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Home My WebLink About0061 BRANT WAY 1 ►- ��- 6 � t,c� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map Parcel �� Application # 6 Health Division Date Issued Conservation Division Application Fee Planning Dept. ` Permit Fee. Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address `1�s�1 iA) A:q Village A AJN)(F S OwnerA.L.Ex.,ffo) iA IQa - Address FceEe Telephone s 7 '2,- \ !::J. Permit Request °i u -Ai i' x) `fie A K AGa-yam Square feet: 1 st floor: existing 2Wproposed 2nd floor: existing SG5 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 W'- Two Family ❑ Multi-Family (# units) Age of Existing Structure 21 I-Jes Historic House: ❑Yes Cho On Old King's Highway: ❑Yes d No Basement Type: Z11"Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing `2 new a Half: existing v new o Number of Bedrooms: 3 existing 0 new Total Room Count (not including baths): existing new T First Floor Room Count 3 Heat Type and Fuel: u'Uas ❑Oil ❑ Electric ❑ Other T Central Air: ❑Yes ��dNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: �existin ❑ ry size— ❑ existing ,_'Ye 'g g g g �ew size Barnes xisting'_ ❑ news size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other---I' i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ i `- Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1,f�� `� /�-nl/✓� Telephone Number �� - Address LOT. �� ✓0 K W A:•( License # Lv ti > ✓Yl� O f 1 f Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /'� DATE ' Y- 1 ' — i FOR OFFICIAL USE ONLY f APPLICATION# DATE ISSUED MAP/PARCEL NO. • ADDRESS VILLAGE OWNER I t 's DATE OF INSPECTION: FOUNDATION FRAME A , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL . r GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. 1 The Commonwealth of Massachusetts Departmerrt`of Industrial Accidents i Office of Investigations 600 Washington Street Boston, MA 02111 yy www.mass.gov/dia . Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): V�� Address: L//4 City/State/Zip: Oq / i 5 Phone #: Q�S �� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction . 2.❑ I am a sole proprietor or partner- . -listed on the attached sheet. 7. 0'Remodeling ship and have no-employees These sub-contractors,have • is g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t r fired.] ` 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or,additions myself. m se No workers' right of exemption per MGL Y [ icom P l2.❑ Roof repairs insurance required..] f c. 15 2,§1(4) h,and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. kContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins.'Lic. #: Expiration Date:. f, Job Site Address: City/State/Zip: Attach a copy of the workers' compensatian policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveragwerification. I do hereby certify und9r.thepains andpenalties ofperjury that the information provided above is true and correct Signature: _ Dater Phone#: Official use only.. Do not write in this area, to be compleie-dby'city or town official r City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5..Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons'to do:maintenance,•construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." -7'-t MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings'in the,cominonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.' Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the'permit or license is being requested,not the Department of Industrial Accidents: Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pernut/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(ifitecessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A.copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each yeas. Where a_home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do'riot hesitate to give us a call. The Department's address,telephone and fax number: _ The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel•:#.617-727-4900 ext 406 or 1-877-MASSAFE Fax#-617-727-7749 Revised 4-24-07 www.mass.gov/dia ' 4 Town of Barnstable Regulatory Services atxxsznsLe Thomas F.Geiler,Director Mrss Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: L/ I N C JOB LOCATION: (a O/CIV I � } II NNE J F S nnumbeer+ streets— village "HOMEOWNER";/�}L^/��(�� name ^ home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply witlr,said procedures and requirements. Ah SirGiff4rntowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ` 1 . n i f f SARAISfASI.E, f 1639.. ,m� Town of Barnstable QED MA'S h Regulatory Services Thomas F. Geiler,Director Building.Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us t . 1 . Office: 508-862-4038 Fax: 508-790-6230 1 /—Proper`ty'Owner Must ~w r Complete and Sign This Section If Using A Builder L ,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 revers'e side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.OUdookWV87AAZ\EXPRESS.doc Revised 0721 10 LAJ U) C" r IMPORTANT ANY CONSTRUCTION THAT INCREASES LIVING SPAC BEYOND 1200 SO. 'FT. PER LEVEL MAY'REOUIRE.TH INSTALLATION OF ADDITIONAL SMOKE DETECTORS`.p nt NOTE: A SEPARATE PERMIT a TIRED FOR HE ELECTRICAL INSTALLATION OF SMOKE DETECTORS PERMIT DO S N SATISFY THIS REQUIREMENT. - J r O JA N�U A R Y ' g M �'kdW T� xFr S C - O - N - K - E - C ' T FULL SERVICE PRINTING, GRAPHIC DESIGN COPY CENTER 2 � 3 4. 5 �64 7 8 9 10 11 12 13 14 15 i6'�1718""az19 ?20I21 23 24 25w 26 a27 28 29" 30'0 31 01, � /1 ,. F��EeB11R`vU��+p�R y ; _ --_ .^ r? 1/' �. 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W T F S ' :7 air ry„a1r"p"2'kk3�t4 5 =� 6 7 8 " 9 '10 11 12 �20 2122 `23 24 25 26 2ECEMBY-ERu S M, T W T, F S 499b . • 6kf. p ,?a iv1 as a¢2 .aN 3 h.,: 4 5 6 7 8 9 10 11'T,12'13 '14 ,15, 1617 18 -19 20 21 22 23'-'24-'- PHONE: 781-331-5635 • FAX: 781-331-5761 246 WASHINGTON STREET, WEYMOUTH, MA 02188 2S iM,�27"s 28s.29,,, 31 } �l Z7 9 E� I E i E • L r � �*eMT;sW T" Fa � rewz.m C • O • N • Iq • E • C • T FULL SERVICE PRINTING GRAPHIC DESIGN COPY CENTER 2a, 3 ,.4� 5 6, 7 8_ ' 9 10 11, 12, 13 14 '15 'i6'17"'18-19 20'�21'"m22 ' ,`23l»24"'25,, 26,62E 28 295,, F "E B R° U"'A R"Y0, p - - - ,i7 Mr4T,mm W"'T"E 4,,, 5 `�- 20,,,21 ,22, 23 24, 25 26�' 27� 28 M A -RC Hm ,7 --- ---- S n A e-ti,T., W-rc iT F, ,tS 1. 2 3' 4 ' 5 9"'"10' 11 121 13'` 14" 15°"1716"A7"^18,Ill 9 20'21 122 , 23, 24 25, 26 w 27�,28 w,29_30 31,r �S M T" W T F St 3 4 iv,5 6. 7,,.,8 o,, 9 ' ,"w101 11" :.W�13w,:1415 .16„, 17,, 18 '12 19,„.20 21'` ,, 22 '23' 24 25 26� 27 28 29"30 -- M A Y . 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Q-S", MAzT„,,W. ,T, , F w,S.,: -," ,2 3,""4 paem 5 i ,,1 ""6,4 7•„ 8, -9 10^^.11 =q12 ,, 13" 15., 16 17,-18 19,',� `•� � { 20 11,21 22 h 23 24- 25 26 "- 127"28 29^n 30 .„ �f(►�i �w� l ECEM D B E R " , 2 3 ' 4 5 6 , 7 "8 ?"9 10 " 11" 1213 14151617 0 18 19 20„„ 21 .."22 �"23 24 PHONE: 781-331-5635 • FAX: 781-331-5761 246 WASHINGTON STREET, WEYMOUTH, MA 02188 25,,26 2T, 28 `29"30 31,; w Tt CA G ^�ks So r M Y Tqv,Ww T F,",S f Al C • 0 • X • 14 • E FULL SERVICE PRINTING, GRAPHIC DESIGN & COPY CENTER 2*10 14� 123 ,,.l6-17,Tl8- 19v,20+w,21;„221 t23 24" 25 ,26,,27 28,,,429,E 430^5 31 " F,IEBRUAk- z M T" W T F S > 1 w 2 "3�'4 5„" '6'w 7�o- g� g"10' 11"�^,12^•^a — 113,'14`15'` 16 17,`18 19„` `20`21 22-23 m 24125-26,z 4 27 w 28 Y ". _ illy.Ax.--R C,,,, H SFM T" W 'T- F S,, `1 2 3 ,4 .x5... 13 14'15 16,17 18 19 "20 21 22 23 24,25 26 C -- 27 28 29'30 31 1 2' ` 3, 4 5 6 r�7 8 9 �10n, 11 12 13 �14"15 "16 17,..18, 19;p 20 21 `22 23'' 24,25,26 27,w 28 29 30't 1 S M ,T� .W ,T .F,.... 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T"W "T F .,S "�'1 "2 '3 " 4 5 ----- --� 6;t'7 8 9 "10 w;11 12; 13 14 15. 16 °18 419 "20�21"22 "23 24 24°°25 426`1 27 28 29- 30 D ECEMBE t k S.;p,,,M X, <W. T w F,,"»S —� 4� ,•5 m 6 w 7 1 9�,13 11 "12 13 .14 -15. 17�16», ,'t 18- 19 20— 21 ,22 .23 24 , PHONE: 781-331-5635 • FAX: 781-33.1-5761 • 246 WASHINGTON STREET, WEYMOUTH, MA 02188 25 26 27 28 29 30 31, p i ;f °f� r Town of Barnstable *.Permit# 1 Expires 6 months yarn issue date y� Regulatory Services Fee . s, * HARNSTABLE, ' - v� 039. �0$ Thomas F. Geiler,Director" ^ . '�lfD M0't to Y� Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us t Office: 508-862-4038 Fax: 508-790-6.230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without ged X-Press Imprint - Map/parcel Number Property Address C i� A✓ �/ A 1V/l/i S - esidential Value of Work C)J Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 4 6 rs 4/JA IJ Contractor's Name Telephone Number Home Improvement Contractor License,#(if applicable) Construction Supervisor's License#'(if applicable) p4orkman's Compensation'Insurance , T _ SS PERMIT Check one: X-PRt VI am a sole proprietor I am the Homeowner MAY J I Z010. ❑ I have Worker's Compensation Insurance TOWN OF SARNSTAPLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ' .� Re-roof(stripping old shingles)' All.construction debris will betaken to ) fJtnA 0,5 A ❑Re-roof(not stripping, Going over existing layers of roof) P . ❑ Re-side y, #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44. )# of windows *Where required: Issuance of thi'spermit does not exemptcompliance with other town department regulations, e.Historic,Conservation,etc: ***Note: Property Owner,must sign Property Owner Letter of Permission, A copy of the Home Improvement Contractors License & Construction Supervisors License is required. SIGNATURE: 0:\WPFILES\F0R1v1S\bui1ding permit forms\EXPRESS.doC 1 { The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t 600 YYashington Street Boston, MA 02111 ivivw.mass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name (Business/Organization/Individual): Cry 1^ h h C-, Address: City/State/Zip: Phone #: Sb 2$M—0 I7- Are you an employer? Check the appropriate box: Type of project(required): L-El I am a employer with 4. I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• 0 Demolition- working for me in any capacity. employees and have workers' 9, ❑ Building addition [No workers' comp. insurance . comp.insurance.# 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.irequired.] I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions mysclf,..[No Workois'_cQzrrP right of exemption per MGLn_,.._. insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year-imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement Imay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. �e� '�"" Signature: /"`7 aa - Date: • Phone# Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Totivn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Phnne#- Information and Instructions Massachusetts General Laws chapter 152 requires a11 employers to provide workers compensation ensation for their employees. loyees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair.work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the -__ _- members or partners,are not required to carry workers compensation insurance. If an LLC or LI P sloes have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents . Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 wwtiv.mass.gov/dia C Town of Barnstable o Regulatory Services > xxszas Thomas F. Geiler,Director NUSS ,�� Building Division ABED MI+�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barristable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 5— 1,3 './ J JOB LOCATION: (�0 17�� w A• - number street page "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zap code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A.. person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109,1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature/Uffo&owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the , State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 —Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require;as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC 7I7: °FIHET 'Town of Barnstable ti regulatory Services SAMSPABLE, Thomas F. Geiler,Director v MAM 1639. n Building Division Tom Perry,Building Commissioner 200 Main Street Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usina A Builder I P r I , as Owner of the subject property t Ybehalf,m on act hereby authorize r.'' to in all matters relative to work authorized by buildin permit application for: (Address of Job) Signature of Owner Date Print Name If Propelty Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side,,., Q:FORIviS:OWNERPERMISSION ✓ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map CR67 .Parcel C -7 Application'# Qo®74/Y66o1 Health Division Conservation Division Permit# Tax Collector Date Issued �J a Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address fi `�✓ � i`�c�, a,/` a 14-S Village CCc1Ce v► n c S Owner A S�cl� Address Telephone U/o - 30 - 0^ Permit Re uest 2 �. X A J� dy� 14(A-,z Ln q �,✓ 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 U No If yes, attach supporting documentation. Dwelling Type: Single Family L/` Two Family ❑ Multi-Family(#units) Age of Existing StYull e Historic House: ❑Yes Flo On Old King's Highway: ❑Yes W,co Basement Type: ❑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 3 new i Total Room Count(not including baths):existing new first Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other "'j C' Central Air: ❑Yes 2 No Fireplaces: Existing l New Existing wood/coal jtove: C�Yes `r No w Detached garage:❑existing ❑new size Pool:®'existing ❑new size Barn:❑'exis ing ❑new size / cn m ["Attached garage: existing O new size Shed:U existing ❑new size Other: Zoning Board:of Appeals Authorization ❑ Appeal# Recorded O' Commercial 0 Yes U No If yes, site plan review# Y Current Use Proposed Use / ..BUILDER INFORMATION Nar`�A VA AQil r I Cwfr Telephone Number Addresr sC % f�f��,I c t9� f�' License# /9�- D A) fL-)/ S , /�'f (�/G Home Improvement Contractor# �✓ / ' Worker's Compensation# G✓C F _ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE""� s DATE" !6 Lo y t S. ? FOR OFFICIAL USE ONLY s s PERMIT NO. r DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE s OWNER t DATE OF INSPECTION: FOUNDATION i FRAME INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' I DATE CLOSED OUT ASSOCIATION PLAN NO. tt) l ti¢e 0 L, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers` Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Le 'bfl e(�/Organization/Individual): . C)/U C/��06 It ' 2 r77 -L "Addy ss: / SQ -C eA) .cJ /Stat /Ze pG� �.� /1(-S Phone.#: ��y��tl�c) Are yo employer? Check the appropriate bog: Type of project(required):. �1% I am a employer 6 4. ❑ I am a general contractor and I with� 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• �. 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions di h ffi ocers ave exercised.their 11. 3.❑ I am a homeowner doing all work h ❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MG 12.[]Roof repairs insurance se wired. t c. 152, §1(4),and we have no q ] employees.[No workers' comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infom1ation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. i �a Insurance Company Name:Aln—g)CC&ZN) AM le t)s5y/eeyo✓G.4� (. Policy#or Self-ins.Lic. Expiration Date: 0 //'s- to Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct 0 �Sien' atture-- Date: 671,5eL _ Phone k Official use only. Do not write in this area,to be completed by city or town ofjccial M City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the inscil—rance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. -The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitilicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year,where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Acwidents Qffiee of Investigations 600 Washingtoxi Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.rnass.gov/dia �.. aF,HF Tom, Town of Barnstable. Regulatory Services FrAXX Thomas F.Geller,Director 16 �� Building Division TomBerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstzble.xna.us Office: 508-862-4038 Fax: 50.8-790-6230 Property Owner Must Complete and Sign This Section If Using A.Builder as Owner of the subject property hereby authorize ()A,JIY rd JQi-(' `Qi it r to act on my behalf, in all matters relative to work authorized by this building pernait application for: , (Address of ob) " Signature of Owner Date Pnnt Name QF0E-M-S:0 NERPERMISSION kao b- ' CERTIFICATE OF LIABILITY INSURANCE -Al-1 S DATE(MMMDNY '' (TaER 06 13 07 [Barry RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 300 Congress St Suite 306 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Quincy MA 02169 Phones617-479-5500 Paa:617-479-8761 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER National Grange lWtu" ma. o0 INSURERS: AIG Insurance Co n Tlndercoyer Tent & Party INSURERC: Tonyp Pr}zzi 31 Ama an 1Payy INSURERD: South Dennis 9 02660 INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE WSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE.ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR S TYPEOFINSURANCE POLIC1fNUMBER ' DATE MIF PDATE IIINlDDn N LIMITS GENERAL LIABILITY EACH OCCURRENCE S R S COMMERCIAL GENERAL LIABILITY PREMISES Fa:141 t nee) CLAIMS MADE �OCCUR MED EXP(Any one person) S I PERSONAL&ADV INJURY S GENERAL AGGREGATE S OEWI.AGGREGATE LWTAPPLIES PER: PRODUCTS•COMP(OP AGG S POLICY JET LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S1,000,000 A ANYAUTO M9H06653 05/02/07 05/02/08 (Ea accident) ALL OWNED AUTOS BODILY INJURY S (Perpersan) X SCHEDULEDAUTOS X HIREDAUTOS BODILY INJURY S I �( NON-OWNEO AUTOS (Per accident) PROPERTY DAMAGE S (Per accdent) GARAGE LIABILITY �2U TO ONLY•FA ACCIDENT S ANY AUTO THER THAN EAACC S t UTO ONLY: AGG'E EXCESSFUMBREL A LIABILITY EACH OCCURRENCE Fs OCCUR ID CLAIMS MADE AGGREGATE E DEDUCTIBLE S RETENTION S 5 WORKERS COMPENSATION AND TORY L1N1RSe ER EMPLOYERS'LIABILITY $ yvC6836887 04/15/07 04/15/08 EL EACH ACCIDENT s I000000 ANY RER(MEMBEREXCLUDED7 UTNE OFFIC E.L.DISEASE-FA FMP10YES1 S 1000000 Hyes,desaftunder E.L.DISEASE-POLICY LIMIT S1000000 SPECIAL PROVISIONS balow OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS. CERTIFICATE HOLDER CANCELLATION - ----�- N111SETR SHOULD ANY OF THE ABOVE DESCRIBED POUCIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN �Y NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. . A A LA00RD6 5(2001108) '' 0 ACOhD CORPORATION 1988 e s ilem".5tance t t� of Pame REGISTERED ISSUED BY FABRIC Date •: NUMBERTOPTEC, INC. manufactured 1905 N.E. MAIN ST.' ��►, �,.e. ,�.•'��' SIMPSONVILLE, S.C. 29681 3/21/94 F1Z1. 4 e� This is to certify that the materials 'described on the reverse side hereof have been flame- retardant,,-treated (Orti are inherently nonflammable). i FOR Undercover '6-nts ADDRESS" 90 Midtech Drive Unit 3 _. I ' CITY South Yarmouth STATE MA ' • is hereby made that: (Check "a" or "b°') Certification i (a) The articles described on the obverse side of this Certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said ' chemical was done in conformance with the taws of the State of California and the Rules and .Regulations of the State Fire AAarsh®t. ' Name of chemical used.-.' ................. .. ....................... ............Chem. Reg. No'.---- Methodof application..-. ,r- ....... ............................ .......... ........-----........--..... (bf The articles described on the obverse side hereof 'are made from a flame-resistant fabric or material registered and approved by the State Fire"Marshal for such use. The Elam' a Retardant -Proeeess Used MILL NOT Be;Removed SY W6shing :a •: TOPTEC, INC. , • y Iil!®DEL � � 940837 Name of Production Superintendont SERI`OL# TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel S,0 eri ;J fi I �m-) I- Health Division (0 Date Issued Conservation Division Application Fee Tax Collector Permit Fee 4"21 L 14 TreasurerE.:S0i 6 Planning Dept. / G / ��/�� LCJjul- PERMh' i AOM THE Date Definitive Plan Approved by Planning Board '4\7GINEERING DIVISION PRIOR TO Historic-OKH Preservation/Hyannis Project Street Address 61 ISRAAIT K14Y Village H y4tilu I S Owner iJtVD2F_VV + 0,420i— 13r&8,QN Address - &I IMA"T klAY Telephone So 7-7/ —0 2-0 7 Permit Request TO colv5n2v-577 o' x 36 IAI 'q2OVAIQ 5t4--#)M I"17V4 /000 Square feet: 1 st floor: existing. proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ail, boo Construction Type Lot Size Grandfathered: U Yes Z1 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family Q Multi-Family(#units) Age of Existing Structure Historic House: L1 Yes U No On Old King's Highway: Ll Yes Ll No Basement Type: Ll Full Ll Crawl C3 Walkout Ll 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: Ll Gas 0 Oil Ll Electric 0 Other Central Air: Ll Yes Ll No Fireplaces: Existing New Existing wood/coal stove: 0 Yes El No Detached garage:0 existing Q new size Pool:C]existing 9 new size 36 Barn:0 existing Q new size Attached garage:U existing El new size Shed:Ll existing C3 new size Other: Zoning Board of Appeals Authorization Q Appeal# Recorded Q Commercial El Yes Q No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name_Siwtyln-,xl< 09boi_ --f 5)0A 41201.-,10 Telephone Number 5,og—4577—78 0 0 Address +35 ��4ag-l-r Ah-v $Z License# 0.7.8 4 39L 0 2- r'3 Lo Home Improvement Contractor# i30666 Worker's Compensation# 8 Tq 61760 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Dt1ma5Tfl_t2_ SIGNATURE Z�n DATE LO 2— C/ r FOR OFFICIAL USE ONLY i ERMIT NO. ; DATE ISSUED s; MAP/PARCELNO. w, ADDRESS - / = `F •VILLAGE f OWNER DATE OF INSPECTION: r 3 7 FOUNDATION —6 -.FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINALE' %— GAS: ROUGH FINAL+ FINAL BUILDING ' DATE CLOSED OUT t ASSOCIATION PLAN NO. 4 , r't � { The Commonwealth of Massachusetts Department of Industrial Accidents - Office of/nrestigations • - _ 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name: AN02fa w G'4-"4 S MAX A/ location �4t2ANT l�/f!-4l city /Y6,NA/f t M Q phone# ✓Ar—77/d zo.17. ❑ 'I am a homeowner performing all work myself ❑ I am a sole r netor and have no one workin in ca ad %%%%%%%/G��%/%%/%/%%%%%/%%��%%%%%%%%/%/% %/G%I%%%%%%��%%%%%/%%/%%%/////%%%%%/%/%%%�%/G/��%/G/G%//�%///%��%%�%/ I am an em 1 er_ rovidin workers' compensation for my employees working on this job.l::::::: Y:.,}.::::;::::::.Y•:{:n:•.:::_;:: :'}r P oy P g.......................::::.:::::,:.:....r....-.....,:::::::::::::::.:...:.:.n.......,..............::.::n.::::::.:::::::.:::::....:................:::n..n:::.:.::.n.::Y:::::::.:.:... ..........:.::.......................:.:::n:.::.:.n...................:.:::::......................:.::.::..:.........................::::.:::..:.........................................,...::::::.::..............:::::::::.::::: :.:n.:........................, ............ .......... :.:........:. n� •�ilr :a Y::Y::;.:: %i iJ!:iii':i:YiY:?>.•Y:?4Y;b:i•YYi:+:;JY::'•��,�;sy:r';'}:';,Y.�.:::'�'.�•'•�;:��:'•'.�.�:•i::;,v; ��;'��.,�'%�'�}'��'.'�.•-�:::�;:;::i`}�ii:�;::jj:��`�;:;:f�{:jib:;iii:iii};:�v:!'Y�'��:i:}'%:>.;i:%�;;��.�:?;�;!:{vi:!j;i�:��:� :��:��:�:j�:�:�:� :4Yiii iiiii:�ii:<?hyi:i`ii:?':•it�:J;ii'L?y,:;i{i;iiii::ii:4:;}ii:;:^ i fii i>ii::i::i;G::i'iifYi: i':•�: iY''{J:';<'vii:i:"}::?t:::Yii ,�y .::.;'::::::�:•;;Y':.:.::.;,:.::;: ;:'::' ': Y::':. :. •:r::. .... .. ..::. .a..: .... .. .......:.Win:•..:..::%: �rlt.'..M...... ...... ... ... ... .... :... ......-. ;:;;:;::::>::::::::`•:::`:.:: ❑ I.am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have . ` ... . . , ,,.. . . the following workers' compensation olices: - {::i;:....::i:: .....s:.:..ii:::j';'?:;<:::'i:� i::is?::i:;:;:;:::i::::;:j::'::%::ti:%::::2:':;i:t:i::Y::ii i:;:i;:;L >{ii}:!:`is�i:;?;isY :isL::C:i:;:;::i:;:::i;j:;i:;:Yi:.i:;:`:;:iY?:•i:;:n:}:>::>y..;l:Y::�:} ;:. 00 ......:YiY::::wi;::::;:::':•:+:r:i:.�:::4?:::n�::yi;i:3:??Y:};•.':':^Y:•}:;i sYY::::•:y;?:{;::ry:4Yii:"::::r:y::Y4:Y:iiiY:::::.�::::::::.i':n•:::::v::.�.;:w:n::::.:.:..............i:: :ii'if:iijii}}:i:}•�i :nwn.........:::::.�::::vY:::::::::..:::w:::v:.:::.�:::..,?v:::;Y::n:...........:................:............................:...............n:•.::•:n•::::::.:Y':::....:...... ?:: •s: •.4.: ............................:�.�::n•:::::::::r::::::::::.;::;•:r:iYi:•:i;.Y';4:?+^YY:^Y:•Y:??{:L•YYY}YY:;?YY:r:.:............. .:: •.....: :.i. a ..........:.....::..:::::>:::.:�;:::::::::::•.;•::::i?;•:�iY•YYY:;•Y:;;4YY:::YYYrY:a:::?:•i::ii::;;•Y:;;::ii::i::ri:i.';�:�:::_:::i5�:•::;�>Y:i:%:�iiii i;:i;•;;::;::�:;;%'::•%i•:i::�Y Y:•:i::i•:ic;:i;_i;;•:i: :: ................... .................:... .. :r.................... .... ...-........ :.....v::.�:::.......:.n:::.Yi:Y:;.gin•::��::::.�::..}�::.:�.�.�:::::., + rr.: -:,.i.,..r ,a ............nr,. ........r..........r.,•....... .............................1....,:•:::::..:.........r.::.—._::•:::YY;;•:r::.�::•:.:...... ........::::,:.:....-................................Y..•..•:::•::r:,•.•.Y,•::::•:. t ...,•S,r..:•> ..........:.....::::!rn•:::.:::::.�:..:.....:.:...Y•:•:•::•YYY>::•>:;:}::{•YY:.:�i:?2•:::}i:;::�;•YYn::Y:S;•:'.•i:;•>:�>YY:•:;•Y}Y:•YY:•Y::•:%•i:•YiY:;;i:;:.'•;.. 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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 31,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDIM and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. -- I do,hereby-certi u thep d-penalties-of-per-jury that-the-informationpr-ovidedabove-is-true-md-cvnect=_ / l Date signati r@6r Print name .�j Fi 1L t11�` R/� Plione# . .. 796 d AMP- off cial use only do not write in this area to be completed by city or town official city or town: •''permitAicense# ❑Building Department [ Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _ Health DeP artment • contact person: phone#; ❑Other Vigo 11111ovilig (revised 9195 PJLa Information and Instructions 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 thelegal 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 µ: 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 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 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`1aw".901.you are required.tq obtain.a workers' compensation policy,please ca11°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 botto� 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.pernuWC,-en se number which wabe used as a reference number..The:affidavits may lie redunedt the Department by mail'or FAX unless other arrangements have been made f. The Office of Investigations would like to thank you in advance for you cooperation and should you have any_gnestions. . 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 Dmce of investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727.7749 ` : phone #: (617) 727-4900 ext. 406, 409 or 375 °*'THE r, Town of Barnstable ti Regulatory Services r r sA"" Thomas F.Geiler,Director 059.� MAMAS9.. �ArfD MA'S p,0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. a Type of Work: /8 x 36 1,y41W I!/t//J 5'all Y lnluG 00ol-Estimated Cost a3 6ts® Address of Work: CO 644A T 14/,-y Owner's Name: Ay=FLw 5� Date of Application: `®/Z/ I hereby certify that: Registration is not required for the following F_JWork excluded by law FJJob Under$1,000 OBuilding 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: Date Contractor Aarne Registration No. OR Date Owner's Name Q:fomvs:homeaffidav TO'd Id101. J N � F CA PI21rORN REAL-TV -rRU_&_T" 41FOO IF 7y4- f FEW E O F DECK .� I O. c AtAIRM, N i 2 STORY { l_pT i to 5-rpF_F_r JOHN S. cr BRA KI W A Y LAURETANI �. N 34311 im su a o*.r-1070, Scale: 1 = 20 J"S. LAUAETANI inccCCrnuAl .•un nUn.•rvww � � y - I 14 GA.cwum STLI OIIIfNONAL. BRACE P 0AL t1e�kNElf1izms7L.L SEE S7�GL 13/2 AM r :� PLANS LOCNICNIS OMERFOR IMBRAK S-W*KSOLT'S AND 0 2 VASHERS TYWCAL S- '�EL80LT5�NITS 94 GA.GAM STEEL FAA AMEND 7YP _ PC STEM VWEM Lwm cr 20 Ift- VlKVL LVIERT1rC1O1E55 `�� ,y � _SEFES 9W&WO ) 431 NP C}--R 4 4A 2 2 2 RAlis FBR UN.RlgtlS 8D O ONAL�6`� �• n- amm iron N DUKE QF58 SA10g 22TfR i EA.RVM END S-�.'s IL NUTS•• 4 GALYGAMSTEEL AM 2 MI TY>f EA.PAIAEL END 20 MI.TI1MCI81M sm LA MM I*GA.SAM STEEL CORNER PEE • 'JrriD'ATSE 7 4'IQ:'AT SECCTA14 VA- ' 2D 10[_LTO pQ PANEL GALM ST1EL� %& 2 -SERES TOO.T50,1000510501ELCMM T SERIES 700 STAR CORNER B 2 2 2 4'ML9 CTALL OEC>C r4jW3W NOMINAL SE£ MrStTAl.11►TN7NC�OPNO lAUIMMIM NOTE AND SECT BIZ U— _ - - s' �ML COMM ab t� CCP fIG �N Y..� MANI '`M.BOLTS �• j: .•NO[E TYPCAL EACH •�.�zu `�*.. �Y.ra. :Y:�sp NOMSE SECS PANEL END CM2 FOR dAGONALAM HORMOKrAL - • 1!4'aPAN�E r PMIAfELATE 5 LEVELINGCONC CARRIAGE am GUSSET T 7w. ��uLTfliFJ10 y COLLAR 9fMI - 14 GA.GAM STL tFJL PANEL END M A ATUM PANEL TYPAL I M� Iw 2TO _ SEE PLAN VIEW NUTS F IL ABOVE ' 5�'l` S,IS/TS 13Ai�iitl3M� T YPIGY. EA '�X 4!' AND :N 81}BMLYANGLE PANEL END �IpIEAGE BOLTS ry DEEP COMPETE a 7 EA PANEL QD i 20 MLTIlOaEssAOF SE VIM L/ER p�'� SEEVINYL_ tA1Et �t PER TYPICAL 14 GA. �KOtCLATNON NOTE NO.I MOMMiTTED FORGAM PANEL END SEND 009ENSIM �r MIl P1.1. i a 2' MMN Flg o 2'WWTVR TOP 6 Bd'G S' $ 3�M►'r ML BOLTS (LIEVIEtr2 2't 2'-CrGMLY 2=� 'SU2' i SLI aPLATE) TYPICAL WALL SECTION TYPrAL VVAL L S T{FFENER 2�'a wnoH �1 -�MOLE FnR 2 W PANEL n AT MD PANEL TYPI('J4L.. uALL_ SEcmN AT `A` FRAME 13 1 —i u _. —35'-10 , _6 26'-10 3/8" 8' 8' 8' 8' 8' 4'-6" 4111" 4'-6" PART NO ( 32 -4 1/ 6" + LINER42-2282 81 LIC—F2-2382 1 go-ion ' 36'-11 3/ 40'-1 9/16" 8' STAIR (NOT INCLUDED) R4'-6" 4,-6" 4'-6" 8' 4'-1" 8' 8' 8' 8' 3' DECK AROUND ENTIRE PROFILE BOARD 8' 8' BOARD OVERHANG '-8" TOP TIP OF DIVING BOARD 20" MAX. DECK -- --- -- A WATER LINE------------------------ --- DIG 3' 16" * ' DIG W ER 8'-8° 1 1/2" BOTTOM SURFACE BEAD TO FINISH BOTTOM 37" SHALLOW '-1"--"'-8" 15'-9" 0'-4 3/8" 8'-3" DEEP 5'-10 3/8" INSTALLATION TO BE IN ACCORDANCE WITH FOX POOL CORP. RECOMMENDATIONS FOXXX POOL CORPORAT& NOTES: CT o 1. X—BRACES ON 4'—O" SPACING RAD R 2. SAFETY LINE 12" FROM BREAK 3 3/00- 1 00 "m 1 It 3. *IMPORTANT MINIMUM DEPTH UNDER DIVING BOARD ©ALL RIGHTS RESERVED °1p 02-586C NONE 1. cea o Err OR" T. BERRY ruxUAKI .ILL UI MAI LKIALS S IANGAKD HILL UI- MA, ,ALS I LUNINIUAL IIvrUKMAI IUIN 24-F1 -31 12" REROD 8-F1-150 8' PLAIN PANEL PERIMETER INCLUDING STAIR- 100' 47-F1-32 24" REROD 2-171-151 WALL FITTING PANEL SWIM AREA SQ. FT.- 628 24-F1 -389 X-BRACE 1-F1-157 4' PLAIN PANEL GALLONS OF WATER- 23,150 8-F1-404 8' PLAIN PANEL 1-F1-173 8' SKIMMER PANEL APPROX. CUBIC YARDS OF CONCRETE FOR FOOTER- 7 2-F1-405 8' WALL FITTING PANEL 24-F1-31 12" REROD APPROX. CUBIC YARDS OF CONCRETE FOR 3' DECK- 1-Fl-408 4' PLAIN PANEL 47-F1-32 24" REROD APPROX. CUBIC YARDS OF BOTTOM MIX- 7.5 1-F1-412 8' SKIMMER PANEL 23-F1-415 HOOK REROD RECOMMENDED SAND FILTER SIZE-26 23-F1-415 HOOK REROD 24-F1-462 X-BRACE RECOMMENDED D.E. FILTER SIZE-36 SQ.FT. 1-F21-133 HARDWARE KIT 1-F21-133 HARDWARE KIT RECOMMENDED CARTRIDGE FILTER SIZE-42OSF 1-F23-208 SKIMMER COPING STRAIGHT 1-1723-208 SKIMMER COPING STRAIGHT RECOMMENDED PUMP SIZE-1 HP 8-F1-435 8' TOP STIFFNER 8-F1-402 8' TOP STIFFNER HEATER SIZE VARIES WITH CLIMATE 8-F1-470 8' BOTTOM STIFFNER 8-F1-469 8' BOTTOM STIFFNER SAFETY ROPE LENGTH- 18'-0" 8-F1-471, BOTTOM STIFF SCREW KIT 8-F1-471 BOTTOM STIFF SCREW KIT 2-F23-185 4PC. COPING KIT 2-F23-185 4PC. COPING KIT 1-F5-94 SKIMMER KIT 1-F5-94 SKIMMER KIT 1-W13-868 FOX FROG ACCESSORY KITS FOX BUDDY SEAT LIGHT PANEL FOR NICHE LIGHTS FOX WATERFALL SPA THE WATERFALL SPA MUST BE INSTALLED IN THE SHALLOW END OF THE POOL 2' 8' 8' 8' ' 7916" 8' L L U 1'-8 3/8" 2 6' STRAIGHT BUDDY SEAT 2' 31- " 3'—6" ' THE 8'BUDDY SEAT AND THE 1 �—��— 1 2' PANEL TAKE THE PLACE OF AN 8 8' CENTERED LIGHT PANEL e I 8' PANEL AND CAN ONLY BE DIVING BOARD WILL ALLOW YOU TO CENTER THE 3'-6" R3'-6" INSTALLED ON THE STRAIGHT WALLS LIGHT DIRECTLY UNDER.THE DIVING BOARD. & OF THE POOL F1-653 WF PANEL KIT F1-654 WF PANEL KIT TAKES THE PLACE OF TAKES THE PLACE OF 8' A 8' PANEL A 8' PANEL SWIM-OUT 8' 8' 8' RECOMMENDED FIBER OPTIC LIGHTING REMINDER! ILLUM./ II ALL POOLS SHOULD BE INSTALLED IN ACCORDANCE WITH 300ST. THE B SWIMOUT TAKES THE FOX POOL, CORPORATIONS RECOMMENDATIONS AND MEET PLACE OF AN 8' PANEL AND OR EXCEED THE NATIONAL, STATE, AND LOCAL BUILDING 150' PERIMETER FIBER FOR POOL WITH STAIR ONLY. SHLD BE INS THE TALLED END I ONS THE WIMO�GHT AND SAFETY CODES. THIS IS RECOMMEND SIZE AND LOCATION ONLYI IS ONLY TO BE USED TO EXIT THE /- THERE ARE MANY OPTIONS AND VARIABLES FOR LIGHT POOL AND IS NOT MEANT FOR ENTRY. LLOCATIONS PLEASE REFER TO YOUR FOX PRICE BOOK 1 AND/OR FIBER OPTIC LIGHTING MANUAL qr Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Replatration: 130666 Tape: DBA Expiration: 4/6/04 The Swim Pool Spa Sale & Ser, MaketGrp Steven Senna P.O. Box 3612 E. Falmouth, MA 02536 1 Update Address and return card.Mark reason for change Fj Address [] Renewal Employineut [] Lost Card - f. . f•''. ipJf.'-....^^i•.J!nl:�=r�f'}��'�R�.per:7�tLFpJ�i.:�i/:�l.:�i{'f�:;. ° BOARD W HUlLWi�G.F EGUL AMNS Licanse:COWJTRUCnON SUPERVISOR + fam1her CS 078934 Bkffidab:0"Ifi958 - Expires:05107/ M Ts_no.- 78934 Restricted Ta: 00 KEM F CAVANAUGH 435 WAQUOT HGWY .1 E FAJ.3UIOtIMH. MA 0=6 AdmkdsbMw �o�....� z Board of Bu �din u a#ions g One Ashburton Place, m 1301 Boston, Ma 02108-1618 - ucrosw CONMUC noN SUPERVISOR UCENSE BlrtMddte: 05/0111959 Number. CS 078934 Expires:M0112005 ROSMcted TW. 00 KEVIN F CAVANAUGH 435 WAQUOTr-HGWY E FALMOUTH, MA 02536 y Tr.no: 78934 Keep topforoeaeiptand change of address m0kaffon. 9 PAGE 1 ENDORSEMENT I his endorsement, effective 12:01 AM 12/02/2001 Forms a part of policy no.: WC 899-67-6o Issued to: STEVE SENNA By: GRANITE STATE INSURANCE COMPANY LOC NO. NAME AND ADDRESS SCHEDULE FEtN UI # 0001 STEVE SENNA (OBA) THE SWIMMING POOL AND SPA GROUP o16522178 411 WAQUOIT HIGHWAY E FALMUTH, MA 02536-00oo i Issue Date: 12/12/01 Authorized Representative WC990610(Ed. 1-97) s - - � CERTIFICATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Antonio F Alberto Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 420 Stafford Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Fall River,MA 02721 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Steve Senna 435 Waquoit Highway E Falmouth,MA 02536-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE15 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co I LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE A WORKERS COMPENSATION D EMPLOYERS'LABILITY LIMITS HE PROPRIETOR/ ARTNERSIEXECUTIVE OFFICERS ARE: NCL 0 EXCL 0 8996760 12/0W001 12/02/2002 TATUTORY LIMITS OTHER Coverage Applies to MA Operations Only. H ACCIDENT $ 100,00 ISEASE POLICY LIMIT $ 500,00 ISEASE-EACH EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS/VEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 367_MAIN STREET _ _DAYS WRITTEN NOTICE TO_THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT HYANNIS,MA 02601 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE oa® TM a PO=GP!d .� 0 VERTICAL GRID D . E . FILTERS seo�a P HaywardPro-GridTM isa high- y � performance filter series that provides 1 .§.. - T S X• i � �" �05 superior water clarity,eff icient f low v and large cleaning capacity for pools 0 k of all types and sizes. tfu Y Pro-Grid filter tanks are now molded a Y from new and stronger PermaG lass XL, Cif o •g _ _ i� 3 an improved glass reinforced copolymer, P f providing the ultimate in strength, „c �] durability,and long life. v� c �® y Pro-Grid filters also 1 � �p/p/j combine high C y� '""__ ® technology features s m with a "service-ease" design for dependable operation and x � a low maintenance. Pro-Grid filters are also available with g " i the unique SP0740DE Selecta-Flo s control valve,the only filter control valve ' designed specificallyfor D.E.filters. "' g¢ For the quality conscious pool owner, _ Pro-Grid filters are an unparalleled `. filtration value. ®DE7220 Pro Grid'M72 ft.Zl/ertical Grid D.E.filter with optional SP0740DE Selecta-Flolm 4-position control valve. Large capacity 72 ft!filter,made of durable F PermaGlass&",can-be used in both commercial and large residential applications for years of non-corrosive,trouble-free performance. " Featuring _�— �I PermaGlass;,= Filter Tank Material HAYWARP America's *I Pool Water Systems po-Grid"mVertical Grid D . E . Filters Innovative Automatic Air Relief purges any trapped air automatically during filter operation. — • Screenless Internal Air Relief provides continuous air venting and eliminates clogging. Improved High-Strength Filter Tank molded from new and stronger PermaG lass XLU' material for extra durability for dependable,corrosion-free performance. r< High Impact Grid Elements designed for up-flow filtration and top-down backwashing � a for maximum efficiency. 04, Self Aligned Tank Top and Bottom make access to servicing grid elements fast ry T and simple. Heavy-DutyTamper-Proof One-Piece Clamp securelyfastenstanktop and bottom together and allows quick access to all internal components withoutu ,l Marked Short Element and Manifold provide clear guidelines for re-assembly of rid ;. disturbing piping or connections. p 9 Y 9 elements during cleaning. ,. ; ,. ,i t� .,� Inlet Diffuser Elbow distributes flow of incoming unfiltered water upward and evenly to all filterelements. Noryl®Bulkhead Fittings for extra strength and heat resistance. k Full Size 11)?Integral Brain provides fast,100%clean out and easier flushing of tank. Union Locknuts make disassembly and reassembly of filter from piping fast and easy. Plumbing Versatility.Select from a wide variety of valve options for customized control of your filtration system,including Hayward's 2",2-position slide valve. FILTER TYPE: Vertical Grid Diatomite:24,36,48,60,72 ft(2.2,3.3,4.4,5.5,6.6 M2). FILTER TANK: Injection molded PermaGlass XUm `` �Y` • FILTER ELEMENTS: Monofilament polypropylene cover fitted over 8 curved, t, high-impact grids CONTROL VALVE: 1%2"or 2"6-Position Vari-Flo;M 2"4-Position Selecta-Flo;" p 2"2-Position slide valve.May also be plumbed singularly or in series with quick-connect union couplings(less valve). PERFORMANCE RANGE: Y2 to 3 HP(30 to 120 GPM) DIMENSIONS: DE2420—32"H x 23"W(81 cm x 58 cm) FullyAutomatic Air Relief with double seal DE3620—34"H x 23"W(87 cm x 58 cm) eliminates the need to manually vent filtertank after system start-up and prevents backdraining DE4820—40"H x 23"W(102 cm x 58 cm) NSF® during pump shut-down. DE6020—46"H x 23"W(107 cm x 58 cm) DE7220—52"H x 23"W(132 cm x 58 cm) Above dimensions are for filter only.Overall width with slide valve is 30"(76 cm); overall width with either 4-or 6-position multiport valve is 33"(83 cm) r, r � Effective Design Turnover ' Model Filtration Area Flow Rate* Gallons Kilo Liters "f .,H f Number' ftz mZ GPM LPM 8 Hr. 10 Hr. 8 Hr. 10 Hr. I 1 b DE2420 24 2.2 48 182. 23,040 28,800 87 109 OA DE3620 36 3.3 72 272 34,560 43,200 131 164 ,. DE4820 48 4.4 96 363 46,080 57,600 174 218 DE6020 60 5.5 120 454 57,600 72,000 218 273 -- -- DE7220 72 6.6 144 545 69,120 86,400 261 327 Removable Clamp Tool makes tightening and *Determined by pump size and piping system hydraulics. 2"piping is recommended for flow rates of 90 GPM(341 LPM) loosening of clamp quick and simple,providing or more. Flow rates above 120 GPM(454 LPM)are not usually required for residential pools-. easyaccess to filter internals. NSF is a registered trademark of the National Sanitation Foundation HAYWAR D America's "I Pool Water Systems. 1-888-HAYWARD www.haywardnet.com ©2001 Hayward Pool Products,lac. PGO I a � TM p PPO=GP!d = 0 VERTICAL GRID D . E . FILTERS ®o®tee P k. �# HaywardPro-GridTM is a high- " performance filter series that provides Q 3� s 4 -M superior water clarity,efficient flow and large cleaning capacity for pools 0 " of all types and sizes. Pro-Grid filter tanks are now molded nYf from new and stronger PermaGlass XL�m c;a an improved glass reinforced copolymer, P r: = providing the ultimate in strength, durability,and long life. n�nl Pro-Grid filters also combine high technology features - with a "service-ease" E design for dependable operation and • 4. low maintenance. 3 Pro-Grid filters are also available with the unique SP0740DESelecta-Flo control valve,the only filter control valve ecificaIlY p designed desi s for D.E.filters. 9 v a For the quality conscious pool owner, Pro-Grid filters are an unparalleled filtration value. q ■DE7220 Pro-GridIm72 ftNertical Grid D.E.filter with optional SP0740DE Selecta-Flo'M 4-position control valve. Large capacity72ft!filter,made of durable PermaGlassA,can be used in both commercial and large residential , applications for years of non-corrosive,trouble-free performance. Featuring PermaGlass=�= Filter Tank Material HAYWARKY America's *1 Pool Water Systems Pro-GridTMvertical Grid D . E . Filters 4 - Innovative Automatic Air Relief purges any trapped air automatically during filter operation. - • Screenless Internal Air Relief provides continuous air venting and eliminates clogging. Improved High-Strength Filter Tank molded from new and stronger PermaG lass XL' material for extra durabiIityfordependable,corrosion-free performance. High Impact Grid Elements designed for up-flow filtration and top-down backwashing for maximum efficiency. Self Aligned Tank Top and Bottom make access to servicing grid elements fast and simple. Heavy-Duty Tamper-Proof One-Piece Clamp securely fastens tank top and bottom together and allows quick access to all internal components without disturbing piping or connections. .T Marked Short Element and Manifold provide clear guidelines for re-assembly of grid elements during cleaning. Inlet Diffuser Elbow distributes flow of incoming unfiltered water upward and evenly to all filter elements. Noryl®Bulkhead Fittings for extra strength and heat resistance. Full Size 1%"Integral Drain provides fast,100%clean out and easier flushing of tank. ` Union Locknuts make disassembly and reassembly of filter from piping fast and easy. Plumbing Versatility.Selectfrom a wide varietyofvalve options for customized control of yourfiltration system,including Hayward's 2",2-position slide valve. FILTER TYPE: Vertical Grid Diatomite:24,36,48,60,72 ft2(2.2,3.3,4.4,5.5,6.6 mZ). gs W , P FILTER TANK: Injection molded PermaGlass XLT"" �.;;k • FILTER ELEMENTS: Monofilament polypropylene cover fitted over 8 curved, high-impact grids CONTROL VALVE: 1%2"or 2"6-Position Vari-Flom 2"4-Position Selecta-Flo' 2"2-Position slide valve.May also be plumbed singularly or in series with quick-connect union couplings(less valve). PERFORMANCE RANGE: Y2 to 3 HP(30 to 120 GPM) DIMENSIONS: DE2420—32"H x 23"W(81 cm x 58 cm) Ful mates maneed t manRelually withentfildouble seal DE3620—34"H x 23"W(87 cm x 58 cm) eliminates the need to manuallyventfiltertank after system start-up and prevents backdraining DE4820—40"H x 23"W(102 cm x 58 cm) ® during pump shut-down. DE6020—46"H x 23"W(107 cm x 58 cm) DE7220—52"H x 23"W(132 cm x 58 cm) Above dimensions are for filter only.Overall width with slide valve is 30"(76 cm); overall width with either 4-or 6-position multiport valve is 33"(83 cm) `h ��']j kaMMaWwwrwil Y Effective Design Turnover Model Filtration Area Flow Rate* Gallons Kilo Liters Number; ftz m' GPM LPM 8 Hr. 10 Hr. 8 Hr. 10 Hr. k+5 DE24201 24 2.2 48 182 23,040 '28,800 87 109 DE3620 36 3.3 72 272 34,560 43,200 131 164 DE4820 48 4.4 96 363 46,080 57,600 174 218 DE6020 60 5.5 120 454 57,600 72,000 218 273 DE7220 72 6.6 1 144 545 69,120 86,400 1 261 327 Removable Clamp Tool makes tightening and *Determined by pump size and piping system hydraulics. 2"piping is recommended for flow rates of 90 GPM(341 LPM) loosening of clamp quick and simple,providing or more. Flow rates above 120 GPM(454 LPM)are not usually required for residential pools. easy access to filter internals. NSF is a registered trademark of the National Sanitation Foundation HAYWARD America's *I Pool Water Systems 1-888-HAYWARD www.haywardnet.com ©2001 Hayward Pool Products,Inc. PG01 ......"vT^ rv ,,•cr-;.,T,,.. r�., � �� .. ...,� ,,,,.vryk34"+jy*�- . J f p oiTxe� TOWN OF BARNSTABLE Permit No. Q663....... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .wa 6 HYANNIS,MASS.02601 Bond . CERTIFICATE OF USE AND OCCUPANCY Issued to Capricorn Realty Trust Address Lot #12 , 61 Brant Way Hvannis. Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. March 4, 19 � -- Buildin Ins ed r F _ ;r ��..� °•`w TOWN OF BARNSTABLE BUILDING DEPARTMENT i BARISTAU : TOWN OFFICE BUILDING � ru& HYANNIS, MASS. 02601 �aW�Y1. MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #.... d.. ' -�.»................................................._........................................».....................»..........................»....... »»». issued to .Cr i'� 'a� ..» LT..... ........... .. �' ......» , r�1 �Y ?•�//.....f-*»� r f Please release the performance bond. TDWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT 19 PERMIT NO. APPLICANT- g, �� DATE ADDRESS _ —^— IN0.) (STREET) (CONTR'S LICENSE) PERMIT TO I _(_) STORY NUMBER OF DWELLING UNITS f,•E OF/IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) -.- �ry I �R�N� Y �� #/Z ZONIN CT - (NO.) (STREET) SE:7WEEX AND - (CROSS STREET) (CROSS STREET) SUBDIVISION _ LOT BLOCK LOTSIZE r BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION - TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR VOLUME ESTIMATED COST PERMIT (CUBIC/SQUARE FEET) OWNER- ADDRESS DEPT. ADDRESS — BY l-ilS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ' PERMANENT E ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDIN G.COD E, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM.THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE.OF THIS PERMIT DOES NOT k1'I_EASE THE APPLICANT FROM THE CONDITIONS OF ANY -APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB ANC:: THIS WHERE 'APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UN --rL FINAL INSPECTION HAS -,'EEN PERMITS ARE REQUIRED FOR E'_ECTRICA, PLUMBING AND I. OUNCATIONS OP. FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COV:RING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MC;A3ERS(READY TO LATH1. 3. FINAL INSPECTION :.'FORE I FINAL INSPECTION HAS BEEN MADE, OCCUPANCY. POST TH ARD SO IT IS VISIBLE .FROM STREET ILDING INSPECTIO A RO S PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 L� _z - — — — 2 ----___ ----—-- -- — ---HEATING INSPECTION APPR(b: S U-I'iEERING DEF:RTMENT _..— OTI-E''� ..--- - c-- BOARD OF HEALTH ..aC.L NO PROCEED UN ..THE !NSPEC- PERMIT 'w!LL BE OhiE NULL AND VOID IF CONtTRIirTION' WORK 15 NOT ST;RTED WITHIN Sl,. ;,:ONTHS OF DATE THE. va A I ARRANGED INDIBY TELEPHONE ON THIS CARD CAN RE' .>PPROVED THE VARI'.,UUS STAGES OF —I !Sir ,'2:IOP PERMIT 15 ISSUED "OTED ".BONE. ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. e Assessor's-map and lot number ..... .7D. �fi •,- _ .. CF THE TO +� � Qv /�♦ �i Sewage Permit number �4�au • , / Z MASB9TADLE, House number ..........:.................. ..�...5:....... ......................... roo�Mb a e0' 39• � 0 mi' *- TOWN OF BARN STAB LE BUILDING ' INSPECTOR S r ; Construct Single Family Dwelling APPLICATION-FOR.PERMIT TO ;, �. .. Wood Frame TYPEOF CONSTRUCTION .......... ........................... ..:....:.....:...............................:......:.......:................................ ' September i16� r� :... TO-THE INSPECTOR OF BUILDINGS: - ' The undersigned here y applies-for a permit according to the following information Wa „H annis MA 'L'`ocation Lot.# 2 rat Y... Y.......... r� ProposedUse ................ ... ...... .................... ......... ............................................................ - Zoning' District R.0... .:......... ..............................................:.Fire District ...... a2121'18: ,...... I a Name of Ownel'aP 'ACo,I,n;,Rem.,.' !.. 'X'u .tr:.:.:.:......:Ad.dress76 .^F'almQ:ktr�. R0 , ._.jy < g� Name of BuiRi i . Real. Est:DeY.Co.`.tI?.1Q•-Address :.......:................................ ?,illl3.....:............ Nameof Architect.................................................................. Address .............,...................:.:.. ........................ - Number of Rooms ..5 ........................................................Foundation ....:P. . ,.........::........................................... Cla"- board an or- Shin e - Exterior .......�?........................ . $ vfil.................Roofin As ph$3"�:Sh�ri��8 E{.. ...................,..... Car et Interior ........... Floors .........�?...........:..... _ 5�14•@'�•0•Ck...;............................ , Heatin ........................................Plumbin .........T O..............Heating Gas.............F..W.A......:. g Capper................................... � FireplaceNOn@ ...................Approximate Cost ... . . . . . ................................Definitive Plan-Approved by Planning,;Board _______________________________19-------- . Area 1L1 ........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 13 construction. Name .. . .............. .............. l ... Pr`�. ..... 8. r Construction Supervisor's License ..... .... .................... A-P-R-ICORiq RE-A--11TY ' --------- C TRUST Permit for ...1.1...Story............ .......... Siag.�f��J:��Tilv Dwelling ......... .......... . .... . ............ Lot #12 , 61 Brant Way Location ................................................................ Hyannis ............................................................................... .::Capricorn Realty Trust Owner ....;.�.......................................................... ti Frame Type of Construction. .......................................... ................................................................................ Plot ............................ Lot ................................ April 24 , 87 Permit Granted ...................... .................19 Date of' Inspection ..... ,,),,, 7 ................190 Date Coipleted 19 /........................ Assessorts map and lot number ..........:<..../..,:.?..:.. ......0 r -� ypF THE Sewage Permit number Z DA"STADLE, i House number ...........:.....4..I.....r' c, r Mae& t639. \0 MPV�. .TOWN OF BARNSTABLE BUILDING INSPECTOR 'APPLICATIibN FOR''PERMff' hStruct .-"S h @ Sll ;;j � ; TYPE OF CONSTRUCTION ..q5?d• Fra.I1m@ ................................................................................................................ I SeP.tei m �Ga............. .. .. i _i TO THE INSPECTOR OF BUILDINGS: -- _- The undersigned hereby applies for a permit according to the following information: J LocatiJeq ..#. 2...Bran. ... ........................... - r ProposedUse .. ....:............................................................................:..............................:................................ Zoning Distrr7&q—.. . .. .. ..Fire District .Hyamis............... Name of OA&Pr'J-00M—.Re. 1--t T....Tr--ust..................Addr$a65...Falmouth..Ro.ad ...Hya=i-S.i...-Ma.eg;. Name of EE Go...Real...Est..Rev.-C4,•rZ2lQ.:::...Address ........Same...................................._................................ Name of Architect .............................................................:....Address ......................... Number of RoomsSa.X •P•jC ........................._.................................Foundation ................................. ;................................ Exieri01apbaaxd... .. ...Roofing axuo�. Shy r>g1.es.........:....:.... g .......Aaphal�...Shingle.e... Floor sCarp@t....:...... ..................Interior . . Shestruck..................................................... HeatiaAS......--.:.-Y* -.A............................................:.........Plumbing .... Two...,. ,.....LrCPpeY,,............................. ......... Firepl&nQ.:.........:............................................................:......Approximate. Cost G 040•w 04.....0...,..........:.................... Definitive Plan .Approved by Planning Board -----____ ________19--------. Are 4056--E;q:...ft.: Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH j I I 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 ..i(; ( l l/?;2; ��-' 7 .............. Pres. Construction Supervisor's License .................................... 000989 I � � ll.S.iu��..Irl�.��vve i�q.................... Location .......�ot...#l2.^...... �l.�{}��t.�l��' ' ...................... ........................................ � Owner — �g,K�l..�eaIt��.,I�]��t.— . � Type of Construction --EK�Cqmlg....................... ' ' -------.------------.------. ' ' P|ct ---------. Lot ----------' - � I�� Permit Granted ---..�-.�—zil--24'�--.]g 87 Date of Inspection ------------lA UY . ~ Dote Completed ...................................... � � � � . � , ' � / � - / ) 0 a , e Op i A I I ! p /S onr, JF z/. 9S f V � o ` r cl, l I n Z.4z � ��i✓0.47/Oi✓ ,J I��, i o I\ \ A l ► \N �C9 i i ovk of ti TOWN OF BARNSTABLE .ZONING C. BY-LAWS DATED FEBRUARY 1986 o FRANK WHITING ZONE: RC- i No. 29669 0 s��FCIST E°�y SETBACKS FRONT = 30' / SIDE 15' REAR 15' I I PROPERTY LINES SHOWN HEREON WERE COMPILED FROM PLANS OF RECORD AND 00 NOT REPRESE14T PROJECT NO. 3-1348-05 AN ACTUAL SURVEY ON THE GROUND. -- -—�- THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN i ON THE GROUND BY SURVEY ON APRIL 21 1987 i n AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . i THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND l SCALE: 1"=20' APRIL 22 1967 SHOULD NOT BE USED FOR ANY OTHER. PURPOSE. `��-- --- - BSC / CAPE COD SURVEY CONSULTANTS -2 �-M-" 3261 MAIN STREET DATE PROFES IONAL LAND SURVEYO _ - BARNSTABLE VILLAGE, MA. 02630 -(617) 362-8133 N PoNO 32g49 A o, LO CAT ION MAP SCALE 1 "= 2,063't ZONE RC - I ,•..,.-,.wi.�ti'i xi t..nRA{��yy;3i+hdG.il�,iti.Sd�K.'+S.?gy'.`9�2`F�''.E.f'".-. y`4 ;{i,•. _, a-,.. ... 'Y ,.:a.vV::w*.: -.. .. Y"-r• wi.,. .. _�.c.,.... stf.. 15 ,000 S. F MIN. 12.5 MIN FRONTAGE B R_A N T (50' WIDE — PRIVATE ) WAY SETBACKS P'R0P05E1;T =�. � _. _ � ry v FRONT 30' . rpuo6.#�a #r Y:: Wa.xr: e+ z:'s N�" t, ;, + `!► ` ,'��r �'r� yw�' d.+x:.� ,,e+ � ~s REAR 15' � -� �.✓ l�__ n�o F,. � B. M. USED s I I ° 56' 4�" w I10 C ELEV. = 75. 68 N. CV. D. 125. 0 LOT 12 � �• 15,0004 4 " PVC .. �a+ LOT I I tit;rl _I,zr cfl 3 LOT 13. ,`,—� N O N (.b to r— N f I r � 125. 00' N 110 56 ' 4 3" E F PE COD SURVEY CONSULTANTS 261 MAIN ST ROUTE 6A NSTABLE VILLAGE MA p�yh ' U26�0 PRA ^' I WHII)� (617 i 362.-8133 • f ! �f PROPOSED SEWER CONNECTION LOT 12 IA E A PAUI p Mt r�IVtrW+f'X +'„ , �, 3a„. I N FOR SEWER. MAIN DETATL, SEE PLANS BY KALKUNTE FNGTNF.EPTNC CORPORATION, 1 VTOLET CIRCLE, SHARON, MASS . BARNSTABLE , MASS . �►� ( HYANNIS ) FOR CONSTRUCTION NOTES CAPRICORN REALTY TRUST I. ALL UNDERGROUND UTILITIES SHOWN WERE COMPILED ACCORDING TO AVAILABLE RECORD PLANS FROM THE VARIOUS UTILITY COMPANIES AND PUBLIC AGENCIES AND ARE APPROXIMATE ONLY. ACTUAL LOCATIONS MUST BE DETERMINED IN THE FIELD THE CONTRACTOR MUST NOTIFY UTILITY COMPANIES 72 HOURS IN ADVANCE SCALE I "= 20' OF CONSTRUCTION. THIS MAYBE DONE BY CONTACTING THE DIG - SAFE CENTER METERS ( 1 - 800 - 322 - 4844) FEET o 10 20 40 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE TOWN OF BARNSTABLE DATE SEPTEMBER 17 , 1985 [KEPT. OF PUBLIC WORKS CONSTRUCTION SPECIFICATIONS AND STANDARDS . 3. PRIOR TO START OF CONSTRUCTION THE CONTRACTOR MUST OBTAIN FROM THE COMP./DESIGN TOWN OF BARNSTABLE A SEWER TIE - IN PERMIT AND A ROAD OPENING PERMIT. CHECK: D RAWN : J.C. / C. F W. FIELD: R.E.G. / J.VR FILE NO: DWG. NO: 10 0 1 - I JOB NO: 03- 1348 -05 SHEET: OF