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Home My WebLink About1682 SANTUIT-NEWTOWN ROAD 1 I - IVY iow� 6 0s p� � o N /�C-yh�crv�0 zY �m C0-- r� f. /Vo V / rw w � s -Town of Barnstable �VErp� Building ]department Services ti c - Brian Florence,CBO ! R1R7VCTAR_,T^R « Building Commissioner . � - ti�� 2DO Ma a Street, Hyamus,MA 02601 pr�D 4 www.town.barnstable.ma us Office: 508-862-403 8 Fag: 508-M-623 0 s �� FF�• $35.00 PERIYIl'T ' SEM)REGISTRATION RESIDENTIAL ONLY 200 square feet or less 1,`®� � S." 1�-le t,� 1 oo(ft zocation of shed(address) Village Property owner's name Telephone mm or y- -3 7 Size of Shed Map/Parml# S�gnat�e �X/ Date Hyamus&faro Street Waterfront Historic District? N� Old King's FIighway Historic District Commission j a iissdiudon7 You must file with Old King's Highway = • -t3 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 S1 PLEASE NOTE: IF YOU ARE Wr=THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLIQATION FEE. PLEASE SEE TBE APPROPRIATE COMM[SSION FOR DETAILS. TMS FORM MUST U ACCONTANIEED $Y A PLOT'PLAN . Q-forms-sbedreg REV:08/6/17 ' Town of Barnstable �THET Buflfflng Department Services °F Brim Florence,CBO atxHsrasra Building Commissioner MA.49. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fag: 508-790-6230 PERMIT# FEE: $35.00 SHED REGISTRATION - RESIDENTIAL ONLY 200 square feet or less / c N�FBP� .Location of shed(address) Village S Property owner's name—� Telepham number -- -- - _ X Size of Shed Map/Parcel# - Signature �/ Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic Distdct Commission jurisdiction? IUW You must file with Old King's Highway r" Conservation Commission(signature is required) ----� Sign off hours for Conservation 8:00-9:30 &3:30-4:30 PLEASE NOTE: IF YOU ARE WiTBIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST U ACCOMPANIED $Y A -PLOT PLAN . Q-farms-sbedreg REV:08/6/17 Town of Barnstable o4T"E royy wilding Department Services Brian Florence,CBO s�vsresr,E Building Commissioner � ses9 200 Main Street, Hyannis,MA 02601 pl�D www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-'6230 M1 PRRAHT FEE• $35.00 SHAD REGISTRATION RESMENTIAL ONLY 200 square feet or less ' I;,ocation of shed(address) Village 1,n Property owner's name Telephone number Iola /Parcel# Size of Shed P - /'. Si e Date LO Hyannis Main Street Waterfront Historic District? /y X rn Old King's Highway Historic District Commission jurisdiction? IV1lf You must file with OId King's Highway Conservation Commission(signature is required) `--� Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FED. PLEASE SEE TBE APPROPRIATE COMMISSION FOR DETAILS. rr TMS FORM MUST U ACCOMPANIED BYrA PLOT PLAN Q-forms-shedreg REV:08/6/17 p _ Town of Barnstable Building swxtvywe I ost This Ca�d So That it^is Visible'From the Street-Approved Must be Retained-on`YJob and this'Card Must be Kept lam a pe 'Posted Until Final.lnspection Has Been Made. ' • ._4 twhere a Certificate of Occupancy is.Required,such'Building shall Not be Occupied until a'Final Inspection has been made Permit Permit NO. B-18-3494 Applicant Name: MAYNE,JOHN P Approvals Date Issued: 10/26/2018 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 04/26/2019 Foundation: Location: 1682 SANTUIT-NEWTOWN ROAD,COTUIT Map/Lot: 024-037 Zoning District: RF Sheathing: Owner on Record: MAYNE,JOHN.P Contractor Name: Framing: 1 Address: PO.BOX 1441 Contractor License: 2 COTUIT, MA 02635 Est.Project Cost: $0.00 Chimney: Description: 8x12 Shed (A) Permit Fee: $35.00 Insulation: Fee Paid: $35.00 Project Review Req: 8'x12'shed located as shown on submitted property plan for Final: "shed A" Date: 10/26/2018 �1 ---.--_ Plumbing/Gas mod' Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after'issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials areprovided on this permit. Minimum of Five Call Inspections Required for All Construction Work: w Rough: 1.Foundation or Footing. 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health ' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department ." "Persons contracting with.unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT S.Z.✓-�'6.� Town of Barnstable Buildin ° F.✓Pa?�,. .�,.'�".a�. C..aartr�d t"is T i.,f iSc,,oa tTeh oaft Oitc��c„su.Vp i asinbclye;�Fsr;oRmeaq a fihree Sd t,�"rsec eth, vBA u ildromv ge4` ds'h Pallanl.�'nNs;o Mf bues tO l cee uR peirteyad t nue�i df.iol n�,`�JFoi nba a1'nItdi`sa Ph eicst C�oanr dh aMs ubsete;bne mKae det >"> k�ost U Peymtostib s r,he"e aCe Permit No. B-18-3495 Applicant Name: Approvals Date'Issued: 10/31/2018 Current Use: Structure Permit Type:' Building-Shed-Residential-200 sf and under Expiration Date: 04/30/2019 Foundation: Location: 1682 SANTUIT-NEWTOWN ROAD,COTUIT Map/Lot: 024 037 Zoning District: RF Sheathing: Owner on Record: MAYNE,JOHN P s ContractoryName: _4 Framing: 1 Contr Address: PO BOX 1441 actor License: 2 COTUIT MA 02635 i Est Protect Cost: $0.00 i- Chimney: Description: 8x10 Shed(B) k Pe'rmrt Fee: $35.00 Insulation: Fee Paid $35.00 Project'Review Req: Date ` 10/31/2018 Final: VV Plumbing/Gas Rough Plumbing: 4 _ � �a Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is,commenced within sixmonths after issuance. Rough Gas: All work authorized by this permit conform to the approved application and the approved construction documents"#orkwhich this permit has been granted. g All construction;alterations and changes of use of any building and structures,shall be in compliance with the local zoning-by laws and codes. Final Gas: This permit shall be displayed in a location clearlyvisible from access street or road and shall be maintained open for"public inspection for the entire duration of the work until the completion of the same. a , . Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are`provided on thispermit• Service: Minimum of Five Call Inspections Required for All Construction Work $ 1.Foundation or Footing a Rough: 2.Sheathing Inspection " 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Pers cting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department .. Building plans are to be available on site Final: C All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable �TKE r ti Building Department Services Brian Florence,CBO xsresr� Building Commissioner � is;q tim 200 Main Street, Hyannis,MA 02601 pr�0 wwmtown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 p}�+RMTT FEE• $35.00 SHED REGISTRATION RESIDUiTLAL ONLY 200 square feet or less & tj i.01 61e 6%.) a &J. 60k I Irocation of shed(address) Village Z O d�T6 Property owner's name Telephone number i Size of Shed Ma. /Parcel# i P • g '`Signat�e Date Hyannis Main Street Waterfront Historic District? Lj Old King's Highway Historic District Commission Jurisdiction? AA - c You must file with Old King's Highway Conservation Commission(signature is required) : Sign off bours for Conservation 8:00-9:30&3:30-4:30 V Uj 5 Cu PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLIQATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST U ACCOMPANIED BY A PLOT PLAN Q-forms-sbedreg REV:08/6/17 Town of Barnstable Regulatory Services 3113 Thomas F.Geiler;Director Building Division MAM ,of s639. a`0� , Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# �U FEE: $ 3b SHED REGISTRATION 200 square feet or less Location of shed(address) Village ; Property owner's name Telephone number,, %01 x /�z 0-9. 14,1) , 7 Size of Shed Map/Parcel# Ature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? . .Conservation Commission(signature is required) l� Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042911 TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION, . 'Applicati0b' # Map Parcel.., Health'Divisioh -'Date Issued Conservation Division -AppjicatidnFee Planning.Dept. Fee' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation Hyannis CP_F0_ject Street Address - (::-v age (:5Owner Address : eo 60)e C-1 q I it ,-(A T615-phoffe- 0 roam V1 1-00 6-1 I h:su �-ef rro� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed -Total new Zoning District Flood Plain Groundwater Overlay C,'Project-1 Iuatio___'-2LVo6 Type ,eo Construction Lot Size Grandfathered: Ll Yes LJ No If yes, attach supporting documentation'. Dwelling Type: Single Family Two Family U Multi-Family(# units) Age of Existing Structure 71? - Historic House: LJ Yes 2-No On Old King's Highway: Ll Yes LJ No Basement Type: Ll Full Ll Crawl J Walkout M/Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing neap Zj Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor R Coun? >L Heat Type and Fuel: ZGas L3 Oil LJ Electric LJ Other Central Air: LJ Yes QKo Fireplaces: Existing New Existing woold/ oal stoyfi: Lffes Ll No Detached garage: LJ existing Onew size—Pool: J existing L3 new size Barn: LJ xisting LJ new size Attached garage: Ll existing Ll new size —Shed: Ll existing Ll new size Other: Zoning Board of Appeals Authorization LJ Appeal # Recorded D Commercial Ll Yes LJ No If yes, site plan review# Current Use Proposed Use -APPLICANT INFORMATION (BUILDER OR HOMEOWNER). Name r--A f=P Telephone Number 0 Address 2 Ujil rdt License # Home Improvement Contractor# i t Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO efik SIGNATURE DATE e f-1 617 (;2,,,7 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 7 ADDRESS VILLAGE OWNER i i } DATE OF INSPECTION: FOUNDATION ^r " FRAME o1� �6�D�r OfthcI 1016Fft fc sZ7�e Rm i_ r INSULATION K 9 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ak z O Ff 0 DATE CLOSED OUT ASSOCIATION PLAN NO. k r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 a4 �Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Buildtrs/C,ontractors/Elee'tricians/Plumbers Applicant Information Please Print Lezibly Name_(Businessl0-rganization/Individual): 2�t 10 To�h&Q X4v`4 ,_City/State/Zip�'tv�� ( <oe5 Phone.#: �C 3(0 —Are y u n employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I • employees(full and/or part-tim.e). * have hired the sub-contractors 6. El New construction .2.0 I am a sole proprietor or'partaer- listed on the'attached sheet T. 0 Remodeling ship and have no employees These sub-contractors have g,'❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'.comp.-insurance comp. insurance.$, �quired.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions C3.LJ I am a homeowner doing all work officers have exercised their . 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.M"Roof repairs insurance required.]t c. 152, §1(4), and we,have no �— ( 4 employees. [No workers' 13.[v]�Other 1�Su a comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this.affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy##or Self-ins. Lie.M Expiration Date: Job Site Address: City/State/Zip: _ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimiiiaj penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against.the violator. Be advised that a copy of this statement maybe forwarded to the'Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi_ runder thepains andpenalties ofpe'rjury that the information provided above is true and correct - Si afar": Date: 17, _ Phone M Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License#. Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Insttuctions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or tiustee 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 of on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance azth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-cont>actor(s)name(s),addresses)and.pbone numbers) along with their certificate(s)of . insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter then self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant - -_r_- - _ -F e� T. AA '14, an annlirant Please be.Sure to tut in the pernuVucense number which will be us as a i-e 1 uw iiu+uv a. au u......,.y -.. -yy- - - that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy'information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each .year.Where a home owner or oitizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of ladustrioi Accidents 4ffitce of Investigations. 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727=7749 Revised I1-22-06 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: S`te(a cue A Kc--v/le Site Address: I� cb� �t�7� ��/ ��ag,•l PrA print Town: _��`-�c�� t Applicant Phone: (� Applicant Signature: Date of Application: elt 7, 0 NEW CONSTRUCTION: choose ONE of the following two-options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Q Slab Option 1: Basement P Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value R-Value wall R Value AFUE HS'PF SEER R-Value and Depth National Appliance Energy 3 5 R-3 8 R-19 R�19 R-10 R-10, Conservation Act i NAECA)of 4 ft.- 1987 as amended,minimums or cater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ _Option 2: RE5check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http://www.energ- cY odes.gov/rescherk/ ADDXT.IONS. ALOR:� TERA'TIONS.TO EXISTING BUILDINGS O vER 5 YEA.RS OLD* *)3uildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a) 1,7ao SF - 100 x . Ito e-O L % of glazing (b) Glazing area equals_NSF b a If glazing is<-`40%.use the chart below. If glazing is > 40 0lo roceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL.BUILDINGS MAXIMUM . MINIMUM Fenestration .Ceiling and Wall Floor Basement tiVall Slab Perimeter alue U-factor Exposed floors R-Value R-value R-Value and Dept R-Value and Depth .39 R-3 7 a R-13 . R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling rarea not compressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P) r Town of Barnstable Regulatory Services Thomas F.Geiler,Director attar . � t639. ,�� Building Division PTF° Tom Perry,Building Commissioner, 200 Main-Street,_Hym.=,MA 02601.. W W VV.town.barnstable-ma.us Office: 508-962-403 8 Fax: 508-790-6230 ,�,--HOWOWNER LICENS EE EXEMY ON Please Print JOB-L.00AT70T1:J�" `� SFw h Ty p �J �� Gc�'2 /, • 1 (y ( , number street village (�VOMEOWNER":M^' eAG��r�f �ri,/✓) ��d . 3�® 'j � 5�� Coa 5 �� name 'home phone# work phone# CURRRENT-MAILING ADDRESS:""(�4 �. y X�i gl Lt cityhown state rip 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. - `DEFINMON OF BOMEOWNER 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 Budding Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requir. ents. Stgnatirro.of Homco�;a"' • 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 bomeowner perfomring work for which a building perry&is rcquir cd shall be exempt from the provisions of this section(Section I og.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homcownets who use this exemption an:unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bfLm results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our$oard cannot proceed against the unlicensed person as it Mould with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To m- n=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 msponnbilities of a Supervisor. On the last page of this issue is a farm currently used by _ several towns. You may care t amend and adopt such a fon7Jcertifiration for use in your corrmnunity. Q:forrns:homeexempt zrti Town of Barnstable -j Regulatory Services . ,,A.R,,,6I•ABI,E. $ Thomas F.Geiler,Director Eo;rt16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, , as Owner of th ubject property hereby authorize to act on my behalf, in all matters relative to work authorized by this 'din permit application for: ti (Address of ) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0 WNERPERM1SS10N J� �oFIKE t � Town of Barnstable ' Regulatory Services ' BARNSTABLE.A 1639. Building Division plEO M1P�a 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location 16 S 2- 4A• rX(t k6,b)Ty' Permit Number .cad 2 Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ti0 olue > s i Please call: 508-862-4038 for re inspection. Inspected by ✓ -� Date )0 "w^'y, `��/,' "^aye.y''"vXSY�+v—r•-.`"aMy.:�,�.�.'•+'i'r�trs,`,.7 i`-J "' -''.r•- _. .. _,p,�,: � � ,. _ �-r...t..r-t•: -'+.-..Y,1ti.r-..-.•�`+• -�e:.r v.,�'.'�-�,*'�'7..W i.'3�'rt7��'n. . �oF1MEr�,,ti Town of Barnstable Regulatory Services (� MASS. 0 rEOMP�s�e .A - Building Division - 200 Main Street,Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 f r Inspection Correction Notice i Type of Inspection Location 16 e2- S A1ra«1UbWv&w 6• Permit Number �Ja Owner ? Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: UJ (< 4. 4TZk,�U— � u N - z i 1 'AA Please call: 508-862-4038 for re-inspection. Inspected by ✓l �C C.O Date ` /Lt C -7-t�1 G t cc�A, Town of Barnstable Geographic Information System June 4,2007 024007 024017 #1627 #1600 024032003� #5011 0 024006) 41635 024032002 024005 024044 #521 #4556 #4507 024043 #449695 024003 024034 #38 #4527 N (LOJ C�2a 024095 #520 �0} O �10-0 1 024035 �QJ� 0 m #1666024096 ,', �Py 11532 O . t 0240 024081 97 024041003 Z #555 #546 #1645 9 d 036� G #1676 04562 024098 024082'0 #567 02407 U 024103 024041002 #1682 a V #62 #4575 EO2099 _ 0 024102 676 411 024083 4 "m 024041001 �024038 #581 #4591 #1690 024101 _ #36 ` � 024100 024084 , 024039 #595 024128 Q #1698 #47 024040 ' 024042 #1707 Mp4a`NG pR1V 024129 #4609 #60033 ti Q 023054 023020 0230 #21 #1716 #9% 023063 P� 023019 #118 V 6 6 Fe # 01 ^^ 023056 023062 023021 023034 #614 #106 #1726' #621 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:024 Parcel:037 boundary determination or regulatory interpretation. Enlargements beyond a scale of _ Selected PdrCBI 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:MAYNE,STEPHEN H Total Assessed Value:$254800 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.75 acres Abutters j WIt E boundaries and do not represent accurate relationships to physical features on the map d L i ocation:1682 SANTUIT-NEWTOWN ROAD / V Buffer such as building locations. - -- ' ` . 0 ,-,Parcel Detail Page 1 of 3 r . Logged In As: Parcel Detail Monday,J� Parcel Lookup Parcel Info Parcel ID;024-037 - Developer Lot3 Location 1682 SANTU IT-N EWTOWN ROAD I Pri Frontage 1126 Sec Road Sec Frontage Village,COTUIT � l Fire District COTUIT Sewer Acct� � � l Road Index 1425 Interactive Map _ zl 33j� Owner Info _ owner MAYNE, STEPHEN H l Co-Owner ...._------_- _.____ Streeti j PO BOX 1441 I Street2 City COTUIT l StateMA zip 02635 Country JUS Land Info Acres;0.75 Use ISingle Fam MDL-01 Zoning RF Nghbd F0105 Topography Above Street l Road (Paved Utilities,Public Water,Gas,Septic l Location Construction Info Building 1 of 1 Year 1920 Roof Gable/Hi Ext Vinyl Siding Built l SRoo p l Wall Y g l Effect I 010 Roof AS h/F GIs/Cm AC(None Area . Cover 1- P p l Type! �� ' Style Cape Cod wall Wall Brd/Wood ( Rooms!2 Bed Bedrooms l Model sidential Int;Pane/Soft WoodI Bath i Re i 1 Full Floor Rooms r Heat# _ � Total Grade IAverage Minus l Type Rooms Air l Rooms,4 Rooms _ l http://issql/intranet/propdata/ParcelDetail.aspx?ID=1329 6/4/2007 Parcel Detail Page 2 of 3 MT[Y00] Heat Found- �� a ;Gas Stories Fuel 1 Story w/ Fin ation Permit History Issue Date Purpose F221 t# Amount Insp Date Comn 3/31/1997 Various Repairs $10,950 11/12/1997 12:00:00 AM - Visit History Date Who Purpose 4/4/2005 12:00:00 AM Paul Talbot Meas/Est 6/23/1999 12:00:00 AM Frederick Stepanis Meas/Listed 11/12/1997 12:00:00 AM Lloyd Kurtz Meas/Est ... .._._.._....._. ... - Sales History Line Sale Date Owner Book/Page _ Sale P 1 9/26/1997 MAYNE, STEPHEN H 10973/150 2 7/15/1994 JACKSON, RALPH 9301/109 3 7/15/1994 JACKSON, RALPH 9301/108 4 JACKSON, RALPH "DC 10973/149 5 JACKSON, RALPH *M-792 10973/148 6 JACKSON, RALPH & BETTY S 1335/205 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $90,600 $0 $1,400 $162,800 ; 2 2006 $71,800 $0 $1,500 $176,900 ; 3 2005 $68,900 $0 $1,500 $160,800 ; 4 2004 $57,700 $0 $1,500 $120,600 5 2003 $48,700 $0 $1,600 $56,900 6 2002 $48,700 $0 $1,600 $56,900 ; 7 2001 $48,701 $0 $1,600 $56,900 ; 8 2000 $30,100 $0 $800 $35,100 9 1999 $42,400 $0 $200 $35,100 10 1998 $31,400 $0 $200 $35,100 http://issql/intranct/propdata/PareelDetail.aspx?ID=1329 6/4/2007 Parcel Detail Page 3 of 3 11 1997 $25,900 $0 $0 $30,700 12 1996 $25,900 $0 $0 $30,700 13 1995 $25,900 $0 $0 $30,700 14 1994 $27,600 $0 $0 $31,600 15 1993 $27,600 $0 $0 $31,600 16 1992 $31,400 $0 $0 $35,100 17 1991 $44,900 $0 $0 $65,800 ; 18 1990 $44,900 $0 $0 $65,800 19 1989 $44,900 $0 $0 $65,800 20 1988 $32,100 $0 $0 $28,300 21 1987 $32,100 $0 $0 $28,300 22 1986 $32,100 $0 $0 $28,300 Photos http //issgI/intranet/propdata/ParcelDetail,aspx?ID=1329 6/4/2007 ,,Building Detail Page 1 of 1 7"v SSA h NIA f r s fi° u .- i(og ar a Logged In As: Building Detail Monday, 7i Parcel Lookup Parcel Detail Error: LoadOBGrid: EXECUTE permission denied on object 'getOB°, database 'TOBI_Production_Property', owner 'dbo'. Building 1 of 1 k y� � I- �Ot l , Code Description Gross Area Effective Area Living Are BAS First Floor 760 760 BMT Basement Area 100 17 FEP Enclosed Porch 84 25 UAT Attic, Unfinished 760 190 WDK Wood Deck 176 18 Extra Features Code Description Units Unit Price Year Built Value Commen Out Buildings____ http://issgI/intranet/propdata/BuiIdingDetai1.aspx?PID=1329&BID=1373&N=1&NN=1 6/4/2007 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel View Custom Map Abutters Map Size ® Zoom Out ! j A In er AK r y I 7PG Map: 024 024007 024017 {� 024032001. Location: 41627 N 1600 N4477 024006 � 1 ,; i �' ii 1636 024032002. Owner: 024005 m, k.621 _- 024003 s 624044 024043 �= 4666 �y'h� N 4496 N 38 ` + ^4 "024034 4607 p 4647 Location In N520 Map & Parce 0 C:3 024035 0240 Location 96� #1666 t1632. Acreage 024041003 024081 fi0244097 ' #646 N 1646 r 666 Current OW 024036 k 1676 3 024098 Mailing Addi 7Q , 024082 ',W 62 0 7 + 024041002 24037 N 4676 N 1082, 024099 q 124112 024083 w Appraised �~--�-�024038 N681 �? Extra Featur 024041001 r 1 1090 024101 N 4691 Ci #36 � Out Building 4 .. 024160 024084 �10 Land 024039 N695 Buildings 024040 #1698 Q ►�t7o7 � Q�t�� o24t29 Total Apprai 024042 i�C)CIO N36 N 4609 2 023033 ; �054 Assessed V 023020 k 607 ut {, ' N 1716 2 3'1355 N 21 4 Extra Featur 0 211 Feet r3 Out Building 5 023021 023034 023066, 023062 Land N1726 N 621 N 614 0,6 ti Buildings ...._.. Total Assess Set Scale 1" = 211 I Ae rial Photos Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comment: BarnstableMA v0.2.91 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=024037 6/4/2007 .Citizen Web Request Page 1 of 2 BA RNSTABLE, . ay. Citizen Request Management Internal Use Request ID: 20988 Created: 6/4/2007 9:16:17 AM Status: Assigned To Staff Assigned To: Mckechnie, Robert Building Dept b Anonymous: Yes Category: Work with out,permit E.C. Date: 6/20/2007 Created By: Mckechnie, Robert Citations: Building Dept a Time Worked: 0 Response Time: 0 Requestor Details: Email: Request Location: 1682 SANTUIT-NEWTOWN ROAD Cotuit, Ma 02635 Parcel Number: Map: 024 Block: 037 Lot: 000 Request: CALLER STATED THAT THERE IS A LOT OF WORK GOING ON AT THIS LOCATION. SPECIFICALLY MENTIONED A DECK TURNING INTO A SCREEN PORCH, FOUNDATION BEING CUT AWAY, POSSIBLE ADDITION TO HOUSE, MANY CARS ON LOT, SEPTIC FREQUENTLY PUMPED. Request Work History: Internal Note History: System entry on 6/4/2007 9:16:17 AM: Assigned to Mckechnie, Robert ------------- System entry on 6/4/2007 9:16:45 AM: Related Request 20989 http://issgl2/IntemalWRS/ VRequestPrint.aspx?ID=20988 6/4/2007 Citizen Web Request Page 2 of 2 System entry on 6/4/2007 9:17:53 AM: Estimated completion changed from 6/6/2007 to 6/20/2007 1 l http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=20988 6/4/2007 igineeging Dept.12Ed floor) Map Parcel a •Permit# House ~Datessued 3—�3 Board of Health 3rd floor)-(8:15 -9:30/1:00-4:30)k.� ?S ('nt O &EL 2-2`F� �O'53 q,5-- ft( ' 4th floor)(8:30-9:30/ 1:00- �Iii� lst floor/School Admin. Bldg.) ST BE SEPTIC SYS NCE 16a^^roved by Planning Board 19 { INSTALLED WIT • E AND IRONME °' 'TOWN OF B q P ARNSTABLE �d�� TOWN RED Building Permit Application i roject Street Address L�V` �i /I/,'e fsiJ -/d Uy/t/ A b Village Owner /R'P L P/� . �/4 C,C'S dh- Address S,414-lk f,Y Telephone Permit Request ' /L-4 !I/2 / '-tD ® C r 0 First Floor square feet Second Floor square feet Construction Type ; stimated Project Cost $ /0 4 9Sa 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 1krNo On Old King's Highway ❑Yes )<No Basement Type: ❑Full ❑Crawl ❑Walkout $Other ZVA L E Basement Finished Area(sq.ft.) i Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing_� New Half. Existing New No.of Bedrooms: Existing 2- , New Total Room Count(not including baths): Existing—New First Floor Room Count L_Garage: uel: ❑Gas L)Oil L)Electric ❑Other Yes f4 No Fireplaces: Existing New Existing wood/coal stove ❑Yes �No ched(/siz_e) Other Detached Structures: ❑Pool(size) hed(size) ❑Barn(size) Shed(size) Alo ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# - Current Use Proposed Use Builder Information Name S / — ♦ Telephone Number .S 7 Address w/ /Vo o W.S ./License# f IS blo e e wd 0 P ►l ome Improvement Contractor# �� 6 ---> - C ° F/ql M o L24P ,f1 #' 0 2 5 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING 1FROM THHIIS PROJECT WILL BE TAKEN TO SIGNATURE D c Z BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �., FOR OFFICIAL USE-ONLY PERMIT NO. 2,2- - DATE ISSUE • } MAP/PARCEL NO. ADDRESS - VILLAGE - OWNER DATE OF INSPECTION: t ` FOUNDATION - ti FRAME i INSULATION - FIREPLACE ELECTRICAL: NgUGH'.. FINAL.: ! .j PLUMBING: RIWGH- !- FINAL GAS: off' " FINAL - FINAL BUILDING S r A ' nlf'S ; DATE CLOSED OUTS ♦ ' � � lip " , s ASSOCIATION PLAN*NO.- The Town of Barnstable 1 Department of Health Safety and Environmental Services Building Division 367 Main Strut,Hyannis MA 02601 O&ce: 50"0-6227 Ralph Ctvs= Fa= 508-775 3344 Building Commissioner For office use only Permit no. Date AFMAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,•renovation,repair,modernisation,conversion, improvement,.remcnal, 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 stra r I rrs which are 411cent to such residence or building be done by registered contractors,with certain eaeepdons, along with other regtuirements. Type of Work:. ,'� b'�-y Est. Cost 1_ �5-a J ZAddr=ofW,oTk: /� 6 9 2- /t/e- W_ N R D /�,o 7`y� O%mer.Name: L 10/-� T. -AC1 S 62v J ate of Permit Application: 17 I herein certify that: Registration is not required for the follov►ing reason(s): Work colluded by law Job under SI,000 Building not owner-occupied Ow=Ping own Permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UN1tEGI3 D CONTRACTORS FOR APPLICABLE HOME VAPROVEMIE T 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. L7 Date Conuauor name Registration No. OR OME IMPROVEMENT CONTRACTORS REGISTRATION oard of Building Regulations and Standards One- Ashburton Place - Room 1301 Boston. Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 112182 Expiration. 03/02/99 Type - DBA EZ-TILT WINDOWS THOMA5 J . DALEY 81 SHOREWOOD DR E FALMOUTH MA 02536 I 'EastGUARD� A Subsidiary of GUARD Insurance Group ImP INSURANCE 190 Main Street •Po. Box 537 Saco, Maine 04072-0537 COMPANY CHARISM IVY Payment Plan ART0200422 — SEP A ARTISANS POLICY DECLARATIONS Agency Bill Renewal of Number Direct Bill Policy No. ART 0200422 — SO B Named Insured and Mailing Address(No.,Street,Town or City,County,State,Zip code) Thomas Daley DBA Ez—Tilt windows 81 Shorewood Drive E. Falmouth, IAA 02536 Policy Period: From 9-7-96 to 9-7-97 at 12:01 A.M.* Standard Time at your mailing address shown above.-Exccp1io :12:00 noon in New Hd pohir The Named Insured is: % Individual Partnership Corporation Joint Venture. Other: Occupation: Car nt ry Loc. Street City or Town County State Zip Code 1 81 Shorewood Drive E. Falmuth Barnstable Applicant Interest: ❑ Owner-Occupant ❑ Tenant ❑ Buildings: ❑ Replacement Cost ❑ Actual Cash Value $ � ZKBusiness Personal Property including Tools: ❑ Replacement Cost IR Actual Cash Value $ Premises ou off Loss of Income: 20%of Building Limit and/or 100%of Business Personal Property Limit Included i i ti#ctll t! ❑ $100 ❑ $500 ❑ 1 0$ , 00 ❑ Other i a ' Applicable only if an"X"is shown in the boxes below ❑ Accounts Receivable: (AP300) ❑ Money&Securities: (AP304) ❑ Employee Dishonesty: (AP308) ❑ Valuable Papers &Records: (AP328) IX Theft Exclusion: (AP348) ❑ Other: Limits of Insurance Liability Bodily Injury and Property Damage $ 1,004,000 per occurrence Z,aQO,()Og general aggregate Medical Payments $ 11000 per person Fire Damage Legal Liability $ 50,000 any one fire or explosion i Applicable only if an"X"is shown in the boxes below: ❑ Contractual Liability Coverage (GL-104) Ci Property Damage Deductible (AP222 g ) ` ($250 included) ❑ Non-Owned&Hired Auto Liability(GL-122) ❑ Other FORMS AND ENDORSEMENTS Forms and endorsements made part of this policy at time of issue: AP432. C 9 97 MORTGAGEE/LOSS PAYEE done Agency: 30.22 Jim Sullivan - Tewksbury Ins. JANNUAL PREMIUM $ 507. Tewksbury, HA 8-15-96 Countersigned By , m Authorized e,,esemauve THESE DECLARATIONS,TOGETHER WITH THE COVERAGE FORKS),COMMON PO Y CONDITIONS AND FORMS, AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. EIC•ARTDEC-EDtn-95 The Commonwealth of Massac•husetty Dc partrtunt of Industrial Accidents Olfice of/n�estigat/ons 600 {i aAht-tott Street Boston. Ma.u. 02111 . Workers' Compensation Insurance Affidavit �hnl�•tnt information• c7tion; '/ Sg� �,wo d� 1 am a homeowner performing all wort. myself 1 am a sole proprietor and have no one working in any capacity --- .�+�.�+.+.r•--,.,..,r.•rya _:,..�-+-►'^--- �!�,.�..�.,.•�.... ,.-....r.-.....�._..,,,.,,�_.. 1 am an emplover providing workers' compensation for my employees working on this job. comeany name: address: CON,: phnne#• insurance co. pnlicy# [j I am a sole proprietor. general contractor, or homeowner(circle are) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: Phone#• insurance co . pnlicy# f ._ •t-.- Yw - .'�'.:�'•^_ � _�.__ _1 T'-�`_:�:: -iT"l.'vww..y.- `-T.�.t, _ •_p.- .t_..-.__- _ -_-.__._.... _._ .._.�_�--_.._" r�_l_.._/iyi.a_.._•w...�r.�.rLrilr.ww.I�:tiurr�� - � _ __.��ti.iY�Y`-"' .�._�.-� comnanv name: address- rite: phnne#• insurance co. policy# .Attach addittonai sheet if necessaryry. ...... •-; - i, %'.'''"'+: .;� -'%:?^ ►'___"". -. ---•- ----.... ...._---.....___'J..-•..tom,.. - - e._....rr:_!.:r.,e.iT:l'.as --~-,:�^= .a.:,y:- _.:-.+xi.�ra+ivafi:'-- - �u"e-�:1:..�il..fn.:c::..:.x. Failure ni secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a lineup to S1.500.00 andiur unc�cars' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statenicnt may be forwarded to the Office of Investigations of the DIA for coverage verification. l do herebt•certify a uler the pains and penal tes of perjun•that the information provided above is true and correct Signature Date A A Print name / S Phone# T �—�,�/ IT.Ttiy t'offtcial use o n I do not write in this area to be completed by city or town official y' city or town: permit/license# flBuilding Department'',. €. O Licensing Board t ❑check if immediate response is required C3Sclectmen's Office'` t C3I1calth Departments contact person: phone#; Mother A f- r 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 empluree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An emplorer is defined as an individual, partnership, association, corporation or other legal entity•, or anv two or more o: the forcgoing emzaged in a joint enterprise, and including the lei-al 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_ Douse 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 anv 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 ha\ 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 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 Nvorkers' compensation policy, please call the Department at the number listed below. r Citv or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a c_-ll- �.,..y.v-n....._.... .__.,..-..•v .-�.+...r•.r-..:-..�--..n...-:-�a�...i�-.�...+�•.•rxR�..••.+r�.er....wn�ws.•+:w�!+..��e+--.�.q�+w— �rw.-.w..r�a, S!T... . ... rr.•v. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 F SOUTHEASTERN MASSACHUSETTS r�'SS�,CHUSFTIs�G ICI C,q BUILDING OFFICIALS ASSOCIATION, INC. "G Post Office Box 331 Chatham, MA 02633 �� •g 5 '�lfRNA'T • Established 1975 • Chapter 59 EDUCATIONAL SEMINAR PRESIDENT DATE Steven D. Crawford Wednesday, April 9 , 1997 65 N. Main Street W. Bridgewater.MA02379 PLACE: RIVERSIDE RESTAURANT Route 28 , Cranberry Highway, Middleboro, MA VICE PRESIDENT .(508) 9 4 7-8 3 3 8 Eladio Gore Falmouth Directions from NORTH: 495S to Exit 4 , take Left, go to traffic light, take right;. (Rt. 28S°) TREASURER David Bonney Riverside is 1/2 mile on left. , Hanover Directions from SOUTH: 495N to Exit 4 , take Right, go to traffic light, take right, SECRETARY Riverside is 1/2 mile on Left. Carolyn Redfern 31 Chatham.,M MA 02633 TIME: Tickets: 9 : 00 A.M. Chatha Seminar: 9 :30 A.M. PAST PRESIDENTS James Brandolini SPEAKER: SCOTT COHEN AND ASSOCIATES Hull SUBJECT NYNEX' — COMMUNICATION TOWERS Gerald Hughes Norfolk FEE ti$15.,.0.0 Includes. Seminar and Lunch , William Gedraitis Luncheon: Family' Style Middleboro "'Chicken, Steak 'n' Chocolate Cake" Emilio Scaldini RESERVATIONS REQUIRED N.4itleboro M INWERS AT LARGE David Thyng Brewster Ralph Cirelli Brockton David Silveira Dartmouth rmeeting ease make your reservations. and luncheon selection for the James F. Aikens by calling the SMBOA Bulletin. Board at Weymouth 508-362-7526 or (1-508-DO-A7PLAN) and follow the prompts . Should you require additional "Bulletin Board" Cards or wish to leave a message for the secretary; press 112" and leave a message. This line will be monitored regularly. Should you have difficulty accessing the system, you may call 1-508-69.9-0110 I MOR TGA Gam' WASP. ' TIO N PL AIV APPLICANT: MAYNE TOWN: COTUIT MAP & PARCEL 24--36 217.08' PER DEED D MAP & PARCEL ---- .,.,----- CONC. HOT TUB 24-82 #1682 - w N =_ fV --- -------- --- -- ---- sew 10 Q e F o HED a Z h'�"t m rri. o Mrn AP PARCEL 0 24--37 MAP & PARCEL D 24-83 217.08' PER DEED MAP & PARCEL 24-38 b��M�� OF �G1S Cj�O STEPHEN N j 4. 4 73755E * J arc bb CqN 'ko FLOOD PANEL: 250001 0021 D FLOOD ZONE: "C" DATE MAP REVISED: 7/2/1992 I HEREBY CERTIFY..THAT THIS MORTGAGE INVEC71ON PLAN HAS BEEN PREPARED FOR: " . DATE: 12/27/11 SCALE: 1 A = 40' THE CAPE COD FIVE CENTS SAVINGS BANK DEED REF: 10973-150 PLAN REF: NO PLAN THE LOCA11ON OF THE DWELLING SHOWN DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE PER TAPED INSPECTION THE DWELLING APPEARS TO CONFORM TO THE LOCAL ZONING BYLAWS IN EFFECT THE STRUCTURES SHOWN ON THIS MORTGAGE INSPECTION PLAN ARE LOCATED BY TAPE SURVEY AT THE 71ME OF CONSTRUCTION WITH RESPECT TO HORIZONTAL DIMENSIONAL SMACK REGUIREAOM ONLY. NO INSTRUMENT SURVEY WAS PERFORMED AND LOCATIONS SHOWN ARE APPRO)OMATF- OR IS E)0 dPT FROM IAOLA11ON ENFORCEMENT ACTION UNDER WA GENERAL LAWS CHAPTER 40A AN INSTRUMENT SURVEY IS NECESSARY FOR PRECISE DETERMINATION OF BUILDING LOCATIONS SECTION 7. REFERENCE DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIOI'fTS, RIGHTS OF WAY, AND ENCROACHMENTS, IF ANY EXIST.EITHER WAY ACROSS PROPERTY LINES. YANKEE LAND EASEMENTS. RESMAT1ONS AND RESTRICTIONS OF.RECORD, IF ANY THERE SHALL:BE. AND INSOFAR SURVEY COMPANY INC. SHALL NOT BE HELD LIABLE FOR DAMAGES RESULTING FROM ANY USE AS THE SAME ARE OF LEGAL FORCE AND EFFECT. JOF THIS PLAN FOR PURPOSES 0714ER THAN MORTGAGE INSPECTION. TELEPHONE: 508-428w-0055 YANKEE LAND SURVEY COMPANY, INC FAX: 508-420-5553 119 ROUTE 149, Marstons Mills, MA 02648 yankeesurvey@comcost.net www.yankeesurvey.com 81772 JM t MORTGA. G E' I1VSPHCTION, PLAN APPLICANT: MAYNE .•TOWN: COTUIT MAP & PARCEL 24--36 , 217.08' PER DEED D CONC. HOT TUB MA 24--82RCEL _#1682 =_ N fie u �o� 0 T? g l oT_ rn '0 m m m r MAP & PARCEL n 0 24--37 MAP & PARCEL �j 24=83 0 _.- _ •• ?� 7.a8' .PER DEED MAP & PARCEL 24-38 OF MASS E,r � ' ']''`"" -' vay-�a`sr'°,t^,�,"a •^a"«,".�wf "u ,rrret ,p d Q S 1 EPf�EIV �, sk% c ` FLOOD PANEL: 250001 0021 .D FLOOD ZONE:-"C" DATE MAP REVISED: 7/2/1992 I HEREBY CERTIFY THAT THIS MORTGAGE INSPECTION-PLAN HAS BEEN PREPARM FOR: DATE: 12/27/11 SCALE: 1" = 40' THE CAPE COD FlVE CENTS SAVINGS BANK DEED REF: 10973--150 PLAN REF: NO PLAN THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN A SPECIAL FLOOD,HAZARD.ZONE PER TAPED INSPECTION THE DWELLING APPEARS TO CONFORM TO-THE LOCAL ZONING BYLAWS IN EFFECT THE STRUCTURES SHOWN ON THIS MORTGAGE INSPECTION PLAN ARE LOCATED BY TAPE SURVEY AT THE TIME OF CONSTRUCLTON WITH RESPECT TO HORIZONTAL DIMENSIONAL SETBACK REQUIREMENTS ONLY. NO INSTRUMENT SURVEY WAS PERFORMED AND LOCATIONS SHOWN ARE APPROIOMATE, OR IS EMIPT FROM VIOLATION ENFORCEMENT ACTION UNDER MA GENERAL LAWS CHAPTER 40A AN INSTRUMENT SURVEY IS NECESSARY FOR PRECISE DETERMINATION OF BUILDING LOCATIONS SECTION 7. REFERENCE DEED SUBJECT TO AND.WITH THE BENEFIT OF ALL RIGHTS,.RIGHTS OF WAY, AND ENCROACHMENTS, IF ANY EXIST. EITHER WAY ACROSS PROPERTY LINM YANKEE LAND EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE SHALL BE; AND INSOFAR SURVEY COMPANY INC. SHALL NOT BE HELD LIABLE FOR DAMAGES RESULTING FROM ANY USE AS THE SAME ARE OF LEGAL FORCE AND EFFECT. OF THIS PLAN FOR PURPOSES OTHER THAN MORTGAGE,INSPECTION. TELEPHONE: 508-428--0055 YAN.KEE. LAND SURV-EY- COMPANY, INC FAX: 508-420.-5553 119 ROUTE 149, Marstons Mills, MA 02648 yankeesurvey@com cost.net, www.yan keesurvey.qom_l 81772 JM �t -.z t .l OR TG.A. G-E IAT SPHC TICS N PLAN APPLICANT: MAYNE TOWN: COTUIT MAP & PARCEL . 24--36 , 217.08' PER DEED cn D - CONC. HOT TUB r MAP PARCEL2 #1682- ET C s o z ,�' al M I•Tl m �. � p —I o m m - m r MAP & PARCEL D V 24--37 77 -` 0 MAP & PARCEL 24-83 17_08'_ PER .DEED MAP & PARCEL 24-38 OF fJASS� -_ ••.� O Yc eta PS i G PH f�EN r1 ` I J p kt V : Y .'r� ir�ca aw wed.Y "s: y •` � 1 L < a •`� y►':' m r. t ?� ,r ti�a_� �`.c x�z mot;: ? � '��' (q Fy fi FLOOD PANEL: 250001 0021 D FLOOD ZONE: "C" DATE MAP REVISED: 7/2/1992 I HEREBY CERTIFY THAT TH15 MORTGAGE INSPECTION PLAN HAS BEEN PRSPMM FM DATE: '12/27/11 SCALE: 1" = 40' THE CAPE COD FIVE CENTS SAVINGS BANK DEED REF: 10973--150 PLAN REF: NO' PLAN THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE PER TAPED INSPECTION THE DWELLING APPEARS TO CONFORM TO THE LOCAL ZONING BYLAWS IN EFFECT THE STRUCTURES SHOWN ON THIS MORTGAGE INSPECTION PLAN ARE LOCATED UY TAPE SURVEY AT THE TINE OF CONSTRUCTION WITH RESPECT TO HORIZONTAL DIMENSIONAL SETBACK REQUIREMENTS ONLY. NO INSTRUMENT SURVEY WAS PERFORMED AND LOCATIONS SHOWN ARE APPROXIMATE. OR 1S EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MA GENERAL LAWS CHAPTER 40A AN INSTRUMENT SURVEY IS NECESSARY FOR PRECISE DETERMINATION OF BUILDING LOCATIONS SECTION 7. REFERENCE DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIGHTS, RIGHTS OF WAY, AND ENCROACHMENYS, IF ANY EXIST. EITHER WAY ACROSS PROPERTY LIKM YANKEE LAND EAS>auIENTS, RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE SHALL BE, AND INSOFAR SURVEY COMPANY INC. SHAD. NOT BE HELD LIABLE FOR DAMAGES RESULTING FROM ANY USE EFFECT. AS THE SAME ARE OF LEGAL FORCE AND - DF THIS PLAN FOR PURPOSES OTHER THAN MORTGAGE INSPECTION. TELEPHONE: 508-428-0055 4NKEE LAND SURVEY COMPANY, INC FAX: 508-420--5553 119 ROUTE 149, Morstons Milts, MA 02648 yonkeesurvey@comcost.net www.yankeesurveyxom 81772 JM P7 r , a MOR TGA. GZ LIVSPHC TIO.N PLAN APPLICANT: MAYNE TOWN: COTUIT MAP & PARCEL_ 24--36 217.08' PER DEED MAP & PARCEL __ CONC. HOT TUB 24-82 NC _ W I i�_- e rn (� O Z �.. l� rm L.L.I m � m --I Q m m MAP & PARCEL 24--37 MAP & PARCEL 24-83 � 917,0 ER DEED e ' MAP & PARCEL 24-38 P� df OF fvlAS6�c ya GAS r E P? y STEPHEN +� Ah D0�'Lc v 41V I-Z FLOOD PANEL: 250001 0021 D FLOOD ZONE: "C" DATE MAP REVISED: 7/2/1992 I HEREBY CERTIFY THAT THIS MORTGAGE INSPECTION PLAN HAS SEEN PREPARED FM DATE: 12/27/11 SCALE: 1" = 40' THE CAPE COD FlVE CENTS SAVINGS BANK DEED REF: 10973-150 PLAN REF: NO PLAN THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE PER TAPED INSPECTION THE DWELLING APPEARS TO CONFORM TO THE LOCAL ZONING BYLAWS IN EFFECT THE STRUCTURES SHOWN ON THIS MORTGAGE INSPECTION PLAN ARE LOCATED BY TAPE SURVEY AT THE TIME OF CONSTRUCTION WITH RESPECT TO HORIZONTAL DIMEPMONAL SETBACK REQUIREMENTS ONLY. NO INSTRUMENT SURVEY WAS PERFORMED AND LOCATIONS SHOWN ARE APPROXIMATE. OR IS E)MdPT FROM VIOLATION ENFORCEMENT ACTION UNDER MA GENERAL LAWS CHAPTER 40A AN INSTRUMENT SURVEY IS NECESSARY FOR PRECISE DETERMINATION OF BUILDING LOCATIONS SECTION 7. REFERENCE DEED SUR ECT TO AND WITH THE BENEFIT OF ALL RIGKM RIGHTS OF WAY, AND ENCROACHMENTS. IF ANY DaST, EITHER WAY ACROSS PROPERTY UNES. YANKEE LAND EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY.THERE SHALL SE, AND INSOFAR SURVEY COMPANY INC. SHALL NOT BE LIABLE FOR DAMAGES RESULTING FROM ANY USE: AS THE SANE ARE OF LEGAL FORCE AND EFFECT. IOF THIS PLAN FOR PURPOSES OTHER THAN MORTGAGE INSPECTION. TELEPHONE: 508-428�-ao55 YANKED` LAND SURVEY COMPANY. INC FAX: 508-420--5553 119 ROUTE 149, Marstons Mills, MA 02648 yankeesurvey®comcast.net www.yankeesurvey.co.m. E81772 JM