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d REFERENCES:
Ro
. Assessors..Map: 209
0
post Nud Public W°y� Parcel: 061
(4 '4� E ZONE: C-
RN,5.,9
80.00Setbacks:
old Front:20 .
_ Side: 10
i.P Rear: 10
Fnd
41.0' Lot 1
10,000SFt
E Meter N
N
CP Off_ LL
#167 $ o
1 sty .w/f
Dwelling o
`° u) 00
fi
1�k - a
N N
S � �
cz r,-1 O
o Chimney
co o 20.7'
0
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Fn d
SQ QQ'
rs 9'47" E
N
11.0' N/Allison Wo
F d Martin 6660/343
1 certify that the foundation
shown hereon conforms to
the setback requirements of
0oe<uAsscy`f�� the Zoning
�stable.lows of the
town of Sa
RICHARD R + PLOT LOT PLAN
c {gyp, 34W 2 �o At 167 Old Post Road
Barnstable
Profe d Surveyor Dot (Centerville)
NOTES: MASS,
DATE:211DEC12011 SCALE: 1"-20'
1.) The structures shown were located on the .ground 0 5 10 15 ?O .30 40 FEET
by conventional survey methods on 21/DEC/2011.
PREPARED FOR:
2.) The property line information shown hereon was Eugene P Valliere
compiled from available record information. 167Old Post Road
3.) This plan is not for recording on:d is not to be Centerville MA 02632
used for construction layout or deed description PREPARED BY: CapeSury
purposes.
7 Parker Road
Osterville MA 02655
DWG #: C784 FIELD BY:RRL/WHK (508) 420-3994 / 420-3995fox
e
TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION."
1Io� � .
Map _ Parcel. �a :'Application #
Health Division Date Issued I LA17
Conservation Division , ;Application Fee
Planning Dept ,` h Permit Fee _� � •'
Date Definitive`Plan Approved b Planning Board
pp .Y 9 ow 1l�ly�ll
Historic - OKH Preservation/ HY anni s
Project Street Address ol—
Village
Owner A; U4 � Address - RS-
Telephone1�—
D /
Permit Request ` � �1�1� CeC !9 t° (
tA V- #_Gkr 0 �S-T6)P C
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District R AA& Flood Plain Groundwater Overlay
dS
Project Valuation Construction Type b�
Lot Size r��, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count711
�
Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Y-
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove❑Yrq ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing 0=new size_
Attached garage: ❑ existing U new size _Shed: ❑existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATIONrn
p (BUILDER OR HOMEOWNER) C5 j 7 ( c(IT `
Name" oc Vk t Ity Z'114 9f, c a��3�t� t�l
Telephone Number 1�
Address (¢ 1140 1065r License #
Home Improvement Contractor
Worker's
e s Compensation
#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
s� MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER r r
DATE OF INSPECTION: %-
FOUNDATION '
FRAME 06 q 11117.
INSULATION
FIREPLACE
ELECTRICAL: ROUGH
OUG FINAL
PLUMBING: ROUGH FINAL
r _
GAS: ROUGH FINAL
FINAL BUILDING I 1 ZqSI -�
DATE CLOSED OUT
ASSOCIATION PLAN NO.-.- L.�l
J
�ofYNF, -y Town of Barnstable
Regulatory Services
HAFiNSTAHLE i Thomas F. Geiler, Director
MASS.
_ s639 Building Division
Thomas Perry, CBO, Building Commissioner
200 Main Street, Hyannis,NLA 02601
'www.town.barnstable-ma.us ,
Office: 508-862=4038 Fax: 508-790-6230
PLAN REVfE'VV
Owner: VAU- LU-5 Map/Parcel: ;�09 0(0/
Project Address� 0Lb POST- RZ Builder: 0�1n�E2
The following items ),vere noted on reviewing:
�A5 -8UIX-T'. 'SL:RVCY NEEOtD UNcE •FOWJDA'TFOt)
FOR COLD COO= o iJS
WITH '730 CrMK
Reviewed b�-:
l�ate:_f b�l��l1
�Torms:Plnrvw
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations-
' 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information c `^/J r Please Print Le ibl
<Name-(�ss/Organization/Individual): ��� aLL I L"� c—
�Ad'clr ss I �L 0
GC ty/State/Zip: ��IG �,L� �{ Phone.#: E0q 3 y� 4. J O t
Are you an employer? Check the.appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors6. New construction
2. I am a sole proprietor or'partner- listed on the-attached sheet. T. ❑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. 10.
required.] 5. ❑ We are a corporation and its ❑ Electrical repairs or additions
I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions
lf o workers'co right of exemption per MGL
Yse � mP• 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required_]
*Any applicant-that checks box#1 must also fill out the section below showing their workers'compensation policy information. '
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors have mloyees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip: _
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can.lead to the'imposition of criminal penalties of a
fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day.against.the violator. Be advised that a copy of this statement maybe forwarded to the*Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify and r the ains a d penalties of perjury that the information provided above is tru dcorrecG
.--� VjCSt afore. Date: JJ
Phone#:
Official use only. Do not write in this area,to be completed by city or town offieiat
.-City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Insttuctions 4
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-conttactor(s)name(s),addresses)andphone 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 permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(,if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town).".A copy of the affidavit that has been officially stamped or marked by the city or town 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 io any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone�and fax number:
The e6mmonwealth of M=achuscm
Department of lndustd4 Accidents
Office of IavestigadQns,
604 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 6.17-7214749
Revised 11-22-06
www.mass.gov/dia
Town of Barnstable
jHE r, "
Regulatory Services� t
uT"M : Thomas F.Geiler,Director
Building Division
PrED Tom Perry,Building Commissioner
200 Mairi-Street, Hyannis,MA 02601..
www.town.barnstable.ma.us
Office: 508-962-4038 Fax: S08-790-6230
��-HUhIEOWNER_LICENSE-EXEMPTION
egse Print
DATE: �] t
JOB LOCATION: NA �jL./�j Ta�V Ij
L G
number strpeet� ^�1 /�y village
"HOMEOWNER" C ,G�E q �' I/C..f j.�C�)�G l7 //_D(e�1
name home
phone# work phone#
CURRENT MAILING ADDRESS:
city/town state rip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of sic 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
t supervisor.
DEFINTITON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to-
be, a one or two-family dwelling,attached or detached shuctures 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"asst es responsibility for compliance with the State Building Code and other
applicable codes, bylaws,rules and regulations.
The undersigned"homeowner"certifies that_he/she understands the Town of Barnstable Building Department
inspection procedures and requirements and that he/she will comply with said procedures and
requireme
Signaturo of omeowner
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 EXEAEMON
.The Code states that Any homeowner performing work for which a budding pemrit 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 ad as supervisor."
Many homeowners who use this exemption an 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 responsnble.
To ensure that the homeowner is fully aware of his/her rrsponsibnlitics,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 cacti t amend and adopt such a fomn/certification for use in your community.
Q:for ms:homecxmpt
Town of Barnstable
Regulatory Services.
r •
r • -
nuns. $, Thomas F.Geiler,Director
Enµ96 16 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstible.ma.us
Office: 508-862-4038 Fax: 508-790-6230
" t
Property Owner Must
Complete and Sign This Section
If Using A Builder
r
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work autho by this building permit application for.
)k/ddress o ob)
Signature of Own Date
Print N
If Property Owner is applying for permit please complete.the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISSION
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= 1 -0 REAR VIEY4 RIGHT 15DEVIEY4 FRO1� T YIElnl 1. EFT 5117E YIElnl SGALE . 1 /4o . �.
GENERAL NOTES:
(1) ,ALL MEMBERS TO BE CONNECTED, POST TO BEAM, RAFTER TO HDR, J5TS TO PLATE �°�'�'s"�°��a � TW2446-2
Fg IONA���
CONSTRUCT ALL DECK RAILING AS PER RING RESIDENTIAL DECK CONSTRUCTION FRAMING DETAIL5 N .T . S .
(3) ALL YV�ALL SHEATHING MAILED 50 @ b" EDGES -12" IN FIELD
(4) Y�lALL TOP PLATE LAP NAILINHG 2' MIN Y415 160
(5) CONSTRUCT YVALL AT OHD AS PER APA PORTAL FRAME YVITH HOLD DOYVNS DEsi�NE° FOR:
161 0L b p051' t;OAa
10 MPH SPECS 5GALE: DATE:
YV- 1 b' L-24' NOTE: The purchaser of these plans is responsible for compliance with all 5TATE and LOCAL Building codes and ordinances. ALLEN B. O5G00D AS SHOWN AUGUST20,2011 16'x 24' DETACHED GARAGE
MRH=21'-3" Neither ALLEN B. 05GOOD or participating Designers may be held responsible for the use of these drawings during construction. RESIDENTIAL DE5IGNER
ASPECT RATIO - 1 .5� STOCK PLANS-CUSTOM HOMES-ADDITION5 COPYRIGHT c 2011
The purchaser is responsible to verify all elements of these plans for design, accuracy and sizes, with their builder, prior to start of H15TORIGAL REPRODUGTION5 ALL RIGHTS RESERVED DRAWING NO: ') of
ANCHOR BOLTS 35" OG construction. NOTE PLANS ARE PROTECTED"BY COPYRIGHT c 201 PO BOX"135 SANDWICH, MIA PH 508-833-3830 PERMISSION 15 PROHIBITED UT