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0561 OLD STAGE ROAD
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F�, :-:r'd':.;dlrR ew lot6 � � ")''q}r:a :�f ri„w .>br, '�L ,r•rr��Pj"�1i C,n�9a t�,.�a>� p><..e l ' f Town of Barnstable Regulatory Services �1Me Thomas F.Geiler,Director Building Division r « r snxxsrnsLe, « Tom Perry,Building Commissioner - 9 q �� 200 Main Street,Hyannis,MA 02601 ��FD MA'S A Office: 508-862-4038 Fax: 508-790-6230 September 9, 2011 Timothy& Carole Leonard 561 Old Stage Rd. Centerville,Ma. 02632 RE: 561 Old Stage Rd., Centerville, Map: 191 Parcel: 002 003 Dear Mr. & Mrs. Leonard: This letter is to inform you that a final building inspection is needed at the above referenced address for permit number 79587. As you may recall, the permit was issued on or about September 30, 2004 to convert a garage into a family room. On or about November 17, 2005 a final building inspection was conducted and it was noted as being `not ready'. A subsequent reinspection has not been done.Please contact this office and arrange for an inspection as soon as possible so that this matter may be resolved and the permit closed. Thank you for your immediate attention in this matter. Respectfully, a zon Local Inspector (508) 862-4034 Q:zoning5 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' P reel 0 b 41$Lrmit# Health Division " ° Date Issued Conservation Division d ��n s Application FeeD y Tax Collector d Permit ee R f 2 7,m 0 Treasurer Planning Dept. n 4. EXIS ING SYSTEM r O Date Definitive Plan Approved by Planning Board � UMMSD TQ— .J F BWROOAAS Historic-OKH Preservation/Hyannis Project Street Address 576 / 6 �1%fi c f Village ,. Owner Address sf 7;94 e Telephone S-D X_ :121 Cly� Permit Request aA Ve T_ �xi�r► c &AJ a -f AP l,qrA-iR w.- o -PAiKA Z Pac) Square feet: 1 st floor: existing $$`I proposed 2nd floor: existing 6 k'ck proposed Total new yea Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type1/Crs Lot Size 3 .yere Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ( Two Family ❑ Multi-Family(#units) Age of Existing Structure 9 VeaS Historic House: ❑-Yes *o On Old King's Highway: ❑Yes *No Basement Type: *Full ❑Crawl ❑Walkout ❑Other a Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �L/ Number of Baths: Full: xisting new Half: existing new Number of Bedrooms: existing— new Total Room Count(not including baths): existing new_ : , First Floor Room.Count f Heat Type and Fuel: O Gas AOil ❑Electric, _ O Other { Central Air: ❑Yes KNo Fireplaces: Existing' New, ' Existing wood/coal stove: ❑Yes ,�I`No Detached garage:kexisting 0 new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:9existing ❑new size She4existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# ` Recorded❑ Commercial ❑Yes CkNo If yes,site plan review# BUILDER INFORMATION Name ` Telephone Number 6�6 ,+ Address" _ �61' ,� �lK J 7��5'� �� , License# Aet c x(o 2 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE gas/o it G rz FOR OFFICIAL USE ONLY r, Y PERMIT NO. DATE ISSUED — MAP/PARCEL NO. ' t • ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ® t �— S FIREPLACE ELECTRICAL: ROUGH 3 FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL fa! FINAL BUILDING cU R , DATE CLOSED OUT ASSOCIATION PLAN NO. N ' °ZIME, , Town of Barnstable Regulatory Services searesMU, ' Thomas F.Geiler,Director MASS 9`bpr 019. `°� 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. r Type .of Work: Modk�c o �1 ��C�Sfi nab q���ted Cost Address of Work: 1 0 kC Owner's Name: r-V( M )-- c C_rn Date of Application: Cl— I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 *Building not owner-occupied weer pulling own permit Notice is hereby given that:: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO' ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. �! OR �L T, +e Owner's Name - The Commonwealth of Massachusetts --- --=--=— = - = Department of Industrial Accidents Office 91151VestfgOONS _ 600 Washington Street Boston,Mass. 02111 `} Workers' Compensation Insarance Affidavit e location. 576/ 'Old ci e ! hone# O I am a homeowner performing all work myself. I am a sole proprietor and have no one working m* ca achy %%//%%%/%% //%%%%/%%%/%//G�%/%%%%//%%/%/G%%%%///%%%%------/%%%/%%%%%/%//%% rovidin workers' compensation for lay employees working on this job.:::: Iam an em 1 g .................................:.�:.:::::::.........:::.::.�::..�::::........:..:::::::::::::::.�:::::::::::::..�:.....,.....::::::::.:::::::::....:.:::}:::::::::..:::::::::::.:::::::.]:.]. res ..................::•::.v::...........•:�.v:::::::::........•:•:::::::::•.:...........-..:..::::::::::.:: ..............:w::::............•::�:�::.::w::::.v::........................:v::•::.v:.v::.::...........v:::::,v7:.........,..•.v:4•v::'•w::::• .... ......................... .••••Pi.�}!i:'�:•F.j{�?i;}�;:�:}{'::$?y;:;+.±::::?;:4;i:;.{j}:;;:i?::{:?��:t:?:j�:�:�:L$:7:;vi:'7:G:r •••hon '�i\ice{%�:•iiiiii:i v?}i:::ii{ii::ii :ii{:;:!;:;:�?:;'.�{:y$v- ii:;:j;:.?:4:j;:} iisy;;;;:4 ; •ji:;ii:jiiii%+viii]i:i:•: `Qli� ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following w rk...T...co....P.:.ensatio..n:..polices: : :.......:}::.::::.. e.. : } { ...... ... .... ....... ..................... ...... ................................::}:v;Y::4:?;4:7:?•Y:?�::'7'{?�:iiiriii?}:.ter•:::::M�7:::{n:u?� •} ...v...... :::::n;:?;{:?;•ji:•r:7:•:?7::!7:•}:7:?•:i{7}::::::v]::. ... ..... ;.y: 4 n..........• •........ ..... ..r. ...-. .................. ........... .......................: ::}::::n�:nv:::p:..:.••;w::.v:::::::::n..• x.�..ti.:���';7:;:,•:){v.Y::.::{.:::::...;;, -"yi::;:<ii?i:��iiii:•:?i:^:tii<i;?:?:Li::?i�i}jii:�i:iiii:•i]]:!•;:^}:•}:•];•i]:{7i};7}}:•::.�::::.�::v:•is7;:•::;;J}]:{.]:�;}:7:•::•;}�.:]:!;�:7YY:{?;•]:?;:;?j{;:.i:};?:;:v:::{::.;::i:::.........::....... .......... ::.: ....... ........ ....................... .....................:.{.Y;�;...,{:Si'�J:�{i'>�i:{-j•.}'tii';?•,ti•}:•<}i:•i ...... ... ..........:�::::..::::.�.:...:...::.::.::;.]:Y::•]7]:::-....:.v::.v::::::.v::.v 7]:{{7]};,};w:::::;:r::nv{:.:.:•:::{.•;;......:....:n..:::•. ......-..... ,.......... .........n, .............. ..v::::f.•.v;,:v::.v::::::.v:::•Y..$:•:v:•Y:•}YY:::::7:7:4}:7Y•}:7i]:7}:?:::':.:::•.......:.............n...............-..... , ..... .}................ .......n.r..v..•.................r...:•:.v::::.v::7Y:{{v:::::n......;............w::::::.v:•Y:•i:•}i:Y.{•}}}}.........-..-...::::..-........ .....w::,: .:..... r.....r. ............ .......: ........... .......................:....:::............ .............. ...... ..... v':i7Y:inY•:;•::{7}:{>•]':v:x..v.m:}. ....:.::::::::....:.:::::::::::::........::.::::::::::.......:.�.�:...... r.:.::................ 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':;)ii$i:'}ii:<i;: iiij f; : .'•: :<}.r;:;'.t::{;is;:;},??:•,:Y:f:•:•:;:ti:i{:;:;:;:v::F::;:;:•, :::;'i,'{�i::::jy{Q: ;:}•v.::...:::.:...:::•:::.:�;:.]'�{:{?•}y?:>.:i:>�iy:�i'i:}".{y7Y:ti;7:7:::7Yi}ii:7Yi::•::•::v:::.}::.,...... purzy. asm ...�:.::...:............... ..............:...........:;........r.:. � w ......:....:.. v.7 r ?0;:::::...... :....::•:n... ;}: x:.v:::.v::::::::•i}}:{?•}}i}YY.?•Y:7:7Yii:•}}.v:::::n..:.....:.v::. � ... X. gam a to secm a and/or coverage as required under Section 25A of MGL 152 can lead to the imposition of erhninal penalties of a Sue np to S1,SOO.QO one yam+ p�o,�®t as wen civII penalties in the form of a STOP WORK ORDER and a Hue at S 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 veriScatiom I do hereby certify under die p and pe es of perjury that the information provided above is trtu and correct Date 6 Signature / Print namel/1� L C��I A L7 Phone# official use only do not write in this area to be completed by city or town official city or town perndttlicense# ❑Building Department ❑Licensing Board use is re aired ❑Selectrnen's Office ❑check if immediate rapo q ❑Health Department contact person: phone#; ❑Other 6551,51,151,555 (devised 9/95 PLC Information and tructions Massachusetts General Laws chapter 152 section 25 requires all'e pl ryoyers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined,as eve person in the service of another under any contract of hire, express c r implied, oral or written.employer er is fine as an 1� N An p Y o d individual, partnership, association, corporation or other legal entity, or any two or more of ! ed in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or in en 7 rP the forego g g� trustee of an indivi ,partnership, association or other leg entity, employing employees. However the owner of a dwelling house ha ' not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construct"on or repair work on such dwelling house or on the grounds or building appurtenant the�eto shall not because of such emp oyment be deemed to be an employer. MGL chapter 152 section 25,0so states that every state r local licensing agency shall withhold the issuance or'renewal Of a license or permit to operate a business or to cons ct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with he insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions enter into any contract for the performance of public work until acceptable evidence of compliance th the insurance r ements of this chapter have been presented to the contracting authority. Applicants Please fill in the-workers' compensation affddavtt o letely,by checking the box that applies to your situation and +r address an b along with a certificate of insurance as all affidavits may e supplying company names, ?` n of insurance coverage. Also be sure to signand V submitted to the Department of Industrial Accidents date the affidavit. The affidavit should be returne to city or town that a appilcation-or-the-permit or license is being requested,not the Department of Industrial A cidents. Should you have any questions regarding the'law'or if you are required to obtain a workers' compensation po ,please the Department at the number listed below. ME City or Towns Please be sure that the affidavit is complete and p legibly. The Dep has provided a space at the bottom of the affidavit for you to fill out in the event the Office f Investigations has to conta ou regarding the applicant. Please be sure to fill in the Peimit/license number which vill be used as a reference numb The affidavits may be retumed'io the Department by mail or FAX unless other armements have been made. The Office of Investigations would like to thank you in advance for you cooperation and sho d you have any questions. please do not hesitate to give us a call. The Departinertt's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 0Mce of Investlgations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 RESIDENTIAL BUILDING PERM— FEES ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE vALUE woRKSHEET NEW LIVING SPACE 3 • x.0031= square feet x$96/sq.foot plus fr low(if applicable) ALTERATIONS/RENOVATIONS OF EMSTING SPACE � �square feet x$64/sq.foot= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft >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$961sq.foot= STAND ALONE PERMITS Open Porch x$30.00= (number) x$30.00= Deck (number) x$25.00= Fireplace/Chimney (number) Inground Swimming Pool $60.00 ` $25.00 Above Ground Swimming Pool „ Relocation/Moving $150.00 (plus above if applicable) Perrnit Fee= � a � f Ul �CdG .wD. Cd k 1 v 1Y."t f • r f f \fir 4 Tt I.. • 71 T , _ i - NIF NSF MALTER L. MORAN DOROTHY 6 JOHN PETERCUSKIE N/F JAMES G TINA VAUSCOY LOT 3 , LOT 2A • rn fflF'`� o �• ; can a 0 m EASSW �� • - 7- 'A IN g C -� R 89-302A � CERTIFIED PLOT PLAN LOCATION : LOT 3 OLD• STAGE RD, , (CEN7ERVILLE) BARNS TABLE, MASS. SCALE : !° = 60' DATE : 1/12194 REFERENCE : LOT 3 P8 497 pG 37 PREPARED FOf I HEREBY CERTIFY THAT ME" 3TRUCTURF _ ' GREENBRIER HOME'S SHOM ON THIS PLAN IS LOCATED., ON THE 6ROUNO AS SHOWN HEREON. D"fw.`' down cape engineering Inc. ARNEy CIVIL ENGINEERS H• - LAND SURVEYORS �2 7 MAIN ST. YARMOUTHpORT,MASS 02675 DATE - 013 VEYOR f Town of Barnstable ' Regulatory Services anaxsr.►aLe, : Thomas F.Geiler,Director 03A � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wwwAown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: y�/S�r�C,/ / JOB LOCATION: .-6/ cr/ number street village "HOMEOWNER": 7,1—A i7 -771—WO L/—(//a name // home phone# work phone# CURRENT MA11ING ADDRESS: Ce 7 -6/V1Ile . �iR na 6 3 2 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a.one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official.on a form acceptable to the Building Official,that he/she shall be responsible for all such work-performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 'A IMPORTANT R �I h ANY CONSTRUCTION THAT INCREASES-LIVING SPACE i BEYOND 12 00 SQ. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. •--NGTE -SEPARATE INST LAT ONOF SMOKE THE WEC aRS-TH LkTRRICAL PERMIT DOES NOT SATISFY TICS RREQUIREN ENT. `4 'p 6 P �— 4F .S. - b ad % 1 . `• ----�� w�� Mgt.::_;,.___- �, c�,c— � . reb,or �r�1� �t � O f'uf F—o E - R®om o f lK 24ACte-7 r4t �..�_`��. ���� t=.�. ter,•-P' i+ka: -`-•-�-.._'��`"-- e � I P!lk` 'f%CW 10Gr SMOKE DETE.GTQRS R VIEWED . . , � Y-R&OBA BUILDIN DEPT. DATE 1 ' FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIREDO PERMITTING I .. i L kL y V\ I\ . iC'1°r1"�p Wv t l �� r T -pooR � -- np, .r; .. .i _ � ate .. ... - � •. . ... _� � (• � f 1 r}.. Off I - f 1 ... J .asp - � _ ..•_ _ _ 3 _.--.....- .- _•PR .._ _.. .__. _.•. ..._-- •r---_��wb- 1. 11Y ffi 00 ..,` -.� ..• _ .. ..',._yam,-. .. .. 1 - 5�• +� � ati ' SA A.} { FAour :a oi-TT fdew t { 34 ed t9 ® , M �. � _ 6 jig y � i 1 - ` J � i � 1 . .... .... . .. �-f J t�e l , 1 { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 00�- 00 ,. Permit# Uf¢ i , df?t` S irk' —o Health Division o BLE Date Issued 2 Conservation Division ' rApplication Fee �, UZ� • N® #�� ; Tax'Collector 4 Permit Fee Treasurer �. '-SEPTIC SYSTEM MUSS'13E Planning Dept. INSTALLED IN COMPLIANCE VM TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ARIL TOWN REGULVIONS Historic-OKH Preservation/Hyannis 61 Q dn'y NO 1�41,wM S• Project Street Address '6 l D/J e— �o�dC Village _ C ye Ile . Owner T/^ fp' 6!? e. Address __T 6 l ots J:66 Telephone LI V6 b Permit Request ��K PLY + p e—r a c�� (,A, .2 ;C r' •-•�I . �� �c�;Q Square feet: 1st floor: existing l goo proposed 2nd floor: existing SDO ` proposed Total new Zoning District 2 Flood Plain Groundwater Overlay Project Valuation 36 Construction Type Lot Size /„A Grandfathered: ❑Yes ,eNo If yes, attach supporting documentation. Dwelling Type: Single Family ;t Two Family ❑ Multi-Family(#units) , Age of Existing Structure f Vega S Historic House: ❑Yes 4No On Old King's Highway: ❑Yes ❑No Basement Type: ,Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing `\ new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing J new First Floor Room Count Heat Type and Fuel: ❑Gas *Oil ❑ Electric. ❑Other Central Air: ❑Yes *No Fireplaces: Existing' / New Existing wood/coal stove: 6.41 Detached garage:❑existing *new sizeaI je;LI` Pool: ❑existing ❑new size Barn:❑existing ❑new size' Attached garage:,existing ❑new size Shed4 existing ❑new size Other: 4 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan r6iew# Current Use Proposed Use . t BUILDER INFORMATION Name %/Jj1i®o/�fi'�� Telephone Number 60' 771-4��1n a Address t� ��cV_ �E' License# ce47 'V1 P /704- 02 631 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DAW_ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE OWNER DATE OF INSPECTION: 1 FOUNDATION 63 1 m FRAME 0 INSULATION FIREPLACE ELECTRICAL: _ ROUGH FINAL PLUMBING: : ROUGH' + : . z FINAL GAS: ROUGH: `':. + r FINAL FINAL BUILDING *.+ ►, DATE CLOSED OUT " ASSOCIATION PLAN NO. The Commonwealth of Massachusetts - - Department of Industrial Accidents — Office ofinrrestiyations 600 Washington Street Boston,Mass. 02111 Workers' Compensation-Insurance Affidavit q aPRI name ) location .-61 d d J��C e_ �04 city {art 7-e'yil e low eAb3_— phone# �QO "�� ���06 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job 'R -- com .. c "'�� "tal� `z�. r€��--�?�'�.a�`h�v� ���'�ra�l-�:� �'Se �' �sH d a.3 �zs �:, •r � ��t � �. e 7&�P�r•. �.,7�c� ter �' k: { bd=s� y�y .. , �„„z,,,qf�y, C`�YY + :.� v 6w£�ryy$.�� �1�4 �.: ,, f'.7`-r'� S� c.:',. i �.'._ `y�y3R;�,t J� �D� ��,5�'4 x y_Y*'h k= .:�"�Z�i���$�,gr§. 4'✓,a "�r�'f��+;�°'T": "t`�' -"St ,x'�#�,{b�YS"K:�(�a$`��i '�y,�E��Y�.,� 3 � $"� M ^'{s;' d W .J t� S,t E.'?•; �d�. S�.a"3'»C`"Y d:'- 4 :,t Pik 3.N._f+ �-b ). 55"'� �� �}'.c$A kCItV��� s�� Y��-�a"���- f �,e.�`'a �} s-�+ �, �:�£,_•• x sxt r.�.t pli0ne# {�,5� `�,_.s x ,� s %txk,+�'�c�sr��'c+e'w TOW! �����z° ,insurance co � � r - I am a sole proprietor,general contractor, r homeowner circle one)and have hired the contractors listed below who have the following workers' compensation polices: p oa l,i.ces� " Y" r 6 2.$.x Y �r r ComparlYname . s !a.T2f 3y: yzk x*z" ✓^^� r. r 9' s9aiT v,F 5, `` Y: it r z r t Fx £y y_ "'t `r",r �" "'� t e ..* ,s _t.�„�-"` r *>s,.dx'� 4� � �b "� t `"�,�.�,'^£ ✓t ..{v is � t -�'£r �' �,xc r� a n+a �'�zk.�"+� ��'� ,� d" � 4n�, �' .a4. 0.A,u-, -:pis coin U an NY n'amee t�axF `. .,' -r-.£ 'ts` }„r ,I _ ,<-,..a, -`. xr ..? '� . 5wa -✓g a:�'v �� o r � --.:.'°�+ r .'v',Z 'c �t-�'fi �" .,na i,V .- ..3fsr tt¢ �€ ,�.._: '�Ta.„�"xj.` �,, 4 sT_ tst�2,�r+ '' s� ui 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 forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under thepaains and penalties ofperjury that the information provided above is true and correct. Signature �i., / K / Date Print name /+?Q226Z Z/�/i 4 Phone# �y�"7 71'fl`-l0 6 official use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department ❑Licensing Board check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; nOther (revised 9195 PIA) r Information and Instructions Massachusetts Gen al Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quote from the"law", an employee is defined as every person in the se ice of another under any contract of hire, expres or implied,oral or written. An employer is defined as individual, partnership, association, corporation or oth legal entity, or any two or more of the foregoing engaged in a jo' t enterprise, and including the legal representatives f a deceased employer, or the receiver or trustee of an indivi l, partnership, association or other legal entity; mploying employees. However the owner of a dwelling house having of more than three apartments and who esid s therein, or the occupant of the dwelling house of another who emp s persons to do maintenance, con ructio or repair work on such dwelling house or on the grounds or building appurten t thereto shall not because of s ch empl ment be deemed.to bean employer. MGL chapter 152 section 25 also states that very state or local lice sing a cy shall withhold the issuance or renewal of a license or permit to operate a b siness or to construct bu�il ings in the commonwealth for any applicant who has not produced acceptable e ' ence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any o its political sub"diy/isions shall enter into any contract for the performance of public work until acceptable evidenc of compliancelwith the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,/,�b hecking the box that applies to your situation and n supplying company names, address and phone numbers alog with certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for co irmation insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to th city or town t t the application for the permit or license is being requested, not the Department of Industrial Accid ts. Should you h • e any questions regarding the"law"or if you are required to obtain a workers' compensation p cy, please call the Dep ment at the number listed below. City or Towns Please be sure that the affidavit is compl a and ,rinted legibly. The Department has provide a space at the bottom of the affidavit for you to fill out.in the a ent the fce of Investigations has to contact you regard) the applicant. Please be sure to fill in the permit/license mber w Bch will be used as a reference number. The affidavits ay.be returned to the Department by mail or FAX un ess other arrangements have been made. �`� The Office of Investigations wou d like to hank you in advance for you cooperation and should you have any questions, please do not hesitate to give us call. gill 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 �O,LIME Town of Barnstable ti Regulatory Services sAsxSMU ' Thomas F.Geiler,Director nswss. 9`�pr 1659. N 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 constriction 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: ./)e,,Z Z 64!',,e Estimated Cost30, 000 Address of Work: Celt J �,,*e- Tloa CP,%CIVj11e_ 1 W g1k,6 Owner's Name: 7ih C,,YrDI _ `e&1.4 t O 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 UYIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR -mil 6/d3 Date Owner's Name r RESIDENTIAL BUILDING PERNUT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSBEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES (attached detach �� 14 14 _square feet x$32/sq.ft._ x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch. x$30.00= (number) Deck x$30.00= . (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) 3 Permit Fee 1.00 Beam B 1 Design Critiria Supported Area (s.f.) 37 5.00 Design Load (Ibs./s.f.) 50.00 Point load @ mid span (tbs.) 0.00 Beam length (ft.) 27.60 Forces W + P. total load (Ibs.) 18,750.00 w, uniform load (lbs./l.f.) 679.35 M, moment (lb.-ft.) 64,687.50 Steel Values Fb, fiber stress, bending (Ibs./in.2) 24,000.00 Fv, horizontal shear (lbs./in.2) 14,400.00 E, modulus of elasticity.(10s./in.2) 29,000,000.00 Calculations I, moment of inertia (in.4) 340.00 A, cross sectional area (in.2) 10.00 Required Sy, section modulus (in.3) 32.34 REQUIRED ACTUAL RESULT A, deflection (in.) 1/180<= 1.84 0.90 PASS A deflection in. 1/240<= 1.38 0.90 PASS A, deflection (in.) 1/360<= 0.92 0.90 PASS Fv, horizontal shear(Ibs/in2.)'<= 14,400.00 625.00 PASS The Town of Barnstable ble Regulatory Services � r3' Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: -2— O 3 JOB LOCATION: sLLZs,' Re Cep TPr u i l!!c , MA v).-U l number l street village "HOMEOWNER': Zl/1zo7� y ��E�IJ�!/l/�7 Sb L7X VV06 name / home phone# •work phone# CURRENT MAILING ADDRESS: �6[ ULcQ r7l- 26( oa6-2 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellin.-gs of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more.than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and - other applicable-codes,-bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimilm inspection procedures and requirements and that he/she will comply with said procedures and requ3repagnts. 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 pemut 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 fern,currentiv used by several towns. You may care t amend and adopt such a form/certification for use in your community. NIF N/F WAL.TER L. MORAN �. DOROTHY& JOHN PETERCUSKIE N/F JAMES & TINA VAUSCOY 203.64' LOT 3 56, 514 +/- s.f. ab L.OT 2A 65.9'+1- 4 N O F. Z m L c m Ln Z `\ m EASEMENT `\ Z \ 142.79' o 0 0 o m O m 0\�y�,o 89-3O2A w r _ - CERTIFIED PLOT PLAN , ' LOCATION LOT 3 OLD STAGE RD. : (CENTERVILLE) BARNSTABLE MA SS. SCALE : 1 " = 60 ' DATE,: 1112194 REFERENCE LOT: 3 PB 497 PG 37. PREPARED FOR: I HEREBY CERTIFY THAT THE STRUCTURE GREENBRIER HOMES SHOWN ON. THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. down cape engineering inc. ARNE c H. J` CIVIL ENGINEERS - LAND SURVEYORS Z 8 MAIN ST. YARMOUTHPORT, MASS 02675 DATE URVEYOP, THE,°�ti The Town of Barnstable p� 1R�STABLE. Department of Health Safety and Environmental Services MASS rFOMpy�'` Building Division 367 Main Street,Hyannis,MA 02601 508-862-4038 508.790-6230 PLAN REVIEW r Owner: ! . 't-6- bl"t a,Y— Map/Parcel:l 9 (- b b Z- n U 3 Project Address:6 h I 1d Sge'ae Builder: 0 W The following items were noted on reviewing: 0. V 2'Y SCE 0.lN ZX P) Its Uc_ 22 — q Reviewed by: .. Date: 3 -As§essor's officer(lst floor): /� if //y, y r SYSTEM MUST BE oFI ETo Assessors map and lot number ... ..�."l.l...�aU.O� Q•• �`` l floor): 114S LED IN COMPLIANCE Board -of- Hea th_(3rd f oor). Q *^� �� Sewage Permit number .................✓.v!. .2..6. ., �,�llTf� TITLE 5 t 33AHII9TGDLE, i Engineering Department (3rd floor): ENVIRONMENTAL CODE AND +, NABa m0 House number ............................. ,.1......................,... TOWN REGULATIONS °moo war aye Definitive Plan Approved by Planning Board,---- )_�_____19_�3 �7 APPLICATIONS PROCESSED.8:30-9:30 A.M. and 1:00-2:00 P.M. only APPROVED T OWN OF B A R N S T A BL E Ifomwable Comma"o*P" rU I L D I N G NSPECTOR PPLICATION FO&MIT TO CaJ�strveE r�. TYPE OF CONSTRUCTION r4nA e �z I9q TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r-- Location Lot s4 3 D C d ...... ............................................................. .' .......................................... C' Proposed Use .... ...+� �e �. ......9............. ...........................d. . , Q.� - M� Zoning District ......... /`...................................................Fire District _.......... IleName of Owner .. ✓ee.cb�ie.-............n`.eS �,cC..........Address ........0. �X 5/U C��,�.tr.��... Name of Builder .....5 ame ....Address r s� Name of Architect rC�`.:..: cC. �s5C...................Address .!F�a.. � . Z� r9eK6rv-�.4.................... p.................... • � .....................................................Foundation ... �?Urtd' eo:x e re Number of Rooms ............. . :.............................. Exterior ..�`.��?�lLi•! .."... w c.............. ..... �•-�` ............ � Roofing .....c5 ��� ............................................................. . ..... ....... f Floors .... 6ticJ� / c� a✓�2k V. .. ..!...............:.......Interior ........c��e r C Heating N 6 .......... ..`..........: g .i a Edf'S .......................... hFireplace r e ..........Approximate Cost. �.. 8gy Area �3 ��............. Diagram of Lot and, Building with Dimensions syp�y ;� Fee ......... ..2-:...boo................ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To' n o arnstable egar ing the above construction. Z / : Name .. .. .. ......... ....�..... .. .....�. .........................` :.�Z z L ` Construction Su er isor's License 9�' GREENBRIER HOMES, INCCS 36468 Na .................rPermit for . ..l.z. .Story,......... 'y Sin .ami1 (a in �(.... .....Y . Dw ..... ......... _ Location :-Lot #�3 ..`56'=1, 0 d Sta e JZoad ..Centervill�'e,,,.,• .. ...... ......... Owner ....Greenbrier.�Hom. 's......I?lc....... - ' r "r Type of Construction F.r*al'me..:. ....... ......... r 1 Ploy.......`...................... Lot ............................... - t _ t Permit Granted ........Jan``uary...2 8.:...19 94 t Date'of` rfspection /!'!..�� . ..... .......19 ' f ,. Date,Completed ........................' ' � .........19 + i i� /III 177 i 7°" Permit No. . TOWN OF BARNSTABLE 36468 BUILDING DEPARTMENT ""n I TOWN OFFICE BUILDING Cash 07D• 39 X ire.►+` HYANNIS.MASS.02601 Bond ................ f`. CERTIFICATE OF USE AND OCCUPANCY Issued to GREENBRIER HOMES, INC. Address lot #3 561 Old Stage Road, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL 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. 4 . . May 4 94 19................. .............. Building Inspector � THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) i M A- C(, � L DATA TOWN OF BARNSTABLE, MASSACHUSETTS 7C A=1e1 . 002-003 , DATE u�d2llldi: 28, 19 .'94 PERMIT NO. (�o `e7V4V8 APPLICANT Greenbrier HOT!cs, Inc, �. G Pk .1�? ,ADDRESS S�nn -�,+- `J APi E�r _ (N0.) (STREET) . J 1 3 J / E- E 1 Hulk. Uw�ll.� ' .. T �. (CON TR'S LICENSE) PERMIT TO �:�� C' ' - (+1) STORY1.).?!,(NUMBER OF PE. ITVPE OF IMPROVEMENT) NO. (PROPOSED USE) DOWELLING UNITS AT (LOCATION) Lottt3 E SG1 Old SGd e iYC?i1 C�, Cen- terville ZONING f. (H0.) (STREET) DISTRICT_ RIC r BETWEEN E (CROSS STREET) AND I (CROSS STREET) SUBDIVISION S, LOT LOT' BLOCK. SIZE. BUILDING�IS'TO BE F'n. WIDE 8Y FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION B t TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION_ -� REMARKS: Sewage #94-25 (TYPE) F ' / AEA OE 1324 s�T Bond `3•. ft. ESTIMATED COST 75,000.00 PERMIT(CUBIC/SQUARE FEET) FEE $ 9 2. f�7 5 OWNER Greenbrier Homes, Inc. ADDRESS L / En ervl e BUILDING DEPT. BY PROVED BY T® WO KS. TH — 1 FROM THE DEPARTMENT OF PUBLIC i OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. HERE MINIMUM OF THREE CALL APPROVED PLAf:S MJST E E R�TA.!NED ON JOB AND THIS PERM PERMITS PAREC REQUIREDBLE ARFOR INSPECTIONS REQUIRED FOR: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND ALL CONSTRUCTION WORK: ' 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL_ )UIRED,SLJCH BUILDING SHALL NOT BE'OCCUPIED UNTIL. MEMBERS(READY TO LATH). FINAL INSPEGTION HAS BEEN MADE. .1. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT a5 VISIBLE FROM RISTCAL SREEPECTIONAPPRDVALS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS 2 2 �N /'• 6'���G is� -. , �i,�'��!� r �( V ENGINEERING DEPARTMENT HEATING IN c 'ION APPROVALS ' BOARD OF HEALTH (jTHER / y PERMIT`�'!LL BECOME NULL AND VOID LF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE / VVORK SHAL_NOT PROCEED UNTIL THE INSPEC I WORK IS NOT STARTED ^(THIN SIX MONTHS OF DATE THE ARRANGED FORBY TELEPHONE OR WRITTEN / TOR HAS APPROVED.THE VARIODUS STAGES OF PERMIT i S ISSUED AS NOTED ABOVE. t'OTIF!CATION. CONSTRUCTION. I` t ( NF N/F WALTER L. MORAN DOROTHY E JOHN PETERCUSKIE N/F DAMES & TINA VAUSCOY J � LOT 3 Q 55. 514 +/- s.f. 65.9'+/_ LOT 2A N O J , 7 m �l m Ln a Ln z EASEMENT, \ Z 142.79' o .a 3 CiLn J m # 89-302A - CERTIFIED PLOT PLAN LOCATION : LOT 3 OLD STAGE RD. (CENTERVILLE) BARNSTABLE, MASS. SCALE : 1 " = 60 ' DATE : 1112194 REFERENCE :. LOT 3 PB 497 PG 37 PREPARED FOR: I HEREBY CERTIFY THAT THE STRUCTURE GREENBRIER HOMES SHOWN ON, THIS PLAN IS LOCATED ON THE: GROUND AS SHOWN HEREON. ` N - down cape engineering inc. AHNE ' CIVIL ENGINEERS A LAND SURVEYORS ! MAIN ST. YARMOUTHPORT, MASS 02675 DATE L fr►,,°A9 '' L Ul 1EYVR — Lij a ME ol ---------------- I It I � IIn Y'--- -- --� � ..o I- �_ .'- i : • - -"saws - w - 1-1 N Y Am5 ` ,d.Y; ,. x�:.-c :..:',i.r,,,S ... ...=:� -ur&,�'�-.: �,ffi,...7�.•.....r;S..�u.. ..r..sfl,.._... .."? �-ra� �� T:,1S•, 4 �F� - '.. -� ,_.... ,. .,. +.'sa. -.... -.: .... , a-:.•..,._...1:. "` _ � .•"1irYi '.�'. 4s_;s•• --:F ":Ib :'3 P�a-,t _r .... 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