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Engi eeririb ept. (3rd floor) Map Parcel al (f, � /�`T 9
elmit#
` House# Date Issued
-moo
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 9'y-S a-9 I�I Fee
5. Conservation Office(4th floor)(8:30-9:30/1:00- 2:00) �C SYSTEM h ; E
LLED IN CC
ROTA IRT
WITH CRT
19
•G� .'v . ' BAR�STABI'E
L%+L _MA9S
....... r''•-...s.^_�,FD MPS p`
TOWN OF BARNSTABLE
9�4 / /Building,Per/'Qmr,,it�A�pp/llication `
Project Street Address l 1 �` 1k,-
Village
Owner Address
Telephone ���'- ".� 99
Permit Request (J
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family p/Two Family ❑ Multi-Family(#units)
Age of Existing Structur l Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: 3<11 ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(noXinclu ng baths): Existing New First Floor Room CountHeat Type and Fuel: Oil ❑Electric ❑Other
Central Air ❑Yes oo Fireplaces: Existing / New Existing wood/coal stove ❑Yes 040
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
ttached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name �eJ Telephone Number 7 83
Address — License#
3 Home Improvement Contractor# / 6
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE L/222��%O DATE101
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
Q.
erne'
. The Town of Barnstable
• a�uvsrnauE.
Department of Health Safety and Environmental Services
E16 D. Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work:
Est.Cost O G a
Address of Work:
Owner's Name
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
I
Work excluded by law
Job under$1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
a
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the age -of the owner:
D e Contractor Name Registration No.
OR
Da e O er's Name
CLASSIC / EVEN PITCH LOFT SALT BOX
DESIGN DESIGN DESIGN
i 1
PIN
_ � I 6 e i• I i � ,
p
t
I
6X8 $ 920 8X8 965
8X8 965 8X8 $ 1260 8X10 1185
8X10 1185 8X10 1480 8X12 1335
8X12 1335 ! 8X12 1725 8X14 1550
8X14 1550 I 8X14 1920 8X16 1770
8X16 1770 I 8X16 2195 10X10 1400
10X10 1400 10X10 1715 10X12 1595
10X12 1595 10X12 1955 10X14 1865 ;
10X14 1865 10X14 2145 10X16 2140
10X16 2140 i 10X16 2415 12X12 1815
12X12 1815 I 12X12 2155 12X14 2255
12X14 2255 12X14 2365 12X16 2615
12X16 12X16 2615 2745
i
; J
M
POOL SIDE STANDARD SHEDS COME
DESIGN COMPLETE WITH:
• Full dimensional rough sawn pine
• 2x6 pressure treated floor frame
• 4x4 post and beam framing
• 1x12 pine board flooring, walls& roof
• 36"door
• Heavy duty hasp e y �®
• Maple handle'
• Louvers 0
e • Asphalt shingles (choice of color) A®
• Stationary window 0 w0��
• Shutters & flower box
• Ramp E COD, t* ' 1;
v _ • Concrete blocks
• Slate (for under ramp)
� AVAILABLE OPTIONS TO FURTHER
CUSTOMIZE YOUR STORAGE SHED
(PRICES ON REQUEST)
�.. , •Double Door
•Extra Window
•Opening Window
•Extended Ramp
•Double Hung Window
•Extra Single Door Uj
•Cement Poured Footings > M
6X8 $ 1095 STIPULATIONS FC N co
6X8 1200 • Payments are due FULL the day of delivery. C co
1370 • Credit Card Sales are to be processed BEFORE r-
8 X 10 DELIVERY NO EXCEPTIONS = Q
8X12 1590 • Please check with your local building V MMM
w W
8X 14 1800 department regarding permit requirements, Uj 0
co
8X 16 2065 setbacks and other regulations that may apply. I... _
1 X 1 1600 • We ask that you please prepare the site location ti
0 0 the shed is to be constructed on. Trees, shrubs, _
1 OX12 1810 and miscellaneous should be removed BEFORE p
1 OX14 2225 we arrive to build. LO
1 OX16 • Please notify us in advance if the site you have W Q 0
12X 12 2085 chosen is NOT accessible by truck, or is in 4 M
12 X 14 2415 excess of 50'distance. r
12X 16 2625 • Please be certain of shingle color and options r
you choose; we cannot make changes once we N r
are there.
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10.00'
EB
10.00'
FRONT VIEW BACK VIEW RIGHT GABLE
WINDOW BOXES & SHUTTERS
WILL GO AROUND WINDOW 8.00'
12.00'
-4.00'-►� 1X3 BATTENS COVER WHERE
'ALL THE WALL BOARDS MEET .
(FRONT, BACK & GABLES)
10.00'
LEFT GABLE WITH A
4' DOUBLE DOOR
8.00,
EasteinsCasualty'Insurance Company-
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
NCCI Carrier 16942 Risk I.D. # 345454Y
Policy No. WC Vo024,436 Federal I.D. #043286174
1. The In6ured/Mailing address: ElIndividual C Partnership
ROBERT DRINKWATER & ANDREW COURSER
PONY WOODWORKS Corporation or
211 MID TECH DRIV£-BAY £
WEST YARMOUTH, MA 02673-0000
Other workplaces not shown above:
2. Policy Period: The policy period is from 04/25/96 to 04/25/97 12:01 A.M. Standard Time,
at the insured's Mailing~address.
3. Coverage: _ `y
A. Worker's Compensation Insurance:Part One of the policy applies to the.Workers Compensation Law of the states listed
here: Massachusetts e ....................................
r .:
B. Employers Liability Insurance Part Two of the policy applies to work in each state listed in item 3.A. The limits of our
7"
...
liability under Part Two are: m: : :Bodily:,Injury:by:Acc dent: QQ: ::.O.O.O. : :each:accident �
Bodlly Injury by Disease 500,Q00 policy Ilmit
Bodlly Injury y. Disease 100�004 each employee
C. Other States Insurance: Part Three of the policy applies to the states, If any, I�sted hereX>��statuV=P(; W6111
V.
X It09BdX8W,AV Imte"78 -via 1N)kNe tQhl,lMlA6? )Bi 4 S� Eric4ors�r.....I WC 20 03 .06A.
D. This policy includes these endorsements and scheduleskw W.0 WC242, WC332�WC350 1NC367, WC441.
a. *f1
i See Information Page III for other applicable endorsements
e ...i —
.r f
77.
Total Estimated Annual Premium $. 1 .gbb2A ,,
Pro Rata PremiuV(lf.Applicable)t$
ANNUAL
M�
TIT, . 5s - s 'b!1:..x.� °�` :`^, .� ,.,i. ,s" '"7%'�,5e,....Pd- c3t- 3r,psns_:.i&•� :' �. �.;,xa 's � s.
Countersigned CHAGNON I NS AGCY INC
P U BOX 355
WEST YARMOUTH, MA 02673
Date 06-10-96 By
ARC: 112.87 SB Authorized Representative
THIS INFORMATION PAGE WITH THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY AND
ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETES THE ABOVE NUMBERED POLICY.
INSURED COPY
�• " The Co innon wealth of Afassac h usetty
De partinent of lndustrial Accidents
ofliceoffnyestl9MOns
600 I1 ushington Street
Boston,Afuvx 02111
Workers' Compensation Insurance Affidavit
�pplicani tnformation: Please PR11VT lebY "`•` �'~M^� �-_
name•
Incitiow
city Phone#
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
company name-
address-
city: phone#•
insurance co. Itolicv#
I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
cirv: phone#•
insurance co ltolicl•#
Nrf7�:. ':71wrt:'r-.�!••r:••:�'•R•,evf-7:�-• •- ram•--r�a�:i�'��•-CT;rf.;�w.;.• F..•_• �.w��;•---�vy^F�:�:r^r_...._•.i�.rtvi-',"e"'..".'--z�
comnatn-name:
address-
city- Rhone 0-
insurance co Policy#
:Attach additioeal shctoi if neces_sa'r + �` s�+ •f*; -1 = _ %� ''- :^''' """'• 'z"" '��
Failure to secure coverage as required under Section 2SA of 111GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur
unc years' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a
cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 rlo here .1 ceni r under the pains and penalties of perjury that the information provided above is true and correct.
Si mature Date
Print name Phone#
a�oial use unly do not write in this area to be completed by city or town official
cityffic or town: permit/license# r•Itluilding Department
Licensing hoard
check if immediate response is required QSclectmen's C)fficc
[0I1ealth Department
contact person: phone#; riOther77
PJAi
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers* compensation for their
employees. As quoted from the "law", an empinree is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An enrplurer is defined as an individual, partnership, association. corporation or other legal entity, or anv two or more .
the foregoing engaged in a joint enterprise, and including the lei-al representatives of a deceased emplover, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing; employees. However the
owner of a dwellin�u, house havin'a not more than three apartments and who resides therein, or the occupant of the
dwcllin`,, house of another who employs persons to do maintenance , construction or repair work on such dwellin- hour
or oft the `;rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL cha.picr 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonvcalth for anv
applicant who has not produced acceptable evidence.of compliance with the insurance coverage required.
Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha-
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not tlle 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.
_ 7.
-
._. .....�...i�
Cin• or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
Tile 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.
r'suvr+T�"'-.•..,..._...___.�..-v,.n.. :-��-..mr-rw•w��. -r1_t�.!.....•...r�w.• _.
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The Department's address. telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
GP�pEN SHEDS
by
ADM'WOOD�1`f0�
PE CnD,MPS
✓!ce "C�arr�iirto�rctue� o��,��itt4e�6
MM eB EEMM R N
' Boar1� otPBuul ing e9ula io�soo n�%andarrds
One Ashburton Place
Boston , .Massachusetts 02108
HOME IMPROVEMENT CONTRACTOR -
Registration 120680 Expiration 02/20/98 �
Type - PARTNERSHIP
HOME IMPROVEMENT CONTRACTOR
j Registration 120680
PONY WOODWORKS ' Type - PARTNERSHIP
ROBERT D . DRINKWATER i °o Expiration 02/20/98
211E MID-TECH DRIVE
WEST YARMOUTH MA 02673 PONY WOODWORKS
ROBERT D. DRINKWATER
- f�LmQTH MID-TECH DRIVE
ADMINISTRATOR WEST YARMOUTH MA 02673
� GG
211 E Mid Tech Drive • West Yarmouth, MA 02673 • (508) 775-8341 • FAX (508) 775-5035 • (800) 487-6387
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