Loading...
HomeMy WebLinkAbout0083 GOFF TERRACE o r Town of Barnstable -Permit#.000 o 5,?3 Fapirw 6monthsfromtissuedate MSS Regulatory Services FeeThomas F.Geiler,Director 'T Building Division Tom Perry,CBO, Building Commissioner DEC 19 2006 200 Main Street,Hyannis,MA 02601 T 'town.barnstable.ma.us Office: 508-852= 39F BAR�STABLC Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number / ?o Property Address Residential Value of Work 7,' 0 ' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 67,e o� l ©14 LO uA l S Contractor's Name Pl C 4,f42 s!AiO5 k t. Telephone Number 5p( 31-2 97 7 Home Improvement Contractor License#(if applicable) 106009 Construction Supervisor's License#(if applicable) D0 ?63 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance r Insurance Company Name 6}SS�C�► �o IAWV"t- °S Q/— Ajj //US CA, Workman's Comp.Policy# 6W L 70 d,j 57 1 A006— Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) p / M-Re-roof(st ipp'.ng old shingles) Pal construction debris will be taken to /�i J6JAJ ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ 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: Pr O er must sign Property Owner Letter of Permission. H e Im ovement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 t` Boa d rg""'.r`o'uaPalll u�ldin r_._.. a g Regulations and Stagy HOME IMPROV EMENT cONTRACTOR License regis lop Lic - . . Regrstration tration valid for individul use only E�pir�t on' 106009 before expiration d 7/21/200g Board ofB ate' If found return to: r wilding Regulations a I TYpe IndiiVidual One Ashburton Place and Standards RI�yARD T. SEN ' Boston,N1a,02108 Rm 1301 Richard QSi« ' s Senoski { r � 3413 MAIN ST. !3ARNSTABLE, '; M a 02fi30 i... _.., DePutyAdministr•ato#, without signature-.._._ `.- - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations to 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/OrganizationAndividual): Address: 3 q/3 l 5 / City/State/Zip: R42w(1' 1,,4 h4e� Q Phone#: 504 30. -9!72 Are you an employer?Check the appropriate box: Type of project(required): ` 1. I a ,a employer with 4. ❑ I an a general contractor and I 6. ❑New construction have hired the employees(full and/or part-rime). 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 S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required-] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs, ' insurance required-]t employees.[No workers' 13.❑Other comp-insurance required-] *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. li I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. p Insurance Company Name:&OUA,Test 1,P A ht 4— Gvl�'. ft4c t'6t.� {i� /`.,� eo Policy#or Self-ins.Lic.#: 90 do Cj Expiration Date: Job Site Address: �3 Gi'��!l 9-L� City/State/Zip: CPII) c ./V 0263 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 a fy u r t e pains and penalties of perjury that the information provided above is true and correct Si aturg: Date: —/ —U 6 Phone#: �� `L _ ' Official use only. Do not write in this area,to be conWleted by efty or town of iciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfPown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: d ®4 a Town of Barnstable NAM Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. Pro perty Owner Must Complete and Sign This Section If Using A Builder I 6-c6eqe-, —s ,as Owner of the subject property ` hereby authorize IC� SPAS K 1 to act on my behalf, in all matters relative to work authorized by this building permit application for: %S G:7l eat' (Address of Job) w . 1 (- Signature of Owner Date n COS'�e r- �p VJUr1 S Print Name Q:Forms:expmtrg Revise071405 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map tt70 .�o� Parch 90 Permit# Health Division ® Date Issued Conservation Division �! /Jd Fee r 0+ b Tax Collector Application Fee 06(, / 00 Treasurer `A_ L Planning Dept. i Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 93 TID[ro'ce, Village Ce.,VI OL Owner �(C 4, Address 15Gtf1%A— Telephone Permit Request i Ls X L- k 161�-3d 1 ANAPOnl n Sw w rt l�'J a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation b 400, Zoning District Flood Plain Groundwater Overlay Construction Type I ezL W40 u 1 N I 1-fPJ eo Lot Size 1 qo I Grandfathered: ❑Yes ❑ No If yes, attach supporting docum6ntation. Dwelling Type: Single Family Two Family 0 Multi-Family(#units) -� Age of Existing Structure Historic House: 0 Yes I(No On Old King's High)`q ❑Yeses vvo r, p Basement Type: Full ❑Crawl O Walkout ❑Other _ Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) cc�� r- Number of Baths: Full: existing o, new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑+ Other Central Air: 0 Yes to No Fireplaces: Existing ` New Existing wood/coal stove: Cl Yes �No Detached garage:O existing 0 new size Pool:Cl existing ❑new size Barn:0 existing ❑new size Attached garage:10 existing ❑new size Shed:10 existing ❑new size Other: Zoning Board of Appeals Authorization .0 Appeal# Recorded 0 Commercial ❑Yes ❑ No If yes, site plan review# ti CurrentUse Proposed Use BUILDER INFORMATION Name - L. Telephone Number 9- - � ; Address 3V 1 A4 4!a/ 5l License# 00 q 63 5 C'3 'NSr�-b et , /K/4_ '6�� 0 Home Improvement Contractor# 101009 Worker's Compensation# qyc-7-ao2 7,5-01,joDy ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE '` DATE 6 �� 5 h i FOR OFFICIAL USE ONLY PERMIT NO. ` DATE ISSUED y MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: M FOUNDATION SG -/S'� O (OU ec_I L)4 ih FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING b�ZY�lI DATE CLOSED OUT ASSOCIATION PLAN NO. - _ I ZNElp Town of Barnstable Regulatory Services snnxai E Thomas F.Geiler,Director rFo N,p+A Building Division Tom Perry,Building Commissioner - 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date t 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: V r tAi tw9', t f e Poo(`-- Estimated Col 0 0 Gov Address of Work: 93 61 p gj-. l�oUotce— Owner's Name: � `� ��"�G�U�✓S Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 1060 Date Contractor Name Registration No. OR Date Owner's Name .•.�Q:fonns:homeaffidav I ofTME,a� Town ®f Barnstable Regulatory Services - f * s�uvsres - Thomas F Geller,Director • 9 MA9S $ .. ��FD►A�p�� Buidiug Division - Tom Periy;Building Commissioner, 200 Main Street, l yannis,MA 02601 Office: 508-862-4038 ' Fif Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder CM' d Uyj S ,as Owner of the subject property hereby authorize:'' �k,� O�rG t to act on my behalf, in all matters relative to work authorized by this building permit application for; O ^ C,e.q.�vu il-e (Addres s of Job Signatl of OvneV Da e owl, Print Name BOAR©:,OF BVI�L©IN.G REG UL,gTrj License CONSTRUCTION SUPERVIS`vy 4 z Num,ibe�jC`:S 00963 5 I � :I xI?ars Q / 61D:7 s.4 , Tr.no: 1201 r '}' Re RDCHAR,p 3413 MAIN ST { BARNSTABLE, Admrmstrag I r 7eomvrno�uuea a� p�utaelta r' Board of Building kegulations.and Standards HOME IM1 OVEMENT CONTRACTOR 2006 - (dual r yRICHA U f. SEI Richard Senoskf — 3413 MAIN ST. °^N ^`e` C G»a •A 80 BARNSTi-BL.c,MIA 026 Administrator NOTICE NOTICE Il liTo T t, EMPLOYEESEMPLOYEES f . I. • The Commonwealth DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street,ikston, massachusetts 02111 617-7274900 As required by usetts;General Low, Chapter 152, Sections 21, 22 & 30, this will give y ou notice that I we)°have provided for payment to our injured employees under the above mentioned Chapter by insuri i with: CI TBp.INQU TRP AAA3 A TT§MVTUAL k :URANCE CoMpANy NAME OF INSURANCE COMPANY 11 NORTH AVENUE,P.O. BOX 4070 BURLINOTONi MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7 s7 1 11/1 12 4 - 11117/2 $ POLICY NUIbIRRR . ....... EFFECTIVE DATES PO Box 1013 Unkind►Imwome ApM l!V .: Ba as& MA 02W. NAME OF INSUiRANCR,AGRI T ADDRESSPHONE Rt T Si 13 tw 9street Bam$Ub*MA 02830.1234 EMPLOYER ADDRESS 1 4 EMPLOYRRIj wo KE' fts C o SA�"Ittl�<OE'I1►ii�C$R . The above oaf lowaaer,k re4+tiMd k eotee the t Gone of flopki te`teWsb asley�aate Died red�spltbR'o�deeedlioi eee�lied:�oraea� vain!�b ��14�s'�f't��were O A wf tl�a P!t'st : Py Report of I*ry Sta®t be given to lbe kglz ed eonployee, The a loy"o..may Select ble or liar own The Mweahk toot of the oer4eee provided b ft trees , h "evl8 be P y S p yt pold by the ltaama°ar,if at t"ottt Is 0e4siry aDd meanolely< aee�d to tPao,work reNted t ry. Ira c4e 'I�osp iM'eihte aia;employees are her*Oby 12001fled 00 the Insurer kor road for oweb *of ': NAME OF HOSMAL TO ADS E POSTED EMPLOYER 4p riii�iyP' �r S y pp F. J d it 41 R�pi^I 7 i { I�" I " U4I:I ; I fegf^i• tl. �,?� "I :` tlw 'tf. �tP ni '�j �4�S (``#li.'r 4 .;r' r'II'.I fell—, r nil k r i 1 il.n ly Sa'��r�4t,}�,�����It-�. h TA,TAIR TE WISIK 314MiUw:.W TML m1wUR Af IICWA ARE NI AUl1 Iuc To m mi (oc A.r mpov. ���py�VIC ISFY gLT-1APLANS FOR LOCATIONSB QTHEAITEMS INi Ky%� BRACEIRANEL PRE-FABRICATED STAR ASSE]I�Y� X � � � 5-3/8'*1WC� OW.GONAL BRACE (i.^ 5-3/8•oM.BOL7S BOLTS.NUTS AND 2D MILTRICKIffSS / L IKx17x12G4G4LV �' - ANDT,p2�MAW1ERs �� I LASHERs TrF VINYL LINER �SECT T5/2 AND /� NEE-FABRICATED - - I PLANS FOR LOCATIONS STARR ASSEMBLY 5-518•4 M.BOLTS 1 8 OTHER ITEMS IN BRACE I STAIR'LNE - I NUTTYPS AND WASIE}i5 -- ' -FABRICATED / VI Y L.LI EOff�55;.—j STAIR ASSEMBLY —{ �tt20 THICKNESS LINER VINYL LINER � - SAIR_L-11E- I \L—JM`GA.GALIC STEEL STAIR LNE, NUTSI ZB�TS y� I�MIB/ER NI[IEL - ~� WASHERS TYP.EA I!.... iWEL.END i SERIES 550 61 650 STAIR_CORNER � SERIES 750 STAIR CORNER /z1 SERIES 850,950 EA 1050 STAIR CORNER n E v PUTAP AND R 'PUMP A/O1. r O MOTOR �. - r�IICTiON TOR — ,�ETl1RM • ^ 1/ _ _ — — — '♦'FRAME ASSEMBLY 2 e LTYPKAI W/£fiE SNIOVM /�� TER T I �1 FLIER �f —1 2 _ —IRETURN Z ii. L .+Di,- S ♦ 2 PERMANENTLY FLTEQ \ 'A•FRAME TTAC-fED l z - .- _ Y LINE 1 ASSEMBLY SAF'ET a TYPICAL WFERP PERMANENTLY I T Si1DWN - m-nLc,ED .� - �sNAOEo PON ..• sAFErr L� f 2 �pHAA'T1Of5 ! ar .:'*''�' x _ PIMP AND 1 ! - sewn t MOTOR +' :,,. —I �+Y to I au3 PRESEKTS p �A - I ^b- �-^�.•: � �. AT AREAS far.> STAM ARf X �' �' I--—► ———�'.�� LPOSMON. 12•202@f SF SURF AREA6 ZZ)?p6AL:CAP I .; S/CTIONSIZESMOWEr- 15X3Z S� .SE SURFAREA 6 1884QGAL_CAP ♦ - " I6'x36_fi� SF SURFAREA I.26.00 GAL.CAP CD 20+40'T96_SF SURFAREA 6 26900 GAL-CAP L—-- _—_—_J 2 'rh ; ASSEMBLY SERIES 2000 a 2050 INGROUND T;P Sw 0 Q 52E SHOWN.18ti64 784 SF SIRIFARE 0 AE62480 GAL-CAP o- RAP_AI® - - PERMANENTLYwTTt _ _ STAIRS ARE oPno SAFETY LINE _. `IMME RETURN I I SERIES 2IO0 6 2150 INGROUND SIZE SHOWN 0-26.38 90•EL_822 SE SURF AREA j T 2 6 26928 GAL.CAP a ' I. I• - Li. ARE SUMS 2000 a 2050 INGROUND w_PTNON L PERMANENTLY ATTACHED SAFETY uE . a 1sNADEv PoanoNs ' . REPRESENTS 0_0 ,+'d= i ,FIAT AREAS •^Z+� d - - -I —ETURN 'A'FRAME ASSEMBLY • [ 1_,►- ♦, J 2 TrRCAL WHERE SHOWN SIZE SHOWN:16.3T'567 SE SUE AREA.6 20720 GAL.CAP ALSO AVYLABLL 01.41'713 SF SURF AREJLL249S5 GAL.CAP 20143 835 S.F Sl/RF.AREAL 2'9223 GAL CAP -, • SERIES 2100 &2150 INGROUND I3/13/119 _ IfYk i Yh j2 G0.SZl,,,L hW •QF®OtCil06 Q Owlms DO,[QTaI■IIc M OTIGl., - q GA.GALY.. STL-:'. SAL �(A SI61MTaR Or TK(WZD(Y O EOORD AN Am AIDLBARED - !I N 64 BALX STEEL PYEL �JAT T,a( TO BE USED FOa A PLWa'. .. , N41/EL ! ,PL.1tN5 FOR LOCA ?� - SEE SECT 13/2 AND � L OTTER-ITE]6 N 5-L:♦K BOLTS AND ZZZ _P WASNERS TYPICAL iarue4 5-wo ALBOLTS.NUTS7 -Zf6 GA.GALY. _ j•T AND 2 ELVALSHERS TYP � STEELHWEL �EA.PANEL END I �2 VASH c TYP J \ G4LLR STEEL �' I EA-PANG END 1_T 5-Prs'�M.60LTs.NUfS! 1 AND 2 MDLSFERs TYP ,•``. o EA PANEL ENO i� 1-T---- a y E ( c?b :&` .�: \ ', N \ T,b•�M I SMi / 164 Gtt GAPI STEEL SIM TYF �� TML1OE55 W ImA. ALMC Tm N _ < ^ G VINYL L T n�-CIOGESS PIE STEELPaDqE GE BOLTS20 YL TNIC(OESS t VNYL L2ER r `�' -��- /I20 bIL-THICKNESS 1 wm LINER i VINYL U ER SERIES-m 8 750 OCTAGONAL CORNER (\ SERIES 800 81 850(90D CORNER) SERFS 900 9 950(90'CORNER) (1 SERIES 550.1000& 650(TYB CORNER) M G0.6ALY STEll�- l 5-iDY K BOLTS.NUTS PD'TO E70 OF{MIEL COWER PEGS .-i.A/O 2 MASHERS TYP� �A mm \C. • - / I EA.PANEL END - .. 13/2 AM M G L.(W STEEL; ^ .. H GAGN-Y STL OTHER REINS N SPACE .� �SEE SECT. \ FRw MCA O/2 TYPICAL j I I ; P�(y _ YKLTSTdliS;- LN�ER EA.R4EE!(D �R ! W 6�GtY.SR�1 A1'��2 R�ae n / _ �MNE-1 EA.PWEl END «n TM00E1'S - -`• L - _ o�I _ LAMER 1I4 GA.BALM.STEEL VINYL ...� `CORNER Pg= S Ft � /\ ' z-m•A SEG7®ppuG�(n .,Vt.6 ( ANGLE.SEE SET:L 0 r4D'AT SECT.7A l e/ It n L3/2 AND PLANS FOR LOCAT101t5 a G2 GALK 5TEE1� m _.\ ®(04160N)AL BRA1�Rtx r-12 AND' NYL TT� RDNEL' 211=' PUNS FOR LoeATTORS B - OTIER-ITEM N BRACE m m. CD n - SERIES 1000 a 1050 EL CORNER 5 SERIES 700 a 750 EL CORNER n SERIES 709,750,1000 a I SERIES 700 STAB? CORNER Go 2 2 z 2 z o 0. _ 5' I q 6A fa11LY.STEFl. F K GA.GALY STTEE22- q 6Bi GONG.OEQ( 4 7 $ 3�p,•.NOMINAL `I TM m m f ES/2 TYPICAL _ _ - aP¢0 PANEL SEE SECT. 2 L TYPICAL • k ALLRrRAi�) NO ftSiALSECT + -L' - COPO�-_ SEE -COMC.OEC ! ' a - 01107E AM SECT LS,/rt� �7��_ 5 -11 SEE 04 CONC DECK - o �. A•.B'IFS FOR - �JirY K80LS5.MUTE COPES F^ T _ml 1 �NOfE NO .i t m'0 `7�iea�aEss / - vt35'' RYES AM Y rM9ERs TYP - - � /TYPICAL .KEAOta(� •.•l.- 3C p O NMN1. LJE7i MOTE:SEE SECT. •°'L1r i ( PANEL Q(D CD 20 WUL-THICOUIESCW2 FOR OLAGONAL 7YP - y:, • 3!n 1/4 T3p ANGLE . �- cAidluGE - 1 YNYL LEER S - APO HORIZONTAL SR� INGF•Nf(IBE BOLT; I q I =T TW. - �.ALLTH EAD BOU's.Nur. i - PLATE 6 L CONC. EA.PANEL 6 YMLSNERS i CARBAC# - el COLLAR B�FO1tK- 1 -M BA-6ALV.STT_i TYPICAL J gpL S - ATWt •I.. FMNE1 TYPK'14.� 1 MOTEALL BAOffI.L 1/4• -2. wR L. VALSHERS TYP _ (WILL ST►�FE ER)e I NOTE N.I Loh i Wx 12 CA. Gmyx W GA.6ALY.STFfi�J `��At'♦KBOI_TS.HUTS (6 GA 6ALY`STEF1 - I N GA:GALK,STEEL I .SEE PLAN VIEW 1 FLIER F�ECE _I A D 2 IMAS ERS TYP F9.I R P&-CE I FM1EL SEE SECT. S ;+F'0 K BOLTS, ABOVE �� . I 6-Ihi♦KBOLTS,FE.7T5� ri 34.'a I SK'x L4' �- - 5� J 113/2 TYPICAL NUTS E.2 WN:tE7 T_ '� I AFD 2 .PAE% ,:M 6A:GALY ANGLE TYOF.:Al_ EACH i ue*x ITT I TYP EA PY1fE1.DO / /• ( . SERIES 800 900.000&O50 OpRNER n SERIES 600 &1000 STAIR CORNER Io PANEL ENO �A E DOLTJ' I� rB•DEEP CONCRETE - - 20 LL TOCTOE55++ , i COLLAR AROUM GOAOOFENT MOTES 2 - NSTALLATION-NOTES.- __.. .z 20 MLTMOOE9ss ADO( STIFFENER) J 4eAoazL°. I YNri LEER _ \ n PEfmETER OF F OOI.f yNn•,L>g7y I.L-2"A 2'x 'GALV - I NSMU-LAT10N NOTE N0.11 L ALL TYRE STm 0 FORMED MMU MATERIAL COIMORMIM TO I.TE BASIC®eN OF THE POOL O 14ESNA?ED ON A TYPICAL NSW-WTOR1 -� I (1 J ASTA A-829 WITH AN Aa2E GALMIOZFT COATING. - BE■AD N BOAS NUT CouThomIe oft"WC CATS.PEAT.NOMU3 DO{L OR I AT OF PANEL PVC TYPICAL 14 GA. j 2 M■NI.l ExMMSQYE sals. - TYPICAL M,GA,� Tt/2(ONIIZTED FOR, � GALY. PANEL END; 2 ELL STEEL ANGELS(fi1E1514YYJERS AT fRI11E MACES). - CLAiDTY) I BEND DEIENSION ARE ROLLED FROM MATERIAL COIFORAWN6 TO ASTr A-36 1.NSTALL AM■'TRTC CONCRETE COLLAR ATM BASE OF THE OVl7Ef�FR01 BN-K-PANEL ETD -J _ 1■rTH AN AST E A-I"GAL%amcm CagiMC AREA-AROI/O THE FTAL PERIMETER OF THE-IOOL..T16 b MHWM ON VEDA."E'L BE/O DIMENSION _ - n Au DQas AND THFEwoRm ts1NPOrEMR ARE MA1uRacItATED 3.SAL]CFRL tIT1`(LEAM EMRN FREE OF IIOOIS YID OEM13 NSTACLID NO tsTElRs WL FLL 2• NIN FILL PROM MATETBRL COIfVbIT6 t0 ASTr a.lO7 NUTS-ASGAGA) RIOT ExllmlNc 9.EaON RATER aNaLl E PRA0.ED aMDTA)lEFliL.I.T 77UAPED lO - AO ARE ZW-PLATE.F&STEM4 VA.51ERS ARE-STAIOAM ZFN: ELIMINATE YOt06.FILL F'OOL..MTN WITTER..4RND irOffWMG.WEER LEVEL ... -/ PIATYL SHALL 10T-DWnX PITON OICff11 LEVEL BT YORE TNA11 ONE FOOT. - 4.ACOI T A R t NOT EOptS TH" �W SLOPE ARA7 FROM 2 3J8• TYP.TOP 6 SOT. � •- 5•,1 _ I►--y K BOLTS t -�LEMEI.NG(TARTS) 4.ALLNE'7BRA BRACE). CAT PANTED ST'!N ALA AIM) PANT AFT � WDID RA RATE/DT 1.F88 TIAN 114 FF7.W. - - DROIZONTAL BRACE) -� / a-PRaIt MwGL I.aE MATED DrtTi AN YJANSRI FwDET AFTER G.TM FOOL HAS NUT SEMI TE31im FOR A NRRCHARDE LDADMIL '1 5 V2 i 51✓�F 5 Lrt'a/4 Gtl Mo1>aA. i a1ADE DRTY AAOI■O P00.AID tI!METIT AAai'N.70 LAST EOt■RAILETTT ���[2'■A1'X 2'-O'64(Y'r. 2,-0. 1 B• 1 P B=LG ANG B rL■IR[Y OEOC SIMLL E TwEal E•000 PE MK sTTF]aGT1 Mr xmcA1 FLI■D PIREsmNE of RETYAED EOL TD 3D Pcs oR LESS. TYPICAL WALL SECTION TYPICAL WiQLL +ENER 1 2-8• ( ' 7.THE POOL MUST BE INSTALLED ED ITT LICENSED.FACTOW TRAI ED � I NTALLOMAPPWWEDNIM13OAL POOLS.INC. FOR 2y2 PANEL 1M AT Mi0. PANE 12L TYPICAL WALL SECTION 1AR AT FRAME 13_ z z�� =_ The Commonwealth o Massachusetts Department of Industrial Accidents —_ Office of Investigations ° 600 Washington,Street, 7`h Floor Boston, Mass. 02111 ' Workers'Compensation Insurance Affidavit:Building/Plumbing/Electrical Contractors a�A::lira a'tfo a"tMsn-1 `T 'fit: ( . .:a. ;l ae s ) 1e i l; a;`� PENNINE sf;,s�,� Lvl� j 0 name: � >�`"t * - • address: 3 Ga city Cexk2(it state:r'0 zip: �O�[� phone# `) "(` J 4"', % /7 Y work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑BuildingAddition M{..,,.,..:R,+nS`+Y:rv'•.':;Sb�. �?.: >t?�','9'. 44p.: 4. 'F.. �;r,.... �....<__,.dt; <3;°�'e.':+s.f°:,,. fi;4;::�ts7tr ''kv:�i:� °'!.'FCp?'mca. ,;;r "•;'�':� ::k't`:;'�_..',"� ..�z:x�5 ;':�-as�: t.:°�-rs-a>:�.r.:<:: •:rr ::w.,,.,. ..... :ci-':�.. ..... .t.;.a't .-..,.•c.....� .:..>�,.A,...,.. ..�r}�':�:•:...�,`:.;i-:*`...:... I ld�I am an emplo r providing workers'compensation for my employees working on this job. M company name: Ock4.4-* ���C f' • ; address• �� y�ll!t� ✓� city: 630 phone insurance co. policy# ?�'Ve-7033 60 ..:�.,. `.mow} xti !s;r...+R w.�.:.�,. ;.>y .'�°'3r: :'•.. •. .:.� ^+ti r ".:6`•.r'4. .;�+.4.,,. ,.a, y.w•. ..,�..�,,. kA, v.. w4ew. F`bu..<`�p3s� .!`�..... , "rH�u:'�:+:...._a_•' .... §:`.''+..�:o....#.ail••:,..;�.ne?.i.i:.'.':;a2.,"•r:r'.<it::•s:��•J�:`�;,i:ai':'?d'n".�.x"..'r:. ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation policesc company name address: city: phone#: insurance co. policy# d( �b , ... .. �r"-.-.'� ... .'.ii'�TtC...�l.h,.,•,?s.. .:z.:.:• «'.ice`•,.. ,..... v;;:C;,,:a-;{. s=d' company name: address- city: phone#: insurance co. f,Volicx# Atia ,..;� Frr. aa00 „ '.. Jf.:. �`'r.i(Pn :C: Li d ,•,qt .!f'igFi iti3 '^ :� :.. r - al_;§.�'etiafaoeCe;sar"�X �• : '� _ h,�P:rs.;!°�: �Si;: 9q ,;.;�r.�i,, ..�.`,7��•'' :rr� `� �>*� '4��'��9a'` ,.��°s` "�� 'r h:�.,.. `.sd.`'T3,• '6.e,,.a.dl` �se.`bw�a•'1(�`..<'�P`.;. ''^�# •.�•�§+:$�'��. "'`:'3;' _ "`. "!i .,.• A,. .._, , t�a'-a' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a' copy of this statement may be forwa ded to the Office of Investigations of the DIA for coverage verification. I do hera y Tde t e pa' s d penalties of perjury that the information provided above is true and correct Signatur Date G ~��— 0 Print name /l/�ILI�L � � ( , Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑check if immediate response is required []Licensing Board ❑Selectmen s Office ❑Health Department contact person: phone#; ❑Other (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under.any contract of hire,express or implied,oral or written. . 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. ,�;. w;t- .de +a'•i� $��? .r ..i`-- _ , ,riy,z;:x>•x�y ✓ �k,"ix;�d'�,y'�C:ieFF,"..,i�mjr+;kg"i:;+'Ys�`se:�er=• e s� 1, �- .�-"�q;, ..:)'+�' '�` ., ¢�•,y} t(t`vk3.+�;. a2Tr ti".�;�-_,�P:._ o k..,_.,a'...,,��''�`4�.-,'''��. rr:.r'b:w:;:,'.��.. .�` +..�, •�'b.. P•�>•.. .h.J'.r{M'+;?'"1'P� ...y .i;y+,t�'+t �`wi ,.�i-.:;.'',•7.T�'+"f .<'". ,.tS!:. t y,, ?rir'.. u��`{' '�,}.�' va i , � a.'+'.� s. r 7' t.- '�i:':i>:ts:a..:r `��: €iL`�:'i4R�i'�.r:`.�?i.x:'•:„��:�v�.4%'1."� 'a. �-�d,'.. ... ..t��6 'i: .::.. .:u,``$.�',� :P �' �."c� 'mac"t-:sE}.ti✓7 .i�.'4° �C. `"s'f4�y,'• :R'l;yti Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation, Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted 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. ram• 5��,. ,��-�">,k. _ner.^e.,<e,;r?. 't. s�`+: -�a?.'""� - Y�g:',%f'x�, �r'9s: «. ;d;�y'•.�'S_ -55:r:T�i4., .:.a'^.;�•,..:h.:.: �. .�.sy;,•e . %& • 6, vi �.>q�rr .r`S7.rs?9 ry:.?.', :Y-.i1: ` 4�.'"�,�'-"'- - :� E -'i.Mti= " nh yt�.e: x r3'p. ;e,rJii. - -? c. �. i-p" - `✓ �ti _�i.�,,.�,v, ># :« r�',c•t,.,. .�.,r..-c7:{�'�i?x«�,,?,�_�:.x�?%�� : .;, ??a?'v�5�i�r'���r � <���. �' :tf�'J �.i:>,-•a:6:,? '��ir:< ¢.,,.'t:'..+Yr �ad"«.�'� =�1'�...�^'ar � •# ,rn��d' :e��.:�.xS�.•k- :�:1# ••�>r•,r���ss �.- ' ..��... -r• k•. .;a .Y-.n�:` �.,t . �`r„ ',;'} s_,xCr..:�� City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. 't.).. - - - Y7i.:^'. :-t: ..ip; _•q..i- :a?v-:Y2 •.4.0 a., - ':8'S�Frr Tl"pv,�.;f:.'gK7: r'y^•,,'a-P:;^e ;CSG !.}v/�- n;{S%;'P.;.':xk!:- � -;(a Si Ci•,u np`•i6..�:C r 'i.a .Lrn:r.,. ln:WC. `a pp5.: >:.� ,i'; ��'^; 6:.em"� `�,. y�,"'''�y y� s.e {< *'q..�_ ,a~ '.:S-a:rH :� fr•1 �:.���vr<:•. ak+#s.`,,,,,,���� 3'�,pdF M_nz•. f^.;. pp^�kv'�t�`.`�, •. ��L',R - ::.`-A't��te':I'- w4: �1,*�.rc. .i..0.f�- :6��•.:4�'''�:•:' .+t,' �':'�.'•} -`.:FJ 4 '.4.. T �.r ,.'�,`:;�.. _ �- ? rn.�a,,� .7:.a, _ .:.f;)y,e },a.z-,�,��:r4�t, '^�::y�;. .e.,�..,.. •��.yYt -4._��ti "ram a�+�.}�,a.xe'�w�� •k s e f,<�r�4a� Ct2�.e° i-'St� �F�=z�rr� 5�4a�R","i�ro��✓~�s'±'i F r{?. ,�'Y i a' +k a" otN >F' r 4��T a The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 / I ` i 1'4' SiVDy l'4'STuny '� _F 'I • i 9 1 �. IJ� fC AN X , — �a I� or �• I s i I — a y� CLOSET (Corpet) EXISTING r BATHROOM .(Tile) et , y FAMILYROOM (Corpet) TOY 1 CLOSET PLAYROOM UP TO SECOND FLR o (Corpet) ' o COAT ' CLOSET FI R S T FL 0 O.R SCALE: 1 /4"= 1 '-0" r, I ' P I I I � r- I V I O u I BEDROOM /1 I (Corpet) I I COMPUTER EXISTING I R001A BATHROOM (Corpet) (Tile) DOWN TO FIRST FLR I w I SEWING p BEDROOMg2 AREA (Corpet) I (Corpet) i I r O I N . r I X p N I Lip O I o I o I. I 1/2 WALL. WALK—IN CLOSET (Carpet) SECOND FLOOD SCALE: 1 /4"= V-0" �ngin6�.ring Dept.(3rd floor) Map / '7 d Parcel '� Permit# ( 2-G0 House# Date Issued 2, U Board of Health'(3rd floor)(8:15 -9:30/1:00-4:30) 7r✓ Fe ® Conservation Office(4th floor)(8:30-9:30/1:00-2:00) , SEPTIC YSTEM MUST BE Planning Dept.(1st floor/School Admin.Bldg.) INST COMPLIANCE Definitive Pla ed y Planning Board 19 TLE 5 S, E,IVV& - L CODE AND, TOWN OF�BARNSTABLE � 'A'"� _ULATIO�'� ` Building Permit Application � ! Project Street Address /:� ' -��e 106 Village Owner 0 zi. C� 2 �cfy��S Address Telephone I" Permit Request , First Floor J.-1 8_7 square feet Second Floor square feet Construction Type -�- Estimated Project Cost $ no � t Zoning District Flood Plain Water Protection Lot Size ► 3E Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing S7ull 1-7i Historic House ❑Yes o On Old King's Highway ❑Yes 0 Basement Type: ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) y1 b Number of Baths: Full: Existing 9--. New 0 Half: Existing — O - New No.of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing New _�First Floor Room Count j Heat Type and Fuel: ❑Gas 010'il ❑Electric ❑Other Central Air ❑Yes Q�<o Fireplaces: Existing —a - New Existing wood/coal stove ❑Yes ®Ko' Garage: ❑Doiched(size) Other Detached Structures: ❑Pool(size) Attached size ,,Z: - ❑Barn size ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name S - Y ► 2 t Lo"1It Telephone Number `�'� �'- 0�]. - Address License# 1 & e c��s -�; 2 Home Improvement Contractor# / a 7 6, yI I S7 Y)l 0 Z�,O Worker's Compensation# a Ti (;L'7,6 D NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V(A-.V yr n r7 1►'1 SIGNATURE DATE BUILDING PERMIT DENIED FOR E FOLL NG REASON(S) a r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED. - MAP/PARCEL NO. s f , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION y pew• '" / _ �w\// t I .•, FRAME 9Y- _ INSULATION FIREPLACE .r _ ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH .FINAL GAS:_ ROUGH FINAL • FINAL'BUILDING Z,._ / ` DATE CLOSED�OUT-i— , ASSOCIATION PIi ANNO I• ! i In r * 1 I !ti 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: 5-28-1998 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 154 Your Home = 137 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 352 30.0 0.0 12 WALLS: Wood Frame, 16" O.C. 912 11.0 3.0 70 GLAZING: Windows or Doors 96 0.400 38 FLOORS: Over Unconditioned Space 352 19.0 17 ------------------------------------------------------------------------------- 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 ti cf MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 5-28-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-11 + 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. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------ Z"d-UMU]C',4KMAT 2•/U RnF TERs.::.._._. T. .. I.1 6TW\PPI Fig l y - _..R3F41G5U�;[V/•PRpPtq-. 1-5 rtAPII� e . D/4•Tf5 PE'nvOOn i 0 1.4 SLvnS�v/R:LL.5.15i14_... ^ CLOSET (Carpet) ' EXISTING BATHROOM (Tile) FAMILYROOM (Carpet) TOY CLOSET 0 PLAYROOM UP TO-0 SECOND FLR (Carpet) 10 O p COAT CLOSET FIRST FLOOR - - - SCALE: 1 /4"= V-0" I , r I I I I - I I I � N I of � I BEDROOM /1 I (Carpet) I I I COMPUTER EXISTING I ROOM BATHROOM (Carpet) (Tile) DOWN TO FIRST FLR I I r I N I SEWING � BEDROOM g2 AREA (Carpet) I (Carpet) i I F N.. X O W O I p o I _ I 1/2 WALL. WALK—IN CLOSET (Carpet) SECOND FLOOR- SCALE: 1 /4"= 1 '-0" n `�-�---i+...Z.'�'`rt-�<`''7�t+r'.,:w: .'{a"s+n,i'i�`.<^e.+P1'art-yr!':{\.�'h'.+..�y:.,�,,;.t.,,rR;,..f+tR-.rtwJ•f -- - 7.y.�A.Few+�'v�;ty�"-ova^--."'`i':,=i-•.•�'�...r�....�.. :a ,... - ,_..a�%�,.-,a`^^r;;. �1HE o� The Town of Barnstable BARE. Department of Health Safety and Environmental Services MASS. t639. �0 ' �Eo, .•a Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Lo Location Yermit Number —3 (-2—( 0 Owner Builder; , One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 1 (A A-::�3 U r\ k _ Please call: 508-790-6227 for re-inspection. Inspected by V- �, Date f• 1 ` s t � - � r __ ,. �, `� �— . �, .. � i .,,,, � .` )� .'' 1( � i � .- 1 �. � r �4 .. Y ,. '• .�/ �, -. , ? , i � i r I \ � .. � � � � , � � ' +. F � � ' r ` .' j 1 � o X � �. � ', } . � � � i t � { ; � � � k ` } � � � ; • • � , 3 • ' - l � ✓ F r i • • • i / ' • �3+l+-•' ��/ Imo! C ♦ ,,"; �� ✓ter, • t • The Commonwealth of Massachusetts Department of Industrial Accidents .="= Olfice of/nYestiffJ ians -_ � 600 Washington Street F ;r/ Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: f� location: city phone# ❑ I am a homeowner performing all work myself. ❑X Ia sole ro rietor and have no one workin in any ca acity „��,,, I am an employer providing wor rs' c pensa n for em o es working on this job. company name• address c hone#: ity: insurance co. olicv# l�t� ��✓(//�S/F / . c one) the contractors listed below who a sole proprietor, general contr actor, or homeowner circle n )and have hired ❑ Iam P P , g - have the following workers' compensation polices: com anv name: address: city phone#: oltcv# insurnnce ca. com anv namer address: ctty- phone# olicv# insurance co.. Failure to secure_coverage a+required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oitice of Investigations of the DIA for coverage verification. I do�f, wins and penalties of perjury that the information provided above is truo and correct Signature Date � 4� _ Print name C �•� Phone# , ofIIclal 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 inunediat.response.is required ❑Selectrnen's Office ❑health Department contact person: phone#; ❑Other (sewed 9/95 PIA) Information and Instructions .. ,A 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 con= 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 trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a three apartments and who resides therein, or the ant of the dwelling house of occupant having not more than thr p P dwelling house vmg another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds c 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h, 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 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 yoi are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of th 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 perniit/license number which will be used as a reference number. The affidavits may be retuned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 0Mce of levestlgallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 ✓�e -P I HOME IMPROVEMENT CONTRACTORS REGISTRATION j Board of Building Regulations and Standards ! One Ashburton Place - Room 1301 Boston , Massachusetts 02108 I HOME IMPROVEMENT CONTRACTOR Registration 100871 Expiration 06/24/98 Type - PRIVATE CORPORATION ! HOME IMPROVEMENT CONTRACTOR Registration 100871 MARKWOOD CORP I Type - PRIVATE CORPORATION TIMOTHY M . PEARSON ! Expiration 06/24/98 110 BREED 'S HILL ROAD UNIT 10 j HYANNIS MA 02601 I MARKWOOD CORP i TIMOTHY M. PEARSON &ef;-L-�10 BREED'S HILL ROAD UNIT 10 ADMINISTRATOR HYANNIS MA 02601 -- ----- -----• —.-- -.— --��_ ------- - - —! 4 y' • 4 > I ✓/ze �anvrizoaz��leal�- c�._•�/�����d�ccLiecJe%Gi , DEPARTMENT Of PUBLIC SAFETY ' 4 CONSTRUCTION SUPERVISOR LICENSE Number:. 'Expires: 4 r _.. ._ Restricted xTo: 00 6 , TINOTHY- PEARSON Ott"/POBX 519 ,• CENTERVILLE, MA 02632 a �INGLr FAMt0 - '� BE.OR�oM FLOW - 110 x 3 = 330 6.Pp SEPTIG TP�K = 33OX15o% = �495G.Ro r �� u5E- %000 GAL. 0%5Po5AL PIT S�DGYi/A�l A2GA - I,cs.F 9B.G 9 •5 - S. T. �t»[.=r . I BOTTOM A2EA= • �0 5F. NC S 3r>=}f Sp S.F x 1• o �. 5.o G.P o.. -TOTAL.. C�E516N = .4.2 5 G.P. D. �-YjS 7'• + 98•S� 'TOTAL. DAII- Y 330G.Po N 9a,e , PEIZco�ATIoN FZATEj I IN VAIN ol`Lr=551 9e 34 41CT63 yf I ' 'y tr C: ti,t��F'��s �q ALAN G RI CHARD ��v W.A. - - /S•ao ` 4 @A TER y� o0 25 l rr A No.21048 Gr O �� G�,�,G -TG.�e���-•- P Q srg�R h 'TEST ` S ZZOG �G 99� Yw TOP FHP=109.044 , coA JOPSvc` ptST. INY. +Tk iC- 973 9uX TA►• '� 7- 10oo IWY. 97/ Gp•L•• ' • L�PG�•1 ma's .i ; . . PIT INY,. NY. . Mc,•a W I T N . , 9G•7' 9G•9 . WASKGD 6TvNG G . GE2TIFIGD PLoT PL-Arl A'oo P R.U F I L 1_ L 0 C A'T t o IN e sw ---V I L-Lz- No. SCALE SCALE 1++-_yo VATS �181�3 '. . PL•-Ar l RGFEQENGE i G LERTIFY THAT Tµ�PP�PoSe;'DE{S'c,5µ0µ(N HEREow COMPL�(5 WMA-THE SIDELItiE ��- g Awp 56T8�.GK (Z6Q�IR.6MI=NTH OF 'C1�E- ' 10WN OF BA9-145-rA3L-E AND IS MOT LOGp.TED •WITHIN T .� GL-ooD P a.1N D AT Assessor's offioe (lst floor) t Q� %' /' THE Assessor's ma ..and lot number .... ... .. ....'."•:. 0 ' SEPTIC SYSTEM MUST P: �� ,iJ....;,...... ..... Board of Health •(3rd floor): �12 _ , p ��? ' INSTALLED IN COMPLI Sewage Permit number ..........:`'........ BASd9TODLe L. Engineering Department Ord. floor)•. , House number ..............:.......... ......��. ..� .(. .. TO .CODE v'a�'� VIRONI�E "b WN REGULATIONS APPLICATIONS PROCESSED 8:30-9:30 A.M. and"1:00-.2.00�;'�P,M. only, t'. • '•� TOWN: �OF �BARNSTABLE •� � _ • BUILDING #ANOECTO:R APPLICATION FOR yPERMIT TO .�.. ..elf`.! ...... 6 `'! ....,• ....,, TYPE OF CONSTRUCTION'.......`. ..... ... gr .............. ............ ....................19 ... TO THE INSPECTOR OF BUILDINGS: v The undersigned hereby applies for a permit according`.to the following information: G � V Location ....ST��. .......3`". �211��C..er:..f... .. ..N.� ..�. �i.�.. .............................. . ................................. Proposed Use ...:.......&e e.z.e:....W.E!:y.... ..�;(`! a.w...... .y1r.vq ._.x......................................... Zoning District ........... .....................Fire District S k. ..t ..... .."....��. Y� .✓'.�.� NN J 1✓F 11� J� . Name of Owner ..Address 68 Name of Builder ......... Address ....... .. !'� C Name of Architect ............ .....:............................................Address .....:.. .......................::.................................................. Number of Rooms -.Foundation y..... ... v/1.° ......t cJ wv p�y�� Al . ............ .......... Exlerior ..G . 5............:....Rnofing ..... /7. /7v�G.�.................... ................ Floors Interior �`' /� C ........................ .......:................:.:.:... HeatingPlumbing �� `.......�.. ......................................... ....................... ................. Fireplace ......... . ... f....~...: ... ,. ....,................... Approximate Cost ..... /..`1..�.�!.�:..�.v.....:.. 4 Definitive Plan Approved by Planning Board --------------------------------19________ . Area ... Diagram of Lot and Building with Dimensions _Fee_.. .. ...... ......... .. SUBJECT TO APPROVAL OF BOARD OF HEALTH y� N� ifi ` L 12 y 1. .. . ,vy 5 f 1 �a OIL- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To n t table regar g the above construction. l Name .. ` �... 4 ........ ...... . .. ............... .......... .. Construction Supervisor's License ..... s�/��/ EHART, ANN & JEFF , 29950 Build Addition/G3ra9e No ...... Permit for .................................... u Single Family Dwelling 17 Location 1.83. Goff •Terrace x � ' r Centerville =:, ....................................... .. .......... Jeff EhartOwner A.n.n L� e:.. ....... J 4. rrt Type of Construction 'Frame... - t ` r , .. .......................- r. ..... A ......... y r• - t �- u^ r; - _ - ., a .#.' Plot, .. -LotZZ ... . ........... Permit Granted `.Sapt mb.er_, 23.,.19 86 Date of Inspectio ...19M Date Completed .... .. fro FROM - �- TOWN .OP BARNSTABLE BUILDING DEPARTMENT Mr. Francis Lahteine � Z Z Town Clerk V,,�.v e WMAIN`STREET HYANNIS, MA Q28, -. Phone: 775-1.120 SUBJECT: .. FOLD HERE C DATE an. 231' 1984 � MESSAGE s, Work has been completed >ar�c�e� ,..�e�r�� R#�2�,����� �aG3dct� B�,�lders} • Please rgjease ggq4. - v, ` SIGNED DATE REPLY e •. SIGNED 'I 1 N87-RMI 4 - 4 RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. ' 25525 TOWN OF BARNSTABLE Permit No. ------------_-------------------- Building Inspector m•seanT, Cash ----__-_ -- 16)9• � ''to""• OCCUPANCY ` ..PEF2M9T 'Bond X-- - T, Issued to Bradga,tf'f $L1llCE' 5, Address ` — » . » Lot 8, ' 83 Goff Terrace,, : `GEnteuvi•11g Wiring Inspector , Inspection date Plumbing Inspector . Inspection date Gas Inspectors '"""` ,���-' 'r , Inspection date XEngineering Department, Inspection date/ ✓ Board of Health `� . .... M ry Inspection date f`/s THIS PERMIT WILI: NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. t ��r.,... �:3 19 ..;%� Building Inspector •P � pK 3DL . 8Ijs/g Assessor's map and lot number .��� dh" � SEP � E . '»- " d "�J`............. _ '� �Y F THE T AN Sewage. Permit number `:..� �' ��Y�¢/` !NSIA L .D TITLE r d d�"+L , tr •• ARNSTABLE. i House number ....... -�T..:....................................................... " NKEN' 'oo Mb I t��� � as gar. � 31 ,. TOWN OF. -BARNSTABLE I. r BUILDING I-N S P-Ervj0R r . � ` APPLICATION'FOR PERMIT TO ...........y............/.. ....... ..... .... ..................... ............................:....... ' + . ............. .... .. ......... .. TYPE OF.CONSTRUCTION ..... .. y ....... ................19 TO THE. INSPECTOR OF BUILDINGS:;' The undersigned hereby applies for; a permi ccordingr to the following' information: .. Location ..... .. .......... -@w ............................... ... ....... ............... ... �:� -�. ... ....... r ProposedUse ..........�""""tY�.... :................................................. . .................................... Zoning District ......Fire District Name of OwnerBca-b..GA-770 1.L .`......Address ....5,`..��/.... .... .. ....W...r a Name of Builder .......................��. .4,01. .C...................Address ..........� .................................................. ....:.....Address `Name of Architect .................... ...........:......:........:...... ...../'�.......................:................................................ Number of Rooms ....` .1..........:.....................................:......Foundation ..... D..�U.�! �' .:. /1 n- �--y Exterior ...... .d ... .h'L `i!'.�..� e-�.........:...........Roofing ...:.... P C L-/............................................. Floors ..cjq- .f-1 ......... ....................Interior �. .e �' Y �D.G/ ...................... ........... .......... ..... ............ .............. ...............,....... . .. / .........Plumbin ..................:. Fireplace .............y .............................................................Approximate Cost .......... C�l ...........`............... Definitive Plan Approved by Planning Board---------------------------------19=_______. Area '?3.............:......� Diagram of Lot and Building with Dimensions. Fee 56,... SUBJECT TO APPROVAL OF BOARD OF HEALTH ® ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . Construction Supervisor's License ....... . . .. ..... f BRAPGATE BUILDERS z Story No ..............:. Permit for .................................... Single Family Dwelling............ Location „Lot 8, 8.3 Goff Terrace s ' .. ... .. .. .. _ enerville .................. - L�_�•) - _ Owner ,�`;Bradgate Builders T e{of Construction Frame i .................................................................. `' ` p + ✓ i _ _ - Plot ...... ..................... Lot ................................. Permit Granted .Sept....-3 , ..' .... 19 83 ` Dat•of Inspection `..... .......... .......19 r Date�Compteted ' ........... .....� f. 19 x , w �I►J�LG- FpMI��( ;3 BC.ORooM wl' ►.JO 6ARgAGE• (�211.IDE2 _ //,S_ dO ��."}� Dla1L�( F1-oW c IID A 3 s SEPTIC. TANK = 330x15c> = 14956.P• Q u5E• l000 GAL. ot5P05A1.. PIT v5E (00 GAL. SIDGWAIL A2.GA = I�oS.F 98,E R •5 - S. T. - ,��'� 15p - BOTTOM AREA= SO 5.F x I. o � " 5.o GPp... . ti ► Q S ^IT -T OT A I- TaTA►- pA%1-' FLOW 330 G.Po N GOLAT►ON LZATEI I''IN 2MIN00 o�L.�55 `� 9/ " ,• ' I' 9e Asr (. CH ALAN yG _ RIARD �u,v ! _ A. a W. //S a0 i (� BAXTER n y 10NES No.24048 0. 2511` O �4 PST GIs 1 P� *0 siol � T��1-r ZZOl� 99� ToP 'FNP=�oo.o ,aCGAN� ` $a, v` P1ST. 97.3 7— .t goo INY BvX 97/ TANTK �'� L�QGl1 �•S INY. IN ' . PIT • - 7w.. .5AVV WASKGD a 94p s CE2TIFIED P1,-oT PL_AtJ PZDF-ILA _ _ . aa S L o L A-t I o t-I W0 5 CA.I.E ScAL.E �'�_�o' VA.TE a P L_p,r,.r R E F S 2E N GE `. GE cz"f lFY THAT THE�P-oPo54'D NScS}{oWN NE.Rr~oN GOMPI-�{5 YJITN'CHE �,1o�LIt�� `�-t 8 AuD S�15AGK R.6Q�IR.EMEr11'� oF 'C1-IE- AWN OF ANC IS I4O — I j p6i ,, L.OGATfE'�D(••WITN1�1 T 'E GLooD P AIt•-I • • , Assessor s map,and lot number ... c'r'j .............................. .......... • raj / &T E T��•i �, F�' ,� .•• '" r' fig. ��'� �w... �, ..,».-� �Q O Sewage Perm{ it number f t-x rj... �y Z BARNSTABLE. i House number `......... MA°a......... 9�p 0 • ,o� 39• 9 'FO MP't a� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO f r .. . TYPE OF CONSTRUCTION ................ :...1..`... ...:...` ....C:................f .. ... ........ . / .!.... .. ................19....... 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fob}rya permit-according to the following information: Location ..... !! ' .......:: �,�f-n�� ! .......��!�1................................ ................................... ProposedUse ........ lf'.: :.rR'f �....� �:". :::... :� . .......................................................................................... ZoningDistrict .... .� ..:. .... .... ....... .Fire District ... ..:.... .... ........................................................... Name of Owner�I+,;f �F+ .'rys �<< °.. �A: : `......Address ;r s„ � f t. f� ..... ..:�9'............. Name of Builder ..................... `�� k' : '? :Fr....................Address ............ . ............................................................... <. ,. Nameof Architect ...............i �^ ...................................... ..Address .....A : . ..................................................................... f Number of Rooms ......................................................{ Foundation. ... r'`'P ...•, " : .. ..... ......................................... .. r Exterior ..... I. .. .. Roofing ......... .,.. , P�' �� ,t" ?.r............................ k Y Floors ............ 1F' 3.. . ' .? ..: .........Interior ............. !, ....:............ .. .. .......: :......................... Heating ` �.,1.`.. ..............................................................Plumbing ......... ................................................................ Fireplace ..............................................................Approximate. Cost .......... :: ................................................ . . Definitive Plan Approved by Planning Board --------------------------------19________. Area �' Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... Construction Supervisors License ..,:c......... .... BRADGATE BUILDERS A=170-80 No 25525 permit for .,1 z Story t Single Family Dwelling ............................................................................... Y. Location ...Lot... 83„Goff ,,Terz��,P 1 Centeryi # Owner Bradga. ...te Builders. . . ................ .. .... ..... .. .... ....... i i Type of Construction ..Frame,,,,,,,,,,,,,,,,,,,,,,,,, 1 r ................................................................................ Plot ............................ Lot ................................. � r Permit Granted ....Sept. 13, 19 83 , Date of Inspection ....................................19 Date Completed ......................................19 Assessor's offioe (1st floor): /r oFTMEtO Assessor's map and lot number ..�.7 ...�'.. .a........... Board of Health (3rd floor): 3 Sewage Permit number ..........° .........U.3........ �.. Engineering Department (3rd floor): it ,t1 '°o,�Wb& e� House number ..:................... ..�................................ ........... = ` 0�p9 w APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only t TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ ...............�....L�............C?...;:..... .......G................................................. TYPEOF CONSTRUCTION ..................::............................................................................ ................................... 0 � TO THE INSPECTOR OF BUILDINGS _ x The undersigned hereby applies for permit according to the following information: ^� 9 Y PP P 9 9 Location ....(.7"��.? ........f.{✓I�Z. ... :...f....�n.. ..�. t 2. u.:.L..Ltr............................................ .............. .................................... Proposed Use ...........4`jJ e-e.. ......�!>..!7.ri ..........! ` -i/���.(1a �...:.................. ........ .............................................................. Zoning District f�/!�?f.!Sf ..naL �- .......Fire District �., , .......................................... .. Name of Owner l /,n! .. �.. rl-/ 2 7� 7'r�/I.J L ..... L��.. .��/.�, C , ................. ................................... ....Address .................................. .................... Name of Builder t� n` % G •��, ,-�! �.1 � hT r -r ................Address ...... .......... ... ./ �..:........................... tea............... ..................... ..... - ...................... Name .of Architect ..................................................................Address .................................................................................... Number of Rooms .....................................Foundation y "ri /..... .............. =� ..........., Exterior .......................21 ......................Roofing .......I V 1-114'G f. ..................... ..........,...... Floors �s�/?fll e � Q a �c / -7`�`? .....Plumbin :.........:Heating :. ............... g...................... . Fireplace u�✓ - .........Approximate Cost S T` Definitive Plan Approved by Planning Board ________________________________19________ . Area .......................................... Diagram of Lof and Building with Dimensions g 9 _ Fee U_.� .,...�.. v..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Cis C t,0/4 ✓t Sf z r ' r. l OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , ,,hereby agree to conform to all the Rules and Regulations of the Town' of Barnstable regarding the above construction. Name ... . �...: .. .......... ........................ Construction Supervisor's License .. ...................S`................... EHART, ANN & JEFF A=170-80 No 29950 Permit for .Addition/Garage .... .......... ... Sin&le..Family..Dwelling... ............... Location ...83..Gof f..Terrace............................ ..................Centerville Owner .....Ann & Jeff Ehart Type of Construction ...Frame............................ ............................................................................... Plot ............................ Lot ................................ r Permit Granted .......Sept. 23, 19 86 ................. . Date of Inspection ....................................19 Date Completed ......................................19 ' 1z x /G J/ Z 2z a C a s LEGEND a �n PO '; " • 99 PROPOSED CONTOUR F 99 1 PROPOSED SPOT GRADE EXISTING FENCE _ Q , 'EXISTING CONTOUR f_ -_99 Hj j EXISTING SPOT GRADE ' 558040'I OW ti TEST PIT o � 1I .00' i �1` LOCUS Q _ I VV EXISTING WATER SERVICE `r pnrke Rd PROP I I' EXISTING i ti p PROPOSED ., I FENCE CI1W— EXISTING OVERHEAD WIRE LOCUS MAP N.T.S. 2� I 55' SWIMMING I U EXISTING UNDERGROUND UTILITY r cc� POOL BENCHMARK BENCHMARK: i STAKE *TACK 5ET EEV.= 100.00 (A55UMED) ~' C NCRETE EXISTING S.A.S. PATIO I DECK I w.: PATIO. TO BE PUMPED C(oS� FILLED W/SAND _ j �� �r `, r w �1% L kf ! rIA EXI5TING 5EPTIC TANK w _ Ef f f, / I�f ` 1//, "� > ` ' ` �� r N (f0 REMAIN) — w A /GKRAC;E� I p Q 1/2 p 100.85,� 4 / , / 11 �� OF R ��� OF MAs, m` BIT. GONG-- o RICHARD CZIV I: � o PETER D ( g J. McENTEE P'r � HOOD o CIVIL No. 35031 No. 35109 APN 170 — OSO S1E��°�����" A FSS�£�/sA���° �! I AREA = 15, 180± 5F i i 5.00' PROPOSED SWIMMING POOL ` 55e4O'I O"W / 83 GOFF TERRACE, CENTERVILL�,- MA ✓ ` Prepared for: George Conduris, 83 Goff Terrace, Centerville, MA EDGE OfPAVEMENT Engineering by: Surveying by: SCALE DRAWN JOB. NO. f GOFF TERRACE EngineeringWorb HOOD SURVEY GROUP 1"=20 P.T.M. 144 05 12 West Crossfield Road 18 Route 6A DATE CHECKED SHEET NO. Forestdole, MA 02644 Sandwich, MA 02563 (508) 477-5313 , (508) 888-1090 5/28/05 P.T.M. 1 of 1 1