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0043 SIMPSON AVENUE
fHYôaJ-A. Caarwd ( 143u� KiDsoY\-Li i - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 34 7 Parcel 00 I Application # c O 1 l O as ( Health Division d004-' VA Date Issued Conservation Division (-)I(--' Application Fee 6 d Planning Dept. Permit Fee t 67, 71 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis 11 / Project Street Address 43 S'un1p saki Aiue YgyMoutl/i Cary 6)-°'-"4 S Village 5 qrN Sfu Ste M4 Owner Bt-uc e AU _ DO wtI Address 43 SiMpsoN,41c,t *-/9,ov1-1, Cv'ip64-o& Telephone h C) a ---;�s 9 6,9 Permit Request 60,. 3-( /*X 2-,et- De 1 e -`-- Square feet: 1st floor: existing proposed ;tog 2nd floor: existing proposed Total new 3 6,a Zoning District Flood Plain. Groundwater Overlay Project Valuation aOioo c) Construction Typelrievi .Llh Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new TTotal Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other rCentral Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 'O Detached garage: ❑ existing 34 new size¢Pool: ❑ existing ❑ new size Barn: ❑ existing ❑,new ;size 7 _ -Attached garage: CI existing new size _Shed: ❑ existing ❑ new size Other: . 2 _ ........ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ :Y. 7 Commercial ❑Yes 14 No If yes, site plan review# r —I Current Use Proposed Use I ' i LJ1 4. No 4 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) p// Name DGu i A P. Ada Al s Telephone Number 7 74 48 7 O 8 i 9 Address 34- Um;OH S+ License # 19 3 9' \AYM Ou+( PG)4- ilia O 7 -19 3S Home Improvement Contractor# 1 094 7 3 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G1�X DATE --3fr -d1/ 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. • , Ors' The Commonwealth of Massachusetts I ^ Department of Industrial Accidents I ,Ai, i, !t d Office of Investigations \ ���l; ,� 600 Washington Street k....#k/. Boston, MA 02111 • f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Dave ..1,4 M S C o M TY&cfo i, Address: 3 4 Oita off Sly City/State/Zip: j6J-iti ovfll Pouf 44 0,24 1S- Phone #: 7 7 4 4 7 G 8/9 Are you an employer?Check the appropriate box: Type of project(required): 1.Igl I am a employer with a 4. ❑ I am a general contractor and I 6. IN New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.0Other *Any applicant that checks box I 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 sub-contractors and their workers'comp.policy information. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:T t.'44ev-j PYope.vJ (4 s (0 cf4M. / Policy#or Self-ins. Lic. #: Expiration Date: 3111 aU i D-. Job Site Address: 43 S i M p S G1`l%C( City/State/Zip: 134)-1,1 sic',S 1< t'Vy¢ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided/above is true and correct Signature: ,,D,Q /C9-,i,4Y Date: 3/1 2-o// . Phone#: -Cog 36,a 97? 1 Official use only. Do not write in this area, to be completed by city or town official City or Town:. Permit/License# Authority(circle one): I. Board Issuing of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,. express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1=877-,MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia A WC Guide to Wood Construction in High Wind Areas: .110 ntp/r Wind Zone Massachusetts Checklist for Compliance (780 CM 5301.2.l.1)1 L1 Check • Compliance 1.1 SCOPE 110 mph IVWind Speed (3-sec. gust) B Wind Exposure Category C 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) a stories 5 2 stories JZ_ . Roof Pitch (Fig 2) 12.1/2, 5 12:12 . Mean Roof Height (Fig 2) t a ft <_33' .__IZ__ Building Width, W (Fig 3) 14- ft 5 80' g/ Building Length, L (Fig 3) al- 5 3:1 !/l ft.s 80' 1/ Building Aspect Ratio(L/W) (Fig 4) ` Nominal Height of Tallest'Opening2 (Fig 4) g6'8' 1,-- 1.3 FRAMING CONNECTIONS General compliance with framing connections (Table 2) • 2.1 FOUNDATION - Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete Concrete Masonry 2.2 ANCHORAGE TO FOUNDATION1'3. . 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only • Bolt Spacing—general (Table 4) M- in. 1/ Bolt Spacing from end/joint of plate (Fig 5) i 9. in. 5`6"—.12", V Bolt Embedment-concrete • (Fig 5) • '1 in. > 7" _/ Bolt Embedment—masonry (Fig 5) in. >_ 15" Plate Washer (Fig 5) >3"x 3"x'A" t/ 3.1 FLOORS Floor framing member spans checked (per 780 CMR Chapter 55) Maximum Floor Opening Dimension (Fig 6) ft S 12' • Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall (Fig 6) . Maximum Floor Joist Setbacks ft 5 d Supporting Loadbearing Walls or Shearwall (Fig.7) • Maximum Cantilevered Floor Joists ft s d Supporting Loadbearing Walls or Shearwall (Fig 8) — • Floor Bracing at Endwalls (Fig 9) 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 . i 4.1 WALLS • Wall Height ` • Loadbearing walls - (Fig 10 and Table 5) $ ft 5. 10' Non-Loadbearing walls (Fig 10 and Table 5) + ft 5 20' Wall Stud Spacing (Fig 10 and Table 5) 1 t) in. 5 24".o:c. • Wall Story Offsets (Figs 7 &8) —ft 5 d 4.2 EXTERIOR WALLS' j Wood Studs l` i Loadbearing walls (Table 5) 2x to $ ft v m. a Non-Loadbearing walls (Table 5) 2x-__—- ft_in. .1 Gable End Wall Bracing 1 Full Height Endwall Studs (Fig 10) • WSP.Attic Floor Length (Fig 11) • ft zW/3 •Gypsum Ceiling Length(if WSP not used) - (Fig 11) —ft L•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 t ft Splice Length (Fig 13 and Table 6) . ... ----- -_a- /Tohlo R1 ••t - . • • AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone • Massachusetts Checklist for Compliance (780 cMR'5301.2.1.1)1 Loadbearing Wall Connections • Lateral (no. of 16d common nails) (Tables 7) oZ 1_ Non-Loadbearing Wall Connections • Lateral (no. of 16d common nails) (Table 8) Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) . Header Spans - (Table 9) 71 ft d in. < 11' �_ Sill Plate Spans (Table 9) ft_in.s 11' . Full Height Studs (no. of studs) (Table 9) 3 v 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. 5 12" Full Height Studs (no. of studs) (Table 9) Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension, W r • Nominal Height of Tallest Opening2 8 <6'8" 1/ . Sheathing Type (note 4) Edge Nail Spacing (Table 10 or note 4 if less) 3 in. v Field Nail Spacing (Table 10) /2, in. �� Shear Connection (no. of 16d common nails)(Table 10) • Percent Full-Height Sheathing ' (Table 10) - 38 % ' 5%Additional Sheathing for Wall with Opening > 6'8"(Design Concepts) Maximum Building Dimension, L Nominal Height of Tallest Opening2 7 5 6'8" L.---- Sheathing Type (note 4) Edge Nail Spacing (Table 11 or note 4 if less) 3 in. v Field Nail Spacing • (Table 11) 1 a in. • v Shear Connection (no. of 16d common nails)(Table 11) Percent Full-Height Sheathing (Table 11) 3$% v , 5%Additional Sheathing for Wall with Opening> 6'8"(Design Concepts) Wall Cladding . Rated for Wind Speed? • 5.1 ROOFS Roof framing member spans checked? (For Rafters use AWC Span Tool, see BBRS Website) " Roof Overhang (Figure 19) 1 ft<smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls . Proprietary Connectors Uplift , (Table 12) U='74)plf V • Lateral (Table 12) L=/7(,plf v Shear .. (Table 12) S= 77 plf v Ridge Strap Connections, if collar ties not used per page 21... (Table 13) T= plf Gable Rake Outlooker (Figure 20) ft 5 smaller of 2'or L/2 • Truss or Rafter Connections at Non-Loadbearing Walls ` . Proprietary Connectors Uplift (Table 14) U= lb. • Lateral(no. of 16d common nails)...(Table 14) • L= . lb. Roof Sheathing Type (per 780 CMR Chapters 58 and 5.9) Roof Sheathing Thickness Ja•1 in. >7/16"WSP e_ Roof Sheathing Fastening (Table 2) 8 ;_ Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of • 780 CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: • a. Steel Straps per Figure 5 • b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 • • d. All Straps per Figure 17 • e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. • Exception:Opening heights of up to 8 ft. shall be permitted when 5% is added to the percent full-height sheathing • - -'requirerrients shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. • 0.rHgr Town of Barnstable - Regulatory Services BARNSTAH /$� Thomas F. Geiler,Director rEo„tzl 4 BuiIding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79C-6 Property Owner Must Complete and Sign This Section If Us ing A Builder I, BF✓c.e„ C Mae Pannfil , as Owner of the subject property- here by authorize U 7 ' �/ G RGr'/�S to act on my behalf, • in all matters relative to work authorized by this building permit application for: 4/3 za,is'.ovi (Address of Job) Signature o er Date i -U G e fria Dime/ Print Name If Property Owner is applying for petiiiit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION . Town of Barnstable • of THE Toil, • , Regulatory Service • s • Thomas F. Geiler, Director BARNSTABL.E, ' � MASS. q 16S9. ,$ Building Division pff° � Tom Perry,Building Commissioner • 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us • Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 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 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 Depaitiiient 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 I27.0 Construction Control. HOMEOWNER'S EXEMPTION • The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they arc 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 caret amend and adopt such a form/certification for use in your community. , 1 • Officeghofsumer airs diidsz+terkege HOME IMPROVEMENT CONTRACTOR 109473 beforeLicenseOffice othe cr orengsexpirationiusmtrea rtndf favataierl. foundisdIaffnodr i d vreturnu st eo:only Type: Registration: a Business Regulation 10 Park Plaza-Suite 5170 Individual Boston,MA 02116 Expiration: -946/2012 — 7 D •ADAMS DAVID ADAMS \ 34 UN ION ST e— YARMOUTHPORT, 02675„-:,:!' Undersecretary Not valid without signature 1 • i,,,V_Iassachusetts Department of Public Satet% ,Ifk4 Bo-11rd nt.Building Regulations and Standards r . , Sonstration Supervisor License License: 't s 1939 Restricted to: 00 DAVID F ADAMS , 34 UNION ST YARMOUTHPORT, MA 02675 *••' 1•! ' Expiration: 9/8/2011 - (ommossioner Tr#: 21292 • • • NOTICE OF ASSIGNMENT EMPLOYER: COMBO I.D. STATUS OF EMPLOYER DAVID F ADAMS 000754139 Individual 34 UNION ST YARMOUTHPORT, MA 02675 COVERAGE GROUP 0783330 Coverage under this assignment The Waiver of Our Right to applies to Massachusetts Recover from Others Endorsement operations only. For coverage is available on Pool policies. outside of Massachusetts, contact Contact your agent for details. the appropriate Pool or Plan for that state. AGENT LEONARD INS AGCY INSURANCE COMPANY: OR 7 WIANNO AVE TRAVELERS PROPERTY CAS CO OF AM PRODUCER: OSTERVILLE, MA 02655 Jonathan Scharnberg P 0 BOX 3556 ORLANDO, FL 32802-3556 (800) 443-4404 AGENCY FEIN:0434 96504 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION CARPENTRY-DETACHED ONE CR TWO FAMILY DWELLINGS 5645 $0 8. 68 $0 CARPENTRY NOC 5403 $0 9. 61 $0 EXCAVATION & DRIVERS 6217 $20, 000 4.35 $870 CARPENTRY-DWELLINGS - THREE STORIES OR LESS 5651 $0 (8. 68 $0 EMPLOYERS LIABILITY 100/100/500 9845 STANDARD PREMIUM $870 EXPENSE CONSTANT 0900 $250 TERRORISM CHARGE 9740 $6 TOTAL POLICY MINIMUM PREMIUM D � � (� (1 �� � $1$1500 26 TOTAL ESTIMATED PREMIUM is If DIA ASSESS. 6. 8% $59 1111 MAR 8$ 2011 �� TOTAL EST. PREMIUM PLUS ASSESSMENT $1, 185 INSTALLMENT BASIS: Annual By DEPOSIT PREMIUM: $1, 185 THIS IS NOT A BILL COMMENTS Coverage effective 12:01 AM on 03/01/11 DATE OF NOTICE: 02/28/11 PREPARED BY: Joanne Shea EXT 530 * * VOLUNTARY DIRECT- ASSIGNMENT.. * LETTER ID: 3542305 COPY: AGENCY The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street ' Boston, MA 02110 • Camp ground 2ssociati)3armou1hon, Du. West 'Yarmouth, al4.2 02673 March 10, 2011 M/M Bruce MacDonald YCGA0- 43 Simpson Avenue West Yarmouth MA 02673 RE: Request permission for a 14' X 24'garage with a 4' foundation to the rear of the cottage, moves the 4' x 8' from the right of building to the left and a 60' X 11' slightly curved driveway which bypasses the septic system on the right. Dear Friends, , , On March 9, 2011 the Board of Directors approved your request to add a garage and driveway to your cottage #36 located at 43 Simpson Avenue. Your project includes a 4' foundation, a 14' x 24' garage with a 60' x 11' T-base driveway on the right. This work requires permits and it is the responsibility of you or your agent to obtain proper ones from the Town of .Barnstable. Additionally, all codes and rules must be adhered to. Any debris resulting from the project is your responsibility and must be removed from the grounds at your expense. You also must respect Standing Rule of the YCGA, Section 1, item 11, "no excavation of major construction or reconstruction shall be started between July 1 and Labor Day" and "all excavation shall be filled and foundations capped, and heavy construction equipment removed from the Camp Ground before July 1." Upon receipt of your building permit, you are required to "present a photo copy of the permit to the clerk BEFORE beginning the project". I will also need a copy of your agent's liability insurance coverage. I am enclosing three signed copies of your approved plans and copies of this letter for you, your agent and the town. 'Good luck with the project, it sounds wonderful. Very truly yours, FOR THE DIR CTORS, (Mrs. ) L. E. Barle4, Clerk LEB/db Enc. 3 cc: pers. corres. renov. • Established in 1863,as a place to conduct religious Camp✓. 4eetings. %organized Igg6,as a Collage Community, cooperatively owned by the Collage Owners. Pr: .,.. IV of LO GUS ,„i' R7.-6 LEG ENv \vv j Q' C..-B. G.,c.eere .130./...a �S/ Pieov. PRoA.nsx-r, Ik �/ SAN.- SAti/7-ARY •q / S.A.S. -Sew- Aeso.ep r/ov Sysr —G— GAs I. pP p W w7ATE,e L/NE Q Q'J] APAR,'x. .r1.�PROX/A-gTE k P< I NY t i Lx. LacAr/oN f.)'-') 9)3> ::-------- rj EM Dr. /�r'c� LO GAT/ON MAP 7? \ Upv/ALD No SGA L.4- y8• . • o LioN0EV102 �1, — % er.-ak, %.. o� Gam" c fit; a�* o .0o Wit. -1,-Q"..../ d_'S 10l\ D �,9 JE j,. 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V Bs 1 A / ) 91 91 71 .0607 , I I I Y V a 42 > sAk Fl 00Y Pickfl_ /g24-4-y, -a/A/el Yarmouth Camp Ground Association, Inc. t� a / 7 y = is Ili s c ;,, a n J2.=.0 tp__t esz4 F).oNf ,C iet�q '►'oxl _ *pptidez) �l�`ti Yarmouth Camp Groun Association, Inc, a <, 3 / 1 - * /91i �.g R i b id7 E k v o,�-i c0-4 4 f C-��2�� Yarmouth Camp Grounds Association, Inc, 1- / 99A,IAD 04 Leci- E let/a-F- 1' 0K/ = y k Yarmouth camp Ground Association, inc. ,s- / 1 ,‘ 1 ..! r_... 4- I ecav Eieva.fl' oN *pplie .3//// - Yarmouth Camp Ground AssociatIon, Inc. 6/7 ?At a- Ri8S< )3 L r)x PI/ ,Xg RP p,c-- //« -el . x8 aXIo - aXly 1 — �_ xt� pTL , I1 1I 4 ► ► l._ _I ,&. g/q4 i - 4 CYoSS (. ... 4•ioN 4 7 1 -- . cizt-/Ig7, e .& Yarmouth Camp ,round Assusianon .nc. 0 Q Y uC e MAC* D o N a l _4 3__5;.MpSON A I/ < 81 we.S4 `�%y M ou+hi M.4 o a(v 13 tl.' 4 - X L Ie "1-6/- _ ►t 9 /4 9- 9„ 4.. 7' _ ( 3--t ) a4 > ( 4/11134// �► �M,hoY I3c1+3 3a''0.6.,or1P Foum Da+;_o " PI a l' , 4,,/i i i V el-aZm A . Yarmouth Camp Ground Association, Inc. APP1-1 GANT/a w1iI R Is is E G. eib Gr4ROLYN A. A4AG I ,kJAI 0 3 L4,,,.p —4 k,kz,‘",'A„kN,, Q-i,Nl-4l1 O,, 9 .:i- i2-4c9. 7.5- - 6 ,o 40-4-r70 0 ACclC ,,} __. €X/ST/1,"G GARAGE 6G T NGS'. i Q( 2-ir/ cP 0 , 0 p �, r I � vi `1, o� pONALD 0,sN . , 4 47 o MONCEVICZ U, ,ANo.204870 a. kI ' 90 lsTE �, � ' I / -Cis ,t3 \/oNALEa )))/ 1U MS — Co ti/c/eFT. fr-40/_},v4:›A7 /OA/ G. --"R'T/PX �0ebv2A77OA/ b �}3 /�srlP50NS A Yam. 1 ,45-s/-40WAi. b k Y,ARMQUTH GA NIP G/e?UN.DS .8,4A2J STti5L,ic j AA A 1 _SG/},LS- / = 20 Donald W. Moncevicz, P.E. `h 1 0 y Civil Engineer 47AT." �(,4 � 29) 2.0// 40 Pond Street West Dennis, MA 02670 TE,L 63-08)394-0S09 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 ,111/ 41Z • Map . Parcel LljI r F f. ,. - Permit# 12 0 Health Division 7/ C100 �' Date Issued !I `6/©y �� (� Conservation Division �G�7.�-h.(�E. � � �',-;' �; 5 r � Application Fee Tax Collector Permit Fee p 0.S.. a Treasurer \1 \ g Planning Dept. EXISTING S PTIC SYSTEM Date Definitive Plan Approved byPlannin Board LIMITED TO -' -#-OF BEDROOMS pp g Historic- ®o''o9 hII e eRaI /l lyanrtis �t I l S.) l0 19 CRMP6-/20 U 10b Project Street Address 1-3 3►M PS(2ty uc yc6)-,itowf ga1-W Sfct Silo Village fiyq N N, S 414 of(oa4 Owner RI-tic c C I 1 cLc Dom q Address R9 Q 1 i f l e G(ice ste)- Telephone S-o 8 - '7S!� 3 4-9- Permit Request flepicic tM six lf( Se4rvo#+1 w i4-11 ck /Cv`X fel Sec(►-eoM wi¢4 ' c dI1 a See A 'Q//co- ati4R)- +',e s+) JC-Furc Square feet: 1st floor: existing 5'40 proposed 17 Co 2nd floor: existing 0 proposed o't>38 Total new 1 fo¢ Zoning District Flood Plain Groundwater Overlay Project Valuation �,�j Construction Type (.c2 F>c Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family T t Two Family ❑ Multi-Family(#units) Age of Existing Structure 130/ '-S Historic House: XI Yes ❑No On Old King's Highway: ❑Yes No Basement Type: 2S1 Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) 7 36, Number of Baths: Full: existing 1 new 0 Half:existing o new 0 Number of Bedrooms: existing of new 3ee the Total Room Count(not including baths;: existing 4- new Sane First Floor Room Count 3 Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other A�c�n re Central Air: ❑Yes No Fireplaces: Existing No. New o Existing wood/coal stove: ❑Yes >S1 No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 21 No If yes, site plan review# Current Use Co 7�c;5( Proposed Use SoM-1( BUILDER INFORMATION Name Dau od .F 1dc.M-,f Telephone Number cos 34a 977 I Address 34-(.(h i ot7 S4- License# 00 19 3 9 �ay Me-u-ii I'G 1),4 Ga4.7c Home Improvement Contractor# ► 0947 3 Worker's Compensation Noll( 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :t 1-h0c=-c Tc k,N I�,t✓►� SIGNATURE 291T-" / .- DATE /ri o't7 0 FOR OFFICIAL USE ONLY i•PERMIT NO. _ DATE ISSUED • MAP/PARCEL NO. • ADDRESS _ VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION g(Oi) l-(I-® sr �tC FRAME ,?/ i old . 'U t S-- � INSULATION �5 aC� 6 —/ -6 Sr- 1 FIREPLACE ELECTRICAL: ROUGH ' FINAL t= PLUMBING: ROUGH ) .- FINAL GAS: ROUGH U FINAL FINAL BUILDING - f/ /' ' t. t. DATE CLOSED OUT � t ASSOCIATION PLAN NO. iv • Town. of Barnstable . v 404E ro� Regulatory Services S Thomas B,Geller,Director T ses9. 4, Building Division • prFD^��F Tom Terry, Building Commissioner ' • 200 Main Street, gyam ia,MA 02601 . • - - Tory.town.barnstable•ma.us --- ' Fax: 508-790-6230 Office: 508.862-4038 : - Property Owner Must _. - Complete and Sign This Section • If Using A Builder I ._ _. ,as Owner of the subject property to act on my behalf;` _-- • . . hereby authorize • . . .• • ' - . in all rca tters relative to work authorized bythis building permit application for. , I 6 i'9) _______ ssofJo -. - - - attireDate.of er , � _ e Print Name The Commonwealth of Massachusetts . fir - Department of Industrial Accidents• ' • , 600 Washington Street • -., 1 • Boston,Mass. 02111•. • • -• Workers' Com ensation.Insurance Affidavit-General Businesses // d / re Y• „t.. —. ? : ;:' • •fitr.. 4.'44*• • • ' .. ..a . : ] =• • G ` name: • — • ' ,a 34fUti iron sf . • . . •• . _ i ! 4 I - state: 44 av:o 1.c • hone#• 5 9 8 3 . '6 9 77/ • city work site location full address : ' • • I am•a sole proprietor and have no one Business Types []Retail 0 RestaurantBai/Eating Establishment ' working in any capacity. . 0 ees(full& art time 0 Other //%%%/%%/r///G/O%�00/%//%%%%%%//%/%//O�%%%////%%////G//%%#//%%/%/%/%O/%%/% ////%%%%%/%%///%/%/%%%%%/%/%�/��/%%/O %/%%D/�/G%�%%%. , I am an��loyer providing workers' compensation for my employees working on this job. • . • • cent an •lenet •r't • • - r: • • . • • • • • 'l. ..a >.. .:Ij•ff..• .'g• '.,i..:▪ �` .�q:. .i.: •.�.... :1• ..•it. •T'-'F.'••.r' 9fiClre$Sr • •t .• •s.' •. •t.:::.• •4•. :?::s ,,!, :„: one#:".'. • i ". • •..I I^ 2t1.: , • • ir;y:.IL▪: :i'''r43.•'•}�.`•.. olio• •#"• •�' risurarice.c'a °•''• - . •❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: >any name'.. „C' i T •. ,/.• 74••••l ::•7.1:a1�.. • • �).il•. .l' • - .•�. .. 4: •. . , phone#:. .'. . . ... :`,.'••,.. :i:•; • .1, :•?f,.•• sl•,: I r':r', '`P •,t '..;•:*:.;:.'':.: ..•i: r• • r n r•. • v:: .:i.' • '� 1.. 'd';:.:`i '•;:k.:., ?•..c...;:rs• :•:�.fit•.' address:. . . , > • Cl� . •. •.r •-� .f. •A.•• •1' it.i V,..4•• •4'?. •j�•`.4:- i:7:�r`•. '•.5_ % •} •t. insurenc 4 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a • copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the pains nddppeennnalties of perjury that the information provided above is true and carted. • ' Signature � �t/�'� • Date /C/�7/O 4F • Print name JD a tJ i • , ��+Cr f1'1 Phone# 5o8 r�6 a ?'7 7 3• official use only do not write in this area to be completed by city or town official city or town • permitllicense# . ['Building Department . • • ❑Licensing Board ❑check if immediate response L,required : . ❑Selectmen's Office ❑health Department . contact contact person: phone#; ❑Other (reused Sept T003) • • ' . Information and Instructions. Massachusetts General Laws chapter�152 section 25,requires all employers to provide workers' compensation for their. • employees: As quoted from th £ e law", an employee is.defined as every person in the service'of another under any contract of hire; express or implied; oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mare of the foregoing engaged in a'joint.enterprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. '.However the owner of a • . �P. dwelling house having not more than three apartments and.who resides therein, or the.occupant of the dwelling house of another who employspersoris to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such•enployment.be deemed to be an employer...: . MGL chapter 152 section 25 also•states that every state'or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.cOmmonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the. commonwealth nor.any of its political subdivisions shall enter into any contract for the performance of public work until ' acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority.. • • • . Applicants • • • • • Please fill in the workers'compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted • to the Department.of Industrial Accidents.for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being . requested, not the Department of Industrial Accidents. Should you have any questions regarding-the"law"or if you are required to obtain a•workers' compensation policy,please call the Department at the number listed.below. City or Towns . . . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event.the Office of Investigations has to contact you regarding the applicant. .Please . be sure to fill.in the 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 yo•u in advance for you cooperation and should you have any,question, please do not hesitate to give us a call.-• .. • . • ' . The Department's address,telephone and fax number: . , • . The Commonwealth Of Massachusetts• • - - • Department of Industrial Accidents • Once of I vesfigations • • 600 Washington Street • .• . . • Boston,Ma. 02111 fax#: (617)727-7749 . • phone#: (617) 727-4900 ext.406 • RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 ? 'S0 o d Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE d �/ / square feet x$96/sq. foot= 7 v`� Vt� /x.0041= cr2 C S plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 9 1 square feet x$64/sq.foot= 7 /6 x.0041= �C �" 3 plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee tli-'14'Zilitel Projcost Rev:063004 g s d` • • • • . . • • of E Town. of Barnstable • i~ . • sty co' Regulatory Servides f aW atZ+ . , Thomas P',Geller,Director • 1 9'A4c •ck1e1 Building]) vision . . • Tom Perry,Building Commissioner. ' 200 Main Street, Hyannis,MA 02601 • . Office: 508-862.4038 Fax: 508-790-6230 Fermit no. . Data ' • AFPTDA•VIT ' HOIYLE IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PER/MT A .PLICATION • MCI c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, • •improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied . butiding containhig 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, ' • • .pc,P ti • Type of Work: g-er gr—iN S ' a-c k7 ( ?Plc ht�Y $stimated Cost -Ai Coo • • - AddressofWork: 4'S S npSor-t Al Y64-Marm}t (QrLp( N j i74hhif Vatic � - Owner's Na � v C 4 c *Mac )c c.I . . Date of Application:, pip..-7/0 Gi�7 0 1 ' • . I hereby certify that: Registration is not required for the following reason(s): • ' • [ Work excluded by law . • • D7ob Under$1,000 . •. • ' OBuilding not owner-occupied. . • • • []Owner pulling own permit . Notice is hereby given that: . OWNERS PULLING•i'lAIR.OWN PERMIT OR DEALING WITH UNREGISTERED CONTRA.CTORS FOR APPLICABLE HOME IMPROVEMENT WORK D 0 NOT HAVE ACCESS TO TEE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A, • SIGNED UNDER PENALTIES OF PERJURY ' Ihereby apply for apermit as the agent of the owner: P P•7ket- Dow i F .% 1 s / o L 13 . Date Contractor Name Registration No. OR . Owner's Name • - - S •' ,, , • • ,k , -4 ''''' ' 4 .,..; a . - •.,. . .... , . 7T:;"444adifidel4n:U 9 RD OF: ...... -' ' • ( '• •• . . L., nse: CONSTRUCTION I: 'LA' • 11-c) - ' . _ • • . 001939 . . • . . .. . / - 5,--:-'.--:•.: Nurnil_e_r,H;. \\ E SUP-RVISOR . . - :•-' Birth,0 --',,-.;,-...7-T--------,__, . • } , . 1 i':•-,,,r'-',. -81-117 DAVID F AIDA.Zess-irct"14: : . , . • . , UNION sTN- YARMOu • ..>, ‘%-:.---- '.-:%' ; THPORT m ,,.. Administrator . . •...... . - • --, •• .... _ . , • . . . . .. . • 72e -e0., weatex ../7../gader,dumeAla . - Board of Building Regulations and Standards • • -e.wirtm. ,1 HOME IM;r'OVEMENT CONTRACTOR v...i...- -,!•17.-----).• Re!istritle 09473 t.,..4z=...: :g.FiffAii. 2006 :i W .'... i• ri DAVID ADAMS •6. DAVID ADAMS "•, •• ,?',7f,:E- .,,,, ,, .. YARMOUTHPORT,MA 02675 ..„ '34 UNION ST '''' '-•..,-,- --,-,..';';'> Aidmifilikator • . • • , • . . _ .• ..• 207..01s18 . :1, Nov-12-04 14:07 From-CAPE COD COMMISSION 5083623136 T-602 P.02/02 F-806 . ,°F ` ,s,. CAPE COD COMMISSION O `_. ,�',, r 3225 MAIN STREET a E_ P.O.BOX 226 BARNSTABLE,MA 02630 Y ......) (508)362-3828 `S4CHVS- FAX(508)362.3136 E-mail:frontdesk@capecodcommission.org To; Danielle St. Peter,Division Assistant,Historic Preservation Pro .e From: Sarah Korjeff„Preservation Specialist, Cape Cod Commissio L',)( Date: November 12, 2004 RE: Proposed Yarmouth Campground and Wianno Club alterations Thank you for sending me information regarding the proposed alteration of these two National Register properties. As you know,the Cape Cod Commission has jurisdiction over changes to National Register properties if the property is located ou i side a Local or Regional Historic District and if they involve demolition or a"substantial alteration." I have requested additional information from the Wianno Club in order 10 evaluate whether the proposed work constitutes a substantial alteration requiring ('ape Cod Commission review. I will contact you once I have received additional plans and staff has had a chance to review them. After reviewing the plans for the Yarmouth campground structure at 43 S impson Avenue, staff has determined that the proposed work does not require mandatory i eferral to the Cape Cod Commission because it does not constitute a"substantial alteration" of the historic and character-defining features of the building. The proposed addition would replace a mid 20th century addition to the rear of the structure. The most historically significant part of this building, the original carpenter gothic structure, would not be altered, and would be separated from the proposed addition by a rear ell c onstructed in the mid 20'century. The design of the proposed addition is compatible with the existing and surrounding structures in scale,height and roof form. Please feel free to contact me if you have any questions. /Q- .,c'. D,e.A,wiivG No CAM- / T••:' , , "ek-visoD Ocr: /9, .26O4 • � of ° 1,110r - 3 :•.--....,:i.. � y ;�O�` DONA �° MONCEVy . - 1 Al i ,••r..: ,p No.204Q : ;14.3: 4 i �� ^ /mil �'t't- �b4,s 3 s , • / 4k• P. ' i l'` iti... , ,c, ,c_.o OAT/oN P,L,4N , kjli Y . -43 S/41P-CON AV,& YAtiehi4O77-f cAAele �©[JAt.t,s ' ter/ 13.4R/Is rA d-•�j MA c�'�Q � �`� .,SC.4/-.E.. / N = •20 1 11 e c T®1.3R -25,?.D041 GSA 4.- t A W/AI • CAM- a -, h • • -Yarmouth Camp ground association, Jnc. West -Yarmouth, .,7VLk•R 02673 July 22, 2004 M/M Bruce MacDonald YCGA - 43 Simpson Avenue West Yarmouth MA 02673 RE: Request permission for renovations replacing 8' X 14' bedroom with a 16' X 18' bedroom with a 2nd bedroom above, a cellar under the structure and a new septic system. Dear Friends, On July 2, 2004 the Board of Directors approved your request to renovate your cottage #36 located at 43 Simpson Avenue. Specifically renovation includes removing and replacing an 8' x 14' bedroom with an 16' x 18' bedroom, adding a second bedroom above, putting a cellar . under the structure and installing a new septic system and leaching area. This work requires permits and it is the responsibility of you or your agent to obtain proper ones from the Town of Barnstable. Additionally, all codes and rules must be adhered to. Any debris resulting from the project is your responsibility and must be removed from the grounds at your expense. You also must respect Standing Rule of the YCGA, Section 1, item 11, "no excavation of major construction or reconstruction shall be started between July 1 and Labor Day" and "all excavation shall be filled and foundations capped, and heavy construction equipment removed from the Camp Ground before July 1." Upon receipt of your building permit, you are required to "present a photo copy of the permit to the clerk BEFORE beginning the project". Dave Adams has already presented me with a copy of his liability insurance coverage. I am enclosing three signed copies of your approved plans and copies of this letter for you, your agent and the town. Good luck with the project, it sounds wonderful. Very truly yours, FOR E DIRE TORS, (Mrs. ) L. E. Barle Clerk LEB/db Enc. 3 cc: pers._ corres. renov. established in I863,as a place to conduct religious Camp c. ileetings. reorganized 1946, as a Cottage Community,cooperatively owned by the Cottage Owners. .x ,� G 7--o/ ZDDETEr REVIEI�IED &,—,1—k BARNSTABLE BUILDING DEPT. DA E YARMOUTT . CAMP GROUND ASSOCIATION, INC. FIRE DEPARTMENT DATE //o I BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Y_ t l I IMPORTANT — UPGRADE REQUIRED 1 I STATE BUILDING CODE REQUIRES THE UPGRADING OF ji ic 6 SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED, B? G Y G 0 M NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. _ (0 • ISM l • (0 , A. !moo . . — d - , i 3 4- 5 la, ti �� II a— _l I. • �IYS - -� IGw PI `�• &rZ 7- ..2 • - , a de 401111r Cr---e/I-k- IrNMEWUTI-i CAMP GROUND ASSOCIATION, INC. •/ f'(p+ • "f-- or - .. ( e�YooNt a 1 I w . 1 _ ...,. NL I" look Plot-11r V , 7 ;--oL ,) /.&1"4L YAMMOUTII CAMP GROUND ASSOCIATION, INC. I7i 9- I --..., , / t , DD. hem 'fro,: /4/1- ce44,7e . e xistih� J z. 3--- ' j� i — ' _ r /Z e��� >--/ t 1 i c)i`1°+' E t e u0.+ ;0,I ' . � ' v « AHCA P"GR | ^ - . " .� -~--~-- ^ ~ ` � -- . . ' ' � -- | ' �� ���� � ' . /9a YARMOUTH CAMP G OUND ASSOCIATION, INC. 'F'immat ilm.' 1 III NIL p/57,iyle e ftiRiot e p7(tafe> g L e E le o . /5/a . -7472-4Y 17--- 1(47 ,Y -a /( 01 1: X10 1 " 4 Xio la" i 9- FlooY ' � � r r ► 1011 X a0" Foo41 Ns s /tlGe 1 VW tS 4- Macy` (4(items , Engineering Dept. (3rd floor) Map 3 4 7 Parcel ('o I Jr Permit# y 6 g c House# 43 Fes. Date Issu d 6 " +3 6 -- 6 7 Board of Health(3rdfloor)(8:1�9^30/1:00-4:30) 0`r wee �5� (i - nn se:ri 0 Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) CL , (4 .‘,..4/ 9 7 Planning Dept. (1st floor/School Admin. Bldg.) STALL , ►Nsra��E� ;�J '� ��sT s� ,i.Definitivet a •���ro ed by Planning Board 19 w -�� �� �:� � �AIVCE �, I ,�� . � � ENV RGNAq 1x''.., ',V fir® E AND �l� TOWN OF EARNSTABLE wN�� '®Ns ' R Building Permit Application Project Street Address 43 S 1 MICAS o,- Av6— Village vi.7, ,_J! ,...„...„4, Owner (f1 '<'t\ tl f ,,(,, ,,v, f � l.iC4er CZ\11woolkddress ' =3 -5i Y) (If,rtn'1 CO&, / to k re.i 9 Telephone ,'S(`,s-- !%:.i - 1/c j(; Permit Request- Ricltt(inc Cc I 'X ('7, ' tom`O( 4 e n tnin'{---c:(,prys, -cc,P0 FirrePol Irlelk,SP : J First Floor square feet Second Floor square feet one truction Type , 4 Lr., C-t`C-fY).e , I x i r„ de(lc i vi 36 Estimated Project Cost $ .5-C'( ., O() 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 ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing 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 ems/ Telephone Number Address 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 �/t SIGNATURE C_11.10-PrrH . �� 'mr:.r../ ) ,ri.k/a DATE V e i,}f r / ,7_ /(%9 7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY r M 21 / PERMIT NO. -krft 5 DATE ISSUED ! - • MAP/PARCEL NO. , . 1 ADDRESS VILLAGE . OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION • FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ` 4R'OUCB r.. FINAL ems:+ GAS: aldrag: FINAL f rei 'FINAL BUILDIN R . • DATE CLOSED Oc ASSOCIATION PLC . r£ II:I za is • 1 1 O 'ME r N ' 9* -. The Town of I:arnstablle • BARNSTABLE. • 7 MASI 0 Department of Health Safety and Environmental Services Pea IA 0 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. • Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: G'ox 1a,' uia,vt C.41- COC t'n Est. Cost .qn(`? 00 Address of Work: `rV, trn `_;c tn C,,-Lin Ccb�P. MA- Owner's Name ((II^(>Av+n A. (iC. no ( - )C:fktPr BC�11n'11ZT11"1 Date of Permit Application: R UV), r 2 i1 t ''t ci 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied '-'11wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR ✓ / ( 6AP-1)i Jrn . 6 r I)Mt/7 a / ~ Date Owner's Name J v 'l • �`" The Commonft'calth of Massachusetts •:�:i! _ • --_71:1�; Department of Industrial Accidents V _ ! iii. Olficeofleyesligallees ;-1 • ( iii! — \_::. '_: r `' 60(l Washington Street \ ,�; Boston. Mass. (12111 c.v► �,%> �' Workers' Compensation Insurance Affidavit. Alipiii':int • Please PRINT legibly information: r __+-..._ t_- me: Ci 'C t/r A. VV\nr 717)(mtyfcl(t 1 cation: t-��) IYY�rV�;(in 4-i c, nrn5-i-i-Cih Ie- et.. A rvl_�-,-k- a\r)I.e, i- nhpne# .iri) - 775- 7r9( �( am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity [i I am an employer providing workers' compensation for my employees working on this job. eompanv name: address: city: • nhone#: • insurance co. noiict•# 0 1 am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address city: Shone#: insurance co. polies•# - • ••-:..•, yw_ ... _ • •••-•_. ':1; �- 7:2r ^::.:FF-'IL iT•' !1.w:S 77T.'71- _7::.f..ti...', .-..._.T_ company name: address: city: ohmic#: insurance co. noiicv# Failure to secure ctrverace as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.0U and/or one years' imprisonment:ts well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA fur coverage verification. 1 do hereby certift�under the pains and penalties of perjury that the information provided above is true and correct. 7 Signature 'L/ ( l_i.S rtP ia'r _ l_!. Wr),r717)CS;fed_ Date �. _1.t_z,tJ ,,2 7 /7 q� / � A r Print name OArc,lvA ii, ria(--•.I Ir:,in a 1A Phone#_ 4 t _.. ' official use only do not write in this area to be completed by city or town official '6 city or town: permit license# 1,Building Department Licensing Board •,. 0 check if immediate response is required Selectmen's Office i • °flealth Department r- contact person: phone#: 11Other `"1•�...-.ram.w...�.�. -..�..._ • - Information and Instructions • Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th( employees. As quoted from the "law". an employee is defined as every person in the service o1 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 mo the foregoing engaged in a.joint enterprise, and including the legal representatives of a deceased employer. or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However tl 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 he or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employ( MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. • .._.._._...._.� ••'•__•_,.—.• _.. 77--7777.... .... .. .,,C •3 .. 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 require to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns • Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plc be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned 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 questic please do not hesitate to give us a call. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents .. Office of Investigations • 600 Washington Street • Boston,Ma. 02111 fax #: (617) 727-7749 • phone #: (617) 727-4900 ext. 406, 409 or 375 • TOWN OF BARNSTABLE BUILDING DEPARTMENT • HOMEOWNER LICENSE EXEMPTION • • Please print. - DATE ; i 11, e_= : ri I g c 7 • I OB LOCATION ��� - l b'Y1 p��r11 %n. F. . V 11 7 I E Number Street address Section of town HOMEOWNER" Cf r0 v�� �. ��n r. l��,11 c l c�:� OF -'i 7,�i- 7�I l�9 .... Name' Home phone Work phone - • . PRESENT MAILING ADDRESS • • • City/town State Zip code The current exemption for "homeowners" was extended to include owner-occupie dwellings of six units or less and to allow such homeowners to engage an in- dividual 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 re side, 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 Offic: on a form acceptable to the Building Official, that he/she shall be responsii for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the St Building Code and other applicable codes, by-laws, 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 comp with said procedures and requirements. • HOMEOWNER'S SIGNATU ( c a _,: )Bnt.. J • APPROVAL OF BUILDING OFFICI Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. • • HOME OWNER' S EXEMPTION The code state that: "Any Home Owner performing' work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owner. shall act as supervisor. " • Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our. Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/bier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the 1azt page of this issue is a form currently used by several towns. You may =are to amend and adopt such a form/certification for use in your community. • • • )3arinouth Camp 9rounclST4ssociaiion,L2ssociation Jnc. Utyannis, c7VL 02601 June 26,1997 Mr. Walter Bohmann and Mrs.Carolyn MacDonald 80 Warner Avenue Worcester MA 01604 RE: 12' X 12' screen house platform behind cottage#36,located at 43 Simpson Avenue. Dear Friends, The Board of Directors of the Yarmouth Camp Ground,Inc.,approved your request to build a 12' X 12' wooden platform behind the cottage at 43 Simpson Avenue,to be used as a base for a screen house. Please notice-this is only to be a base for a screen house. At no lime can it ever be used for anything else and nothing permanent can be erected upon it. This is not to be considered as setting a precedent. This is a one time arrangement for a particular item for a particular use. I have attached a copy of your approved plans along with this letter for your use in obtaining proper permits from the town of Barnstable. All local building codes must be adhered to. It is your responsibility to remove and dispose of all waste building materials and debris necessitated by the project. Just as a reminder,"any EXTERNAL construction or reconstruction be completed by July 1 and no new construction be started between July and August for the comfort of all members of the Association." This is one of our standing rules and must be adhered to. The only other item to be completed by you is to get permission from your abutters,Linda Brett Conaway and Franklin Holt. Should there be no objection,you may proceed. Good luck and here's to a bug and pest free summer. God bless. Very truly yours, FOR THE DIRECTORS, C:22 L. E.Barley,Clerk LEB/db cc:file corres. renov. pers. Established in 1863, as a place to conduct religious Camp 71'leetings. Reorganized I946, as a Cottage Community, cooperatively owned by the Cottage Owners. Cc1/bo/yn. acDc/2a - IV0tac. dke permission �o � a., l, x la ' wooden laf-rornn behind- fhe col/aye S build. p 1.3 Simpson Ave be usedd_ as a base for cL screen house . atAx›Ert___ Nac Corres.GE ,�i 2. FLAT Raw! Nl 1�I G ra Pis \ ; : . ; , : .1",,\ ' \..). „ ,•-'';:'.:.::==-='"''''.-*:',..7-;: ',%:':','%;-:::"..-..;:::1-'-' '------', '\ N„'\..•:, (1 1 .;Z:::,Y', +,' (L..---,, X 7..§,CI,'d-')......... . . I I\ \\\,, lie ) I / / ''''\ ) j , I t .., „........._,.1 I,/ r -i% i 11/..„.\\ \V,,,,t.„.„,......,_ i/ ''';-"v.::.":;'''-''......--'-',-;','„'"•-• ' •'----",.. ;: ,) .N. 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