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0192 LINCOLN ROAD
19�. G� . _.--- - �. 'I i y as/6-����� °Ft„E, ti Town of Barnstable *Permit# P Expires 6 months from issue dale * Regulatory Services Fee L3 ;f+9� 1639. Richard V.Scali,Director �Es a ArEo�,t Building Division APR Tom Perry,CBO,Building Commissioner 0 7 2015 200 Main Street,Hyannis,MA 02601 TOWN OF BARNST www.town.barnstable.ma.us ABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / Property Address l /� 1—in r0L17 esidential Value of Work$ / � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` 7 ('�fif/7�elephoneNumber,!5]Y- 77�// Coniractor'sName /[��'�� ���/��� l,{P�P/1- Home Improvement Contractor License#(if applicable) Email: 4COe C`O/77 Construction Supervisor's License#(if applicable)0f_D ' �D ,-P�orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner A ave Worker's Compensation Insurance Insurance Company Name l Workman's Comp.Policy# (j C Cs-tz Copy of Insurance Compliance Certificate must accompany each permit. U'7� /4j "Y Permit Requ st(check box) �. ) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to_t ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side r 3 Z ❑ Replacement Windows/doors/sliders.U-Value (maximum, #of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. :6. r ***Notaildingen.nit er must sign Property Owner Letter of Permission. Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: QAWPFILESTORMRESS.doc Revised 061313 4 t t,1I• g � f , E AcV JDP CERTIFICATE C)F LIAWLITY:INS"U AXE' — PAT`'�-� 12/i/2 014 . THIS CERTIFICATE IS.ISSUED AS A MATTER OF'INFORMATION ONLY AND CONFERS'..NO RIGHTS UPON THE CERTIFICATE HOLDER..;TNt3 CERTIFICATE.DOES NOT,AFFIRMATIVEL,Y;OR NEGATIVELY-.AMEND, EXTEND OR ALTER•THE COVERAGE,AFFORDED BY,THE POUICIES BELOW.: THIS CERTIFICATE OR-INSURANCE:DOES-NOT CONSTITUTE A CONTRAC.T'BETWEN THE iISSUINGINSURER(&), AUTHORIZED REPRESENTATIVE OR PRODUCER,A14D THE CERTIFICATE HOLDER IMPORTANT: If the certificate holderts an ADDITIONAL INSURED,ihb;,,policy{Ies)must be endocsed.,'If SUBROGATION'ISsVI(AIVEDsubjectt0 the terms and conditions of the,policyi certain'policies may,require=an,endorsement,' A-statement.on thiS'ceitificata.dOes..not confer rights to tt16 certificate holder•in_Iieu.Of suCh.egdbrsement(S). PRODUCER CONTA T LOL8:1 FiNAMIE tz63er81d Southeastern Insurance•A .PHONE . 401 , 0997" 6061E Fax , c a {90®)QB(1,2,7,33 4.39. State Rd. E-MAIL -:lfi-tz@aautheasternas:com P.O. BOX 7939$; INSUR AFFORDINGCOVERAGE NAICp North Dartmouth I)fA b2797 INSURER A-Arbelia Protection Insurance 41360 NsuRep aN � eociated'E l errs. InB. Co. _ � Tupper-:Construction.Co_ LLC; INsuReRc: 79,Mid'Seth,Arne. INSURERD.. Unit B NsuRPR;e: Weet Xarmoukh. O2'67,3 Nau RP. _ .- COVERAGES CERTIFICATE NUM®ER 2015-1. REVISION'NUMBER; THIS IS TO CERTIFY THAT,THE POLICIES OF INSURANCE LISTELI`IIE6AW NAVE®EEN:'ISSUEO T,O PHE INSURED'.NAMED ABOVE FOR THE POLICY PERIOD; ' .INDICATED, NOTWITHSTANDING ANY REOIJA€MONT,TL�RM:®R CflNPITION,OF ANY CONTRACT 67R CT-H -0 CIIMENT WITH RESPECT TO MICK1HIS CERTIFICATE MAY 89 166UED,OR MAY':PERTAIN; T-E INSURANCE,AFFORD€D BY THE ROI,ICIIwS DC9CifIBE®;HEREIN I$'_6118JECT'TD A 'fiNET El3MS EXCLUMONS AN9 CON®ITIONS OF.6UC.H PQLiCIES LIMIT$sSHOWN N1i1Y HAVE°@€EN R€,DUCE9 6Y'PAID'CL AIMS; -.. _.: - , TYP!§OF.INS C6 URAN 61RR R 1 LIMYf$,. GENERAL'LIABILITY `" WH OCCURRENCE' 4 1,QQQ„AO.p X COMOEROAL GENERAL LIAtIILIfiY AA7A63 ri o Soo:oAA A CIAIA98M4DE 'X�,UCCUR 600068769: 3y1/2014 YY3/201e Mfg€XP(!ny i+n®. on .. PERSONAL&'ADVINJURY, 1< S,OQ;O':,AOA GENERAL AGGREGATE Y Ii :2 00:0400 GEW Al3t;,R,EGATE OMIT APPtAt'$:PER .PR08UCTS ,COMP/AP AOO t -'2 A.0;0`,.OA A-:'r. X_ POLICY PR i LOC. 6 i AUTOMOWLS 4.IABIUW . , ANYgqAUTG TO BODILY INJURY(Par parnfl) s , TQREt3 -3C" A4C19uLEA OA^'OW093S9016 2/A/29�l3 homy INJURY(flbr 8066filj X HIREQAUTM AUT WN 9, PrPRR YA( J. 2.50.000 UM9RF14A"AA OCBIJR - AI U RFR1 ._ Fi10E$ !V46. OiIMSMAAF AEARFATK. 6 ' " tems e)0®. LL-�/ @9 WORK AAMs€NA WW" .,._. n . AND EMAk6YeKS'kIRKINT9' TY A-NY RROPIRIFTAR113 R iR/9X9q/TIVF F�.EA61H AC�IOIINt § ®A 00 I�fICRf$/MFM9l=RpkD2 N/A 4M�►Isltl4.rylgNH) OAA®A�4�fl991iA 1A/�/B®46 A/�./20 § € : f <F:AFM Yd A f �4 Ap€�I A'o IBEA� POLICY T ® .,...d_ RSI RIRT! N AP€" fil N& 9W _ ._.. D€$9f71PTI6TN€!€fINERR°T16NS 169 ATlONA/t<€HIC,I��(At€aEN A991$9 491,A0010,91 ftvmjl b 909 NIe,'!t M r@4fi ®!fl regUir@a) — RT 6H@UkA AftY @P THE A@Qv9 P- RIR90 POW010 8E DAINIFI?kQ @l3 RA" THE kXPIfRATIAN DATR `D11'RE-0F,. NO'f16E Wl k of 09 lVEff9A AN A6999-PANAE WITH THE P WQY I�R@Vl6rsN6: . 540 4 KIMNO t✓W-144 BOAR AdTtiQM.z PNtpltkKNTATn1€ WEPT YAW9T9f M 02073 S Q 9000-9010 A CROP IWRPORA`!04 All fa h r®§Qr l� 1NS9a6l7(!7!!(1fi1 n± Thfl et�l1F t!T r►ernR and Inns arP renlattFtrru�msrbs�f A('(►RF1 • n The Commonwealth of Massachusetts Department of Industrial Accidents Ogice of Investigations rd I Congress Street,Suite 100 Boston, dl?A O2I14-20.17 www mass gov/dia Workers'Compensation,Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information :Please Print Legibly Name()3usiness/Organizatiandlndividual); Tupper Construction Address:7018 Mid Tech Cyr City/,Stateq p.,West Yarmouth, MA 02673 Phone Are you an employers Check the appropriate boar Type of prefect(required)- 1.X l am a employor witla � 4, 1 wn a general contractor and 1 employees Gull and/or part-time).* have hired the sub-contractors 6. 0 New construction. ,0 lam a sole proprietor or partner. listed on the attached sheet, 7. F1 Remodeling shipand have no employees ees These sub-coati-actors have p y 8, rl Demolition working for the in any capacity. employees and have workers' 9, louildin addition (No workers' comp.insurance comp, insurance: ❑ . required.) S; We are a corporation and its 10.[Bleetriral repairs or additions .0 l am a hotnemwer doh €t all work officers.have exercised their 11,El Pluinbing rep airs or.additions. myself Nl o ww orkers' comp, right of exemption per MGL 12,=- ool'repair� instarance required.) c, 152,§1(4),and wve have no employees, [No workers' '13, Other�� _ —� .cote, irrsurartce t�i�titir�: � ` �Anv alaplImit that ohu6 box 01 aatust MAO 1111 Out,tlsct n0tl0sa Wow showitah their k*rkern"t aita�t tasatiora ptal.i�y:ia�raatatirart: - - Fl uaea aef tvho &0 treiaaa all wwrk and then hiw:wwAd®eaattraat�r satvet ttatatt`tif a aaa�v:atltctavit;indi�atitag such: ICOMgat:tars that ehe@k thla box tinitt atfaehed am additiuraaal,sli t alataiA tiiE nataae. r the sul�=aanteaet�t�aad state r fhatlac �r_taot tiiuse.antltit s:hawe ettVOY&& If Ole sula=eotatfaaton have tmployL"y thev,nftlst pmvide their vIO&W ewttap.poliq wittiAw, 1 ttM ON emplaw that fsproviding itwipkars'tv. "a wdon Jastrrenr6AP rev entpt®01ft Below is thelrt,wlicy q#dJob ske t;��rara!it?Fnrt. lusuraftee Company Natneo AEiC' policy 8t self fists; UO,k<WCCS_006bi1369 2007' � 7�d3d1� E p rad6ra Dater10 job Site Ad"—s,./. d. �1 Cd Citydsmte p; d�/f' f �L;��l At ch a spy of the workers'eoMpetrsati6a policy declaration page:(showing the policy nu leer and expiration da(e). laallure to sebure Overage as required under seedob 25A of MG-L u. 152 can lead to the imp6sitlon of.crifttinai penalties of-a,, 41tte up to$1,500,00 find/or one3,ear irryprisrinmertt, as wall a8 civil penalties in the rbrm of STOP WORK ORDER and a fine Vrup to$250M a day against the. violator,, 86 advised.thht a copy of this statement may be:forwarded to the Of irce of [twvesti atietts ®t`t e l lA rr uraf ce covet t eai#i utie h, I do her+rt .1�n er..t ae airs andjioatdites.dflt jury that the infnratittion prov ded above-h trre,and ; rrst 878111 ?ni tt, oral . Bo rice rut'itu ur tlrfs tarn,t, e »ipl�>' d b ett�+.rlrr hilt 6&161. City or`l'own.---.-- - t�ernritd�ieehse 14suiag Authority(eir'cle Bac). I.;hoard of Health 2.Building.Dopnrtment 3,City/'l'own Clcrlt ,l lectc�Ieal tinspector;5.li'llumbiug tv p Mr 6,Other contatt per On._ -- C'V.'o, 11�'�3i1JNf3lNtNMtt�Jt.'ti�'`i'l�.!7tt,NPf,/Nta�l��f' -piiice pf Consumer.Affairs dh.8usaness Ctegplgnon L'tee se•�r registrntioa.va lid for individulmse oniy: -. IMPROVEMENT CONTRACTOR Wore•the cxpi date. Lf fou-d fetur'n`to � . eglstraflon; 178?13A OffMce of C ffairs and Bus►ness Itegutat�oo F t4 Far axa 5u a Y'10 Explrallon 1,411612i11�r. LLG' Bo^ ;MAD21 � TUPPER CONSTRUCT{ON CO LLC,' RICHARD TUPPEO ,4 a - 79 8 MID TECH DR. « t k YARMOUTH MA,diS73"- indcrsccrecari. o . tthout s►gnature E; j, _ . ._.... _ � t Massachusetts Qepartment of Public Safety t -� ;,.� E s .w!. s.,ri` qTy,, 0,• r.tf. +� eN ''g"' .t - `. as F�o(a�ct,Stti�i10� ss � Y�,� � �,. �a$oariiot38c.►ltltng'Reguiattans and.Standar�is , Matta W i+G{71 Gd �GrK 7 ' truCL0Qfl 1lf" c!�'Ngl; r n .r ;' (8M 274-t274 r* r s- �b t.icer%�e prcorn p 'wS`ti '4. - � � y. '' i h�� � ���'{,t, t' �iCbAfY�.�!T11ppeT tV. 4`X._T F .. r ♦a>"f—.4 AB�aa:Cr�6w`e w t��"J i a} t r �. wCSt,Y81IDOUtb+• k t ` tv Rlch4 e� t r '�a'^+ s gg pp g �3P1ID$55o� )' ` lip ♦4 yr SEr4@SItTtDNsary¢fX ; ,3"3 ` Cotrimissroneri �1?J31/207$ fig— IcOnh 1 tnt ` 11� nr$a1g Peopte,; ngopleBulaafe�W�rld O + �,�"'' ��� u• , 114�emu, �yy��`� �, 0� ' `�� 1S aB ding Saf;er P Dress�,n'1ac�► �. N� ,._�+`d�d M t•Sal �.r-afr"na R',M1l � � .i �' r 3Bftibe�pAA.,, 41 foil, IR oNf iSfrt,'. 4 a p Ye y, t,Q _ Y Paz,.Ma �� • ' 4 • 0 COPUSTRUCTION CO.LLC 79B Mid-Tech:Drive West Yarmouth,MA 02673 Phone 508-778-0111 Fax508-778-5010 Registration#U1845 License#069058 Date: to'- Attn: Building Department i hereby authorize Tupper Construction Co;., LLC to pull the permits necessary to complete the projectdescribed on the attached permit application form. Thank you, Owners' Signatures Print Owners' Names: 1, Street Address; o TOWN OF*ARNSTABLE BUILDING PERMIT APPLICATION Mai r'10 Parcel ® Permit# Hdalth Division ��1 ' C,� Date Issued 7. V, Conservation Division / 2a� Z�p� �41`C�. Application Fee 1 Tax Collector ' SEPTi: "; � � D;Permit Fee; O'D "STALLED IN COMPLIANCZ Treasurer (7 �7 VIIITH TITLE 5 i Planning Dept. ENVIRONMENTAL CODE ANE Date Definitive Plan Approved by Planning Board TOWN REGULATIOIy'S Historic-OKH Preservation/Hyannis Project Street Address ��+r1 Cc31"� el(5 G ZL f Village!M C£ J Z 6'ity Owner n `)P o,-cs�►-e X Address C1 Llt,\Co CQ ,, Telephone SO)� 7 Permit Request p ` �_ c�►�cQ C��� 1 -�- Lour, c/ CD s3 Square feet: 1st floor: existing proposed 2nd floor: existing proposed 1 5otaI n w Zoning District Flood Plain Groundwater Overlay Project Valuation I o 0 Construction Type 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 )iNo On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full Crawl U Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 'Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: O/Gas ❑Oil El Electric ❑Other Central Air: ❑Yes �IV0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes L�No Detached garage:❑existing ❑new size nO Pool:❑existing %new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size 00 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use r BUILDER INFORMATION NameI,,.,4 6 I(C3 Telephone Number Address ��� �i�col'� �O0. License# Home Improvement Contractor# Workers Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �- FOR OFFICIAL USE ONLY F w S PERMIT NO. -, DATE ISSUED ✓MAP/PARCEL NO. ADDRESS _ l VILLAGE OWNER DATE OF INSPECTION:- - FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH' ; ; . FINAL a PLUMBING: ROUGH - FINAL+ GAS: ROUGH -FINAL ' J -- FINAL BUILDING r z - j r DATE CLOSED OUT a ASSOCIATION PLAN NO. The Commonwealth of Massachusetts xal Department of Industrial Accidents ' ,D Office ORRY stfONORs • : - 600 Washington Street - _ Boston,Mass. 02111 Workers. Co.m ensation Insurance Affidavit name: Dfe location: l Y1 C. vl h (cc( ci Ct `� T` ( hone# am a homeowner performing all w06 myself I am a sole proprietor and have no one w)Ain in cap icity /////%//%//////� ///%%%%%%%%%/%/%%%/%%//////%%%%/////%/%/% %%��////%%/G%%%/%////%%%/G�///%%//G%%%%%%/%//%%%�/%�% ❑ I am an employer:praviding workers' compensationfor my employees working on this job.::::::::::::::::.::::::::r::.:•::::::: :::::::::::::::: copsav neat .. • .'eSs ' ' ' 'r`'1`'<` ? `s 5 '''`? j_: %; '<>< :;:::;:::.....:....:....:;::;;;;::.<.:<;::;; ::;::?::::>:;:;:;<::;;;::?:::;::;;::;;::;>::ist;;+:<::;:;:;5::::::;::::::;;::::;:::::::::.: :::::f F hori :Snstlrance.fi0.:.:::::::::::.::.:::•::::::•:::::::•:::•:...::...:.................................... / ❑ I.am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have _ workers' co m ensatto n olices. the following P •��81T1E'<} ?`::{•�?''�`� `�iii>?i�izii:'ii'ii�itii% iiiiioi[r''i�i2E±i}i'i ''''.riiz?#>'�; `z?'ii)iai#%%i''i%"'ii%ii>'.'`a2i' '�>` i ?'3i`i?•r,:i �ijr:yi%i`ii <i _Y{:? i :: ';%�" <'�.;�j? �ooari�y�n .............. .... ....::::::::::::::::::...:.. :.:::...,.::..::::..::.:..........:...........:.... ........................................................................................................................................::. ......,...... ....................r::?;:;>:•':•::•::<::•:r.........�:i:%rr:::isi::::::d:;:}:;:::st:::>::+:;;;:<ii::•'.::,..4 .:{r:„....}.:<':::z+'... ...}.:.0::::1•::..... ... ....,.:.......................................::.,..........-....; :::::::•.::::::•:::::.�::.:?::..::.: ...................................:.:..•.::.::::::::..:::::.::::::._::.�:::{{<.�:{:{:::,.::-:??:;•;::•:;�) lie. .:.... ...:..........:. :... r.#:•: .... .......................:....,..v...... .:•::•:•::•................. .s.........:......2....... ...., ......................... ...........;...,:..:::::.?::..:�::n�:•-:.S{^_::i:•i:•.�::•??:•?i:rr\•::{>v. ..0 J.'{•i lr.,*::i$i:..... .,5.v.�.�... ..! ,:,{.:::::...L:.::x,1px:1:::«::::v:.v::.Sr.•.�.f,,:_v%•lv....v1J1•..f:•.. ..................... :C BII life:::.>::;:{::;•:...... % :,. :�?i=:=�`::;?+' :2;:::�:`�:ri:??�::�;::;;;:�r`:::i:�;:�::�i::::}•�r::;:S;i':�r i:::::i::4:;:;:;:�::::;:?;:;::;::;:;�:?�;::::•`.2�:t:{:;::;:�:3':':i•::;;:;:{•::;��;r:::x�{ ..................................... t..r..........:....:.::.::-::::•:::::::.........:....... .::.:::::.::::;:.N::o{{..:<.{.;�.�,-::x<•:.:•:. „h ti ..:::.:•:::::.�:;:.:•.,.:...::::::::{S;:{G:trii'•i::{di:{vi>!{.:':•:i20i:..sY::.�.w::.�::::::::::.. -:.::v.i'-..? Litt f:::�2:;::;;::S:S;:':;:�is%�:i::;::;:"::';'::`}':'f`:::;:�R<;5+i:;•'?:?�::c;.:<::{::<;{:{�::{.:{:.?::?:?:;?:v:: .:::.:::..:......:............::?::::.�.�:.�._:.�:::::.::i?:{•:•?:�?i::•i?:i._.4?:v':•:ii:ii?:•?:•i%;;:;:2%;;:;�i1:?.^'::�`:•i?i:^:{:. li Failure to secure coverage as required ender Section 25A of MGL 152 canlead to the imposition of crindiwl penaltles of a See np to 51,500.00 and/or one years'impiivonment a,wen a,dvn penaltfes in the form of a STOP wORK ORDI:R and a See of 5100.00 a day against me I understand that a copy of this statement maybe forwarded to the Office of Investigatipns of the DIA for coverage verification I do hereby-erdfy-under-thepaim-andpenaldes-of-perjury- at-t e-information-provided..above_islru(e_and.enrrect_- Signa 0 Date 1 `'l °� Priat name Phone# �� official use only do not write,in this area to be completed by city or town official city or town: perndt./license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Seleitmen's Office _❑HealthDeparbnent contact person: phone#; ❑Other awised 9195 PJA) Information and Instructions ` Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation of other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a .. . dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit.to operate a business or to construct buildings in the commonwealth for.any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. -- _ Applicants Please fill in the workers' compensation affidavit completely,by checking,the box that applies to your situation ands supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the`.`law".or...you are required,fo obtain a workers' compensation policy,please caIl`the Department of 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-Ofthe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please.. . � .�P._.,....T...��...._.s—.....+...-_.-........ a.. .�....._.. �...... �,.. . . .. .ram ...+ - .,.. be sure to fill in the. ermrtlhcense number wluch will be used as a reference iiiu76er' The'affidavits may bb'retutned to the Departmei t ,mail'o'r`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 anygiestions. . 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 ff: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 1 �oFtHe r Town of Barnstable ti Regulatory Services 9�>�AB`E. Thomas F.Geiler,Director �'OIFnNu,'�A`0 Building Division Tom Perry;Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION 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-rc�v p"6.� Estimated Cost Address of Work:\� L( Y1 'Jr�, e c \L' C"n�- S' 01,4`,4 0 L (Q G 1 Owner's Name: La l r` I Y `Vres'tree - Date of Application: (P I_6 a�- I hereby,certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. (� _ co lv2 �R Date Owner's Name Q:forms:homeaffidav f 15) HELPFUL INFORMATION 16) SAFETY RULES- 1. Proper filtering and chemical treatments should not make 1. Read your instructions and safety rules careful) If Y• You it necessary to change the pool water. do not follow the safety rules someone could be injured Your pool dealer will advise you of the proper procedure. or damage could occur. To estimate the amount of chemicals needed here is the 2. Plan carefully where you are going to put your pool. It approximate water content of the pool based on full must be close to a water source for filling. Also think capacity: about draining your pool. 3. Never let anyone swim alone.Children must be carefully 15x48 tzxa8 75,,400 gallons 24x48 120 gallons 21x48 10,00 gallons watched. For added safety,install a convex type mirror , 00 gallons above 18x48 ,400 gallons 27x48 16,500 gallons Pool t0 give full view of interior. Available at most mirror dealers. 21x52 10,800 gallons 4. Do not let anyone rough-house in or around your pool. 15x52 5,600 gallons 24x52 14,000 gallons The pool area and decks can be slippery. Someone coulii ='` tsxsz a,000 gallons z7xsz n,eoo gallons be badly injured. You can prevent this type problem by'... enforcing the safety rules. 2. To help keep the pool clean and child proof,a pool cover S. Always keep the water dean and sanitary. Dirty water should be on the pool whenever it is not in use. This also can be dangerous. Use your filter system. Follow reduces loss of water and chemicals. instructions included with your filter. Also{use water To keep the pool in working condition check the following purifying chemicals as needed. operation. 6.DO NOT DIVE OR JUMP INTO lk'#. a) Leaks in skimmer and filter connections must be stopped. A constant drip of chlorinated water on metal POOL. THE POOL IS NOT DESIGNED . will corrode the metal. FOR DIVING OR JUMPING I t h' b) Signs of corrosion must be Immediately repaired. Sand off 7. Remove ladders when there is no adult to watch the p1,ol. the rust. Paint with rust resistant paint. Remove anything else that can be used get into the pool c) The pool should be left up and filled year round properly winterized and covered with a good cover. The water level Use a cover if the pool is not in use for a long period of `. time: must be lowered to about 6" below the lowest skimmer opening if your area is subjected to be below freezing SAFETY DECALS CAN BE AFFIXED TO A to wnpefature. All pool leaks must be repaired before CLEAN,DRY,SMOOTH SURFACE SUCH AS THE k" d) Do not empty your pool in spring_ Filtration and VINYL LINER,TOP SEAT THAT HAS SMOOTH chlorination will remove all impurities. Leaves and other FINISH. THEY MUST BE PLACED THAT THEY AREA matter should be skimmed or vacuumed out of the pool. EASILY SEEN. t , 'A i{'' 64 ALL THESE POOLS ARE DESIGNED FOR SWIMMING ONLY. THEY MUST NOT BE USED FOR JUMPING OR DIVING. DO NOT JUMP DO NOT DIVE PERMANENT INJURY OR DEATH CAN.RESULT Jumping and diving into a ASAHI CHEMICAL'S Pool is STRICTLY FORBIDDEN. It is your responsibility as the owner of the pool to do the following: Wo not locate pool near objects that would entice diving i.e.,garages,tree, porches, etc. t Wo not let anyone use your pool unless they are fully aware of the DO NOT DIVE OR JUMP notice. �Do not promote horse play or other activities that would cause injuries.-' GDo not allow people to sit or walk on the top seat of the pool. RESPONSIBILITY AS A POOL OWNER TO INSURE THE SAFETY OF WHOMEVER USES THE POOL NOT THE MANUFACTURER. READ ALL INSTRUCTIONS CAREFULLY BEFORE ASSEMBLING YOUR POOL. rough all instructions completely and familiarize yourself with all pool parts and accessories before pool assembly. Damage may done if all instructions are not carefully followed, and in such cases, will void manufacturer's warranty. When assembling pool, read through what you must do for each step,then proceed. WARNING THIS POOL IS DESIGNED FOR SWIMMING ONLY. IT IS NOT INTENDED FOR DIVING OR JUMPING. E FOR A MAXIMUM OF SWIMMING FUN, BE SURE TO FOLLOW ALL SAFETY RULES WHEN USING ANY SWIMMING POOL. Printed in JAPAN. Dec.1998. 7 13) INSTALLING SEAT COVERS For 6TH Frame Attach seat-cover by placing it from irlsid, s mi.,«rigor'K- P.No.0912 as shown in the figure. Cover Cap(Plastic Cap)© / and then tighten up 1/4"x1/2"Truss,head screw to IV PNo.0513 ` washer,Screw cap should be attached to the topof.y 1/4"xl/2^Truss Head Screw / ," after all Screw tighten up. - .P.No.0911 - Screw cap washer % For 6S,7HT,7BT Frame Attach seat-cover by placing it from inside of pool in right position �� as shown in the figure. \ ` P.No.2472 Insert the outside two tabs outside of seat-cover into two slots at Tin Seat Cover/ top-end of cover bracket,and then tighten up 1/4"x1/2"Truss head screw with screw cap washer screw cap should be attached to ' the top of seat cover after all screws tighten up. / P.No.3473 7Hin Cover Bracket j PNo.2402.PP Seat Cover Cap P.No.0513 1/4in x 1/2in Truss Head Screw Ll"i J1 -' No.2482.PP / Bin Sheet Cove For BP Frame Attach seat cover by placing it from inside of pool in right position as shown in the figure. =', P.No.2483.PP put seat cover and cover bracket together, / ( Sin Cover Bracket Insert Smm x 20 sheet metal screw from cover bracket to seat cover,and tighten it up.put 1/4"x 1/2"truss head screw to I P No 03a2 seat cover and tighten it up.put seat cover -,•e:.:., -S'a smmx.20 Sheet Metal Screw cap on top of cover. 1 I `"` I 14) FILLING THE POOL The hard work is all behind. Now the fun begins. I s When pool is completely assembled and ready for water,run water 3) into the pool. Wrinkles in pool liner should be smoothed out as Set as many hoses as you want to help speed up filling time. The water is added for easier maintenance. pool holds a considerable amount of water(ie;i 8'round pool holds 7650 gallons.). s3 IMPORTANT: STOP FILLING POOL AT 1 F00T DEPTH `^. INSPECT BOTTOM RAILS-make sure they are not scalloped,see detail 4) To keep the water clean and protect your liner from being damaged at right. If rails scallop,pull outward at the bottom of the verticals T� to allow wall and rails to assume natural shape. it is best to cover hose end(s)with several layers of rags. k By using a string and small weight,check each vertical.To see that 5) they stand straight. When desired water level is reached,turn on your filter. Be sure each vertical stands perfectly straight. (Follow separate instructions provided with your filter.) 2) CAUTION: Measure all around the pool,from the TOP RAIL down to WATER Do not attempt to straighten liner after you begin to fill with water. LEVEL This level SHOULD NOT VARY MORE THEN ONE INCH. An Severe damage could be caused and You will void warranty. unleveled condition will cause overstress of the pool wall and frame. Remove excess soil as required to establish a level frame and bottom rail condition. See"ASSEMBLY OF BOTTOM RAILS" CORRECT WRONG 6 10) ASSEMBLING VERTICALS Starting at the lower joint of the wall closure, Secure the bottom of the vertical to the prongs of the lower joint with 1/4"x 1/2"truss head screw.Do the same with upper joint. Do not tighten until all screws !f for top and bottom of verticals are in place. Continue installing the verticals in this manner all around the pool. Tighten all screws after all screws are attached. '. 0 �. �D For 6TH FRAME: Joint Bracket Assembring Insert the lower lip of joint bracket into the slit of verticals. And tighten it by using same bolt for upper I joint in front,Then tighten two each side bolt on upper f' joint. DO NOT TIGHTEN until all screws are in place. 12) INSTALLING TOP SEATS Place each of the top seats over the upper joints p and secure with 1/4"x1/2"Truss head screws. Note: There is a front and back side of the top seats. the holes do not line up perfectly,reverse the tt seats so that you do not have to force the hole line up perfectly. Install all of the seats in this way around entire pool. Seat sections are installed between the verticals. Each end of the seat section rests on an upper joint and is attach to it. It may be necessary to move the complete verticals I slightly to left or right to accommodate the seat. Do this carefully so as not to disturb the ound. Check all screws to be sure j, they are tight. te. Do not-tighten screws until all screws are attac z\ TIGHTEN after all screws are attached. j 4 F 5 (wFR+,INSTALLATION Step 4:Take the plastic edging and clip it over the liner and the F s . . . top of the wall. The ends of each section of edging should 0 Remove1)your.shoes. The liner should never be forcefully touch each other. The edging forms a full circle all ,fq pulWd oQdragged, especjally when it holds water, even around. Cut off.'excess plastic edging t, 6619,012,1yfWhen you enter the pool during installation, a-q a adder other than a pool ladder. If the liner doA"riot fit evenly around the pool. $'. . Make{:sure the legs rest on a strong flat board Remove the �'rnasking tape gently from the collar of the liner and wall. Smooth out all wrinkles on the bottom of �S a ,1}Open the liner carton carefully by removing the tape (Do the liner. There may be extra material around the side. �npt cut open carton.) Spread it evenly all around the side of the pool. There p42,Unfold the liner inside the metal wall. Carefully spread it may be extra material in height. AT out on the ground. The seam around the bottom of the liner should be well up the earth mound. Do this evetily, ` all around pool. Side of liner .a Step 3:Remove top rail temporarily placed,Place the metal strip over the wall closure. t I I I I I! I!I! r`^ " Lift the side of the liner over the top of the wall. Forma I� I I it I,I I�I I III I I !III collar approximately 3" down the outside of the wall and I - I temporarily tape it,to the outside of the wall using masking tape at intervals of 3'. Bottom seam II,i Metal Strip II III ',°� I I! 'lllll'I,jllll�llllll�lll � 11 I yam, Wall closure 8)INSTALL THE TOP RAIL-UPPER JOINT Lay out these parts on the ground alternating upper joints and Joint rails at the same position with the lower joints and bottom rails e assembled before.lnsert the top rail into upper joint,Clip a rail Oa over the plastic edging and top of the wall as shown at right.. Rail j Clip all rails and upper joints over the wall in this way until the entire top rail is formed. NOTE: Be sure upper joint is directly above lower joint. x Check the seam at the bottom and side wall of the liner. Plastic Edging It must rest we y 9(il�`fhe earth mound event - Liner f+ I Illlllli' Wall i _ r i 9) " PRE-ASSEMBLING VERTICALS a ! 0 0513 1/4 x 1/2in Truss Head Screw I, 1/41n Nut / ' PN6.2483.PP PNo.03 Bin Cover Bracket I O P.N.-0911 t Smm M 0 Sfceat tat Screw i Screw Cap Washer ® e Screw � I Screw Cap(Plastic Cap) ,• � / PA 0342 E 5mmx20 Sheet Metal Screw For 6S,7HT,7BT Frame For 8P Frame Insert cover bracket into the slot of v ical,and put�lr Put cover bracket to the vertical as shown in the figure. 1/41nx1/2in Truss Head screw with cap washer t s tighten up by Smm.x 20 sheet metal screw. then fasten by 1/4in nut,put screw cap after--7— M tightening screw as shown in picture, —+ � 3 0 �s � � 4)INSTALLING WALL Use Wall Joint Bolt Package packed in a Wall Carton. INSIDE OF POOL INSIDE OF POOL Reiff cIng Washer ?/ y WALL ® BOLT. m • P.N.n /4lnfi R 1gihforeingWasher ® Reinhercing �" 1 REINFORCING NUT WASHER INSIDE OF POOL ® Reinforcing D Washer -. O® WALL Due to the weight of wall,some bending will occur Reinforcing in the top and bottom corrugation.because the wall - Washer is built to flex. Simply bend those sections back before inserting wall in top or bottom rail. Step 1: It is practical,.if two people work together, 1�2 one inside and one'outside of the pool. P.N.-0611 Step 2: Place coiled wall near bottom rail one O P.N:0513 y1/4inNut section open. Note: There is an up and down side on steel wall 1/4 x 1/21n Truss Head Screw Locate the-skimmer cutouts which are near the outside end of the wall. These cutouts must be at the TOP even if you will not be l using these cutouts. I` STEP 3: Bring the wall close to the bottom rail. DO NOT FASTEN THE WALL WITHOUT USING THE gip: Make sure there is nothing in the bottom rail before REINFORCING WASHERS I FAILURE TO USE REINFORCING "•k: l inserting the wall. If there is earth or something is in the WASHERS AS INSTRUCTED WILL CAUSE WALL TO SPLIT bottom rail,take out it accordingly. WHEN POOL IS FILLED. THIS CAN CAUSE SERIOUS PROPERTY �i Begin to insert end of wall into bottom rail. One person DAMAGE AND/OR BODILY INJURY. unwinding wall (wall should be on a plywood base for ease INSERT THE SCREWS FROM INSIDE OF WALL. of rotating) while the other person Is feeding wall into NUT MUST BE FASTENED FROM OUTSIDE OF WALL. Slot of bottom rail around entire pool. As you unwind the wall and insert it into the assembled bottom rails, temporarily place top rail sections on top of * Reinforcing Washers must be on INSIDE and OUTSIDE of wall. the wall. This will help to prevent the wall form bending * Insert the screws from INSIDE of the wall. or falling over. * Insert and fasten screws from hole to hole down to the bottom Should the wall be either too short or too Iong,Adjust of the wall.Do not fasten tightly before insert all screws. bottom rails,The circumference of bottom rails can be * Fasten all screws tightly. adjusted slightly by equally tapping outward or inward at * Do not leave any open holes. the each lower joint until the wall ends meet. * Cover all the screw heads with strip of fabric tape. iStep 4: Bring the two open ends of the wall together as shown * Check the level of the top,of the wall,if more than 2"off level Thise.is one of the most important steps in assembling the Rework the ground to achieve levelness. I; pool. Pay close attention to the following points.. G S) BUILD AN EARTH MOUND(cove) 8 in Build a mound 8"high and extending 8 to 10"on the I: ground around the inside of the pool wall. Pack the earth I. gently but firmly. i! j' IMPORTANT: The earth mound must be built right. you must ='+ rebuild the earth mound each time you set upi the pool. .,. 2(n Water pressure can force the liner out under the'bottom rail. If this is not done.This could cause damage to the ----7ine�and void warranty. The earth mound will prevent this from happening. . i 6) THROUGH THE WALL SKIMMER Step 1: For anti-rusting,All edges of cut out have to be At one point during the installation of the skimmer,you coveredby vinyl tape or rusting paint. have to install the liner. The skimmer installation will Begin the installation of the through the wall skimmer. tell you when. Complete the installation of the liner as Follow separate skimmer installations. described next. Then finish the skimmer installation. 2) (;ROUND PREPARATION The preparation of the around is the most � important step In the installation of the pool. 1 a) Mark off your pool area by driving stakes. Have a helper Wall Length as below.; hold a tape measure or a string and mark off the pool 12' Diameter Pool 446 11/16 inch perimeter using flour or chalk. Remove sod inside the pool 15' Diameter Pool 564 3/8 inch area to a distance of 1 feet beyond dimensions shown in 18' Diameter Pool 673 13/16 inch the plot layout around entire perimeter of pool. 21' Diameter Pool 783 3/4 inch 24' Diameter Pool 893 75/16 inch b) Remove all grass from within the entire pool area. It is 27' Diameter Pool 1,004 5/16 inch not enough to just cut the grass. The sod must be removed. c)Two or three inches of sand is the best for your liner. Using sand eliminates the necessity to level inside of frame area except where exceptionally high or low areas exist. These areas should either be dug or filled in. This does not mean the perimeter or frame area. That area must be �3- firm and level by digging only. * d) Do not fill low spots in the area where pool wall will rest.as setting may cause your pool to become out of level. Making sure pool bottom is flat.This is a must. e) If your site is not on firm soil, use 2" patio blocks for the 1W base of the wall Care should be taken to center,a patio —— block under each bottom plate. 6 " cleared ground 3) ASSEMBLING BOTTOM RAIL Before proceeding to the next step,place a large amount STEP 1:Before proceeding, remove the steel wall from carton to sifted earth in the middle of the-circle..(see chart for and stand on a 3'x3'board inside pool area as shown at the amount on the first page.) right' Put Put the liner, (leaving it in the carton) inside Sifted earth should not contain any pebbles. pool STEP 2:lnsert,the bottom rails around the entire perimeter Place a patio block under each lower joint around curved using lower joints on the circular portion of the pool. area. Leave one section open that will be nearest to where you will locate your filter. in ram:-•.: 4-Nn Q ® Top of patio block even with ground surface. 2 �) S I Fl-I Il1N ur ryv� .7l1L RMATION Before starting the installation, the following points are ,ng to set up the pool, read the entire im ortant; There are certain areas in the instructions that p nportant to follow exactly as written and/or a) The site must be large enough to accommodate the deviation fron'i these instructions voids pool with plenty of area around .it for pool pool and could cause bodily harm or damage to accessories, chairs, tables etc. be b) Deter located. It must be connected where your netted toltrationaa grounded 1 Olvolt is and remove all parts except steel wall and electrical outlet,with a G.F.I. (Ground Fault Interrupter) ;embly ,you must identify,count and check all c) The pool must be in reach of your water supply. nbly by parts list. Although the water should not be drained, but kept rself with all of the parts. Refer to the parts clean through filtration and chemicals, there should be drainage facilities near in case of need. f your pool unless d) Perimeter area of ground must be absolutely level and tart the installation o not firm. All grass and sod under entire pool.area must i have an entire day to finish the work. The be dug out to avoid unpleasant odors from not try to set up your pool on a windy day. decomposition under the pool due to lack of air. II will be difficult or even impossible to handle.. Remove sharp objects, stones, twigs, pebbles, roots, installation. etc. They may damage the liner. If the ground has of needs 2 or 3 people for insta been treated with chemicals or weed killer allow two tools and materials are needed. weeks before setting up the pool. Do not set up the Earth Roller String pool on concrete, asphalt, tar paper, peatmoss, sand, One for each upright) Hammer and Nails gravel, or where nut grass has been planted. Poorly Pegs and Stakes Carpenter's Level prepared ground could allow certain weeds or grass to ,e 2"x4"Board sand grow through the liner. Liner is not warranted Marking Pencil Masking Tape against this. If ground is uneven in perimeter area, Chalk or Flour Plastic Tape dig out the high spots. The not build weightn the low side by BSERVE ANY OF THE ABOVE INSTRUCTIONS WILL the waterwl ill pack down the fill causing the pool to TY. sink. Inside perimeter of pool (the area H inside of the frame and wall) can be leveled with T OR SAND NEEDED POOL AS FOLLOWS : 1" or 2" of sand raked and rolled smooth. 12Eer Pool 9 cubic feet ter Pool 10 cubic feet ter Pool 12 cubic feet ter Pool 15 cubic feet ter Pool 17 cubic feet ter Pool 21 cubic feet Friends MATERIALS Screwdriver 2 x 4 1 Tamping Tool j� Center 'r Silted Stake � Earth String 4' nail Rake vel Masking Tape Chalk or ® � Shovel • - Marking Pencil Flour Roller Hammer 27 24 21 18 15 12 Size Radius Size Radius 24' 142-1/4" 27' 159-3/4" 18' 107-1 /4" 21' 124-3/4' 12' 71-1/8" - 15' 89-3/4" 1 Oil WIN I"MW N1 - .INSTRUCTIONS . -: ROUND OOLS . INSTRUCTIONS CAREFULLY AND THOROUGHLY BEFORE STARTING GROUND PREPARATION AND POOL ASSEMBLY. �- DOING SO WILL PREVENT PROBLEMS. P.N.-0611 1/4in Nut C P.N.-0513 1/4 x 1/2in Truss Head Screw P.N.-0341.SUS �'.. O YSheet Metal Screw P.N.-0911. Screw Cap Washer P.N.-091 2 °° O P.N:0411 screw Cap(Plastic Cap) 1/4in Reinforcing Washer Page. General information ---------------------------------- 1 1) Selection pool site ------------------------------- -- 1 --- 2) Ground preparation ---------------------------------- 2 3) Assembling bottom rail ----------------------------- 2 4) Installing wall ------------------------=---------- 3 5) Build an earth mound (cove) 3 6) Through the wall skimmer ------------------------ 3 7) Liner installation. ---------------------------------- 4 8 Install the top rail,upper joint 4 9) Pre-assembling verticals(6S,7H,8 frames only) --------- 4 p<, i^7 10 Assembling verticals -----,:---------------------- 5 12) Installing top seats ---------------------------------- 5 13) Installing seat covers ----------------------------- 6 14) Filling the pool ---------------------------------- 6 15) Helpfull information ----------------------------- 7 16) SAFTY RULES ------------------ 7 RESIDENTIAL: SHEDS - POOLS -DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >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—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL (E-0:0�) $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ ✓ ' �� Q:forms:dkcost eff:082301 ltcaxt head' 1AcaltiortOf.11110perty: y Qrtnis f ' I obi'43 j I i 140� f _ �sl�ed I tR2 � 'Story dwc.lfiv► - �! or i �I SNOW I � f �I 1 1 ref Mood.pan.¢ ;25ax l fx5-c— �oo& zont; C �IAOF �o AULT. 4 I j hereE� certify t1a �t7t��t�s mo��r�tgargle�DiMPect1"on x1as-Prepare4'for G WER VV,G�nn (Jv {�V nn /'(�. an VV 611,S ergo a• �� 0 1 131 Jwe zry hereon does rot rfaU tm a s pxac a, FEmA hazo& arva with am effective daze of 6-rs-Bran& the Wahom a cor:Fc rm.rt'o� local gon ing -laws trt�sect' the d�vOng does -fl � mi the tww oFcotrucrton 'Anft respeet'to horiSon.�cel dtm1erl.5f0;i_ Seale: 1^ _ 40!___. Isetback reqt4rcnuiitS or is eX`c111f� otn vt6latlon eXLfflt' enitnLC Date:_ ! v i:om muter Maas. Gwjura,L s Caul r40N-50 rt.' M 7. ! Fite ®-. -4 1 PLEASE NOTE The structures as shown on this plot plan are approximate only An actual survey is necessary for a precise determination of the building location and encroachments, if any exist. either way across property. lines- This plan must not be used for recording purposes or for use in preparing deed descriptions 'and must not be used for variance or building plan purposes. This plan must not he used to locate property lines. Verification of building locations, property line dimensions, fences = or of configuration can only he accomplished om lished by an accurate instrument survey which may reflect different information than what l i = is showy. hereon. Please note that this is "NOT A BOUNDARY SURVEY,• and is "FOR MORTGAGE PURPOSES ONLY". WCOLONIAL LAND SURVEYING COMPANY , INC. U �I d Y 269 Hanover Street - Hanover,Klass. 02339 - Phone: 781-826-7186 Fax: 781-826-4823 The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: (10 6 JOB LOCATION: 2 L��'`C ^ �jyc�h f S. number 1 street village "HOMEOWNER': KC_�L name home phone# work phone# CURRENT MAILING ADDRESS: �G _ 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 si Mervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection p edures and requirements and that he/she will comply with said procedures and requirements. ii-gnatue of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often.results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN ' 7 .76- The Town of Barnstable Department of Health, Safety and Environmental Services = Building Division 639.}�� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 9 Name: Address: V / ll Village: oJ0y;72' �c� - oy Type of Business: Map/Lot: 43 / INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor, no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare, humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in . excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the saw address shall not be included • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Town of Barnstable �TNKE ' tic Regulatory Services : Thomas F.Geiler,Director w RARNSrnBIE, 4 9� MASS. ,�� Building Division iOlEo Mpg°' Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINUINOUIRY REPORT Date:? Rec'd by: Complaint Name: /l Map/Parcel 2, 7 e9 Location Address: �a Originator Name: Street: a Village: State: Zip: Telephone: 7 7.F'- S 707 Complaint Description: FOR OFFICEUSE ONLY Inspector's Action/Comments Date: —7 `G Inspector: (✓��" Additional Info.Attached Q:forms:complaint T"Er°�� TOWN OF BARNSTABLE• i BABBSTABLE, i 9� Ou"i'O'. BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ...... .:.. .......... .............. ..... ................. ............................. ............................. TYPEOF CONSTRUCTION ................. .. ... .......................................................................................................... t ................................................19..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... 7.. .....A114AOI ......1.62%..........'. &K.Ls. .........lm.�-t...�'S.... ......:z-o-.7Y .4 Proposed Use /..... p (yi Q ,���.b....... V1.......'? ?.....6W L t.S. Q4�......................................... Q � y . Zoning District �,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,•,..,Fire District l (D l ........................................................................ Name of Owner ir.LM�I.. .. v W.fi *�f ..... �i ft irdQ. ........... ..... . Address ..........p. ........................:� ��.. Name of Builder ............... 11 ........................Address ....... ...... .fir GC/�`2 ...... lov........... Name of Architect ............D .........................Address ®� ......4<.>., !!`ii. l�t:.....:. ,/ .,......... Number of Rooms ........; , � ........................................Foundation .. ftl.f.�'..>.........1. .U�.G.:�.C." . .,...........1' �ffa� Exierior .lZ.�:.. ..� ............Q.Pe: .....................................Roofing .............� ................................................ Floors ...�0 c° 9®. ........ V�C.V � ..........r? Interior ........�.I"�'. ............. .(�.....(4 A-Perr...................... Heating ............lval z- ...................................................Plumbing ..................l Q ...i................................................ ® a Fireplace :............:...../.Y. .................................................Approximate Cost ..................e .06.. Difinitive Plan Approved by Planning Board __________________________ - 19 - - Diagram of Lot and Building with Dimensions / 3 0--" WWW �t ` a SCflL6 1�� i o Fri-, 6a' - I hereby agree to conform to all the Rules and Regulations of\the Town of Barnstable regarding the above construction. , Nam p� I� , � 1 � Carpenter, uorzqgn~,R°_ ' | ^ � . � No .. '. pe,mit for ... ...............---..''" ................................................ | Location --.��2. .�&an�_______ / ...................... ....!4�__.___________. / � Owner B_ | -----.----'=���`��=`-----.. � � Type of Construction .........;r�mm..................... ' ----.—^--.-----------------... / Plot ............................ Lot ................................ | . � Permit Granted ..........Q�ob.e.rl..........lA64 \ Date of | ------------.l9 � , Dote Completed -- ----l9'�`� | . / ' l | � � | \ l , ] ~ / v�' '------^---'z=---------~--' � ' [ / --^—~----^^'^—'------`—'—^---- ' | � . . -----^--^--------^—~^^------ ` ----.—.—.—.~--.—.------..--.—.~. ` ' ' r Approved ---------------- lQ -------''-------------~--^'—'' � � --------.--.--------....�..---... ^ � » e�PyofTNET,�°o� TOWN OF BARNSTABLE BASBSTADLL i NAM p JulY BUILDING INSPECTOR 'F �`• • 44, V .......... v APPLICATION FOR PERMIT TO ..`...�...1 j�1..... ............................................................. TYPE OF CONSTRUCTION v�N. � E .. ?� G(i��ZI�V�r .................... . .... ............................................. ............................................ ..................�7 9 .,9..�� v' ,.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .C_.//v(_t�� !U ��. l'1 ?. N.�,:.}...................... ProposedUse ....U EGL Oj.&`................................................................................................................................. Zoning District ..............J�„A....... ........................................Fire District ........ V� / .. ....................................... Name of Owner .P... � � o� �// �'OL y� ;..,. ................Address .....................................�....�!�./...... ..P... Nameof Builder ......... .QWE. ............................:......Address ...........0 f i'Yl. ........................................................ Name of Architect ........0�1).�.I�..............................Address ............5.....M.4. . ..................................................... Numberof Rooms .......... :................................................Foundation ........,? S i........................................... Exierior7......� Y �/1 ��t-�.�� C................Roofing .............,. ...... . ..... :........................................... Floors ............. ......TI ...............................................Interior L' Y ., �7 �L! ` . �-- ......................p... ....................................... Heating �� - " `7 v�,,,.7 .................Plumbing .................�/.Od .�.��.;............................................. Fireplace ................... ,. ....................................................Approximate Cost .......................... 1 ................................... Difinitive Plan Approved by Planning Board --------------------------------19-------- . Diagram of Lot and Building with Dimensions -6 - - �- - I 00 W I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name(.7)r4( �f / Carpenter, Dorman R. 1134.5 enclose carport No ................. Permit for .................................... ............................................................................... Location :........192 1inclon Road Hyannis Owner ............Dorman. ..R....'Carpenter......... .... .. . ................................ Type of Construction frame I ................................................................................ Plot ........................ Lot ................................ Permit Granted September 29... .....19 67 ........................... . Date of Inspection ....................................19 Date Completed ....... ..... ...............19 7 PERMIT REFUSED ` ................................................................ 19 ............................................................................... t ................................................................................ ............................................................................... ............................................................................... 4 Approved ,............................................... 19 ............................................................................... ...............................................................................