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Home My WebLink About0086 PONTIAC STREET �(p h�� iti �. I. I I --� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: - —CAI Fill in please: x -grip, APPLICANT'S YDURNAME/S: ass ��uV,U I�e550. < , BUSINESS YOUR HOME ADDRESS: � r -7 n1S V�l�q. c)z ol TELEPHONE # Home Telephone Number SU NAME OF CORPORATION: NAME OF NEW BUSINESS u7 Oh TYPE OF BUSINESS .IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS 0 1 ' c IHA MAP/PARCEL NUMBER — (Assessing) ' When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 20D Main St. — (corner of Yarmouth Rd.&Main.Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SIO ER'S OFFI . This individua a in a y rmi equireme is that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION Au o { d i mat RULES AND REGULATIONS. FAILURE TO O MENT :A — �sv v 2. BOAR 0 EALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Town of Barnstable ql �SNE T Regulatory Services ' o Richard V. Scali,Director BARsT,B Building Division MASS. �' Tom Perry,Building Commissioner �TEo Ma't a 200 Main Street,Hyannis,MA 02601 www.town.barnstabIe.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: d/ . HOME OCCUPATION REGISTRATION t � y/fg _ 3 Date: r I Name:_ j Pa in Y\f'.. e- l6(1 T Phone#: Address: D ALT�b{� i/i[, S� Village: S ' .Name of Business: Afli( Type of Business: S Map/Lot: t'9' WrENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. r • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. ' • There is no exterior storage or display of materials or equipment: • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length-and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date Homeoc.doc Rev.1031 p r Check one: Certificate ❑ Corporation [3. Partnership _ D Firm/Co. equivalent which meets the requirements of MGL Ch. 142. e by checking the appropriate box. mnity❑ Bond ❑ nsee does not have the Insurance coverage required by ture on this permit application waives this requirement. Check one: Owner❑ Agent ❑ or entered)in above application are true and accurate to the best o1 my er the permit issued for this application will be in compliance with all 142 of the General laws. Sign ature of Licensed Plumber or Gas fitter Ucense Number I TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION Map �( Parcel 19/ Application #Q61 6n Health Division Date Issued l Conservation Division � Application Fee Planning Dept. Permit Fee lz Date Definitive Plan Approved by Planning Board �f Historic - OKH Preservation / Hyannis Project Street Address �L eo N r1a c Village 4661&�-5 Owner 60 Geer E5sa Address leL . Telephone s ok - 77 - Permit Request gOC2 u' Qga&a— en Q Q1, !?WA/ A.10aGG IAI FRo.✓T =6 �Aik �x�sTi.,ic ��17u t� ✓n ,�,U ge- IX)rO 4 ,c1�s m��AP Yin-W Square feet: 1 st floor: existing..*proposed 2z.`2nd floor: existing proposed -- Total new 9,Z Zoning District Flood Plain Groundwater Overlay Project Valuation = Construction Type c000(z Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ua-"' Two Family ❑ Multi-Family(# units) Age of Existing Structure 3 Historic House: ❑Yes Wr<o On Old King's Highway: ❑Yes Lil o Basement Type: ❑ Full ®'crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) — Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new O Half: existing O . new 0 Number of Bedrooms: _3 existing o new Total Room Count (not including baths): existing S; new O First Floor Room Count S Heat Type and Fuel: O'Gas ❑ Oil U-51-ectric ❑Other Central Air: ❑Yes &<o Fireplaces: Existing New Existing wood/coal stove: ❑Yes Detached garage: xisting ❑ new size Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ - Commercial ❑Yes &<0 If yes, site plan review# .' �arrent Use _,Z�oyr�[.p Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number L2 Address ��3 /S � License# /l/35�� C� g, (If�[ i4 C� Home Improvement Contractor# /o0 56n Worker's Compensation # 'ul dZ 6'0 .1�rayo ;Zo/o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 11in SIGNATURE DATE is sl FOR OFFICIAL USE ONLY i APPLICATION# 7 DATE ISSUED s MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: liy FOUNDATION_: }}� FRAME k INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL � �- GAS: ROUGH FINAL iE 0 'FINAL BUILDING �i 2"21- , I f .DATE CLOSED OUT ASSOCIATION PLAN NO. F t S s ? The Commonwealth of Massa.chusetts I Department of Industrial Accidents y,� ] Office of Investigations ' 1r. . t500 Washington t n on g Street Boston, MA 02111 ' f z wwi v.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nane (Business/Organization/Individual): 1}7_K Allcle"_w„�' �dlress: /3 =>S C it7/State/Zip: Q5? VILLE;7` hj,, cvn hone Are iou an employer?Check the appropriate box: n FE] ddi�ii f project(required): 1. I.am a employer with G 4. ❑ I am a general contractor and Iew construction tmployees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the`attached sheet..xemodeling ship and have no employees These sub-contractors have ' emolition working for me in any capacity. workers' comp, insurance, uilding addition No workers' comp�ins uranGo 5. ❑.We are a corporation and its rtquired.] officers have exercised their -Iectrical repairs or additions 3.❑ lam a homeowner doing all work right of exemption per MGL mbing repairs or additionsmyself..[No workers' comp.• c. 152,§l(4), and we have no of repairsinsurance required.] t employees. [No workers' er comp. insurance required.] 'Any appikant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowters who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: sw a 14 2"�' E;,;,7 p,l byzFk 0, Policy # or Self-ins. Lic. #: iu eC Fw 00IS0/6 Expiration Date: Job Site Address: $'� 1�OJVT��41° i /Ao✓/y/S ty/State/Zip: _ O.ZLD L 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 ofthe DIA for insurance coverage verification. r I do.hereby certify tinder the pains and enalties of perjury that the information provided above is-trite and correct; Si nature: Date: " o/O Phone#: 2 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 Pierson: Phone#: 7 Information and Instructions r Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. lursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, txpress or implied, oral or written." ,In 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 nceiver or trustee of an individual, partnership, association or other.legal entity, employing employees. However the oyner 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." NOL 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 permitAicense 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 fi Iled 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. # 617-727-4900 ext 406 or 1-877-MAS.SAFE Fax # 61 7-727-7749 Revised 5-26-05 www.rnass.gov/dia AfYCCrride 10 Wood Cons2rcr.ctroir in Fli 1E 1Yind f(rerrs: .110»"p/i I'Yir{rl Zoile Mzssacllilsett;s Checklistol col 11plj'111Ce (780 C-Nf.R _301:2.1.1)1 Check Compliance 1.1 SCOT? , Wind !peed(3 sec, gust) .. ... . ......... ............... ....... 910 mph. Wind Exposure Category.......... :.....:.............`.:...........,.... B Wind Rposure Category................Engineering Required For Entire Project ,.........................C 1.2 APPLI,'ABILITY n Numbs of Stories (a roof which exceeds 8 in 12 slope shall be considered a story).-—.—stories s2..stories RoofPch ..............................:...'......._...............:.._.............(Fig 2) .,......................................... s 12`12 Mean foof Height (Fig 2).......; :'............. ft 5 33' Buildlny Width, W .................,..... ....(Fig 3). ........... ............ ft _ 13V Building,Length, L .......................... ................I. ,. . ........(Fig 3)........:;..........;..:... . .. ........:... ..: ft 5'80' BuildingAspect Ratio (L/W) ..................................(Fig 4) ........ .. ......... 93:1 NominalHeight ol"Tallest Opening2 ........ ':......................(Fig 4)...............:...... :... 1.3 FRAMING CONNECTIONS Generalcompliance with framing connections............ (Table 2)....................................................... 2.1 FOUNDATION foundation Walls meeting requirements of 780 CMR 5404.1 Concrete........ ............................................ ... ConcreteMasonry ........ ..........:..:...................... .....................,..•.....,....;....................,....... 2.2. ANCHORAGE TO FOUNDATION1'3. 5/8"Anchor Bolts:imbedded or 518"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ............ ............:...... ....:.(Table.4).............,........, 32,in. Bolt Spacing from end/joint of plate .........(Fig 5)... ........ iri. s 6"— 12 Bolt Embedment—concrete...........•......... ...:.... ...: (Fig 5)... .... .in. z 7", Bolt Embedment—masonry:....... ........ .... ..(Fig 5).... .r... .— In. > 15" Plate Wsher....................................... . .............,(Fig 5) ......... >3, x 3, x y:, 3.1 FLOORS Floor-framing member spans checked..........., (per,T80 CMR Chapter 55) Maximum Floor Opening Dimension... ... ....(Fig 6)...... ...... . ft:5 12' Full Height Wall Studs at Floor Openings less than 2"from`Exterior Wall(Fig,6)................. ✓ Maximum Aoor Joist Setbacks Supporting Loadbearing Waifs or Sheaf-wall......... ..... (FIg.7)......; . .... :.. ...., T ft s d Maximum Cantilevered Floor Joists Supporting Loadbearing Wails'or Shearwall ........... ..(Fig 8)........ ......... .. ..... ...... _ft s d Floor.Bracing at Endwalls...................... ..(Fig 9).......: Floor Sheathing Type ..'....:....................... ..... ......... ......(per 780 CMR•Chapter 55) .....I. Floor Sheathing Thickness ............ (per 780 CM hapter 55) In. Floor Sheathing Fastening........................:.............. . .... ...(Table 2)..Yd ils at in edge/�n field 4.1 WALLS Wall Height Loadbearing walls..........:..... ........ .............. (Fig 10 and Table 5)............ ft -5 10, _Z0—O • i Non-Loadbearing walls .::.:................(Fig 10 and Table 5)............. .......... ft s 20' Wall Stud Spacing :........................:.............. (Fig'10 and Table 5) in. s 24'.o,c. Wall§tDfy Offsets .......................................................(Figs 7&8)..., .. ,,. .:.. ft s d .. .4.2 EXTERIOR-WALLS s { Wood Studs J s).......... ...................x ft rn. Loadbearing walls.......................... ..:.... ...... .(Table - 1 _-_ Non-Loadbearing walls .................:....... ....................:.(Table 5)..............................2x ft in. •{ Gable End Wall Bracing ( Full Height Endwall Studs ................................. (Fig 10) .,...,... WSP•Attic Floor Lehgth.......:..:......:................:............ (Fig 11). .......:,.,.....................,,,..,... ft2 W/3 GGypsum Ceiling Len th if WSP not used (Fig 11 ft? 0.9W" - yp 9 9 (� )....:............ .( 9 ).....,....,.....,.....,... and 2.x 4 Continuous Lateral Brace.@ 6 ft. o.c. .. (Fig 11)... .................. ......... . a. or 1 z 3 ceiling furring strips @ 16"spacing min, with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays Ooubie Top Plate ft Sofice Length ...............................(Fig 13 and Table 6)................. ....... ....:..... r A[VC Grrirle /o [Ploo l Collsc vrcctiocr in Hi,4111 ll�iicrc',lrerr : 110 fuph 11'ic-lri Zolfe JVf"1SS"1C111lSCtt,3 CNHICHSt fbf- C01111.1.1I.211Ce (790 CivIfz-53bI.2 I.1)t ' Loadbearing Wall Connections Lateral(no. of 16d common nails)................................(Tables 7)...........,..........................I............... Noi-Loadbearing Wall Connections Lateral(no. of 16d common nails)................................(Table B)....................................................... Loaf Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................:...............(Table 9).................................._ft_in. 5 11' SillPlate Spans ........................................................(Table 9).................................._ft_in. s IV Full Height Studs (no. of studs)...........'.............:...........(Table 9).........................I...................... ...... . NonL.oad Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................. ft_in. 512' Sill Plate Spans.... ..(Table 9) ............... ft_in. S 12" Full Height Studs (no. of studs).......................:............(Table 9)........I........................... ...... ..... Cxteror Wall Sheathing to Resist Uplift and Shear Simultaneously° Minimum Building Dimension, W Nominal Height of Tallest Opening z ........................ ................ ........... 6'8" Sheathing Type..............................................(note 4)........................ Edge Nail Spacing......:..................................(Table 10.or note 4 if less)......:.....,.,......... in. Field Nail Spacing......................:....................(Table 10).........................................,.,..... in. Shear Connection (no. of 16d common nails)(Table 10)......................................................._ Percent Full-Height Sheathing...................:...(Table 10)...................................................._% 5%Additional Sheathing for Wall with Opening > 6'8" (Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening Z........................................................................._s 6'B SheathingType..............................................(note 4)....:..............................I..........I....... Edge Nail Spacing.........................................(Table 1 i or note 4 if less)........................ in. Field Nail Spacing.......................................:..(Table 11)..............,................................... in. Shear Connection (no, of 16d common nails)(Table 11)........................................................— Percent Full-Height Sheathing........................(Table 11).............................................:......._% 5%Additional Sheathing for Wall with Opening> 6'8"(Design Concepts).................:.. Wall Cladding Ratedfor Wind Speed?.......:........................................................ ............................................................... 5.1 ROOFS Roof framing member spans checked?.......:................(For Rafters use AWC Span Tool, see BBRS Website) ' Roof Overhang ...........:........................................(Figure 19) ............._ ft s smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary.Connectors Uplift................................................(Table 12)....................,........................U= pif Lateral..............................................(Table 12).............................................L= plf Shear...............................................(Table 12).........,..................................S pif Ridge Strap Connections, if collar ties not used per page 21... (Table 13)............................... T= pif Gable Rake Outlooker...........................................(Figure 20) ......:,..... ft s smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietay Connectors Uplift.........................................:......(Table 14)............................................U= lb. Lateral(no. of 16d common nails)_(Table 14)........:..............................L= . lb. Roof Sheathing Type................:..................................(per 7B0 CMR Chapters 5B and 59) ............ Roof Sheathing Thickness.....................................:..... .............................................. in. >7/16'WSP Roof Sheathing Fastening............................................(Table 2).................................. Dotes; i This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure .18a and Figure 18b Exception:Opening heights of up io 8 ft. shall be permitted when 5%is added to the percent full-height sheathing -'requirements shown in Tables 10 and 11. The bottom sill plate In exterior walls shall be 2 minimum 2 in. nominal thickness pressure treated#2-grade.. °F THe r � Town of Barnstable regulatory Services. snxxsrasi.E, ntnss. g Thomas F.Geiler,Director 4'pr1659. m 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 Complete and Sign.This Section If Using A Builder I . 1 S� as Owner of �l� Le--� - , the subject property - here by authorize 1:-I l-ke -S OIA- to'act on my behalf,, m all matters.relative to work authorized by this.building permit application for: � �S o (Address of Job) Sig na e of Owner 7Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side: t Q:F0PMS:0 WNERPERMISSION Town of Barnstable �OFTHE Tp�y yw� o Regulatory Services # t F BARNSTABLE,- Thomas F. Geiler, Director y MASS q, 16S9. ,m Building Division AfEO MAC A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wwfv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellinU 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 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. T` Massachusetts- De Board Pa''tment of Public Sal-et }let of B aruildin" Re Construction "ulations and Standards License: CS supervisor License Restricted to: 00 14358 MELBOURNE NICKERSON 13 THIS WAY OSTERVILLE, MA 02655 (ummisiuner Expiration: 1/17/2012 Tr#: 13140 , Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:Registration:; 100560 Type: Office of Consumer Affairs and Business Regulation Expiration S%1912012 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 F'o NICKERSONB'MO- " EMQ?DELING - 1* r' - >, ,ourne Nickerson �r his Way4.4 rville, MA 02655 'Z-z.-- Undersecretary Not valid without signature I F z - I INFORMATION PAGE Y` Associated Employers Insurance Company Burlington, Massachusetts (800)876-2765 NCCI NO 40959 POLICY NO. I WCC 5008940012010 PRIOR NO. I NEW BUSINESS• . ITEM 1. The Insured M Kempton Nickerson dba Nickerson Building&Remodeling Mailing Address: 13 This Way Osterville 'MA' 02655 (No. Street Town or City County State Zip Code ® Individual ❑ Partnership ❑ Corporation ❑ Other FEIN 97-0240725 Other workplaces not shown above: 2. The policy period is fror110212010 tD03/02=11 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA. B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Rem&A. The limits of our liability under Part Two are: Bodily Injury by Accident$ 10 0,0 0 0 each accident Bodily Injury by Disease $ 5001 000 policylimit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20-03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated Total Annual of Annual No. Remuneration, Remuneration Premium' HITRA 240725 SEE EXT NSION OF INFORI IIATION PAGE . Minimum premium$ 500.00 Total Estimated Annual Premium $ 3,207.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 853.00 ❑ Annually ❑ Semi Annually ® Quarterly ❑ Monthly MA Assessment Chg. $2,852.85 x 7.20000% $265.00 This policy,including all endorsements,is hereby countersigned by 02/26/2010 Authorized Signature Date .§ GOV GOV I KIND PLACING CLAIM I NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP The Fairway Agency Inc MA 5645 123 1504 1 1 305 Forest Street . WC 00 00 01 A(1 t-68), Bridgewater,MA 02324 Includes copyrighted material of the National Couna'I on Compensation insurarxe• used with its permission i � 75 - a � Irma r , The Town of Barnstable Department of Health, Safety and Environmental Services Building Division HAM c 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: l 6d Name: 92�� Phone i#• Address: �D po'n / 0� L Village: Yt4 r4 n n ► S Ga�a Type of Business: ��/C ]� Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4.1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwellingwhich are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applies Date: Homeoc.doc 1 r O L-----------, ; rn I I ' I'I rI `----- 4------ -----7----------------- , b I I D 3 I I I I- rn I , III I I 1 I --I , y , ' ...' 1. - -----' I �rn a Lessa Residence a ARCHI-TECH Pontiac Road s school street t o.safts sos.a a Hyannis, Massachusetts AS0CIATE S� cotit, ma azs a info@archtechassadates.com®� °s Foundation Plan architectural design arc6itech assodates.com N t� - n D -7 rn 0 O -70 . r z II I . I o J T W I - m . d . O 3 .. 1 1 a e 0 6 0 s rn Lessa Residence t •V I 5885 If 86 Pontiac Road ARCHI-TECH s school street t 508.420. 508.420.5304 Hyannis, Massachusetts ASS 0.C I A T E SA cotuit, me nws a info@archtechassodates.com N o First Floor Plan arch i t e c t u r a l design architech associates.com rn o r- rn O z . Y ED - rn q 6 ` '0 Lessa Residence 0 ARCHI-TECH z 86 Pontiac Road s school street f 508.420.5335 f 508.420.5304 Hyannis,Massachusetts ASSOCIATES A cotult, me 02635 •info@archdechassodates.com o Exterior Elevations a r c h i t e c t u r a I d e s i g n architech associates.com 0 r m �I rn o r z 1 a Lessa Residence ARCHI-TBCH 86 Pontiac Road a school street a e08.411.5U5 f soe.<zo.ssoa. Hyannis, Massachusetts ASSOCIATESAI ootuit, ma 02su a info@archhechassodates.com 0 Exterior Elevations arch i t e c t u r a l des!g n. architech associates.com (1 (l �! P 1frl r'i GDN. �Tlll. A 6. - Y pwT>i fn D O O c 3 riiCo O mm D O 1 T p>aP� o NT��«TTz� �. N n Q i _ - _ �gw � _ fOlm D --------- ,QOT O m 71 . I I 1 I , I 1 Z 1 r I.. ,. 1 ---------- ----------1, C----1 1 OZO Z' N - I - I X NrTI I I I I I Z7�0I n� I I I I rn . I I I 1 I L----_-' III T: EXI5TIN6(3)2X8( — — r ,. N , GNw'o N A. n vE I t rn I ____________________________. .-____- 1. GI s s ° a Lessa Residence a ARCHI-TBCH 86 Pontiac Road 6 school street t508.420.5335 f508.420.5804 Hyannis,Massachusetts ASS 0 C IATE SA catwt, me o26,5 a info@archtechassodates.com 0 Foundation Plan a r c h i t e c t u r a I d es i g n architech associates.com N - - - n m N - o r - 4_b' .n r - ,"`fill I N m o a= - 40 P?;ur B v • �zA in v r N m g C CJQ ft V X a - a M a � S ° Lessa Residence mn., U 86 Pontiac Road w A R C H I-T E C H 3 Hyannis, Massachusetts ASS 0 C I A T E S A I 6 t�ht lmetreet '508.420.5335 f 508.420.5304 N a fo@architechassodates.com s First Floor Plan Mfg arch i t e c t u r a I design architech associates.com rn (S) 7 — —n. o r70 --- . V e° O O L I I •#� ��vvI 11 T � 111 0.— � I 11 I 4' ' w rn 111.E TT 1J1 II D 1�1 _ ... �� N ` Lessa Residence ,• � a 86 Pontiac Road ARCHI-TECH6 school street t 508.420.5335 f 509.420.5304 Hyannis,Massachusetts ASS 0 C I A T E S A OOtUIt, me oms a Urfo@archtechassodates.com N g First Floor Plan arch i t e c t u r a l cl e s i g n architech associates.com b N I I 1 r I I 1 1 2XI5ITNiG(9)2�X8 �~ . -I X5-FLOOR J015 5 -• 1 1 i e i- D - r i 1 1., I.. , • i , I 1 I I 1 I I I I I I I - I 1 V� 1 I I I I I I q� I' _ (2)2X5 HEADER. Z I D C1i I I IT 1 1 1 I Iy 1• J 1 I I I I rn - 1 . 1 - . 11 r 1 1 1 I 1 ' (2)2:xb HE&DER m.. . Z` � - r y@ TC I 1•- 1 I 1 U-11 m O V I'll � � 1 �I - 1 I I I • A- OOOy o»»C(( 1 I I I I I m� •�t I I I � 1 -I I t� .I •, 1 1 I I I i 1 ~ D I I I 1 J( • y I I I I I a s Lessa Residence m'• ABCHI-TBCHI 86 Pontiac Road s eanool street t508.420.5335 f508.420.5304 r I Hyannis, Massachusetts ASS 0 C I A T E S A ootuit• me o2w sinfo@archRechassadates.com 0 Framing Plans arch i t e c t u r a l design architech associates.com T WM 24 N. N n rn LIW T T� `Am0 A� g - z 6 z.Na 0 A ' s u E 8 ` Lessa Residence z 86 Pontiac Road ARCHI-TECHs school street t 5os.42o.5sas i508.420.s304 Hyannis,Massachusetts MIN ASSOCIATESAI cotuit, ma omms a info@arch techassodates,com xBuilding Section arch i t e c t u r a l design architech assodates.com 0 i ,r t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel / 9) Permit# Health Division • Date Issued Conservation Division f Fee �Sr Tax Collector ` Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis _ Project Street Address - Village Owner Wokej,-� `r 'S-Pg ►gaffe Address S"d�-tom •'' Telephone 72 r ,2 VPr Permit Request 5-r10 1f 9' iC Aw-r eYv ad Spd F Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 4100.D b Zoning District Flood Plain Groundwater Overlay Construction Type e Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family 9- Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes '❑No On Old King's Highway: '❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new ° Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new .size, Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing"❑nevi size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name_ 0/114 `v� duo ffO-" Telephone Number 6"p-4rl Address 56 7e 7?qc k4, License# 0 0 9 9 7s- 1�.v Home Improvement Contractor# 1/6 e�d g Worker's Compensation# W T 3 —ads'F7 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO "s 4s'W/ SIGNATURE DATE og-A-, c 0 FOR OFFICIAL USE ONLY PERMIT NO. ' _ _ s DATE ISSUED - MAP/PARCEL NO. = ADDRESS VILLAGE OWNER _ 4 DATE OF INSPECTION: FOUNDATION r y FRAME INSULATION ` FIREPLACE t. ELECTRICAL: . ROUGH FINAL` _ PLUMBING: ROUGH FINAL i GAS: ROUGH FFINAL' _ XEFINAL BUILDING J ` v I DATE CLOSED OUT r - ASSOCIATION PLAN NO. TME The Town of Barnstable • L►axsres�, ' � Department of Health Safety and Environmental Services; A'Eo ram+' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 6;,Zt Pa e��a aU f, Estimated Cost �wd,, d 6 Address of Work: �'�o f p' v-f/Ac Owner's Name: /1,4,h `►' ri'<? Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Datd Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav �,\ _ _ The Commonwealth of Massachusetts -�=. - - " __ -= ' Department of Industrial Accidents =. Office offorestfoo fops 600 Washington Street -� Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: ;F,r 11� Af, (7,-dV-tHt--t0 location: 6>60 Ple-A- h-4. city 2!1�/-lti.ri I S R,4, vhone# 7�D-Dey/ ❑ I am a omeowner performing all work myself. ❑ I am a sole rietor and have no one workin m. ca aclty ''///%%%%/%%%% % %%%%%%/%%%/%%%%%%%%%%%%%%%%%%/%/O %%%%%%�%�%��/�%%%%%%%%%%/%��%%�%%%� I am an employer providing workers' compensation for my employees working on this job. f .:: } . ::::.;.:....::.:. .::..:.::.::.::...:....:: . somaany:name.. 0 ... : . <'. :. t' t c:. .< . . : :>::i:::>:::: address. .. > .. .:;vhone:#. �} :. cttw : . l insurance co: /�: 1J : ... .:.: . oiicv<# " ....:.:.. ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have `- the following workers'compensation polices: . eoman name. ,'::::::'.;::. :.:..:.:::.... v v address. ....... .... :: ...:: ........................................... ..:..:..::..:.:<.: :.... :.::::. >::::::: : <:., ..:.....:.......:...................................................:..:::.........::::::.:::.:::::.:_... . hT:'. ......... :. . ::vhone:#. .. ..::::::;:::.. .....::::::::::::: :::.:.:::... ::. :. .... .:. ................................. ........................ .:......... r ..................................................................................:::::::::. ... .. ::•:!A <i:: :?:+:%!?•'r`::'isiiiiiiY.:i:':'`::is�:•a >isL:i.,n:,}:}i.:{i::::::`::•iiiii>ii$}i::'ri4.`:::::':isiiii?>::•.:i;r:;::j'i;:y;iii'r'isr'x:�;y`';4i:!i`:i?::^i::ii}:t>: ::::::.:::: ............... ................... ..............:::::.�:. .::: .:.::::.�::. �11 . .. .. ................................... .......... ....v:.:_.�:::v:.�:.: ....... :.:::..::.i.:i:::::::::::::::: ::.:::::•::::::.�::::::.�:::.�:::::::::::::: .... .:::.i::::...:::::ii::::::::::.i':.::•.�:::.i'.:i:.i...:•::::::.:'.::....;:•CSXL:r�✓Ai:JZ+tJikJ:ii:iv hsntance.co olrev# . . 7/1 c antF name amv ......... ................................. -rr 1. e3S. :; :;:: :::::::::;:::::::::::::: :stidr ..:. ..... - ::. : :.;.>:.:.;:.:.;>:.:.;:.::. city: " hen6 :: 's;:z:; : .:.s :.,:. :::i>: . aturance.ro... _ ......... olicv# Fafiure to seeore coverage as required under Section 25A of MGL 152 can Lad to the imposition of crhninal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify raider the pains and penalties of perjury that the information provided above is h w.and coned �/ Signature G. Date /,�� _ Priat name �� ZA�tiC. Phone# 71'D-Ui-�/ official use only do not write in this area to be completed by city or town official city or town: permWllcense# ❑Building Department ❑checicif immediate response is required ❑Licensing Board ❑Selectmen's Office Icontact person• phone#; ._ rlHOti erer ealth Department Ormad 9/95 PJly I 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 cones. 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 receive: c- trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews.; 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 contracdng authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. XXXXXXXXX The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Iwestfeauens 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 ,t ti: 7 sessor's Office(1st floor) Map O% Lot M% 111.11Rer-mit4 Conservation Office(4th floor) (r,1Z Date Issued Board of Health(3rd floor)(8:30-9:30/1:00-2:00) �— ;� /l��SL'�e� v, Engineering Dept.(3rd floor) House#1 A ,P Planning Dept,(1st-floor/School Admin.^Bldg.) S,�BE Definitive-Plan Approved by Platming Board 19 �NS"� � NCE �!. TOWN OFBARNSTABL IRONM AL cOOE AND Building Permit Application 7®WN REGULA IONS Project Street,Addresg Village i Owner Address Telephone , ` �] `� , J, q R l� Permit Request SEVOQ 5 Total 1 Story Area(include 1 story garages&decks) square feet ' Total 2 Story Area(total of 1st& 2nd stories) square feet Estimated Project Cost $ :6�qC Zoning District Flood Plain Water Protection W Lot Size l7 � C�d2� Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use I&A0 _ t rp,,✓ Proposed Use Construction Type n O!z , Commercial Residential ✓ Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finishedn Historic House Iva Unfinished Old King's Highway Number of Baths /1 p No.of Bedrooms 4. n n� Total Room Count(not including baths) On Q/ First Floor Heat Type and Fuel 19 OL S Central Air Fireplaces Garage: Detached. - Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name , Telephone Number Address License# _ Z Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) _9 FOR OFFICIAL USE ONLY - PERMIT NO. �� DATE ISSUED p MAP/PARCEL NO. 191 j ADDRESS (o VILLAGE j J OWNER- DATE OF INSPECTION: FOUNDATION FRAME 7 ' INSULATION � FIREPLACE ` ELECTRICAL: ROUGH FINAL ' { 1 PLUMBING: ROUGH ,.: FINAL GAS: ROO.# FINAL , FINAL BUILDING i 1 DATE CLOSED OUT _ ASSOCIATION PLAN>;. 11/02'94 1 :02 *&e1772,77122' DEPT IND ACCID Z 001 C� fr`,t I -�11 // 11 onunoiutle.alilt o f /WaJJac/i.a4�tb .1JaPartinertl.o�J"ndu�Eria[,�fcc�denti 600 Wa L.Iton Shy t James J.Campbell Uo &A, ///addacfiadrelze 02111 Commissioner Workers' Compensation iftsuraJnce Affidavit with a principal place of business at: Pc'o-xicc c 4( Fuca,12/7 i s WI n ), 0 �(GZ)r/StserJziv3 do hereby certify under the pains and penalties) of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number 0 1 am a sole proprietor and have no one working for me in any capacity. () 1 am a sole proprietor, general contractor omeowner circle one) and have hired the contractors listed below who have the fo o - compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy gumber (+� I am a homeowner performing all the work myself. I understand that a copy of this stzternent will be fo.v.zrded to the Office of Investir2rions of the DIA for coverage verification and that failure to secure ccverage as recuired under 5ection 25A of MGL 152 can lead to the imposition of criminal penatties consisting of a fine of up to s 1,soo.00 andfor or.-, years' imprison-meet as well as civil penalties in the for:of a STOP WORK ORDER and a fine of$100.00 a day against me. Signed this " day of le_ , 192, Licensee/Permittee Building Department Licensing Board Selectmen Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BARNSTABLE BUILDING PERMIT # The Town of Barnstable BAMSTAMZ �e� Department of Health Safety and Environmental Services %659. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME U"ROVEMENT 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: o % •/ 6?I-CcA Est Cost Z U O O Address of Work: Owner Name: '1 O�P a - e c�s c,, Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied _Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME 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. ti OR Date Owner's name • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION 0I S Number Street address Section of town "HOMEOWNER" 7S ' Name Home phone Work phone PRESENT MAILING ADDRESS f 0"_6o . City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellinqs of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Offici: on a form acceptable to the Building Official, that he/she shall be responsib for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes :responsibility for compliance with the Stz Building Code and other applicable codes, by-laws, 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 wi h said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner, actir. as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. : f r. . i r I l fk Q. $ If a { . r i v.. .'� ': I'�_�"'��* , -1. " -i.' -��.�,.:. �-, / , *�'��' 1,�'%'.-'_-"'K�. :,,'� i e. y ._r .No': _f ti a . e t � o .� .o . _ a . y .z'{ c 1 - - r o- �F4 �' � r :u' � '' \ -.r. -,-4- - "'�--z':., , �.�4. 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F .D 1 r :-, tSS \ 1 :+.�i ( 1 t 1 - I 1 t Zi 1Ti ; 2 I Y Y f -- M7 t \S ..+�•,'1 t_ p e t � Y4z, �to t t r Yr'`c + _ # : ,-vs f 1 cz�-s,Yi } \ ) <s x is x a S v �..x ''r '- k. tq. is:: 7 s'h'`u�-�sh'�":,,.rf: fY'-,�„st •K;:,r yc, d'�'3r,a i mill � if , , ��+► �`►�, ='�-�.'�� `�,'-� t ) �� ,� • Ml 2.2 c t � 1 1 r� c. . FROM �L TOWN OF BARNSTABLE t - C.G.P. & Son Building & Remodeling BUILDING DEPARTMENT 183 Longview Drive 361 MAIN STREET HYANNIS, MA 02601 Centerville, . MA Phone:775-1120 J SUBJECT:' Barnstable Building Permit #30229 Robert Lessa FOLD HERE DATE - - April 30, 1987. Ni E S SA G E The addition to the dwelling located at 86 Pontiac Street, Hyannis has been' inspected by this office and the construction meets the requirements of the Commonwealth of Massachusetts Building Code. - xPi-c/h/a�rdR. Bearse Asst. Bldg. Ins .. DATE - REPLY i SIGNED 7 N87•RMI - RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY -�- SENDER:.SNAP OUT YELLOW,COP_Y_ONLY,..SEND WHITE AND PINK COPIES WITH CARBON INTACT. Assessor's map and lot number ?,...'" +� ....... �• THE ............. �oF roe Sewage Permit numbed/,,,/7�!r„i,/fir,, ., ,,,,• ,� j ;,� w�Q Rye BA"STAMLE, i House number 6 .4 " �— MAB6 .:...................................................... O�,o�i639 9� 'FD MPY a` TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....4 '.................................................................................. TYPE OF CONSTRUCTION f............................................................................................ f ...........//Y................19: 1 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... `a......rll( ?I.Ac ........................ .... r Proposed Use .... ..............C!* t................................................................................................................................................ ....... ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner .. r, �3• .5< Address .." :.....t'?:, /.srfr' f�d: ;: 5 ..............A............. �......... Name of Builder %. r:.�` ...:.. '"/' 1Su�lf.n ,; r A fi r x,Address .......... ... ..•>,�t"....;j< ................... Nameof Architect ..................................................................Address ................................................ Number of Rooms ................... ...........................................Foundation<l� c: .... ,!? ?•" ?...ir/ 1"cr3tiat ; i f �. Exlerior ............ ...... ? ,r.f.....................................................Roofing •' S r d�/?P f .........•.iy...........................,............................................ Floors f .............................. Interior ..... *: "'�'.%!:F� ........... . ,........ ..................................................... rHeating ..... Ir:::.•`......................................................7n.......... .........................,......................................................... Fireplace ..................................Approximate. Cost l .................................... � �"}. .1... .Definitive Plan Approved by Planning Board _______________________________ 19--------. Area .... ........ .... Diagram of Lot and Building with Dimensions Fee ................�-�... SUBJECT TO APPROVAL OF BOARD OF HEALTH i Ar [A T,�o�gt-y AL 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 ... o ..... .!.. .h! .a4�.................... - ' Construction Supervisor's License .!= �............... Lessa, Robert & J. A=269-191 34229 add No ........::....... Permit for ............... to single ..................... family dwelling ............................................................... Location 86 Pontiac Street ................................................................ '' H annis ............................Y................................................. Owner Robert & J. ..........................................Lessa........................ Type of Construction frame Plot ............................ Lot ................................ I Permit Granted .....November 26 ........19 86 Date of Inspection ....................................19 Date Completed ......................................19 ^ i i t Asse oor's map and lot number .. C?. .�.�. /......;S..'.K'' SEPTIC SYSTEM E • � w Sewage Permit number .Q��...p4f.:..V.�<.ianae,. INSTALLED IN C.. C� ry �� z WITH IT • House number ..:. ......-Yt4.1. .............. ENVIRONMEi�TAL TOWN REGUL b a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....Oq.t.kd.... .............................................. TYPE OF CONSTRUCTION ......WAA r.......................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locationr�b �KTI A�. ? �Y ! !.5..................................... ......................... ..... ........ . ............................................... ............................ ProposedUse ....!v.?M.....Z941!!'A......................................................................................... ................................................... ZoningDistrict ........................................................................Fire District .......�...................................................................... Name of Owner ..t!�A e�!.... d� 147 . .��5 .................Address . /"on'7 �G 2e i"fY�i'/Ji F........................ Name of Builder .. ..�T<.��-...7..•S�M../ i�i/G��ner.Nc /rri�.Address .� .. .v� 'cc/ lei^ {a�y/Y '................... .......... .. .... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ......Foundation (7Qf?4.f::r 71r...5prlt;j„ ...%?Ct Exterior ..........C.f/yXJQ ..............................................Roofing ... S ..................................................... Floors .....rA,! !'7..........................................................Interior .... ........................................ Heating .......r.Z-6 .............Plumbing ....., wl- .............:................................................. Fireplace ..................................................................................Approximate. Cost r,2/ wo. - ..................... ................................ Definitiver Plan Approved by Planning Board --------------------------------19--------. Area .... .. . ...! ...." `C9... ' Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH � I �> �DD�Tay . to AL 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 ... J.......... ................�.:................. Construction Supervisor's License .00(p(0 Lessa, Robert & J. N oi,q.......3022.9Permit for .............a da.ii9 ......... ...... .... single family dWe�. 74g ......................... Location ................... ...V.Q.u t i a r-..S.t x.P-e t........ ..................................Hyajmjs.............................. Robert & J. Lessa. Owner ...!fi............................................................ Type of Construction ......................frame.................... ................................................................................ Plot ............ ............... Lot ................................ Permit Granted .......NoveiA.er...2.6.........19 86 ........ .... Date of Inspection.....................................1.9 Date Completed ........ . .......z. .....19j tr > & oM lio- M tr ru Assessor's map and lot number ..�.6 ............ THE Sewu,ge .Pd&it number/..0.. �11 I d � BJBH9TADLE, i House number ........z!... ....�u� s MAs6 .................................................... �p �0 YpY p" T TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... I• .. �1 .�� ............................................................ TYPE OF CONSTRUCTION ........,...1.�00...... .................................................................................................. ..................... 11............... .199. TO THE INSPECTOR OF BUILDINGS: The under/signed hereby applies for a permit according to the following information: Locations, ... ....... ......�Gi� .!��-.. ..... ... .�. .......... \V O YlV\�`J ...�.�...... ............................... t. �. ProposedUse ................Q c7 �................................................... ......................................................................... �l r ZoningDistrict ............................�. .... .................................Fire District ..... 1 .h.. ..5.......................................... Name of Owner �Q ,Y A...A.:.......� ........Address .............. 20.01za .... ................... Name,of Builder .............._,5 YM.-Q-'............................:.....Address .................................................................................... ......... :. 'Address ..................................................:................................. Name of Architect .................................................. .... Numberof Rooms }..................................................Foundation ......blo-c,.k............................:........................ .................. Exterior ................ .............................................. ....... Roofing ........... ...44.......................................:.............. Floors G .. 1..e_.YLT.....................:.;,..................Interior; ..........,�! F�:�/"�1 c Heating ................1�.C.?.l?.. .................................$ ..........Plumbing ............h t� 11..�................................................... .. ...................... ..... .. . Fireplace_ 11................... ��v.n.. ........................................:....Approximate. Cost 00— . .... .................................................. \ _ a Definitive Plan Approved by Planning Board -----------_--___-----------19________ . Area ....... ............ Diagram of Lot and Building with Dimensions Fee ...... �� .................... ......... SUBJECT TO APPROVAL OF BOARD OF HEALTH , v, i 3 ma`s J J a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name! ................... ,... ... . Construction Supervisor's License .....:'.........`................... a�+ LESSA, ROBERT A. A=269-lgl No .. 26.7.65... Permit for ..to........ .........Dwe 1 l.ing...(.Qg. a9. )................................. Location ,Lot g, 86 Pontiac Street ................................................... Hyannis ............................................................................... Owner .....Robe A.. Les .rt.......... .......s.....a............................ Type of Construction Frame. ` ................................................................................ Plot ............................ Lot ................................ Permit Granted ...............August...i........19 84 Date of Inspection 19 Date Completed ......................................19 LOT 10 a LOT 9. � I a -° 2 �+ 110226 S.F. w IDE I N f 24.G o Z CAR. i 0 P= r I ✓ E GAR. r i 1_So•G7 i LOT $ r , SCALE 17-30' DATE,.7/5/$4 S F 1 SKLTCH I-LAN uF LAND IN HYANi4IS, PA. for RUBEaT LES�A Beingg lot 9 a-s shown on a plan of land for Cronan Construction Corp; Dated 12-69- by Barnstable Survey Consultants Inca Recorded -in Book 236 Page 145 t F All Cape Engineering 1 Box 1533 Hvennis, Pia.ss. 02601 Tel. . 778-0053 . . s FRAN i ' Cot4E.RY E. Assessor's map and lot number ... .6.�.'.........,................. THE �. �o o� ry ,6 Sewage Permit numberA ... f • • H9SBSTAHil LE, i House number "'tea g6.... 'I..................................:..... Op 039. 0 MAY f►`6 TOWN ' OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......� V..1.1 qq. CCA,C V TYPE OF CONSTRUCTION ` .................... 1.................19�>...I. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: pt� \ LocationL�.k.3)- ........Q.! ...... �?Y� 10.� ... .�.. ............ . . . ............................................. ProposedUse ................. .................................................................................................................................. Zoning District ...................................Fire District ..... .. . . ............................. .. /t .!�..h.I.s1.......................................... Name of Owner ........ �� .A........�. G- ........Address ..............34...... -Pard ia.!:; ... .L.................... Nameof Builder .............. ..................................Address .................................................................................... Name- of Architect ..................................................................Address .................................................................................... Number of Rooms ..............I...................................................Foundation .....�(.QU.k................................................ Exterior ll ............... .....�...�..f.f.........................................Roofing ...........Q„� ��G�... .............................................. Floors .........................................Interior ...........y e,e. O.Ck............................................ Heating .................nC�.IL. ................................................Plumbing ............n.4.n.:�................................................... Fireplace h.a n ...................Approximate. Cost ..A 00— ....................................... ............. a Definitive Plan Approved by Planning Board --------------------------------19--------. Area .......5� .................... Diagram of Lot and.Building with Dimensions g g Fee ......9w/.1...... SUBJECT TO APPROVAL OF BOARD OF HEALTH i 5 r � 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 ............... """- Construction Supervisor's License SSA, ROBERT A. A=269-191 ` la 4..765...... Permit for ...Accessor• to•••••• ,j Dwe 1.1.1.n9...(Ga rake)............................... „ Location ...l.az..9. ...P.on.t.i•ac...S•t•ree• ......... ...............iY°anr)J.s•................................................ / ► �- Owner -Rohe.r.t..A,...Lesser............................ s - Type of Construction Frame...................... 1 1 ti yp ......... r .......................................................... .................. Plot ............................ Lot -Permit Granted ..Au us.t...I. ' ` ..l 9 $4 j Date of Inspection ............................ 9.G Date Completed .. . .......,......1900