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Home My WebLink About0184 CROCKERS NECK ROAD e`S� �� /� i� �� .. t ,. -� _ . � �� I �, . ' o �. , � .. �, i q � n t ran �. . � �,-��- �, �. f KYV\, s c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map D Parcel Permit# r7 19 0 3- Health Division �� 2 �3 S� 3 �9M ON Ly Date Issued l l 1 3 Conservation Division ri Application Fee L .d 1 Tax Collector Permit Fee bo �7�, �77 Treasurer SYSTW laus't Planning Dept. WTALM IN COMPLIANCE Date Definitive Plan Approved by Planning Board VM ME G ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS (� Project Street Address ��/ 6K66Ile Y Village L,-A Owner TIm e! Address ep-oc)�CCY Telephone _'ID—L Permit Request p�/[3l 1�&ftle bji�a�P V Ile P f dHdZ eJ Qt/tdl Square feet: 1st floor: existing proposed 2nd floor: existing /� proposed -.��- Total new 3 Zoning District 7 Flood Plain Zap C Groundwater Overlay Project Valuation Construction Type Lot Size /� 7 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) T- Age of Existing Structure Historic House: ❑Yes No,'� On Old King's Highway: ❑Yes _-I(No . Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Opt Basement Unfinished Area(sq.ft) ,$ - I Number of Baths: Full: existing �' new Half:existing_ newer CIO Number of Bedrooms: existing new - Total Room Count(not including baths): existing new_7 First Floor Room Count ' Heat Type and Fuel: PdGas ❑0il ❑Electric ❑Other _- :1 Central Air: ❑Yes 0 No Fireplaces: Existing New Existing wood/coal love: D-Yes F-❑No rn Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exi frog ❑new size Attached garage:❑existing O new size/t Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use R BUILDER INFORMATION Name /e//Qe� �6S'S� Telephone Number Address a kS License# GS D�y�f7 Home Improvement Contractor# Worker's Compensation# 2 L $� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1114,� Si P¢e 30,-,&/ h ref^ • SIGNATURE DATE 2-1c2,?1U3 x FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 16/2itk3 �� FRAME 5C' 7 2 t 0 6 remc _ INSULATION 0� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' r 1 tit DATE CLOSED OUT. t - �fl r ' ASSOCIATION PLAN NO. r� 5i P f, The Commonwealth of Massachusetts , �`- Department of Industrial Accidents ` — Office Of/OYBSI% RMAHS 600,Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit r y: ne am location: ,(EII 46=� f leo ` city AA I/ phone# c�U/I`/.��'1�/. l✓%c ❑ I am a homeowner performing all work myself. ❑ 1 am a sole etor and have no one workin in ca achy workers co .... on for employees es working on this'ob. rovldm g em 1 mP o3'e J ❑ I am an P P S.........................mP......................... ':::::::::::.:::::::::::::.:::,::::..::::._::::::.:.::.::.::::.:::.::::::::.::::::,:.;:-:.:.:.;.:???.;:.;:.:;:.;:.:.;:;?.:.;;;:.,;;;;::..>:.;:.:. 'onru v . A. . ii ��i:vi.%::j;:`:':::il%iiii::'i::i%:%iii�%'i$ii':iiii::%;i:;?i:% is%i�'::%:%i:`•':.:i!+%ii:%:%is fi:::'v:Li?%::::%:%:%:':%i:i:%:i }'..........:;: •;{:;:;i:i:;:C::}?:; ::::< 4:! :%:%:%':%:%i' :!%: ii:!�ii:%:%':iii:%:<Y;: ti:ti;:{:%`.:.i:;}�:v:,•,•?}�:;':;:::::`i:-i: ':<::soh e; RlMs*ole proprietor,general contractor, or homeowner(circle one)andMaveired the contractors listed below who have the following workers' compensation polices; .................. ..............:.:...:.::... 'mnosriyn m ..,� _ - -- .. }'': '.`-` <;::...<,;:<;;.. s«::,• `bon ::•'f' :: ..�... L nSFWF .::::.v..:v':n:{:.::.:..:.::?tin:{:: :i:•.%:v.:::ii ii•. .;.',:',..:?.v`:'••, '::••f,rA;;i;k`+,;:;T'•:i!:�i:}i?:•:4i:•::+{4::??•-611 �: •?::::::;:� ?<;:.,:>:..;:.:�:::;.: .. ::.;�,.�<.,:•'.%:;:=�:.;:::?;::<:::::;:;;:;:::::::.::,:::.:::<.;::::<: OlitP�::>',:>:� ... �a dlr 's `ltin :....:.... .............. :.:::::::::._::::::::::.::::._::.::::.::::::::......................................... cites • ...................:...::•:::::n.v....{:?w:::::::.yvv::.vw:::::..:v:..�:::::::::::::::nv:::::.v::::::nv:.v:•::•:::::::::•.:..:•:•:::::::::::::::::: :' :L>:::.v?:?i:::i::i:iti:iii:::ii:i::�iiiii:?n:rr?.:.iii:?.iiiiiii:?.i}•.+.:C:•::::::x.i':v:._:}.:;;.::v:::�:':: Failure to secure coverage as required corder Sectlon 35A o[MGL 153 can lead to the impositlon of criminal penalties of a fine aP to SI,S00.00 and/or one years'imprisonmmt as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against ma I understsind that a COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trw.//mid correct signature Z, Date Print name ./'�c,1///�P� ,SSC� Phone# C Ccontact ly do not write in this area to be completed by city or town official town: permit/license# ❑Building Department ❑Licensing Board mmediate response is required ❑Selectmen's Office ❑Health Department n: phone#; _ ❑Other Ocyiwd 9195 P1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association,'corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your 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 you 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 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 peimit/license number which will be used as a reference numb er. The affidavits may be retu6R 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 Office of Invesugadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 °F�HEr Town of Barnstable Regulatory Services BAMSTABL& " Thomas F.Geiler,Director ,FD.19. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: a VQ Estimated Cost Address of Work:�Z-1QP.5}' Cr'Dt K r iVeG K 9 (Al!( Owner's Name: `)I V1'1 Na_IV 5 Date of Application: , yk y 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: /m Date Contractor Name Registration No. OR Date Owner's Name QIorms:homeaf day k- RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE Lt square feet x$96/sq.foot= 3 u v x.0031= 13 3 • 3 Z 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&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf �35 >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 yri l y 33L Ll STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost i r oFT ro,,, Town of Barnstable P c� Regulatory Services 9MAS& Thomas F.Geiler,Director V OTED MA'S� Building Division Tom Perry, Building Commissioner , 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Ltm ,� f�L! P_G� ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: c-r- 06ker NeC/V kJ (Address of Job) A` J J ' Si ature,of Owner ate Print Name n.rnn-A s e.nnmmuyrnr xTeemm .......... . ................X.: .w....................... .................... ........ ....c ............................................ ........ ... ... ...............D...I..Y.....Y.... ................ ........... ... N . DATEM/DL iU . (N ) F I .RA . . . ..... ................. 09/23/03 I.:::::.AT ...I..*...I..... *.D.ASA..MATTER.OFNFORMATIONPRODUCER THIS CERTFICES SSUE .. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BAYSIDE INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENDOR P.O. BOX 910 ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. 242 WAREHAM ROAD COMPANIES AFFORDING COVERAGE MAR ION MA 02738 COMPANY A PREFERRED MUTUAL INS. CO. INSURED COMPANY JAMES A OMARA JR B COMPANY 34 LAKE DR C PLYMOUTH MA 02360 COMPANY D ......................... ........... ................................................ .......................... ..................X ...................................:................................................................ ........ ........... .......... .... .......... ..........._....................... X* ........ ..... ........... ....... ............ .............. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD[YY) LIMITS GENERAL LIABILITY CPP0110560357 3/21/03 3/21/04 GENERAL AGGREGATE $ 600, 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 300, 000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY $ 300, 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 300, 000 FIRE DAMAGE(Any one fire) $ 50, 000_ MED EXP(Any one person) $ 5, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY- SCHEDULED SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ .......... ............. ... ..... ANY AUTO OTHER THAN AUTO ONLY: .......... ... ... ........................ .......... ...... EACH ACCIDENT $ 1 AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WCS U- I JOTH- TAT ............ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CARPENTER ............ ................................ . ....... .... ............ X .... C. ... ......... ..................... ........... ...... ANCUZOION ....................... ............ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE JIM DOANES EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TGIAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TEWFT, 184 CROCKER NECK RD BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OILIABILITY COTUIT MA 02635 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MICHAEL W. TURNER MT M .............. ........................... .....::........................ ........................ ..................... ................... X, .......... .... ........ .... ... .............. . j`+ ev i ,VCR 1 irltoR i C Vr LImmy 1 T impummmoC 09/16/2003 PRODUCER (508)540-2400 - FAX (SO8)760-1988 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 406 Jones Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02540 Douglas MacDonald INSURERS AFFORDING COVERAGE NAIC 11 INSURED M R Bosse INSURER A: Insurance Center Special Risks PO Box 3316 INSURERS: Pocasset, MA 02 S S 9 INSURER C INSURER Dr 94SURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING, ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 3CL6652 07/10/2003 07/10/2004 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ S0,0O CLAIMS MADE a OCCUR MED EXP(Anyone person) $ 1,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 1,000,00( GENI.AGGREGATE UNLIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,00( POLICY JPER LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ ANY AUTO ,t (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESSAIMBRELLALIABILITY EACH OCCURRENCE • $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE .$ RETErMCN $ $ WIN OTH- WORKERSCOMPENSATIONAND �•. TOCRYLST'NdRS ER EMPLOYERS'LIABILITY . ANY PROPRIETORIPARTNEREXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEE $ I s.descobeunder tPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER ` DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS r • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Jim Doanes BUT FAILURE T'O MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 184 Crocker Neck Road - - OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Cotuit, MA AUTHORIZEDDREPRESENTATIVE IDouglas MacDonald ACORD 25(2001108) OACORD CORPORATION 1988 . I ' y IL '-:� � . is• ! MtA \\ 4 LS i !-fC'�t-•../ ►-�E�Fn�/ C!'�••1/Ft"i'PiFf� ti �,�' w a �_.��?"":='�'�- �ram'_: / �3i.� c Tom= - • _1'Fs'r' �--' _�"'f�'.� G. .'t-,c;, y' -7.;�' c-s.-cr.yy•� ... ._� �.`-_r/c.- / U_ .l ' �j-�- "' .--'_ ..-• Of • . - •fit�f Board of Building Regulations and Standards + HOME IMPROVEMENT CONTRACTOR Registration: 140140 Expiration:;9/19/2005 Type:---Individual MICHAEL BOSSE MICHAEL BOSSE 35 GREENGATE RD APT.24A � i FALMOUTH,MA 02540 Administrator — - T'��►18�`i��sI�CPft� I License: CONSTRUCTION SUPERVISOR i Number: CS 084987 Birthdate: 07/0.911979 - Expi es:'07/09/2007._ Tr...no: .84987 Restricted: :00 MICHAEL'R BOSSE PO BOX 85 WAREHAM, MA 02571 Administrator o� cl Z� C TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map D ,l Parcel C7 Permit# Health Division VDate Issued / Conservation Division ��. o Z Application Fee Tax Collector PTIC .ee�r �e „e,r nG (�®, Treasurer INST LED IN COMPLIANCE. Planning Dept. V'TITU 6 EWRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board -TOWN R€Gill.;TONS Historic-OKH Preservation/Hyannis Project Street Address i CL-0C cei/ ""e Village Owner ��- F tV �_Address Ct-ne-kcr i,e �.k y Telephoned I <7 7 Per 't Request �' � 1 ` SWL hr1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Q. 600 Construction Type %e-3 _ Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentajion. - VEL C Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) v T Age of Existing Structure Historic House: 0 Yes ElNo On Old King's Highway: OLY-es 0 No Basement Type: ❑Full ❑Crawl 0 Walkout ❑Other I ' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ w rn Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: 0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:O existing ❑new size Pool: O existing new size N;22 Barn:❑existing ❑new size Attached garage:O existing O new size Shed:❑existing 0 new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded 0 Commercial ❑Yes O No If yes,site plan review# �G Current Use Proposed Use BUILDER INFORMATION r7 - Name Vie, e A C T� %0 Telephone Numbers Address License# CS Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE K DATE /3QI�� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUE_D w_ MAP/PARCEL NO. ADDRESS ; t ? �. ��! VILLAGE OWNER n _ f DATE OF INSPECTION: tt"} y' FOUNDATION FRAME INSULATION �1 • r e FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH -- FINAL - y GAS: ROUGIz t FINAL - spa! �•;; � �,_ �' ; FINAL BUILDING T DATE CLOSED OUT--# ASSOCIATION PLAN,NO. r' r w The Town of Barnstable Op 7HE Tp� 13 F NWP '. Department of Health Safetyand Environmental Services MASS-' a 7� 1639:..`0m PTEO MA+p Building Division �• 367 Main Street,Hyannis, MA 02601 ( (� Office: 508-862-4038 Fax: 508-790-6230 _. PLAN REVIEW Owner: /fri- S + ��'✓ �J r� '`� Map/Parcel: y/! LO 6- 7 r Project Address: �`�� Gil/!,K4A1Ce-A / Builder: F l o\-e .- t Ca Tv/r' 2 r<D�l2 r c ft 7: /��✓.-515/s�/V O The following items`were noted on reviewing: i \ 7 (rdl? 7 G, IVQ ----------- 1 k) Reviewed by: Date: 7 �� O v q:building:forms:review a, • `` �` The Commonwealth of Massachusetts —{ - Department of Industrial Accidents � � -= - - Olfice of/n�est/gatlans - :_ t 600 Washington Street �s- " Boston,Mass. 02111 Workers' Com ensation Insurance davit name: .............location city ❑ I am a homeowner performing all work myself. ❑ I am a sole roprietor and have no one work' in ca achy workers' co ensation for my employees working on this job.::;::_;:; :;::;::;: ::;:: :;;:: ::::,v;,.<.,:::: ::::::>•,,>::::::::;<: ane 1 r rovtdmg u?P..........:.:.:.:::..:.:.:::.;:.;:.;::;.:::..:::::::.::::::.;. I am mP P...................:....:..:...:...... .soar ......:.::•::::::..:..:.:.:.:.;::::.::::.;•:::..�:>:;>::::>::<::::;::.>:.;:>:.:;:;:::.:.:;:.:;��:?::::::<>: :3listiranCe:ctx:>:>:><' ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have ' n o lices: following workers c mp p... :.::::.�:::::.::::::.;::::::::::::.::.�:::::::::::<:..::::::::::.:::.:;.;:.;:;.;:.:>:;;t.;:;;:. the fo g ............................................................ ::.::::......:..: :.:.:::.::.:t..:: ::::...:::.:t :.:;<.;:.;::.....::. . . . ... •`•'> • .crr-.. ��<:SS:`•i::%;:?;':;:i:#:`i``iiY`:3:�� :3�a��ii5i':"?;?;i•':�`3?3iii%tiii"i;i<}i?r:;z!'v.:;i.;%:aii;i%;i;;:':i:+;?2�� ii;i3i`:i;i:i:iii2iir<i� :i:i:i;:i ii :i�:'•r,.t%::;:;:;:;.:;2:;::•:;;::<:;:;:;;:::.::::.;•.;::.,.;:t:t.:;»x.;::.:::::::•::•::.v...��,•`�`.. .::.:.:... Z. 'ait�te ............ ::::...::r.:..v::::;.:;•::;•::.v:::::::.,•:r�•.:..,•r::.:::....:::r::..v;•::::.::;•::..v::::::..•.v..•::....::::::..,•.:•,:.:::..::::::tt:::::.;:'r.::?<':-%::;:�::::"::: � .:iF�>::�::.::�::::�.�::t;•:;.:;;•>:•:.:::.::...:,;:.:::�:•»:at.>•.:...,:-t;:..:•;�...:•:.. :•:.:t•::::::•:;•::�::: :}::.::•;.>::<::;>:;.::;:.:::::,.::;t•i:;•i:•i:`:•i:::•ii:;•i:•:.ii:;•i:•i':'{•i:•i::•+:•iii:-i:•:i:•}:•>::.>::•iiis9::•::•:i;-is•}:::ist•i:•i:.:;.>::.;:•.:.;:: :'•i':::•:::::•---------------- 01; ............... "gat X. ::::.:::..:..... ........:..:........ ..t :;:YQ1I'rt'i :;�?L.;S:?i:' � 'i;%;: ';:r'.;`> [vjxrc��;;.`•>'nisi;< :`:?y>isf;a.ji:(tyv,1�<S:ii'J`x+: . :�TIyIITBaCt'C 4.- Fai}mx to secure coverage aS req�ted under Section Z5A of MGL 152 can lead to the impositloa of crhninal penalties ga a fine up to S understand and/or one years+imprisonment a'weII as dvII penalties in the form of a STOP WORK ORDER and a Sne of SI00.00 a day sgshut me. I mmderstand that a copy of this statement may be fotRarded to the Office of Invesligatioas of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is trt -and correct Sigoature�n iir��a� ,� ^r a• •--� Date Print name iFt .Ya Phone# offidal we only do not write in this area to be completed by city or town offldd perndt/license# ❑BuNing Department dty or town: ❑Licensing Board response i9 re oared ❑Selectmen's Office ❑checkif bnmedlah q ❑Health Department contact person: phone#; ❑fie! (devised 9195 PJA) II - 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; .ithhold the issuance or'renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any,contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and address and hone numbers along with a certificate of insurance as all affidavits may be names addr. . supplying company P d o sign an f Industrial Accidents for confirmation of insurance coverage. Also be sure t gn to the Department o submitted ep date the affidavit. The affidavit should be retained to the city or town that the application for the permit or license is e an questions regardingthe"law"or if you Accidents. Should you have b requested, not the Department of Industrial y. Y� g lease call the D artment at the number listed below. are requir ed ed to obtain a workers compensation policy,p ep 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 maybe retam�ed 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investlgetlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 east. 406, 409 or 375 v+b . ROYAL . . - r RADIUS 8 8 8T 4 77 3 4' 3 14 x 28 Rectangle 6 + 6. 14 x 28 Rectan le w/Center Ste PART# DESCRIPTION LIGHT 14, 6' 8' PANEL 31'3 3>4" STEP 5 4 05102 8' Plain Panel OPTION 1 UNIT 1 1 1 05104 8' Skimmer Panel 2 2 05108 8' Return Panel 4' 2 1 OS112 V-Platn-Panel3 + 3 2 2 05123 4' Plain Panel 2 05128 3' Plain Panel 8 8 8 4 8 9 05188 A-Frame 28' 4 1 4 OS180 Rectang lar Filler 4 4 05181 Radius Filler. 05201 Nut& Bolt Pak T 3'4" I 67418SNR 8'4 Tread Ste -N-Rest T + 2"MINIMUM PREPARED BOTTOM �- 4' 4' it s--- 12' 8' ------ TYPICAL CORNER ._ T A-Frame Brace • rI WA 111,KWM&W-410 1XVILTCA Q&M 1 3 ILOM • • • RECTANGULAR FILLER Pool is designed for use below grade and only In areas where the ground water table is a minimum of 4'6". 05160 below the propused finished grade. - Backflll with clean earth,free of roots and debris,Do not allow the height of basitfill to exceed the height of _ the wale in the pool by more than b"nor water to exceed backfill by more than 6'. SPACER' Pour 2500 P.S.I.concrete(outing around entire perimeter,minimum R"deep. RA —I U5 3'wide concrete deck Is to be poured at least 3"thickness and a slope of Il4"to 1' -�� away from the pool. FILLER All Inside pool dimensions are to be finished dimenisions.Finished SAFETY NOTE 05t81 nished bottom is to be 2"minimum of suitable material or undisturbed earth.' A safety line,with buoys,is to be permanently attached I'll"by the shallow Pool bottom configurations side of the point of first slope change. we for Illustrative purpose - Slairs:For all stair layout,refer to imperial installation manual. only. The configuration - Construction Drawings:These drawings and notes are for illustrative pun shown coofotms with cur- pose only.Different methods and precautions may be dictated by various mat N.S.Pj suggested mia4 ground conditions.This is to be determined by and Is the responsibility of the mum standards for pools on contractor who is not an agent of the manufacturer of the component pant. which nuumf scismid diving .Installation is to be done in accordance with all federal,state,and local build- equipment te"prohibited, . ing code,as well as NS.P.1.suggested standards. ✓�e �o»wrrovuura`l� o�:.�lfrra�ac�uvelQ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 080416 Birtndate: 10/25/1965 Expires: 10/25/2005 Tr.no: 80416 Restricted: 00 FREDERICK J ABASIANOr 10 VANCROFT AVE i SHREWSBURY, MA 01545 Administrator \ Board of Building Regulations and Standards }• HOME IMPROVEMENT CONTRACTOR �. 4a Registration: 134168 mxpiration: 10/04/2003 - Type: DBA PIECES OF THE BEACH FRED ABASCIANO 10 VANCROFT ST. !L-� •� SHREWSBURY,MA 01545 Administrator I 178E C . G 110. �JG CV-,1 J -s h w� 009 � 15i5 _ 160A 4 LOT 160B 16.381 S.F. 92 71.94 CROCKE'RS NECK ROAD MORTGAGE SURVEY PLAN Location : COTUIT Scale lin 30ft Date SEPT. 7. 2000 Plan reference : .BEING LOT.160B4ON A,PLAN, BY FRED A;JQYCE, S„ Ci RECORDED w/BARNSTABLE REGISTRY OF,DEED¢, PLAN. .BOOK 94 PIrGE,47.......................... v� ........................ FAGESs ................................................................... ,P ps.11229 �4"ISTfIL ERNEST H. FAGERSTROM, R.L.S. 138 Norwell Avenue, Norwell I hereby certify that the building shown on this NOTE : i CERTIFY THAT THE ABOVE PROPERTY DOES NOT Plan is located on the ground as shown thereon and LIE WITHIN THE FLOOD HAZARD ZONE AS DELINIATED ON that it confam to the zoning and building lows of COMMUNITY MAP # 250001 D the TOWN of BARNSTABLE when constructed and to THIS PLOT PLAN WAS NOT MADE FROM AN INSTRUMENT SURVEY.AND IS DRAWN FOR THE USE OF MORTGAGEE ONLY. restrictions on record. ,n/ /" i �°FZHE Tpk, Town of Barnstable ti Regulatory Services BAMSrABLE. ' Thomas F.Geller,Director 9 Mass. g 1639.�A`0 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 f' 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. ih Type of Work: 1 ASMI ( cwcmrn t'n& ?exn Estimated Cost I Address of Work: iR4 Cy-/y1''JfV- 1ne C_k �—,J Owner's Name: es Date of Application: 13 0 1 0;)_ I hereby certify that: Registration is not required for the following reason(s): OWork 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: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav Amp f I i 71- 7fl Cl JAMES C. PAI 1 aw' t i� fit `}t { I � EE g1 1 i f 4 n j S s i 08/22/2002 20:28 FAX 5083988200 SALTTSSPRAYSHLEDS 0001 HOME IMPROVEMENT CONTRACTORS REGISTRAT:-ON Board of l8uil4ina Regulations and stancJards One Ashburton Place Room 1301 ' 6oston, Massachusetts 02108 % NOIRE IMPROVEMENT CONTRACTOR ration. 10/2b/02 E x x .�a•+� Registration 120457' p � �.��c� TYP® " DBA HOME IRPROVERERT COW Renistratiion 120151 BRIAN EDWARD WARBURTON Type - 08A BRIAN E. WARBURTON Expiration 10/2610: 82 RYDER RD HARWICH MA 02646 BRIAN EDWARD HARBURT01 BRIAN E. 1sARBURION 82 RYDER RD AOMNOTPOW HARVICR KA 02645 Change in license or registration application. Complete the form below.(Print or Type).Send to the mailing address on the reverse side.Matt reason for change- 0 Address ❑Renewal ❑Fmpinymenr ❑Lnat t and ❑0ther - r Last First Mid License or registration valid for individual Company(If any) use only before expiration data. If found return to-One Ashburton Place Rm 1301 Boston Ma.02108 Mailing Address City SI' ZIP -Foe �"AMA ettmcuara. ��c�� i2a7A� , co7vi T, r4A SAP c�tq OP 08/22/2002 20:28 FAX 5083988200 SAL�TsSPRAYSHEDS 10001 - � �%leQ T/�dl7l/lfEO'lZGG� s�✓vt C�dd�bb HONE IMPROVEMENT- CONTRACTORS REGISTRAT'ON ; Board of Building Regulations and Stani�ards One Ashburton Plat® — Room 1301 1 Boston, Massachusetts 02100 HOME XMPROVEMENT CONTRACTOR Registration 120157 Expiration. io/26/02 � OL4...L.Wd,�,,�� TYPe DBA HOME IMPROVEMENT CONE Ra9istnation 124151 BRIAN EDWARD WARBURTON Type - 06A BRIAN E. WARBURTON Expiration 10124/0; 02 RYDER RD HARWICH MA 0264S BRIAN EDVARD NAR30101 5/ 'g, BRIAN C, HARBVRTON 82 R!fofa RD NARIIICN RA 426d3 Change in license or registration application. Complete the forts below.(Print or Type).Send to the tnWlity address on the reverse side.Mark reason for change. Address ❑Renewal ❑Envkymenr O Lost Card '❑Othet Last First Mid r License or cWtration valid for individual ComPwr+y(lf arty) use only before expiration date. If found MUM tot One Ashburton Place Rm 1301 Bosmn Ma.021" Mailing Address City Sr ZIP caecv.4saa- t[tct- TZOA0 co,rLA T, rtA 2S 7 MAP ol9 o � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ .01q Parcel O5-7 # ] Permit# 60 Tl/q Health Division / S� nQ� Date Issued ! Z Conservation Division 2 � AA ,, Application Fee Tax Collector (? _ /��— '—� �/ Permit Fee i 0 D IC L d 95� SEPTfC S°r�T �� L�,ULT C-e Treasurer � � O�, r 22 ZINSTALLE®IN COMPLIANCC Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by g Plannin Board ENVIRONMENTAL CODE AN4 TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 184 Gamyxz AW-K _1_2eunD Village nn,i T Owner Address acc loam I4az.V__-V;?,bA0 Telephone. So&-4ZB— t2-S7 Permit Request Chpysc'12ucT- 12X1tp S;yeb wNaa4& L--4, nr4&- Ship IS, izehk �3�a.,r►� i7ea�c -�, 22 c C�-2GAT ca�3"�.,1 2�a�o , �+9.�yFi � 62,,-pu►c� Stts0 Square feet: 1 st floor: existing Ici 2 proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation -900 Construction Type Lot Size Grandfathered: O Yes ❑No If yes, attach supporting docu mlentation jv a Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) v Age of Existing Structure Historic House: ❑Yes ❑No On Old King's HiggAy: ❑Yes L60 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 new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric O Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing O new size Pool: O existing ❑new size Barn:O existing ❑new size . Attached garage:❑existing O new size Shed:O existing ❑new size Other: . Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name_'9g,&4 Telephone Number s®z-39B— rqo o Address z3s (mze-im- L,,P& L--Y.vj n-o License# (0G2- aS 7 ��dNS 14A u Home Improvement Contractor# t 2dtS Z Worker's Compensation# Sow rtiy u n,� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO z Cs2r�Ri t�3, z"� 1�oa� SIGNATURE DATE < r FOR OFFICIAL USE ONLY PERMIT NO. J' DATE ISSUED h' MAP/PARCEL NO; -. ADDRESS �; 4; r' VILLAGE OWNER r _ DATE OF INSPECTION:;_ , FOUNDATION Y ; FRAME '~ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH. Ci' FINAL- GAS: ROUGH; t� FINA 7 FINAL BUILDING K -1 ' ♦� 2 , - DATE-CLOSED OUT�� ASSOCIATION-PLAN'NO. i°' ? r The Commonwealth of Massachusetts Department of Industrial Accidents Office o//aFOS M 899Hs 600 Washington Street - - Boston,Mass. 02111 `3 WorkersIC om ensation Insurance Affidavit ail aia�i �� name: location 2-35 CIZEAE cif �vv�J� PrWv, phone# �o—�1'��'y� ❑ I am a homeowner performing all work myself. I am a sole r r'etor and have no one workin in ca achy %%% %%/%/%%%/%%%/%%%%//G��%%%%%%%/%%//%%%%%//G�/��%%%/��%%%%/%/%O////D%%/i%///%%/ r providing workers' compensation for my employees working on this job. .:: :.! Iam an e 1 g :!.:.:::.:::::.:::::::.::::::..;;'::...::::.:,:.::............:::.:::::..:-.:::::::::............::....::: ::::::.:.»; X. an :nam address.. :::::.:::.::.::::•.;:....: h ..... 911st1ranCe co:.><: .. ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have oe ' co mP. ion polices: :. :: :::w ...... ; nrthe following s : :: : . :: : _ aom an ::name. .. adds ........................:::•:::::::::::::v:::::::Gill:4:•:iTisiii:ii:•i:•ii::::::::::::::::::.:'i:'i:4i:•i::::::::::::i:.inh•:::::n:v:nvx•:i:.i:•i:•i �>::i:;:;:y>:4iiii'rii?i`ii:!i}i:<vi:!Gi::.....:f •}:•:jj• ii:•ii:•iiii:•i++:�::i)i:�ii:v:i:i?riii:�•iii:::•i• ::'•::.:••.::•�••.::..•.. ..•••....• ..•.... .•.••••.••..•.•• .. .............................................. :.:•w:::•::w::vim::::v:•:::::::::.�: y::is:•::::.�.�::::w:::�::i::••::::is?i.::•i!C.�:.: .:i•:::::::.i:::::::.;•i'�::.::.:v...:.:.::v............... •i:•.;:+ii:-0iiii'f:ii:?:•i>i!:j:;:ii1:::4ii':;•i•:':' •iii:•iiiiii:i::::�i:iii::•::Jiii:::�:vii:�}:ii•::iti•::v:4i:4Y4iii.�i:i•i.. _�..:•..::•:..:v.•:...:.:.::"�: .;vi'•:ni} �,/j ax: ................ ...... ..n.. .... ..... .......:................:�:::i...:..................::.•v::.sY;•:i::j'{:�isi•::::::::i::::::::ii::v:.�::::::.:................:::iiiiii}•:... bi:SJriiiiii::;J:;vii:L::::::::::::::::..•........•..••...• :•:+w:::ii::.:::::.;:•i:::!•iii;Li::�:•i:4:......:....... .. .............:.....::•.:w:::•:nv":bii?::v::��:..:?'1..::Yi:v:ii+S:Ci:: .............................................:.............:::::::.�::::::::::::}:n:�i:v:!^}}:>i}:i;}:::}:::;.}}:>Cii:................................. ::}�.j:�i::::::i:::::.;:::.:::::::::::.i::::.:iii:.:l:::.ii:?::!+<•::.ii`i:t::xv<••:.iJiii`;�iiii:•::Uii:iiii::• i>i%it `irc! 2 ';f" %%`a<... S" ess� adttr h on ............................................:::::::::::::::................ ........................:.............................................................................................................................................................. .: oli / Fafime to secure coverage as required raider Section ZSA of MGL 152 can had to the imposition of crbninsl penalties of a fine to S1,500.00 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 mderstand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. I do hereby certify under the pains penalties of perjury that the information provided above is true and correct Signature Date Prin name sit r.�li+� .rJ/ 1 v a rbIV Phone# 3 q 8/POO official use only do not write in this area to be completed by city or town official perndt/license# ❑Building Department city or town: ❑Licensing Board ❑dueckif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other. (teviecd 9/93 P7I� - 1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your 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 you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns legibly. The D artment has provided a space at the bottom of the and tinted davit is completeDepartment Please be sure that the affi omp P 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 pe��rtnit/license number which will be used as a reference number. The affidavits may be returned k 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 Offlee of Investlgations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �OptNE 10,�� Town of Barnstable O Regulatory Services Thomas F.Geiler,Director AM Mass. 1639. 1%, Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: 4,, I z;rlc S Wcp Estimated Cost 9--?CV Address of Work: 18V e oe_"n. AX*- C �,�rv, r Owner's Name: Date of Application: 9-"—O�^ 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: Date Contractor Name Registration No. OR Date Owner's Name Q: n-mhomeaffidav Y 1 - . k 41, BOARD OF License: BUILD[NG REG CQNSTRUCTI ULATI.G,, z NUmbei::'CS GN SUPERVISOR +� B4h 062056 date UB/0811968 Res,r,�cfed .(0 Tr.no: 10T6'9 BRIAN E IWARBUF2TQ . &2 RYDD ER Rp N liq"RWIFi, MA 02645 Adrrnnisfrafor / . / r' I z f r. a w r k _,LC*T 2' oN i I , - f F 5 �� - -- Z `, i 9 X 3 SECOND MEMBER 9 X 6 RAKES 8"X 92"METAL LOUVER TRIMED OUT IN 9 X 2 PINE i 6-9 6'7" JJLLIL 7 9 X 5 TRlM CORNER BOARDS if 6-0 6'-19" } `! " r r X 'V O do 10 R 6„ DESIGNED B Y SALT SPRA Y SHEDS 92'EVEN PITCH SHED WITH 92 PITCH ROOF AN 235 GREAT WESTERN ROAD 3t0 < « 3'-0" <N .SOUTH DENNIS,MA.02660 —6'� WHITE CEDAR SHINGLES.&DOUBLE DOOR , MADEOF 9 X 5 V-GROOVE PINE WITH ACORN r r Y : Facor STRAP HINGES. r SLTSPRA Y f�7[GIS.NET E-MAIL t ALL TRIM IS 9 X 5 AND 9 X 6 PINE 978:680-6779 PAGER SHED TO BE PLACED ON 8" NA (506)398-f900 OFFICE SO TUBES TO CODE WITH METAL STRAPS AS ANCHORS 92,�„ ��..,tuS-A,aii. in«.ilst3;a!i-Y .2✓,.,......-a..H,,...0 n....._ � .w -.o.u. .v.. ....:>...vrw..,,.u.vw.....,.......'.,..,u . . .�.. .. �'.... 1 X 3 ROUGH SAWN PINE TRIM 1 X 6 RAKES ROUGH SAWN PINE 6 9" 7;X 13'-6' 112"X 3 BATTEN STRIP ON CORNERS 8"SONA TUBES 36''BELOW GRADE 12'EVEN PITCH GABLE i � �~^ DESIGNED BY SALT SPRAY SHED 12 PITCH ROOF BOARD&BATTEN SIDING 235 GREAT WESTERN ROAD 8"SONA TUBES 36"BELOW GRADE 6'0" 6'0" _ SOUTH DENNIS, MA.02660 2 X 6 PRESSURE TREATED FLOOR FRAME ° WITH GIRDER AT 6'-0" SLTSPRAY@GIS.NET E-MAIL "-`�-- -^-- `------- 9978)680-6779 PAGER (508)398-1900 OFFICE 12'-0" I X 3 SECOND MEMBER PINE i 1 X 6 RAKES PINE 6,9„ s 7'-2" 13,6 I 1/2"X 3"BATTEN STRIP ON CORNE 1/2"X 2 BATTEN STRIPS ICI ' 5'46,, 6,6„ S„ DESIGNED BY SALT SPRAY SHEDS X-0" 12'EVEN PITCH SHED WITH 12 PITCH 235 GREAT WESTERN ROAD BOARD AND BATTEN SIDIG. SOUTH DENNIS, MA.02660 6'-0" '0" 6'DOUBLE DOOR WITH 6"T HINGES Z 'SLTSPRAYd@GIS.NET -E-MAIL 3'-0" SHED IS RESTING ON 8"SONA TUBES (978)680-6779 PAGER 3'0`' 6'-0" (508)398-1900 OFFICE CODE WITH METAL STRAPS AS ANCh 12'0° 'DESIGNED BY 1 SALT SPRAY SHEDS 235 GREAT WESTERN ROAD SOUTH DENNIS, MA.02660 16'=0" SLTSPRAY@GIS.NET 1 (978)680-6.779 PAGER (508)398-1900 OFFICE t R 6.6„ 3 -�-g 1'-1/2" i 1J jl �T i ul 6'9" 3,9" � t - 8,0„ 16'EVEN PITCH SHED 12 PITCH ROOF0 2'-0" 4'0" 2 WINDOWS STATIONARY ` 4'0" BOARD&BATTEN SIDING T � � " 8"SONA TUBES 36"BELOW GRADE 5'0" 6'-0' ASPHALT SHINGLES AS NOTED IN APPLICATION 16'-0" SALT SPRAY SHEDS 06-2056 CONSTRUCTION LOCATION . OF PROPERTY LINES MAY NOT BE ACCURATE STANDARD LEGEND NOTE:not all symbols will appear,on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY V—V—v—v EDGE OF CONIFEROUS TREES MARSH AREA — • •— EDGE OF WATER DIRT ROAD DRIVEWAY PARKING LOT PAVED ROAD — — DRAINAGE DITCH 1 Q — — — — - PATH/TRAIL MAP 1 / n PARCEL LINE** 57 MAP r1D-< --- MAP# 21 < PARCEL NUMBER #1860<HOUSE NUMBER "1 U`E 2 FOOT CONTOUR LINE 1G•bs �� • -_ —EB— 10`FOOT CONTOUR LINE Elevation based on NGVD29 ;•�4.9 SPOT ELEVATION 00o STONE WALL \- -X—X— FENCE a� RETAINING WALL +1 r1� RAIL ROAD TRACK STONE IETTY . SWIMMING POOL PORCH/DECK X0 BUILDING/STRUCTURE 1 \ H+FL DOCK/PIER \ HYDRANT \ e VALVE OO MANHOLE \ 0 POST 0'` FLAG POLE T O W N O F B A R N S T A B L E O E O „O R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N I T .� SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetiics(man-made features)were interpreted from 1995 aerial photographs by The James ❑ ,.�� 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE TOWER wee 0 15 30 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Plonimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards "�� 1 INCH=30 FEET* enlarged scale. on the map. at a scale of 1"=100'. 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T-n 2• �H: r PROPOSED FIRST FLOOR PLAN A, _ t4.Ci• 'W,y+M r"L l,kli fcE} 4�YJ•�, , ! � q f n ^r .-m 'T - P •'",ry ogle: ''`' � '.' r�� rF,,'N.. 1 a y Efr I r�, Y 61„�tyY r}lIT ' r� t- 9� °it -1 IE n}yhl,r�"'LeA,��f`L 1L.� 1Yr •- PLNOTE:The purchaser of these pfitths is.respansibte For conlpllmtce.tu(th atl STATE and LOCAL BuUdtrng codes and ordinances. Neither AL.LEN B.-,OS000V,or.pwddpaft Veslamrs may:ba held resons4fe For the use of these dralafngs dpttir ccntsbw-ddm T! ''pwrahaser is responslMe to veft-au elements of these pans fordo-MV, Resu�eetrva r w�''K y x t, "7 wears +and styes, to stsdt of wnsbUdkML NOTE PLAN ARE PROTECTED BY COPYRI61•IT a 2002 xoce:laei0 .COu �e n f �' ,mralarAe wemc m,A��>� x "