _Shed: 9existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes I�No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name I �� Telephone Number-7-7 (6J(1�U-1 V J Address Y '' License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 SIGNATUR DATE Rr� )ty, FOR•OFFICIAL USE ONLY APPLICATION# 'k DATE ISSUED j - MAP/PARCEL NO. ADDRESS VILLAGE r OWNER V DATE OF INSPECTION: FOUNDATION t FRAME 2.29)II P4j INSULATION ZlIZ'6 ►l {r f FIREPLACE - t i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' ; GAS: ROUGH FINAL FINAL BUILDING ' DATE-CLOSED!OUT ASSOCIATION PLAN NO. ' r r v 0� The Commonwealth ofMassachusetts �Y I Department of Industrial Accidents' Office oflnvestigations C �J 600 Washington Street Poston, MA 02111 wwfu.mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: J W S40 r, Aind 5 City/State/Zip: �J �� ► r l Phone #: 5- Are you'an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole.proprietor or partner- listed on the attached sheet. # �• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its equired.] officers have exercised their 10.❑Electrical repairs or additions 3. LJ I am a homeowner doing all work right of exemption per MGL I LEI 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.❑Other111 $ comp, insurance required.] *Any applicant that checks box'#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ►Contractors that check this box,must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy.#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c: 152 can lead to the imposition of criminal penalties of a fine up to$1,500.06 and/or one-year imprisonment, as well as civil penalties in the form of 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 the DIA for insurance coverage verification. I do hereby c ti and the pa' penalties ofperjcrry That the information provided above is trere and correct. Signature: bate: Z g 1 t♦ Phone#: OJjlcia!use only, Do not write in This area, to be completed by c!ry or lotion oJficia[ 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 I , I , lnforma' tion and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant t'o.this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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 whoihas not produced acceptable evidence of compliance with the insurance coverage required." Additionally, GL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any cp ntract for the performance of public work until acceptable evidence of compliance with the insurance requirements o0this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees .a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents, Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,'please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Departrnent has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant . that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if.necessary) and under"Job Site Address"the applicant should write"all locations in (city or . town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 _ (.r Town of Barnstable �ofY�ray Regulatory Services Thomas F. Ceiler,Director 1' .% Building Division PrfD '� Tom Perry, Building Commissioner 200 Mai i.Street, Hyannis, MA 02601 vrmev.to wn.b arnstable.ma.us Office: 509-962-4038 Fax: S08-790-6230 HO)M,OWNER LICENSE EXEMPTION Please Print DATE: d JOB LOCATION: O. , number street h village "HOMEOWNER": bbhe_r+iA7 5 name ho A h.,N Ct work phonc# CURRENT MAFLINO ADDRESS�&,) Swd S k4 � . city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellin>7s'ofLsix units or less and to allow homeowners to engage an individual for hire who does Dot'possess a•license,provided that the owner acts as supervisor. DEFIT'MON OF EOIYaOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on wbich 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.L 1)' The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. e undersi ed "homeowner"certifies that,be/she understands the Town of Barnsiabl�eiB=lding Dc partment UM ' coon procedures and requirements and that he/she will corrzply with said procedures and emen II i . \ �` 'rc of Homeowner Approval of Building Official 1 Note: Three-fancily dwellings containing 35,000 cubic f1 or larger will be required to comply with the State Building Code Section 127.0 Construction Control. ROMEO WNER'S EXEWTION .The Code state that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions Of this scctign.(Scction 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a pa-son(s)for hire to do such work, that such Homeowner shall act as supervisor." Many homeowners who use this cxcmption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bftcn results in serious problems,particularly when the homeowner hires'unliecnscd persons. In this ease,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 risponnbilitics,many communities require,as part of the permit application, that the homeowner certify that he/she understands the respons bilitics of a Supervisor. On the last page of this issue is it form currently used by several towns. You may care t amend and adopt such a fonn/cer6fication for use in your community. 0 t T ti Town of Barnstable o Regulatory Services q . hL sa IARNM13L- $ Thomas F. Geiler,Director o � 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 Pr6per-fy Owlier Must Complete and,,Sigp This S,ecti,on If Using A-Builder' r i , as Gamer of the subject property . bj J .P P rtS' hereby authorize to act on my behalf, in ail matters relative to work authorized by this built g permit application for. (Address of rob) 31 Signa.tvre o r kate -Ar v)6 riot Name If Property Owner is applying forpermit co e Home owners'License Exemption Form o 'the reverse side, aI r z . ®vpell I / c . z � ci �-- .e n r - ...�.�---...-•.-•------�-'�' ._ ��.•••--.,--_--_��..�.-may � --- --� � i I t Coo O, wcr 5 r loco P I T Iwo - � TK E .P m rn IG4-•03 t CI"4ARD A. B�xTFa `" - C6QTIFIEL'� pl.bT Pt_../S1.1 A� ?4OOb tea su LOGATI O" 05reev I LLE CAL C6RTtFY T►-IAT' T14E•�OUWDATI01, 5t4orv►J FLAW R�F•ctZ��.1GE Wr-ZQa&1 Cory\PL-eS vJl'r" Tt-1E 5IVrE_UWG LoT Ce+� Auto SETBACK VC-4UiReAAE:WTS 6P T14t± -zowv Olr -6Aet45'AF3L& OSTS E.0t,.LE 4IBI64TS DATE S Cl BA,XTCtZ t. t4JG_ RE6tS[r--ZSD LAWO SUQIJa`(O ZS THIS DLAM-1 15 LJOT BASES ON A&.J OSTEtZV1�l.E o /4rtASS• I�•lS("etJMEtJT SCJQVC�( �Tt�E dFCScTS S��w�-n APPt_.1 GA►�1T , / ���, AX ssa* map and lot number SYSTEM MUST BE LLEO IN COMPLIANCE Sewage`Permit number .........................2...:................... 9 ZTIC�E 11 STATE ! FTNe � NIT,ARY CODE AND TOWN .. TOWN 'OF BARNSTA, ILE ! BasasT�nis, t . BU.IL;DING IN 4p i639- 00 0 Yf►Y a. sh PPLICAT16N FOR PERMIT-TO .................. ... ......... ..... .. . .............. .................................................... TYPE OF CONSTRUCTION `4:1:@st�x,K..•......... .. ........................................... ...... ........ %. .........................?s . ........ �. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: y0 � ........ / Loco tion,1=.,o•-��....�.C3... Zz"�G�"Z.:..:.-.:m ..�.. .... ..' ..... � ..:-:..L//.r.�:x.. ��' .............................. r ProposedUse ........... ................................................................:.............................................................. J � r Zoning District ......... r.�I.................................................Fire District / ? ... ..(. . ... ............. "�`� ............ /yamName of Owner ....C..��. . �:... ... r...:..Address ................. ...`. ........... ............................................ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................( ..,..........................................Foundation .....la..... r....................................... Exterior ...................7. ................................................Roofing ...... ........................................... Floors I&/ ..............................Interior ..... Heating ..... /7:..� ..../J .................................Plumbing ................................................................................... Fireplace ............. ! '- ...................................................Approximate Cost .. .`'' ................................. Definitive Plan Approved by Planning Board ________________________________19________. Area . . .....d................ n �/� Diagram of Lot and Building with Dimensions Fee .........3../...- ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............... .................. v Capewide Develmpment � � N919214 one story ' ` ---.--. Permitfor ------------ � �� single family dwelling ��.---...--.---..------....------- ��r7 ��W Seth Goodmpemdm Way ^~^....' -----------.---------' . � Omtervillm .-----.'----.--------------.. � ' . . Owner ............Capmn«idm...0eve.l.opment.......... . ' ~ . frame � Type of Constr.ucdon -------------- ' . -----.--------------------.. . - � . `Pk #�0 . ' � ------___� �� __________` . . � - May l� - 77 -Permit C�onue6 ^ lV ' ---� —. � � ^ � �n�e of |n --l� v ' _ ��' � ' Dote Completed —./���4��------.]g ^ . PERMIT REFUSED . , . � -----`--'---.-------._—. 19 � � ^ . � .----..---^—.-------.--------. � --.----..---------------.--.. .---..--------..-----..--.----. � � -----------^---'^^----'—'---^^ � � . Approved .---------------' ig � � . � -------------....----.,---..--- . � � � ------------------------.—.. � ^ � . . ^ & � � | Assessor's map and lot number `..:... Sewage Permit number ................................:......................... I"E.T TOWN OF BARNSTABLE t BABBSTLBLE,MAM i 039. �FQ YPY a• BUILDING INSPECTOR APPLICATION FOR PERMIT TO11 �• .................................. ....................................................... TYPE OF CONSTRUCTION .. ` ........................... ... ........19..:..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... ..:: ... ....... ........ . ........ ......... ......... .... ..:.. .. ....... . ........ ...................................................... ProposedUse ...... ..._.... .... ........... ..................................................................................... Zoning District Fire District <.. ...... ... .................... ... ..................... Name of Owner ......... :. . .... :: :.:..... ........... .........Address .......................... .... ......:::::........................................ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..........................................Foundation Exterior ..................................................Roofing ................................... .................. .................................................................. Floors ..:...............................................Interior ............... ...:.. .. .... ........................................... .............................: : Heating . ................................Plumbing ...... ...... Fireplace ................:..:.... Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .. ' ..':.: ....................... Diagram of Lot and Building with Dimensions Fee ................ ....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Caoemvida Dmval ' l22 � ^' . l^^^ N ' 19214 one� a°°`#' No -----.. Permit for ------�--���—.. ' " single family dwelling -----^--------'------------ ISO Set6 Qomdopamda Way ' Location --. . ' � ' . . apewide Development u"vn�, ' t frame ',- — . ^. . . .. . ^ ' . . Permit ` . uotem* - ' uote . ' PERMIT REFUSED ' ' ............................................ . . . — .—.--.--------.--.. ---. ......................................................... --.---..�^ -----------,—.—.---- . ^ ' . ' .Approved ---------------.. lg ' ' -------------------------- ----------------------.---.. ^ ' ^ LEGEND � �� F GRAPHIC SCALE CONCRETE BOUND -s •'`�`` �`"� s 20 0 o so ao UND (FND) CATCH BASIN ® Q. 1 inch = 20 ft. `~ `°anm" tj S LOT 61 � •5..=4t p fm' artA Ra C f ' u a28 )N3 air } �� �I��Sti� /%.C,S� Q '' ;maPGUE"y:' � ',�" 1 -".oxo�o u.p¢..00e,x.-e,ouoro r•.,v�ec,eu..w.y cC LOCUS MAP STEPHEJ. N a D _ ® o REF 311-77 °O L` N DEED REF. 13533-281 37^ 9 NOTE: SEPTIC SYSTEM IS DRAWN PER ASSESSOR'S MAP.- 122-91 TOWN OF BARNSTABLE AS-BUILT CARD. ZONING. RC SETBACKS. 20'-10'-10' l i l���I o FLOOD ZONE.- C PANEL NUMBER- 250001 0015 C 15.6ft �A W DATED.- 0811911985 cn „�•�,,,, OVERLAY DIST. GP, RPOD o' O SALT WATER ESTUARIES,,,,,,,,,,,,,,,,,,,, LOT 60 ,,, r n ,,,,, , ''' 20608.4 SQ. FT. m m v ' ,,,,,,,,,,,,,, ""'/'"" o ° 0.47 ACRES PLOT PLAN OF LAND LOCATED AT 0000 120 SETH GOODSPEED WA DECK 11 OSTER VILLE, MA 84.7ft # ,,,, r ,,,,,. ,,,,,,, ,,,,,,,, n -- --����- ,,,,,,, PREPARED FOR.- ,,, o ARLINE DOHERTY o :::::::::,,,,,,y ,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,, z w 41 """"'�""�"'"� NO VEMBER 18 201 CP ,,,,/„/,,,,,/ REV REV O REV 15.0ft YANKEE LAND SURVEY CO., INC. S 89°24'10" W 154.03' 119 ROUTE 149 MARSTONS MILLS MA 02648 TEL• 508-428-0055 FAX 508-420-5553 LOT 59 YANKEESURVEY®COMCAST.NET WWW YANXEESURVEY.COM SHEET 1 OF 1 JOB ,¢` 54683 SH