HomeMy WebLinkAbout0052 STONE BRIDGE LANEr.SaStd�� 8,eidge /-�!
09,
a
r Town of Barnstable *11eb t# as
Expires 6 mont not issue dole
rY
Re ulato Services Fee
Regulatory
nAlwBrwBM
1 Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number_ aQ(a p
Property Address 11� S OYI r `�• `( ` S
[�Residential Value of Work o Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address U� ey - h�
2i k dc /n,lk
Contractor's Nam e_'BQkc?- d Aacezawl c —yyl c Telephone Number-Z29_-��4:ca?05
Home Improvement Contractor License#(if applicable) / (� �� _ ---
Construction Supervisor's License#(if applicable)
[ Workman's Compensation Insurance
Check one: MAR O 6 2012
❑ I am a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance
_ 1'®WfV OF BARNSTARLE
Insurance Company Name 16solfler�o�' �D�CL� '_ I�GL�v!� ...__........__.. .---------
Workman's Comp. Policy# IV",�00 d e7
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑ Re-roof(hurricane nailed)(not stripping. Going over_ existing layers of roof)
❑ Re-side
#of doors a
[ Replacement Windows/doors/sliders. U-Value (maximum .35)#of windows y
*Where required: Issuance of this permit does not exempt compliance with other town department regulations-i.e.Historic.Conservat ion,ctc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License& Construction Supervisors License is
required.
SIGNATURE:
C:\Users\decollik\AppData\Local\Microsoft\Windows\ emporary Internet Files\Content.Outlook\[)DV87AA/.\EXPRF.SS.doe
Revised 072110
I
The Commonwealth ofMassachasetts
Department of InduNd Accidents
Office of Invadgations
600 Washington Street
Boston,MA 02111
www nmas goWdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A Inf o Please Print L
ghly
Nurse(Business/OrganintioNlndividualy
Address: /
City/State/Zip:r" 1 (e Phone 0:��`
Are you an employer?Check the appropriate box: _r
I.`�] I am a employer with 4. I am a general contractor and I Type of project(required):
'\ employees(hill and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partrier_ listed on the attached sheet, 7. []Remodeling
ship and have no employees Thee sub-contractors have g. Demolition
working for me m any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.t 9. Building addition
required.) 5. 0 We are a cwporstkm and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.❑Roof r epaira insurance required.]t c. 152,$10),and we have no
employees.[No workers' 13.❑Other
comp.insurance required,]
fAnY WHOM that checks boa MI mug am no out the section below showing their workers'compeatlon poNcy information.
Homeowners who submit this affidavit indicating day am doing all work amd thm Idle outside contractott must submit a new affidavit indicating s k
tContractors that check dds box muu attached an addition)dart Mowing the on of the suttcontncu n end sous whether or not those entities have
employees. If the sub-eo wscom have cnwlo)vm they must Provide am waksn'cmro,policy number.
Ian an employer that is providing workers'compeesedow lesun sce fir my arrpleyeext aelew tr the poUeY and/ob.rite
Informaden.
Insurance Company Name: 'tDn/G�ti�/��tyl��J�•t .f'
Policy p or Self-ins. Lic.p: // �� Expiration Date:y a 3— / .]_
Job site Address: — brrGd,B o IAyt.o City/Staw/Zip:t?I� rn��_/y
Attach a rnpy of the workers'compensation policy declaration page(showing the Polley 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 full to 51,500.00 and/or one-wear imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
_lmyeatf>tatiom of the Ql&for imtraMe coveraQe verification.
I do hereby certify render the pains and penaldn of perjury thm the info
rnratlow provldtd above Is pre and correct
s!"—rut�-, 44zvali-JA
Z _
Pbpnc #:
OfIkki rate oa . Do not write In t area.to co err y'c or town o,Q?cial
City or Town: Permit/License N
Issuing,authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone N:
Client#: 9742 213AKERAS
ACORD,. CERTIFICATE OF LIABILITY INSURANCE UAIL(MMzollYYI
osriz/zotl
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AIITHORI7ED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must he endorsed H SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this cortifii ate does not confer rights to the
certificate holder in lieu Of such endorsemeni(s). .,
PHODUCEI/ LUN TALI
NA Mt:
Dowling R O'Neil Insurance PHONE —— " - - I Aa
AIC Nu E.dI 508 775-1G20 _1.IaFy _50B17H1218
Agency E-MAIL --~--
973 lyannou ADDRESS,gh Rd, PO Box 1990 I ;
INSURERfSI AFFORDING COVERAGE NAICB
Hyannis, MA 02601 — --` —�--` ^'--
INSUHEH P National Granga Mutual Insuranc
INSuIltU INSURERB:Associated Employers Insurance
Baker&Associates,lnc. -- — ---'—
P O Box 923 I INSV HtH C.
I INSURER D
Centerville, MA 02632-0071 — -- --
INSUHtH E 1
MU RER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 15, TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED roTHE INSURED NAP.IED ASS)VE FOR THE "O1_I1`•'DERIOD
INDICATE('. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY f;(7.NTRACT I_R -)T-aF.R PnCOMENT V111 H RFFPECT"0 INHICH THIS
CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED 61 THE POLICIES DiESCRIKED HEREIN IS SUBJECT TO At... T_ TEQMS.
E<CLi1SIOt,IS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RECILJCciJ By PAID cl-AR:1:=•
INSR IADOL UBR POLICY EFF POLICY FXP
LTR IYvt AF wSur(ANCE INSH YYvO POLICYNUMBtH MMIDDIYYYY
A GENERALLIA13ILFTY I MPJ7223M /19/2011 04119/201 EFL=H_ICCVI?RENCE '(:1 0001000
uanwl;F 1i��Frnl-.l t
X
C:(ir.•u>o-lx'.w1 i;!IaFHAI , AN I 11 fRFMISFS,Fe._u•�,:�•,_ 500 000
I eLAlrr:-rnADE � ,i:cvR I arD:1:...rlAl::,:•:_,lCl- 1•tU,000
A'Nu,.:N n IH• :E 1,000,000
iGLrJERALAI_REGAIE J•2,000,000
(;�rLl AGi;F:Fi;AIF I IMn APFI VFW.: I ��'inn!( It, i ara- -• ',r, sz,000,000
---
f:>uC`r u7C _
AU•OMCHILE LIPHILII Y rf iFll:hlhi) ,'hl(iI F 1 1�:1
AtJY AIJT(I NX I h_ irJJ'rR�H•:•I unl..oI i
ALL i1,WNF1- SCHEDULED� H(ll hl•ihiJ•IL•,(F'rr a.nrlrau '6
I N(:N-n WhlFn FI-(:^I L:I'•IIAAA(iF
AUTOS Ir•„, _FJenr
UPABRELLA LIAR
E%CESSLIAB rLAJfIS-fIA.DE AGGRE
ul-n � I F!F IFwniml•,; I -----
'NJHKtHSCOMPENSAIION I tl I.1I11- !l il+
B WCC5002454012011 23/2011I0412 3/20 1 X—LL R.ILt:LT I t
AND EMPLOYERS'LIABILITY I —t
AtJY f•RC+f•RtETOR%rARTIJFRiE:XECUTI`!E Y/N F 1 I"�,<H•:a.(.:ul^n 's500,000
nl-L1CFH:Trhn�FH�7.c:liwFu', I ] MIA ------- ---
?MantlalmY In NH) I E L DISEA`_'E-EA ELtrLOYEE 1,500,000
Dt5CRI'TIQFJ;_F^('ERAT1QrJ5bnl'jw �FI ur,F•r-F rin:l'r1:1.q:1 +500,000
I
I
� i r
UESCHIP 110N OF OPENA 1IUNS I LOCAI IONS I VEHICLES(AMICh ACOHU'101.ACtlltlondl Karn.lrka SChatlula,If morn%p-a m mqulratl)
Insurance coverage is limited to the terms,conditions,exclusions,other
limitations and endorsements. Nothing contained in the certificate of
insurance shall be deemed to have altered,waived,or extended the
coverage provided by the policy provisions.
1
I
CERTIFICATE HOLDER CANCELLATION
Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANGELLED BEFORE
TTfF, EXPIRATION DATT THFRFOr NOTICE W11.1. RF r1ELIVERFD IN
Thomas Perry ACCORDANCE WITH THE POLICY PROVISIONS. j
I 200 Main Strout
Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE t
1
(?1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010108) 1 of 1 The ACORD name and logo are registered marks of ACORD
#SB07221M80721 LS1
1,1H'Y-12-2011 09•316AN FaY: Irl:BAKER _. ASS0H_INcfE1_,
w
�ta..a�huscth - pclruuncnt u( Public hatch
Board of Building- Reumlation. mid Standard. _
Construction Supervisor License
License: CS 9714
Restricted to: 00
-K
RICHARD P GARNEAU JR
251 WOODSIDE RD
W BARNSTABLE,'MA 02668
�--�— Expiration: 4/4/2012
(',nuniw nrr Tr#: 25310
1110 k*:I, I)k I 1.11 t 11 %',11 , 1,141111,Finard , ..
'd, Buildill'-, Rc-_tjlmioo, nd 11% '-
Construction Supervisor Licens#.-.
Ocense: CS 9714
Restricted to: 00
RICHARD P GARNEAU JR
251 WOODSIDE RD
W BARNSTABLE, MA 02668
Expirallow 4/4;20 121 25310
0F 1-ic'e of�Consumer(Affa�s /nds u' iness Regulat.1011
10 Park Plaza -'Suitc 5170
Boston, Massachusetts 02 116
Home. Improvement Contractor Registraticlii
Reqistration- 162600
Type: Supplement(,aw
BAKER & ASSOCIATES INC. Expiration' 3/26/2013
RICHARD GARNEAU
521 SHOOTFLYING HILL RD
CENTERVILLE, MA 02632
Update Address and return card. Mark re;j,on for olalil
Address Renewal Flnplovfllent 1.110
Offi(T of OOMMICr Affairs& Rusincss Rq:ulation License or registration valid for individid use wil*v
O. ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business RVL'Ulation
vc.;-Registration: 162600 Type:
10 Park Plaza-Suite 5170
Expiration' 3/26/2013 Supplement Card Boston,MA 02116
&-ASSOCIATES INC.
-:101ARD GARNEAU
1,o BOX 9')3
CFN i FR VJHLE,MA 02632 �;/ valid-.7
Underwcrelar% Not valid without signature
Authorization Form:
I lyka& r , as owner of the
s b'ects ro ert�hereb—utho e Bak re &Associates to act on m behalf, in all
J� P P Y Y Y
matters relative to work authorized by this building permit application for
Address of property: 52 Stone Bridge Lane
Marstons Mills, MA 02648
Signature of owner: — -
Print Name: ��=
Date: `�_�
o�j"E,Ow� Town of Barnstable *Permit# /(D`
�(. Expires 6 month rom issue date
Regulatory Services Fee
BARNBrABLE, : Thomas F.Geiler,Director
`� ,�� Building Division �(�
lFD MAt to
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 X-PRESS PERMIT \
www.town.bamstable.ma.us I
Office: 508-862-4038 MAR 2 7lM$08-790-6230
EXPRESS PERMIT APPLICATION - RESII?,.ENIIAL ONLY
Not Valid without Red X-Press Imprint i QVVIVSTAE3_LE
Map/parcel Number
Property Address 5a►S�o,ne n
O
Residential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address `6M, m e
Contractor's Name l + G GL S Telephone Number 150(s -6(oa•a44`,rJ
Home Improvement Contractor License# if applicable) 11�'49'4
Mworkman's Compensation Insurance
Check one:
❑ •I am a sole proprietor
TII am the Homeowner
have Worker's Compensati n Insurance L �l
Insurance Company Name 6G l: ` 1(l . ` 0 .
Workman's Comp.Policy# (3 1 00
Copy of Insurance Compliance Certific to must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑ Re-roof(not stripping. Goin over existing layers of roof)
❑ Re-side
Replacement Windows/doo s/sliders.U-Value tW . 30 (maximum.35)
•Where required: Issuance of this permi does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owncr must sign Property Owner Letter of Permission.
A copy of the lome Improvement Contractors License is required.
SIGNATURE:
Q:\WPFILES\FORM btu perms[o�rms\EX SS.doc
Revise020108
The Commonwealth of Massachusetts
Department of Industi ial Accidents
Office.of Investigations-
600 Washington Street
s
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pli,mbers
Applicant Information Please Print Legibly
Name (Businessiorpnization/individual): 1'Y ��jOG IC GS C1G .
Address: xl 3
City/State/Zip:C&8�C ('y�%\ e1' ►�'t o��3 c� Phone#:
AV -
1on an employer? Check the appropriate box:. Type of project(required):
1. 1 am'a employer with( 4. ❑ am a general contractor and I 6. ❑New construction
employees(frill and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on.the attached sheet. t Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
o workers' comp. insurance 5. ❑ We,are a corporation and its
[N .
10.❑ Electrical repairs oradditions
required.] ' officers have exercised their .
3.❑ I am a homeowner doing all work right of exemption per MGL 1�1.❑ Plumbing repairs or additions
myself. [No workers' comp. � c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers''
] comp.insurance required.] 13.❑ Other
,Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infommatiou: `F
Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contraators and their workers'comp.policy information.
'am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site
nformation.
nsurance Company Name:
?olicy.#or Self-ins.Lie. #: QC0_SO6ot45A 0 Q Q(A. Expiration Date:-
Iob Site Address:5a►laoY)E bCl Ln• Max-GA, ►I State/Zip:
attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
aihue to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
)f up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
'do hereb ertify n r the pain d pe aloes of perjury that the information provided above is true and correct
ii ature:.
Dater.
?hone# rJ�8- (�' �'l
Off ieial use only. Do not write in this area,to be completed by city,or town official,
City or Town: ► Permit/License#
Issuing Authority(circle one):
1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
oFIKKE Town of Barnstable
Regulatory Services
• BAMSTABM
NABS. Thomas F.Geiler,Director
'ArEo;9. Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Cc)mplete and Sign This Section
If Using A Builder
I, LoUe a f 7 el ,.as Owner of the subject property
hereby authorize & Sedgy►c. to act on my behalf,
I in all matters relative to v ork authorized by this building permit application for:
. 5 ,n b�-► �.. . Mars . (�1►lls
(Address of Job)
ature of rQAer Date
Print Name
If Property. Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:0 WNERPERM ISS ION
oFTHE r Town of Barnstable
Regulatory Services
BARNSTABLE. Thomas F. Geiler,Director _
y MASS.
1639. .0�a Building Division
lfD MA't
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
ww`v.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 Officiation a,form acceptable to-,the Building Official, that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned "homeowner certifies that he/she understands the Town of Barnstable Building Department.
minimum inspection procedures and requirements and that he/she will comply with said proced&es and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S-EXEMPTION
The Code states that: "Any homeowner 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 supensor(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 forn✓certification for use in your community.
Q:forms:homeexampt
Date: 5/5/2008 Time, 10:03 AM T03 R 9,5083626115 Pays: 002
ChenW,9742
ACORM CERTIFICATE OF LIABILITY INSURAN E os0510088 "YY"'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dowling&O'Neil Insurance ONLY AND CONFERS NO RIG 4TS UPON THE CERTIFICATE
Agency HOLDER.THIS CERTIFICATE ES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFC RO':O by THE POLICIES BELOW.
973 lyaruuyn Rd., PO Box 1990
Hyannis,MA 02601 INSURERS AFFORDING COVER kGE NAIL#
INSURED INSURERA: Harleysville Worcester Insurance Co.
Baker&Associates,Inc. INFER B: Associated EmployDrs Insurance Compa
P.O.Box 923 INSURER C:
Centerville,MA 02632-0071 INSURER D:
INSURER E.
COVERAGES
T HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY RIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
rFFECTIVE POLICY EXPIRATION
Lit TYPE OF INSURANCE POCKY NUMBER DATE DAIS LIMITS ---
A GENERAL UASH fY C3831748 04/19108 U4/19109 OCC IRRENCE $1 000 000
r(31-tfl.
MERCIAL GENERAL LIABILITY REMISES IO RENTED $100 000
CLAIMS MADE nX OCCUR o ExP , One person $5 000
Ded:250 RSONAL a AIN INJURY $1 D00 000
ENEHAL ACCRLGAT; s2.000.000
GREGATE.LIMIT APPLIES PER: I
CDUCTS-Ca WfOP AGG s2,000,000
PRO- LOC
CT
AUTOMOBILE LIABILM OMBINEO SINGLE I IMIT $
a acddent)
ANY AUTO
ALL OWNED AUTOS ODILY INJURY $
'or person)
SCHEDU LF-D AUTOS
HIRF:OAUTOS OILY WJURY $
er acddenp
NOWOWNFO AUTOS _-----
OPFRTYDAMAGL b
er acddent)
GARAGE LIABILITY vUT0 ONLY-EA ACCIDENT $
ANY AUTO THI-R THAN EA ACC $
�UTO ON.Y: AGG $
EXCESSAIMBRELLA LIABILITY CI I OCCURRENCE $
OCCUR CLAIMS MADE GGREGArE. $ --_---
b
UETJUCTIBLE b
b
RETENTION b
WCS'TAPJ- OTHF$100B WORKERS COMPENSATION AND WCC50024540120M 04/23/08 04123-09
EMPLOYERS LLIBRM I �cH ACCIDENT 000 ANY PROPRIFFORIPARTNEIVEXECUT NE
OFFS•—:.. _4a-,L.,EXCLUlE07 NO
ISf Pyye[s .L.UISEASE-EA EMPLOYE 51 OO 00
donSd -L.DISEASE-POLICY LIMIT $500000
:CIAROIIONSb
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEIDCLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECULL PROVISIONS
Officers are included udder the workers compensation policy.
Insurance coverage is limited to the terms,conditions,exclusions,other
limitations and endorsements. Nothing contained in the certificate of
insurance shall be deemed to have altered,waived,or extended the
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE oESCRBE POLICIES BE CANCELLED BEFORE THE EXPIRATION
Town of Barnstable DATE TLiHtEOF,THE ISSUNG INSURER WL ENDEAVOR TO MAL In GAYS WRITTEN
Thomas Perry
NOTICE TO THE CERTIFICATE HOLDER 0 ANIE0 TO THE LEFT.BUT FAILURE TO 00 SO SHALL
200 Main Street IMPOSE No OBLIGATION OR UABRJTY C F ANY KIM UPON THE INSURER.ITS AGENTS OR
Hyannis,MA 02601 SENTATIVES. —--
MU:WyRIPf�SENI'ATIVE
S1 0 ACORD CORPORATION 1988
ACOR:,[o<<001/08)1 of 3 #SS1922/M51911
f
�zx ✓�te "l�ona„carcue� a�'✓�aasacltudeltd
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
_ Registration: 162600 Board of Building Regulations and Standards
Expiration': '3/26/2011 Tr# 282115 One Ashburton Place Rm 1301
Boston,Ma.02108
Type: _Rrivate Corporation
BAKER&ASSOCIATES INC::-.:.
MARK BAKER
521 SHOOTFLYING-HILL,RD' � ''Q� --- -- - — - - ---
CENTERVILLE,MA 02632 Administrator Not valid without signature
7k iaa,�v„zovwrea a� ac�ucaelta
= Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registratiori 152600 One Ashburton Place Rrn 1301
Expiration 3/26/2011 Boston,Ma.02108
?Typei=Supplement Card
...
BAKER&ASSOCIATES INC'=.; ,.`:_.`
BRETT BUSSIERE.
521 SHOOTFLYING'HILL RD"
CENTERVILLE, MA 02632 _...... -.__.._-..-
Administrator Not vali ithout signature
p u h 1k:
BoardEon' Bust( i•la°u► �a`��tli��st a���§ and �t����t��€s ���,
��_•� Construction 'Supervisor License
License: C S 74477
Restricted to. 00
BRETT J BUSSIERE '
111 WAREHAM LAKE SHORE D
EAST WAREHAM, MA 02538
Exp atton. 1/6/2011
E ��titi:aea.b•vi,�ct.e r Tr 8715
I
t
,�_ ,,� The Commonwealth of Massachusetts
William Francis Galvin
r
Secretary of the Commonwealth,Corporations Division
x One Ashburton Place, 17th floor
%ti Boston,MA 02108-1512
`+ .t..,��� Telephone: (617)727-9640
BAKER & ASSOCIATES, INC. Summary Screen
Request a Certificate
The exact name of the Domestic Profit Corporation: BAKER&ASSOCIATES, INC
The name was changed from: BAKER CUSTOM ALUMINUM&VINYL COMPANY INC. on 1/8/2004
Entity Type: Domestic Profit_CgMooration
Identification Number: 000522085
Old Federal Employer Identification Number(Old FEIN): 000000000
Date of Organization In Massachusetts: 01/01/1996
Current Fiscal Month I Day: 12 131_ Previous Fiscal Month I Day:0. /00
The location of its principal office:
No. and Street: 521 SHOOTFLYING HILL RD.
City or Town: CENTERVILLE State: MA Zip: 02632 Country: USA
If the business entity Is organized wholly to do business outside Massachusetts,the location of that office:
No. and Street:
City or Town: State: Zip: Country:
Name and address of the Registered Agent:
Name:
No. and Street:
City or Town: State: Zip: Country:
The officers and all of the directors of the corporation:
Title Individual Name Address (no PO Box) Expiration
First,Middle,Last,Suffix Address,City or Town,State,Zip Code of Term
PRESIDENT MARK BAKER 521 SHOOT FLYING HILL
CENTERVILLE,MA 02632 US
TREASURER CAROL BAKER MRS. 521 SHOOTFLYINGHILL ROAD
CENTERVILLE,MA 02632 US
r SECRETARY BRETT BUSSIERE MR. 521 SHOOTFLYINGHILL ROAD
CENTERVILLE,MA 026323 US
DIRECTOR MARK BAKER MR. 521 SHOOTFLYINGHILL ROAD
CENTERVILLE.MA 02632 US
http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummaiy.asp?ReadFromDB—True... 3/25/2009
r
i
Town of tlarnstable *Permit# o2666 5 q �0
Expires 6 months from issue date
X-PRESS PERMIT Regulatory Ser.'PCes Fee
Thomas 1�.veiler,.Director
DEC 2 8 2006
Building Division
TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner
200 Main Street;Hyannis,MA 02601
www.town.bainstzble.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
n I�Not'Valid without Red X-Press Imprint
Map/parcel Number
Property Address S Mcionft,
YResidential Value of Work 51 '" " Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
5�S1�"e�o � Lc1 . Meals
Q)Contractor's Name �o.rriQ S' Telephone Number �9 O - �-"'
Home Improvement Contractor License#(if appli le)_ - 194-Z 0
Construction Supervisor's.License#(if applicable) _
❑workman's ompensation Insurance
Ch one:
Fj I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
�Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Zoow en Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise071405
i
Town of Barnstable
Regulatory Services
HAMSPABLE, a
v Mass. $ Thomas F.Geiler,Director
�A s639. �0 Building
Pf1639. Building Division.
Tom Perry, Building Commissioner
200 Main Street, l:iyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Trust
Complete and Sign-This Section
If Using A Builder
I �6r�1t�. . U e,
' ,as Owner of the subject property
r
hereby authorize l to act on my behalf,
in all matters relative to work authorize this building permit application for:
(Addre s f Job)
a 'q u
Signature of Owner ate
Print Name
Q:FORMS:OwNERPERMISSION
1 he Commonwealth of-Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: ]builders/Contractors/Electricians/Plumbers
Applicant Information Please Print L,ezibly
Name (Business/organization/Individual):
Address: P 0 boy,43 1
City/State/Zip: s, '�)R 04U 0 J Phone #: Iq Q - `t`�V_�
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
&Iam
loyees (full and/or part-time).* have hired the sub-contractors2. o[ a sole proprietor or partner- listed on the attached sheet 1 ?• ❑ Remodeling
ship and have no employees These sub-contractors have 8'. ❑ Demolition
working for me in any capacity. workers' comp.insurance. g, ❑ Building addition
[No workers' comp. insurance , 5. ❑ We are a corporation and its 10❑ Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ PPambmg repairs or additions
myself.[No workers' comp. c. 152, §1(4),and we have no 12. oof repairs
insurance required.] t employees. (No workers' 13 ❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.'
_t Homeowners who submit this affidavit indicating they an 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
-information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,50Q.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 dohereb�unthe pa' s nd penalties of perjury that the information provided above is true and correct
Si afore: Date: loci
Phone#: -1 9 0
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Insprecter
6. Other
Contact Person: Phone
Y .
71.
Board of Building
g Regulations and Standards
HOME IMPROVEMENT License or registration valid for in
CONTRACTOR
Re Istration 1243t0 before the expiration date. If founds return
use only
��rat a�i``=!. Board of]Building g} 007 turn ds
One q. g Regulations and Standards
H y ividual Ashburton Place Pm 1301
ames Curley ; —-• — i Boston,Ma.02108
n
imes Curley
:7 Fuller Rd.
�nterville,
MA 02632 �--�
Administrator
Not valid without Sign
a ire
i
i
.o K
Assessor's offioe (1st floor): INE
/ a��-
�, Asse,,�ior's map and lot number .. ............... .......��� S+EmC
Board of Health (3rd floor): SY
Sewage Permit number .....�
Engineering Department (3rd floor): o ,b 9- ♦�
Housenumber .............................................................. QQQ N d'
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TO REGULAPONs
TOWN OF BARNSTABLE
BUILDING, INSPECTOR
APPLICATION FOR PERMIT TO .G.QX1S. ]dGt... ...5.]. �. e,,,family dwelling
TYPE OF CONSTRUCTION ......W4oa...frame .......................................................................................
.......... March 25 .........19.8.9
j TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
' Location ....Lot...#.7.................................S.tone...S.>;idge...Lane.....................pia.tat=5...Mx.11,5............................
I
ProposedUse ..................................................................
............................................................. ire District ...CEn.te7:.v..iI.I.e/..OS.t r'.vil,le
Zoning District ...�,,,� F'
I .
Name of Owner .Ca.prA.CA.rn...Realty. ..T.r.us.t...........Address ....7.6.5...Fa.ImQutkl...Rclad......Hywani.s............
Name of Builder ..F.ran.Oo...R...F......Dev...CO...In.0........Address ....7.6.5...F.almo t.h...RQadr....H.y.saY HYP=Ii.5............
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ...........SiX................................................Foundation ........P.—C..............................................................
Exterior ..C.Lapboaxd...an.dl.ar...shingle.s................Roofing .........a.sph.alt...sbingle.s..................................
Floors carpe.t.....................................................................Interior ......Sheetrock......................................................
g ...°:Plumbing .......'1'wC1-CO.p�]er...................................
Heating .....Gas-F...W_A..................... t
Fireplace .....Ye.S.....................................................................Approximate Cost .........$4.�.r.000 . 00.............
Definitive Plan Approved by Planning Board --------11_(__°23_._______19_0�_ . Area ...�DCO... .. ... ..........................
Diagram of Lot and Building .with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. .... .. . ... .
Construction Supervisor's License ....0 0 0 9 8 9
......................
CARRICORN REALTY TRUST
N+33X. Permit for .... ?. .S.....tory...........
.....
SinglSinqle Family. Dwelling....,..,.
e .......... . .......
Location ..Lot.. #7.,. 52 Stone Bridge Lane
........................................
Marstons Mills
...............................................................................
Owner Capricorn Realty...Tru.s..t........
Type of Construction .....Frame
........................... .........
. ............. .................................................................
.......................Plot ..... Lot ..... ..........................
7? 2 ,
Permit Granted .......June...................1...............19 90
Date of Inspection ..............................19
k Date Comple ed ...... ......-.9z 19
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�iECTION �OF to
' 'TOWN OF BARNSTABLE, MASSACHUSETTS 11 U 1 L 0
A=125-006.001. 002 �7
DATE �U11: =�- r 19 90 PERMIT NO. 1.O 3823
` Franco R. E. Di:,v, Co. j:i1C. ADDRESS 765 Falmouth Road Hyannis #'00.0989
(q APPLICANT.
G' (NO.) (STREET) (CONTR'S LICENSE)
Build Dwelling 1 .11 T NUMBER- OF
PERMIT-TO - ( 2) STORY Silaicile Family Dwe•..linC�DWELLINGUNI.TSr` '
I' (TYPE OF IMPROVEMENT) NO. (PROPOSED USE)Lot
,.
AT (LOCATION)) .# / , 52 SLonu BridCJE? Lrcuar3. liarstons Mills ZONING'•:,.
t (N0:) (STREET) Y
DIST.RICT_`R�'
BETWEEN- ,AND ap
(CROSS STREET) ItEROSS STREET)
SUBDIVISION LOT BLOCK LOTSIZE
BUILDING IS TO BE FT. WIDE BY FT LONG BY FT, IN HEIGHT AND SHALL,CONFORM IN CONSTRUCTIO
TOTYPE USE GROUP BASEMENT WALLS OR FOUNDATION
Sewn (TYPE)
Sewage .
REMARKS: CJ #89-15'%
' ..-B
(� ond;.. ;
AREA OR
�I VOLUME 1836 sq. ft. ESTIMATED COST _®O i OOO. PERMIT,; ''1.,3'��1
( 00 FEE, $,.` 7.5
)a (CUBIC/SOUARE FEET)
Pricorrr Reuity 1�'�OWNER Ca f _
ADDRESS 765 Falmouth Road, f(` cu ii: BUILDING DEPT.
BY
A S t 1`H E L APPLICANT FIR O
M THE C O N D I T I O I lip
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED ' FOR
ELECTRICAL, PLUM81NG AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI TO BEFORE
FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET .
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
�� Y�1•
2 2 --
HEAfING INSPECTION APPROVALS ENGINEERING DEPARTMENT
M
1
I
)
OTHER BOARD OF HEALTH
� 7� �l a
7 �Gv t1 e er
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD GAN
CONSTRUCTION. 11 PERMIT i5 ISSUED A$ NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITT
NOTIFICATION.
TOWN OF BARNSTABLE 33
Permit No. ................
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
HYANNIS.MASS.02601 Bond ......V..........
CERTIFICATE OF USE AND OCCUPANCY
Issued to Capricorn Realty Trust
Address Lot #7 , 52 Stone Bridge Lane
Marstons Mills, Mass..:
USE GROUP FIRE GRADING OCCUPA.N.CY LOAD
E
THIS PERMIT WILL. NOT BE VALID,- AND THE.BUILDING SHALL NOT BE,OCCUPIED.UNTIL•
SIGNED BY.THE BUILDING. INSPECTOR UPON SATISFACTORY; COMPLIANCE :WITH ,TOWN +
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS.STATE
BUILDING CODE.
March 1 i , t9. 9 0
...... .... ... ....... ..
Buildi g Inspector
Q,INC TOWN OF BARNSTABLE 3��
Permit No. .
BUILDING DEPARTMENT
I "":Nnl I TOWN OFFICE BUILDING Cash ................
7
X
HYANNIS.MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to Capricorn Realty Trust
Address Lot #7 , 52 Stone Bridge Lane
Marstons Mills, Mass.
r• USE GROUP FIRE GRADING OCCUPANCY LOAD
J THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE'WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
a�
March 11, 90
........ 19................. ..................
Buildi g Inspector
y.r . _. ,' .._ _ -+.,. f+ ..-`p•- ,.-.:�.;., k s .,........ .r+Fes,• -: ... rr�y:.-._" ......+ 9t' 3�f'f_9N::O�w lX i.fAC:t� 7al' xA Y.
�
AR ,
TOWN OF BNSTABLE, MASSACHUSETTS BUILDING PE RM I T
A=125'=.0�06.001. 002 yy�T
DATE June 21, 19 90 PERMIT NO. NQ 3382a n
II APPLICANT Franco R. E. Dey. Co. Inc- ADDRESS 765 Falmouth Road. HvannjE9_'___'W0bff989
INO.) (STREET) (CONTR'S LICENSE)
�. Build Dwellln 1} NUMBER OF
PERMIT TO g ( ) STORY Single Fa?- ily Dwel,linc� DWELLING UNITS
i (TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
Lot #7 52 Stone Bridge Lane Dfarstons Mills ZONING
CT— RE AT (LOCATION) i
(NO.) (STREET)
BETWEEN ,AND ;b. 0
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
r
(TYPE)
REMARI(5:. Sewage #89--157 -
Bond
AREA OR
VOLUME 1836 sq. ft. ESTIMATED COST $ 140/000. 00 FEEMIT
FF 135. 75
(CUBIC/SQUARE FEET) ,q
OWNER Capricorn Realty Trust 1 lI
`C BUILDING DEPT.
ADDRESS - 765 Falmouth Road Hyannis BY +++,,,��� r
..... lo:.-1 •++ ,�r y. _ _ � /".«��.
TOWN OF B
B;ARNSTABLE;-MASSACHUSETTS l25 pp(,� UILDING P RMIT
A=1250-.€ 46.001.002 C07 ��rr
DATE .Tune 21, 19 90 PERMIT N N9 � <«
APPLICANT Franco R. E. q)e°V• Co Tnc• ADD�ESS 165 Falmouth Rood, Hvann�_'*0-0 89
(T (NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO L3u11C.1 Dwelling:J (_�•) STORYS�eig e Faaily Dwe:�linq DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)Lot # 1, 52 Stone Bridge Lane, Marstons Mills D ZONING
STR CT RF
(NO.) (STREET):
BETWEEN '+AND-
"o
(CROSS STREET) � (CROSS aSTREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE -FT. WIDE BY "" FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: Sewage #89•-157
Bond
rr y
AREA OR
VOLUME' 1v36 sq. ft. ESTIMATED COST � do 000 00 FEE
135. 75 .
(CUBIC/SQUARE FEET)
Capricorn .Realty Trust
OWNER BUILDING DEPT.
ADDRESS BY
i
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE J'URISD'ICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI 70 BEFORE
FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
3 aaq. HEAfING INSPECTION APPROVALS ENGINEERING DEPARTMENT
OTHER 2 BOARD OF HEALTH
0 VDK� 'f, Qv 6�.17 p'l •�
7
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE
TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN
CONSTRUCTION. I PERMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION.
BUILDING
PERMIT <�
Assessor's�d`offioe-(1st floor�l
Assessor's map and lot number .. ./ —� P�OftTME T0�`
........................,..
Board.of Health (3rd floor)!
Sewage Permit number 1.. ./ ..........� /u.(� :• BASII9T(�DLL,
Engineering Department (3rd floor): moo >re}v
House number 7�.`......z.....:gic/?�...... c aY L�0
APPLICATIONS PROCESSED- :30-9:30 A.M. and 1:00-2:00: P.M. only `
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .cons,truct.,.a,.sincgle...family„dwelling ,
TYPE OF CONSTRUCTION .......wood..............frame
...................................................................................................:............
,tA 9
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..... ot....#7.................................Stone...Bridge...]Gane.....................Marsq�d�ns 'dills............................
r.
ProposedUse .........................................................:... ...................................................................................:.....:;.......
Zoning District ...R-F'.r...........................................................Fire District ...centerVillel,0sterville
Name of Owner .Capricorn...Realty.,.Trust Address ....765...Fa.lmouth„Road,,,.Hvanns
Name of Builder ..Franco..R...E,,....Dev.Co...Inc........Address ....7.65...Falmouth„Road,•,.Hyannis
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ...........Pj X................................................Foundation ........P.q C..............................................................
Exterior ..clapboa.rd...andlor...shi,ngl:e-9................Roofing .........asphalt..shingles................ ...
Floors Carpet.....................................................................Interior .......she.P_.tr.o!zk..........................
...........................
Heating ......Ga.G.-F.....W.e.A.....................................................Plumbing .......TXSJ7nC.0np..er.................................................
Fireplace ......y.. ..
es. .......Approximate Cost 40,000.00
pQ ff
t, Definitive Plan Approved by Planning Board _______��_-___�3..______19__o_[__ , Area .......................-..................
Diagram of Lot and Building with Dimensions Fee ............................................
.'SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
f
f
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... ..� ..../ �... .,�G/�!1 .... —�
f r
000989
Construction Supervisor's License ....................................
CAPRICORN REALTY TRUST �
A=125-00 001 002
ids aab.��
No ..33$.13 Permit for ..1.i...St9.rY.............
M..4 ...Dw�l.l.�, g........
Location .Lot #7, 52 Stone..Btidge Dane
Marstons Mills
Owner ...Capricorn Realty...Trust.....
Type of Construction ...Frame
..........................
...............................................................................
Plot ............................ Lot ................................
Permit Granted ..... ..............19 90
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT COMPLETED 1,1/,_j.(_
0 7
REVISIONS: '
SEPTIC TANK DETAIL:. 1000 GALLON, DISTRIBUTIONBOX DETAIL: LEAk"n
C -'ING PIT DETAIL. .'
-MICATES
.1ii SOIL TEST PIT DATA:
DATE
OBSERVED NOT TO SCALE NOT TO SC�LE 1NOT TO SCALE , NQ
P6955' OROUNDWATER
TEST .04M G SEED
NOTES: L SEPTIC TANK SMALL BE STEEL 4. VWET AND OUTLET T"S TO IIIE CAST 9M OR NO. OF OUTLETS: MAN14OLIE 0MR
OR PAVEMENT
BROUGHT TO FINISH DRADE-A
'REINFORCED CONCRETE. "SCHEIN 40 PVC. MS Td 6E CENTERED UNDER
_TP
TP & 7 TIP TP 'MANHOLE 1150YER. NOTES! fillil
2. SEPTIC TANK TO WITHSTAND IH-10 LOADING
I:-L.— GRO. IEL. r L DIST. BOX TO WITHSTAND H:40 LOADING 2"WIN.OF lov�
65,0 ;VIRD. EL. UNLESS UNDER PAVEMEmTbRrVEs OR
I 'WOER PAVEMENT.DRIVES OR
UNLESS U TO Ift FILL
OW. EL. TRAVELED WAYS,WHEREIN H-20'LOADING
J PRECAST EIN H-tO LOADEG
SHALL'APPLY
GW.'IEL. 1V0",C- QW. EL. TRAVELED WAYS WHER
SHALL APPLY.
1511 DIST. I
3. ALL PIPE CONNECTIONS AND CONCRETE wxw"m town
Box 2. PROVIDE INLET TEE OR BAFFLE 0
PC INLET PIPE- 0 C3 c= c= t= 9= tm c2b
INLET PIPE EXCEEDS 0.08 FT/FT OR (V
CONSTRUCTION TO BE WATERTIGHT. 80ROU13"T TO Tn"""An WHERE SLOPE OF
PUMPED SYSTEM.
63,0`
_j 0 ts 9= 9= C3 tm 0 a 6 440TE: GENERAL NOTES:
mi . I- &
1- 3. FIRST TWO FEET OF PIPE OUT 0 i
F DIST., LEACHING PIT TO
1 000- GALLON
WITHSTAND H-10 LOADING
ME'DIUAJ 81-611 BOX TO BE LAID LEVEL. 0 t3 1= 1= t= C= C3 C3 0 tp .
1. THIS PLAN IS FOR'DESIGN AND :
PLAN VIEW UNLESS UNDER
CONSTRUCTION OF THE SEWAGE
PRECAST
REMOVEABLE DISPOSAL IFACILITY ONLY.�
70 Q= tM 1= t= :Z= C3 0 TRAVELED WAY,WHEREIN
"Oft"L O&T91t LXVIEL COVER 3/4"TO We PAVEMENT,DRIVE OR
7
-LEACHING PIT -CONSTRUCTION METHODS AND
10 ]DOUBLE %&.. H-20 LOADING SHALL 2. ALL
#.-5. 7 A W- APPLY.
93 WASHED 0= C3 C= C= =7 C3 T3 0 '
1'4! f MATERIALS SHALL-CONFORM TO MASS
4" STON
PROVIDE E
-. I t D.E.O.E..TITLIE-5 AND LOCAL BOARD
HT no fineit)
WLtT TEE OF HEALTH 'REGULATIONS.
WATER
C3 C-_3 C3
015 a cm
JOINTS C3 C3 0 :::z
PRECAST
W-Ir am. OUTLET 51-81'
ENT
SZPTIC LMM DEPrN TEE or "OTE-2 0 C3 C3 CM r_3 C3 13 a 3. ALL PIPES LOCATED UNDER PAVEM
OR TRAVELED WAY SHALL BE
41' 1011
TANK
W
:0- wi
(D -w SCHEDULE 40 OR EQUAL.
elf-.
4. ALL UNSUITABLE MATERAL (TOPSOIL,
DIA.
L _J
6' SUBSOIL, CLAY) ENCOUNTERED BELOW
-77�-
THE INVERT OF THE LEACH PIT �TO
-BOTTON ON
SOTTON 001 LIVIEL STARLI 10' DIA.
LEVEL!TIkBLE BE REMOVED FOR A DISTANCE OF
CROSS-SECTION AROUND AND REPLACED WITH
10'
PLAN VIEW CROSS-SECTIM VIEW CLEAN COARSE SAND.
&ROSS-SECTION
144" .............
DATE:
DATE-* DATE: '31 AT E:
INVERT ELIEVATIONS:
5-3 1
TEST BY: TEST BY: TEST BY: TEST BY:
INVERT AT BUILDING'
STEPHEN HAAS
A
INVERT AT SEPTIC T NK(in)
WITNESSZO BY: WITNESSED BY: WITNESSED BY: WITNESSED BY:
&3.3L
INVERT AT SEPTIC TANK(out)
JERRY DUNNING
PERC. RATE: PERG. RATE: PERC.IRATE: PERC. RATE:
INVERT AT DIST. BOX(in)
_'MINJINCH
MINJINCH _M1N.fINCH MINJINCH
z
6 INVERT ATDItT. BOX(Out)
-7
INVERT AT LEACHING PIT
BOTTOM OF 1-'EACHING PIT
DATUM.
U.S.G.S. MAXIMUM GROUND
IV
WATER ELIEVATION
VERTICAL DATUM: N.G.V.D.
65
OBSERVED GROUNDWATER
BENCHMARK USED:
M28RA DISK M.H.B. ROUTE 2B EL. 61 .76 N.G.V.D. , ELEVATION A
LOT 7
t
22
ZONED : R.F. LOT
o- 51 -4, Ac .
SETBACKS ( OPEN SPACE) :
3 0'
FRONT ,
SIDE : 15'
REAR: 15 19 65�
0
0 0) DESIGN"CRITERIA,
[RESERVII
X,_ �ol
Or 7 110
_�_BEDROOMS AT G.P.B./D L3_0 G,P.D.
A
NO GARBAGE GRINDER
-ot
NOTES:
4116
Y LIN' Sol V
E INFORMATION.
I FOR PROPEAT SEE PLAN C Group
Ifo
REQUIRED SEPTIC TANK:
RECORDED -AT THE BARNSTABLE REGISTRY OF DEEDS. 14 -In T I
0
0
PLAN BOOK 447 PAGE 44.
Ap \0 I 1z
?0 &be 330 )( 150 % 495 ' GAL.
2. THE TOPOGRAPHIC INFORMATION SHOWN WAS
SEPTIC TANK PROVIDED: 1000 GAL.
OBTAINED BY AN ON THE GROUND SURVEY.
LP Cod Survey Corwiltants
SIZE, OF LEACHING FACILITY REQUIRED:
3
3. UNDERGROUND UTILITIES WERE COMPILED FROM AVAILABLE DESM PERC.RATE:-
MINJINCH
&4-
RECORDED PLANS OF UTILITY COMPANIES AND PUBLIC AGENCIES 3236MainStreet
(A RoLAe6A
AND ARE APPROXIMATE ONLY. BEFORE CONSTRUCTION CALL
330 G. P. D. CAPACI Bamstable Village MA
TY
'DIG SAFE* 1-800-322-4844.
026W
617 3628133
614
Ae
PROJECT TITLE.
6z SVE OF LEACHING FACILITY PROVIDED:
WDEEP X WDIAM. PIT W/ 2' STONE
SEWAGE DISPOSAL
J9
_IDEWALL 178 S.F , 2.0 356 G.P.D.
SYSTEM DESIGN
139. 0e. '
79 S.F. 0.83= 65 G.RD.
-BOTTOM
0 F
TOTAL: 257 S.F. 4 21 G.P.D.
LOT 7
I" OF 4f Al�
S
21 G.P.D. >- G. P. D. OK
:W W10,E W,471EZ A-(41A.1 45.4SEA1f&A17- 4
STONE BRIDGE LN,
RENWICK
B.
CHAPMAN I N
-A ' 2083'&
L
No. 2765 OCUS PLAN ' I"
NAL MARS'rIvt'\Nb MILLS MA.
NGINEER — CIVIL LOCUS _j
LOT S 70JY_r_-,
_�ZD?AT E PROFESSIONAL DG.15
...........
PREPARED FOR:
NICHOLAS FRANCO ,
Pomp
I" OF
C.
Q1 FRANK --:z DATE:
WHITING JUNE 13 19BB
No. 29
869
COMR/DESIGN: S.A.H.
CISTE*
CHECK: C.F.W./R.113.c ..
'PLAN VIEW DRAWN: T.A.-W
DATE- PROFESSIONAL LAND /dURVEYOR SCALE: 10.= 20' FIELD: R.E.G./T.A.W.
FILE NO:
IL
FEET DWG.NO: 1336-7 SHEET:
0 0 20 . 40 60
JOBNO:3.3047 .0 I OV I
JL
4" INLET
i:j 7E -
7
iq 7:
------------ ------—-----