HomeMy WebLinkAbout0052 MASSACHUSETTS AVENUE f _ _
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel w5f)0- Application#
Health Division
Conservation Division Permit#
Tax Collector Date Issued G'<
Treasurer , Application Fee
Planning Dept. �. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address 5 0Q aUr1.u5 &t-e .
Village 4Q&AJAj5 Q O
0 Owner ��C P �- M (�` Address
Telephone i ,5�� _ �o� �I 59. �Vt A��c3 Oab
Permit Request WS ` CA (
1x2r� �' G` C�'Pt� - IOC 9n
, r d� ,.a I cr Q ��,
Square feet: 1 st floor:existing proposed�"��2nd floor:existing proposed ('7zaz7 Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation rm Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family X Two Family ❑ Multi-Family(#units)
Age of Existing Structure SL Historic House: ❑Yes Klo On Old King's Highway: ❑Yes �No
Basement Type: C'Full ❑Crawl ❑Walkout ❑Other /
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ` �U
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: XGas ❑Oil ❑Electric ❑Other
Central Air: �%Ies ❑ No Fireplaces: Existing T New Existing wood/coal stove: ❑Yd.'s O!No
v
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑ne,a-- size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: _j
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ E,r
Commercial ❑Yes ❑No If yes,site plan review# ,
__J M
Current Use Proposed Use
ftuuo
BUILDER INFORMATION
Name Telephone Number ZA
Address 52 License#
��01 in Y1 A _ Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
K I
Jn,,L�r\ (Jctm.)
SIGNATURE DATE /atS
FOR OFFICIAL USE ONLY
PERMIT NO. R
DATE ISSUED
MAP/PARCEL NO.
ADDRESS- VILLAGE
OWNER
t
I
DATE OF INSPECTION:
FOUNDATION 4CC LP'-a r0 7
FRAME
r
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO:
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 Legibly
Name(Business/Organization/Individual): . OPit
Address:
City/State/Zip: M 0&7Phone.#:
Are you an employer? Check the appropriate box: Type of project(required):.
1.❑ I am a employer with 4. I am a general contractor and I 6 New construction .
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. i employees and have workers' g 0 Building addition
comp. insurance.$
[No workers comp.insurance 10.0 Electrical repairs or additions
required:] 5• ❑ We are a corporation and its p
3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no 13.0 Other
employees. [No workers'
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 isproviding 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi n er th ains-and penalties of perjury that the information provided above is true and correct
Si afore: Date: 2i 0 _
Phone# 1 /�' 52./�— Z
rIssuing
only. Do not write in this area, to be completed by.city or town officiaL
n: Permit/License#
hority(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 L 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:.
The Commonwealth of Massachusetts
Department of industrial Accidents
Office of Investigations
600 Washington Street
Boston,.MA 02111
Tel. #6.17-727-4900 ext 406 or 1-87 7-MtASSAFE
Fax##617-727-7749
Revised 11-22-06
www.mass.gov/dia
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i a i
/TME 'i V rru V1 -vaAJLL0 CLLFA%,
Regulatory Services
w
y/�tNSTAB ~' Thomas F.Geiler,Director
ass.
Building Division
Tom.Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Fice: 508-862-4039 Fax 508-190-6230
Permit no.
Date
AFFIDAVIT
HOME EYIPROVEMENT CONTRACTOR LAW
-SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion,
improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units.or to structures which*are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along With other
requirements.
Type of Work: P O� A I /A Estimated Cost 4 IS,
VZrD
Address ofWork:.
Owner's Name: AA 1
,(,.e be4j/L
Date of Application
I hereby certify that
Registration is not required for the following reason(s);
C]Work excluded by law
DJob Under$1,000
Building not owner-occupied
TOwner pulling own permit
Notice is bereby given that: -
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PRO GRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PBRNRY
I hereby apply for a permit as the agent of the owner;
Date Contractor Signature Registration No.
• r
Date wner's ignature
Q wpfiles.forms:homeaffidav
Rev: 060606
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings $100.00
Residential Addition $ 50.00
Alterations/Renovations $50.00 =�
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x .0041=
plus Com.below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot= x .0041=
plus from below applicable)
GARAGES(attached&detached) -
voe
square feet x$32/sq,ft. x.0041=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
?500 sf-750 sf 50.00 , "
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0041=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00=
(number)
Fireplace/Chimney x$25.00
(number)
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable)
Projeost Permit Fee
Rev:063004
Table JIM(cautioned)
hucriptive Packages for One and Two-Family Residential Salldlogs'Heated with Twa Fuels
MAXfMUM MINIMUM
C3laurrg Glazi
n
g Ceiling Wall Floor Basement : Slab Hesting/Cooling
Attar(/6) U-value= R value R-value' R-valuer We11 Perimeter Equipment Ellicieary?
Parage R value° R-value
5701 to 6500 Heating Degree Days'
Q 12% 0.40 38 13 19 10 6 Normal
R I2% 0-52 30 19 19 10 6 Normal
S 12% 0.50 38 13 19 10 6 85MUE
T 15% 036 38 13 25 N/A NIA Normal
U 1S% 0.46 38 19 19 10 6 Normal
V 15% 0.44 38 13 ZS N/A N/A 85 AFUE
W 15% 0.52 30 19 19 10 6 .85 AFUE
X 18% 032 38 13 25 N/A N/A Normal
Y 18% 0.42 38 19 23 N/A N/A Normal
Z 111% 0.42 38 13 19 10 6 90 AFUE
AA 18% 0.50 30 19 19 10 6 90AcTry
1. ADDRESS OF PROPERTY: t. > [)=4JA
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING:
4. %GLAZING AREA(#3 DIVIDED BY#2):
5. SELECT PACKAGE(Q—AA-see chart above):
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
BUILDING INSPECTOR APPROVAL:
YES: NO:
q-forms-0803 03 a
780 CMR Appendix J
Footnotes to Fable A2.1b:
' Glazing afea is the ratio of,the area of the glazing assemblies (including sliding-glass doors, skylights, and
basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall
area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement.
For example,3 ft=of decorative glass may be excluded from a building design with 300 ft of glazing area.
2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
whole units:center-of-glass U-values cannot be used.
3 The ceiling.R-values do not assume a raised or oversized truss construction: If the insulation-achieves-=the full
insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include
exterior siding, structural sheathing,and interior drywall. For example,an R-19 requirement could be met EITHER
by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction.
The floor requirements apply to floors over unconditioned spaces(such as unconditioned craw*aces,basements,
or garages).Floors over outside air must meet the ceiling requirements.
'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must
meet the same R-value requirement as above-grade walls. Windows and sliding.glass doors of conditioned
basements must be included with-the other glazing. Basement doors must meet the door U-value requirement
described in Note b.
'-The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes elgbtric resistance heating use compliance approach 3;4, or 5. If you plan to install more
than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest
efficiency must meet or exceed the efficiency required by the selected package.
'For Heating Degree Day requirements of the closest city or town see-Table J5.2.1a
NOTES:
a)Glazing areas and U-values are maximum acceptable levels.Insulation R values are minimum acceptable levels.
R value requirements are for insulation only and do not include structural components.
b)Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC,test procedure or taken from the door.U-value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with
different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
43
Town of Barnstable
Regulatory Services
BARNSTABM Thomas F.Geiler,Director
9 MASS. g
639. p�0 Building Division
n 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: Z U 6
JOB LOCATION:
-
number ) street n village
"HOMEOWNER": I , \(C�l� ll/{.�1 I �. l9 52 9 2 1 /
/
name home phone# Cr,�{ work phone#
CURRENT MAILING ADDRESS:° &�q ���
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 with said procedures and
require n s. h
Si azure of Homeo er
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.Ll -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
r Town.of Barnstable
Regulatory Services
8AAN81'A6LE, �. '
M _ Thomas F.Geller,Director
9639.
Building Division
Thomas Perry,CBO,Building Commissioner p
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fa 508-790-6230
PLAN REVIEW
Owner: 4 L-ie-E Q Ham/&L Map/Parcel:-
�
Project Address 5-1- Ld4 SS i4'16 NY Builder: d Lo H
The following items were noted on reviewing:
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Reviewed by: L-V+ _
.Date:.. t _ D 7
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MEMORANDUM
TO: All business
FROM: Michael Brooke
DATE: Ap W
RE: The Addition
Alice:
Per our discussion,below please find a basic material list for the deck project for
permitting purposes:
1. Structural Framing- 601b load,deck and porch area: Pressure treated 2x10 joists
16"on center, strung on triple 2x 10 girders spans not exceeding 10'
2. Wall flaming of porch area-4x4 western red cedar posts let into girder 40"on
center with intermediary 2x4 western red cedar 2X4 studs also let into girder or
boxed in Joists. Top plate of doubled 2x4 wrc.
3. Roof firaming of porch area—2x6 western red cedar trusses with 2x6wrc collar
ties 20"on center.
4. Decking—5/4x6 ipe
5. 9 (nine) 8"concrete"sonas"tubes set to 4' depth at locations numbered on plan
6. 1 (one)9'4"xl0'xl2"slab with 24"footings at corners
Please call with any questions. z
Michael
. _ ... .. - ty; ,' •t-. •-1 ^"re. i ;.j:y, .�:e } 'a��'.'3'i.ir;�F ;.�f.�
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map WVD2Rarcel %'Application# o206
Health Division Date IssuedY �l
Conservation Division 10A -.Application'Fee
Tax Collector Permit Fee 0 ,
Treasurer
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address 5oC Mk S_ts(X[':t/l t c._S 60S
Village V n n r 1 i S 1"a 4
Owner 4�ce v- V o f\cP Addressb�b(LA fflbus so f ioslan,0
c72(�g
Telephone� F� - Sa-9 °1 21 I
Permit Request 2E j2 1 a e.n ' p S,
Square feet: 1 st floor:existing +Q_D proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 22 , O O Construction Type
Lot Size Grandfathered: ❑Yes '❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure 5 6 o Historic House: ❑Yes Clo On Old King's Highway: ❑Yes �(No
Basement Type: XFull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1_T�
Number of Baths: Full:existing_new Half:existing new
Number of Bedrooms: existing 3 new /
Total Room Count(not including baths):existing new First Floor Room Count (�
Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other
Central Air: l Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing Onew_-size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: , Ciw
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes No If yes, site plan review# -CD
Current Use Proposed Use rn
/ BUILDER INFORMATION f
Name"O o r1 C! Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 160, ro rn �e
r
SIGNATURE DATE
FOR OFFICIAL USE ONLY ,
APPLICATION#
1
DATEISSUED
4
MAP/PARCEL NO.
.ADDRESS VILLAGE
'�OINNER '
DATE OF INSPECTION:
'P
FOUNDATION
.FRAME
' INSULATION
FIREPLACE
I
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
II
GAS: ROUGH FINAL
FINAL BUILDING
I
' DATE CLOSED OUT
ASSOCIATION PLAN NO.
'r
Town of Barnstable
Regulatory Services
• UhRNSTABt�,
,, Thomas F.Geller,Director
i639. �e a
► Building Division
Thomas Perry, CBO,Building Commissioner
200 Main Street, Hyannis;MA 02601
www.town.barnstable.ma.us
'Office: 508-862-4038 Fz 508-790-6230
PLAN REVIEW
Owner: `f 0 0 C— Map/Parcel: 2�7 d dd
Project Address SS Builder: 071'%-3 F-ET2—
The following items were noted on reviewing:
v
Reviewed by:
Date:.. — 7 ' `7
Q:Forms:Plnrvw
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
A' 600 Washington Street
Boston,MA 02111'
'r www.mass.gov/dia '
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A_pnlicant Information Please Print Leizibly
Name(Business/Organization/Individual): 11 f.P 1 n C P ' O
Address:
i -1 Q Y c7 t`'�— rn� Phone#: 6 r�-
City/State/Zip: n 1s
Are you an employer?Check the appropriate box: :Type of project(required):.
1,❑ I am a employer with 4. ❑ I am a general contractor and I 6 []New construction .
employees(full and/or part time),* • have hired the sub-contractors .
listed on the-attached sheet. 7. ❑Remodeling
2..❑ I am a'sole pioprietoi or partner- These sub-contractors have.
ship and have no employees 8. ❑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
required.] officers have exercised their 11.❑Plumbing repairs or additions '
3. I am a homeowner doing till-work .
myself.[No workers'comp. right of exemption per MGL 12,[]Roof repairs
insurance.required.]t c. 152, §1(4),and we have no 13.❑ Other
employees. [No' workers
_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. .
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have
employees. if the sub-ccntractors have employees,they must provide their workers'comp.policy number.
I ant 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:
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 secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment,as well as civilpenalties 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 maybe forwarded to the Office of
Investigations of the I)IA for insurance covera a verification,
Ido hereby certify under the pains•andpenalties ofperjury that the information provided above is true and correct
Si tore �••X Date ZYd _
Phone#• S2- — Z r
Official use only. Do not write in this area, to be completed by.city or town off ciaL
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#:
, 5
Eta Town-of Barnstable
yP o� Regulatory Services
Thomas F.Geiler,Director
MASS
t61 ►��� BuRc incr bivision
�'�FD MP'� b •
Tom Perry,Building Commissioner
200 Main Street, Hyaffiis,MA 02601
Office: 509-862-4038 Fax: 508-790-6230
Permit no.
Date .
AFFIDAVIT
HOME MROVEMENT CONTRACTOR LAW
SUPPLETNIH;NT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion,
•improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work R o�1 Estimated Cost
�
,Address of Work: _Q M o.a (I ILLICO,M [��_r'1 15
• Owner's Name• .�'��LP �- �/ t 1�C.P 2'/V C�.i�11
Date of Application: I c O
I hereby certify that
Registration is not required for the following reas on(s):
[]Work excluded by law
❑Job Under$1,000
ud.ding 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 Name Registration No.
A
Date Owner's Name
psrsedgtivo Pseksgd rar that tali Two-F mil�R=Ideatlsl Unalup of tsd wi# ,
I5'iAXfI4I"t1M ' Ilf>QYIMZTM
4laxing Gfaztng Celifng Waal Floor $as 224 Stab •Heetfag/Coollrtg
'pmU-vatoe'� R-velue� &Yafue, R,yaluc° Walt �Pairad�tfmscnt E[6deary�
' ping° j{-Y + R`YsIfUC
1701 to 6500 Hcs#ing tegro Days'
IZ■/■. O.aO 31 I3 19 10 N0'�
I2Yd 9.iZ 30 19 19 10. 6 N0
R •6 15-AFUS
S . 12✓`a "a 31 ' I3 I9 IO
Ii ■ 038 38 13 23 .NIA NIA. N0=
T ■ Z'f°tdSat '
U 1P■r■ 0.46 38 19 t9 10 S'
y 11% 0.4 4 31 13 2S E I�UA 83 Al°tJ1's
am 30 t9 19 � U AM
I8■�■ 0.32 31 • 13 23 NIA N1A Normal
y 18■!. 0.42 31 19 21 NIA NlA` Nomml
Z 13■f o,az 31. 13 19 ld 40AFM
IS'/. tt,3G 39 19 19 to 6 5n7AFt1£
1, ADDRESS OF PROPERTY:
--�
a n i s Qn
SQUARE FOOTAGE OF ALL.EXTERIOR WAILS: � -
3, SQUARE FOOTAGE.OR ALL(3LAZING:
4, % bLAZIN4 AREA 03 DrVMBD BY 2):
j, SELECT PACKAGE(Q—A.A-sea chmt above): ,
NO'p: OTHM MORE INVQLYEb METHODS OF DE'IEAMIN NG EXM'G'Y gEQUIRL'IvIENTS
ARE AVAILABLE. A-SK,US FOR THIS MORMATIONi
BMI)INC"L EPECTOR.AMC)YAL:
• YES:, �+TO,
q_r�,poG303a
t
��F1HE Tp�
Town of Barnstable
"o Regulatory Services
z3nRtvsresr.E, Thomas F. Geiler,Director
9 MASS.
1639• Building Division
rE�MA'1 A
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: 12oI U
JOB LOCATION: p,GUL U S X1 ( tr VI I� I S �t�
number 11 y� �)I ^ street village
"HOMEOWNER": 1%((,P �-VI nCP VII
name home phone# work phone#
CURRENT MAILING ADDRESS: �{� 7�((- Les, "
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwelling 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 dwelli,69,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
require nts.
Signature of Homeowner
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.
0 �W
Ps
ClCD
..
a ,--- - oe _
i1-S „ - -9 l
—
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�3 PROPOSED WEST ELEVATION
WAM ift ra
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4❑ PRO D NORTH ELEVATION
. Ln SCAM vas ra I
o ` e ko'ce. all LA -J0�s, �°� rre �AAy
P 35 `� °i 3S X 39 o
S 35
3 � x � I 3 X
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1� PROPOSED EAST ELEVATION
U
SCALE treb r# A ( 3 ax [ s
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• Z101
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E PROPOSED SOUTH ELEVATION
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map V1, 0 Parcel .. F Permit# Z l
is7uq ? G
Hear Division issued P v-
/fin
Conservation Division d
utl; 9 Application Fee
Tax Collector Permit Fee
._�Treasu 66 , 06
rer r� - ,w
Planning Dept.
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address ►'11 ; scn sus �-1�
Village � -
Owner Address ul 1,11 b u
ll
Telephone - - Z
Permit Request )LSn A l° A -5t1 y L -, 0 r-; A 'A AC'. .% .
Square feet: 1 st floor: existing `` OCd7 proposed w2nd-flb-5 existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation I , �L,(J Construction Type
Lot Size 2! � Grandfathered: Cl Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family A Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes V 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 3 new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas XOil ❑ Elect it c ❑Other
Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes 1IV0
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 O Appeal#_ Recorded❑
Commercial ❑Yes 1 No : If yes, site plan review#
Current Use Proposed Use
v
BUILDER INFORMATION.
Name�t-t lf� V�nc_P C� /vie I Telephone Number
Address S2 ktq e License#
jn(I i S Po� >'Y1 Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �) c� ✓,�l7
SIGNATURE . DATE Z �/ -�
FOR OFFICIAL USE ONLY
PER MI,+NO.
DATE ISSUED
MAP/PARCEL NO.
e ADDRESS VILLAGE
`j OWNER -
t
DATE OF INSPECTION:
i
s FOUNDATION
h 1 FRAME
INSULATION
r
r
'"FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
r
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSEDfOUT
ASSOCIATION PLAN NO.
The Commanwealth of Massachusetts
_ -- Department of IndustrialAccidents`
600r Washington Street
Boston,Mass. 02111
Workers'.Coin ensation.�iisnrance Affidavit-General Businesses
„i
a%////%/%/// �� %////%%%///////%//G�%%%%l//%////%%�%O/�////��%%%�%%%/
r�. eta t't';fA.e•4i•a .. . '� •,.;�'7++257
name:
ass -a
address i�
0�
hone
state: zi
ci �..
work site location(full address)
h
[]Retail❑RestaurantBar/Eatih Establisment
I a>ri.a sole proprietor and have no one ' $psiness Type: g •
working le any capacity. E]Office❑ Safes(including Real Estate,Autos etc.)
❑I am an em to er with . em to ees(full& art timed Other
%% %%�/%/////a,/� /%%%% %%y1//////m///////////%%/%%////
I aai an ermployer providing vtorkers' comvensation for my employees working on this job.
CID
eri emit +�.. .4; J ". r,�• .. :,�,::,�,_. - ;..
..j:;.(ri, -•4t:.' ..�. ..5:: _ rr..... :ca: ••::1 �„ i•:,,•n. •f.'.: ..
:ri; '•i'�'qr.� Y.' ''X'i. ,•YYti�;.:'.li••' '� e S
Me
T am a sole proprietor and-have hired the independent contractors listed below'who have the following workers'
compensation polices:
:.irs�.i.• ;iyi• ;:pr,;'' .t".t-• 'ia' ,r:•i
CID
`wane. <. TJ
t
Vtoni
•bar�• 'i
siddses . .;•.
:+:. 1:�+, yr•.a z�r,i .:i'•j' ...:'k'5..�. .}•":. •+.• ..ti ',i;. •r ,r:
J",,fi�tt ,• ,1;:.. �::r;•
r l�;ri •.,
W. r.�..• .••
MIMI
coin an. name: <'
87dressi. .. .
' 0 #:
w.' .:t••..v
• :1;, :..j.a; 'r— k'.:•. .tM1f.ti.i;J;4::. :fi. r.h �:.,:�k:' -
insur$ner=so•i"''�
Failure to secure coverage as required under Section 25A of MGL 152'can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'impri+onment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that
copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification
I do hereby ce under the ains an penait' of perjury thatfhe inform ationprovided above is true and correct
Date E1 c j
signature ../ �ry / / /.� , ..
5-5
Print name l`1'� C tV l� V �he' I/ Phona# v s
official use only do not write in this area to be completed by city or town official
city or town permft(license# []Building:Board
ment
❑Licensicheck if immediate response is required ❑Selectmce❑Health ent
contact person:
phone#; ❑Other
(revised Sept 2003)
Information'and Instructions
Massachusetts General Laws chapter�152 section 25•requires all employers to provide workers' compensation for their.
employees: As quoted from the law', an employee is.defined as every person in the service of another under any contract
of hire, express or implied; oral or written.
• r
An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mare of
the foregoing engaged in a�joint enferprise, and including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,partner'shiP,.association or other legal entity, employing employees. •Howevei.the owner of a
dwelling house haying.not-more than three apartments and-who resides therein, or the.occupant of the.dwelling house of
another who emploYs.persons to do.maintenance, construction or repair work on such dwelling House or on the grounds or
urenant thereto shall not because of such.employment be deemed to bean employer.
buigding.apPt•. .. •• .
MGL chapter 152 section 25 also•siates that every state'or l6cal Dicensing 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 tpe insurance requirements of this chapter have been presented to the contracting .
authority.
Applicants
Please frll is the workers' compensation affidavit completely,by checking the box that applies to your situation..Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
cidents for confirmation of insurance coverage. Also be sure to sign and date the -
to the Department of Industrial Ac
affidavit. The affidavit should be returned to the city or town that the application for the perrnit or license is being
requested, not the Department of Industrial Accidents. Should you have any questions regardffi�"the"law"or if you me
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 permitrlicense number.which will be used as a reference number. The.affidavits maybe returned to
the Department by,MA or FAX.uiiless 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
unke of Ue esffgatlens
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
nhnnp#- (6171 727-A900 exE 406 ,
cf 'Er Town of Barnstable
Regulatory Services
vB aar,E,$ Thomas F.Geiler,Director
S
�prao39. k,� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax: 508-790-6230
Office: 508-862-4038
Permit no.
Date .
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
rovement,removal,demolition,or construction of an addition to any pre-existing owz►er-occupied
?mP which are adjacent to
building containing at least one but not more than four dwelling units or to structures w J
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work
Estimated Cost �
Address of Work: C,� ► /,�. -�- G.�y► .� ��—
owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
DWork excluded by law
[]lob 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
CONTRA.0�FAI BITRATIO PROGRAM OR GUARANTY FFUND UNDER MGL c 142A.
ACCESS T .
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
r .
Date Owner's Name
of�►,E ray,
Town of Barnstable
Regulatory Services
BA6NSTABLE, : Thomas F.Geiler,Director
MASS,
1639• ,.• Building Division
lFD MA't
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: /' 2 q ZD tl
JOB LOCATION: -1>2- Ai
rj(� A. S 2e, (I Yl cl i S ( c7 (�
number street
/� �1 p � village p
"HOMEOWNER":/yyw /� l t t P — A)P1 1' A 1� 4A Z f 1 l kh C7 17
name home phone# work phone#
CURRENT MAILING ADDRESS: �S Z ( U vy, 10 l-S �I-(�p 4:y-
0 2 1)
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 with said procedures and
requiretne ts.
ugnature of Homeowner
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
N
1 �
3� PHASE 1 WEST ELEVATION
eaus nm.ra
in IFP
. aB
r
I
3❑ PHASE 1 NORTH ELEVATION
O 6
WAR aa.ra
c
ra
d'
Q j
r
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ft'tit'1ii f}Iz�Si 7f1'}I�'4 4ru}, ��c,�
1❑ PHASE 1 EAST ELEVATION
WA2 SVWM
ra
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I
q
4
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M PHASE 1 SOUTH ELEVATION
ewe aura o
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29
I
PAD08.01N
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4� PHASE t FIRST FLOOR PLAN
ewe eor.,vr
ra
MEMORANDUM
TO: All business
FROM: Michael Brooke
DATE: April 22,2004
RE: The Addition
Alice:
Per our discussion,below please find a basic material list for the deck project for
permitting purposes:
1. Structural Framing- 601b load,deck and porch area: Pressure treated 2x10 joists
16"on center, strung on triple 2x 10 girders spans not exceeding 10'
2. Wall framing of porch area—4x4 western red cedar posts let into girder 40"on
center with intermediary 2x4 western red cedar 2X4 studs also let into girder or
boxed in Joists. Top plate of doubled 2x4 wrc.
3. Roof framing of porch area—2x6 western red cedar trusses with 2x6wrc collar
ties 20"on center.
4. Decking-5/4x6 ipe
�10 5. 9 (nine) 8"concrete"sonas"tubes set to 4' depth at locations numbered on plan
6. 1 (one)9'4"x10'xl2"slab with 24"footings at corners
Please call with any questions.
Michael
ANU NtLLit t. /ANUGM-lu", rG�rwnii -I ' gARNSTABLE REGISTRY
BOOK 113 PG. 49 - ALSO SEE .PLAN BK. 26 PG. 95,
� O
OF DEEDS.
w
CRAIGVILLE
BEACH RD.
=CAT
ASSESSORS MAP 287 PARCEL 23-1
DEMAREST L. QUINN'.
BK. 12701 PG. 51 ASSESS-OR23M�P.
PARCELS
1'NEILL ZONING DISTRICT
ZONING OVERLAY DISI
MINIMUM AREA = 4�
MINIMUM FRONTAGI
- FRONT SETBACK
SIDE & REAR SETBA
HYANNIS FIRE DI
ASSESSORS MAP 287 PARCEL 146
GLENN W. ANDERSON ASSESSORS MAP 28
BK. 5434 PG. 197 FRANCIS D. BRO(
BK. 863 PC
• A
+ 1 � �i9•
' 00
• 50 �
N B4 18
45:91 ► •p
CB
(FND.)
HATCHED AREA DENOTES \
LINE OF PROPOSED
CH 'DECK
POR / S
z �
O
N o AREA
O 17 ,471 SQ . FT.
Wo c'' 0.40 ACRES ± ti�Ps 6
S. 17 . 14
� S
BRB
(FND.)
CB
FND.) 62.75
S .sa 3s oo w
P(
PLAN OF LAND IN BARNSTABLE (HYANNIS
NOTE:
THE PURPOSE OF THIS PLAN IS TO COMBINE LOTS LABELED "ALBERT E. i
ANDERSON AND ARVID R. ANDERSON" AS SHOWN ON A PLAN ENTITLED
"SUBDIVISION OF LAND IN HYANNISPORT, MASS. PROPERTY OF RUBEN E.
AND NELLIE E. ANDERSON, FEBRUARY 27, 1953" AND RECORDED IN PLAN
BOOK 113 PG. 49 - ALSO SEE PLAN BK. 26 PG. 95, BARNSTABLE REGISTRY
OF DEEDS. ` 4,
CRAIGVILLE C/i LOCUS
BEACH RD.
FOR REGISTRY USE ONLY LOCATION MAP
ASSESSORS MAP 287 PARCEL 2J- 11 F
DEMAREST L. QUINN
OWNERS AND APPLICANTS: i BK. 12701 PG. 51 ASSESSORS MAPS 287
VINCENT G. O'NEILL & ALICE F. O'NEILL PARCELS 23-2 & 24
552 COLUMBUS AVENUE #5 I ZONING DISTRICT - RF- 1
BOSTON, MA 02118 ZONING OVERLAY DISTRICT - AP
DEED REFERENCES: / MINIMUM AREA = 43560 S. F.
BK. 17214 PGS. 274 & 297 % MINIMUM FRONTAGE = 20'
PLAN REFERENCE: FRONT SETBACK = 30'
PLAN BK. 113 PG. 49 SIDE & REAR SETBACK = 15'
HYANNIS FIRE DISTRICT
ASSESSORS MAP 287 PARCEL 146
GLENN W. ANDERSON
BK. 5434 PG. 197 �.% ASSESSORS MAP 287 PARCEL 22
FRANCIS D. BROGAN ET AL
BK. 863 PG. 47
ASSESSORS MAP 287 PARCEL 25
ROBERT A. ANDERSON ET AL, TRS. N 84' 18 50"E
BK. 11998 PG. 229 1
45.91 '
'o
�p I
HATCHED AREA DENOTES ��
LINE OF PROPOSED (FNAI
�'�
PORCH/ DEK
z
o /
N o AREA
17 ) 471 SQ . FT.
o c 0. 40 ACRES ± S.5
S . N . = 1 7 . 1 4
Y0
BRB
(FND.) i' .�� �N WP
(FND.) 6 2.7 5
S 88 38 00 W
PLAN OF LAND IN BARNSTABLE (HYANNISPORT), MASS.
AS PREPARED FOR
VINCENT G. & ALICE E O NEILL
SCALE 1 " = 20' MAY 24, 2004
0 10 20 40 60 80
APPLICATION DATE THOMAS E. KELLEY
SIGNED DATE PROFESSIONAL ENGINEER
APPROVAL NOT REQUIRED PROFESSIONAL LAND SURVEYOR
346 LONG POND DRIVE STAMP
SOUTH YARMOUTH, MA
I CERTIFY THAT THIS PLAN CONFORMS TO THE 1976 02664
BARNSTABLE PLANNING BOARD RULES & REGULATIONS OF THE REGISTERS OF DEEDS. (508) 398-3360
NO DETERMINATION AS TO COMPLIANCE WITH THE
ZONING ORDINANCE REQUIREMENTS HAS BEEN MADE MAY 24, 2004
IOR INTENDED BY THE ABOVE ENDORSEMENT. DATE PROFESSIONAL LAND SURVEYOR 2 2 21 - 0 0