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HomeMy WebLinkAbout0047 WINTERGREEN CIRCLE � �1/i�fier r�e� ���- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pp/� A ^ /J Map l"' Q .� `6 Parcel Permit# b 9�3 Health Division -7 a 0, Ar 4 Date Issued1 , d Conservation Division C> Application Fee Tax Collector Permit Fee Treasurer 4'3Js. 3. FxISi1N0 SEPTIC SYSTEM Planning Dept. UMRW'1'02...POF MR0OMS Date Definitive Plan Approved by Planning Board S d' oh one Orre^r_ Historic-OKH Preservation/Hyannis Project Street Addres L Vt A 0"J 4fal `mot If, Village Owner L( o 6/do Address �c U �Ef� N C`-C (f Telephone — 4 Z0 Z Permit Request C°� ✓�� �I� �� 90� 04Y(,R,/ Mu �k-j` f�V A - - v,�P✓kov�P - Q CD Square feet: 1st floor: existing�� proposed 2nd floor: existing 0 0 proposed o� T f I new4 Z Zoning District Flood Plain Groundwater Overlay ldcumentallon. Project Valuation 45� oo0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach suppor m �'- / w Dwelling Type: Single Family 16 Two Family ❑ Multi-Family(#units) Age of Existing Structure 4 o &. Historic House: ❑Yes m No On Old King's Highway: ❑Yes pl�o Basement Type: Oct Full dcrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) C1�0 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 f No Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes 0"No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:d existing ❑new size Shed:Cl existing Uenew size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Owl Telephone Number Address License# c Home Improvement Contractor# ,�/�7`�/ Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 13 U-114 IGNATURE g(W DATE '7 117 04 FOR OFFICIAL USE ONLY F PERMIT NO. - PATE ISSUED •MAP/PARCEL NO. - - ADDRESS VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION � Q FRAME mil\ - cl—os, INSULATION CYO,''-, PD -S '0 F` FIREPLACE R' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL '• ,GAS: ROUG FINAL' FINAL BUILDING d7 n 0 DATE CLOSED OUT« corr ASSOCIATION PLAN NO. lK " C RESIDENTIAL BUILDING PERMIT FEES r APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 7 Y' square feet x$96/sq.foot= Cell 0 x.0041= r? �r3 —1 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft = x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf. $35.00 h D >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.0041= STAND ALONE PERMITS I Open Porch x$30.00= .(number) Deck.... ... �_x$30.00 (number) F' ace ey . x$25.0.0= (number) Ingrodnd Swimming Pool $60.00 Above.Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 of E Tdwn of Barnstable ' Regulatory Services 13 SMIn, # Thomas F.Geller,Director q�A s659, k � $uilfflIIg Division tEb MA•4 Tom Perry,Building Commissioner 200 Main Street, Hyam ie MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. . Date AFFIDAVIT ' ROME VORO'VEMENT CONTRACTOR LAW SUPPLEMENT TO PERIYUT APPLICATION M(L e,142A requires that the"reconstruction,alterations,renovation,repair,modernization,convarsion, •iraproyement,removal,demolition,or contraction of an addition to any pre-existing owner-occupied bugding containing at least one but not more than four dwelling units or to structures which are adjacent to • such residence or buildingba done by registered contractors,with certain exceptions,along with other requirements,Type of work: Nl u i` /� �rA Q It(9 VI Estimated Cost c o o Address of Work: 1 wt Owner's Name• V�1l L(.5Y G�o� Data of Application! i Z I hereby certify that: Registration is not required for the following reason(s): []Work excluded bylaw (]Job Under S 1,000 ' Building not owner-occupied Owner pulling own.permit , Notice is hereby given that; OyMRS PULLING MIR OWN PERMIT OR DEALING WITH UNREGISTERED COIF(TRA•CTORS FORAPPLIC4)>S ROMM ZUROYEMENT WORK DO NOT EXV3 ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUND UNDER MGL c.14ZA• SIGNED UNDERPENALTIES OF PERJURY I hereby apply foi a permit as the agent of the owner: Date Contractor Name Registrationlio. 0AV fttw ' 6w�wa/- Owner's Name The Commonwealth of Massachusetts Department of Industrial Accidents' 600 Washington Street Boston,Mass. 02111 . Workers',, Com ensation.Insurance Affidavit-General Businesses �/� ,`- 'Ifni` ����».�" �„". .. . . . . -1•-.. .'•:�= -; .:��,�� lame* M CtIcU • address' state: ziy: ��" hone# `i.74 2`G work site locatiosi(full address)• . ❑ I am.a sole proprietor and have no one Business Type: []Retail El RestaurantBar/EatYng Establishment working in any capacity. ❑Office[:1 Sales(mcluding.Real Estate,Autos etc.)' ❑I am an em to er with emi to full& art time): ❑ Oiher I am an employes providing viorkerS. oomvemsation for my employees working on this job.. coin' On'Janine: _ adQl'e85:. -'4' -•; .. . .. .�' ,.. .>E...-.. :;�•.`• �•,. :.V' �•i, r. I.W 15 '� •;' '_ phone.#.:i. ' ?,..:.: idsiiatice.cart' I am a sole proprietor and have hired the independent contractors listed below who have the following workers' .compensation polices: :'aII M =:r coID :. ¢.: A. 2. 1 -- -- U`li'one r •`'' 7: insurance co. com'eri. riea�e - ciy' a:• .x:. ::t�. X, .:�,• •..,fit,.' •,:.. ;�,�,:.:4. .t�; :_:. .;f;';:�� �:;•;:.. s,.•y4: : ....a. . e .. msurancetcb:• olio•::#">'`•' . Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 it day against me. I understand that ti copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. i I do hereby ce � de the p r�and�lenalties perjury that the information provided above is true and correct. ��// Date ignature I - e � . . . . . �,� ' (/✓Ci iA�`�1� Phase# Priest name . . E7Pnly do not write in this area to be completed by city or town official permit/license# ❑Building DepDard ❑Licensing Bommediate response is required ❑Selectmen's[]Health Depa on• phone#; Other3) Information and Instructions i Massachusetts General Laws chapter�152 section 25,requires all employers to provide v✓orkers' compensation for their. employees: As quoted from the 'law", an employee is.defined as every person in the service'of another under any contract of hire, express or implied; oral or written. i An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mQre of I the foregoing engaged in a�joint enferprise, 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 dweIIing house or on the grounds or big appurtenant thereto shall not because of such.employment.be deemed to be an employer. . MGL chapter 152 section 25 also'states thatevery state'or local licensing agency shall withhold the issuance or renewal of a license or pernut 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, neither the• commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until compliance with the insurance requirements.of this chapter have been presented to the contracting . acceptable evidence of authority- . Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation..-Please ess and phone numbers along with a certificate of insurance as all affidavits may be submitted supply company name, addr -of Industrial Accidents-for confirmation of insurance coverage. Also'be sureto sign and date the to the Department affidavit. The affidavit should be returned to the city or town that the application for the perrnit 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 listcd:below. . I • I City 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. event-the Office of Investigations has to contact you regarding the applicant. Please nse number.which wM be used as a reference number. The.affidavits.may.be.returned to be sureto fill.in the permit/lice AX unless other arrangements have been made. the Department b}�,mail or F in advance for you cooperation and should you have any questions, The Office of Investigations would like to thank you please do not hesitate to give us a call.- The Departn=t's address,telephone and-fax number: The Commonwealth Of Massachusetts- Department of Industrial Accidents efffce of Weftadons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 exL 406 MCMRApp"kJ Table J5.2.1b(continued) Praeriptive Packages for One and Two-Family Residential Buildings Hated witb Fossil Fuck MAXIMUM MINIMUM Glazing Glaring Ceiling Wall I Floor I Basement Slab Hewing/Cooling Aegis'(%) U-value= R-valued R-value' R value° Wall Perimeter Equipment Efficiency' Package R value° R-value' 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 to - 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T - 15% 0.36 38 13 25 N/A NIA Normal U 15% 0.46 38 1 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A NIA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE i X 18% 0.32 38 13 25 N/A N/A Normal Y 18'/a 0.42 1 38 19 25 1 N/A N/A Normal 2 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE I 1. ADDRESS OF PROPERTY: WC ��'rl✓� rvt fl o74 s� . 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 1" 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. .BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table J$.2.1b: I Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation. thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. Q The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement &:scribed in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes eleetric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of.heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town.see.Table J5.2.1a . NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-Xalue in Table J 1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). i 43 CAT10 F PRQIPE-FC7 Y LI N it n!W I M SIANUAKU LERNU NOTE:not all symbols will appear on a map ° Q'� GOLF COURSE FAIRWAY �Y mr EDGE OF DECIDUOUS TREES I EDGE OF BRUSH t --- 43 . 1 FY_�' ORCHARD OR NURSERY G V--T-V-V EDGE OF CONIFEROUS TREES MARSH AREA \---•— EDGE OF WATER DIRT ROAD \ / DRIVEWAY �PARKING LOT PAVED ROAD ------- DRAINAGE DITCH ----- PATH/TRAIL / PARCEL LINE ' MAP 326 �—MAP# ° 021E—PARCEL NUMBER � MAP 1 19/ #367 E HOUSE NUMBER 062 2 FOOT CONTOUR UNE MAP 119 037 7 �(�, 3 3 �- 10 FOOT CONTOUR LINE � •�`� Elevation based on NGVD29 `,•�4.9 SPOT ELEVATION # 55 v/ C=,� STONE WALL 8 (0� re.nc-e- a � / \ / -X—X- FENCE I 3. 4 RETAININGWALL• RAIL ROAD TRACK' STONE JETTY 43 . f 1 roes SWIMMING POOL 1. PORCH/DECK 0 BUILDING/STRUCTURE 0 9 ' L DOCK/PIER t� HYDRANT . �\ v �• 1C�-�Jr� c� . � ' �' "v ; �Y � e VANE O MANHOLE , o Pon oW HAG POLE .. T O W N O F B A R N S T A ® L E G E O G R A P H I C I N F O R M A T I O N S Y S T E M S U N I T o SIGN ® STORM DRAIN N PRINTED SCU.IN FEET *NOTE Tbb map is an enlargement of a **NOTE The parcel lines are only graphic representations DATA SOURCES:Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James rs TOWER 1'=100'sale map and may NOT meat of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were Interpreted from 1989 aerial photogmphs by 6EOD m UTILITY POLE National Ma Accra Standards at this do not Q 20 40 p ry represent actual relationships ro physical objects Corporation Honlmetriq topography,and vegetation were mapped b meat National Map Acamry Standards 1 INOI=40 FEET* enlarged scale• on the map. at a sale of 1°=100'.Forc.lines were digitized from FY2004 Town of Barnstable Assessofs tax maps. � LIGHT POLE O ELECTRIC BOX _.�__.___-._a.-._ _r_- cur-rnnn• ��+.�n.�• ww• 1 �14 13 c� r id �k o'D P-00 C41 I� I d lrl f ICU OA Ale r 1 l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map�l 1 Parcel 036 Permit# Health Division �''tg�:1�� ) l�l Date Issued Conservation Division tv Application Fee Tax Collector Permit Fee tk_ Q® Treasurer SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE . Planning Dept. WTH TITLE 5 , , ENVIRONMENTAL CODE'AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis G. Project Street Address il fe-�- Village 0 5 fc�r v; 11 e- Owner /,//'/C 0- �.r r% e.r Address 3 c:r_ ®sil_,r v Telephone _ 5 O A - 14 2 8 - 8 2 1 O A n Permit Request S / Ge�� a.J C-Ak it / m .�i/I Id, r, e..►r .1 r%G r cn u A w u V"fh Vy.4 i O y Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family lb Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ,_.�, ber 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 0 Electric Cl Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:0 existing 0 new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes .0 No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 96A C,,a_ Telephone Number 5D 8_ 90 41 - 31I Address 13 License# n q-,� .2136 x-0 e-_I% 14) (Vm O2 3 n I Home Improvement Contractor# /3 6,30,4 roe ve_l��g Worker's Compensation# 4g?A U 6 �5&3 ,gyp 8 S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO e_so v r c.&_ SIGNATURE DATE /o 4 FOR OFFICIAL USE ONLY R PERMIT Nam. DATE IS, UED MAP/PARCEL NO. ' Air r ADDRESS ' VILLAGE c OWNER - DATE OF INSPECTION: I J Al FOUNDATION COD 7`I`6Y,44=" FRAME INSULATION FIREPLACE ? ELECTRICAL: ROUGH FINAL„ t , S S PLUMBING: ROUGI� > , FINALcr , O 0 t fY GAS: RO Nqn Z� FINAL a"�' � } CJt-- � OC • FINAL BUILDING S Oa`i � � t mnf-- - � cr 0 � DATE CLOSED OUT ' •< ms t ffi ASSOCIATION PLAN NO. OFIME ram, Town of Barnstable Regulatory Services • BARNSTABLE, Thomas F.Geiler,Director MAM 039. a``� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date --Z/i/6 4L 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: --On 4 It^I a V%rX -st Pen L Estimated Cost 1-5,®®O Address of Work: A)4— 1f C P A o Owner's Name: P � to V- r+ e ir, Date of Application: 611SZC3 I hereby certify that: Registration is not required for the following reason(s): ❑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. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 1 o m L Co 3 3 6 Da e Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav i The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit-General Businesses name: J n e_ -7 .e " address: /3 tr S ti 5 T. city Br 0C]c to state: �a.. zip- 02 3 O/ Phone# S Oct- 51O'*7' " 3/1 work site location(full address): ❑ I am.a sole propnetor and have no one Business Type: ❑ Retail❑Restaurant/BaAating Establishment working in any capacity. ❑Office❑ Sales (including Real Estate,Autos etc.) ❑I am an em to er with en to ees(full&part time.). ❑Other %/M%///%%%%///%/%/%//��/%%%%%//%%%%%%%%%%%% ///%//////m/11 I am an employer providing workers' compensation for my employees working on this job.•, . c a a oiii n .n me. P V •�:P'� GYc_ P' r.�ci`:`�.�?'ice. ���'. address: - ki . .. © , /:.:►^tkv .` insurance.co: of I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: comPanV '"•- � "name: ' - address: ctty:..'. . .•.., :. .:.: ... :.•.: .: : ..•..: ti&one'# � _ . • .is :, , insurance'co. �i. 0nipaily naae ....•....... ... ,. .. address:. . city. 'r7 Al10IIE:# tnsuranc_so. ` Failure to secure imposition covers a as re required under Section 25A of MGL 152 can lead to the - .g q of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that p copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ins and penalties ofperjury that the information provided above is true and correct Signature Date Print name J ey Phone# official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Building Department []Licensing Board ❑-check if immediate response is required ❑Selectmen's Office El Health Department contact person: phone#; ❑Other (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers.to provide workers' compensation for their. employees. As quoted from the 4`law", 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 haying'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 section 25 also states that every state or local ficensing-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, 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address and phone numbers along with a certificate of insurance 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. 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"lave'or if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. . City 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. Please be sure to fill,in the permit/license number.which will be used as a reference number. The.affidavits nmay.be returned to the Department by mail or FAX.unless other arrangements have been made. The Office of Investigations would lice to thank you in advance for you cooperation and should'you have any questions, please do not hesitate to give us a ca1L The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents BMW of wesugadens 600 Washington Street Boston,Ma. 02111 j fax#: (617) 727-774.9 phone#: (617) 727-4900 exL 406 Town of Barnstable o��K�rati Regulatory Services Thomas F.Geller,Director Gb 019. p1 Building Division Arlo Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . vtww,town.b arnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder as owner of the subject property to act'on my behalf, hereby authorize . in an matters relative to work authorized by this building perrmt application for: (Ad ss of Job) L Date Signature of Owner kA Print Name .,.cna t,dC c(1WNERPERMISSIOrI Jun 22 04 04: 05p p, 2 �Y�rs' Gateway Center 1000 Legion Place P.O.Box 3556 Orlando FL 32802-3556 800443-4404 FAX:407 649-3574 June 11,2004 Insurer:Travelers Indemnity Company ANGELO,JOSEPH DBA BRIDGEWATER POOL P O BOX 3678 BROCKTON MA 02304 Policy No: 316IBS4804 Effective Date: 05/29/04 The Travelers Insurance Company has been assigned as the servicing carrier for your Assigned Risk Workers Compensation Insurance policy. We welcome you as a customer. We have received your application and premium Your policy will be issued shortly. In the meantime,should you find it necessary to file a claim or communicate with us,please note the following: For Claims Reporting: For Policy Services: 1-800-832-7839 1-800-842-9886 x3577 The Travelers Insurance Company CL Alternative Markets Division P.O.Box 3556 Orlando,FL 32802 The Claim Reporting system is a toll-free service that is available seven days a week, twenty-four hours a day.Usage of this system has been proven to provide significant benefits,with the immediate assignment of a Case Manager,automatic production of the First Report of Injury forrn,and earlier resolution of employee claims. Safety and Loss Prevention are critical concerns to any business. We have long been a pioneer in the field of accident prevention,having the experience,resources and capabilities to provide a complete range of safety services.Your policy will include more details regarding these services. Please keep this information available. Reference the above policy number on any correspondence and have it available when contacting us or submitting correspondence. It is our pleasure to work with you. If we can be of service,please call. Sincerely LAURI PIOTROWSKI Account Manager Underwriter Orlando Service Center Cc: MORSE INS AGENCY INC 285 WASHINGTON ST N EASTON MA 02356 74, BOARD OF BUILDING REGULATIONS Llcenae: CONSTRUCTION SUPERVISOR Number: CS 042236 ®_I;t9idate 07/2?J1949 _. Exphj4:071ZZ/2005 Tr.no: 359 Resgsfd4ed:00 JOSEPH R ANGELO 10 ARBORVIEW TERR — W BRIDGEWATER, MA 02379 — Administrator I ^� ✓/.e �o�w.no�srcax/G4 o�✓lla.�c/r,�oell.�, 4 Board of Building Rejulatioos and Standards HOME IMPROVEMENT CONTRACTOR Registration: 136336 Expiration: 7/12/2004 Type: DBA BRIDGWATER POOLCO. JOSEPH ANGELO 13 CRESCENT St. BROCKfON,MA 02301 C� AdrWai w%for i I , Cardinal Systems, Inc. :dam 2" .$"" In, 61 SoAuOkIN Doran. PA. IM2 DESIGH OF 2—BRACING Conf_rolNno condlllvn — water io the log of The a.9gj 4 WATER DEPTH 3•-6'io1 OPEN 1'-0" DEPTH OF EXCAVATION FOR POOL. WATER SIDE 8' X 2-C CONCRETE SIAS AROUND THE SIDE �� BASE. OF THE FOOL MALL. I POOL DIMENSION ASSUMED & 161 1t 32' ktATER1AL, 14 GA. GALVANIZED STEEL WALL PANEL Fv,, = 47 K.S.I. P. i �---2'-®", POINT 'A- I' d WATER PRESSURE AT BASE OF STEEL WAIL PANEL IS 219.4 #/FT. ((62.4 #/FT,) (3.50') (1.0')) = 216.4 @/FT. R. - THE RESULTANT WATER PRESSURE ACTING 1/3 FROM THE BASE IS t AT ma B/FT [(208.4 4/FT) (3.50') (1/2)) = 382.2 #/FT. NEGLECT THE EFFECT OF THE EARTH PRESSURE DETERMINE IF THE POOL. IS STABLE WITH 3'-6" DEPTH OF WATER INSIDE THE POOL; TRY ANCHORS AT 8'-$ MAXIMUN. E MOMENTS AT INNER FACE OF THE MALL 0 POINT "A P, n 352.20 X 14 = - 3.,350.80 24(6X100) - 14,400.00 X 12 m 172.000.00 24(6)(150) = .2.1j600.0 x 12 = 2 0.00 j 36,382.20 426,649.20 1 I I.7261r > b/3 ca D.W. b/2 1B" _ P,�, �(4 x: 24) -- 6(9 9.7269))$$ 352.20 -�-- - 1.619 PSF/FT. Pm., 6(11.7262) - 2(24)]36,382.20 = 1,412 /FT. c�4 . THE POOL 15 STABLE. AND THE FOUNDATION PRESSURE 15 *4 A-OcAoori o F Pk 01P LI N V N -r a E ►CCU R T STANDARD LEGEND NOTE:not all symbols will appear on a map ° Q-N=Z� GOLF COURSE FAIRWAY /-Y"Y-Y•'" EDGE OF DECIDUOUS TREES ^^ EDGE Of BRUSH 43 ❑ 1 , _ G ORCHARD OR NURSERY V'-V-V-V EDGE OF CONIFEROUS TREES 1 MARSH AREA 'J - •- EDGE OF WATER DIRT ROAD \ / DRIVEWAY �— �-PARKING LOT ^ ,• 4 ° 4 -- : PAVED ROAD ------- DRAINAGE DITCH ----- PATH/TRAIL PARCEL LINE MAP 1 19 MAP326 �— -MAP# /1 ° #367 -PARCEL NUMBER 367 —HOUSE NUMBER 'g ,�a�+� . O 6 2 - 1 FOOT CONTOUR LINE MAP 119 �' ® A # 3 3 10 FOOT CONTOUR LINE 037 7 1T,,� Elevation based on NGVD29 1 U `,•�4.9 SPOT ELEVATION # 55 v/ (DC-)C:> STONE WALL e,n -X—X- FENCE COX .Q� 4 3. 4 .e, RETAINING WALL o� f+ / \ -r-'-rr RAIL ROAD TRACK c_-_=--=•� STONE JETTY 43 .11 SWIMMING POOL r� PORCH/DECK (� � ] 0 BUILDING/STRUCTURE 0 9 ' DOCK/PIER HYDRANT Ce VALVE O MANHOLE 0 POST pF` FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N I T v .SIGN a STORM DRAIN M PRINTED SCU-IN FEET *NOTE:This map Is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James ❑ TOWER 1'=10D'sale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTILITY FOIE w e 0 a M 10 40 National Mop Accuracy Standards at this do not represent actual relationships to physical objects Corpomfion. Plonimetdcs,topogmphy,and vegetation were mapped to meet National Map Accumcy Standards 1 INCH=40 FEET* enlarged sale. on the map. at a sale of 1'=100. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps ¢ LIGHT POLE O ELECTRIC BOX ROYAL - r , , , 8'THERMOPLASTIC ' T SIDESTEP T 8 4 \ (right 51de Shawn) 20'X 40'2' RADIUS 2'R 20'X 40'W/STEP 40' 20'X 40'4 CORNER W/8'SIDE STEP PART DESCRIPTION X 2'R 2'R 7 5 6 05102 8' Plain panel 2 2 2 05104 8' Skimmer Panel ' 4 3 '3 3 .05108 8'-Return Panel 4 2 4 2 05'123 4' Plain Panel. a e - 4 4 4 05161 2' Radius Panel `�N;R 10 11 11 05188 A-Frame PANEL g, f r 41'-21/4" k THERMOPLASIC . I 05202 Nut& Bolt Pack 2O 51 EP 07418SNR 8'41read Ste -N-Rest 8 4 , f2'FPZ, 2P 2R 2R T-A-FRAME BRACE + 20` 40 1 1. Paul is deigned tor use below gmde and omy in areas where the ground water(able is a minimum of 4"6" ' below the proposed tiniaheJ grade. 40" r 40"' • . -. Backf ill with clean earth,free of roots and debris.Du not allow the height of bnekfill[itexceed the height of the water in the pool by more than 6'nor water to esceetl bucktill by more than 6'. - 3. 1, 251g1 P.S.I.concrete hurting around entire perimeter,minimum 8-Jeep. 4. 3'wide concrete deck is Go he poured at least 3"thickness anti a slope of Il4"to I' SAFETY NOTE - - - awayfromtheped iPitiil bidtutn cunfigumtiuns ore. - ' 5. All inside Pool dimensionsare tobe finished dimenisiuns. I All dimensions are finished dimensions. h. Finished bottom ism be 2"•minimum of suitable material ur undisturbed earth. ;tor illustrative purposes only. / Jf ;The configuration shown can-, 2'MINIMUM 7. Asafety line.with buoys.is to be pennanemly:ntacheJ l'tl"wthe shallow Ifortm withcurrem N.S.P.1 sus- PP,EPAPEDB011'OM ` . side of the point of first slope change. Bested minimum standnnls fors ' R. Stairs: For al kstuir layout.refer to imperial instal latiun manual' pools approved for use with" I ' 9. Construction Drawings:These drawings and notes are for illustrative pur- i ` 4` 12' 4' •- L 4`1 ,10, I 14'. I 12' only.Difterem methods and revautions may be dictated by various !manufactured diving equip- poses _ - - . P >' responsibility>' (ment.If diving equipment.is' a r ` •. ground conditions.This is w be Jetennineil by and is the of the install ed.fulluwtheeyuipment. - - •ramnnmr who is nor an agent ol'the manufanurrrol'Ihe component pans, manufacturer's installation,, ' •" ,: t- - ;�• « ~ Y III.Installation is to be dune in accordance with all federal,state.and Itkal build.I - • " t use and safety insmctions. ing codes.as well a N.S.P.I.suggested standards. • r i �'�r .1: 4. 'b• • t'4 F '• h► rT _ fT ti.` A. e �+ -ROYAL i ill . . ; 8'THERMOPLASTIL _ 8 I SIDE STEP /,1 \ (right side Shown) �i r 18'x 36' 2' RADIUS 18'x•36'W/STEP. - 1'8'x 36'-4 CORNER W/8'SIDE STEP" L 2'R 8 8 8 8 2'R7 2'R. 2'R. �'� PART# DESCRIPTION 7 6 6 05102 8' Plain panel { 1 05104 8' Skimmer Panel 3 3 ' 2 2 05108 8' Return Panel 8 B 8 2 1 2 05112 6' Plain Panel CENTER - PANEL B• 2 05128 3' Plain Panel 18' 36'-83/4' THERMOPLASTIC '- 4 4 4 05161 2' Radius Panel '- 8 9 9 05188 A-Frame 1 1 05202 Nut& Bolt Pack 6 6 �� 07418SNR 8'4Tread Ste -N-Rest 3 3 ) 2,R 2 R v 2'R 2'R ; /- T-A-FRAME BRACE r ; _ - - •rah 1. Pool is designed for use below grade and only in areas where the ground water table is a minimum of 4'6• ) ' below the pmpned finished grade. 2. Backfill with clean earth,free of r-ts and debris.Do not allow the height of backfill to exceed the height of 440" the water in the pull by more than IS"our water to exceed backtoil by more than 6. L 3. Pour 25W P.S.I.concrete footing around entire perimeter,minimum S'deep. _a ., _ •L •4. 3'wide.coricreie deck is to be poured at lust 3"thickrass and a slope of 114"to I' SAFETY NOTE 8 �NJ 7� away from the pail. - - • - . bosom cu irVnun'—ors are, ., 5. All inside pwl dimeC)iuns are m be finished dihienisiuns. . i .. fi. fiished bottom is ai be 2"minimum of suitable material or undisturbed earth. for illustrative purposes only. .,.,r;� . TTe configuration shown con•) - �climen�!5ion5 are finished dinaenstone. 7. An safety line,with buoys.is ri be permanently attached I'll"ro the shallow 2'MINIMUM - - %r'"` <!1 form with mnem N.S.P.t sug-1 _ v„= Tr',,: side of the point of first slope change. I PREPARED BOTTOM ` gesTitminhnum standards for %. Stairs:For all stair layput,refer m imperial installation manual. Poo pp t L �_ �_ J L I I �R • 9. Construction Drawings:These drawings and notes are for illustrative pur- approved for use with poses'only.Different methods and precautions may be dictated by variuue` manufactured diving equip. z 4' 10' 4' .4' y 6', _ 14' _ - 12' meat.D diving equipment is < ground conditions.This is tu be determined by and is the responsibility of the �, y •- -, installed follow the equipment! J, - conuac�tor wfaf is nix an agent of the manufacturer of the component pans. - s. - .•% _ manufacturer's installation.' • .. _ ,,. ".'r 10.Installation is tu be dime in accordance with all federal,state.and local build- use and safety histructions. - �. . '� ing codes,as well a'N.S.P.I.suggested standards. - .• _ - _ • ,1 � r Town of Barnstable o� Regulatory Services Thomas F.Geller,Director SAIN cb s6s9 Al Building Division ArED � Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 . wvrw.town.b arnstable.ma xs Fax: 508-790-6230 office: 508-862-4038 Property Owner Must j Complete and Sign This Section If Using ABuilder as Owner of the subject property x to act on my behalf, hereby authorize in all matters relative to-workauthorized.bythis building permit application for: kA4Address of Job) !•� ! Date Sig tore of er i print Name .,.cnat .cz!nvJNERPERmjsSION IMPORTANT — UPGRADE REQUIRED ' IMPORTANT ANY CONSTRUCTION THAT INCREASES LIVING SPACE STATE aLRLDING CODE RECKARES THE UPGRADING OF SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN SMOKE DETECTORS REVIEWED BEYOND 1200 SQ. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. Qjo A04 NOTE- A SARA"fE PERiA(T IS REQt11RED FOR THE NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE N EP NOTE--ATI OF SMOKE DETECTORS-THE ELECTRICAL AR AB *UILDINGDEPT. DATE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT, PERMIT DOES NOT SATISFY THIS REQUIREMENT. -FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING �6 ►p /I'vcbrr[cFwtrl 3o Y/ kpr,olL �s lb r---elf PvPDr - - � 7,nlo,° . � 9 —tcg Collin LI� SHw�er 1"4-1 Twv447- Cotlu/J,t? �rvF1 fvu M � V ["rLl4f of5 II 2)7-20c4 rime Sor(',f w[TZ Fy„ll.c/- tJ top rrP vo�+1 QrA N.- _ w�IFp crdarStir�51Es j 1Vt iC El o�cpu�tr� 3 SFucr. Fo juJP. - qz�b �F�Js t�2'' Cb� pllri�0�1 ~ �- I'S Lvlt,�lbllut� o cl°titf Z,4r :� - � IIIAA-wGgGK� zXt chow> Vruft c td ` 3)7-4,0b slr�eal• zrb r 9 tiulSc l4k,oh `! urI ' U- COILOr,, go Leh lq+N• - w01r �IoS{� � zo,<aEcgro Z�A Frata,l.,5 C11oc,hoil i ( tr 04 A. � i� to N - Y I t ` c ovclvieJ u"IUje tj jfM. 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[/trALLO • � - . sr r• A►A tIK Gl•t.AG. /tlt•wIN YY•pG Apt AtAA•A►G [A LATa Rr gCQairG V. fAir LAIQ arMLi S NGiO •AGI , , 1 . r/N Gl•tN. 'In rA/G•ta TO d[raMTa VU[Ga. TILL •URIL WIT"rAreu =MIra �Nw*lirtr.lrr. IF s--�r a`' ^ •� ..•_. GACIvtLL1M. VATO LaVd a1raL rrT GaAaa r0 tACWILL L K.KL rR + ;••.♦ r..,•a All .•A••G i•l.aG Ali wj :tArio A-Pp�s r►ACr. APO Mum TNM ors Tour. +aQlaZitOVT'AL DaAt a�� I �'s`�4"� ,••+`M` wl uMIM .atr • 81.4 plus 0.I.4 AtlAp ..1•t.a. L�. • 14�..LV. L • Slitid •. A AT a oll.MAT WALGary Las Or RN aGrts GrAGs SMLL Rtas ANAT F• a/ wlrrT •.•:r •rraa w.l.aA,�. a.000 �a sA.ap...l.. cr►Is AT A Mrs wort Las nalr ai•- /'GA •oor. l+�LL �T !iNJ� _ • {o �1 ♦o-�'y' �� •ap.Nar b�••10.. , _ y ov�s:t�r. �a. etas pool Ms rot Gaaw GoaGlo rs A IaAon.Ga L oAGI•� - — /1T HIP. � ' �� eau i�- • G. Gr1lA Ga•Ia AtMG� •Gt< Aug, a! ..,.,, ..'..... .� .._�. w+Ll �p t1 n•a,►.�_ •. ais:a.J TYPI�<t t_Ivl Plait�tit .�-•sl 2 . c �r 1/(/ 1 ��,'" _... ., ---.._ li`i1 .Sur+! �I:r 1 ale 1 --- 2 x,,g• P J�P ' i z eC,' 1 ; t ' a t p r �'t.!'' i r 11 S�nR-) {- Q. 1 ✓r Y) I L.4 Iv.F, i SCAlE:.1 I..[: APPROVED BY DRAWN BY . .. ' ,. J.. .. ..� DATE' Y AWING NUMBER OSTERVILLE N • 8(j Cz 'ypS d IC A.M. 119 1 w� PAR. 37 a Locus-- �4w x WINTERGREEN Gj _ CB a CIRCLE 191. 73 DEED) 193 f( ;�_ cr 22 3• 42.1 CB �. �! ,,,,,,, LOCUS MAP o ,,,,,,,,,, •�, � •,,,,,,,,,t;� � ASSESSORS MAP 119 PARCEL 38 N % - PLAN REF 20619, 1661107 395117 & 280117 ZONING. RC" SETBACKS: 20-10-10 0 VERLA Y DISTRICT "WP" pOOL9. A.M. 119 � " PLOT PLAN OF LAND ��,.HO USE��� PAR. 36 � 20 0' AREA=19,941E S.F. LOCATED AT O L8 v,cJ #4 7 WINTERGREEN CIRCLE o PROPOSED ,, ,,- cn OSTER VILLE MA. b � ADDITION r - "" PREPARED FOR.• b ►o wv 44, O N O MICHAEL GARDNER L .ti .... ,24 3':: Hr K' �V 20.O _ b SCALE.• 1"=,20' w °D CB y JUL Y 29, 2004 'pW 199. .�- S ri ,;♦os S►� \Sc.9c REV OF rtuS.EED) REV 193 (D 7)CB 58'(PLAN 28011 REV g7EPHFd �. poYLc s "755- A. YANKEE SURVEY CONSULTANTS 9 A.M. 119 t '.� �� =s r� :® UNIT 1, 40B INDUSTRY ROAD PAR. 62 - P 0. BOX 265 �r o�„ yo- MARSTONS MILLS, MASS. 02648 si- ,' ;. µ TEL• 428-0055 FAX 420-5553 \� NOTE LOT LINE INFORMATIOX COMPILED FROM DEED DISTANCES AND ABUTTING PLANS, ~� 'ITS RECOMMENDED THAT A PLAN SUITABLE FOR RECORDING AT THE REGISTRY OF DEEDS BE MADE. SHEET 4 OF 1 JOB jy 53703 GM Lam.