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HomeMy WebLinkAbout0050 WOODBURY AVENUE � %oat i I q I s Town of Barnstable Regulatory Services Thomas F.Geller,Director - t "im 1 Building Division KAM 659. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 $ PERNIIT; FEE: R / SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Telephone number 3o y7 Size of Shed Map/Parcel# Si ature Date MPQ ILL.'x ' j Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? r 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 COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A. PLOT PLAN Q-forms-shedreg J V REV:042506 r. i' t-r Town of Barnstable *Permit# 06,709� Expires 6 months from issue date Regulatory Services Fee Thomas.F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address o cc i hur V p_ L4GL VA,V) l S C12-66 I . Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address `J '� y��� e rvw V Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ®PRESS PERMIT ❑ I am a sole proprietor (5� I am the Homeowner ❑ I have Worker's Compensation Insurance S E P - 5 2007 Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) (3(Re-side €'-Va t,URe lacerent Windows/doors/sliders. Ulue (maxunum. *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 is reg5ired �ns�a s SIGNATURE: - Q:Fomis:expmtrg Revise061306 �OEVE tp� Town of Barnstable Regulatory Services MUMSTABLE, Thomas F.Geiler,Director �pT 1639.A��� Building Division FD MP'I 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: 9 0 JOB LOCATION: 60 number stwao village "HOMEOWNER": La\) r lC� B(_C)L✓/) name ome phone# work phone# CURRENT MAILING ADDRESS: 5-0 l oc c�_bV ' v\ � /town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there.is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other .applicable codes,bylaws,rules and regulations. The undersigned"homeowner'.'certifies that he/she understands the Town of Barnstable.Building Department. inimum inspection procedures and requirements and that he/she will comply with said procedures and r quirements. 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. I -�.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):. LjojV V-t c T-�C a_-,- /\ Address: 0Co City/State,/Zip: Y>\ "P` hon�. : �S ' 3o Are you an employer? Chec the appropriate bog: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).'" have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole pioprietor or partner- listed on the-attached sheet' 7. ❑Remodeling ' ship and have no employees These sub-contractors have 8. ❑Demolition • worldng for me in any capacity. employees and have workers' 9 .❑Building addition [No workers' comp.insurance comp. insurance.$' 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 11.❑Plumbing repairs or additions myself: [No workers' comp. right of exemption per MG L 12.❑Roof repairs insurance required.]t 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. YContractnrs 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 tsthe 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 certify under thUains•and penalties ofperjury that the information provided above is true and correct Sienature: Date: Phone#: S� Official use only..Do not write in this area,fb he 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 CIerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 03- Permit# 6.2/ .�, Health Division �-✓ ! �'" '�� Date Issued � 1 Conservation Division hllt,00L Fee ck&7> 2 7 Tax Collector ob At? FEE c,6�-V 00 Treasurer 6 /7 Qc� SEPTIC SYSTEM BUST BE INSTALLED IIq CO PLIA14CE Planning Dept. Y WITH TITLE 5 1-MV'IROr`IMENTAL GORE AND Date Definitive Plan A[A* roved by Planning Board T0,,11V'�I !EEO- A i0? UL �!,5 Historic-OKH Preservation/Hyannis Project Street Address go vj��mu 1 y A%!G' Village Owner � 6, Ams 00 GtiI.15-S Address _ 1�-��bt�y Ry /1446 Telephone 7 7,G OZ9¢ Permit Request AVV l $ ZS Xtlt7 11D G A-), poP 0eEk) fen' Tz�-ae:,­cl) — an - 13&--Pf?ooH . I-3A ra 2,.%c:;, L7 7?i�(< -to Z. / 7 Square feet: 1stitoor: existing 72T proposed 179 2nd floor: existing proposed J�g� Total new 7 D Valuation b, Zoning District Flood Plaines Groundwater Overlay 1� Construction Type LO V � Lot Size 6no Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family rX5, Two Family ❑ Multi-Family(#units) Age of Existing Structure 77 Historic House: ❑Yes ;I(No On Old King's Highway: ❑Yes XNo Basement Type: A Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ? �� Basement Unfinished Area(sq.ft) ''-2, Number of Baths: Full: existing new Half: existing — new 69 Number of Bedrooms: existing new 3 Total Room Count(not including baths): existing new °y First Floor Room Count 3 Heat Type and Fuel: �Gas ❑Oil ❑ Electric ❑Other (4 A X G�3 Central Air: ❑Yes 4 No Fireplaces: Existing New Existing wood/coal stove: ❑'Ws o t Detached garage: ❑existing ❑new size Pool: ❑existing ❑new size Barn: 0 existing ❑ne$i: sizQJ Attached garage: 0 existing 0 new size Shed:❑existing ❑new size Other: LAC auL V)�-- Zoning Board of Appeals Authorization Cl Appeal# (A- Recorded❑ co 3P, Commercial ❑Yes .No If yes, site plan review# , rn Current Use Proposed Use BUILDER INFORMATIQN; �,. Name 7- o .yi.a_4 Telephone Number Address d a e- License# C Home Improvement Contractor# f 3—V 9 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE e FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r' - t OWNER ,k DATE OF INSPECTION: ' - FOUNDATION x FRAME a G INSULATION `p FIREPLACE i f ELECTRICAL: ROUGH FINAL a - `_ PLUMBING: ROUGH — FINAL GAS: ROUGH FINAL FINAL BUILDING (' ` DATE CLOSED OUT ASSOCIATION PLAN NO. s- j • r- The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_=� 7 del Z JOB LOCATION: d It/ 0,0 L�,&L,j 4 d, number / street/ C village "HOMEOWNER': ��d' � � /�rJ �d •age, name home,phone# work phone# CURRENT MAILING ADDRESS: 0 's?ea iRJ e146 d/ city/town ` state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. , Si ature of Homeowner A roval of Building Official PP g . 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:EXEMPTN a ;Z�* j . I. t yy1F. L - I _. - . .. ..:_ .. v .. -_ y.. - .. _ "..:.e .. L 8': S d i �1 M .! 1 4 ti i -11 1 I - .. [[[iiik ._.. x. z F N ., - t : r f.�. 11 t- ~� 3 A. ; 7y Z_ - k, . .: % = . M ,.. 1. ; . . . - s gg z N- 1. �I. 3Z 4.T g• ps Z zT 3iet I - . sI . Air fYI. . f p. a 25` 4 Q �: E r - t I �-- z - _ (s,oaa� s � . � , i � r� _ Q a 7 1 j}ff 0 I i -!�, ` %�- F�I - - - _ � �. l . .. �: N - - 5Z ao '1 i Z 8T ,.. . ,. .> } - :! - - -i t. i. ,. SS . j2 BT �= ! o I ra. 1,..1 cvT 1-1 i 1.1 `F'F F'a...C�C o P L.,e►.L tV - . <:y,_ . .m.�:n A. ..:�. ..�,., r _ .yr.,,;n,.,;, -...s.+'c'.omwe.:.tv'� .y;.� v.-.... .Y.v'.v.- TM1,. l _ ^. _ 4'.— .• ...5�a•s �7.r:a - " Pie.g Y .� r : - t_ . r 11 g �` F� r f f= v'- _ _ _ . % *, _ ..f rrm.. _.. ,_r ,. ` . V 1.e F'vt 11.. 1�t.�S f V. •; _ .�,. . c 4 -a t�4, r l.y'.gi '` 'I ` M l^G did{-.' Y-A �"� ' t s� �` � - f�- � '""I�' e l l i .i .1: 7i .,. 3 @ . _t1 m''. ''-�zr�f'. .. c o- 'mil,.r .,.F. !d r: , !- /i &ufi-",a t et f + t ..�c a"� l.. „�ye P f -,.ti rt y sa a t ;� -! rya- - - ..j ..c-R a 3.F fa` -* Y t } �1' !5s 7'?,.t r d•Twf—r- f�t�'"!'+a . �.'Fg:,.. C s-11 q,' 11{�f Al, . } t .:"4� �Lo = y a = . i �,. { x ;. aj6 t k y' z � su v,�. r r' MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date . CITY: Hyannis . STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-28-2002 DATE OF PLANS : TITLE: COMPLIANCE: PASSES Required UA = 166 Your Home = 142 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 540 38 .0 0 . 0 16 WALLS: Wood Frame, 16" O.C. 920 15 .0 3 . 0 61 GLAZING: Windows or Doors 110 0 .400 44 FLOORS: Over Unconditioned Space 450 19 . 0 21 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with -the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of 'the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date f MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE: 5-28-2002 Bldg. Dept . Use CEILINGS : [ ] 1 . R-38 Comments/Location WALLS : [ l 1 . Wood Frame, 1611 O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1. U-value: 0 .40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed . lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors.. MATERIALS IDENTIFICATION: [ ] . Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 .0 . DUCT CONSTRUCTION: ( ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. ELAR ,STAB The Town of Barnstable 1639' Regulatory Services �0 � AlEo►�►i' Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax:• 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction,alterations,renovation,repair,modernization,conversion, improvement.removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more thanfour 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: f V 4js -Vt� Estimated Cost 8 Address of Work: 5a bpt0 UtW .�y 14 r_J c-� 1,5 Owner's Name:__ Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded bylaw []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: Date ontractoi Registration o: Z OR Da a Owner's Name q:forms:Affidav The Commonwealth of Massachusetts ....... - Department o Industrial Accidents eP .t IV. UR. -- office ofinsestigations _ 600 Washington Street Boston,Mass. 02111 Workers' Cam ensation Insurance Affidavit name / �r 6 e�l,��► /��U/mac S location ci I^� e�A6.�.►� hone# am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one workii in ca achy I am an e 1 er_ roviding workers' compensation for my employees working on this job.11? ❑ mP oy ioit"`sir?' iairr • ���.tiSS:sr::;:;::t+::}•:<;{;:j?Sj;?.i;:;:i�?;:y;Y.,+.j:;v;:{y;:;;y`.;:Sri.`:j+;<:?�}:.:'; }SY,'.Y]ii:,n?;.C:i'? .;`<:;:?;:!;'isj�:�;:;i:;:;+:;:i:>5.sy>i':i:;i:;is�:;:j�:;:}`::{i?:i{??:j{is:{:;s4:;::i:•,:�:?i''?:j}::;�:j;i:;;::�i:;:;:��:>.;:{yi>:}'i:::�:�:`�::C':;:Ci;:;{:;:;'i,.�i:;{..�>{�:..{}{:?;: a Mom ? ................. .G �tiSlTan ❑ I.am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have � - . . . M1 .. . . � ,,..• . . _ lices: ation o ens - thefollowin workers comp .P..........................:.:...:..........:.............:..........,.::::.�;.�:::........:..::::.......:......::.......:...........:..............., „rrr:;�'�.n.. ..........:.::.::................. 'am . .........::. rci4r: .::::::.v:::::::h;}}:;•}}:•�•::•}:•}:?;:.... v???•}:•}}:-::::.v:'4:?;:::}:4:w.�'fjii:;.}:S}.:•}?i:�;}}}i}:::}::}i: x:.:.:}..: }.4:}:•:?•W}}}}::.}:::..........:��> +.. :.::..........................:.:..:..............:..:............ :4a;;•::;:. siz::::<:::'« '•ti:=::;%: :#' :;....:;.»:r: > `•::;.s:> :#.>:`%>:<:> >:zi:;:;:::;?%:is>:z:?:>=r::%::?:i.>:?...:.:. 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"•'t:::�i;�':;�:�?`:':>��%`'.�:$:::�:•..:'::�':�';;:<<:�.''`� :�:;;t;:y.'�::.:::::: :<:;3.%;.;.;..'.�:;:?�::.�.Si%": :::::::::::::: �:`!`:`;':%3i:.;.;�:<:.%�:':?2�.�it�r::::`:'::;?:::?�i<:`.`:::''%:'t•`:�:?:�:: `.:.:'`is�:$i::. �.: ?` ....t.. .....:.... �adifress.. ........ ,:..... .........::................ ..........:::::r......,...•r.n;;�.x}::r::•}}'r}:•........r...,{..........,. .::::n ....................:::::v.,,,::r::r::::r.n• ,...r::::•:.,• .�••.�•:•. .4{:iQ�.: .................... 1:....} :v.:._...r....................:•::•::.:.............r.... ......:...... .n.. ...........,4,::::...... : ...............•,•.:,.....it....;yi.,,?•.?.-::�.:::..:v;•.:•:Y i}::iW-'f:???:.. ,ri•:4i:}:•:`'• Failure to secure coverage as required ender Section 25A of MGL 152 cant ad to the Imposition of crin►inal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP wORK ORDp:R 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. --. Tdo hereby-certifyunder-thepains-andpenalh—es perj' ry-that-the-information-provided-aboveasl =r te_wd-correct _ _... Signature /I . /7 Date Print name' ,�'�, e.✓�s¢..:r� �.✓1 e Phone# -5 official use only do not write in this area to be completed by city or town official city or town: •' permit/license# • ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _❑HealthDepartment contact person: phone#; ❑Other (OmrA ed 9/95 PJN 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 pgntract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the.legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe 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 ale required,to ob-a a workers' compensation policy,please ca1l'tlie Deparment at the number listed below:. PA City or.Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom'of"& 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.pernntllicense number which willbe used as a reference:number. The affidavits may lie ietirn dto the Department by'niaiT of FAX unless other arrangements have been made; " The Office of Investigations would like to thank you in advance for you cooperation and should you have any_questions. . please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Ineesduatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727.7749 phone #: (617) 727-4900 eat. 406, 409 or 375 I RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 S Alterations/Renovations $25:00 Building Permit Amendment $25.00 . FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot c x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.fL >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= . STAND ALONE PERMITS Open Porch x$30.00= (number) Deck �_x$30.00= �O (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 . Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost SMOKEG BARN TA L=: uii,�i�v:� �.Cws7 C9 2 tv ok F,,lrs o/1— 5 7' la�4o Mp1N StREEt LOCUS INFORMATION REVISIONS: NO. DATE DESC. N SO"StREEt CURRENT OWNER: JEFFREY&LAURIE BROWN OVERLAY DISTRICT: AP _ HYANNIS TITLE REFERENCE: DEED BOOK 20372/154 NITROGEN SENSITIVE — ZONE NOT A ZONE II PLAN REFERENCE PLAN BOOK 250/63 FEMA FLOOD — ZONE DISTRICT: 'C', DATED 7/2/1992 — LOCUS y1 W ASSESSORS MAP: 307 PANEL#250001 0006 D — PARCEL: 55 a r MINIMUM LOT SIZE: 43,560 S.F. — > 1n ZONING DISTRICT: RB EXISTING LOT SIZE 15,524t S.F. SETBACKS: FRONT 20' a vaWi SIDE 10' EXISTING LOT COVERAGE: 1,596t S.F. (10.31) 0 REAR 10' LOCUS MAP I CERTIFY TO THE BEST OF MY NOT TO SCALE PROFESSIONAL KNOWLEDGE. INFORMATION AND BELIEF THAT THE LOT CORNERS, DIMENSIONS AND SETBACKS TO THE STRUCTURE AS DETERMINED BY INSTRUMENT SURVEY AND AS SHOWN ON THIS PLAN ARE CORRECT. PROFESSIONAL LAND SURVEYOR DATE CONCRETE BOUND FOUND CERTIFIED PLOT PLAN S7r4g'00 E AT - _. EXISTING DIRT DRIbEgAY 9 S7r 00 E #50 WOODBURY AVE. � 4 S 49. $$ 1 t 3308, IN DOE ,Q m /�'8,,,- °6•a6 Z HYANNIS / bI NGA EWE- 30.00' MASSAC H U S ETTS j N�I °w l I CONCRETE (BARNSTABLE COUNTY) jGAS 1 �o BOUND FOUND 1 METER 1 WATER GATE I 40.00' ai GAS® I CONCRETE M I 44.1' 1 GATE I 1 BOUND FOUND MAY 9, 2007 EXISTING / DWELUN 1 $ I 1 26.0' 6 I I PREPARED FOR _e ;1 FLAG � Q MRS LAURIE BROWN POLE 1 1 50 WOODBURY AVENUE 1 I EXI G 1 HYANNIS, MA 02601 I 1 � 1 / DRIVEWAY 1 1 I / EXISTING \\V I / ONC ON 64.6' 1 '° ; m ; BSC Gl W V 1 — iR ° d�, L 1 / 0 ;1 349 Main Street, Route 28, nit 0 SLr 1 I West Yarmouth, Massochus is � �ENE I1aA ; I i 02673 � 1 I 5� 1 508 778 8919 O.W x\ �J I 1 © tam TIN BSC mew,Jr.. it?.e7• X\X 1 I SCALE: 1' m 20' I 0 2.5 5 10 �. 0 10 20 40 �m PROD. MGR.: CRAIG FIELD FIELD: D. GAZZOLO /J. McCARTIN CALC./DESIGN: K. HEALY J DRAWN: K. HEALY CHECK: CRAIG FIELD FILE 9226-CPP.DWG DWG. 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