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Home My WebLink About0988 BUMPS RIVER ROAD �, � _ .- a � � a ... . t � ,. � t .. � c � �.. '_, ,� a '.. � � � y y ..: �:. � r � a f .. � _ ... �. .. y � o A • c e .� . n :. � r v. _ ,_ ..- .. .a s � .. .. �.: -.. - - � �n�. . .. � ., .. _. n � r 4 _ ,. ,,. _ :.. ,. ,, �: .. .. .. _. 8 - r " - v q �� „ . `� a - ... .. � -. ' � o ,- .. � :' .. n � _ 4 . i'.i n ., s �- . � .. ,. .; f .: ,. + i o - c ,; e �� e Jo wn `of.Barnstable' *Permit# ' �{ Expires 6 nwnAs from issue date rvi Regulatory Seces Fee BARNsraBr E 9 ]WASS ' . �pT16 59.�� Thomas F. Geiler,Director X-PRESS MST Building Division Tom Perry,CBO; Building Commissioner r SEP 25 2012 200 Main Street;Hyannis,MA 02601: www.town barnstable.ma.us Office: 508-862-4038 , 'OWN.OF # LE EXPRESS PERMIT APPLICATION RESIDENTIAL- ONLY Not Valid without Red X-Pr ess I r'mp tut Ma P.P ip arcel Number C/ S Property.Address residential Value of Work . Minimum fee of$35.00 for work under$6000:00 Owner's Name&Address Contractor's Name Telephone Number 19.3 I� Home Improvement Contractor License#(if applicable),. P Construction Supervisor's License#(if applicable)f ❑Workman's Compensation Insurance _f Check one: ❑.I am a sole proprietor XI am the Homeowner ❑ I have Worker's*Compensation Insurance Insurance Company Name . Workman's Comp,Policy Copy of Insurance Compliance Certificate must accompany each permit. = Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping, Going over existing'layers of roof) Re-side / �� #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows Smoke/Carbon.Monoxide detectors 4 floor plans marked with red S and ins peciions.xequired Separate Electrical&Fire Permits.required. *Where required Issuaucc ofthis permit does not exempt compliance with other town department regulations,i;p.Historic;Conservation,etc- ***Note: ' Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License'&Construction Supervisors License is required. i . SIGNATURE: Q:IWPFI MT0RMS1bu$ding permit fbrms0PRES3•doq p tt , 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): . l Address: 23 66 &&_bA v�1 a City/State/Zip: ' l 4—> Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a Y emP to er.with 4. ❑ I am a general contractor and I 6. 0 New construction . employees(full and/or part-time,).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y p tY• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' co right of exemption per MGL y [N mp. 12Roof repairs 13 insurance required.]t c. 152, §1(4),and we have no .DK Other � employees. [No workers' � �� Jtctg comp:insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy.information. t Homeowners who submit this affidavit indicating�they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#; Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of . Investigations of the DU for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si afore r / Date: .�"'_��.�-�-- D Phone#: Official use only. Do not write in this area,to be completed by city or town official y City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2:Building Department 3.City/Town Clerk 4.Electrical Inspector '5.Plumbing Inspector 6. Other Contact Person: . Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the ...dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line: City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"I:he applicant should write"all-locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license orpermit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address;telephone and fax number: The Corn onweaM of Massachusetts Departmemt of Industrial Accidents Office of Invest gatims 600 Washington Street Boston„ MA 02111 Tel. ##617--727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax##617-727-7749 w.mass.gov/dia :1 f Town of Barnstable P "s Regulatory Services RUNSznsr.E, « Thomas F.Geiler,Director, . v MASS. 1639. Building Division . rfD MA't A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 r www.town.b arnstabie.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: OCC t�E JOB LOCATION: number street village "HOMEOWNER": C�✓L�.� �.ST'F1Pb+i. �� name home phone# work phone# CURRENT MAILING ADDRESS: ? " l city/town state zip code The current exemption for."homeowners".was extended to include owner-occu-pied 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 suP ervisor DEFINITION OF HOMEOWNER Persons who owns a parcel of land on which he/she reside( s or intends to.resi e P d ,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 BarnstableTBuilding Department minimum inspection procedures and requirements and that lie/she will comply with said procedures and requireme 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. Q:forms:homeexempt 1i �TNE Toys Town of Barnstable Regulatory Services •. snxivsresc.E, • y M+ss. g Thomas F.Geiler,Director 4� 059. Building Division Tom Perry,Building Commissioner'. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8. Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit: (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 62012 p SlZs�b6 Town of Barnstable *Permit &6� 2 I eP Expires 6 monfhsfrom3aI' de P�RIWI egulatory Services Fee MAYThomas F.Geiler,Director To 4 2006 Building Division Ng7-qjjt Perry,CBO, Building Commissioner 00 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint dap/parcel Number /6 8 ®7.5- ` .43 'roperty Address � o (?--LLB Residential Value of Work - � Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address contractor's Name -%� bv�lA,�� -�C.S'f'((2�/� Telephone Ni mber,5 07 Some Improvement Contractor License#(if applicable) Ye:_Z=z construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp:Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All constriction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) >�Re-side N� F- b�. �02 ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.masSgov/dia Workers'-Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AnDlieant Tn.formation Please Print Legibly Name(Busiaess/Organizatim/Individual): � Address: Ci /State/Zip: v< Phone M. Are you an employer? Check the•appropriate bog: 'Type of project(repaired): 1•❑ I am a employer with 4. ❑ I am a general contractor and I 6• ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $• Remodeling ship and have no employees These sub-contractors bane i3: ❑ Demolition working for me in any capacity. workers' comp,insurance, . g, ❑ Building addition [No workers'Cep.insurance [3 Ve area corporation and its officers have exercised their 10.❑ Electrical repairs or additions required,] 3 I am a homeowner doing all work right of exemption per MGL 11-❑ Phimbmg repairs or additions myself.[No workers' comp; c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp,insurance required.] ' 13.❑ Other *Any applicant that checks box#laaust also fill out the section below showing ibeir workers'oomp=_%atioa policyinfbn=tiow t Homeowners wbo submit this affidavit indicating they=doing all work andtben hire outside contractors must submit anew affidavit iudicsting such =Contractors that'checkc fts box mnst attached an additional sheet showing The name of the sub-contractors and their workers'comp,pQU0yinfarrnj9tiva. I am an employer that isproviding workers'compensation insurance for my employees. Below Is thepolicy gndjob site information. Insurance Comp any Name: Policy#.or Self-ins,Lin#: Expiration Date: Job Site Address: 1 � rW L,,=, City/State/Zip' r� A:� /1�� -2 Attach a copy of the workers' compensation policy declaration page(showing the policy number and eaplration date). Failure to se=' e•coverage.as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,90 and/or one-year m4msonmmrt as well as civil penalties in the form oi'a STOP WORK ORDER and a fine of up to$250.00 a day kgai ast the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Signature: �? �S Date Phone#: ��g 7` � -:�/?02 Official use only. Do not write in this area,to be completed by city or town offieiaz City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Deparanent. 3.City/Towa Clerk Q.Electrical inspector 5.Plumbing Inspector 6. Other Contact Persona: Phone#: ~ .�./bi.i V i iii��ri V ii �».J. �.T ia.i 7J�'i �•��'VI v ai N Massachusetts General Laws chapter 152 requires all cmployers to provide wbrkers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.&al or written. t An employer is defined as•"an individual,partnership,association, corporation dr 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 aVloyer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants ?A, Please fill out the workers' compensation affidavit completely,by checldng the boxes that apply to your situation and,if necessary,supply sub-contractors)nanre(s),addresses)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLQ 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 tb a 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 comp arEics•thouild criterthe3r 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 fin out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pernrit/license number which will be used as a reference number. In addition;an applicant that mist submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under`Job.Site Address"the applicant should write"all locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that•a valid affidavit is on file for future permits or licenses, Anew affidavit must be filled out each ' year.Where a}home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, of hesitate to give us a call. Please do n gn' 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 ob 1-877-1viASSAF ' Fax#617-727-7749 Revised 5-26-05 www.mass.gov/&a C� �v-t, � � �� , � s (2��e� 6Z � f ��2� �� S� � � 25-�- � � ` � � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r ' Map Parcel Permit# Health Division r ' Date Issued O I 4` �v Conservation Division .S,gad D 02-0 V? Application Fee Tax Collector Permit Fee 2 e� G SEPTIC SYS a Ear) MUST UE Treasurer d ' INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE$ ENVIRONIVIENTAL CODE AN4 Date Definitive Plan Approved by Planning Board TOWN REGULAMNS Historic-OKH Preservation/Hyannis Project Street Address Y Village Owner � lut .r.S _ U 61� Address Telephone Permit Request i ` -& f o (' Square feet: 1 st floor: existing �'� proposed ( 2nd floor: existing proposed Total new Zoning District Flood Plain groundwater Overlay Project Valuations U Q-D Construction Type ITA Lot Size �,'� � Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Flo On Old King's Highway: ❑Yes l�l`o Basement Type: ®'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ !cK-fly 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 3 Heat Type and Fuel: 216as ❑Oil ❑ Electric ❑Other c51" 'v�,.rr �yI- Central Air: ❑Yes fNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Vdxisting ❑new size Shed:Cl existing ❑new size Other: ? It s co 1 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ C' r" Commercial ❑Yes (WVo If yes,site plan review# Current Use Proposed Use �� EN t BUILDER INFORMATION Names Telephone Number � � o Address License# 0 9 UA ) v �r4A Home Improvement Contractor# JJ,, Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE662:7r-�-f f/ ' ' /`� I DATE R. FOR OFFICIAL USE ONLY PER NO.14 j DATE ISSUED MAP%PAACEL_`&O. :5 ` �� 4 I! ADDRESS OWNER DATE OF INSPECTION: - s -4.. FOUNDATIION — D FRAME INSULATION— FIREPLACE 77 rl ELECTRICAL: ROUGK- L FINALs � PLUMBING: ROUGWI, C "! FINAL- GAS: ROUGH'S g FINAL FINAL BUILDING ... V"1 45 DATE CLOSED OUT ASSOCIATION PLAN'NO. } 1 . • . r J / a a j , r L� r —___ The Commonwealth of Massachusetts V - Department of Industrial Accidents -- Office of1,0851i9-MMs • : - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit 4) G n- . location: city "'� rX , � phone# ❑ 'I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one worldn M' ca achy ' ensation for m e to ees working on this job. 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IYl�. ..� ... ... ............ ...... ... .. ...�. .. ... ❑ I.am a sole proprietor,general contractor,or homeowner(circle one) and have hired the'contractors listed below who have following workers' com ensation olices:.:..............................:::.:.:.:::.:::..r::::::.:.:::::::::.::.}Y:.:<;.;:.::{. Y:.:;.Y}:.YY:.YY:;:.}:.:;;.};:.;:.:. 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'.v:YJi.:i• • ................:v:::::::::::::::::::::::::::iw::::.vr:::::::.�:::.............r::.::...........v.....,...lw.v::.�.vi:::�::• r..,..... .....................:............................ :�...........:..:.....}••..::::::::::...:...:.,:.:�•.�:••:Y:•::•...r.:.:.:?•Y}::•YY:;.}:Y::•Y:•Y:•YY:•:;•:%:=Y}:•':::::%%i%::::.Y:{?•}:;::',•";;:•;:•:;{:•:`•;'::;:':}::>%}%:^:;<;.:.:]:{?{?;.�Q1f ... ..... ...:..... ...........:..........:: fii+lIIT81LC�::GQ«::%>t:::::><::<::.>%Y:;;;{•:•:::;r?;?{?•Y:•Y::.Y::{<.::::�::::::.:•:::...�:...................... ��/ Facture to secure covers=e as required under Section 25A bf MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civII 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 c fyunderthepi ins-and penalties-of-perjury-that-the-informationpr-o-sided-above_is_tr-ue.an�cor-rect ' Sipature � Date (W �• Priest name . ;Phone# ' .. official use only do not write in this area to be completed by city or town official city or town: permitAicense# OBufiding Department OLicensing Board ❑check if immediate response is required ❑Selectmen's Office _011ealth.Deparhnent contact person: phone#; ❑Other (Fevised 9/95 P7l) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including 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 situatioa'and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Deparbment.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`9aw or if.you are required•to obtam a workers compensation policy,please call.the Depaitinent at the number listed below:. VEEN Oil City or.Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the batt� 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.perEMc_ense num ber which will.be used as a reference number..Tlie affidavits ma the Departlneiit tiy'mai7"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�ueshons, . please do not hesitate to give us a call. The D artnient's address,telephone and fax number: • ` The Commonwealth Of Massachusetts _Department of Industrial Accidents Me of Investigauans 600 Washington Street " Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �oFSHE►� Town of Barnstable P �°^ Regulatory Services 1ARNSPABM " Thomas F.Geiler,Director 39.� MASS. �ArEDMA'�p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: �� ' ° ,-r r Estimated Cost 0.. ru J Address of Work: '' � rA Owner's Name: � d��/ : 5 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 thjaent of the owner: Ad AJA Date Contracto Name kegistration No. OR Date Owner's Name Qhmis:homeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORMHEET E NEW LIVING SPACE�� -� W x.0031— �• 11(M, square feet x$96/sq foot= 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.1 ` , >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: x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck _x$30.00= (number) Fireplace/Chimney ______x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost 92. �omynianufea o�� ac�ucavE Board otBuilding Regulations and Standards HOME IMPROVEMENT CONTRACTOR a Registration: 117610 y Expiration`:TO/25/2002 Type INDIVIDUAL I ST EVEN L.MB LLOR:' I I. ST E1rt�N ME1,.LOR. • 199 PERCIVAL 0RtP0 BOX 334 o W BAR NSTABLE,MA 02668 ' I Administrator. -� BOARD OF BUILDING REGULATIONS License INSTRUCTION SUPERVISOR Numbei< 049879 1 BirttEdate p1957 j M r , _, i /22/2Ek- 104 Tr.no: 198 Rea� bi00 s ° STEVEN L MELLORh 199 PER'CIVAL D'R� r W BARNSTABLE, Administrator ' DRAWN BY ri 4 —_ Gfylc �aW � Roo®'RT.WlNOaJ — _ ,sId Toll I• i�c vec�dcc. REAR ELEVATION 71G' bb° 7%& Li ---....... R-(ELEVATION' - Rao aa'T�o SD�6o-t¢o cE�uN6' . S oft PRR.LborY- kpicA" --lay TeGao w�W. �y�a ibf aK�-o+Pa�-gin tilc!F ou1N6A R.I�Nfe l+o C GWt$ <+ TIMM SEASONS PORCH 6=9' 4=3' .�twµsa_casa*i: dZcf �, =6^ _Q".PbilR.ac-a(bClM1N5 R SECTION - - --I:Sn'rvurva.an!a:xa�v^_occ. Tab],353-115(oastbss+dj p�vcripttre Fasb pact-Ta for daa aad Twe-Fsm+� Asaidaa�3a1 B�d3distt Aar wrt��O� 11iA?QhiUM Rraii FlowBsaemast 't1� a pig . GLudag ccu at RrvWall P'ecic� A=es!(•/.) U-vslu•cl R-vxlu2 R-valua� R Packs?e S1D1 to 6500 H p D Nas�aal 11 19 to . 6 Narsaal Q 12'.'. 0.40 t 19 10 6 g 12Y; 032 30 19 i3 AFVE 13 19 10 ' Nasaal g 12:4 030 3t 7S WA Nlt T 15% 0]b . 3 t 13 6 Noizaal 3t 19. 19 10 tS AFVE 0.46 13 ZS VA. 1ilA y IM/. 0.44 3t 6 tS AFVE 19 ID ' 19 ortasl ■ 3 o N R' 15 t. 032 13 25 WA ?>!A U2. 3t IyA y f E'!. ' 0.42 3f 19 6 90 AFVE Z 1E•/. 0:42' 3t 13 19 10 6 90 AFUE M 1EY. 0SO 30 19 19 10 A ADDRES5 OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTEEtIOR WALLS: Q 3. SQUARE FOOTAGE OF ALL ciLAMNG.' • #3 DIVIDED BY#2): L 4. /o GLAZING AREA( 5: SELECT PACKAGE(Q— AA'see chart above):' R MORE IN E VOLVED METHODS OF DET MINING ENERCy REQU�M» S r NOTE: OTHE ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: ,YES: N0: gdarm5-f980303a • Footnote's to Table J5.2.Ib: t Glazing area is.the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights. and basement windows if located in walls that enclose conditioned space, but exeiudlig opaque doors) to the gross wall area. expressed as a percentage. Up t aria may 1% of the total glazing a may be cxc requirement. the U-value For example;3 ftl ofdecorative glass may be excluded from'a building design with.300 ftz of glazing = After January 1, 1999, glazing U-values'must be tested and documented by the maaufaenuer in accordance with acional Fenestration Rating Council (NFRC) test procedure, or'taken,from Table 11.5.3a. U-values are for the N . whole units:'center-of-glass U-values cannot be used. The ceiling R-values do riot assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness• over the exterior walls without compression; R 30 insulation may be substituted for R-a 8 insulation and A-38 insulation may be substituted for R=49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if.used). For.ventilated ceilings,.insulatiag sheathing roust be placed between the conditioned space and•the ventilated portion of the roof. Do not include wall R-values represent the sum of the wall cavity.insulation plus insulating sheathing (if used). exterior siding, structural 6heathing, and iatericr•drywali.For example,an R-19 requirement.couldbe met EITHER by R-19 cavity insulation OR R-13'cavity insulation plus R,-6 insulating sheathing. Nail requirements 'apply to wood=frame or mass(concrete,masonry,log)wall.construct dns.,but do not apply to metal-frame construction. 'The floor'requirements apply to floors'aver unconditioned spaces(sttch as unconditioned erawlspaces,basements, or garages). 1?loors over outside air must meet the ceiling requirements. must The entire opaque portion of any individual basement wall with as average depth less than 50%beIow grade met: the same R-value requirement as above-grade ywalls. Windows and sliding glass doors of conditioned br..,ements must be included with the other glazing. Easement doors must tweet the door U-value requirement d-scribed in Note b. ' The R-value requirements are for unheated slabs,Add an additional R-2 for heated slabs. If the building utilizes eleetric iesistaace heating use compliance approach 3;4, or S. If you plan to install more than one piece.of heating equipment or.ml rt�than one pie= of cooling equipment, the equipment with the Iowest efficiency must meet or exceed the,cf ciency required by the selected package• For'Heating Degree Day requimments of the closest city or town see Table 35.2.1a. NOTES: a) Glazing areas and U-values are maximum acceptable.leveIs.Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only grid do not include structural components. b) Opaque doors in the building envelope must have a U-value no gr==than 035. Door U-values must be tested and docttittenzed by the manufacturer is.accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.* One door may be excluded from this regi irement'(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the am-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(().35 for doors). . _ 43 r k ' ` 4 f � I y 1 o \ {•. r} 1. - � `\ -44 ; ., 7419 •', t M 25 P TA Q1l.,:` Div • ri0 r d 6 � tI f!�.' V1 kCHARD y . T{f TW su T_ 5-2 CAL PIA�.T`• T,:1�/6`. .ov1� ;; P�LFO LOCATION �wl-e EvT/ ATd�RY 'TEE5i LoCTI i Zl EuF�-.�(rIGL.E.,6 TIA: �aa)(TM7, L,YE I'-JC. - �. ��'•�•• �.� r�',x�CJ tP��,s? �j REGISC'G�],ZFs't� 1...�iJD 5uev�YoeS Sd Ys ^,i {i;N�i*f.. "CNE. OFs=SirTS. .SNoWt.a' •��.• AP.Pt_t � SarV t'.tCs ;,Qe`T «JC Lq'T LI�J`5 Assessor's Offi Parcel Permit Conservation O 3 ffice: 4th floor :30 9:30/1:00.2:00 tr,)sec � '(Z.4�� Date Issued r a Ir ( )(8- ) V Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Gt / --qlp(74 Fee /X44 ,s— ® Engineering Dept. (3rd floor) House# ZEE THE . Planning Dept.(1st floor/School Admin.,Bldg.) RNSI'ABLE. Defin' ' an 'proved by Planning Board 19 r EO MAy TOWN OF BARNSTABLE ; v 94PBuildin .Pe it Applicationo'ect St' t Address Village+. .17 Owner. Address es( ' r-per (2t 6s.- �. Telephone -Permit Request First Floor square feet f Second Floor square feet Estimated Project Cost $ J-7J-2) Zoning District / � -- / Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling YP g Y i Type: Single Family ✓ Two Family Multi-Family �y Age of Existing Structure S Basement Type: Finished Historic House 96 Unfinished Old King's Highway /l�d Number of Baths 1;1? dZ No. of Bedrooms Total Room Count(not i uding baths) First Floor Heat Type and Fuel Central Air �� Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone Number Address License# 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 DE IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE IT CL BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. L 3 ADDRESS VILLAGE _ OWNER r DATE OF INSPECTION: E , r FOUNDATION FRAME INSULATION FIREPLACE ^4 ^t ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING DATE CLOSED'OUT ASSOCIATION PLAN NO. s i r y The Contniall"'calth of'Massachusetts ,i .ii icy Dcparinrefrt of Industrial Accidents 61111,Washington Street Workers' Compensation Insurance A1lidavit �licant information= Plestse PgWrle t iv �w U `' I am a homeowner performing all work myself. I ani a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. co_mnn�•name• nrlrir�c• � . cih.. phone#- - incur�nce ce neficv# 1 am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who the following workers' compensation polices: comnanv name• address• city- phone#- incurnnce rn peficv# _ _ ••• _ � •c - .w--�.• -—' .�,..arr:s_•..se.e�-ever,r•s'�T•ra'�sr"7�� -- - - +P�!POT_��R7:!ALiD!S77F_� --L-� ---- comn-lnv name! - address, - city, phone#t incur'+ncc co. peiicr# :Atiachadditioaal•sheiiiftieeei'sar ��+»: •r'�� :+ '-�'� •�' :""'•� •""" Failure to secure coverage as required under Section:SA of DIGL 152 an lad to the imposition of criminal peaalties of a fine up to S1.500.00 and une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand tha copy of this statement may be forwarded to the OMce of investigations of the DIA for coverage verification. 1 do herch.r carif•under the pains and penald of perjure that the infornmrion pan ded above is rive and coffam �ate Signature J / � �[ v Mnt name �nh9 S /� eG k -S 0 ne# 12 a -t Cial•use only do not write in this area to be completed by city or town aMcial sin•or town: - permitATeense# 118oifdfng Department (3Uccm ug fiinard ❑check if immediate response is required aseleetmen's Ofnce Ofieatth Department • contact person: phone#: Mother__ • l Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for i employcrs. As quoted from the -law", an employee is defined as every person in the service ofanother under an-,, contract of hire, express or implied. oral or Nwitten. An cmplurer is defined as an individual. partnership, association. corporation or other legal entity, or any two or rr the foreaohm, 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 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 wort: on such dwelling or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo MGL chapter 152 section _'5 also states that even•state or local licensing agency shall withhold the issuance or renewal of a license or permit tooperate a business or to construct buildings in the commonwealth for an,% ,applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionallv, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the - P w • until acceptable evidence of compliance with the insurance requirements of this chapt_ performance public work p nee of p P 'been presented to the contracting authority. I ...r�.�...�-. .. '+.Li:f.,: . \T.�.:� .y.....,`Mti';i N...:�•.:.�Y' .•• S�•:. ..YL}:i� .r^►1,.:.:Y�. •_•ay ._.t..._ Applicants Please "I in the workers' compensation affidavit completely, by checking the box that applies to your situation an supplying company names. address and phone numbers 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 ra 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 requir to obtain a workers' compensation policy, please call the Department at the number listed below. _.�• 1_._..'A.R�.1►.I.. � .• .a•.A,• .. •... ••�K ..•/.: _. .'..�«M�-i;.• ...r�.'.,!.!V�".�?i�• �a..•.l�Jl.� �wi`..• City or'Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the botton- the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne 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 an),quest: please do not hesitate to ;,give us a call. -... ...�._........-. ...«.::.::r: .:..�:.«... .::. . The Departmenrs address. telephone and fax number- The Commonwealth Of Massachusetts Department of Industrial Accidents .r. Office of investigations 600 Washington Street - - Boston,Ma. 02111 fax#: (617) 727-7749 The Town of Barnstable Department of Health Safety and Environmental Services .e Building Division 367 Main StrCC4 Hyannis MA 02601 Ralph Crosses Office: 508 790-6ZZ7 Bing Comm F= 508-775 3344 For office use only . Permit no-__—. AFFIDAVIT HOME ZVROVEMENT CONIRACtORLAW SUppLMKENT TO PERMIT APPLICATION ctio alterations;renovation,repair;mod=iz==comas m MGL c. 142A requires that the"tecorutnr n. � paatt.,remrnal, demolition. or conseuaion of as addition my P •� building containing at least one but not more than four dwelling units or to -z aches to such residence or building be done by rcg stor s ed cmm=tm .with certain ado= along requfremenm V Type of Worts: Est, Cost Address of work: �a OR-ner.Name: Date of Permit Application: I hereby certify that: Regisuation is not required for the following rcason(s): Work excluded by law Job,t ,°°° ng not owner-occupied Owner pt>IIing nett Permit Notice is hereby gz`'=that: CONTRACTORS � OWNERS PULLING TfIEiR OWN PERMff OR D WORK EALING DO NOTrrREHAVF S TO THE FOR APPUCAHLE HO1VlE IIueROVEiVffiN'C ARarMATION PROGRAM OR GUARANTY FUND UNDO MGL c. 142A SIGNED UNDER PENALTIES OF PMOMY I hcrcby apply for a permit as the agent of the owner Conuaaor name Registration No. Date OR . PAX 420 3640 Designed For. T�L7Z'�T242l-/1IZE-.1 Del�Lr-- This isan original design and must not be released orcopied unlessapplicable, Equipment KITCHENESIGNS q fee or deposit has been paid or order placed. and Address `�� t,...es kr.Ue` The Purchaser understands that an order has been placed and any changes In BATHINC. i /,�. 1" measurements or appliances MUST beapproved byKB B Designs Unlimited. Specifications TOM F. LECKSTROM C.K.D. City. /I�tate: -zip: oa-f. Approved gy. Date:. Range Certified Kitchen Designer 5 Parker Road.Oste -41 Mastachusefh 02e555 Designed By. W/- r kc=, t �-��Stale: T m 1'0" All measurements are finish measurements unless otherwise noted. Cook Top Cook Top wall Oven Microweve _ _ ... Mood zx�.lzaFTE es.-rL".o.c. Compatrfor -.. --- —,e5 AQGN ITEGT SE W ES --__- i wa.her ASPHALT 5HIFJ(;LES TO TOFOF 4r_ >-iE..3El-EGfED C3Y AVl�IEPi _ •ng Freezer ea Maker L__ _ __ ,r l .. I _ �-- .III_ �VN ITE GGf�AZ SH I I-Y�I.ES N; +i I - I ink SO:-KI TGH EXIST'Ch.1-464SE I jJ—i 1 . Sink I t I I I I I 1. ;_ 1 I .1 1 I I I J- r _ I j ! POST I l I 1. 1 ' I I L.I T i_ ql2'.GoRIJEfL G'`D. L1,43 - Leaded- I� Soffit I u I J IJ-LLI T�I LI I L.1 I I L1I I 1 G''HIGIH RT.SILI-r.Z"Clt P06aEG Glen Bela Cab Toe Spew I I _ram Flooring Material L�VAIT I O Q r rzowT(SDUTH) E L-E y^T I O 1--t Mood Venting �GfLLE%YA'- i'-O" Appliance Panel. A Under Cab lights . - Casing. Count.Top. . Back.pla.h CNlirp Ngt. Q6TE �/9r. PAGE zor z ® KITCHEN. Designed FOr 1- -rCTE=-r-- This is an original design and roust not be released or copied unless applicable Equipment . $d ��S fee or deposit has been paid or order placed. °' r NLIMITEAdd... o i11 �>oQ The Purchaser understands thaten orderhasbeen placed and enychanges inU INC and. � r ,�I// measurements oreppliances MUST be approved byK&8 Designs Unlimited. Specification., TOM F. LECKSTROM C.K.D. City. -State: y ZIR Ca�1— Approved By. Date: Renee Certlaed Kitchen Designer T _- s Porker Rood.OsteM�ile,MMossacnusetts 02655 Designed By. `y't^ � 1'f"t20�"�G�Scele: 1'D" All measurements are finish measurements unless otherwise noted. Cook op Cook Top Wall oven 2r l�1.1MP . Hood 3 ALICIH %/IM1IDow mpactor rr abler • e no "`Pr-lUFo2GED...I�DbIO.l1T1�IL Q I .SL�ij� oN 1pNTi F�O1.I5 '=C' i 2 X L��.FTE lZS Freezer I. I2EEP... FCD F7;�S/fS �-L�3-rll-IGrS- _ - 1&"O.G., F+AI-LI FPC>H Ice Maker 'n 3P N� +oi LLLI I ' 4Y2" �AGIA (3D sink -1-C8 i Ell B sort 'lY2"-GO ��^ i-Peo1-1 , _ PITCH �k" PEZ I-O" - r . i ' •4 ' I w I U o0w ra.1�2�2 Leaded leu _ FDofI i 4•-O^ �, (=OIZ.POS'T'r�'. J `i �— f ILw CAb TM apse Fl—ing Manrlal 2'-3"L Jy=�, 2•-3°. - i-ti-11 � i-' ' r Hood Venting 1 2'—O" Appiienm Pamir UncWr Crib Llohts S) 471 D}J A,-A._.__ Ca.ina. . Counter Top. eacksplesh .ALlI11'.1JJll1-'I -LAD DATE PAGE oFz ow"n 1 4ot �F co is• �� I � �i�'"1 r, ,� : "` t: �.t '- su Jec /77 .�µ� . . ... . .. ., a— T.14 G.6 rOOWDATIOJ'.5c-lowU PtA►.1 R�.1= �.1cE •�,.W IT s•A TWlr= 'S 1 UE.L1�-i� c tZ>= u,E?;cSY ?lCK' :REgt]tcZE�rti=j.lZ-s. of THE Lo.r . •°' '1 .tip:•=�•.•�.:.,'.'• Cl t'.. �:i `�' 1.... .Ft"'.a'•:.a• 'i��,::i-+�+•tl;;..tfi�:: 1:=''•:i.: �E�s•� •'�'-+��.(� t � L�f;;.T1-�� ,7 '•.L?,�,.AIJ tS '.LJOT'81�SE't7--0 K��, ; ;; ;;;;, S TEI�V1l1F3 w 'SU2vc focz.tQ�1J �E1J=' ; iZV G 1{ r r•' � Y.,�'c E. SETS SNot.a '`�"-='' '' ,� •. , ':• ";' '• 1 .. •'' ''.�! — - - - ADD 1 I oo A . t—`-� •---_:. _- , TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE . JOB LOCATION -Number Street address Section of town "HOMEOWNER" ./ �►.t /mac�csr �f�� o ^/�� 1 •'•:_ . Name Home phone Work phone-- PRESENT MAILING ADDRESS •�' City town State Zip coy The current exemption for "homeowners" was extended to include owner-occur dwellings of six units or less and to allow such homeowners to engage an—: dividuai for hire who does not possess a license, provided that the owner acts as supervisor' DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to side, on which there is, or is intended to be, a one to six family dwellii attached or detached structures accessory to such use and/or farm structui A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner". shall submit to the Building Off on a form acceptable to the Building Official, that he/she shall be respor. for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the Building Code -aad 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 requireme: and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATII APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be require 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 wh chYa buiic permit is required shall be exempt from the provisions ofmthis,-section Section Licensing of ConstructionSupervisors) ; provided tha Home Owner engages a person (s) for hire to do sch work, that such Home shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assun the responsibilities of a supervisor (see Appendix Q, Rules and Regulat for .licensing Construction- Supervisors, Section Z.15) . This lack of aw often results in serious problems, particularly when the Home Owner hir unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home"Owner -,� gas supervisor is , ultimately responsible. :. ... To ensure that the Home Owner is fully aware of his/her responsibilitie communities require, as , part of the permit application, that the Home 0- certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. You care to amend and adopt such a form/certification for use in your commu: Assessor's Office(1st floor) Map (Q g jParcel C' .S Peimit# /le Conservation Office(4th floor)(8:30-9:30/1:00.-2:00) f 1'V:\�� F-�Ne Issued i q__96 Board of Health(3rd floor)(8:15 -.9:30/1:00-4 45) J,& jP cXFee 3,7 '0q-0 Engineering Dept.(3rd floor) House# SEPTIC S ST BE No - -- 91�9STALLEAdmim 9ANCE _ 19 wl TOWN OF BARNSTABLE Tcff", � ' Building Permit Application Project Street Address_ _ �� `��r�PS R\\32� Ro LOT 3 Village p,5-yea bye\\.,e s � ,-.Owner---\6n -1= ��c3G� Ctc*,-s- o Address .Telephone ' VcZ.©•- \3�-\ ' Permit Request C C" ' ,{p i�*. N POOL f First Floor square feet Second Floor square feet Estimated Project Cost $ \2I bo 0 Zoning District Flood Plain Water Protection Lot Size QQ a5l } Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use l Construction Type C®PPCcL c2 L, Commercial Residential r ag 5 i Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool 1 W u 3S Attached Barn None Sheds Other Builder Information Name f YQ oL QcrZP Telephone Number s _,�Oi8 co I►1p Address L,;—i Q rr License# (fin 0, 5 fs Home Improvement Contractor# O Worker's Compensation# We 30n VIA cR C) NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION D I RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Wen a, DATE BUILDING PERMIT D NIED FOR THE L ING REASON(S) E FOR OFFICIAL USE ONLY c PERMIT NO. i DATE ISSUED MAP/PARCEL NO. r � l _ �• e + 9 ; � i ' 1 � 1 ( • C. ! i ; r f r ' r � r s• *'+ I. r t _ f I ADDRESS•' { 1 t VILLAGE OWNER DATE OF INSPECTIO FOUNDATION - a FRAME INSULATION 1 FIREPLACE ELECTRICAL: r R0`UGH FINAL . r PLUMBING: ROUGH - { FINAL r GAS: I TROUGH c ! ' FINAL i =' FINAL BUILDINGi' G err i a r, DATE CLOSED OUT;= r ASSOCIATION PLS-N� O. The Cotlttttottivealth of Atassachusetty Deparmiew of Ltdustrial Accidents 011fceol/nsestiffMONs r ;..;.._� 60(l li ushiii ton Sire ry ��., ►' Boston,Mass. 02111 fir.�v `- Workers' Compensation Insurance Affidavit Please PRi1VTle tbl Anntic2nt information a G„ e �: name iocntion city a Q e iT-e\o �\—e nhone# I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity /_....ear•• — `�] I am an employer providing workers' compensation for my employees working on this job. company namc t t . .. address: may• �P�.��S�o�'C �P\ phone#• 'J�� L,2.kinsurance co. # 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: comijany nam address: city: phone#• incurancc co oli # i'. ;:`u . _ c"`'`r.s .+7ywn- �-y�•i'T•rn Ns .+Sav_ .i�y� rs>�naamm�esr7T�r sa�R�a'i' _w^tau+ �3: 's^^^�s mavname: • address- ` cit nhone#• insurance co policy# ;Attach additional'sheet if iiecess �w :��-''""'=F�y' y'``'` = t ^= VIM.,'� -+x•_ �__ Fuilure to secure coverage prq, ' ed under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1.500.00 and/or one years'imprisonment acivil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement mayr to theOR of Investig ions of the D1A for coverage verification. I do hereby certifj,under d penald o erju •r l at the information provided above is true and correct. Signature Date Print name Phone# Econtact nly do not write in this area to be completed by city or town official permit/license# ri Building Department❑Licensing Boardmmediate response is required �Scicctmen's OfficeO11 jih Departmenton• phone#; nUthcr (revised 3,95,P1A) ' t i, _ ° of Ba rnstable f The Town 5 Department of Health Safety and Environmental Services Building Division 347 Main Strut,Hyannis MA 02601, OSOC: 508-790-6227 . Ralph Crosser F= 508-775-3344 Building Commissior For office use only Permit no. a. Date AFFIDAVIT HOME EVIPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement..remo%-4 demolition, or construction of an addition to any pit-eadsting owner occupied building containing at least one but not more than four dwelling units or to structures which are 2d3accat to such residence or building be done by registered contractors,with certain eeccepdons, along with other rogtnirzmeats. Type of Work: Est Cost L- oZI 0 Address of Work: Oarner.Name: Date of Permit Application: I heseb-certify that: „ Registration is not required for the foIlouing rcason(s): Work excluded by law lob under S1,000 Building not owner-ooCUpied kOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITS UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL C. I42A . SIGNED UNDER PENALTIES OF PERTURY I hereby apply for a permit as the agent of the owner. Date Contractorname Registration. No. OR [Tamer's name e.o{ E O r..r N o ti PI4 oC .. _ . . : co I. _ C ail T� cj 13AX1'C,i 1!- ., ;:. '` ,.7 v �„�1 ;tie ',:.��}'�'!. �� :� •f, r� � Ili. ?a:•.ti, r i� suo tEeT�F�En p�a�- t�L...a.ti,.1 C �rE i (L r '�' `•ate__!�_ :I=col /4 /�- lT;s-lA-r. ;TN6. ' DVhIUA'1"Id�.S�lo,,c�U pt AVl Rr-- ! $� t?+� GogN�Pt:�(5• ,W tTt•3 T1-lEs 51IIE.1_I C—. :.PitSt3�4GK''.tzgtlllZEAr«uTS. o� THE tzeG1S • h4•• �t"",��f:*f�M•!''�g�.4a�r•C�;..? y' .: .., .`sr- •:1..'. rcumi> IS. .�.IoT ►SE.�--o K; ;�� :;�;; r;;.L:p; ZE�.vi 5.; :JStp�1J✓1EtJT ; CJev `f., T1�Er. 0;:C'51=T4 In`r- itT: "t1�Gh[7 Tii :n�7r PA iQ1t -- l._DT LIWe< /iPPLI CAh1 L.-. FEE-07-1956 09:57 FROM FREDERICKS & GERARDI TO 15087603459 P.001i001 - :e. d'�• ' : i" �i•6"i�`^'y'', •:.i.y,:x:%:.: ,xs b.b::;.,3.:K:;:?':' ;iS;ri :iK eu; i•' 6m01tIP. N , urd ' Pg h x tt;$UE DATE (MMI)Dn ............................ry , R Rw # $ : b�rr� ''',3"d"tiL k ' R ,''? r ,• M ........• s " R• Y'4 '4 'iri h<. yykY� ».iE: `$ s°.Z' »;:, ?,?.0 Ry <....:....r. , .........,M ?'��!JJ G :rS�Jd:$ :d{ ...... i3 M $.x:;••nw i �4N :...:;.:'::i:<:3;:.:!t!::S:n^ii,•.i:ir:%4...C,L.:.u.:.hl,r:, .v. .., iararR PRODUCER THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS,UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Frodwicka and Gerardl ! POuCILS BELOW..",",,........... ......;..r.rr..............r.rrr................,.r.r..,.,,............,..rrrr,r.r........ :.............r......................... .r. Insurance Agency IrLC. COMPANIES AFFORDING COVERAGE 1313 Belmont Street Broc MA 02401- kton ...........r.r..rrr................r,r.rrr................,.,,,r.rrr............,,r, r......................r.r L AANY A CNA INSURANCE COMPANIES ...........................r... COMPANY ........................... ......................................................................... LETTER IN8URED ...................r.r,,... .r............................r r,..r r,.r COMPANY ANCHOR DESIGN & POOL, INC. C 143 Upper County Road =.,....r ,r..r.....................r.,..,.,.r.....................r.r..,.r...............,.,,.r,r:.,,................,r,rrr,,, ............,...r....,............. COMPANY D Dennlsport MA 025SOM ;.r.r..,.r.r..... ...................r,r..r.r.. .............,,.r.r.,,......._........... ..... ..............,,.,,r„..........................., ..... COWANY E x,� u REM ' x. 9 •. ..Y. n,s;a:R• xne a!'x�.ii%kF 0 7 >f d £'; » 3 � »>: N, r y 1, •r• v `v ytk.s R• $ Y{3# ��.,a':3xr:i�:ixr.,:••:��'.',.R�'��'?�'r�.�i�i��ki'e::S:;��';^,..$:i,<:"�'fiYs��.'�ii4>c�`'$.�z��'r.8:5 ..x;atfi�:Kr�`•�4€xx� 5��,. '.�$.'}�;i,Fk&8 ?f�.,..�,r�.F�dRC�»Mi. �C: r:h..#. <J;: ik:,1Rv;�s%' THIS 1S TO OE TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .........................r.........,.......................,.r.,r„rr,....r.................rr•,.r.r..r.r.r,.............................r.,r.r.r.,...........................rrr...........................r.rry.r.....................�.•rr r.r,...................,..,1.11.11,................,.•,rrr, CO ' TYPE OF PLt3UNAN0E POLICY NUMBER 'EFFlCT1VE fpOLICY EXppg7gN LEARB LTH DAT@ (MMIDD/YY) DATE(MMIDORY) .............................r....r.r.r.r..r.,.....................,,,,r....r.r...r,.,......:...................r.,.,,.r,,,,,r...r..?...................r,r..,rr.,..r....................I...........................,r QOIiE0A1...............:S.r.......................,r,r,r.. OENERAL UABI M 61 30715576 04mom pgJ001�8 GENERAL A ;........, .. .... ......................................... ............. X I COMMERCIAL OENERAL LIABILITY ; FRODUCTS•COMPV AGO. 3 1ow= i ...............................r.r.r.r.....{.................r,.........,. CLAIMS MADE X 'OCCUR. PERSONA{.B ADV.IN IURY :8 50 M ........ .......:. ;.. OWNERS&CONiAACfOR9 PROT. i i ......... EACH OCCURRRENCE i$ E00000 :...........r.r...,r.r,r.. ................. FlRB DAMAAE(Any One fi(0) 5 5M :........ §....... ............ ... ................ ` ....................................................... ...,. MW-Ei1PE]M(Any One pefon)E 50 .............................. r,..................................,....r,....,rrr....r.....,....:........................r. ,.....................rrr.r..r>,.,...............,r.r.r.r.r.,r....................................................... AUTOMOBILE LIABILITY :COMBINED 81NOLE 4 LIMIT ANY AUTO ;...... .................r,r,.., ALL OWNED AUTOS ;BODILY INJURY js :........i i i SCHEDULED AUTOS (Per pen+On) ........................................... ....................... HIRED AUTOS 1 BODILY INJURY .........• i e NON-OWNED AUTOS ;(Per ccldenU ........................................ OARA13E LIABILITY ........; . PROPERLY DAMAGE is ?. ................ .................r,r,.r.r,r,.r.r,r.r.,,,r..,...,................ ........................r„ ....... ..rrr.r..r.r ................................. • ..... ...i... ,r�i..r EXCESS lUleR LTY i i ;EACH OCCURfiR10E 1 . AO(9REGATE UMBRELLA FORM 'S >:rs: OTHER THAN UMBLIau FORM ........... "STATUTORY LiMrTg ; WORKER'S COMPENSATION .................,...r.r,,.r,r.rr,,,. ........ s>'>%' ? WC 1 3071m 04ta0 0 04/OI0 A : AND EACH ACCIDFM.. ..................... .............. c i OISE►SE•POLICY LIMB .3 (b00 .........................r....rrr,..............:.................. E1IPLOYEAS LIABILITYpLq�gE,eAp,E]NPLOYEE j8 100000 .............................r............................................................,,.rr,r,„r,..........,............................................... OTHER :................................................................................................................r,..,,.,...,...........:..........................................,r.,.,,r,,.............................................,,r„„ ..DEBCRIPTgN OF OPfeRAT10N&�LOOATtt)NSIVEFIICLE818PEC41L.iTLMB > ;4i;k"k r x;W 4 xrix�,��k u x�8xksi ..0�;' `��x .•kx• I�rY �x•.�wx%`:•,; '� R6KMx�w;�o �, .,...•..�....;,.:• of x. ��••yy�� ,, s� �s R e x u �p %;� 3��i r,.;;'4,.r:R;i�r';� n�s��a'n��wx.ua;�#�.�.��'.:£ ?�F.��.�?�.��,K.�°.khv.J.,S.�.w$�� .,, r, ,R�$x•;iK,,�w.� �.'�.,$�:R�3:n. i3;n„»;SuR�Su�rR�i�'•,�xo.4�ysfe.' ,.i£�::i...s'�G:$'�L� d�r.:RS�i.K:?� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE j.: EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OF BARNSTABLE MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE• SOUTH STREET k LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UA81UTY OF THE COMPANY, n AGENTS AR REPRESENTATIVES, HYANNIS ILIA ml AUiF10R REARS .,..,..,�..,`.^:r.�c:�k�..•axr^^� `��.'t#f.�f.'f:us�s�:�r".�'o�Sa:s'�fi�ilR;S'YV'R:P.?:?.'^ex'gnu:uS:iu"n?�.�7,nuuy,?y'�tr�R�3:d��..$v' �.;k�rW,.'•r�'Sd,..�;�? �kR�xS•.o"I.�sFEA»x��k �x%�.l�Kst><`�'�' �L�'!��. ''.�;'K: W •'+ � fp ,y O V j r � u W A O • T J i' :�'-' Y '.•.':._..•:t: .L.r..i,Ali:.... (•A.,1 a-:: .. ... _ } J,� - ( _ - _ .aT - tt _ t ^J}Fa. i s r ,....r......._•.e. .]-.f. . 5) _,:.i. m,, _ } _ f'rt, Ar: q; r,�IJ c:?_`...., r, b :;? r /,o •may 'ia{!•rj+tl' J 1 rr,:F':.., '�:r• -COMMOPfWfJ�l1'FI';;: v+•• -�y1:,, bEPART>�ENTOp••PUBLICSAFETf` �'_ _ - -N. �. - ;: ?,� > I { f„>yll.�::': ONE ASHBORTON FLACE . 1K� 4 ,.Y L , t= is',tt, ..; ,; of .t, ,. 9 ��go�Ira war=, �. r.:. :r. t, I 1jSS�10E1�1SETTS . +-. ,7 -bOSTON MA 62108 o �L w+` •J/r3.••._. 'i: A .'Yl �{{irrSt /� ��r, .a' •Tr' _ J %: ;i. . :� �. �,.. t}:: S•` x ! -- 'ii- 1. S� 1. Y f' "'� =f'o 1 Lh�ENSE CAUTION r� N•,, r :9-i.:ti ' wino1. ', '4': N DATE T t .. ..,. 1 aV. .l= -,'f t �'] JJ If 'tr. ._�t4_� l��/19'3 7 - cz::: \Z, . .t J:J u .A; K, - FOR PROTECTION AGAINSfi= " -�: �. _,r,l.: �, �FFECTIVE , , e' � 7 JJ `:�. . _. . J _ it{_, , K: RESTRICfiONS}; 1 ` rr �. BATE UC-NO. ?.. THEFT,PUT RIGH tT7 W{.a ::` t•:.t c •1 .NX•- .S 'a -. ='t �,- T THUMt3.•l y /,..- ; •,l i � � yrl F 1+' _:>. PRINT IN AP =� yiyr ,s :r.\.�; :.� ,.t, 00 _- PRCPRIATE n.:,�, i ;lv-,,V•„ f � q ,.zc.., g 02/ i4� L�)94 0620L:, BoxoN � '' 1. t it ,=r rdy .>• g LICENSE : it i FI: {] az a {f a ! "NIr 1 \is�.1 yi!fi+,.`ii`,((.fr�e'vy! ->r - �- -'lam',,; =y) f. •'�': i• -y i .,t� ..17 `f.•. :'s�.ll:�_.'N •i •'•''.,- .-S- r�.):!•. .i:3r.•'J r;a jY.r :.'-� -l`^.. t ,� Y�.�Y.t Tye•/C.:f_- ir �> _.�;.€:, f.E�•ti'ix .z*�,,-_:.��• ^ »lY �, MARK• J COLEMAN BLASTINGOPEI�ATOkS , .. "7. !r'J� :.::<.! , •� rt< �. MUST WCLUDE PHOTO �% �_:':}'J- -�: J-+-:.:i:" �5 - J,.�.-,•• t=r _ .2 ri- CHE ROKEE-BRA _ % ,.+ _ :•JzA -c ` -s^:,R'4: . �Wt 's t rvt j` •ti. a �;C PHoro(BLASTINGoaa,xJL� 'FEE: :k o / '. ��u:. tJ 31 E�;SL+� s`Y :Yi< ,.., a J<"s �.,*-�••1 --� ,,, _ - -HARW I CI I . Mn :Ot_6 4rJ 4., .: -,, ny c �' »>.:;' .f» r t J i�i>:jNJ� �.7'?`s �dy.I NOT VALID UNTIL•SIGNED BY LICENSEE AND OFFICIALLY T. •al .�jlldra!0 i•Jr7I{':'. . first: f K T , 1 },'t, 3:, x.:a i iy ka4w �i1tIAa %.;i Yl ?" a` f: i• >{ :`! 1 .:�_ :t.r° i r •�,..�:-7 a' STAMPED r OR• fpPitTU,gE_Of TiiE QOMMISSIONEA A N jt S tw ~`sl+',�is:: �, s.. . .,.._. .. �.. acArtalttStita l� %rat.i .. EIGHT .. ..I E; ,y•nip t'+ r vx .. •+ _ f• �•,ES7'rK'.>;Tf; ;-1r.�J i.1+4fi?a -r J !d�; Cod1/a 0�fi :'r f rJ. '•:3' t x, �,. ] .yt l �, " .f. DOB.. �. lifof�Iro� +� �: ... ;. (h� iE3 yg J •JS:{ e ✓JJ T Y y?:-7 _ l:E;{:�:tt'.F _ -yW :. T '.p' ,E �IIQ�':, •�]/. r w1 J,t :-ry•: _ + ". i. •�.,- :'i , _ .,�i _y f 4 n E ?i rS 4,. 4 3, �r.'�. r.A.r a •. '4 r ., ..:. .-. 1./ 1 s 041221 l 9582. ,� * "It _ .f .:. - J _, tx2 '"- .l l-. •- 5 N%: jt ( fir I ;.G a TN,S DOCUMENT MUST BE Q, i` y-•_. a .,,�c .L 2 �. :r+'i�•'• ..: ',� K;'3.,i ." ..,w .ram:^ _ _ 'S,GN-NAME IN FIALAB04ESIGNATVi=E ...t2 ..fa�4�{+:'.":'. + .c -•,•r C,`'I,S^�t;_;y'�ii �:r; -, rd..�T''Yt _ -;•!� }e- CARRIEDOH TriE Pt"RSONGr' 'S' •-S,C>IJnr 'EG"LICENSEE: f:b Uf ' a�. ,r.__ __ ':u' wl•-�v t"7.ti= 'C_7� _ ..•_ ' ,,t Xtr5'J•`s 1_ .�i • -!- THE HOLDER WHEN EN- - �' .'.:: ?� - '�i� - t¢ `j.��.1 ' i{y: .. ar_ •_} rf r -1 ,7S_{'li OTHER9 •RH'>♦•R 7}iUMB PRINT G4GEDLYT/gSOCCIWATIM •.> .-'+'.. +.JS =,? _. x .,;.r 'tf T`+i w r-�+Th,��::,':'-' V-z. 4F- {* .c �.i,'r.,,'K] ii-E-r.!} w` r ' _ _ "r ::3x;�' "• .tir`r -� ,•:y '�./ .> 1 ,L: fir' - - ;r. -F. J, _�- �C' �,,, �.L R.,=i1. 1. nr`'�. .t-- ltr. ut.€. A�.J�XXXX - :�L - •... ' fiat':.x , �: A 1 a,.rr = >,< f•� ,,>.' - r'. acl lan. v �,. 5�14-11. �c y r s ,J. F• _ \. 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C7. ..:5t. - - .]i -�i'). r, _,J. f.. :,t. yr r T,- �J it ♦ -i .Y� �• �1.• r/ t i•r ! fir..--.: ',':. Jrw J c ( .r- ( .•. Vic: a ::i=:•rr . A r is J': �.. ,v5 r- {.+ct•i� S:• l. 's- - s:i t1:-' ] tom{ .r ':aj' ':. v •_... '} y• 'esr•'^L' L t pis , , a ` ...�t , 4J..-..i• t ]_._z ....:.. '!-.Y.i. I ,-y,t"`�:� tliiwt•%J'•:t'ra! t {L T...J... --✓.¢_...- ....C}-:�J,;. ry' 1!','t7 -r. ..r-... "'k ..i-� /fj' 'f •'. .�, •. ' J J' ...,r.,Lt/., .N�Yau:a��,� i •..;, r 'i3.. 1 t .7•`S:}`t'siY_ �vai A- . \ 7. r•- ;• :.a: 1 J JI Y. ti,Y! J J. �+; 'r :». •f :f. t. ,,��.. {%- ./y '{ u'1 .''YS^Lid• ,4", - +(. yY•. •:• .r+.t• ,:h,ii -rN1. .-.. K.' j', n% -Y, / >2.,a,-a. •,Kh: 'f41Y.-,•rJ' JY_•_ ;,rc:Y 'r'. -v.,a J' r,t,i��..-/J'.[ f ! Lt•i r' c;v. V:J'J rV,' . f Ir :':r 3.• t .i:- s. •C _ .!.ITS'r-•�, T•••.-,;7!A, `s. '"r'. ".�r`I ,r YSi'ft+Y 7A' r�J.:, -fir;1.; r.•'sI .V '.S c7R• ::" •s•• 1 av r A .�a I zfJ � . ..r.� .. _ .. ... . . __ _ s -.. ... ....._. ... ... - / ..8 NEt A-L_,_VO GE .'-. _.-.._T- __ j details areXplcal sor all fLshage 2. ---- -- l \ -'— *"•a All concrete is to, be-placed-as a monolithic pour and is to be consolidated using itandard,methods..for preventing segregation and honeycombing of con cfete. _ 3• Pilaster and assoiciated footing shall be constrIucted at all skimmer locations. „yo � 4. All concrete reinforcment shaP be 60 ksi (grade 66) steel reinforcing. 5. All concrete shall be 3 500 p;i, 28 day strength concrete and shall T i P I C BAR 6- They min'A L B minimum A I i allowable LAP DETAIL bea soil tearing capacity shall be 1000 on e.rK3istz-rbFd-so;;; ---aew Pst• Walls shall 5" I 7. A two (2) inch mmlmurn clearance shall be provided between steel reinforce- ment and skimmer fixture. 8. 'All tiackfill � shall be compacted to 90?6 standard proctor. 7EG ILI U(.� •o pl.J6 9. Construction.of .all reinforced_ concrete is to of NC1:3_IS-83�ntess-otherwise noted or specified�mply with recornmendations jl l DESIGN fSSUMPTIONS I. Structural design is based or. the assumed facts Perma-cret and warranty limitations. established in the e Construction Manual. I J 2• Owing to vaT-ying site specific conditions, the pool for any earth or structure is not designed.frll but not .gr-of+nd--movement caused by factors which may include; be Itrriited to,'expanslve or,.otherw of.God: ise. unstable or unusual soils, acts �! • - — -----'- :blasundfsturba:jces or acts of others. 7. Design loading..on Pool walls is based on an empty Pool with a 62.4 pcf'equiva- - '��P e &ure-exterror-l-oad alongthe entire wall height and a .full pool with backfill in la ■ .;.:(' � _-p ce: U , 4. Pool walls are 'not �..., '.:0 designed for surc:flarge loads exerted by wheel loadings within tour (4) feet of pool Ma!I from construction equipment weighing more Z. . than 2500 lbs or any other addtional loading ® ,' >_ structure by existin or condition imposed on the pool $ proposed'adjacent structures. ' TYPICAL-_ WALL SECTION _0 0 5. The oval, kidney and figure "8" pools are not designed to withstand interior hyprostatic loading.without being backfilled. gLu ,' O` z 3 � t I. - - -- o h , „ y. C onstructo; 'of .all reinforced concrete is to comply with recommendations of n1C1:3_t T. - _ unlsss otherwisenoted orspecified. I> DESIGN /ASSUMstructural•-dc ign is based on the assumed facts and warranty limitations established inhe Prma-crete Construction Manual. g to �arytng site specific conditions, the ool structure is not desi ned \ for any earth. o-r Lill-gr-ovnd movement.caused by factors which may incude;.. i - but not be Itmlted,-to expansive or_.otherwise unstable or unusual soils, acts - �I _ - - --- of.God blasttnp�dtsturba-,ices or acts of others. n a c� 3. -Design loading on_pool walls is based on an empty pool with a 62.4 pcf equiva-- �e1ft"�presstme-extertar loaa' along the entire wall height and a .full pool Q with backtill in place. 4. pool walls are 'not designed for surcharge loads exerted by wheel loadings C C within tour (4) feet of pool k'a!l from construction equipment weighing more than 2500 lbs or any other addtional loading condition imposed on the pool �•_ '¢ structure b existin or Y g proposed'adjacent structures. C TYPICAL WALL SECTION 5. The oval, kidney and figure "g" pools are not designed to withstand interior - hyprostatic loading without being backfilled. JL laAYwaRci:/OL. fi—r'.'s .�i. Gr ': M ror cc - - .3 T/ES f i —L f t cL BUT. OF RiALL - i �A �.� 3 rOn I I n Iowa w PLAN --- ,.ti GL BUT �F WALL17 - _ a __ �63 PLAN Qcc-r TYPICAL PILASTER ,qT SK1 - MMER r ! I r v II•,_ILl 1�2va_ mow. -STL_ `�11, ' rM37iESN Pto L !O~D.C. --I l_.J✓ I� 6YMFe6 I Ld �.FE:" - Q'r N I i a. r _ SY_,o.�E 6 2 I 9/�.. . '•, JAr, PLAN 4 3 x 3_0�? S _ sH SE LAppE, I r R1. - r Assessor's offioe (1st floor): O 10 , Assessor's map and lot num �..� �.....�... ...... "��oF T e toy` Board of Health (3rd floor): l � �-7 p,G� w �FIpTIC SYSTEfVI Sewage Permit number ............. ....[.. :.�.:G..F... .. 8W ® IN �s® g.' ALLE Engineerm8 p egartm nt (3rd floor): WITH TIT& 639• � House number' 6�0 APPLICATIONS rrPRbCESSED 8:30 9:30 A.M. and 1:00-2:00 P.M. only' T ' ' *1 PraovToOWN 'OF BARNSTABLE 11"U" I L D I N G INSPECTOR I 0$ PPLICATION FOR MWIMIT TO .... ....... L.L7�. f.. ........................................................ p TYPE OF CONSTRUCTION ............F .IT.Y!.!.�........:....................................................................................... ............... ................. .............19 TO THE INSPECTOR OF BUILDINGS: The undersigned herebyapplies for a permit paccording pto the following information: Location ..............1.0..(1...... �f -5........el.Ve—.!`. ........ .k ........................................................................... ProposedUse ......T:g (4t:.P/j'�AX/.............................................................'....................................................................... Zoning District ......�...............I.............................................Fire District ... . TL L-P .................... (�5. ....Y✓.�...................... Name of Owner ..Dft.V.I.D...... r Ty..................Address ............. ................................................................ -e !'►..... 'Ic-.J7U�t.�t�-� 1Q....4rnd ....L" ill Name of Builder ..... .. Address .......... ....... ......... M/f Ls/Lple�,e Nameof Architect ................................................................ Address .................................................................................... Number of Rooms . � �� .....Foundation ....P�.u.✓..'te�(.. Ye-� ......................... Exterior .......Wood..... ........................................Roofing ....ti��Q..��....S#Y.N.67.4.C..................................... Floors ...........! ..Q.. ,..,.........................................................Interior ........ .....� LC�........................................... Heatingw ........Plumbin g ..................... ........................................................ Fireplace ..................................................................................Approximate Cost ... `.!I... �../� .......................... Definitive Plan Approved by Planning Board --------------------------------19-------- • Area Diagram of Lot and Building with Dimensions Fee .. SUBJECT TO APPROVAL OF BOARD OF HE quyql � . DID!Tt 0-v% I� IS I a0 ' 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. �G I--, _ Name . ....: . ..... Construction Supervisor's License ....D��i�� ................................ Hegarty, David a:d I to single No 310534......... Permit for .... ....................... family dwelling . .. ................... ..................................... Location 988 Bu RivilRoad Y .......................- ;;# ........ ... ............... Center;7Mi IL e �.. ; ....................................... DP avIH?,:gdft ..................... Owner ..........................q...Ut....... ...................... Type of Construction ....... ...... frame .............................................. ....... ....................... Plot ............................ Lot ................................. Permit rGranled .......A49!4�:t... ...............19 87 Dute,of"Inspection ....................................19 I. � -71 - I,- - . Datei-Completed ............19 i6. Assessor's offioe .(1st floor): Assessor's mafi and. lot number. -y �?Q .�...0 9.11 . ..of THE rod Q • Board of He'al,th (3rd floor) ° I {�epp`,,3�om Sewage.,Permit; pumber .............� 7. ..."'`..�.:(.�.. ...� ' ' Z 33AS39TSDLE, i +� Engineerin4 eRaRtmnt (3rd floor): '° Mba 3 \e� Houser)'m r :.. ............................................................... o ypY a• APPLICATIONS''r'POCESSED 8:30`.9:30 A-M, and 1:00 2:00 P.M. only R TOWN OF BARNSTABLE -BUILDING INSPECTOR APPLICATION FOR PERMIT TO"i.... i�tl.��. -y... ........A-M.T�..(T ........................................................ TYPE OF CONSTRUCTION ............1........1. l.. 19 "TO THE INSPECTOR OF' BUILDfNGS. The undersigned hereby applies for a permit according to the following information: Location m pS �e .......... .... '.0...........................i.............. .. .. o. .! .......................................................................... ... �, .;RO Proposed Use .......... �� ........................................................................................................................................................ Zoning District .....�.b — Fire District ...C,d,. .vte.C�-0kr� L( e .............................. Name of Owner .... 1..D......Y4�-figT. .................Address ............. I ...................................... Name of Builder 4-/fJrt�1.....M.C,-.,yl.VMCL.t.(4.'...............Address ....... �. ...... ........... .... .....0/�!� Name of Architect ........................Address ........................ Y A F U........ � A Number of Rooms .....�............ ��.�..........................Foundation .... ... . u��C.. . ........................:.............. f Exle for ....... ........................................Roofing .... Q�.��...Sll.../f-L e................................,... Floors ........... ..........................................................Interior ` ....... 2 (.UL� ...................................................................... ... ".:...:.::. :..'.............::...:::..:... Plumbing" .:.... ...:.........:.......:........................... Fireplace ......Approximate Cost ........ ...... Definitive Plan Approved by Planning Board --------------- 19 Area ..... Diagram of Lot and Building with Dimensions Fee y. ..�' m®.............. SUBJECT TO APPROVAL OF BOARD OF HEAL _ 3 D F LP e gray" 44V �s lao ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby .gcree to conform to all the Rules and Regulations of the T�Barnstable regarding the above construction. Name .. .................. ......................... Construction Supervisor's License D��............................... Hegarty, David A=168-095 No permit for ....add. tAAingle... f Ami. .1.y...dyglling.................................... ...... .... Location .........9.H..RVXIP5...RiYg.r..fta.d........... ........................ Mg. U(p............................... Owner ........I....DAvid..He arty........................ ........ .....9...... Type of Construction .........fra=...................... ............................................................................... Plot ............................. Lot ................................ Sri Permit Granled ..........AggMqt... .... .........19 87 Date ofAnspection ............................:........19 It Date Completed ................ .....................19 //of fi f� i n J � low(S4?- TA OIL: \9 , EYl ' FUCHARD --_ l9� •'I BAXTER No. 24M `��.��, CEQTt'FIED pIOT .P'�.lSti..t. t OCAT1 o" L��JTE e-4/ l u-e cnL�. I rr� I bA'T 5�� /77 I C61ZT1F1j T"AT T"r- VwOtAT1 -5"CWQ Pt-AQ RSFGRIEkica W6Q r,,a" Go&%PLYS W l'rT % TWG 51 VS-LI I-Je: Lor A1.1L� SET$AC1G QE4c.�1cZEN�c.�.iTS OF THE . -tow w Opt -B I& PL, tz boy ' �6L ' B/.S.XTCtZ l� u�E t�.1G_ THIS at--A�-I t5 UOT B�•S O'�4 A'"~ OSTE��/►l.l.E o /4CASS. %f4STIeUAnE%.iT 50evcY .4 Tt4E or=c SETS. ekorwt.a gpP�,1 LA1J T I�IbT 8r-_ USC-0 To r~Le.-jp,.. r ao r i � -- - - - - -- --- -- --� - - -- - -- - - -- \ - - k t 7 , � �'� y� el�� •JY�C1il��ZJ�LGG�� BARNSTABU,B.163 00 639_ ENAYA. TOWN OFFICES 397 MAIN STREET (617) 775-1120 Ex. 126-129 HYANNIS, MASS. 02601 STIPULATION AGREEMENT I, Edmond LaFleur, 46 Long View Drive, Centerville, Mass. , do hereby agree to the following conditions set forth by the BARNSTABLE CONSERVATION COMMISSION, and intended to regulate work done under my authorization at Lot #3, Bumps River Road, Centerville, Mass. 1. There shall be no structure at the site closer than 90 ft. to the pond. 2. The septic system shall conform to all applicable sections of Title 5 and the Barnstable Board of Health regulations. 3. Any grading of that portion, of the lot lying easterly of the proposed con- struction shall require a filing under Gen. Law Ch. 131, sec. 40 and Article XXVIII of the Zbwn of Barnstable by-laws. 4. Copies of all permits obtained in connection with this project and of the j septic system plan and the certified plot plan shall be delivered to the Conservation Commission as they beom-e available. 5. This agreement expires one year from its date of issuance. This agreement should in no way be construed as a waving of the rights of the Barnstable Conservation Commission under General Laws Chapter 131, Section 40 nor under Article XXVIII of the Town of Barnstable By-laws. Failure to comply with the conditions set forth herein, shall result in the Commission exercising those rights, and requiring complete complaince with above cited u ignature Adress: On this day of 1977, before me personally appeared 001L�.;ptt .' ,to me known to be the person described in and who executed the forego' g instr m-ent a9d acknowledged that he did same as his free act and deed. Notary Public My ConIInission Expires: 'S Assessor's map and lot'number .....l.l..l. ..`..101,....." .� 97) KS 7 Sewage ...Permit number ........:... ff...................:..............:.,' . ,,�!_ED V, FILIANCE�I �' � I •1 ARTICLE ti t 1J,,'TE � .ITAR"( CODE i�D ®1iV� y0F TN ErT0� TOWN O F B A R N S TANBTLE' r--_ 1 B11,1 D:1,NG INSPECTOR y cf I -1 APPLICATION FOR PERMIT TO........ v#I.,Q............................ ................................................................... ' TYPE OF-CONSTRUCTION ........ ° ...f Y.40.'P......:............... ..................:................................................... .r...............1917. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a perm' according to the followi information: krr Location �.7 . ...... �.4!�. T....f/l..l.v. �`. ...1R... . . .Ie(/;,�4�.�............. ��.....�.. f'. . C� ........ ProposedUse .....'... ..$.. .C'��'J�!...L.s...J .................................................................... .. .....................................:.......... Zoning District ...... �...�..............................................Fire District ... .: .!^.U.L.. .1. ...................................... p Name of Owner .V.. S.1.41. ....... .........:.............Address .. G...aSQkl. .h!/..P..S.4/.....z!''"...::.. :��s Name of Builder tz.k' f.(.C/. .....co 1..V.......................Address ..f��..z W...k �. .1.4�.4�t+........�.,..�ti.. Nameof Architect ........:.........................................................Address ........:........................................................................... r r� Number of Rooms .... lt�.........................................................Foundation .(.A..�1.!!. �.CJ...... .Qkt.('.P..P...�.� Exierior ..! .......................................Roofing ..... sp... Floors ...0.0.0.4...........................................................:........Interior .... f4J..A.�..J.... ............................................. Heating ...�.[ !.. ...............................................:..........Plumbing ....COW-gz ................................ ............ Fireplace .....`............................................................................Approximate Cost � Definitive Plan Approved by Planning Board ____� -----------19.74-. Area 22.. ..�.�................ Diagram of Lot and *Building with Dimensions Fee ..........�a.?.1................ SUBJECT TO APPROVAL OF BOARD OF HEALTH w y �D r - Al I hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. Name .... ..... ..... .. ............... OTS71e Corpq 19180 a` = 1 1/2 s Y No it for ........ ...... osingle xfaptly,Z el ling ...............................:.. ................................. Location l Bumps River Road Centerville T (house 988) •{ t_s s �' Surf............................................. -' `"� �-.� ' ,.,•': r, ._ .z r.. side Corp. Owner Typef Construction .........frame....... Plot ............................. Lot ..............................3 - , . Permit-Granted ........ May 4 19 77 - ` --Date of Inspection 719 Date Completed .... f ....... .19 -' PERMIT".REFUSED ✓ �` �# Al,s .............................................................. .... .................. ... ..............................................:';,-rt•s . ° _ Y . f" " r ��` 4 x " .1 t a Approved . ........................................... 19 ......................................... .................................: .................. ...................................................... , r 1-�"�.,,� .. a.....;i 4'Ce,,.�t-. „...fL ic. S ^,, �r ;.i ��` �.� �`qw" ... k�v �.� +c�'�.`.•4f::1'P eTC.�r:.'�,M�`c A�".4,',�t�..,f. ..:r`. ka.'.'+�.,.. rk!'ttt',.a,J..?r..�t+a;•�-`., 'l�j:. r,' Assessor's map and lot number .....t..E �.....!..�....(.... . ..:.:.� U ✓ ��1 �y_ 7- �,�' KS ` - 1ge_Permit number ............(..`. ................................... TOWN OF BARNSTABLE 13ARISTADLE, i ° ��"6 9 X . . BUILDING INSPECTOR Opp NO a' APPLICATIONFOR PERMIT; TO ....... ................................................................................................... y :TYPE OF CONSTRUCTION ............... .............................................................................................. L- /• .F 19 .............. ._ ............... .. i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followingt information: , Location u .......:3........ :.).!'. .. ....!�.�..!. .P..h....... '1............1...::.. !",..".................................................... f Proposed Use ....... F?,S,! �I�c� �1... .......................................................................................................................... ........ ........ Zoning District ...... ........!..............................................Fire District ...1, .te 1 c?.r .?..!..C.'` ............................ Name of Owner ......1, uu. 0......................Address ....44. lzni t� ', ;env. ,/PM N,4(/,"P Name of Builder .......................Address o ....o....v.. ................. . .) Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ....��...'..........................................................Foundation ./ ,r�..!:f'. !!........AM.f^ .,o lam ` ....................... Exterior ......................................Roofing ..... L.S..�aa.. ? 1.. ..!........:......................................... Floors ..................................................................Interior ....1)!✓.V, rA.a A Heating . ............ ..................... ..... .......Plumbing ........ ...................................................... Fireplace ..... ..........................................................................Approximate Costr .�' .....,................................... Definitive Plan Approved by Planning Board ----- - ------------ Area - ` ................... Diagram of Lot and Building with Dimensions Fee .......... ...� ............. SUBJECT TO APPROVAL OF' BOARD OF HEALTH. A a 1 n rd � E I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �l / Name`U 6 ...... ......................................... . s�rfmlde Corp.. . ep=16u~95 ° ' ^ ' ' OU0 l 1/2 story Nb .. .., Permit for .................................... a��*g16 femilv dwelling ---..-.- -.------.-.~-~.~-.. � ~ yJ�� ' -|c»uBumm»a River Road (booma #988' � � Location '--....._.----------..----. Centerville � ----..-----.------.--------- � � . Sor0ai6e Corp. � Owner ------______...._________ ` �ra�e ' Type of Co c�on � ~ � � ro, � ------- / - . ' �� Date of Inspection .............. ....................19 � PERMIT RE�USE� . . . . . . . ' . � 19 ' ' . . . . .- .�/_______.. /y� � -----'' . .-'��4^''----'-------'-' _~~ . ---------------------.-.---.. ' - ` ------'---'----^^^^^^^^-------^ . � � Approved ................................................. lA ' -------'--------^'-^------^-^' � -----------.------.---.~--... ' U M . rl 1 `\ a 7 F� 53 i- Ave& � \ 1 \ r' In o t Iy , Pr t,, E, v