HomeMy WebLinkAbout0022 PASTURE LANE a� �sizrre !.,
-- —
I
r Town of Barnstable *Permit# C) 6 I J6 5 00�{
Expires 6 nths from�tte date
Regulatory Services Fee
* BARNsrAsts,
Thomas F.Geiler,Director
�ArEb MA't�
Building Division X-PRESS PERMIT
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us AUG 16 2012.
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDE RNSTABLE
���� Not Valid without Red X--Press Imprint
Map/parcel Number
Property Address % gq
Residential Value of Work 0 G U Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address �� ✓ I P` c3
Contractor's.Name Telephone Number ��
Home.Improvement Contractor License#(if kpplicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
A�I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Requgst(check box)
�` 1'�`Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to u S l
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
#.of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.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
req 're
SIGNATURE: .44
Q:\WPFILES\FORMS\building permit formsTMESS.doc
Revised 053012
T7te Commonwealth of Massarhuseffs
Department of Industrial Accidents
f?,Qice of Inmtigatiorls
600 Washington Street
Boston,lMA 02111
ww",,mas&gov/dia
Workers' Compensation Insurance ,davit:Balers/C,onhmctors/Elect6ciansiPlumbers
Applicant Information Please Print Lembh�
C Name t}- 21 a y•i> ,� I�j r� ry.----
Address- 7,-"
C ty/State/ I f-1 a ./i f Phone# v/
Are you an employer?Check the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New coast uction
employees( n andfor part-time):* have hired the subs-contractors
2..❑ I am a sole proprietor or partner listed on the attached sheet. .7- ❑Remodeling
ship and have no employees. These sob-contractors have 8- ❑Demolition
working for me in any capacity- employees and have workers'
[No workers'comp.mauance comp-hispranm Y 9. ❑.Built rug addition
r 'red] 5. ❑ We are a corporation and its 10.ElElectrical repairs or additions
I am a honieoiivner doing all:Rods officers have exercised their I LE]Plumbing repairs or additions
'self[No worbaW right'of exemption per MGL wP 12: of repaus
insurance required.]T c:152, §1(4�and we have ono ---w..
employees [No workers' 13.0 other
comp.rnsmmace required-]
•Aay applicant fat checks tax#1 Dust also fill oat flue section below showing then wodere�p �policy mfurmaticm
Hameoaro es Wbfl submit this afidar�in&cxtWB they ase tieing a1l'waolc and they hue outside t amuactors nmut submit anew affidavit indicating such
TCaotrsctots that check this bola must attached as additional sheet showing the name af'the wb-comftwWcs and state whetbEr oF=those entities have
employees. Ifthe.subtnm meson hwe emtployee%8uey must provide then workers'camp.policy numtier
I am an employer that is providing workers'compensation insurance fussy sngA&U eeL Below is the policy sand job site.
information
Insurance Company Name:.
Policy#or Self-iris.Lic.#: Expiration Date:
Job Site Address: ', CitylStatetzip:
Attach a copy of'the workers'compensation.policy declaration page(showing the policy number and expiration date).
Failure ta,secvre coverage as required under Section 25A ofMGL c-152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or onie-year m4 sonment,is well as civil penalties it the form of.a STOP WORK ORDER and a tine
ofup 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:.
Ida hereby c P U7 t pains anopenafties ofpadittythatthe information proW*d above is tons and correct
sigm A,
Phone#:
Of jzcial use only. Do not write in this area,to be completed by city or town a,04tgal
City or Town: PermitlLicense#
Issuing Anthority(circle one);
1.Board of Health $.Budding Department 3.Cltyl Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other.
Contact Person: Phone 11-
6
f
EVE Town of Barnstable
Regulatory Services
9 M&Qa Thomas F.Geller,Director
039 •
prEo Ma'+► Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,M.A.02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION-,
Please Print
JOB_LOCATI6N--7 Z 2_ � !Z� 1" #4 ly f--.
number street village
1
"HOMEOWNER.;- /y14L)I- St59—ch_-Cr_ 3�O I
name home phone# . work phone#
CCURRENT-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 nerformed•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
p E d requirements and that he/she will comply with said procedures and requirements.
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 thisexemption are unaware that they am assuming the responsibilities of a supervisor
(see Appendix Q,Rules&Regulations for LicensingConstruction 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\FORMS\building permit forms\EXPRESS.dac
Revised 051811
dFTHE
i
i
MAM
,0� 'own of Barnstable
Regulatory Services
Thomas F.Geiler;Director
Building:Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must.
Complete and Sign.This Section.
If Using A Builder
as.Owner of the subject property
Hereby authorize to act on my behalf,
in all matters relative to work autho ed this building permit application for:
a
( ddress of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the(omeowners7the
reverse side.
QAWPFILESWORMSUilding permit forms\EXPRESS.doc
Revised 051811
oFWE r Town of Barnstable Pest#
e Expires 6 manihs from issue date
Regulatory Services Fee
3 �aNer'13U. - -
1 obi KAM
Thomas F. Geiler,Director-
Building
Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable"ma us
Office: 508-862-403 8 Fax: 508-790-623 0
EXPRESS PERMIT APPLICATION - RESIDENTIAI;ONLY
Q Not Ya1id without Red X-Press Imprint
Map/parcel Number l U
Property Address 94 STD. A-(
[residential Value of Work ,Q)C>-0 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
�-� 0'1gs`TTc-A per -6 Al �-
Contractor's Name Telephone Number
e
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance - I
gCbnek one: •
I am a sole proprietor
CiV " 2011
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance TOWN OF BARNSTABL
Insurance Company Name
Workman's Comp. Policy#
-opy of Insurance Compliance Certificate must accompany each permit.
'ermit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
' #of doors�i5 L ('�E�
Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows
l*Where required: Issuance of this permit does not exempt compliance with other town department n gulations,i.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
XreM.
GNATURE:
WPFnm\FORMS\building permit formslEXPRESS.doc
vised 070110
- The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Legibly
aI11e-,(Business/Organization/Individual): Li l�
Address: ?� P S
City/State/Zip: ' `'� 4-n #k Phone #: �jCis'`�o?� -- �j
Are you an employer? Cheek the appropriate box:
1.❑.I am a employer with 4. [] I am a general contractor and I Type of project(required):
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
working for me in any capacity, employees and have workers' g' Demolition
[No workers' comp. insurance comp.insurance.# .9. []Building addition
required.] 5. [� We are a corporation and its 10.❑Electrical repairs or additions
�3� I am a homeowner doing all work officers have exercised their
myself. 11.❑Plumbing repairs or additions
y [No workers' comp,. right of exemption per MGL
insurance required.] t c. 152, §IN, and we have no 12. Roof repairs
employees: [No workers' 13.❑ Other
comp insurance required]
'Any applicant that checks box#1 must also fill out the section below showing their wo
Homeowners who submit this a rkers'compensation Policy information
t affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
employe
that check this box must attached an additions]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:
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 a 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerd der t pat and p alties of perjury that the information provided above is tr a and correct
Si afore: 1•--D e:".;.,�s,
MEhone#: 121
�' --
EE
only. D7ny:Rol�e be completed by city or town official
n: Permit/License#
hority(c Health . City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
tson:
Phone#:
THE Town of Barnstable
gulatory Services
MASS
1639. �
Thomas F. Geiler,Director
"�►�` Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
-WWW-town.barnstable.ma.us
Office: 508-862-4038
Fax: 508-790-623 0
Property Owner.Must r-, `
r - •# Complete and n S1' This g his Section , , .
t. .� If Usin n,A Builds . ;
• �- cr
'
I,
as Owner of the subject property
hereby authorize
to act on my behalf
in all-matters.relative to work authorized by dais building permit
(Address of Job)
Pool fences and alarms are the 'bionstity of the applicant. Pools
are not to be filled before fence is installed and pools are not to be
utilized until all fiml inspections are performed and .'"J
'
nL
Signature of Owner Signature of Applicant
Print Name
Print Name
Date
Q:F0RMS:0WNERPERMI5SI0NP00LS
en
�IHE Town of Barnstable
o
Regulatory Services
13,uttvsreHra, Thomas F. Geiler,Director
639. •�� Building Division
TFD�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
I Please Print '
DATE --
JOB IODATION L a Ll n `/�
number street tT �? `
,� village
OMEOWNER:'•"-' "" ` � �A\� �ii� �db.�►, �'0 )
name home phone# �
work phone#
CURRENT'MAILINGADDRESS:���g. (�O J2.
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.
DEFINMON 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
reS JLonsmble 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 Barstable Building Department
minimum' spection procedures and requirements and that he/she will comply with said procedures and
r em
Si - lure 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:homeexemMt
Town of Barnstable
01J
�0*THE)p�
Regulatory Services
• uxxsTwsLe,
• Thomas F. Geiler,Director
MASS. Building Division
p�Eo �. Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www,town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-623(
q
PERMIT# ;0 9�)3(o -t� FEE: $ vZ5-
SHED REGISTRATION
120 square feet or less
7iJA4Ar/ .�
Location of shed (address) Village '
Property owner's name Telephone number
/off < .�--
Size of Shed Map/Parcel# .
f0
Signature Date
Hyannis Main Street Waterfront Historic District?
OId Icing's Highway Historic District Commission jurisdiction? ' q
7"
Conservation Commission(signature is required)
Sign off hours for Conservation 8:00-9:30&3:30-4:30
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE w rn
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMNIISSION FOR DETAILS..
THIS ]CORM. MUST BE ACCOMPANIED BY A
- . - P�OTPLAN
Q-forms-shedreg
REV:042506
f
„�• TOWN OF BARNSTABLE Permit No. ----26-6---2-
Building Inspector
s.asrr.n S Cash ------------------__--
OCCUPANCY PERMIT Bond ------
`X---_-�-I_ /
Issued to RaVS (3P Rui.lclind Co.* IM.a Address
Int 18° 2121Pasture Lane, West lfrannisport
Wiring Inspector �h' ��� Inspection date
Plumbing Inspector .-_ Inspection date
Gas Inspector '�� Inspection date -
XEngineering Department / 'f� ` �/���I�f Inspection date,
Board of Health rf�^ p- Inspection date
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
BUILDINGCODE......................................................... ....��........... .........................................
Building Inspector
_ - - FROM -
TOWN OF B;RNSTABLE
Mr. Francis .Zahtelne BUiLl34Ca DEPARTMENT"`7 -..qr•mS A r+t;t a 4^w:.��P#:W i#+!0'Y�4!P
TEl Clerk
.« ,x,•« - �,r.. 387 NfAtN STREET tYANNiS, A 02 !
Phone. � -1120
s
,.SUBJECT:
' FOLD HERE • - ,
DATE _September 18, 1984 ME S S'A G
Work has been carpletecrAM&W 7#itm `f'Z j:j Nk ?%lr ni �C0). Alsoµ#26629�
Please release idss•
' SIGNED
.DATE
REPLY
}
SIGNED
FNe7rRMi. RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY
PRINTED.IN U.S.A.
SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.
Assessor's map and lot number ..... ............................�. . 4-P;IC SYSTEM THE
MUST BE cF ro
.INSTALLED IN COMPLIANCE
Sewage Permit number ........................................................ WlT11 TITLE 5
!v)e,-i fi � �� �' = BARNSTABLE. i
House number .......................a.�......' ....................... ODE AN 9 X"& �
�.. .r.� 'Ep MFY Or•
r ,
N TOWN OF BARNSTABLE
>>
V BUILDING INSPECTOR
o-ter APPLICATION FOR PERMIT TO /!/ ..... . �.. ............ . . .. ....
ar
a TYPE OF CONSTRUCTION ....... ,�.. :................................
Q .. ... ..... ................... ..
TO THE INSPECTOR OF BUILDINGS:
The undersigned h eby appli s for: permit according to t following inform 'ion:
Location ....... ... ......:�... ...ts7�. ....v"� . ... .e�Yv/l�`.... .G .«...............................
Proposed Use ... .�. ?:.�. ... ....� ....... ..............................................................
. . ... ... .. . ... . .. .. .. . .
Zoning District ,.
.' . ..........:................ '...............Fire District . .. . .. . .Jd^h✓�/�
Name of Owner .. .. .......... Address �D ..9 �'. ....................
Name of Builder Y5,�. ... ... . . .. ���.Address .., � . .. ..., Z„/..... �...
Name of Architect .. .:.0.. Address ....... .� . ..... .............................,�................................
Number of Rooms ....16......................................................Foundation ... ..
/� `-..�'�"`'� ..............
..
Exlerior ...........� �..... .................................... ...............Roofin g
�i 1
Floors f�' h 1. ... Interior ........ ...... J:��"��.. /
� /
Heating .......,� ....... ................:......................Plumbing ......� �
Fireplace ............. .... .................................... ..............Approximate. Costy.. .
Definitive Plan Approved by Planning Board _--__._-___-___19_ Area �..J..�..... .s.-�..........:..
Diagram of Lot and Building with Dimensions Fee //
SUBJECT TO APPROVAL OF BOARD OF HEALTH
t ,
w
� S
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Tow f Barnstable re rding t e ove'
construction.
Name ......................... ........ .. ..�77. . ........ . ..............
Construction Supervisor's License .0.:........��... .........
�#hAYftDE BUILDING CO., INC.
No'26629...... Permit for Story........... ...........................
Single Family W611in5............... ........................
Location ...........
West Hyannisport
. ............................................................................... .
Owner ....BaY.Side-Buildiag-Ca.—Inr.........
t. Type of Corittruction .....Frame..........................
. ................................................................................
Plot ........... ........... Lot ...........A.*.................
-June 26,
Granted .........................................
'Perm G 84
Date of Inspection .............. ..... .19
Date Completed
1114
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: �lJob. �► \ <
14 4.
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Assessor's map and lot number ....... .
j/w�� •�J.
Sewage Permit number ................... .....................................
Z BARNSTADLE, i
House number rasa
............:............................ 9
Opo�1639. 0�
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION"FOR PERMIT TO .. I�,ND.A�n
v �.......... .�...�.v...:..... ..............................................
x TYPE OF CONSTRUCTION ....... ���),. . ..................
A.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies1 for,a permit "according to the following information:
Location , ..............................
Proposed Use ...... !.'..`� ... .. ..................................................... ..........................
u
Zoning District ....... "' Fire District �+ �. !✓il/�
Name of Owner .. lyxly,.---.�.'.�.�..,�..............�.....•��l�.t�,.;/.•.•Address !!. �! ` �r� •.!. �t ,�;:�'•� ...............
Name of Builder� �`. djv, n-?� .' G !?��.'. :,..Address . ob.................. i. 0 �! �•/% ...
Name of Architect ...�.:.��...... ........ � Address ........ ...:: .......� ..........................
Number of Rooms .....4 �' ................... Foundation ...
...........r........................................
.. ........
l
Exterior ............ .. ��:.......A 1 ' `...................Roofing .............lh
d �
...... .( ... .. eFloors r 12 . ...`..�...
Heating ...... .�jtom.. ..r......
.................. ..................Plumbing...._..{)..... .�' .+� `1;:.........�...................
Fireplace ........`. . . ?................................................. ...Approximate Cost '.I--�. �� . ..........................
Definitive Plan Approved by Planning Board ____ I __ � .�.. .... ... ...
------19__` _. Area ............. ..._ ....
Diagram of Lot and Building with Dimensions Fee .... �......................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
r
lo
r 0
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 ..................:Z::` ... ...... ..`.1.. ...........................
Cki� C
Construction Supervisor's License .................../.................
BAY5IDE BUILDING CO., INC. A=248-262
Z(a
No , ........ Permit for .One Story...............
Single Family Dwelling.......................
Location Lot 18,.....22 Pasture Lane i
West Hyannisport
...............................................................................
Ba side Buildin Co. Inc. i
Owner ....... '..........................g..........................
Type of Construction ......Frame
.................................... 111
1
................................................................................
Plot ............................ Lot ................................
Permit Granted June 26, 19 84
Date of Inspection ....................................19
Date Completed ......................................19
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Application #Map Parcel
1 Health.Division 7 72 , Date Issued
Conservation Division
Application Fee V
Planning.Dept
Per 'M it Fee
Date Definitive PlanApproved by Planning Board
Historic 70KH Preservation Hyannis
Project Street Address ST L4 P"F-- -A
Village 4 nf/_r 4 .2 � 7 7
Owner DA L) iJz -+Ki5 i2ST-IN J A] iY11-Address
S",
Telephone d 20-462—
Permit Pe-0gou_e s�t e-r- A/Z C9 e9)
r.4 2ap o,4-- 5Q �DeAorl" 17 r hllk-l)Ad.
A V G_ re a- 5—, a ra G
Sq,yare feet: 1 st floor: existing //Pd proposed 13.0& 2nd floor: existing pr oposed Total new o
Zoning District R C3 Flood Plain Groundwater Overlay
Project Valuation 1400 Construction Type WooD
Lot Size 0 -Q) JAD- a o b Grandfatherod: J Yes ANo If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family L1 Multi-Family (# units)
Age of Existing Structure Historic House: Ll Yes XNo On Old King's Highway: Ll Yes K,.N 0
Basement Type: >(Full LJ Crawl L1 Walkout Q Other -
Basement Finished Area(sqft). 4&WE Basement Unfinished Area (sq.ft) 5,Y 'PT-
Number of Baths: Full: existing new Half: existing V___Lnew
Number of Bedrooms: -1-5 existing —new
Total Room Count (not including baths): existing new First Floor Room Count 61
Heat Type and Fuel: )(Gas Ll Oil LJ Electric LJ Other C3,
Central Air: 'AYes Ll No Fireplaces: Existing New Existing wood/co'al stove LJ Yjs No
Detached garage: Ll existing LJ new size—Pool: Ll existing Ll new size Barn: LJ existing O'newxsize
Attached garage:Xexisting Q new size —Shed: LJ existing L1 new size Other: !;'I
>
Zoning Board of Appeals Authorization Q Appeal # Recorded L3
rn
Commercial L]Yes )(No if yes, site plan review#
Current Use 6.4 6?-02 0- Proposed Use A-,L
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Z)p9g,11? Telephone Number
1,
Address atl_ License #- 4
Home Improvement Contractor#
Worker's Compensation
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A05dffl 1P PIS
SIGNATURE DATE 0 0
}
FOR OFFICIAL USE ONLY
APPLICATION#
r
DATE ISSUED
MAP/PARCEL NO. r
Y
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
r
FIREPLACE
C
s
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
't
GAS: ROUGH FINAL
FINAL BUILDING 6 0
DATE CLOSED OUT
� 1 +
ASSOCIATION PLAN NO. '
f f
I
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston,MA 02111
w„ s• www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lejibly
Name(Business/Organization/Individual): P A V l.D Tee) .YO L X-1
Address: a IA ST L 2 G AF} -ItF
City/State/Zip: j/ V A"A/II/l J 446 7 YPhone.#:
Are you an employer?C eck 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-tithe).* 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 8. ❑Demolition
workin fo_te t an ca aci employees and have workers'
_K�-- Y P tY $ 9. ❑Building addition
[ 6workers'comp:insurance comp. insurance. 10. Electrical repairs or additions
required.] �`� 5. ❑ We are a corporation and its ❑ P
.3.�K I am a homeowner doing a l work officers have exercised their 1 LF1 Plumbing repairs or additions.
ri t of exemption per MGL
myself. [No workers comp. P P 12.❑Roof repairs . ..
insurance required.] t ;%F c. 152, §1(4),and we have no
-✓ employees. [No workers' 13.❑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.
tContractors 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:
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 ce under the pains and penalties of perjury that the information provided above is true and correct.
Signafore: - Date: 3 �6 9
Phone#: C� _,;96
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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact.Person:. Phone#:
w
t
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 an. Y 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-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 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
TO. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
THE r, Town of Barnstable
Regulatory Services
awxtvsrnsrt:.
Thomas F.Geiler,Director
MASS.
ft6 9� ..0� 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: `-- 3 ®o
JOB LOCATION: P i4:S T L4 (2 /. /}a(tZ /'r 64�►/K`S
"umber street
street village
"HOMEOWNER": TOL, l ��'in'HOL� LOOG— )- !y 3.60�
name home phone# work phone#
CURRENT MAILING ADDRESS:
cityhown 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 thathe/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
r eme
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 ct,that such Homeowner shall a as supervisor."
Many homeowner:who use this exemption are unaware that they are assunring 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 hues unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it wDuld 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 farm currently used by
several towns. You may care t amend and adopt such a forn/certification for use in your community.
Q:forTmhomccxempt
oFTati Town of Barn-stable
Regulatory Services
N st'�LRB � Thomas F.Geiler,Director
i639 ` 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
Property Owner Must
mplete and Sign This S ction
If Us in ABuild
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work autho ' d by building permit application for:
Address of Job)
Signature of Owner to
Print Nance
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERM ISSION
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JUNE
SO. I�-L TEST LOG DATE OF TEST: DAVID D. 2009 DESIGN CALCULATIONS + �
r APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #46I
WITNESSED BY: DAVID STANTON. HEALTH DEPT.,
PERC NUMBER: 12593 �,DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD
NO
GROUNDWATER ENCOUNTERED
OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS
TEST PIT
REPLACE CRACKED 1000 GALLON SEPTIC TANK WITH
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER NEW 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
46.75 0-6 O LOAM 10 YR 2/2 NONE FRIABLE
SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 Ft x 2 Ft .LEACHING GALLERY CAN LEACH
-
6-8 E LOAMY SAND 10 YR 4/1 NONE FRIABLE Abot = ( 24 x 12.5 ) = 300 sF
Asdw = ( 24 + 24 + 12.5 12.5 l x 2 = 146 sF
6-12 A SANDY LOAM 10 YR 4/4 P4ONE- FRIADLC At = 44F, FF
, Vt 0.�4 x 4466
= 330.04 GPD
43.�5 12-36 B LOAMY SAND 10 YR E5/6� NONE FRIABLE
F- i { USE A 24 Ft x 12.5 Ft x 2 Ft GALLERY. Vt = 330.04 GPD > 330 GPD REOUIRED
36-138 C MEDIUM SAND 10 YR 6/4,- NONE / LOOSE
35.25
NO ATERLEACHING GALLERY
TEST PIT 2 PAARENOTUMAATER AL EPROGLACRLD OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO
2 MIN/INCH IN C SOILS LEACHING DRYWELL (H-10 LOADING) SCALE
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 1500 GALLON SEPTIC TANK
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONSTRUCTION DETAIL DIMENSIONS AND DETAIL NOT TO
46.20 USE SHOREY ST-1500-H-10 SCALE
0-8 O LOAM 10 YR 2/2 NONE FRIABLE DRYWELL UNIT STONE
8-10 E LOAMY SAND 10 YR 4/2 NONE FRIABLE 24.0 Ft
.10-16 A SANDY LOAM 10 YR 3/4 NONE FRIABLE +, TAPER
42.45 16-45 B LOAMY SAND 10 YR 5/6 NONE FRIABLE
45-138 C MEDIUM SAND 10 YR 6/3 1 NONE ILOOSE N 17-071
�j Ln �o
34.70 of 0
5 f t-
m 0 8 In
m
GROUNDWATER ADJUSTMENT DISTRIBUTION BOX" 3.5 f- B.5 Ft e.5 Ft .5 Ft
EXISTING GROUNDWATER LEVEL DIMENSIONS AND DETAIL USE SKIREY OB-3 H-10 24.0 FL
BASED ON TOWN OF BARNSTABLE k'
GIS DEPARTMENT RECORDS. 10 Pt_6 In
500 GALLON DRYWELL
INDICATED GW 20.00 [will"
INDEX WELL M1W-29 NOT TO 12 1n DIMENSIONS AND DETAIL
ZONE D SCALE MIN INLET CENTER OUTLET
t USE H-10 UMT END COVER END
READING DATE MAY. 2009 INSTALL ONE INSPECTION
READING 7.4 O [ FROM —� RISER TO WITHIN THREE
ADJUSTMENT 6.2 TANK TOcl INCHES OF FINAL GRADE 3 IN DROP
O � �p SAS AND INDICATE LOCATION -► FLOW LINE
ADJUSTED GW 26.2 O �, :z.!'; ON AS-BUILT PLAN FROM =
.cpt._ .BUILDING 10 In _ 14 TO
6 in STONE BASE In D-BOX
48 in
15.51n �� CROSS SECTION VIEW 0 33 LIQUID GAS
OO LEVEL BAFFLE
NOTES 00000 In
lzDmoo � 00
00 00
WORKS PERMIT TART N WORK.
C-]
1) INSTALLER TO OBTAIN DISPOSAL O SBEFORE STARTING G 0
SS SECTION 1 CROSS T N VIEW
a
2) SEPARATION OF TEES IN SEPTIC TANK SHALL BE NO LESS THAN LIQUID DEPTH. 21n
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). CROSS SECTION VIEW
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES
BEFORE EXCAVATING FOR SYSTEM. 2 In PEASTONE 21n PEASTONE SEWAGE DISPOSAL SYSTEM PLAN
5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED OR REMOVED. o 0 -TO SERVE EXISTING DWELLING
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. 28 314inTO EF CTIVE 4 TO 26
Z) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES In 1-�"'GRA� DEP7.H 1_112j�GRAVEL In DAVID & KERSTEN DENHOL.M
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 22 PASTURE LANE HYANNIS. MA
8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 46 In 58 In -- In
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 1501n EEO-TECH ENVIRONMENTAL
MAY SUBSTITUTE9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL FABRIC LINRPLACE OF THE 2 1n PEASRTONEDLAYERE SPECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-3158 I JUNE 15, 2009 2/2