Loading...
HomeMy WebLinkAbout0150 BAY SHORE ROAD 16-0 I, .Y,F PIN r_�ra`r: � � � 11. "'- sae• -,MY. F4 - Z 'fir i so r� l ock)iv q L J 1 J �j Town of Barnstable �oFzH�E roy, Reguilatory Services Thomas F.Geiler,.Director Building Division seaxsrA13M v n ��* Tom Perry,Building Commissioner �'`'rEo ,t►� no Main Street, Hyannis,MA 02601 Office: 508-862-4038 �0-6230 Approved: Fee: Cl? Permit#: O 123Q HOME OCCUPATION REGISTRATION Date: Name:. W LLAMA A-Yy-, 00 o Nl 1-- Phone#:./��k4• g�6" 6 906 Address: VD-D `3ett4 t4 A-M 1,_1 k S Village: Name of Business: W 7K Type of Business: 1AAk--�0 1- w\W • Map/Lot: 3 S Oro 2 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the- premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space; '*- • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of.normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. There is no-storage-or use of toxic or-hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met.on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. o There is no commercial vehicles related to the Customary Home Occupation, other than one van or one ek�r truelc nat to exceed one tor�:ca aci and one trailer not to exceed 20 feet in length and.not to pi p- p, ty,. _ ... .. — . ex=d 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the underp'gned,have re d agree the above restrictions for my home occupation I am registering. q Applicant:' Date: LA—l t_I . YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permissbri'to"operate:) Your mils first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: �+ Fill in please: APPLICANT'S YOUR NAME/S: t�i i w� coo t 1 BUSI ESS YOUR HOME ADDRESS: i Z 'C tfiaA.t: 243 TELEPHONE # Home Telephone Number S'bk-1N 0 0 NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS ► 1A P MA-ti W Uaa— IS THIS A HOME OCCUPATION? YES NO t�tfsu� f ADDRESS OF BUSINESS 1S'D'uA^JS i 1r1,C L—JJIV�6 AaaZT, vv%4. V2(ac�\ MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate ermits and licenses required to legally operate ou-�r�usm�s in this town. yp 9 5 Y P Y 1. BUILDING COM ER'S OFF CE This individu I ha b n irrfor e f a y p rmit requirements that pertain to this type of bait}td�T COMPLY WITH HOME OCCUF c AND REGULATIONS. FAILURi Aut _ rized Sinwdfe* ( i'J!A`f RESULT IN FINES. COMMENTS: 2. BOARD OF HEALTH This individual has b form ermit requirements that pertain to this type of business. MUST COMPLY WITH ALL KAZARDOUS MATERIALS REGULATIONS Authorized Signature**' COMMENTS: 3. CONSUMER AFFAIRS LICENSING AUTHORITY e This individual ha inform Pth lice4 ,g r uir nts that pertain to this type of business. Authorized Signature* COMMENTS: CAP OFHE T Tp� 'own of Barnstable *Permit# 6�6��� ,�, Expires 6 mont sfrom issue date Regulatory Services Fee IARN5rABLE, .: Thomas F. Geiler, Director (^J� MASS. 4, 1e39. ,� Building Division VV pTED MA't 6 Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not {valid without Red X-Press Imprint 'Map/parcel Number ' Property Address /�� l J �ll D LQ r, n i t�7 UV Residential Value of Work AWO� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address � � (�� ( TO J� Contractor's Name Telephone Number Home Improvement Contractor License# (if applicable) — '❑Workman's Compensation Insurance X-PRESS PERMIT Check one: �I am a sole proprietor I am AUG the Homeowner 2008 ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) �r Re-side [Replacement Windows/doors/ ider -Value (maximum.44) . *Where required: Issuance of this permit does not exempt compliance with other town department regulations,'.e. HlstorlG"l:onseN.atlon,etc. ***Note: Property Owner must sign.Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is require ram' ooe Y SIGNATURE: QAWPFILESTOPMMuilding permit for s\EXPRESS,doc J „ The Comrrconwealth of Massachusetts Department of Industrial Accidents UVOffice of Investigaiions 600 Washington Street ,Roston, MA 02111 vww_rnasv.gov1dia Workers' Compensation Insurance Affiidavit: Builders/Contractors/Electricians/Plumbers Appucant Information Please Print Le 'bI Name (Business/OrganizsldonllndividuaI): Address: 0 City/stata� elZip: �'(� S D! Phone.#:. �' Oq 3 -70 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ T am a employer with 4- ❑ I am a general contractor and I 6 ❑New construction employees (full andlorpesrt-time).* have hired the sbb-contractors 2❑ T am a'sole proprietor or partner- listed on the attached sheet 7. ❑R-emodeling ship and have no employees These sub-contractors have g, ❑Demolition orkers'ees and have loy w working for me in any capacity. evp 9: ❑Building addition [No workers' comp.-ms trranrC comp.rncrlrancc.t 5. [] We arc a corporation and.its 10.❑Electrical repairs or addi iot rtquured ] officers have exercised their ILL]Plumbing repairs or additioi 3. am a homeowner doing all work myself [No workers' comp. right of exemption per MGL 12-❑Roof repairs incnran�r Y P. 152, §1(4), and we have no e4d] employees. [No workers' 13-❑ Other comp.insurancc required.] *Any applicant that chccla box 91 must also fill out the section hclow sbowing their warka-s'cmnpaisaticn policy inforrnatiarL t HDrnmwnat who gubaut this affidavit indicating they arc doing all work and thrn hire outside contractors must submit a new affidavit indicating such- TCantraetors that ebrzTc this box vino atiached an additional sheet showing the namc_of the sub cantracturs and stain whether or not tbosd entities have anploycrs. If the sub-conhactrns have employees,.Yhcy must providt their workrrs'camp-policy number. lam an employer thug isprcviding workers'compensation insurance for my ernployee,'�, Below is thepoucy and job site information rncYirarce Company Nam Policy#or Self-ins.Lie.#: Expiration Date_ lob Site kddress: . City/Statelzip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date; Failure to secure coverage as require under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of: fine zip to 31,500.00 and/or ono-year imprisonment, as well as civil pcnalti'cs in the form of a STOP WORK ORDER and a f of uup to S250.00 a day an inrt the violator. Be advised that a copy"of this statLmcrit may be forwarded to the Office of Investi ti of the DIA f insurancr coverer e vcrifiicatiom I d�hcrj u e erred penalties of perjury that the information provided above is true and correct Si > Date: — Phone# O j7cw u_se only. Do not write in this area, to be completed by city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one)- L.Board of Health 2.Building Department. 3. City/Town Clerk 4.Electrical Inspector S.Plurnbiug Tnspector 6. Other Town of Barnstable y o Regulatory Services rt Thomas F.Geiler,Director rt t3ARNSTA91E, ! - - ,� MASS. Building Division pTED 1��a Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 vt,ww.town.barnstable.ma.us Office: S08-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: J ��� ✓ " bcr �C. street �vilillage Q l ..HOMEOWNER �Af�f� 'fo� name N # work phone# CURRENT MAILING ADDRESS: v� city/town state zip code The current exemption for"homeowners"was extended to include owner-occu6ied 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 riot"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: T e dersigned", o owner"certifies that he/she understands the Town of Barnstable Building Departnent inspe on pr cedures and requirements and that he/she will comply with said procedures and equ' rr e ts. 1 igna re of Homeo Cr 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 perfomung work for which a building permit is required shall be exempt from the provisions of this section(Section 109.IA-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 rxemption 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 arith 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 hrlshe 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. F, �oF-THEt, Town of Barnstable Regulatory Services BARNSMBLE. ' Thomas F. Geiler,Director MASS. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section ff 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. ................._....._.. Massachusetts Department of Environmental Protection Bureau of Resource Protection—Waterways Program Transmittarl BRP WW 01 Waterways License or Permit: Non Amnesty DEP BRP WW 02 Waterways Amnesty License or Interim Approval BRP WW 03 Waterways Amendment to License or Permit General Waterways Application ' Municipal Zoning Certificate Pbw typo or Charles Ro, Jr. print ataxy allInf came aagoaanr pry an 150 Bay Shore Road �form. P*d*W Hyannis ._......__.._..........................................................._ __._ ___— _ _ ._I._ ONTO n ' Lewis Bay Wirerwey ..............._.................._............................__.............._.._......... Qeurlptl4n dprgoamd usr or dope In use Construction of private residential �ier._.as.accessory_to.ex single family dwelling •:iiTTi:::i:?iT:v:?L:;•>:;v:.;s�iT:?T:•:i??•:�}T:•T:•i'JT:^ism::::::isT:•: isT:4:??v:•:�i'rr:?4iT::4?•TT:•:4::::i.i:•T:+:i" Tu.{t n..T::.........n. '+9}TT••}•{?.TTTi'4:Sii:??S%:?•::?:�:•T:•TiT::::4iT:•T.'•:4T:4:v;}iTyTTT:a'.:}:?^T'•'i ... •TTTT:•:4;T:?•T:L}}}T:::???•;;?:.::::::::::::: :...,..;..:..:xxfr:•niT:;ai:•:.?^:•:•?:•:?•:; \\i�W.�'w?:W�FJf:' 'AW\tKOA\?dCJ�.\w\��d'a:.Ui.%MR000OOOpiMVAvtAViO.'....••;••••.;• •.'; 'M To be completed by.municipal clerk orappropdate municipal official: 'I hereby certify that the project described above and more fully detailed in the applicant's waterways license appGaodo and plans is not in violation of local zoning ordinances and bylaws.' Ralph Crossen Rhf Aar�r dAkrilCpir pr<nl , Building Commissioner nr Barnstable a4'/lam � . Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee ' X PRES Thomas F.Geiler,Director RG S PEA MTding Division JUN 0;2T?Rgerry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTAown-barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint T� vlap/parcel Number 2 ?roperty Address S 14v o Yi n'f aesidential Value of Work ! Minimum fee of$25.00 for work under$6000.00 owner's Name&Address R� lS ® ell :ontractor's Name Telephone Number come Improvement Contractor License#(if applicable) / :onstruction Supervisor's License#(if applicable) t� e ]Workman's Compensation Insurance . Check one: �❑ a sole proprietor Pr I am the Homeowner ❑ I have Worker's Compensation Insurance asurance Company Name vorkman's Comp.Policy# ,opy of Insurance Compliance Certificate must be on file. ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) Atli xe-side - J A ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of pemut does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope weer must sign Property Owner Letter of Permission. H In ovement Contractors License is required. IGNATURE: Torms:expmtrg wise071405 »o Department oflndustrialAccidents Office of Investigations 600 Washington Street ' r Bostoni MA 02111 www massgov/dia' Workers' Compensation Insurance Affidavit; Builders/Contractors/Electridans/Plwmbers AvDiicant Information Please Print Legibly Name (Business/Orlanizationalulividual): afios Address: S�►\�C� City/State/Lip: • Phone#: > Are you an employer? Check the-appropriate box; Type of project(required): 1,❑ I an a employer with 4. ❑ I an a general contractor and I employees (fall and/or part time).* have hired the sub-contractors 6' Now construction 2.❑ I an a sole proprietor or partner- rested on flee attached sheet,t 7. ❑ Remodeling ship dad have no employees These sub-contractors have 9% ❑ Aemolition working for mein any cape,city.. workers' comp,insurance g; ❑ Budding addition [N workers' comp•insurance S. ❑ we are a corporation and its 10.0 Electrical repairs or additions r ' ed.] officers have cier6ed their 3. am a hordeowner dojAg all work right of exemption per MGL I L❑ Phimbmg repairs or additions ruyself:[No workers' comp. e. 152,§1(4),and we Iwo no 12. Roof r insurance rcT*c&]t . employees.[No workers' ❑ �� cam.insurance required.] r3.❑ Other aAay applicant that checks box#1 aacat also fill out the section below showing their wormers'compensation policysnfenaetioa Nomeowners who submit this affidavit indicating they are doing all work andthen hire ouWde coub at=must submit anew affidavit indicating such. $Contractors that checkthis bon mast att abed an additional sheet showing the name of the sub-mbahm and their workers'comp,policy information. ram an employer that is providing workers'compensation insurance for.my employees. Below is the pollcy and job site dnformattan. . . : .,t Insia'anco CvmpanyName: lob Site Address: City/State/Zip': Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'Failure to secorc-coverage as required undei 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 tbe•form of.a STOP STORK ORDER and a lime 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 Ilrvestigati f the DIA coverage veriizcatioa. 1 do hereby e u er rain an Jaloes,Ipedury that the information provided a is true and correct, Sr tore: Date• Phone#' G,f lz:rd µn off- Do P&Mft M ift oat,to ik ca ie €T c .or tom.i ftid City or Town: Permit/License# Issuing Authority(circle one); L&Prd of health 2.Building Department 3.City/.town Clerk 4.Electrical inspector S.Plumbing Inspes tor• 6.ether Ce��act Person: ?hone#: k TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 oZ Parcel Permit# DP sz Healtb- awsion 1 I g I S o Date Issued / 02h/0-0 rd Conservation Division 1� ��'^/ e�i ` Fee Tax Collector.' Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owner C)7PAFL� Z57— Add re'ss Telephone —�� 0 Permit Request ��� /�� 7/0�e� � Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost-W22. 567V Zoning District Flood Plain Groundwater Overlay Construction TypeT-LY Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of'Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 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 1� ' C LfA--. �� Proposed Use BUILDER INFORMATION Name& ��'�1�<i ,-& Telephone Number "�_7? Address T; 2 License# G� Home Improvement Contractor# 1 Z� Worker's Compensation# � lf'9� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ r :S FOR OFFICIAL USE ONLY . `& PERMIT NO. r DATE ISSUED "-�►. ,£ ` .. _ t MAP/PARCEL NO. K ADDRESS s + ' r. VILLAGE OWNER DATE OF INSPECTI,OA,,'• FOUNDATION ` FRAME INSULATION FIREPLACE � t ELECTRICAL: ROUGH }r FINAL; t , PLUMBING: ROUGH FINAL — GAS: ROUGH '' - FINAL FINAL BUILDING f' f DATE CLOSED OUT ASSOCIATION PLAN NO. P • it it °*VE 11, .�.'Y The Town of Barnstable BAMSTABM M 9 Department of Health Safety and Environmental Services Argo '" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. LL Type of Work: l T Estimated Cost Address of Work: Owner's Name: IV Date of Application: 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: to Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav -N -___— The Commonwealth of Massachusetts • - — _ , - Department of Industrial Accidents - - OIIICC 01 iff sdoz off r :- t 600 Washington Street - �� Boston,Mass. 02111 Workers' Compensation insurance Affidavit name: a6��� " . �/i�—�• ' location /� C�� /�- 29AZD city f/ / /'6 phone# ❑ I am a homeowner performing all work myself. ty . I am an employer providing workers' c1a.-..—-N.",..1......,,--..,ompensation for my employees,working o,n this job.:. : :.:: :::::::::::::::::::::::::::::::::::: ::::. is i::::::::::;:::::::::::::::2;:::::":::::: ... ":':' :::. x.....;m�.-..�..-.!-.v.. :. :::;::::::: :: ii ::.; m an.;name:. .... .. :.. ....................................:........................... iii'ii::.;'.. iiiii::::: .. v•::�:::::: i:::::::::: ?'•::::is .j;::ii:viiii::i::-::i:::::::::i:i:::�: :iiii:�i:�i.j:v:���':i.:}::,i ii f i:j::Yyi:`�.;:'::!:'ij::<:•::•i:;•^isSi:i:.iiii:::?��:�:�Yii::.:;!v.:'>.i... i:::;..':.-;i}{: '{i}•:.,':}:.....::::.:.:.:.X.;�:i:;i iyv::i:: :. ..::.�::: .. •::h: 'Aid ::::. ./ ::::::::.X5., Ci ..:.:�..::,::e2&�M..,,.�.:"":,: 0- M 220 :<:;::>: .....r:.: .:: ::::<. : '`'s >: . ::::; �_ ......::::.::..: :... 9nsuralrce.ca,.:.. _... :::::: : olicv#;:.:. . :.: ;.;; ;:: ::':::::: :;:>;:.... ❑ 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: .:,... :; eons ativ'name ::`::>';::%;::`<' .::....::::::.....:::::>:::....:]. >>':>> :::>:::<:><:::>::»:<:>::>?:::.:::>: <:::>:::<:>:: o ` :i;:;:.;:isj;:::::Li:Siiii``:iy}i:':;:;`.^`iivi: i2;2i''.;::t.'::::::::}:iii'': i:`:;:;;:y:j:%;:::''r':5::L:::i:'v:^: isi:{::::......:.....: :Y;:::+:':::tjki:;is�>:j.:iy'i{:;i:;'}:.:;is j:;:;:5};?:;j'j::::i>:j'is�•i::`<i::!:?i:!`;:?!$::;:;i'rii}i�:::iiii::<::iv` :•iiii>:: :-i:...::. :... address.: . _ .: ......... _........ .. ... . ... ............_.......:::.........:..::.._.:.:::....:.: ..........::.:.::: ::::..: .........._.. . . _ . .....:. .........:....:............ . _.................................................. ><' :t ti> >: :_ .................... ...::....:::::::::::..:.::.::::•::.:.::.::::::::.:.:::. :::::::::.::.:::::::.:::::•. yy.:::.<:.,.::._.<.::. :........::::.:::::::::.::::.:::::::::::::::::::::::::.::.::.................................................................................:.::::::•::::::::::.:..:::::::::::::•::."...1:::::::::::.:::::::::::.::::::::::.:.:::.:-:::: ::..M:•:.:.M:.:.�•::::. •rltvR . .:.. ....phone#.,..:.,: .:.......... .... ....... <.:�::.;::.::::N. :'':YJ:+::ii:lSY:ii::i}::ii:: Siiiiii:ii:<v::6iiii:•yiii}}ii'-0:ti:w:.�v::v::.�::.�::.�::::::::::::::............:::::.�:::::.�:::v:�:::::::::::::..::::::..:.......................................................•.��.......... i i:S i:<:ii�iii i`.'•ii: ii}:.*....?:':::::......X..:i_...::iii::i::Sv .:l}::ti:;r:i ii i:.i'f:{il.'•iiiiiii:>::;i:.:.:+:i:i.;::?i ii{j ifti:.itii....: i.... :i:;i:;::::i:ii:St:?::::::....::i:':r:}::}::;: ii,?.:.:•ii:i!v:•i:?Gunn:ii:•.•Y-i}ivi:•ii:::::::i .. ......................................................................... ::.:.:•p.....v.....;..-M1...............:::4ii.....•.........S•i:•iiir<n'i4:Sri,vNt}:?,.;:J:;i :r :i4 :..::::::::::::::::::::::.::::::::::.............::1". ..............,.............:.::::...::::::::::::::::-:::.�::::::: :. :<•.:.:iiiiii:J?iii::v::L::ii::-i::y}iiiii:::::::::...............:. ::::•...:................... nsnrance.ca:::::.....:::::.:-:::,:::::::.,:::::..::.:.:::::.:.:.:::,..::.:::.::::.:::..: 81# .#.............................................................................:.. ..:..,...: . ::.:: :....• ..... ..................... ..:....::. »>_..� ����� V. ... .................................................................... .... :.:.::::::.:.:.:::.......::::. ..........:.::.....::::.... :. .address.:. . ..................................................... <i1plen ....................... :.:.........:::::::.::...................... .... .. ........................................... :*11 > .r>': ............ ::::::::::.:.:,:.::..... X. is�j'ry}i:i:;i:±:>i ii:{ii i??f::i:::::-..::::C:ij?j:fiii�iiii i4ii:iv:::ii%{ii::T $ii`::iii^Y':iii::: •. :yiii::iii{:;:;:}+;?:.:.:.Y'v}:'}.::. s%/// Faflme to aeeore 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 Me of$100.00 a day against me. I understand that e copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is gasp mid coned ., Signature Date _ Print name Phone# official use only do not write in this area to be completed by city or town official _ city or town: permdt4icense# QBujWing Department QIdcensing Board ❑checkif immediate response is required I ❑Selectmen's Office . ❑Health Department contact person: phone#; _ ❑Other . Oniud 9/95 PW . Information and Instructions r Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' 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. 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 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 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 eater 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 and supplying company names,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`law"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 p 6ermit/l are number-which will be used as a reference number. The affidavits may be rei a'ib the Department by mail or.FAX unless other arrangements have been made. _ The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a'call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts .Department of Industrial Accidents Oftice of lmiesugatioos 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 t 1-4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 068433 Birthdate: 06/10/1955 Expires:06/10/2000 Tr.no: 5979 Restricted.To: 00" GEORGE R GILLMORE PO BOX 940 COTUIT; MA 02635 Administrator, :JlP6porvarn�eueull�. HOME IMPR(1VU CjKlr rrl rT n TYRe - PRIVATE CORPORATIO"! tat.];;n Gillmore Marine Contracting, G� Gy�eofge,1R. Gillmore ADMINISTRATOR 80t4do1 n Rd ., • - Mash.Pee MA 07649 r 5 '/D T0?BE CCA TREATED rA�iERIMENSIONS IN INCHES,NOMINAL r ARE•3/4"HOT DIPPED GALVANIZED ,AAR©w LEWIS BAY 6)SffE PLAN DIMENSIONS IN FEET 6)MLW •1.5 NGVD HY ANNI INNER HARBOR NOT DESCRIBED 2..—EBB LEWS II B_Y LIC BAY 1� 35 � 43 PROP OS ,��y LOCUS 3-8 FLOATS O zcd EL 6. 9 a -2 S OSFD 3 X 20 RAMP SCALE: 1"=40' SITE PLAN r 126 � J W oC EL 8.0 z _MLW=0.0 v N 42 " ;��'�0 THOMAS&LAURIE P GODDARD 2 DRAIN 166 BAY SHORE RD EL 3. . ••, PIPE HYANNIS,MA 02601 M 6'WIDE STONEWALL DRAINAGE MICHAEL HOESCH EMENT 134 BAY SHORE RD ' HYANNIS,MA 02601 8 FLOOD ZONE A9,EL 10 : FIRM 250001 10 05 0006D OF 07/02/92 ESN Mqs BERNARD St�yG 12 JOHN YOUNG N No.30078 I r ARCH•MAR LCC 7615E � ; LOTS 91 & 61 RQ� Y ACCOMPANYING, THE PETITION OF e �- PLAN , s�e CHARLES F. & JAWYELINE RO CFNlqPr-co- G !3 TO CONSTRUCT&MAINTAIN A PIER, RAMP, FLOATS, AND PILES IN AND OVER THE WATERS OF HYANNIS INNER HARBOR BARNSTABL.E COUNTY ; A. M.WILSON ASSOCIATES, INC. 2 X 4 RAIL 12"0 PILES 3X8 ! JOISTS 3 X 8 LEDGER h t 1---u 1 2 a 4 0 SCALE: PIER SECTION 2 X 4 END 8' RAIL 4 X 4 14.0 STANCHION 1 X 2 3.0 C6 ECK E 8.0 CLEATSSAW 514 EVERY 12:0 3RD 3 X 20 TIMBER PLANK RAMP L 3. ' IrILESS Y 10' jNOF BERNARD •s JOHN YOUNG N No.30078 -•�-- 9 ARCH•MAR o SCALE: =1'-0" DETAIL PI ELEVATION Et 13 X 20 4 _ -r-- RAM ` MHW EL 3.2 :r MLW ELO� •--- 8 31.7 16' l rO TIMBER PILES, BURY 14 TY IV MIN Y � 125 150 PLAN ACCOMPANYING THE PETITION OF 1 CHARLES F. & JACQUELINE RO SCALE: 1"=30' PIER ELEVATION TO CONSTRUCT&MAINTAIN A ry PIER, LAMP,'FLOATS, AND PILES J IN AND.OVER THE WATERS OF HYANNIS INNER HAAROR � DOE BARNSTABLE COUNTY r} i 8.0 5/4 X 6 DECKING 5/4 X 6 STRINGER 12'DIA PILE x 26,BURY 10' 24°O.C. 10.0 ROLLER CHAIN (TYP) 3 FLOATS REaD AV "IV 30.7 SCALE: 1/4'=1'-0" FLOAT PLAN&ELEVATION 8.0 5/4 X 6 DECK RUB RAIL , _ 2 X 8 FRAME 2 X 4 LEDGER 10'X'20'STYROFOAM BILLETS 3/4'KEEL BOLT OF M,qs 5/4 X 6 KEEL z 8ERNARD cyo 12 JOHN YOUNG cn SCALE: 1/2'=1'-0' AR.H- Z H FLOAT SECTION 9� C v, c PLAN . ACCOMPANYING THE PETITION OF CHARLES F. & JACQUELINE RO TO CONSTRUCT&MAINTAIN A Qh 2 t 3 J D PILES v PIER, RAMP, FLOATS, ARC IN AND OVER THE WATERS OF HYANMS INNER HARBOR ; BARNSTABLE COUNTY • I- .,876 0 06-99 01 ��7 310 CMR 10.99 BAR Form 5 H�-)�O - 8 j�Y CFTHE TO (To be prowaea by DEOE) Cily.Town Barnstable _ Commonwealth of Massachusetts 1 7ARTSTMM P Applicant RC YAte i639, `e0 Order of Conditions Massachusetts Wetlands Protection Act G.L. c. 131, §40 TOWN OF BARNSTABLE ORDINANCES, ARTICLE XXVII From Barnstable Conservation Commission To Charles Ro, Jr. CharteG & Tarnnaline RQ,.r (Name of Applicant) (Name of property owner) Address 4 Randall Rd. , Saugus, MA Address same Map Number 325 Parcel Number 82 This Order is issued and delivered as follows: ❑ by hand delivery to applicant or representative on (date) Q by certified mail, return receipt requested on July 22, 1999 (date) This project is located at 150 Bay Shore Rd , Hyannis The property is recorded at the Registry of Deeds in Barnstable Book Page Certificate(if registered) The Notice of Intent for this project was filed on Feb. 2, 1999 (date) The public hearing was closed on March 162 1999 (date) Findings The Barnstable Conservation rommi ssion __ has reviewed the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Commission at this time, the Commission has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act(check as appropriate): Public water supply M" Flood control 2" Land containing shellfish ❑ Private water supply Storm damage prevention C9'Fisheries ❑ Ground water supply GY Prevention of pollution 9,' Protection of wildlife habitat Total Fling Fee Submitted $312. & $195. State Share $143.50 City/Town Share $168.50 & $195.00 (1/2 fee in excess of S25) Total Refund Due S City/Town Portion S State Portion S ARTICLE 27 .only: (1/2 total) (1/2 total) Public Trust Rights ❑ Agriculture Erosion Control ❑ Aquaculture (Recreational ❑ Historic [Aesthetic .Effective 11/10/89 1 SE3-3486-Ro Approved Plan=July 7, 1999 Revised Site Plan by Bernard-Young,RPE. Special Conditions of Approval: 1. General Conditions 1-12 on the preceeding page are binding, and demand both your attention and compliance. 2. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein, General Condition number 8 (preceding page) shall be complied with. 3. The applicant shall pay for their legal advertisement as invoiced. 4. This permit is valid for 3 years from the date of issuance, unless extended at the request of the applicant. 5. The applicant shall provide project contractors with copies of the Order of Conditions and approved plans prior to the start of their work. 6. The Natural Resources Dept. shall be notified at least 21 working days prior to the start of work at the site,to inspect the ares for shellfish. If deemed necessary by the Shellfish . Constable, shellfish shall be removed from the work area to a suitable site and/or replanted at the locus following construction. The foregoing measures for shellfish protection shall ensue at the expense of the applicant. 7. The applicant shall obtain a building permit for the proposed pier from the Town Building Commissioner. 8. No creosote treated materials shall be used. 9. Deck plank spacing shall be at least one inch. 10. Pier construction shall,only take place between Oct. 15 and May 1. ,k 11. Boats shall only be berthed at the floats,and not along the fixed pier per se. 12. Piling may be minimally jetted to assist in setting and aligning. Thereafter, however, piling shall be mechanically driven. . 13. The seasonal storage of floats shall be at a suitable upland site. Floats shall not be stored on banks,marshes or dunes. 14. No boat shall be berthed and operated at this pier (and its floats) such that at any time less than one foot of water resides between the bottom of the boat (or engine in drive position) and the substrate. 15. Any desired pier lighting shall receive prior approval of the Conservation Commission or Department.' 16. All work shall ensue from a floating barge. sea-3486 Therefore, the JU=ztMh1O Conservation Commission hereby fiords that the following conditions are .necessaxy, in accordance with the performance , Standards set forth in the regulations, to protect these interests checked above. The nmm4 sion orders that all work shall be performed i.n accordance with said conditions and with the Notice of Intent referenced above. To the a=taat that the following conditions modify or differ from the plans, 'specifications ar other proposals submitted with the Notice of Intent, the conditions ahal,l control. General Caadittonss Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this order. Z. This order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This order does not relieve the permittes or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from: the date of this order unless either of the following apply: a) The work is a maintenance dredging project as 9 g P�j provided for in the Act; or b) The time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this order. 1 Y 5. This order may be extended by the issuing authority for one or more periods of up to three years each upon application to the { issuing authority at least 30 days prior to the expiration date of the order. - 6. Any fill used in connection with this project shall be clean fill, conta;ning no trash, refuse, rubbish or debris, including but not limited to'lpmbar, bricks, plaster, wire, .lath, paper, cardboard, pipe, tires, -when, rafrigerators, motor vehicles or parts of any of the foregoing. c 7. No work shall be undertaken until all +;n +motive appeal periods from this order have elapsed or, if such an appeal has been filed, until all proceedings before the Department have been completed. S. No work shall be rMC1MrtA1MM t2rtt4 7 tba Final ezdar 1,.w S%m .. v district in which the land is .located, within the chain of title of the affected property. In the case of recorded land, the Final order shall also be noted is the Registry's creator index under the name of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the commission an the form at the and of this order Prior to commencement of the work. 9. A sign shall be. displayed at the site not less. than two square feet or more than three square feet in size bearing the words► Mmassachusetts Department of Environmental Protection, File Number SE3-3486 10. Where the Department of Environmental Protection isrequested to make a datezm nation and to issue a superseding order, the Conservation cozmissioa• shall be a party to all agency•proceedings and hearings before the Department. 11. Upon completion of the work described herein, the appl icant shall forthwith request in writing that a Certificate of Compliance be issued stating that the work has been satisfactorily completed. 12. .The work shall conform to the following plans and special conditions. 2 16. All work shall ensue from a floating barge. 17. Work on the pier shall ensue mid-tide rising to mid-tide falling or as otherwise necessary to prevent the grounding of the work barge on the substrate. 18. It is the responsibility of the applicant, owner and/or successor(s) to ensure that all conditions of this Order are complied with. The project engineer and contractors are to be provided with a copy of this Order and referenced documents before the commencement of construction. The foregoing condition shall not be construed to exempt project contractors from responsibility for any work performed in deviation with provisions of the Order of Conditions or with the detail of the plans of record. 19. The Conservation Commission, its employees, and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. 20. At the completion of work, or by the expiration of the present permit, the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Where a project has been completed in accordance with plans stamped by a registered professional engineer, architect, landscape architect or land surveyor, a written statement by such a professional person certifying substantial compliance with.the plans and setting forth what deviation, if any, exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance. sea-3486 Y Issued By Barnstable Conservation Commission Signatures is J v5i i J This Order must be signed by a majority of the Conservation Commission. On this day of J `S 19 before me personally appeared , to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. ' Notary Public My commission expires The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed work is to be done or any ten residents of the city or town in which such land is located are hereby notified of their right to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department within ten days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work. To Barnstable Conservation Commission(Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT 150 Bay Shore RA• , Hyannis , FILE NUMBER SE3-3486 , HAS BEEN RECORDED AT THE REGISTRY OF Deeds in Barnstable ON (DATE) If recorded land, the instrument number which identifies this transaction is' If registered land, the document number which identifies this transaction is Signed Applicant . r ' JOB A.M. WILSON ASSOCIATES, INC. SHEET NO. OF 3261 Main Street P.O. Box 486 CALCULATED BY DATE BARNSTABLE, MA 02630-0486 (508) 375-0327 CHECKED BY DATE FAX (508) 375.0329 SCALE ..... .... ..... r .......................:............................... �..:. .. ............................ ...... ... ..... ..... . .......... ..:....................................:............i.............;....... Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work . To Barnstable Conservation Commission(Issuing Authority)OF CONDITIONS FOR THE PROJECT AT i cn n,p Sye Rcl, PLEASE BE ADVISED THAT THE ORDER Hyannis , FILE NUMBER SE3-3486 , HAS BEEN RECORDED AT THE REGISTRY OF Deeds in Barnstable ON (DATE( tifies this transaction is If recorded land. the instrument number which_ids ti ist �-,1 ;,-+� j i� (�'• ���:{ 1 i i °�1+ If registered land, the document number which id�tifies this transa�Cdb �l h Signed Sign � �Q� Applicant r� °-'�-- BARNSTABLE LAND COURT REGISTRY .......... 1 ............_......................................................:......................... — Assessor's off ioe"(1st floor): ... � p o*TNE tO Assessor's map ,and lot number ....... ....... y............A: �; `o 4. Board of Health (3rd floor):`' F WP a Sewa Permit, number oo�c!G u . 2.1D.f w��..-S'Grf A P P R O V E n S g y�: y r� EAR3STLBLE. Engineering,Department (3rd 'floor): ' 8arnstab onservat On mil d 0� House number ' 0....! JS....::.... m t �cMaR .............•......................... APPLICATIONS -PROCESSED 8:30-,9:30,-A.M, and 1:00-2:00' P.M. only' '✓ '�` Signed Dato TOWN -OF BARNSTA'BLE . BUILDING INSPECTOR } APPLICATION FOR PERMIT TO .....„(. �Z`�4 :. 1.. !.. TYPE OF CONSTRUCTION ... fJ .... �l . Y/ ,.l.S+ �6 „ I 3 ...... t' a*k -- , 19.16 `TO THE INSPECTOR 'OF' BUILDINGS: The undersigned hereby /applies for a permit according to .the following .information: Location ......14.. . ..:%. J.. ��. ../.tv./, ........... � .N. .�..5...).. ! ...:...(......... ,/............ •poi � �� Proposed Use .........../�.1../�/yam....... .. C�......... . ........... ,�r �/1r�. '1. ... -..F.!4. ....1...:.��(.� :... ` , Zoning District .............. ..............:................................Fire District b'..... ............. Name of.Owner 1 PeC-P A-ffi�...:�.R`..U.S ... Address�fsly? (la��......:..:..�D,�'�j/�'�ASS�. 4/6Q� ............ ¢ Name of Builder ...V. `(. ... �.Cl�/li�!�J ............':r°'.Address ....eeh,� /�/.S r.. . ............................ Nameof Architect .............................•...................................:Address. ......................................................................... Number of Rooms ............. �l!' `5......:.....................Foundati.on 1f. Z..E�.... �:dG1�.U�..$��C.��..... Exterior ... C�AAl.•Q.a. g 5....... Floors ......p4.../ve'. 1�.f..���.� .T..... ..........:'..........Interior ....1 :►.'�� t. �. ��..? ...(.t�P.4.:...:...r.................... Heating .......................Plumbing ................�' Fireplace ..................................................................................Approximate Cost .......... Definitive Plan Approved by Planning Board _, _f ___ _____19141, Area ...!A.�...... .................. Diagram-of Lot and Building with Dimensions Fee ....... SUBJECT TO APPROVAL OF BOARD OF-,HEALTH Y XaZ OCCUPANCY PERMITS-REQUIRED FOR NEW DWELLINGS I' hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above s construction: , Name ..: ......... ..........................................` ` Construction Supervisor's License .:.ter a PAhi;ER REALTY TRUST i ? -.. Permit for Build Addition; ec No ............... Single Family...Dwelling...................... - 4 . Y Location P150 Bay shore Road - t H annis V .... • f• * V e , x ParkerT•Realt Trust. � 'I •� 1-0 l Owner Type of Construction Frame r ................ - - :, T V- ' ......... . ................... .... / T rP Plot ......... .... Lot.................................. r Per"mit Granted ......August 25�..'.. .......1.9 86 Date of/Inspectio'n. ........................... .......19 j Da ej{ C_ompleted K ... b ...... .19 A, Assessor's offioe (1st floor): FTHET � ... Assessor's map and lot number .:................. 4f Board of Health (3rd floor): `O�Q ♦� Sewage Permit number Z BABII9'fADLE, � Engineering Department (3rd floor): -•4t �o rasa House number / SQ �J S O,s�i63q. ...................................................................... •E0 No 6 APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only �'✓ '�\ w °� t "'�"'���� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......��iYL� /4�/r/ .• ,../' .......................................... ............... ...... � TYPE OF CONSTRUCTION ... P....: � ..!... . r.... -o............ ' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby /applies for a permit, according to the following information: 1 Location .... .;X..�J...Q... ..<!...J.. rv...).././.. .��.F..;� i .,...... j6�1..5....?..X 4 ..:...(�...0.�....�.��s/............ //li'lr C� 1 /�l r ( 4 Wl Proposed Use �. .�' 5��:..............: �ti:� .........m.5.........F..............�..,r......��D......................... ........... Zoning District �l ..............................................Fire District .............. <� r } ! I .........."­**'­*"­ . .... 6,_� ......................... r Name of Owner lhY �IE� T� rcrS� �flG GC�/�Y�AS.� , � ..... Address ........ ......................1} ... Name of Builder ...�.............................. .�.�✓.......r... .................Address .... .................................... Nameof Architect ..................................................................Address .........�i..................................................I....................... Number of Rooms ............ :...16vV..5............................Foundation ..!1..7.. - ...C.—fL1l`/U�- ....f,oC( Exterior ... ... r? r / .p./?.........�..../.............................................Roofing ....162X ..� / �i,/f S ..................................... Floors ....... ........................Interior ....olt ./ O.0 l � ............................ Heating ....f: _ '.....Plumbing .................E.'...1..,..y..a.../.�..�.=.............f..� Fireplace ...................Approximate Cost "?� ............................................................... ......... ... ............... .. ................................. Definitive Plan Approved by Planning Board __ � 5_1_ __________19 � . Area ...�p ................7 Diagram of Lot and Building with Dimensions Fee ....,V................. SUBJECT TO APPROVAL OF BOARD OF HEALTH t I X a� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town-of Barnstable regarding the above construction. ` Name ................ksl........... .. Construction Supervisor's License ..f�Ca%.�. � PARKER REALTY TRUST A=325-082 No .... Permit for ...Bmild..Addltio3i.. ........ .... le F _Ug.................. Location $.hQre...Road...................... ..........................Hy ajmi s...................................... Owner ........!?Ar.ker...Realty..Trust................ Type of Construction ......Exame......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ....August 25,............19 86 Date of Inspection ....................................19 Date Completed ......................................19 1 T"Er TOWN OF BARNSTABLE DADBSTADLL i "6 9 a w BUILDING INSPECTOR � ar°'• V APPLICATION FOR.PERMIT TO .. ........-.r...... ..•........................ -- /.�....................:.........................�............................ TYPE OF CONSTRUCTION .......��. .p.�:S..�t"C': ?....... tJ./.•' < r' . '° .... s 's"�:.................... ....�/...... .19.r.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies -for a permit according to the following information: Location ......ZJ. ........ ��.- ...... .......Z)........... ./............:.....:.................................... Proposed Use .......I'rC'��.V.. . I..''t.��. ...}'Q�!. ............................................................................................. ZoningDistrict ...... .?..:E..............................................Fire District .. . ........................................................... Name of Owner ..1 y ../..r?0..�✓.. `�r./U.. Address ./. .. Ccx.m.-nan...s�....../.�. Name of Builder ..42-.lki.Y...4��. Address ................. Nameof Architect ...................................................................Address ................/.................................................................... Number of Rooms 1 ..............Foundation ..... Exierior ../mac . . ...(1 ... ?,7.t. ........................................Roofing ..................... .... ......................................................... Floors ........... .. .... ..............................................Interior ................. Heating ......................Plumbing -' � L . ........................... .. . ......... Fireplace ..........Approximate Cost ....... , ., ..... .................. Definitive Plan Approved by Planning Board --------------------------------19--------. /441 •.`f /<� Diagram of Lot and Building with Dimensions re SUBJECT TO APPROVAL OF BOARD OF HEALTH ^J Q L` .� � LU �� W u'' 1 CL_ O� Q .' X UT OU _ J J Lu O m / — Lyj = W / : Q) , � f COMA :ice W -- - - -� _ 2 I hereby agree to conform to all the Rules and Regulations of the Town of Barnst le regarding the above construction. / Name .. . .......[..... .. .......... .... Lotuff, Robert ' ��d to o�oo�e ' No -.��.����.. Permit for ---.-...-.--��.' ---.������........e...........�-.--..--.--.--- . � Location .........I50..Ban'_Shore^f��ad___._.. o ----'---../���r �o� ----.—_________ ' ^ Owner ---.���5Y���..��zzzzz..----.--.- Type of Construction ----- -----' ' ' | -^---^~--^^^~'--''------------- | ` ( ^ Plot ............................. Lot ................................ ` .� Permit Granted .. /v �il 20 '- ` x ^ X�� �r Date of |nspac�on��.�--------.--l9 ~ '� ~ Date | Completed �r . � . / . PERMIT REFUSED ~ � ^^^~---'.^-^-.--------.,' lA ..--.-.------,..--.-....--...--.-.. .. ~ . ` .,.....--..'...--.~.---......-.~.,..--.^ - ' --..'.-._---'~.^--...,..-.---.,-.,..--..' � - . __.__,____.,,_..,,,__,___.,,_,_,~_. , . Approved ................................................. 19 � Y � ^ ' -------.---------..,---...--..- . , � -------------.-..-.--.....-......., . ' [ ] [R325 08Z. ] L•OC] 0150 BAY SHORE VAD CTY] 07 TDS] 400 fc� KEY] 238745 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 RO, CHARLES F JR&JACQUELINE MAP] AREA169WC JV1338316 MTG12001 4 RANDELL RD SP1] SP21 SP31 UT11 UT21 .43 SQ FT] 3992 SAUGUS MA 01906 AYB] 1946 EYB] 1987 OBS] CONST] 0000 LAND 226200 IMP 261100 OTHER 1900 ----LEGAL DESCRIPTION---- TRUE MKT 489200 REA CLASSIFIED #LAND 1 226, 200 ASD LND 226200 ASD IMP 261100 ASD OTH 1900 #BLDG (S) —CARD-1 1 261, 100 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 1, 900 TAX EXEMPT #PL 150 BAY SHORE RD HY RESIDENT'L 489200 489200 489200 #DL LOT 91 & 92 OPEN SPACE #RR 0090 0165 COMMERCIAL #UP FY98 INDUSTRIAL EXEMPTIONS SALE109/96 PRICE] 479400 ORBIC141939 AFD] I TE LAST ACTIVITY] 10/31/96 PCR] Y i�2� — 7iLlJ R325 082 . P P R A I S A L D A T KEY 238745 RO, CHARLES F JR&JACQUEA LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 226, 200 1, 900 261, 100 1 A-COST 489, 200 B-MKT 379, 200 BY 00/ BY ML 7/88 C-INCOME PCA=1041 PCS=00 SIZE= 3992 JUST-VAL 489, 200 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 69WC ----------------------------- NEIGHBORHOOD 69WC HYANNIS PARCEL CONTROL AREA TREND STANDARD 151 15 LAND-TYPE 2262001 LAND-MEAN +Oo 4892001 210000 IMPROVED-MEAN +240 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R325 082 . • P E R M I T [PMT] ACT*R] CARD [000] KEY 238745 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR .CMP NEW/DEMO COMMENT [B29831] [08] [86] [AD] A 400001 [ ] [00] [00] [000] [NEW ] [HY ADD'N ] Inil RESIDENTIAL PROPERTY MAP NO. LOT NO. �G`'"� FIRE DISTRICT SUMMARY STREET 150 Bay Shore. Road Hymnis .73 LAND i 325 82 H 0 BLDGS. 31 : OWNER — TOTAL JD RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: r� 741, LAND ' ,L O YS / / r a BLDGS. -Comigito—Peter-k:-&�---Wi �--E:3 -&-McAuley RBert-2/1 66.,.2 1-66; - --$7 6 B TOTAL .43 ac LAND ,c" .. -':- Parker Realt _ Cor oration 1- 0- 4 tf.6 Ol 4,a/15 sloo, BLDGS. 2 2 .� I � $r.(J� .1T. WB�'LF�/ /4� �7q,o��00 TOTAL O i LAND BLDGS. TOTAL qw LAND BLDGS. TOTAL J LAND BLDGS. a> TOTAL LAND BLDGS. TOTAL LAND BLDGS. INTERIOR INSPECTED: rn' TOTAL DATE: G -Z-�� f-��� �C Io /5 LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE LOT Jb 7" , `' LAND CLEARED FRONT BLDGS. REAR TOTAL p j WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND O1 BLDGS. —_.. TOTAL LAND In VB L'LOT COMPUTATIONS LAND FACTORS FRONT DEPTH STREET PRICE DEPTH% FRONT FT.'PRICE TOTAL ADEPR. COR. INF.' VALUE HILLY TOWN SEWER ROUGH TOWN WATER 65 HIGH GRAVEL RD. LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. ,c. Bill.Walls Bsmt. Rec.Room V St. Shower Batk-_,',nLI-L LFloors a d O J PURCH. DATE ' .nc Slab Bsmt.Garage St. Shower Ext. PURCH. PRICE. ,ick Walls Attic fl. &Stairs Toilet Room RENT tone Walls Fin.Attic 1.j Two Fixt. Bath v iere INTERIOR FINISH Lavatory Extra .smt. F '1 2 3 Sink .-J 0 e�� y I ;S r/z r/ Plaster Water 7'Clo. Extra Attic EXTERIOR WALLS Knotty Pine Water Only /s {v 7 ZB, double Siding Plywoo Wit= No Plumbing Bsmt.fin. yo la 7 7 /3 Zv a9 .;Ingle Siding Plasterboard Int.Fin. Shingles TILING � .:nc. Blk. G F P Bath FI. Heat f. L O Z912 It t� UI O Ir~ G7, .,re-Brk.On - Int.Layout Bath FI.&Wains. Auto Ht. Unit {- 3,10 Veneer Int.Cond. Bath Fl.&Walls -' Fireplace �. •I-..� __ - , .om. Brk.On HEATING Toilet Rm. FI. y 13 ZO z•� :lid Cam. Brk. Hot Air Toilet Rm.FI.&Wains. Plumbing , -- Tiling Steam Toilet Rm.FI.&Walls ,.lanket Ins. Hot Wate p� i✓ Shower �• .:o Tuotlns. Air Cond. Tub Area Total Floor Furn. ROOFING COMPUTATIONS , Nsph. Shingle Pipeless Furn. - t�U S. F. G 3 U ,Vood Shingle-- - - No Heat tp 7 7 S. F. ubs. Shingle Oil Burner _.— q f 4 S. F. t ,U U .5 2 Z ,;late Coal Stoker O - - _ 7 ., ilia A S. F. �" 73 O J s; , ' -- Gas ROOF TYPE Electric S. F. OUTBUILDINGS .table Flat S.F. 1 2 3 4 5 161 7 8 9 1101 11 2131415 6 71819110 MEASURED .,it, Mansard FIREPLACES S.F. Pier Found. Floor � � 8-23•, ;`ambrel Fireplace Stack Wall Found. 0.H.Door LISTED - FLOORS Fireplace Sgle.Sdg. Roll Roofing /- ' :Anc. LIGHTING t-C/� 7/-71 -- Dble.Sdg. Shingle Roof ..arch No Elect. DATE Shingle Walls Nine Plumbing .iardwoad•r/, ROOMS Cement Blk. Electric ,sph.Tile Bsmt. Ist,. TOTAL -j Brick Int. Finish PRICED .,Ingle 2nd 3rd FACTOR REPLACEMENT �'�� Y ,�.. Q•..J OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL, Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL-VAL. 3`I A G i 3 a v S� -^„'�'v 2 _._3 4 5 -6 8 9 10 TOTAL ROPERTY ADDRESS I I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED(STATE I pCS I NBHD IDENTIFICATION NUMBF8 CLASS KEY.NO. 0150 BAY SHORE ROAD 07 RB 400 .07HY 07/09/95 1041 00 69WC R325 082. y LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T Lana By/Dale Size Dimena�on YP UNIT ADJ'D.UNIT "gCRES/UNITS VALUE PARKER REALTY CORP MAP- CD. FFDe th/Roes LOC./VR.SPEC.CLASS ADJ. COND. E PRICE Descrivlion PRICE #LAND 1 ;. 226.200 CARDS IN ACCOUNT 15. 1WATERFNT .1 X' . _43 =10c 167 314999_.9 526049.9 .43 226200 #BLDG(S)-CARD-1 1 261,100 F 01 OF 01 a I #OTHER FEATURE 1 1,900 COST 48 0 BATHS 3_0 U X> B= 100 13200.0 13200.0 1.00 13200 .a #PL 150 BAY SHORE RD HY �1ARKET 37 OD - NO. BSMT S X 6= 100 5.4 6.8 1921 13100-B #DL LOT 91 : 8 92 INCOME A RG1 DETGAR S 14 X`. 22 :194 C 32 19.3 6.1 308 1900..F #RR 0090 0165 U SE DI APPRAISED VALUE A 489,200 a U � PARCEL SUMMARY AND 226200 x SI LDGS 261100 Mi i 0-IMPS 1900 E TOTAL 489200 'N CNST N i I DEED REFERENCE Tape DATE Rxo.tletl P R I O R YEAR VALUE Book Page Iris,. MO. Yr.'D Sales Prioo -LAND 226200 S I C61015 00/00 BLDGS 263000 TOTAL 489200 3 BUILDING PERMIT ENTRANCE GAINED Ty- An,un'Da,¢ 0 MAIN F L R UNIT LAND LAND-ADJ INC ME SE SP-BEDS FEATURES BLD-ADJS UNITS NO ��������������� 226200 190 100 829831 8/86 AO 40000 C kiss DOnst. TOldl Bds¢Rale I Atll.Rate Y¢dr Bulll Age NOrm. Obsv. CND -OC 4y R G Rep, CDs,N¢w Atl Repl Yalu¢ $lOnes H¢i M Rooms �etl Rms Ba111s •Fia. Part U mts Unils A f DePr. Contl. I 9 r ywall Fac. 028 000 110 110 70.45 77.50 46 87 7 94 120 100 112.8 231491 261100 1.5 8 5 3_0. 11.0 Desc rplion Rate Square Feet RePI.Cosl MKT.INDEX: 1.00 IMP,BY/DATE. ML. 7/88 SCALE. 1120.00 ELEMENTS CODE CONSTRUCTION DETAIL BAS 100 77.50 1921 : 148878 GROSS AREA 399 TWO FAMILY DWELLING CNST GP:00 a15 42 32..55 1921 62529 N STYLE 04CAPE COD 0.0 --------- --- ---------------------- FOP 35 27.13 64 1736 DESIGN ADJMT 62DESIGN. ADJUST 10.0 UWD 85 8.50 150 1275 EXTER.U_A_l_S _I0C-PB_D_/SHINGLE__ 0_0 FSF 90 69.75 150 10463 THIS HOUSE CONTAINS , ANGLES OTHER THAN RIGHT NEAT/AC' TYPE 08GAS H W=ZONED 0.0 UWD 85 8.50 273 2321 ANGLES AND CANNOT BE VECTORED BY THE COMPUTERINTER.FINISH 05 LASTER 0.0 FFU 25 19.38 24 465 PLEASE ASK FOR THE SKETCH CARD IF YOU WISH TOINiER.LAYDUT 12AVER:/NORMAL C.0 FMP 55 5.50 677 3724 SEE BUILDING DIAGRAM! INTER._ 9UALTY 02SAME AS EXTER---- __ 0.0 0.01 D W ! ! EFLOOR_ COVER 04 txkOff 0.0 E TO lAreas AO„ . 1188 Ba,e_ 2071 ! SEE ABOVE ROOf TYPE _ E 01 ABLE-AS_P_H SH 0.0 T BUILDING DIMENSIONS ! NOTE-! ! LECTRICAL 01 AVRAGE _ 0_.O A AS ! FOUNDATION_ Oi OU -COREO CO NC 99.9 - --- - - - - - - --- - L +`-----'----�--------+ NE36H00RH00D 69WC HYANNIS LAND TOTAL MARKET PARCEL 226200 489200 AREA 70000 VARIANCE +0 +599 STANDARD 25 �4_• Engineering Dept. (3rd floor) Map Parcel 64 Z ermit# House __IIssued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30)� �'� ^�ee _���.G•6 ��;�o-� APPLICANT MUST ORTCONN EWER ENGINEERING PE BE CONMUtanON D 0 Defi ' 19 . BARNSTABLE. ` TOWN OF B T 'E° `9.'�� ARKS ABLE Building Permit Application Project Street Address 5® Village Owner cllwifK a. �6- Address Telephone Permit Request � 'A'sIi _ Pg. DIAe [? 00 First Floor square feet Second Floor square feet Construction Type VV Estimated Project Cost $ J , Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ka Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full k 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(not including baths): Existing New First Floor Room Count Heat Type and Fuel: AGas ❑Oil ❑Electric ❑Other Central Air ❑Yes ; No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: Detached(size)UN jS T'� Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes y�n ❑No If yes, site plan review# - Current Use/ -VS) t�1:Tl )0—' Proposed Use Builder Information �C Name Telephone Number Address License# Home Improvement Contractor# 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 J'I KIGNATURE J DATE 0 g7 BUILDING PE T DENIED FOR THE FOLLOWING REASON(S) 1 K f j FOR OFFICIAL USE ONLY ~ PERMIT NO: DATE ISSUED, MAP/PARCEL NO. t ADDRESS 1 VILLAGE 1 � t OVER - 1 1Y f DATE OF INSPECTION: w FOUNDATION 1 FRAME _ ,s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r s PL ING: F,©;o x;RQUGH ' FINAL , GAS: UGH FINAL FINAL BUILDII 5: J �W • 1 DATE CLOSED O 1 1 ASSOCIATION PLAN NO. The Town of Barnstable M $ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Cr0ssen Fax: 508-790-6230 Building Commissior For office use only Permit no.�_ Date ff 1 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. ��pp11D Type of Work: f O Est.Cost JU� Address of Wor • �D Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law :IKiob under S1,000. 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 MWROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER TIES OF PERJURY I he a pl for pe the agent of the owner. Dat Registration No. OR .Tlrr"�l//lll>J!!/ril'Call/r O� ffustachusctlz " " '" " • ''�': +=1�� • DeparrnrCrll of Iudustrial.4cci con ' -:1 OfllcEolloyestl9alloas •=�` 6#11 It 0451riir"rim Srrrcr _ Workers' Compensation Insurance A>rdavit --liPRUIy 0 5b ZA s z C:i1%-77\%ANS a3 -131 0 1 am a 6n=owner performing all work myself. I am a sole proprietor and have no one%vorkin_= in any opacity I am an emplover providing workers' compensation for m}•employees working on this job. entmnamv nnmr: adrlrccc� ' cin•� nhnnr!!- - incurnncc cn. nelin•0 7 1 am a sole proprietor, meneral contractor. or homeowner(circle ogre)and have hired the contractors listed below who m•. the following workers' compensation polices: cernrynov n-irnr- adtlrrcc• tin•• nhnnr�• incnrnnrr rn. nniievAt cnnmlnc• rmtnr- ;tdrlrccc� •in•• nhnnr ncurance a nniin•d lttach additio_nai sheet if necessary re .. �•;•� -_ • -./i'"'•�'••T� -' •`�• •.. •,a.. ..w•• .,.��r•s •.'�� •' 'allu to�ecurr covcraCe:rs required under tiection 3A of A1GL]53 can lead to the imposition of criminal penalties of a tine up to S1.500.00 andlur nc i cars'imprisonment as well as civii penalties in the form of STOP WORK ORDER and a fine ofS100.00 a day against me. I understand that a opt 1Jr1hi.%.,.J2JcmCPf me be fora ricd to the Olfce of larestications of the DIA for covenge verification. do hercht•c rr tr! r r/ nit a/i pciialtics ojperjurr 1/ray r/ic iRjormarion proiided above is tru wid cvmrt :_^aturc u/ Date I �� 'rint name a Phone �w otiicial use unit/ do not%vritc in this at•ea to be completed by city or town otnciai ' city ar ttnvn: pertnit/lleense i# r 1fluitding Department ❑trceminc Hoard S ►- �check if immrdiatc response is required ❑ 'electmen's OlTcr ❑11ealtb Department contact person: phone#: RQther�•�� r. Information and Instructions .Massachusetts General Laws chapter 152 section '9 requires all ern piovers to provide workers' compensation enpim•ces. As quoted from the "fay an enrpl(n ee is defined as every person in the service of :mother under: contract of hire. express or implied. oral or wrinen. An rniplitrer is derirtcd as an individual. partnership. association. corporation or other legal entity. or any two � the rar•e_oirt�s cngascd in a joint enterprise.and including the legal representatives of a dcccascd employer. or t receiver or trustee of an individual . partnership. association or other 1e9eal entity, employing employers. Hone owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of tI d%%?cllim_ house of another who employs persons to do maintenance, construction or repair work on such dwell; or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an err. MGL chapter 152 section also states that every state or local Iicensing agency shall nitlthold the issuance rencival of a license or permit to operate a business or to construct buildings in the commonive tlth for sn applicant u•iro itas not produced acceptable evidence of compliance n ith 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 tite insurance requirements of this chz been presented to the contracting authority. App icants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation suppl�•in_= 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 The affidavit should be returned to the cit}• 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 rec to obtain a workers' compensation policy. please =11 the Department at the number listed below. Ciry or-rowns Ple-e be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bolt, the affidavit for you to J-111 out in the event the Office of Investigations has to contact you regarding the applicant. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retu. the Department by mail or FAX unless other arrangements have been made. The Office of Investigations mould like to thank you in advance for you cooperation and should you have any quo please do not hesitate to _give us a c:i1• ...r..._.�• Tile Deparcmenf s address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents _.. Office Of I11Mes1192dons 600 Washington Street Boston,Ma. 02111 fax#: (6I7) 727-7749 TOWN OF BARNSTABLE• • BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION Number Street address Section of town "HOMEOWNER" 1, hu �r Name Home phone Work phone - - .�r PRESENT 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 such homeowners to engage an in- dividual .for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Officia on a form acGr-ptable to the Building Official, that he/she shall be responsibl for all such work performed under the building ermit. (Section 109.1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Sta Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" : certifies that he/she understands the Town of Barnstable Building Depa nt minimum inspection procedures and requirements and that he/she will co w'th r cedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. V. •x HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if e Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for licensing Construction Supervisors, Section 2.15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it P would with lic ensed Supervisor. The Home Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. i TOWN OF BARNSTABLE REPORT 10PLEMENTARY/CONTINUATSP"REPORT NAME (LAST, FIRST, MIDDLE) DIVISION' /DSPT NOTE DETAILS i OBSERVA IONS-ITEMIZE EVIDENCE, SERIAL IS ETC. i� t �'— / i Gr �G[�9- N r S /' p P s 5 A44.1-Jo -Z- S > r Al a /o «1�— 1 ` % ire r S o� e.le cT,?/ , e2 CID rp SUBMI BY PAGE t ld. a - ............ .....:::. :.x' c > +}< ILD V :. .............................................. ......................: � . �1!�325`4082•.t N ••.•: >. �:' •. •.::..''..`».y..'tL;i.:Yv`iii"$ M1,>.,>.}jt:ri:'•:S^titititi'?.'Y `::}i• �Y~ y`.••:;3;:;:y~?iiii}i;: `i,>.ii;:;:;'f•.�i}$y.{y{.`{,>.isiXi�ii}`t}�i}:i::i::Y:::$y>i::::$::};:`{tj': ................ L �w ;•}Y.iiv:.v:iii:iiiiiiiii:•}};.iiYh:•}vvpyy}:^iiii:O'Si:•iiiiiiiii�iii`iiiii;...;'•ii;•}i::v... :::: ��, �s�•; �� CHARLES .;:.;.:::::::::::.;;.:.::;;;:.: { . .............:.... IHYANNIS .................... . . ..........:::::::::.:.:::..:.::....::. .. .....:::..: ...................... :: .:::::::: ; ::. ml;, ::::::>>::ZONING : .. ::::.::::::::::::::::::::::::::: .......................................................................... ........... ............. LEGAL????????? ............................................:.:.::..::::..::.::..:.:::.::..:..:.::. . .::::::::::::::::::::.::.:::.::::::.....:......:..:....................... :.:SEARCH p �T [ O rs ! Z— S T �I G S H K t i GENERAL NOTES HYANNIS 4.0 2 X 4 RAIL 1)VERTICAL DATUM MLW EL=0.00 INNER e©� I 2)WOOD TO BE CCA TREATED �D 12"0 � 3)LUMBER DIMENSIONS 1N INCHES, NOMINAL O � OCus PILES I I 4)HARDWARE 3/4"HOT DIPPED GALVANIZED YS 3 X 8 5) SITE PLAN DIMENSIONS IN FEET LEWIS BAY i JOISTS 6) MLW --- -1.5 NGVD HYANNIS INNER HARBOR + R qa -- ..___ •� U T DESCRIBED FLOOD 3 X 8 LEDGER > - BY LIC 634 --� EBB LEWIS 8.0 f I i � 35 � 43 —►� �.� ' BAY i 3 8--- 0 POSFLOATS 2� LOCUS 3 4 5w ,c• SCALE: 1/4"=V-0° FF PIER SECTION -2 EL 6.1 �s 5/4 X 6 DECKING 5/4 X 6 STRINGER 2 X 4 u OSED 2 0 12"DIA PILE x 25', BURY 10' 24"O.C. RAIL 8' END -�- ., ; . ' 3 X 20 RAMP . ..• SCALE:"1„-40, 4 X 4 14.0 +I _i �iC, > SITE PLAN ROLLER CHAIN (TYP) 125 �,2 10.0 STANCHION TYP n 3 FLOATS REO'D iX2 � , 3.0 cr- CLEATS J 5/4 X 6 DECK EL 8.0 1 w Y 12"0 � C _ ��, EL 8.0 . EVER 3 X 20 "� MLW=0.0 l�TIMBER . . . . . . . . . . . . . . . . . . _ 3R0 ' RAMP �� PLANK MHW EL 3.2 PILES, U 42 Q,G o��OQgo BURY 10 ,. Q �- M 'y`y/ F /{\��/\) THOMAS& LAURIE 0 .......... ..................P J.IIY T..`..R91R.Td.Y........ ..... ......... !! -'F 3. P*.t'�'� 1.? 2 �./.DDARD ff , yo.Rr r MHW EL 3.2 P PE 30.7IN 166 BAY SHORE RD 4 8 { : ,,,,tia� 4 MHHW E HYANNIS, MA 02601 SCALE: 1/8"=V-0" ti DETAIL PIER ELEVATION rg f<< 6 '.A r STONE WALL 6'WIDE SCALE: 1/4"=1'-0" FLOAT PLAN & ELEVATION MICHAEL HOESCH DRAINAGE 134 BAY SHORE AD SEMENT CL HYANNIS, MA 02601 8.0 k 3X20 4 4_ 8 5/4 X 6 DECK RAMP MHW EL 3.2 O MLW EL 0.0 ......... ... FLOOD ZONE c+ai A9, EL 10 CQ FIERUB RAIL 8 FIRM 250001 w 2 X 8 FRAME 31.7 16 12"0 TIMBER 0006D 10 #150 lip- 2 X 4 LEDGER PILES, BURY • 10"X 20"STYROFOAM BILLETS �, „ 14 TYP 10' MIN 3/4 KEEL BOLT v y 12tiP G s,y 125 LCG 7615E c .3F wi Y`.ijAic' \m 5/4 X 6 KEEL " �A 150 LOTS 91 &92 �'' AR,H.-MAR 12 6 r SCALE: 1/2"=1'-0" ? Q. r; t A6551 'ROAD ��```�����e�`%��� FLOAT SECTION '~ gpY SNARE ` 1R 7r. PLAN ACCOMPANYING THE PETITIOtoI OF 1 PLAN ACCOMPANYING THE PETITION OF PLAN ACCOMPANYING THE PETITION OF CHARLES F. & JACQUELINE RO SCALE: 1"=30' CHARLES F. & JACQUELINE RO CHARLES F. & JACQUELINE RO : PIER ELEVATION TO CONSTRUCT & MAINTAIN A TO CONSTRUCT & MAINTAIN A TO CONSTRUCT & MAINTAIN A PIER, RAMP, FLOATS, AND PILES PIER, RAMP, FLOATS, AND PILES PIER, RAMP, FLOATS, AND PILES IN AND OVER THE WATERS OF IN AND OVER THE WATERS OF � IN AND OVER THE WATERS OF HYANNIS INNER HARBOR HYANNIS INNER HARBOR HYANNIS INNER HARBOR BARNSTABLE COUNTY BARNSTABLE COUNTY BARNSTABLE COUNTY A, M.WILSON ASSOCIATES, INC. A. M.WILSON ASSOCIATES, INC. A. M.WILSON ASSOCIATES, INC. SHEET 2 OF 3 05/24/99 REV 07/07/99 SHEET 1 OF 3 05/24/99 REV 07/07/99 SHEET 3 OF 3 05/24/99 REV 07/07/99 __ __ _ _ _ _ _.