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4701 FALMOUTH ROAD/RTE 28
-- fool- ior . �?C�l� �� < < i v�G�i�-��-�?�v2�� �ol�.,� � � �. p 4 �, i 1 b I I I (_/�SLed - fA2_mnw-r--d ' a . r � . � k f TOWN OF BARNST'ABLE Board of Appeals 49M R. EA10 .......................................................................... Petitioner 1972-59 Appeal No. . ....... _._ ......._..... .At ............. 197 FACTS. and DECISION Petitioner filed petition on slulH... 3 1972 requesting a -permit for premises at . 4e .. ,�'+ ......... Wit, in the village �antuit of ....:..... ......................__.:., adjoining premises of.......................................... ...................._...................,....__.................... Nkersot►, Sdtic A. L�odgea: Hilda P . Aeida, al ioty of S..antuit and Cotult, Male:01m L. Ond ;aura Fraser.,'i € a, R?bel a.o:, EUzabeth _If.. ioa®ttbergex,', Syl�xi a, Olip 0. Headrix and pieta' Hendrix, ,1:oott� Manage nt Co., Francis G. and 9elen 14.arie Silva, IFranz Gahaon and.Martha, Frederick A: and Sally Via.o Bernard and $ona iiea3,7, Ralph E. and g artt+,a Cahoon, Edward S. and iA,ar aret Savers, Join F. ari' 1ar3e,A, v. tilde, ha P., and Jennie A Saegh, JQria and Isabel . Terila, H. Neil and Ellei , Radford., G'harles E. and Catherine M' Hamblin Notice of this-hearini was given by mail, postage prepaid, to all persons deemed' affected and. by publishing in Cape Cod —�Pint�s, a daily newspaper published in Town of Barnstable a copy of which is. attached to the record of these proceedings filed with Tow Clerk. A public hearing by the Board of Appeals of the Town of Barnstable ,was held at the Town Office Building, Hyannis, Mass., at 3.£ I P.M. ......... .. ..Jar....12 ...................................... 1979 upon said petition under zoning by-laws. ` - f Present at the hearing were the following members: lean:. C$e13�1.e. 8@......... ..:.�sr :... d _..... ....... . �} ... �.... ,.. . . Chairman t f At the conclusion of the hearing, the Board took said petition under advisement. A view of the locus was had by,the Board. _ .............................On :....A..............�......3.............:..................::... 19 7�....., the Board of Appeals found Mr. Barrett represented himself, and stated that his business is in the home occupation category, namely the polishing and finishing of Belt Buckles. He described the proposed new show room and submitted a sketch of same to the Board. fir. Barrett has lived on the premises for five years. The Board re- ceived a letter from Cahoon Paintings, a shop located in the area, in favor of Mr. Barrettle proposed new show room. Mr. Hamblin, another neighbor, but not an abutter, appeared. in opposition because of,the emoting flow in the traffic area, d f The Board found that in a Business Limited C District under Section I, Mr. Barrett could be granted a Special Permit if he fulfills the requirements under Sub paragraph 14 (a) through (g), as follows: fi (a) he does carry on his business as a home -occupation. (b) he does live on the premises. (o) the use will be conducted in an accessory building. (d) he is the only employee. (a) there will be no structural changes in the exist- ing building. (f) the new structure per plan submitted, will be resi- dential in character. (g) adequate off-street parking is provided. E Therefore, under Section,, of this Paragraph, the Board unanimously decided to grant this Special Fbrmit with the following restrictions: Restrictions imposed Under Section, the new addition must be according to the sketch an appear residential in character. . Under Section 4. off-street parking for four (4) cars must be provid , with a turn-about area so that cars bill not back out. The Board in its unanimous decision feels that the granting of this Special Permit would not result in any derogation of the Zoning By-Law, or detriment to the public good or the neighborhood affected. Distribution:— Board of Appeals Town Clerk Town of Barnstable Applicant Persons interested Building Inspector Public'Informatvon B Board of Appeals Acting irman y�F TH E TOE � M o BARWSTABLE, o y MASS. p� ooA 039. \00 �0 MP`i TOWN OF BARNSTABLE PETITION FOR VARIANCE UNDER THE ZONING BY-LAW SPECIAL PERMIT, To the Board of Appeals, Hyannis, Mass. Date ........43.......... ..C............... 19 7,.. The undersigned petitions the Board of Appeals to vary, in the manner and for the -reasons hereinafter set forth, the application of the'provisions of the zoning by-law`to the following described premises. l Applicant: ...............a 1. 5 7.........L.L..:....... �t.1'.r�.l..l................................. ::al mauih....../7..1�G'.� . ,.,?�l.l�.�l,l.t �........... (Full Name) (Winter AMASS). Owner 6„� ?$E h 2.......... .... L r21). , ...:. ...... "�i� �»..._. ..................... ...... ......... ( ) ( 1 Name) winter Add ess Tenant (if-any) . ...... ....:.. ..................n..S?ne... .........::.................................................................. .............:-................. ......................»..........:......... (Full Name) /. (Winter ALddress) 1. Location of Premises .......: ......fo.-l..t.2 o.V..T..�........./7ve................................S4./.'.2.�:�1..1.E............................................................. (Name of Street) (What section of Town) r 2. Dimensions of lot ...:.............;Li- .-.TT. ..................................... vG?... '..... Area .... ,� .7D...�� r ........ ) (Frontage) (Depth) (Square Feet 3. . Zoning district in which premises are located............ : ......................... .......................... ..... . � 4. How long has owner had title to the above preIriises? ................. ..... .�A,`C .....:..................:...........:....:.:..........:.......:... 4 5. How many buildings are now on the lot? ....................0.0e......................................................................................................:................. ' s 6. Give size of existing buildings .............c�..&....x.. z......... ......e.1.15 ............ �.�...14..�''J 'I Proposedbuildings .....................I...[..?C........:f..;I .r.......................:.......................................................................................................................... 7. State present use of premises i4.ts��?r ...�:...............!- .rrks 8. State proposed use of premises ............r'r5.IAr_,ftG..........t..'.....abo."Aronm..........� r —"'9. Give extent of proposed construction or alterations: .......P S.?po5.e.........:lo...........�cci..........1.C?...X..:.f i :....... cCt SG......... Z.,,R. ... ....S..f'1.Ct.LJ..:i`:.C�c�xYY.1.........� .f.:.: .�i..x.. ` �.1 ..... .©�......... .......r ICC.0.........a.»..,16.o..............a wa..............5.17n..........:ro......_....be.............e tee .10. Number of living units for which building is to be arranged ..../..Ilan&. .a...,�.o...... 1) .�..... ....lr�`'$, ��J9 -'11. Have you submitted plans for above,to the Building Inspector? ..........Yes....................................................................._.... 12. Has he refused a permit? ..........�,�,�5............................................................................................................................................................................... 13. What section of zoning by-law do you ask to be varied? ISFc7!::A/ .................. ......._............,.... .... a.................. ............................................................................................................................................................................................................................................................................................. _........................................_....................................................................................................................................................................................................................................... ......... 14; State reasons for variance or special permit: ..:... ( tl'1 ...........P..G.f-rn.4..............Cl_ aS-e i.,. , The........»......?pp .-a..��..........�rf..........�fa��........bV&n .............�.�1�.��h..............co u.§L............;mf...........: ......... hx ....LA Jlvn �Q « . ......_........ . ��1 b ._.........a. d............fhei -_. dshl.b u t� t: ,.: �........ ..... 1l c17a ............. z1ld..........b .......... .r '1 ...........cadfac ..........bs� . me .......:c-.�..r.2..sffc;�..t..__ rf J��..:.............. fmai1..........sh ........ ... . ..,,......... .............. l n.............�.........3.(6g.7.�...... ............ ..........�.��..........c��dan. .. ..... .e r..M.tf:........1 za..........beeo.........../. cf ......... .yeti...:.... e,rrn ...:.r. ........._reff. -51e-j . ...............:........_..........._.._................. ..........................................._............................................_........................................................................................................I.......... .................»».._....................._.»................... _ ..............................................................................................................................._..................................................................._.__.................................._..................».........».._»... Respectfully submitted, (Signature) y f»... ..» 1�.. Petition received b .........................:................._.................................... (Address) „... �.ru u14 Hearing date set for _................................................_ 19>.......... * Filing fee of $25.00 required with this petition. * This form may also be used for Appeals. (Over) The following are the names and mailing addresses of the abutting owners of property, name and address of the owner across the street, act`arding to the records in the Assessor's at the date of this application: Please type or print only. Assessor's MAD no. -4. Dora M. Nickerson Falmouth Ave.., Santuit, Mass. 5. Eunice A.- Hodges Main St., Santuit, Mass. 14. Hilda M. Al eida Main St., Santuit, Maws. ,;15. Holy Ghost Society Santuit and Cotuit Santuit, Mass. -16. Malcolm L. Fraser and Laura Fraser Box 134, Santuit, Mass. 1-17. Mary R. Robello Main St., Santuit, Massi. -- 15. Elizabeth H. Rosenberger Main St., Santuit, Mass. 20.. Evelyn Sylvia Falmouth Ave., Santuit, Mass. � 1. Olin C. Hendrix and Meta Hendrix Dunaskin Drive) Centerville, Mass. Assessor's Map no. 10 &,2. Alcott Management Co. Route 28, Sa:ntuit, Hass. -3., Francis G. Silva: and Helen Maxie Silva Sandwich, Mass. -4.. Franz Cahoon and Martha Cahoon Falmouth Ave., Santuit, Mass. ✓6L Frederick V. Kaye and Sally Kaye 207 Providence Road, Grafton, Mass. --7. Bernard Kelly and Ilona Kelly Falmouth Road, Santuit., Mass. j. 8. Ralph E. Cahoon and Martha Cahoon Falmouth Ave.., Santuit, Mass. --9. Edward S.. Savery and Margaret E. Savery Shell Lane, Cotuit, Mass. 10. John F. Shields and Marie A. Shields 121.East Bay Road, Osterville, Mass. ,,-18. Theodore P., Saegh, Jennie A. Saegh, Eli J. Terila and Isabel C.. Terila 37 Weymouth Ave., West Roxbury, Mass. Assesser's MaD no. 2 20. H. Neil Radford and Ellen T. Radford 7 Northwest Lane, Centerville, Mass. Al. Charles E. Hamblin and Katherine M. Hamblin Newtown Roam, Santuit, Mass. Verified by Assessor's Office ' O - k A essor There must be submitted with the within application at the time of filing a plan of the land, in duplicate, (or two prints) showing: 1. The dimensions of the land. 2. The location of existing buildings on the land. 3. The exact location of the improvements sought to be placed on the land. Applications filed without such plans will be returned without action by the Board of Appeals. by 1 " 1 �I. fi r 1 i , t i i i 1 : 1 , v i r 4 t _ 1 I ) rl 11 i ' k 7 S 1 ! t I I Y� • i i �. .. _ p � � -. ,. �� 4�y'i;W7�''er43�i�;'.c E46wa.xC+�xs.,Xltnw� A+F1a0.+m+.:�axNur�..drF'�'�mOd�"•j''w-�_...::..,. L _ �j Assessor's map and lot .number ...q:.. / .... .'.'.. . THE e)'�< �( f_ j/ �q -L G �9GS/ �Q�Of . �/LT r ewage Permit number .......... ..............................:............ . - w �FTU �cT E House number .......... �t.Cu/.fGa t.S...:...../.1...... ��d..h �S �c.cU.E . ao6 a L i p�1 39• 6� 'E0 MAY y. TOWN OF SARRNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... -wkl. .....:............ ........................................................................................ TYPE OF CONSTRUCTION !Y ..: ...0'4^..... ... ................................ �., .......... -ar ...M. .......19.- ,TO THE INSPECTOR OF BUILDINGS: ..... The undersigned hereby applies for a permit according to the following information: ��!!- y Location ......470.1.........FoUnTo,&....( 5�....�.) �r...DG.�I�........V���C��.. .... ���..:..� l Proposed Use ......Aa.cf,5.C>. .. ...J� b r( �lw',,,. . ?. �G' .........................................I......................... p Zoning District ..........C .....................Fire District ..... +.c. J..................................................... JA+:.f#.1�-......,�ft..�.0 ..........Address .....y.701......Fa-j.....1 .•Name of Owner .a. .. .. .. ................................. Name of Builder .a.V-.WA.. Address o' .. Name of Architect r ...................°.............................................Address ...............t....................s............................................... Number of Rooms ........ ....... ..........................Foundation 4,0�....w Exterior .....�QzZ ......5.1h� Ilea..............................Roofing . ,lP. ...S�A lC:............................... Floors w5no........ ..........................................Interior .......("Llorn 4 ............................................. Heating ......A&-ru.°�............................................................. ......A :....................................................... Fireplace .... . ..................... .......................: .Approximate Cost ...tAI ................................. Definitive Plana Approved by Planning Board -----------_-------------------1.9________. Area .... .. f Lot and Buildingwith Dimensions Diagram o 0 Fee ......... ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Rae- 09 exI'A OG'! tOpy SI - er DWe-A\Jvas r t'7r�'Z�e.�� 6e— \ , e bserIA--� � 2oO I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .�.BOL�.. ................. Barrett, J. R. & A. H. A=9-19 5 r NoZI33G....... Permit for ...Aeceaso + ....Wilding.............Stor-§W-.sue. ............... Location .......47.01..F.almauth.Rd.......Rte.....28 ......................... ...Cawi t.. .............................. P Owner ................. d Type of Construction ......Wocd...frame............. ............................................................................... ` - •' Plot ............................ Lot ................................. Permit Granted ............kUy..... 1.` .....19 79 Date of Inspection .............................. .....19 _........... Date Completed ................. . PERMIT REFUSED ............................................................... 19 F _ ..................................................................:............ ............................................................................... .................................................................:f. ..... , ......................................................................... r Approved ................................................ 19 ........................................................................... . . .................... .....................................................ta 1. rY,s S Assessor's map and lot number f . C/a OF THE TO 'Sewage Permit number ...... ................... r _ J AHHSTODLE, i House numbeR r`< .: . .f`.. 'a r < � %�,_/.i, - f 90 M b 9 0� • O 39• ON a' TOWN OF BARNSTABLE 1 BUILDING INSPECTOR APPLICATION FOR' PERMIT TO .....j .: ..............................................................................................:.......... TYPE OF CONSTRUCTION .��::�?�...�{'"��^'`�••' ry........., :';�;'?�°G.�.;;...�;3�;,;;'; :.............................. .. TO THE INSPECTOR OF BUILDINGS:. The undersigned hereby applies for a permit according to the following information: !.� ,� Location ...... ......... t}a�- i,+ / ..... ... f, . ....i� ........! f. !;v1, a.aAJ... Proposed Use ...... r,f.x 5 .:X.. ............57c>Cr0.� 4•,; nr,rf< .........................................,......................... Zoning District• ... . . ......tn?. ........../ ... .. .........Fire District .....* r4-,, J..................................................... Name of Owner e. ..........Address ..... :). f ?. ....... :1......l r :................................ Name of Builder .... ...........Address ............'............................. ....................................... a 'Name of Architect ........�..........'..............................................Address ..............!!.................................................................... Number of Rooms ......77raln :?V ............Foundation �._. rtnr,x �r �rr�. x.. .................................. Exierior .... MI.)!.,-r �1 . k. ,v,�-�r�� ............................Roofing ..... Q . ��..�+���r- Floors , ,I,, -r ..... :..............................................Interior .......�eti,�,,tit4 ............................................. Heating ...... ?'.:.............................................................Plumbing ......ftl.,�,.---•A!............................................................ Fireplace !/. .-!a.............................................................Approximate Cost .. (�. : . 7 F ........................................ r° Definitive Plan Approved by Planning Board --------_----------------------19--------. Area K?..... . Diagram of Lot and Building with Dimensions Fee .................. ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH CC,,..•�..'��11 •�:., G•^r�^.%`i•UIGR �<C..�(i1,. f�._ �1 ill Ac e /0 I hereb agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .... r M1-:', . �� ................ _ . ...,..f......,,.�.�-.:uw. a..,.tee..._. .... i Barrett, J. R. & A. A=9-19 No43.30....... Permit for .&Ceasory...to........ bu i l ding...........S oxs ge..she d................... Location -.."�.4.7.Ql..kalmo..uth..Rd-....Rte....28. .............................. .................................... Owner .....J.,K.A.A....R....Barrett................. Type of Construction ..........Wood..tramp........... t F ............................................................................... Plot ........................ Lot ................. .�: .......... t Permit Granted ..........Ma. ../31.. ...19 79 Date of Inspection ............... ...19 Date Completed ................. ...19 PERMIT FUSED _ ... ....................... ........................ 19 .............................. .. . 7� IV .................... .......................................................... r ,lIlk A ro ed ........... 19 ............... ....... ..... ..J ...................`-r....... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (D o c( O ,q. l� Map- Parcel F -' Application Q Health Division L , u n, -Date Issued .x .� � FeeConservation Division Planning Dept. ,�,A.,��.� Permif`Fee�� 2,55. 06 Date Definitive Plan Approved by Planning.Board Historic - OKH _ Preservation / Hyannis Project-Street Address g-�__ Li 40 1 o I� 0 4 Ville -age (C cA I 't R j wner=, Ry�tit E t v r e Tt Address P O kES,-a'f- `f Co 1-V tT 0 2 Telephone S P,ermit_Request den -I v ��k.�a� .'� `�s� t d� �� Is i�v �c ���� 8 0e- kk3 I:r",k-L I s pcct PEA -Ty-cJ%N-e bcr-k to' �►s� treS•Tovie e,5`T IrO-,T f 1z1 t"'A 1 o5S Reckc c, 2 " I) (,t. L5 es?Ov,o Cf0DV1,J(-�1 wt 01.41. QY W• Vi DL-- 5 hi►�l �5 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed a wka. Total new Zoning District Flood Plain Groundwater Overlay �� 50 � Pt roject Va uatio gn D D, Construction Type R �S T�r's �l c� V f q Lot Size a I k V--5 Grandfathered: VYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. V Two Family ❑ Multi-Family (# units) Age of Existing Structure 2j ec✓5 Historic House: WYes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 3 (6 Q Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 3 new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including.baths): existing _( 3 new First Floor Room Count Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes *No Fireplaces: Existing New Existing wood/coal stove: ❑Yes XNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: existing ❑ new size _ Other: o P i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION �v M of '�� Q BUILDER OR HOMEOWNER) ._ '�z 2 �a -�--- � Names �Telepho`ne Number.. Address_ �� Lice ens'e-# C }- 0 96 S fi 8 Home Improvement Contractor# , 4 4 y Email, A w k C) i kA o'�vv-,,( a Co W,Worker's Compensation # ALL 60NSTRUCTION-DEBRIS-RrSULTING'FROM THISaPRQJECT WILL BE-TAKEN--TO,- - SIGNATURE- - -�--- -DATE---Cx-t: 5 ZD I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r ,.?'Ire Commornvealth of_Vassadirrset;s Dept rafferrt oflndu.shial Acciderric Q},,ue 00mVstigadorrs. y 600 Washijigion Streety. BoasMt♦on�,�14��f(� /02��f�'1 , Workers' Camp ensatimInsurance davit:13mldersiContractor--JEIecfrkians/Phi-ethers Applicant Infarmatian Please Print Legffi , kNghie D 4 yt C9 a tt It, c, 'P'1 AddL SS= a 2 t/V.C►✓Cl lj'r �It�f f3tP� _9 �w�✓1 1'1 2 '�)a D Phono to 0 Ii Are you an employer?Check the appropriate box: Type of gra'ect(iequired)_ . I.❑ I am employer With ❑ I am a general contractor and I 6_ [:]New constiuctzoa employees(full anVor part-timed* have Lured the su6�ontsattors I I am a sole proprietor or partne-- Tisted on the attached sheep ?_ ❑Remodeling ship and have no employees. The3e sub-cordractors have g. ❑Demolition- wQrl� for nee in any capacity employees and have wo&-ers' BIIildmg addition ' [No woricers' comp_insurance comp.insurancel 10' Electrical repairs or additions required.] $. ❑ We area corporation anal its ' _❑ 3.❑ I arm a homeoumer doing all urork officers have-exercised their „ LL❑Plumbingrepairs or additions t of ex t;an 14fGL 4 myself-[No ivorlcers'comp_ � per 12_❑Roofrepairs 152 / andwehaveno mc�rcasiCe required-I t �' C. , �I L� 1 employees.[No wod=s' a❑Other ti\L_ ✓il LIT co=p_incur ce required.] ��i'T ' i c_ 5 -C *Any VpFfcsvtffi2tcbec3mboxR mast also filloutthesecfianbgIowsh_gthe¢wo&erecompensatianpoIiicpinformsaoa � #Hameocvaers vrho submit[his afiidays in ag t5vy are daiag all y aid tires hirz outside coatracrors�ct submit anew affidavit iadica3iaa such-. fCaa. tm that check ibis boot must attached an addidand sired shooing the name of the sub-CVMIXXct0r&and state whether or not those echtiesbay employees.Ifthe sub-cont-etflEshave empIoF—,t€teynnstpmvide thek workEn'c=p.policy number I ant all my enrptayem ffetoap.it A,q parity and ob site Insurance Company Name: Policy 41 or Self-ins_Lim. F—Kpiratoa Date_ Job&ta Addses : CitylStafel[.tp: Attach a copy of the workers'compensationpolicy declaration page-(showing the policy number and expi ation date). Failure to secure coverage as required under Section 25A of MGL a. 157 can lead to the imposition of criminal penalties of a t fine up to$1,.OD. D andfar'one rearinxprisonnieTA,as well as civil penalties in the fog of a STOP WORE ORDERand a ftme. of up to$250.00 a day against the violator_Be advised that a copy of this statement=ay,be forwarded fn the Office Of Invest gations of the DD4 for insurance coverage veriffc:ation I do herRby carffir ufer the pmks aged ponaNks afpetjrcry tkat ilia irrfornzatiart pratirled abmrs is trans acid carrect Si�ature'' Phone g 0{okial rise Only. bo irat write in tlrfs area,to be cm npleted by city amen n a;#)4crat City or Town: - Pert tUcense# bmmg kUthorit (cnrle one): r L,Baard of Health,2.ButTTlng Department 3.Ciiyffown.Qerk 4.Electrical Inspector 5.PI.. mbing Inspector,', �3„ 6.Other Comtact Person ' ' Phone#: 6 ormation. and 11astructious Massachusetts Geneaal Laws chapter 152 mq=es all eupIoyers to provide wor5as'compensation far flier employees. p bo this she,as envkyeeis defined as.- .every person m the service of another under any cont-ad ofhoe, express or died,oral or " An empkyer is defined as"an individual,partaerffi p,association,corporation or other legal entity,or any two or more of the foregoing engaged m a joint enterprise,and inclnding the legal representatives of a.deceased employer,or the receiver or tustee of an individual,partnership,association or other legal entity,employing employees- However the owner of a.dweIIm.g house having not more than three apartments and who resides therein,or the occapant of the - dweiRag house of another who employs persons to do maintenance,c0mtaetion or repay work on such dweDing house or on the grounds or budding appurbm art themtu shall notbecanse of surly employment be deemed to be an employer." MGL chapter 152,§25C(t7 also stains that"every state or local licensing agency shaIE withhold fife issuance err 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 4ncorance.coverage required-- Additionally,MGL chapter 152, §.25C(7)stems'Neither the commgnwealh nor my ofits.poIitical subdivisions shall enter into any contract for the perf=aac6 ofpublic worku as acceptable evidence of compIi•mce vriih the in tlr c'6 requirement3 of this chapter have been presented t a the contracting authoiity." Applicants Please fill out the worker'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub�ontractor(s)name(s), addresses)and phone numbers) along with their eertLf:icafe(s) of ms u=ce. Lmutnd Liability Companies(LLC)or Limited LiabilRy Pa taerships(LLP)with no employees other than.the members or partners,are not nqui to carry wolicers' compensafioa insurance_ li an LLC or LLP does have employees, apolicyisregnired. Be advised that this afhdayit may be,submittL-dto the;Deparfinentof Industrial Accidents for confirmation of issuaance coverage. Also be sure to sign and date-he affidavit The affidavit should be reted to the city or town that the application for the peuoit or license is being requested,not the Department of un Tn �Frrai Accidents. Shouldyou have any questions regm mg the law or ifyon arm required to obtain a.workers' compensation policy,please call the Department atf=nomberlisfedbelow. Self-ins<zredcompaniesshouldeatrxthr-ir s elf-ice suran ce license n-omber on the appropriate line. City or Town Officials Please be sm-e that the affidavit is complete andprfiited legibly. The Departrnenthas provided a space at the bottom of the affidavit for you to tip out in the event the Office oflnvestigations has to contact you regarding the applicant please,be sure to Ml is the pen it license number which wM be used as a ref=mce number. In addition,an applicant that must submit multiple peffiitUcense applications in any given year,need only submit one affidavit indicating c roit t policy information(if necessary)and under"Job Site Ad_r1*ess"the applicant shoT�Id write"all locations in (criy or :'own)-"A copy of the,affidavit that has ben officially stamped or maimed by the city or towi maybe provided to the applicant as proof that a valid affidavit is on file for fufnre Pmnits or licenses A new afffdavitmi st be filled oft each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial ventlre (i.e. a dog license orpeD3�t to bum leaves etc_)said person is NOT reposed to complete this affidavit --- —-- --,- The Office of Invest gal ons would like to thank you m advance far your cooperation and should you have any questions, please do not hesitatz to give us a calL The Departmenfs address,telephone and fax number_ 'FI�e CazaEamqZea.tta of Ifassach . Dega> mt of lzrd i Aoridenft� Qmce of ltvestitktio= '� FQ4� Qu Sfrt�t Bostw,MA Q111 Tf,-L.4 617' -4900=t 406 or 14M MA-SSAFE Fax:9 617-'27 7M 1Zevised4-24-07 W W _maz.9gfdia r AWC Grr-ide /o I-Vood ComstYltction in Hi,h Wind Areas:110 mph Wirrd Zone Massachrisetts Checklist for Comp.Iiance (78'0- CYfR5301:2.1.1)' f^ Check ` Compliance 1.1 SCOPE - t Wind Speed (3-sec. gust)...................... 110 mph Wind Exposure Cate o • .. .... ..... ..... Wind.Exposure Category................Engineering Required For Entire Project.............. 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 In 12 slope shall be considered a story) stories s 2,stories Roof Pitch (Fig } 512:12 ............................................................... Fi 2 ....... . ......................... Mean Roof Height ................................... ....(Fig 2)..................... ft 5'33' Building Width,W ..(Fig 3 ....... ft s.a0' .... ..... ... .. .......... BuildingLength, L .............................I...................................(Fig 3)...............•.................................. ft'.<80' Building Aspect Ratio(L/W) .......•.... (Fig 4)............. <_3:1 ............................. ..... Nominal Height.of Tallest Opening? ............................... (Fig 4)...........,. :5 BIB- ..... , 1.3 FRAMING CONNECTIONS General compliance With framing connections...:................(Table 2).............................:..............................,:.. 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.................................:....................................................:.......... ..:..:..............::..:.:.. ConcreteMasonry....:.........................:..:..:.............................................................................:................ 2.2 ANCHORAGE TO FOUNDATION',' 5/8"Anchor Bolts=imbedded or 5/8"Proprietary Mechanical Anchors as an aitemative in concrete only Bolt S acin9—general. ...(Table 4).........`...... in. Bolt Spacing from endpoint of plate...........,.................(Fig 5)..................................... Bolt Embedment—concrete:........................................(Fig 5).....................................:........... in.Z 7" Bolt Embedment—mason .......................................... Fi 5 ................ . in.?15" ry (. 9 ) :...................... 5 _ Plate Washer..:.......................................................... ..(Fig )................._..................._........>3'x3"xI/. 3A FLOORS - Floor-framing member spans checked .........:........................(per 780 CMR Chapter 55).. ... { Maximum Floor Opening Dimension................................:..(Fig 6)............ ...................................... ° ft:5 12' Full Height,Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)...:................. ` Maximum Floor Joist Setbacks Supporting Loadbearing Waifs or Sheanvall.........:......(Fig 7).......... <ft _d Maximum Cantilevered Floor Joists ` Supporting Loadbearing Walls or Shearwall ........(Fig 8).................... < FloorBracing at Endwalls.....................................................(Fig 9)..................................................... 1 Floor Sheathing Type .......... ..................... ..................(per 780 CMR Chapter 55)..................... Floor Sheathing Thickness'.. ...............................................(per 780 CMR Chapter 55)..... ................. in. Floor Sheathing Fastening................................:`.....:.......:...(Table 2).._d nails at in.edge/_in field 4.1 WALLS Wall Height R Loadbearingwalls • .(Fig 10 and Table 5) ft s 10' .._........ _ Non-Loadbearing walls ............ .........(Fig 10 and Table 5) ................:..... ft 's 20' Wall Stud Spacing ........................(Fig 10 and Table 5).... .............. in._<24"o.c Wail Story Offsets.. ....... ..................•............(F1gs 7&8)..............:............................. ft s d 4.2 EXTERIOR WALLS' L Wood Studs Loadbearing vralls ...................:...........(Table 5)...............................2x ft in. (Table 5).. ` — — — Non-Loadbearing walls... •' ' - , Gable End Wall Bracing — — Full Height Endwall Studs (Fig 10 . WSP•Attic Floor Length..:................................ ...*(Fig 11)..........:.................... ...... ft kW/3 , GYPsuhi Ceiling Length Qf WSP not used)....:.............:(Fig 11).......... ft>_0.9W - and 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .. (Fig 11)............................................................ or 1,x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ..I..... I.....................................(Fig 13 and Table 6) .......... ft , ....................... Splice Connection (no.of 16d common nails)..............(Table 6)....................................... ATVC Guide, to Wood Construction iri Higft FViiid Areas: 1101111)h !Vied Zone Massacliirsetts Checklist for Compliance (7s0 04IZ5301.2.1.1)' Loadbearing Wall Connections . Lateral(no.of 16d common nails)................................(Tables 7)..................................................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)......:.........................(Table B)..................................................:..... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans ............I...........................................(Table 9).................................. ft—in. <_ 11 Sill Plate Spans ........................................................(Table 9)..................................—ft_in.s 11' Full Height Studs (no. of studs)....................................(Table 9)............................................... .... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans...... .....(Table 9).................................. ft_in.<12' Sill Plate Spans...........................................................(Table 9)...............:.................._ft_in.< 12' Full Height Studs(no. of studs)....................................(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously 4. Minimum Building Dimension, W Nominal Height of Tallest Opening Z ._5 618. SheathingType..............................................(note 4).............:..'..................................... Ede Nail Spacing .... Table 10 or note 4 if less ................. ' Field Nail Spacing............................:.............(Table 10)............................... in. Shear Connection (no. of 16d common nails)(Table 10)............... ................... ...............:....._ Percent Full-Height Sheathing........:..........:...(Table 10)................................................... % 5%Additional Sheathing for Wall with Opening>6V(Design Concepts)............:. .. Maximum Building Dimension, L Nominal Height of Tallest Opening2....................................................I....................... <-6'8' SheathingType..............................................(note 4)..................................................... Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. Field Nail Spacing.......................................:..(fable 11)................,..............................:.. in. Shear Connection(no. of 16d common nails)(Table 11)........................................................ Percent Full-Height Sheathing........................(Table 11)............................................:....... 5%Additional Sheathing for Wall Mth*Opening>6'8'(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?.............................................................. ............ .....: 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19) ............. ft s smaller of 2'or U3 Truss or Rafter Connectlons at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U= pif Lateral.............................................(Table 12)..............................................L= pif Shear............................:..................(Table 12)............................................S= •Pif Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker...........................................(Figure 20) ..:.........._ft s smaller of 2'or U2 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no.of 16d common nails)...(Table 14).............. = . Roof Sheathing Type...................................:................(per 780 CMR Chapters 58 and 59) Roof Sheathing Thickness...........................................'............................................. in.>_7/16'WSP Roof Sheathing Fastening.............I..............................(Table 2).................................. ..................._ Notes: 1. . This checklist shall be met in its entirety; excluding the specific exception noted in 2, to comply with the requirements of 780 CMR.5301.2.1A Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. ,Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 fL shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-gr6de. r AIFC Gidde to Blood CpII,S'tl-uclloil I-ll l-lig 1 H1ind Areas:.110 ntplr Il hid Zone Massadiiisetts Checklist for Compliance (790 CMIZ 5301_2.1:I)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio, determine Percent Full-Height Sheathing and Nail Spacing requirements b.. Wood Structural Panels shall be minimum thickness of M6" and be installed as follows: i. Panels shall be'installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. Ill. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. - v. Horizontal nail spacing at'double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a) new house or horizontal addition-required if project is 1 mile or closer to shore (generally, south of Rte. 28 or north of Rte.6) b)vertical addition-not required unless there Is'extensive renovation to the first floor c)replacement ivilidows-needs energy conservation compliance only(chap 93) 6_Wood Frame Construction Manual(WFCM)for 110 MP.H, Exposure B may be obtained from the American Wood Counci'I (AWL)website. -VMEN THIS EDGE RESTS ON Fi3Ah1ING USE&1 NAILS „ .. 1 11 I µl ! I ii ii r , , • •, I I zd ! y - O k - .. , J k Ed Lu 1� w is is � 1 1 1 FFlARdIryG MEMBERS � 'I Ii , EDGE1YTERMEDIATE 1 ; 11 1 11 f ::F 1 k . I csi ii II kI ' i " �• 3B' ! i k , 1 ! • I� Ill 1 T _ ^-�, -- __ -+-- 4D11�lEtUGE —�-- STAGGERED 3'MMJ 2JAILSPAGAVG +. TW4 PATTERN PANEL71 1 PANFS— — d � , ,Y` PANLC EDGE LrI ROUBLE NAIL EDGESPAG44G DEML , See Datail Next Pagi; ' Vertical and.Horizonlal Nailing Detall for Panel Attachment Vertical and Horizontal Nailing for Panel Attachment - f r.i a a ` a =ARNSfABLE, a - ,- " Town of Barnstable '" . Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO R " Building Commissioner , 200 Main Street, Hyannis,MA 02601• r , www.town.barnstable.ma.us Office: 508-862-4038 Fax:`508-790-6230, Property Owner Must , Complete and Sign This Section_4 j If Using A Builder I J� '�• ���' e+fi , as Owner of the subject property hereby authorize C�y l Q fi " � f,-tcf'. to act on my behalfy in all matters relative to work authorized by this building permit application for:, { �G i ,Ih0 VT ID CA V 1't (Addiess of Job) S• tote of Owner Date, �.. Print Name , If Property Owner is applying for permit,please complete the Homeowners License Ezemption.Form on the reverse side. t, Q:\WPFMES\FORMS\building permit forcns\EPRESS.doc, Revised 040215 Town of Barnstable Regulatory Services P�oFZHe r � Richard V.ScaIi,Director Building Division txsTesr.E Tom Perry;Building Commissioner v� 1659. `e� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623.0 HOD'ITO'WNER LICENSE EXEMPTION y Please Print . DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# . CURRENT MAILING ADDRESS: - 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 undez the buildingpermit. (Section 109.1.1) the State Building Code and other applicable codes for compliancevvrth , The undersigned homeowner' assumes responsibilityg pp bylaws,rules and regulations. 1. • , . ' 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„performingmork 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:\WPFILES\FOR.MS\building permit forms\EXPRESS.doc Revised 040215 epomvnaaruueaC o�VVGaaracfeuoeCi`t • surnerAffairs;&Business P.egolatiar.` License.oriegi�tration valid for individul'use only OVEMENT CONTRACTGR C.efore the expiration date. If found return to:. f749S 4 Type: Office of Consumer Affairs and Business Regulation 41E17=> 'Individual 10 Park Plaza-Suite 5170 Boston,MA'0211.6 Undersecretary Not vah ithout.signature , '_ .n ' F; Massachusetts Department of Public Safety ' y Board of Building Regulations and Standards License: CSFA-086568 Construction Supervisor 1 8 2 t Family DAVID L OTTINGER 172 R HARVARD ST f; u CAMBRIDGE MA 02139 ' /n_ •. + III Expiration: Commissioner 06117/2017,• . Construction Supervisor 1 &2 Family Restricted to: , Failure to possess a current edition of the Massachusetts a State Building Code is cause for revocation of this license. s. DPS Licensing information visit: WWWMASS.GOVIDPS „ ' . r •" .t . h ,rl .. fir,:. . J, � ° YM a J Engineering Dept.(3rd floor) Map /}d 5 Parcel Q/ 3 Permit# House# a4 740 Date Issued'' - - ) - Fee - -2 00) F Planning Dept 1st floor/4�hn�� sam �l�g,) o,INErp Definitive P1a 19 BARMARr, E. ' ,_ t �Et MPSp`� TOWN OF BARNSTABLE , ''✓ Building Permit Application Project Stre ddress `L �•` r Village- _G� ��'- Owner �J /� � ? Address Telephone ,` 'Permit Request _ V /ZZ' ` First Floor square feet Second Floor square feet .Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes )dNo On Old King's Highway ❑Yes YNo 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 No.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 ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ . Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Numbera � Address /9/> ��1� License# Home Improvement Contractor Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATEjT � f BUIL.. -PERMIT DENI F R F OWING REASON(S) { - FOR OFFICIAL USE ONLY - PERMIT NO. DATE ISSUED_ ti MAP/PARCEL NO. ADDRESS ? e VILLAGE , OWNER DATE OF!INSPECTION: ' FOUNDATION ¢ FRAME V INSULATION i FIREPLACE s j f ELECTRICAL: ROUGH ?FINAL _. s . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` The.Town of Barnstable De�artrrient of Health Safety and Environmental Services Building Division 367 Main Street,Hyamiis MA 02601 Office: 508-790-6227 Ralph Crosses Fax: 503-790-6230 Building Conuaiss: For office,use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION J MGL a 142A requires that the "reconstruction, alterations, renovation,' repair, moderniz2tion, 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: -�L 44 Est.Cost 1 � Address of Work: °- � Owner's Name Date of Permit Application: ' I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 MOROVEMENT 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. -� eI Da Contractor Name Registration No. T/le Cutrrfrtu►rlrcalt/t of:VII.T.achu ells Drpartntc•"t Of Industrial Accide Its OffIC9Of1JTV9S fgatfons h(!O !f'ashi►r,-wit Street Bt►mim Ma.y . 03111 Workers' Compensation lnsurance AMdavit ';AEloTiit informatinr _ PlcTs—e PRINT ledN('��'-'�—M^- —� -•� name Z/V t cin e� nhone [� 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity )'I nil an em lover rovtdin_ workers com ensauon for my em p ioyees work in g on this j ob. � cmm�rns• n rmt '��M 17 ;' ✓ �i� 4�/^�/�[� a�/l-�a� •ttirlrcc�• �L.l�b���i�ll� �/� nhnne t!• � � � incrrrnncc n ' ,�1�6��� /���-��,/ f/ nnlic�•!3 ./r�Gr°/dd n� 71 I am a sole proprietor. general contractor. or homeowner(cr'rcle oirej and have hired the contractors listed below who na% the following workers' compensation polices: cmmri•rrrs• n• tnc- •tdrirccc• city- Phone H, incnrnnrr rn nnHer d cmmn.lns- nnrnr• 'uirlrccc• tin nhnne/�• incurnnce rn nniie�• __ Attach additional sheet if tic ccisary'- > , -^+:<:" ;::�::• v• r,�..,�..L..• �.�..�:`�: '_ +••«o�a�r�. .. "•.ru.�a F:rrlurc to secure cnreraCc as required under Scctton:5A of AIGL 1S2 can Iead to the imposition of cnmtnal penalties o1'a line up to SI.SOU.UU andiur unc cars' imprisonment as Hell:ts ciVii penalties in the form of a STOr WORK ORDER and a fine of 5100.00 a day against me. I understand that n cope of this statetttcnt maj be furwarded to the omce of Investigations of the DIA for coverage verification. !do herehr cerri�t•t trier the pants and pctraltics ajprrjuty that the information prorided above is true and correct. Si=^.amrc Datc Print nae 1� � � Phone;* m official use unly do not write in this area to be compicted,by city or town official cite or tnss•n:. permit/liccase d r7Uuilding Department t ❑Licensing!fund � t electmen's fice ► tt � check it immediate response is required ❑S of i. 011calth Department I, phone9: —Uthcr. E contact person: � I i Information and Instructions Massachusetts General Liws chapter 152 section 25 requires all employers to provide workers' compens:ttian for :: emnloyees. As quoted from the "la��'". all eruplgree is der►ned as every person in the service of :tnotlicr under an%• coiaract of hire, express or implied. oral or written. An ejnplur•er is defined as an individual. partnership, association. corporation or other legal entity. or any t%%,o or ,r,: the foregoing cn�gaged in a joint enterprise. and including the le';;al representatives of a deceased employer. or the receiver or tn►stee of an individual , partnership. association or other legal entity, employing employees. Ho%ve%,cr : o%%,ncr of a dwelling house ha%•ing not more than three apartments and who resides therein. or the occupant of the d%%!cllin�_ house of another who employs persons to do maintenance,construction or repair work on such dwelling_ or on the __rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio" MGL chanter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or of:► license or permit to operate a business or to construct buildings in the common,%vealth for snv icant who lies not produced acceptable evidence of compliance with the in coverage required. Add.:ionall\•. neither tite commonwealth nor any of its political subdivisions shall enter into any contract for the performa,ice of public work until acceptable evidence of compliance with the insurance requirements of this chapter 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 suppiving company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial ,-accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The �Ja\,it should be returned to the cin• or town that the application for the permit or license is being requested. rn the Department of Industrial ,-accidents. Should you have any questions regarding the "taw"or if you are recuire :o obtain a \\•orkers' compensation policy. please call the Department at the number listed below. City or l7mvns Ple::-e be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom . the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plc be : to fill in tite permit/license number which will be used as a reference number. The affidavits may be returned ,:le Department by mail or FAX unless other arrangements have been made. The Office of Investigations Nvould like to thank you in advance for you cooperation and should you have any questic please do not hesitate to _give us a call. The Department's address. telephone and fax number. r The Commonwealth Of Massachusetts Department of Industrial Accidents =x Office of investigations 600 Washington Street Boston,Ma. 02111 fax #: (6177) 727-7749 phone . (6171.. 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���•�r���.����Si7��I. ffil ��If��r�'�ri����ri��F�'���i���a'�I•�'s��ffl701 IL!��� �E��a!'j�L`rr%tr�r�!'ltr ` !'stl `�ts�l►LI��!'j!s!►5�► !?1���\ !'jl��s��►ll���►�tjE���l�irs_t��`��'Zt►��E�`�fZ�:.Gt '1 b OAK AND PINE FRAME.THE PLATES ARE IN ERFECT CONDITION AND WERE NOT MOVED OR DAMAGED 2"PLANKS SECURED AT SILL, x - GIRTAND PLATE-TYPICAL. . Repair Or ig nal ' � r � -�► 9"by 10" N ifte oak post: Se ttached struct ral LANK WINDOW FRAMES ATTACHED TO THE VERTICAL 2"PLANKS Pull bac enginee K-1,SK-2 together Repair/REplace Original „ 8„-16" Vertical p]ani s. efasten 3s i iecessary w/ 6"'Timbe Lo "screws (4)per beam intersection into oak a d ine frame SILLS,JOISTS AND STONE FOUNDATION REBUILT ON CONCRETE Replace Original DOTING AND PERIMETER WALLARE IN PERFECT Push corner CONDITION AND NOT DAMAGED BY THE IMPACT. ost back Sill and foundation L3"by 4-1/2"Oak Door w/jacks. was undamaged. Post 1769 ALVAN CROCKER HOMESTEAD JOE and ANNE BARRETT- NORTH/FRONT PLANK WALL ELEVATION 470� 1=A� Io�TH ROAD COTUIT, MASS. view ofplank WaIl Sheath � n nd eX ant . ' - �' Restore Damage from Trucic impact. a t g House is listed as a "Historic Building"; individually and as contributing to the Santuit Historic District in,the National of necessary repair re Register of Historic Places. Also see chap. 11 , IEBC 2009. , Drawn by: Ottinger 1012/2015 Scale: �" = 1'-0" loo t - + - Repair Original AW 9"by 10"white oak post.See Framing and joinery is intact Pull back —attached � ` structural osts are white oak w/hardwood. together a engineer's SK-1 pegs. r 2. Push corner Replace Original ost back Sill and foundation Sill and foundation 3"by 41/2"Oak Door w/jacks. was undamaged.. was undamaged. Post } I 1769 ALVAN CROCKER HOMESTEAD . 'NORTH/FRONT FRAME ELEVATION - .,- JOE and ANNE BARRETT 4701 FALMOUTH ROAD view of white oak. and pine frame COTUIT, MASS. Restore Damage from Truck impact. House is listed as a "Historic Building", individually and as contributing to the Santuit Historic District in the National Register of Historic Places. Also see chap. 11 , IEBC 2009. � r - Drawn by: Ottinger 10/2/2015 Scale: 4" = 1'-0"