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Home My WebLink About0566 WAKEBY ROAD �� -� � �Da-� a e.._ - —�_ .. __... _�. _ .. . y.:- y --7'e -1,,- 11 1. 1,0 4 0 rrI i a " � 0 0 Town of Barnstable Regulatory Services tbs9 � Public Health Division 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET HYANNIS,MA 02601 PERMIT EXPIRES: ANNUALLY on DEC 31st PLEASE INCLUDE SIGNATURES OF INSPECTORS FROM THE BUILDING,FIRE AND HEALTH DEPARTMENTS AND THE REQUIRED$50.00 FEE-PAYABLE TO:TOWN OF BARNSTABLE APPLICATION FOR A MOTEL LICENSE DATFj14 Z O 1 (o C RxI'P NAMEOFNIG L 194vp j 'TL-aaA c—s 'N55Qca _it~S pq-w1 P ADDRESS OF MOTEL 5(91b 5 O WAV—U-a-( IRO, I(ft;T-e -5 M'111,s rift 0 2 cvL4 Or VILLAGE OF IeTF-L NW S"1" 11Q 1-S NO. OF UNITS.36 4NA91Z SY 4 3 S Jr1��I �t�S 3caz��a MAIN CONTACT NAME: EMAIL: PHONE: SWIM1vIING POOLS: INSIDE POOL CAPACITY OUTSIDE POOL 1-20,t b CAPACITY 19 SOLE OWNER PARTNERSHIP CORPORATION50I-C-7 S06()1LClL1a-'p'1S STATE OF CORPORATION FEDERAL IDENTIFICATION NO.a q-20 2-`'I 95; IF PARTNERSHIP: NAME AND HOME ADDRESS OF PARTNERS Tel.No. Tel.No. IF CORPORATION; NAME AND HOME ADDRESS OF CORPORATE OFFICERS President k AN�'-1 9AQ T LL�IY ` RUG-WE Tel.No.,56-S-(-Qt 7 4,5 8 kom2 Treasurer 1 O 1U C- J�]gsTVA N Tel.No.56S "L46 -2-V 8 i4mvt e- Clerk Pn w�I:1. I. L-?0 D U " ` e29-r c-$ Tel.No. 7 7 2-(obj-Lt QC( Cott IF SOLE OWNER:NAME AND HOME ADDRESS : Tel.No. INS CTED: (SIGNATURE OF APPLICANT) BUILDING DMSION DATE — FIRE DEPARTMENT DATE HEALTH DMSION DATE Q:4Application F6rms\MOTELMay2015.DOC Page 1 of off s o r� � _ i ,�� o � �° �e�� ,2 �� + . . .. . . ` �YI�R �• t Q V A �v RV RY - � v BRIAR LANE irnr�sw, �' .r3 e H , 00Z A o Rv� McLain iZv T U' - House H s - BLUE r L sNowERs D ® Doll v FV_j Tennl E v P Cot."rt E House SAUNA 0 R LONG 0 0 Volleyball �� T T ,� T L 4 L \ -� Sep p t►, T_. �r POND o �.�.;, .� A Dump �' mun C� B u - O - E J Bath use E Pavillio q - '1 Shower H r \ O ; Parking T o L Journ y's Member Sites == R� A L En� 11 Terraced Trails= :OFFICE D o C H w d L S. U Sandy Terraros Nudist Campground O . Camp TOAD ROAD O B R P.O. Box 98 "", p - d Marston Mills., Ma 02648(S08)428-9209 Gate" House .Rv 570 Wakeby Road ENTRANCE - Y (,1S 6 5ek;:yc,lrfYr•}]/a:•n J `.{,x` . - ^" •`�+.'Ft'rKr`.•r e�``.np {'y,y:�. .+3• .81Ct,,,,prd ;r',{t u, r... ^.P{cr t/ ,r. °3 x� i li' ,^1ti' •;� r. �_ 77 �'s; :�iNird{�+4mK,Y,T,.NJISd' Z•'..T.. ,.'. .,... �j,Vn � . ••r'�,.Q� r�� ,/ qw � /, :��'-/�1:<fF4i�:• r�'t�� ,d ►JW �r4MroM�•,+,+tlr1»• .�=••:•r• .1/"/ r•[31^� �v��i.r1 r..,4• �(. uY Il �•Ay</ \.: -�ci' :If.'k'gJ1k+{!i�::Y'o l'IPf:%i,j: \/�� ... .. v:.,r.,�,: � •, �� LA Yl IL •�'%o'�.�:7;�'t.<�%S�h!1;:c � � ,r ::i..n;+:�. �.l• S i•';}Ir(•'.'F",1�: ..��, `M {' '. fir',•,��.� •,. �.._....�p w •,y'.,= xs::', 1�1Vt.��•. � �`y�y�'�:� �`I� e/r1G�� .�V h1.A S ��/�.[/^��YI'.•,.. , � ,-r` •ur. _ ;.:;? w..�. - .IuaWVaf +:l,'f. [.1 N �!�' � ,�/\^ I'\�� X � �) .��:`::!•.7.V.L,1'::{,�r t.�{•!,ri'^.: ``. - n5��-'r7'1;��'•: :.., r��,V :. �.:� ��,�-- { ... �' � �, ,� ,�,,e;:?�;: ram:',: f� T 'uDt�1 _ , �I�i`•j�',H/yyy - fit�,.. 777 *,�-51 . �;�{;:�.1rS 2i••. Qom• �`I�. .� �. Q�� t� ��j/? � , Ilf'+A / b � �, r• y 1 �j J'/ , � / r r�• e),4 t-4 1 eJ r Yy..... rr•O. , 1 f t r..r. H � �•rr�4f:f.. v, _ NZ oo M. IFIrIf. I��.f��: -t[¢j�_�l :��•:.15�r.. ,/:�!, '�i' �J .. � ... ^1:' /� �" 7�,.• _:�1�►VPf�vJ� i,.r:n•;:�''.�::C,,'r.:'v',nr.•�„ .f•..% ;:•,�, •r.• � ' ..L[:,-L., .v ..�Y//'/�„r'///� ' •^�. S'�'T Oi 1�R.'S�- ��'' � ' �!• Jr �\>�/' r •T.!!✓�.,..r rd / ��. T �� I'/ y '1 rf, ..i i .�'.J. .� APB...:::-•: ,, .,,/;/ I T�a.�.��";// ,>/ , . , r � J MUNN OF ABLE I NP11V 21 I' 18: 19 ,1. I UX Assessor's officpe(t st Floor): O�$ SEPTIC SYSTEM MUS to Assessor's ma arid lot nu ber $ Mt INSTALLED IN `. Conservation(4th Floor): WITH TITLE o Board of Health(3rd floor): - �N TITLE 5 � { ssa»rante Sewage Permit number . �''Z/ i M �1�®�84ENTAL Engineering Department(3rd floor)* �0,5- ` > TCE'�f� '�.fr9� � q.6°fir4713 House number' 70 ��JT i I rr. Definitive Plan Approved by Planning Board _ 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only t TOWN O,F 8ARNSTABLE ..BUILDING INSPECTOR A APPLICATION FOR MI PERT TO (DW f-0X L)6- 017—. o TYPE OF CONSTRUCTION Wt50� - w� 919 TO THE INSPECTOR OF BUILDINGS: The undersigned hererebby/applies for a permit according to the following information: ^ � Location Proposed Use ?AV, L 1 Q7 J rO fe 00-( >O 0F_ Zoning District ✓ I ✓ Fire District efC-lV1 05-r. "/1-1,Y Name of Owner 51 10P r,6AWA 5 /95Soe - Address P( &)I, q9 AIAseS''7oAdS MIL 4 —s Name of Builder 1"I�_MJMS Or' 80,6- A.104f Address 14 ` Name of Architect 'f "` Address Number of Rooms ® Foundation Exterior 0 Y f-- 1J Roofing r L-��DO� 7 -��7 �� Interior A)Floors Heating Plumbing Fireplace Approximate Cost ` --o 1-:) 0 Area �`T Diagram of Lot and Building with Dimensions Fee y�®� N 11C! a i Z c9 o wlqK 4 A—P 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 U ll+G� _rA Ivy -76_ S' f}I'f'O G'. Construction Si ipervisor's License i SANDY TERRACES ASSOCIATION No .. 36776 Permit For BUILD PAVILION Location 570 Wakeby Rd. r Marstons Mills ` Owner Sandy Terraces Association �, r Type of Construction ' Plot ! Lot J� Permit Granted' June 9 19 94 ; Date of Inspection: Frame 19 Insulation 19 Fireplace 19 Date Completed 19 S: 0 , vj ►� cif , w. Y l Y TOWN OF BARNSTABLE r: I BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION --------------------------------------------------------------------------- Please print. DATE ��jU �¢ JOB LOCATION (7 WAek-75Y �P.sT�r /�/yZL-f NumberStreet Address Section Of Town HOMEOWNER" 1� Am ;FRAaj �f1ac , 4-2 ,� . 92o 9 NAme Home Phone Work Phone PRESENT MAILING ADDRESS �, O MAkS7_01ur M-71 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 such 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 to six 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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE _211W fA1__PV_,_6&Al2eJ_ �qCfll i APPROVAL OF BUILDING OFFICIAL i Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. NISC5 HOME OWNER'S EXEMPTION {; The code states that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section r (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a' persons) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they. are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction' Supervisors, Section 2.15) . This lack of awareness often results in serious problems, particularly when the Home .Owner hires unlicensed persons. In this case our Board cannot proceed aclainst the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/cer•�ificatior; for use in your community. i �(! �- �' •3 .t:•_�y.,!:y.F7-.-,*I .. r'....,,.' .•'. rig• _Y,.:'!•• 1�t2:.,?�aYt`•o. J°`t•;-^ ,?t':�-•�cc ea y:r� .• �:—z te,if._br. y{h: .. >'L,.•::��..< ;,p.YNx„}• .'�••.d -�F ,�a _ta.y,._-C,r.u�•{:rr,.•� .. ... '..y.t'•.2. °�" '��'.. 1�py�,_; ..r.�..�y::i •• 1{P iiti<teLiie{�b+vaG,f>,Nst�a:.�•y,�,; .::. ... Sur) ,•_',.N�� 1a4�►�'�.. ►4MMMM�n!Pb'w.. .ti.,::•r. :3/"� ..a .r µ:vaJ.�...(,..C.;:..,o ..,�. /'1( i•�K� F••A�.VK.7-,:�r. fn�-ti�:� rtj!�� Jy;L,�::Y'q"iSSr::ta3: l�•—� ... � ..:... -.- •. �t: 't •lJ+;•I �'%;�;i..•x':yy it�; - � � ,,, .r,;::'. .•,. .,_ -J,�t�,Y.F,•;`,, ` 5AVNA .. Y'rC j� X I t N .,i:�' -v-�,.,�•.0 1�!\ l� ?�t /'�� x 1 r •i�:•..,.>.::�r�..•:y rJv'J;j.�.•':. �:r�.4??.• - �ZY++ --� tiX' �: I�lt�i►Y r.� � '� I,./Y� � ,�./� 1,,1'�'�)' ::>>'"y.'.', :L�'i'=!.:i�.�`•`�•�-.v:�;��,.•, , :,i. ttiillJ —t:.,+ ill'-: /� ��' �.'J;�•�r\ r7 x 1� 7'/ 1a �/V'�t vl� �•,�a`Yt•.'/ (� �. ;.e�r wty t,t,s�•; y:Y /, �'C E X �Y y! �� Ir '0, 1A 13 :i{rZ.,',•' �•�`.�.•:•ii,.,.�a 'r• (T. \F'f••r .;O 1 Li it T `I '':r��•' `� ��:�,'1.a�;,•_. •./,r/,/ t� � -,�• � A . is :;fi �_rfa$: r!;•:; ��/" `OLD r�-♦ `'` t t 1 �. ':A'i.� ./;.t t. iF",: '•�• - C�j��' ` p r `,i''♦I .I ��. t1• ��'�ui- %�. �• per,{/ ,i�>^�-•, �i. �: / // ice' � I� � "';�^• �` �� -fit p '"• '� / •'� % Ij sq- ..trx�ji• N�1 �`.sJ a�:r•<�• •� ///.•Jy'/� '�. ��•�— ......"'�wT! % .,� .. //("' - •' • ''i':R6� ;'fat` r �♦/,:, - � •ot Sr/i. �i�, �•�•/.•�,�!':. !`•` '��Vsi�c♦sre' =�Ukc!"',�rrr: ,/. '•.};+r� .. •. .:w �7a;:�y_,�LV�i�� ar/r9 kY 1• •�-%�; _.:.,'ic' j I�/�/'r• . 4 �'.� /' :I .a Klr:P:.}: r / TAa&T4,. I, TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION Map ParceP Application# g Health Division Date Issued. Conservation Division Application Fee 6M 1, Tax Collector Permit Fee " Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis I Project Street Address rJ 6 WA K C BY 1 o A D Village ONR :5 160 N s Ill I L..L5&60 Owner SANSV T2 Aec� CIMAddress '7 Ln ��g�� Telephone Permit Request lL.olt SWk(AAA 1 KJP' ��bo 1. 2- 0 jC 60 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /,56- Construction Type Vituyl Lit-je&-) PbA Lot Size—?)7. �� Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑W%ou ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) l Number of Baths: Full:existing Half:existing new a Number of Bedrooms: existing new n Total Room Count(not including baths):existing new First Floor Room Count I < Heat Type and Fuel: ❑Gas ❑Oil ❑ Elec ' ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: isting ❑new size Barn:❑existing ❑new size E o Attached garage:❑existing ❑new size Shed:❑existin ❑new size Other: e 0 C Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ — e w Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION C* r Name (j c-�;-f m A 4CO Telephone Number Address I `t'3 uQC E2. 0—C3u U License# rl,� E� �Q��► _MCA' d 26 3—1 Home Improvement Contractor# IS-2 ! 26 Worker's Compensation AKA 49 21 15-2 S 2. 1 - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Gxca SIGNATURE DATE CS L y,. FOR OFFICIAL USE ONLY Cyr APPLICATION# DATE ISSUED MAP/PARCEL N0. s - r ADDRESS - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION �oO plcJ U s,3A FRAME .. _ 4 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL' M .� t .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT. F _ ASSOCIATION PLAN NO. 3 i Vie Commonwealth of Massachusetts Department oflndustr•ial,4ccidents' Office of Investigations 600 Washington Street Boston, M,4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/:EIectricians/Plumbers Applicant Information �P^l—ease Print Legibly Name (Business/Orgmizarion/Indivi dual): N C ES i 6 �I -� �O C11 w ' Ad&ess: I 3 UPPE2 03(kQTY 1�0P2 City/State/Zip:�N IJ l5 P02.l-1 AAACZ639Phone.#: Axe youan employer? Check the appropriate box: Type of project(required): 4. 1.LvJ I am a general contractor and I 1 am a employer with �0 6. ❑New construction . employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a•sole proprietor or partner- IistEd on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.•insurance C010p• insurance.$ required] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions. 3. I required a homeowner doing all work officers have exercised their 11. . Plumbing repairs or additions am myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs in c�=Gr.required.]f c. 152, §1(4), and we have no ' employees. [No workers' 13.�Other �Clll►�lA�l/UG- CJb comp,insurance required_] "Any applicant that checks box#1 rnust also M out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavitindicsting such. lcontmctors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ar not those entities have employers. If the sub-contractors have employees,they must providh their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the ollcy and job site ' information. WnTC; (ZJ3 � /:1 Insurance Company Name: C0 oJ�6M $QA AWC€ SF&2 0 a 61+ Nl olS� Policy or Self-ins,Lic.MA)0- A 0215 2S2, 12- Expiration Date: T //-�o /O Job Site Address: O �TVJ City/Stat Mp: Mq2-.S'%a S 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 tip to $1,500.00 and/or one-year i�risonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certi under the pain and penalties of p erjury that the information provided above 's true nd correct Si ature: // Date: _ Phone# Official use only. Do not write in this area, to be completed by city or town officlat City or Town: Permit/License-4 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#1: ACORD CERTIFICATE OF LIABILITY INSURANCE 05iiii200' PRODUCER (508)393-7744 FAX (508)393-6983 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO sox 1129 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 155E Otis Street Northborough, MA 01532 INSURERS AFFORDING COVERAGE NAIC# INSURED Anchor Design 6 Pool Corporation INSURERA: Union Insurance Co 143 Upper County Road INSURERB: Acadia Insurance Company Dennisport, MA 02639 INSURERC: Continental Western Insurance INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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 CLAIMS. INSR ADDI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS at DATE(MMfDDrYYI GENERAL LIABILITY CPA0215251-12 0410912009 0410912010 EACH OCCURRENCE $ 100000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 25000 CLAIMS MADE rX�OCCUR MED EXP(Arty one person) $ 1000 A PERSONAL&ADV INJURY $ 100000 GENERAL AGGREGATE $ 200000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 200000 POLICY EEC LOC AUTOMOBILE LIABILITY 14AA0215250-12 0410912009 0410912010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 100000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) A X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA0215253-12 0410912009 0410912010 EACH OCCURRENCE $ 1,000,00 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,00 B $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCA0215252-12 0410912009 04/09/2010 X I WC STATU- OTH. EMPLOYERS LIABILITY EL EACH ACCIDENT $ 50Q OO C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ 500,00 H yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY FOR INSURANCE VERIFICATION OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. PURPOSES AUTHORIZED REPRESENTATIVE Francis Rittre a EO /CLUI �� ACORD 25(2001/08) ©ACORD CORPORATION 1988 13 0 �dl6f�r�'Yfe �e�i'c'�frt�o�an"913t �ft7S� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Registration: 152726 Board of Building Regulations and Standards Expiration;.•g/25/2010 Tr# 274498 One Ashburton Place Rm 1301 - :.. :Type: :Private Corporation Boston,Ma.02108 ANCHOR DES IGN`&:P00L='CORPORATION THOMAS KEARNS.. .`.;....:: 143 UPPER COUNTY ROAD:-,.: DENNISPORT, MA 0263.9• Administrator not valid with o signature y �. ®eoal INI as Bn S o` "v ♦ V Loan Q LOCUS MAP / I w�aa cw m vulm•_ awl amWffY P1116 025M 0016CC115 9qM ® MAP 28 alm e/la/I,m 3-2 ZOPf10 SUMMARY . � LONG Ica lar s>a Q),Im v.• \ va larrmnnla Im Ica sAwr aclBAa u '� IiL Sm:4ma0K IS lil KAp 3lB,R 15 MAP 28 /' ° ' 3-3 POND a,Holm aticl nc p�18�.' awm.,uam,m„a aWn. B C. wmainale", r�aw¢ _ awr,e lo) ' j i L SITE PLAN OF LAND o �\ "SANDY TERRACES" 1 APPR Am AT °"°ss�0 � MA�26 y n` sErnc #566 WAKEBY ROAD �� 8 ` ; 9 \ � # 566 )� IN fl,01 ji MARSTONS MILLS, .MA / 3aACRES t vavAlBa FM SANDY TERRACES ASSOCIATES 0 �� DAIL'APRIL 13.2007 Fe vce� $keby Roaar 0 1 OF 2 a BC�e,G� ctio,a Lwl� al eae-�-.Sal tm SOB 382-9880 9 TAd.L _ SGLF— CLOS/ue. down cope engineering, inc. �GcF--�MTcNNS� G a C/NL ENGINEERS LAND SURVEYORS Pam- �S 3YpTC Co J t � 939 Main St—t - YARMOU IHPOR7; MASS. YAs/ei �t 1 OF(y�� SinlTaunal Design APpro.'ed � S3. onty when installer)in J rT16I MY 9% strict Accofdence with i•' �J�� ri anulactuter's Instructions CIS'll �� 1.Vrolkcr, P.E. Ic �140. 31376 O t.0 .F COPING LAYOUT XX2:a/•oluS 6 6" Mauro, T y, y, 20 2! 1--7r �1' •F /Z'-'I 2, �E- 1!O' PANEL LAYOUT 7k'2:RADIUS . IPa,IIR 3/f' 6' o' ,I • ' e'b• T t /p' /S 6" �'—B' y' ; X•BRACE DEIjJL A Pa Ivu to of pun Pool Pool I o'MVU.OR U110 Area Capacity ei WM.DTAlnM MAntaL Sq.FL Gallons SUMW J.IMU A -If oralW WMI IIVIM0 . THIS BROCHURE IS FOR ILLUSTRATIVE PURPOSES ONLY A" "" The manulactuner makes orgy Iteae representations which e alerted In Its written warranty.Any Duren EDITION POOLS/ repreaMlalgna,atalements•or contracts made by the dealer and/or the contractor to the customer regarding any matelots produced by the manulaclurer we attributable to the dealer and/or the corltrac• for only.The dealer or contractor who scua or hu alls your pod Is an Independent contractor and not an r lXC"I0011a afMee nr,rt agent or employee of the manufacturer•The construction methods illustrated are suggestions and apply , wow) ' 2O' X 4O' RECTANGLE orgy to normal ground conditions There may be additional precautions and/or methods of construction ' The responsibility is the contractors. raonou wtuW ta•.le•It rk 2' RADIUS CORNERS arayuauo� 04 10QAM SCALE: NONE 1991 RC r 1 TYPICAL INSTALLATION DETAIL ANGLE BRACKET THREADED 3' -�_ 00 ALL VERTICAL DIMENSIONS ROD ---- 2' UVERDIC - -- ARE To IINISFI GRADE AND "(2) 5/6" NUTS " THK. CONCRE[E TN<EN FROM LINER BEAD TRACK SLOPE 1/4" PER REVERSE ANGLE AWAY FROM POOL MINIMUM SLOPE 1/2` PER FOOT TtiQE9(2E2T34Iu2LlNL �DECK, • AWAY FROA1 P001_ FOIL 10' _..�____�. •tea:. . . SHORT DECK BRACE ANGLE-. 14 GA. GALVANIZED ° (OP'ITONAL) STEEL WALL PANEL 3/B"0 A307 MD. LONG DECK BRACE NJGLE (1) DOLT IN ALL HOLES �•° / / / (OPTIONAL) OF INSIDE ROW(NEXT TO OF AS A MINIM! \ /\ TURNBUCKLE ANGLE IlOTE: OPTIONAL TRFADEO ROD S'FAl(E P!/1iULES LINDIM URDED EARTII UATERIAL 6 CONTINUOUS COCONCRETEE COLLAR 2'x B"x 16" PATIO BLACK NOTCHED SHORT ANGLE AT EACH PANEL JOINT AND CORNER FOR NOTE: BACKFILL TO BE SAND, GRAVEL LEVELING, OR OTHER NON EXPANSIVE MATERIAL CONTRACTORS OPTION ANSI/NSPI-5 '1995 STANDARD - --- B'OCA CODE -1999. Table 4-21 . 11 (2) STEEL DITIO 14;1- PAGNA,&LA CH' -.,"Side.Pull" model :ode Applicaiio,ts Color 1 3/8" M SPBX General-Purpose House Gates Blocic,White 8 i Omm 7 �`- Description:An ideal general-purpose,magnetic latch for �I 25mm teiV" I j gates around homes and gardens.Suitable for a\vide variety } :. �- Gore I I of uses where a non-key-lockable latch is needed.Reliable, oY— �i: t effective and unobtrusive. 2.3/8' 1 /16° I ' When used on picket-style swimming pool gbies,a compliant 60mm 27mm LATCH `1 I acrylic shield must be used to prevent latch access by toddlers. ? Oo Consult lace(authorities for height measurement/requirements on swimming pool gates. 25Tmm I~ GATE/FENCE GAP 3/8'(?mm) • , t t MAGNAeLATCH "'Vertical Pull".m®dea Code Applications Color KVPS28GA Pet,Pool«Child Safety Gates Black,White l 45mn I� (ETCH �RELEASE Description:A shorter version of the popular"Top Pull" • KNOB 4r model latch.Shares the same features and is ideal for safety gates around swimming pools and child safety areas.Also ideal 21 as a pet gate latch for the backyard- son, j m I— i0.1/4° s 260mm Ilii j Highly child resistari,magnetic latching(no mechanical MDUNi1NG !:'I j resistance to closure),key lockable for added security,fully' BRACKETS e ' 2,7/8 j —l�mm j °-� adjustable two-part design that provides easy,accurate ;o installation and long term,reliable performance. Y o ---j 'j Fits most gates and all gate materials.ideal for gate/fence ®I ` T T tETcRAI heights or60"(i500 mm)or above. j l•1/8 ADJUSTMENT GATE/FENCE uAP 3/"8'—l.7/1a°(?-37mm) It �28mm STRIKER I I I Consult local authorities for height measurement/requirements 25nm�3-3/8" � on swimming pool gates. Sbmm GNA®LATC�'- "To . Pull".m®dei Code Applications Color 1-3/4" MLTPS2BGA Swimming Pool Child Safety Gates Black,White 45mm _ Description:The most popular Magna-Latch model.The ideal E gate latch for safety gates around swimming pools and child RELEASKNC5 safety areas such as childcare:enters. I'" Highly child resistant,magnetic latching(no mechanics resistance to closure),key lockable for added security,fully UPPER t o • MOUNTING • 'n I;I;I adjustable two-part design that provides easy,accurate BRACKET j� lasts►.lotion artd long term,reliable performance. ' 20.1/2° I i; ceps- 520nm Is I j Fits most gales and all gate materials.Fits mosfigate/fence LOWER heights but is ideal for 48"(1200mm)gates/fences,as the latch R.MOUNTING R �p�e , '��';� I can be installed so ihat the release knob is out of reach of BRACKET e' f t;1I I toddlers. GATE MOVING ! I `••I;i j Consult local authorities for height measurement/requirements PAT= L-.a )illy . 2• �,• I an swimming pool gates. Somrli ,:. d73 of o� 1ETERAL GATE rEtdCE G!1' 3 8"-1.7 15"(?-37-n) �28mm1� SDRUSTDhENi 1 I 1 I I 1 l l --I25mmI�--•33/8•~-I 86mm USA- (20471670888 EUROP€: =31 M30 280 7050 AUSTRALIA: 1800 500 203 vrnw_ddtecfiglobal.com °. Combination Pressure and Cleaning-Cycle-Indicator Gauge grves visual indication when cartridge filter elements need cleaning. Manual Air Relief is a high capacity, rapid release manual air relief valve that bleeds air with a quick quarter turn of the lever. Noncorrosive Top Closure Plate prevents elements from lifting and unfiltered water from backing to pool or spa during operation. Quad-Cluster'"" Cartridge Elements provide 225, 325, 425 or 525 ft' ;1 of filter area and extra dirt-holding capacity for long filter cycles. Precision- engineered extruded core provides extra strength and superior flow. Heavy-Duty,Tamper-Proof One-Piece Clamp securely fastens tank top and bottom together and allows quick access to all internal components without disturbing piping or connections. Self-Aligned Tank Top and Bottom make access to servicing Quad-Cluster I : , Il cartridge elements quick and easy. II` N Improved High-Strength PermaGlass XLTM Filter Tank is made .iIV�VI from extra durable, glass reinforced co-polymer to meet the demands of the toughest applications and environmental conditions, including in-floor cleaning systems. l Uniform Low-Profile Tank Base Design makes removal of cartridge } elements fast and simple. Full-Size 11/21 Integral Drain provides fast clean-out and flushing. Noryl® Bulkhead Fittings for extra strength and heat resistance. PVC Union Coupling Connection provides plumbing options of 11/2" or 2" piping with 2" full flow internal piping for maximum performance. SPECIFICATIONS— A. QUAD-CLUSTER CARTRIDGEr FILTERTYPE Quad-Cluster cartridge elements: 225,325,425 and 525 ft?total(20.9,30.2,39.5 and 48.0 m2) FILTERTANK Injection-molded PermaGlass XL FILTER ELEMENTS Reinforced Polyester PERFORMANCE RANGE 1/2 to 3 HP(30 to 150 GPM).37 to 2.24 kW(114 to 568 LPM) ` C2025—23"W x 32"H(58 cm x 81 cm) DIMENSIONS C3025—23"W x 34"H(58 cm x 87 cm) C4025—23"W x 40"H(58 cm x 102 cm) ` f C5025—23"W x 46"H(58 cm x 117 cm) PVC Union Connections PERFORMANCE DATA EFFECTIVE DESIGN TURNOVER 20 30 4 0 MODEL FILTRATION AREA FLOW RATE" GALLONS KILOLITERS � NUMBER n ry MP G� WIW 00 110 F 50 b` C2025 225 20.9 84* 318 40,320 50,400 153 191 1 or ` C3025 325 30.2 122* 462 58,560 73,200 222 277 pit 0 ® so HAYWARD C4025 425 39.5 150** 568 72,000 90,000 273 341 _ C5025 525 48.8 150** 568 72,000 90,000 273 341 pressure and Cleaning Gauge `Based on NSF recommended rate for commercial use of.375 GPM/h.z "Determined by pump size and piping system hydraulics;2'piping is recommended for flow rates equal to or greater than 90 GPM(341 LPM).Hayward doesn't recommend flow rates above 150 GPM. www.haywardnet.com HSF HAYWARD°Pooi Products Haywardtrodo nd arksof are regardPoolPrerad otlemarkand006 Cluster,PermaGlass XL and n915)ear 1-888-HAYWARD One source. Every pool.are trademark of Hayward Pod Products,Inc.O 2006 Hayward Pool Products,Inc.(23915) UTSWG05 Y � D V W�'lA!AI�L�L�ln1lAZ �� ' � . • � � � � .• • •• High performance. Operational convenience. Hayward SwimClear reaches new horizons in cartridge filter technology. A cluster of four reusable w ` polyester cartridge elements provides a choice of 225, 325, 425 and now 525 ft' of heavy-duty, dirt-holding capacity and extra-long filter cycles. SwimClear filter tanks are created from new, stronger PermaGlass XL" for the ultimate in strength, durability and long life — even for the toughest applications and a environmental conditions. Discover crystal clear results and reliable maintenance of SwimClear by Hayward — r f the first choice of pool professionals. fi c Pumps Filters Heaters Heat Pumps Cleaners err � Lighting Controls Electronic Chlorine Generators �- Total System 5 TOWN'OF BARNSTABLE BUILDING PERMIT APPLICATION �` rn P Map 0-A Parcel (004 Application HIS Health Division Date Issued Conservation Division S Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic -.OKH _ Preservation/ Hyannis Project Street Address Qdo I;URIeFm Qopo) Village I`�/ArrcS'i<tiS I'i71.L S o Owner M C-Sou"_?t 31 *r l a 71 - �I on\10 ry,T'1 Address Telephone SOS, 24 6, 05q 1 o FFSyQ60-V 5w-ni 608,q2.� a2_01 Permit Request hean aW-010 1(13_` P ruK M 6del 1"e-1,L.P_ Square feet: 1 st floor: existing proposed 2nd floor: exisCD ting proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 0 No On Old King's Highway: ❑Yes )if No Basement Type: ❑ Full ❑ Crawl 0 Walkout Other K"E Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing f new Half: existing new Number of Bedrooms: ` existing _new Total Room Count (not including baths): existing new First Floor Room Count 3 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ®Other C JO VC Central Air: ❑Yes A No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 16 No Detached garage: ❑ existing ❑ new size_Pool: ❑existing O new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - -- --( UILDER OR HOMEOWNER) Name L c-dL�� 1t�r��5�. Telephone Number Address f �l Ji �C License # CS—(` 1 BL ' Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6-Ta j-IHJJAaeMC4;-".T I SIGNATUR U DATE '?✓ 2�'/7 T- wc� i FOR OFFICIAL USE ONLY APPLICATION # { DATE ISSUED F MAP/PARCEL NO. ADDRESS VILLAGE l i OWNER DATE OF INSPECTION: r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL.BUILDING DATE CLOSED OUT �' ASSOCIATION PLAN NO. r The Commonwealth of Wassachusetts Department of Fire Sen*es - Office of the State Fire Warshal O. OoC 1025, State 6a4 Stow, MA 01775 FP-6(rev.3/00) PERMIT City or Town CENTERVILLE, MA DIG SAFE NUMBER Date: 02/15/2017 Permit No.(if applicable) 0 0 9 3 2 8 Start Date: In accordance with the provisions of M.G.L.Chapter 148,as provided in Section l0A application is hereby made to Sandy Terraces Associates (Full name of person,firm or corporation) For permission to store a 30-yard dumpster on site, no less than 10 feet from building and must maintain fire apparatus access at all times at 566 Wakeby Road, Marstons Mills in accordance with 527 CMR 1, 1.12.8.6 and Chapter 20.2.4.5 at 566 WAKEBY RD/MARSTONS MILLS,MA 02648 Fee Paid$2 5.0 0 Check#/Cash ,18 77,,5i This permit will expire on: 0 6/15/2 017 Signature of official granting permit q4 �,{� C[ Title Fire Prevention Officer 1cuC) JOURNEYMAN ELECTRICIAN MA LICENSE#18115 E 6 DUPEE STREET WALPOLE, MA 02081 INSURED AND BONDED 617-968-3231 February 17,2017 REF: ELECTRICAL UTILITY SHUT OFF To Whom It May Concern, e I certify that the electrical service to a fixed trailer"Big Bear" located at 566 Wakeby Road within Sandy Terraces has been properly disconnected in preparation for demolition. Sincerely, At'. J lac�-��^ Malcolm D. Morrison Massachusetts License#18115 E l i Andrew D Labonte Plumberboy P&H Services MA LICENSE#21996 PO Box 490 Dracut, MA 01826 (978)703-1297 February 16,2017 REF:Water and Gas Disconnect To Whom It May Concern, I certify that the water and gas services of all kinds to a fixed trailer"Big Bear"located at 566 Wakeby i Road within Sandy Terraces have been properly disconnected in preparation for demolition. Sincerely, Andrew D Labonte DBA Plumberboy P&H Services Massachusetts License#21996 s Massachusetts Department of Public Safety - Board of Building Regulations and Standards License: CS-013841 Construction Supervisor JOHN G EASTMAN� PO BOX 693 V,2662 SOUTH ORLEANS M Expiration: Commissioner 09/27/2017 1 , �THE Town of Barnstable Regulatory Services RARNIMMIM MAM ,per Richard V.Scali,Director s63p. �i° rrua Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder C I, MaJ-e-c,L m. —, as Owner of the subject property hereby authorize _ O yt G- ��5 W��yt to act on my behalf in all matters relative to work authorized by this building permit application for- 5 � rd (Addre94 of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner §ignature of Applicant Print Name Print Name Date UORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services pkT Richard V.Scali,Director All 1 Building Division t EARNME&M a t Paul Roma,Building Commissioner e. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": - name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner 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 wtto use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for LicensingConstruction 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 John G Eastman CS-013841 PO Box 593 South Orleans, MA 02662 Tel:s08.24o.2978 17 February 2017 Ref: Trailer Demolition by volunteer work force To whom it may concern, I certify that the demolition of a trailer know as "Big Bear"located at 566 Wakeby Road, Marston Mills will all be done by volunteer workers. There are no compensated, in any manner, individuals involved with this project. Sin c rely, John G Eastman CS-013841 f ne Commarriveaith rrfMassachusetts. _ Department of frnlrrstWd Accide ds - Offize of 1nvstlgations y . 600 Washington Street Boston,AAA 02111 . tt'rvturnas�grrv.Fitici Markers' Campensatian Insurance Affidavit:Builder-sJ(;antractursMectricians!Plumbers Applicant-fnfGrM2tiGU Please Print f e��ily Name(BurinessnOrganizatioalFndrvirtnal� Address: Are you an employer?Check the appropriate box: ' Type of project(required): I-❑ I am a em to es with 4_ ❑I am a general contractor and I P Y 6. ❑Newconstiucti� employees(full antlfor part-timed* Have lured the sub-conb actors 2.' am a sole proprietor orpartrrer- listed ontile attached sheet. 7- El Remodeling ship and have no employees These sub-contractors have $.,Q Demolition working far mein any capacity employees and bare workers' 9- F1 Building;addition INO W.offers' comp_insure comp-insurartmi r%uired] 5_ We are a corporation and its M❑Electrical repairs or adds 3_❑ I am a homeommer doing all work officers have exercised their 1L❑Plumbiagrepairs or additions. myself[No workers'comp- right of exemption per MGL 12_❑Roofrepaim insurance required]i c-152,§1(4k andwe have no employees-[No workers' 13-0 Other com -insurance required_] 'Asp app&KatBtat cbed s box R mast also fill"the sectionbeiaw sher%iug&-kwoikexe campensaflaapaHcyinfiimisaoa. Sameownerswho submit dvs affid=indltatmg dayseedoing sHwc*sad dumLae auti2decontcscfarsmast submit anew affidavit imhcz=.-sacfl fCanttactm$gat chew erns box must attadmd tar.addiliansl skeet sbotving the mmne of the sub-cant uckrt3 and state whether ar not thnse enhti es Ham employees.if the sub-canttactoeshaveempicyees,they mustprnidethdr warkea'tomp.polirynumber. Ian[Qn ertepivper t7rrrt is pra�zdirzg workers'con tsrrt+iuzr iztsrzrarzce for rick*enrpin}'ees: Betoiv is the policy rcrzd job rule iiformRfrnm Insurance Company Name: Policy,or Self-ins.Lic_ Mxpira—nDate: Job Site Address: City/State Zip: Attach a copy of the workers'compensatioagolicy-declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.1572 can lead to the imposition of aiminal penalties of a fine up to$UO0:Oa andror one-yearimpriso—en,as well as civil penalties in the fozm of a STOP WORK ORDER and a fame of up to$250.00 a tray against the violator. Be advised that a cagy of this statement maybe forwarded to the Office of Invests of tfi�e DMA,for insurance coverage verbcation_ Mo her, bye n��. tins W1dpgnaUks ofperjusy thatthe irzforma#iau pnnir&d abm g is bars Mid correct Si e_ Date- U 202 Phona 7i 6 25 ZT Ojjacial use only. Do not o-vrite in tizis area to be mimpL-teed by city ar tairn oicrat City or Tomm: PermitUcense:9 Issuing Anthor€ty(circle one): L Board of Health r Building Department 3.C ityiTowrx Clerk 4.Electrical Fuspector S.Plumbing Inspector 6.Other Contact Person: Phone#: — -- - 6 a�riratiora and last-uctiORS RMaccar- ctfs Gehex-al Laws chapter 152 rDgak=all employers to Fanvlde Woticeas'compensation for their enpIoyees. . purmauttn this sty,an azrplayee is defhe i as.- ..every person is the service of another under any contract of line, express or implied,oral or Writ." An ErnpIoyB is defined as"air individual,pazincrsb�p,association,corporation or other legal entity,or any two or more of the foregoing engaged in a Joint ent--p ,a adincluding the legal representatives of a deceased employer,or the receiver or trustee:of an individual,partnership,association or other legal entity,employing employees. However the owner bf a dweIling house having not more than three apartments and who resides therein,or the occapant of the- dwPT?ng house of another who employs pms=to do mah tenauce,construction or repair work on such dweIing house or on the grounds orbm7ding appratrnailtthiemtn shallnotbecanse ofsach employmentbe deemedltn be an employer." MGL chapter 152,§25C(6)also stars that"every State or local licensing agency shall withhold$ie 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 ins¢i7.nce_cove�ragerequiz'ed-" Additionally,MGM chapter.152, §25C(7)states'Teithes the comononweakh nor auy of its political snbdi.isions shall enter into a�qy contract for the,performance of pu kblic wor until acceptable evidence of compliancewitii the insurance.. requii: r enfs of this chapter have been presented to the contracting arl-horzty." Applican-ts Please fill out the wozkcers' compensation affidavit completely,by cherlo the boxes that apply to your sitnation and,if necessary,supply sob-contractor(s)name(s), address(es)and phone number(s).along whii their certificates) of Dance. Limited Liability Companies(LLC)or Liai F Liability Pactaerships(LLP)wifhno eanployees other than the members or paiineis,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,apoEcy is required. Be a.dvised that this affdaykmaybe submfffed to the Depa-finent of Industrial Accidents for confrmatioa of insurance coverage. Also be sure to sign and date-he affidavit TMe affidavit should be-retnnned to the city or town that the application for the permit or license is being requested,not the Department of rn Tp cf7•iai Accidens. ST ouldyou have any questions regadiag the law or if-you are required to obtain a workers' compensation policy,please call the Department at the nmmbea listed beIDW. Self-ina2uEd eorapanies should enter their license zromber a the apPra�ate Ime. City ar Town.Officials Please be sure that the affidavit is complete andpziatad legibly. The Depa lmenthas provided a space of the bottom of tine affidavit for you to fit out in the event the Office of Investigations has to contact you regarding the applicant Pleas e be sure to fill in the pennitllicense number which will be used as a reference number. In addition,an.applicant that must submit multiple pen it/license applit:ations in any given year,need only submit one affidavit indicatuag cuseat policy infomation(if necessary)and under"Job Site A ddress'the applicant shoulId writs"aIl locations n (city or town)—".A—copy of the-affidavit that has been officially stamped or maimed by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for fbfur.e'pezmits or licenses A new affidavit must be filed out each year.Where a homeowner or citizen.is obtaining a license or pemitnotrelatr d to any business or commercial ventIM (i.e. a dog license or permit to bum leaves etp.)said person is NOT recptired to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Departne afs.mess,telephone and fax number. -ThL-Cau=out th of 1jassachuscM r)epariment cif IziduSh-ia1 Accidents Qtca of 11masfrgatio.= ��4 T�as3ziu.�an S`iz�et Boston.,M&02111 Tf,-L 4 617' -4900 Qxt 4-06 or 1477 MAS A� , Fax# 61"-`27 7M Revised424 07 -M gQvldia _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map b Parcel ` : 5 App lication Health Division Date Issued Conservation Division Application Fee / Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address S(o /570 tn.iRI t%i gem) Village hkgToNS N►I Owner 5P V QJ IWAct-S 'FV556C1A1r_5 AddressUd4 ">Zh Ni ROpp MQ Telephone_-50S,41tALO1 ML'. 56&2 , 0571 Permit Request to hem e li S� "Boas Aousa" 1 NJ- VAS-it TO Qt DISpo i o of with SOyd V"rnp9 es erov:JO b, allied W-Uk- 31W: G Nrn)b, y Iwo flw 6 e. s)krrrtpv m=l C474 aN P17 ACW,9rD TVc�Mp7. ?"rir-i A'17R CO&O 'Square feet: 1 st floor: existing 11PO proposed 2nd floor: existing proposed Total new Zoning District`{� Flood Plain Groundwater Overlay Project Valuatio�f 1 066.4 Construction Type`ta-Y p t ,.Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Z&y('S Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes ra No Basement Type: ❑ Full ❑ Crawl ❑Walkout R Other _W V6- Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing �IY�- new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing Inew First Floor Room Count N ---1 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric EWtherNVNt� o Central Air: ❑Yes ❑ No ; Fireplaces: Existing New Existing wood/foal stove-: Yes)❑ No 0 Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑Inew `, ze_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: co Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ co rn Commercial ❑Yes ❑ No If yes, site plan review # Current Use GT024G_C- s09cc,- Proposed Use 'TL NY a"IM oil VgowT l.ANO - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name . awi Cy cAS"'tr,-,AAJ Telephone Number SOB, 296 . 05R1 Address lid J�Q3 License # QS-013841 S00-44 Of2le-OW5 MO, - Home Improvement Contractor# Email STAI :k'R96uQegQ COMC,21ST E—r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (�WS 36YO V(in>Qb�R SIGNATUR L. DATE 21 (-}PR.TL 201+t 7 FOR OFFICIAL USE ONLY —APPLICATION# ,DATE ISSUED ` MAP/PARCEL NO. . ADDRESS VILLAGE , OWNER f ' a ' r 4 DATE OF INSPECTION: '. FOUNDATION r FRAME INSULATION ;7 FIREPLACE f !; ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DAT-jl-�CLOSED OUT r ASSOGFATION PLAN NO. f i The.Commonwealth of Massachusetts Department of IndustfialAccidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly NaMe(Businms/Organization/Individual):.ql.,IUCJ`l 159-9-4}CEG R1 SQG' A-r1ES rM(A3L UG," Address: - 64(o Wove-a i Joao 1`Iwi ti rAT.LLs Ise Oz&q6) City/State/Zip:N%Toti S i'14U-S �J pr o Z b y� Phone#: 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.10 I am a sole proprietor or partner- listed on the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors have g, 1<Demolition working for me in any capacity. employees and have workers' con incnranCe,t 9. ❑Building addition [No workers comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work ' officers have exercised their I LE]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.El 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 are doing all work and then hue 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby g!Wfy under the pains and penalties of perjury that the information provided above is true and correct SignatureN U `I R,t= Date: Z 1 M 2ZI L Z o Phone#: &&; 508,4Z5. ZOQ (tZ1J� 6-0� • 24�. O5q1 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in*a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the i sui:ance requirements of this chapter have been presented to the contracting authority." Applicants PIease fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their - self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MAS8AFE Revised 4-24-07 Fax#617-727-7749. v.rn=.gov1dia 41 FEE T Town of Barnstable ti Regulatory Services ' sAR1YSTABLE. "� - .. rMASS. g Thomas F.Geiler,Director 1639. npc Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 'Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Qwnet of the subject property' hereby authorize &"td G, ASZ 6A�qo to act on my behalf, m all matters relative to work authorized by this building permit We lb, t�aK�a�l� _ r+aOotis Mico rcp (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signa Owner tore of Applicant Print Name Print Name 3 M AH 2c3N H Date . 1E. Town of Barnstable } Regulatory Services S. Thomas F.Geiler,Director Eo;9,��`0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 0260.1 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number sheet village "HOMEOWNER": name home phone# work phone#. CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeo-wmers"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 dwellings 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 procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner 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);provide 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 2.1,5) .This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persdns.`Inthis case,our Boardreannot 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. Ou the Iast page of this issue is a form currently used.by several towns. You may caret amend and adopt such a form/certifica"tion for use in your community. C:\Users\decoUikWppDataEocalUcrosoft\Wwdows\Temporary Internet FleslConteatOutIook\QRE6ZUBNIEXPRESS.doc To whom-i` ma c = ncern °I Andrew r-�- _ Ls c 2-19LaboriteMA . 96,J atteat that both lumbin and gaN. contained within and p g attached to said Boathouse h' ;�e been. . permanently connected and rem,o�e disa . Date: .' i April 16, 2014 Town of Barnstable Building Department Inspector of Wires Re: SHD2 w/electric Sandy Terraces,570 Wakeby Road, Marstons Mills, MA To Whom It May Concern: I certify that as of April 16, 2014,the electric service to the Boat House: "SHD2 w/electric"at Sandy Terraces,570 Wakeby Road, Marstons Mills, MA`has been shut off and disconnected. There is no electric service to that structure. r Malcolm D. Morrison License#E18115 6 Dupee Street Walpole, MA 02081 Tel. 617-968-3231 tst FPO Martin MacNeely �p Certified Fire Inspector 1926 N O r-I ENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE-RESCUE AND EMERGENCY SERVICES 0 N B siness:508-790-2375 ext. 1 1875 Route 28 N Fax:508-790-2385 Centerville, \ mmacneely@commfiredistrict.com MA 02632-3117 0 O ---------------------------------------------------------�----�Q------------------`---------- ----------------------------------------------------------------------------------- ✓lea U�Ornmoseu�alf�y��/'�rtaDOdo�ivaeC`f4 ✓�!�,�pero 70.2.4; ,��i'��Oam�.SOfow, ./�.�O7J�.S" FP-6(rev. 3/00) PERMIT City or Town CENTERVILLE, MA DIG SAFE NUMBER Date: 04/24/2014 Permit No. (if-applicable) 006403 Start Date: In accordance with the provisions of M.G.L. Chapter 148,as provided in Section 10A application is hereby made to Sandy Terraces Associates (Full name of person,firm or corporation) For permission to store a 30-yeard dumpster on site, no less than ten (10) feet from the building and must maintain fire apparatus access at all times at 566 Wakeby Road, Marstons Mills. I ` at 566 WAKEBY RD/MARSTONS MILLS,MA 02648 Fee Paid$2 5.00 Check#/Cash 5 2 3 This permit will expire on: 0 6/2 0/2 014 ,//�� j) rnxx fSignature of official granting permit �'�� ,t ['1�U//lllptle Fire Prevention Officer This permit must be conspicuously posted upon the premises I MOP o28 ooq i Unrestricted contai�u less t, Bu�ldiu'�a 35 gs ofr any use encl osed space. 000 cubic feet (991uP3PIhi6h M Failure to i Stat Possess a current editio ' e Building code is cause for , n°f the Massachuse For DPS licensin revocation of tts g information visit: this license. i e. w^w.Mass.Gov/DPS I' t Mass achusetfs _pe - Board of Building Repartment of p >> 9ulatio ublic Safety Construction Superl.- ons and Standards License: CS-013841 r ,I011NG EAST PO BOX 593 � -AF S ORLEANS AIA 026 2. 4,111 \ Commissioner Expiration 09/27/2015 . r„ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 028 Parcel �� Application Health Division Date Issued Conservation Division _ /1�°° Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address IL"e M !ROAD Village hAtS7c,w5 1'12I_l,s Owne . r ►W0°iT wAas �,WaC,bgAaree ?q V�Aa Lty M Address 201G0X6t9 tA0g5-r®4J_S MILLS 15Z649 Telephone �� Permit Request 10 a�7�elsSH��Q� U rr- Ali `�RrL� ' Waecv" 1N1 SZS'R%VtK-VnAe1 �MkkMinurn s1 ;tined -Mole ' 4V4\aas �A\IeA ink d ALL WQ1!6 P_ -TO RE Ms� y� > :rQ V CPR&F O\kk� FMV-1RP, Dw61,\„ 4 UN I Square feet: 1 st floor: existing Z&proposed 2nd floor: existing proposed Total new i Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) MWAAAfa+�er Age of Existing Structure 40- Historic House: ❑Yes X-No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout Wl'Other WNL o Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ^' - c� c "= Number of Baths: Full: existing New- new Half: existing� `� new, Number of Bedrooms: existing _new Total Room Count (not including baths): existing 3 new First Floor Room Cunt Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing Ci New Existing wood/coal stove: ❑Yes WNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use pGPV&j Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name y01AN a Gas`T1-1AN/ Telephone Number Address �b 40%1 3 License # CS t uTij QRLCr4w% t"A O7(o(02 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO R)Vr,J1D1,rtMV%e t'ft-Wt Muff We: ?a cLt)Di c 34rds SIGNATUR DATE �1uL`L2d12 FOR.OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED ' MAP/PARCEL N0. _ + ADDRESS > ' { VILLAGE' _ OWNER- - DATE OF INSPECTION: FOUNDATION FRAME ti INSULATION FIREPLACE - M t ELECTRICAL: ROUGH FINAL-- PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING_ DATE CLOSED OUT ASSOCIATION PLAN NO.- i i r . The Commonwealth ofMassachusetts 4 Department of lndustrial Accidents Y n O,f�`ice.ofInvaWgations• '600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Ii?swAnce Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�tblY Name(Bnsiness/Orgauization/1ngvidn4:: �04k C-, .SST t'''4QAJ Address: ` q s• Sour A O'kt�Lz Aka TIR Cn(0�fo7- City/State/Zip:�®tea (�fLL�t y ft� �-.&O-Phone.# t9_®6 2�1t9 -Zvi 7 Are you an employer?Check the appropriate box: 4. I am a Type of project(required):" 1,❑ I am a employer with ❑ general contractor and I employees(fail and/or part time).* have hired the sub=contractors 6 ❑New construction . 2.�I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. %Demolition working for me�any capacity. employees and have workers' [No workers' comp.M* sun,=c comp.mSMMceJ 9• ❑Building addition required.] 5• ❑ We are a corporation and its. 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing 0-work officers have exercised they 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152, §1(4), and we have no . employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1=st also fiIl out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit mdimtmg they are doing all work and theo hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-con>racim and sly whether ornot those entities have employees. If fe sub-conhactors have c oployees,they mostprovidt their worlmrs'comp.policy number. I am an employer that is providing workers'compensation insurance formy employees.. Below is the polic y and job site information. Insurance Company Name: Policy#or Self ins.Lic.A ExpirationDats: " Job Sit r Address: Cit y/ : Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration-date). Faihme,to.secure coverage as required under Section 25A of MGL c, 152 can lead to time imposition of criminal penalties of'a fine tip to$1,500.00 and/or one-year imprisomnent,as well as'civil penalties in the fowl of a STOP WORK ORDER and a fmc of up to$250.00 a day against the violator. Be advised that a copy of this stat crnm t may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do her c U r the p and penalties of perjury that the information provided above is true and correct; Da1s: 2 I Sul '2 dlZ. Phone# �dg 2Li O ffw- id use only. Do not write in this area,tb be completed by city or.town offtcid City or Town: PermitUcense# Issuing Authority(circle one): - .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Em -tor 6. Other Contact Person: Phone#: i TME' To. wn'of Barnstable Regulkoll y Services AaAf�.�_ATi • ' Thomas F.Geiler,Director Building Division..: Tom'Perry,Building Commissioner 200 Main&reed Hyannis,MA 02601 Wwwaown.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property owner Must Complete and Sign This 'Section If Usin6 A.Builder I, �1 ANd i� 'gA014 5-fT -P Z TI , as Owner of the subject pro petty e P .P�y � hereby authorize �OAN L-1 SA37mO/ to act on my b. � in all matters relative to work authorized by this building permit (Address of Job) - Pool fences and alarms are the responsibility of the applicant. Pools ols are not-to be filled before fence is installed and pools- are not to be utilized until all final inspections are performed and accepted. S' fate Owner tare of Applicant Ptmt Name Print Name 2 l`�uc�f 2d1`Z Date Q:FORMS:O WNFRPERMISSIONPOOIs Town of Barnstable . Regulatory Services Thomas F.Geiler,Director MAS.1� Building Division Tom Perry,Building Commissioner 200 Main Street;.Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-4038 Fax: 508=790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: . numb& street . village 'HOMEOWNER': name home phone# work phone# CURRENT MA —ING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit, (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mir,im,rm inspection procedures and requirements and that he/she will comply with said procedures and j 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 perfomdng work for which a building per nit 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 sucb' 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 Supervisor;,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board carmot 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/cer iScation for use in your community. I . Q:forms:homeexempt Official Website of The Town of Barnstable - Property Lookup g Look Page 1 of 3 P ..................................__........................I..._.......... Select Language 1 T Assessing Division Property Lookup Results - 2012 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< Cam-)Print Friendly _............._.......-- ..__..........._._...........__._.................................... ..............................-......................................._....................................................._.._......_................................... Owner Information-Map/Block/Lot:028/0041-Use Code:1090 .......-- .... .... ..................................................................... ..._.._..... .............._.__....................................-........--.._..._............_._.-_................-.-_-._..............-. ..._.--..-..-...---.. Owner Owner Name as of 111112 MCINTIRE,P&BARTLETT N TRS Map/Block/Lot GIS MAPS j ' PO BOX 98 026!004/ MARSTONS MILLS.MA.02648 property Address Co-Owner Name SANDY TERRACES ASSOCIATES 566 WAKEBY ROAD i Village:Marslons Mills j Town Sewer At Address:No I Assessed Values 2012-Map/Block/Lot:028 1 004/-Use Code:1090 __._.._........_.....................-.__._...................... ........................................................................................................................................._..................._....._............._...._.._......._; 2012 Appraised Value 2012 Assessed Value Past Comparisons Building Value: $213,100 $213,100 Year Total Assessed Value Extra Features: $40.800 $40,800 2011-$1,265,700 Outbuildings: $158.500 $158,500 2010-$1.239,900 Land Value: $964.700 $964,700 2009-$1,709,200 2008-$1.705,500 2007-$1,704,900 !2012 Totals $1,377,100 $1,377,100 2006-$1,859,100 ..................-.........__-.....__......._._._...........-.__._...._........_.__._..........................................................................................................................................................................._................_......_............_.; Tax Information 2012-Map/Block/Lot:028/0041-Use Code:1090 ..................................................................................................--...................................._.._................-.�.._.. Taxes C.O.M.M.FD Tax(Residential) $1,969.25 Fiscal Year 2012 TAX RATES HERE Community Preservation Act Tax $347.86 i Town Tax(Residential) $11,595.18 $13,912.29 Sales History-Map/Block/Lot:028/004/-Use Code:1090 ...................... ....................................-_.._......_.....__....._...�.._. ._...... --...........__...__...._.,.. ......._..................._....._.........-..___._..._......................_...........................................-.......__.-. History: Owner: Sale Date Book/Page: Sale Price: j MCINTIRE,P&BARTLETT N TRS 8/30/1968 1411/681 $0 .. ... .. _._.. ., _ _..._.,..._. Sketches-Map/Block/Lot:028/0041-Use Code.1090 !&--&.................:...................._._..............-......._._......:................_.....................:.................:......................................... .__....................._............._...::._........:__._:......_:..............__................... 'This property contains multiple sketches. Please use the navigation below the sketch to browse sketches. It i i 10' i t i 5., 3 TRAILER-FIXED i Current Building ID=105209 details below Additional Sketches 1 1 213 1 4 1 516 17 Click Here for print version that displays all sketches at once As Built Cards:Click card#to view:Card#1 1 . .-._..__._....._. .. ... ...... Constructions Details-Map/Block/Lot:028 1 004/-Use Code:1090 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen l 2.asp?searchparcel=0... 7/21/2012 ROBERT O'REILLY DBA Date Invoice DONE WELL PLUMBING LLC 07/26/12 002398 1027 RIVER ROAD MARSTONS MILLS, MA 02648 Page 1 Phone: 508-428-8555 Fax:508-428-2855 MASTER LICENSE#M10623 Billed To: Sandy Terraces Job: SERVICE 566-570 Wakeby Rd Mechanic: Phone: Marstoms Mills MA 02648 Description of Work: Day Work I Service call. Map 028 Par 004 There is no gas,water or sewer connection to this camp site known as Pondview Thank You Bob OReilly Labor 50.00 Total $50.00 Customer Copy MALCOM D. MORRISON JOURNEYMAN ELECTRICIAN MA LICENSE# 18115 E 6 DUPEE STREET WALPOLE, MA 02081 INSURED AND BONDED 617-968-3231 July 21, 2012 REF: ELECTRICAL UTILITY SHUT OFF To Whom It May Concern, I certify that the electrical service to a fixed trailer"Pond View" located at 566 Wakeby Road within Sandy Terraces has been properly disconnected in preparation for demolition. Sincerely In Malcolm D. Morrison Massachusetts License# 18115 E /July 24, 2012 Carol E. Eastman PO Box 593 South Orleans, MA 02662 Drinking Water Supply Facilities Certified Grade VSS Full Operator MA License# 12244 REF: Water shut off to Sandy Terraces fixed trailer To whom it may concern, I have inspected and certify that the water supply to the fixed trailer called "Pond View" has been safely and appropriately disconnected.The connection was by garden hose and was removed.The backflow preventers remain in place at the connector spigot protecting the water system from contamination. Respectfully Submitted, Carol E. Eastman Drinking Water Supply Facilities Certified Grade VSS Full Operator MA License# 12244 COMMONWEALTH OF MASSACHUSETTS G' CERTIFIEDIEDGRADE VSS FULL.OPERATR - ISSUES THE ABOVE LICENSE TO: .CAROL, E ,EASTMAN ( = __0 _BOXr 593 ��ORLEANS MA. O2662_O593__ r z 12244. 12/31/13 98309SERIAL NO. r _ _ I ENSE NO. EXPIRATION DATE 46 Massachusetts-Department of Public Safety Board of Building Regulations and Standards ' ££�.�� ill f�,Supervisor License Aenser CS` 13841 t,eo B* '"► IVRL Expiration: 9/27=13 C'gmm YrAt; 3872 • t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ---.'Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Ck Historic '- OKH Preservation / Hyannis _ { VProject,atreet,,Address\5w Lys K r-je ZGiND U,illa-g_e S70Nb j"(YL1S O1, wnerJA►,�'�TtRRAG�S 6 Tele Permit`Fiequest��0 5TR1��N�2a£�4;\� Q�J°f Gc�p�,gs �111�Y'ft c��o� 1.uao� �t��G1.g S ��R� R-r-Mov4 AijV VF_QLACE IJ,z:1 yau's Pwo-2 FjjIR4 D&a, I MMTUG- 0%lZ 6s' Square feet: 1 st floor: existing proposed _2nd floor:'existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation� G b 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 ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: _ existing _new o Total Room Count (not including baths): existing new First Floor Room Count �s= Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other_ Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:_®Yeses No -a Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ exi lting ❑ —hdw ?Ee_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: -- Zoning Board of Appeals Authorization ❑ Appeal #, Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION BVM,'DER- R HOMEOWNER) CName:-at N 0 Cr E AS"i N40t M ele Tone-Number(568"2q 0' 200 CAddr..gss 90 30 (!M License #CS 1384 t Q'-*uTN a9,CeANS, •( 'R 02�6,2 Home Improvement Contractor# Worker's Compensation # %-� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO QDJS wcn—a - SIGNAT_U_ - = .r-DATE-2A U d 2 6` __ y FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED t,,a MAP/PARCEL NO. - -- - ti -ADDRESS VILLAGE OWNER-' 4 DATE OF INSPECTION: �:-FOUNDATION't FRAME �_'I NS.U--LATIO W J'!_" FIREPLACE , ft ELECTRICAL: ROUGH FINAL 7 - PLUMBING: ROUGH FINAL ROUGH , FINAL L'FINAL BUILD.ING�',% . e: .DATE CLOSED OUT r ASSOCIATION PLAN NO: A, i The Commonwealth of Massachusetts Department of industrial Accider& Office of Investigations 600 Washington Street Boston, MA 612.111 www.massgov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep bly Name (Business/organizahon/In&vidae): Address: ® 6C( City/State/Zip:ln�A DQ:L.EAq K & 02 LotdZ Phone#: 806 Z40 2 11` 3' (i A; 8�8 ``24Jo� 05M Are you an employer?Check the appropriate bar. 1.❑ I am a to with Type of project(required): . amp yes 4. 0 I am a general contractor and I employees(full and/or part-time),* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g 0 Demolition working for me in any capacity, employees and have workers' [No workers'comp.mm*rance comp.insurance,t 9. Building addition required_] 5. We are a corporation and its 10.0 Electrical repairs or additions 3,❑-I am a homeowner doing all work officers have exercised their 11.❑Plnmmbing repairs or additions myself [No workers' comp, right of exemption per MGL 12 Roof r insurance required]t c. 152, §1(4),and we have no 0 repairs employees. [No workers' 13.9 OtherS:tDi`'Q ,�U,j comp. m�TMFnce required.] Any applicant that checks bat#1 must also M opt the section below showing their workers'compensation policy iafurmation Hameov ners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the soli-Coahactors and she whether w not those entitieskits have employees If the sub-contractors have employees,they mast provide their workers'c omp,policy member. I am an employer that is providing workers'compensadon insurance for my employeem 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 secin a coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisommezt, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c rti a er the and penalties of perjury that the information provided above is true and correct: Sim , Phone# - 08 24 & "Z,q"j8 Official ase only. Do not:wraenea, to be completed by city or town oficiaL City or Town: PermitUcense# Issuing Authority(circle1.Board of Health 2.Buent 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: y �TME' Town of Barnstable rY Regulato Services F tf i6sq. Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main street,Hyannis,MA 02601 W W W.toWn.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder s�r, , as Ownet of the subject property hereby authorize JOY V4 (,', Ab`rr�cg�/ to act on my behalf; in all'azatters relative to work authorized by this building permit 51�t� A g e o us (Address of Job Pool fences and alarms are the responsibility of the aPP licant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature o er � Signature of Applicant ,BfARTLET-t G- �i4STt�►gt0 Print Name Print Name 2� jvLy ZUIZ Date QF0RM8:0WNEaPERMBSI0NPO0LS i Massachusetts-Department of Public.Safety { Board of Building Regulations and Standards 15kffi ' pr,Supervisor License ' � ��ense:•CS• 13841 .�'►; t- -�,. _-._'t • , OR Expiration: 9/27=13 Cqn nUo&R i Tr#: 3872 i °F1ME r°wti� Town of Barnstable BARNSTABLE. Regulatory Services MASS. g 01 Building Division 'DrFo Nay 200 Main Street,Hyannis,MA 02601 Office: 508-8624038 i Fax: 508-790-6230 o f Inspection O&rgG !un Notice s, T fff c Type of Inspection � `T Location J-66 1t)9IKLf-4 y 4 4f YP- Permit Number Owner � Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Ofu {' i l�� 7 • Please call: 508-862-40-M for re-inspection. Inspected by Date s y � 1 . ��-N�y ��-f�R�� -��-- rl/�uv�- �-+tip. 7%i' .��dS11� .��:.,�. � .� > `' �,� r'"' �f•j�-�"' . '�� r `y,•f •a. y,+ � a.•�sr� a Yt �� r �r,�3 6�i �..t-"v i- �v. •;'*, �� ``Q`'�" �� + .�M�fr,�r;.�G;'"}''.r' .ybt� r.� < y 1� � r f'7 �,al��. '�7��'!� -' r �,_.� s.r��c..'� `"F pr �.•.l'"�5. � i � !fir �j� ',;,rs,�k,,,.+.�7�q "'i��J � _, � '�`F �'+f�-i7' �. -yl �f-.. f ��,,,, � .¢>s a.r�. n:7 tp'f�'47J" i• �'6y .�' ' r' 1i. -0. -..>' � "• h. rw �'% �r f �7�.. z t�},{'{�C -.�'S:+:ir �,� ° 5.: -r ..`..t' a r _ ._ i �y �Y?r,�►> ,r- � k.:k s4,f Jf.�w l r��' r �f. �. :r�� -:_�� p' a4 '�,��'• r r� 7�\�I�'_+�' T}• y�� •I•e_ •''1r rjt`1,.Y•�'��r'i��r'r' 'T a ��j�:�� 1� ` J t f i�'��1 .(', ��"...1 �x� • 1 •i�*+�. , •`i .VI CSR"f�f ty .. r :,w-72.4'S�� CD Cb law) C c c ®Z� PQ ? :�� r Anchor Design&Pbol CORPO ON Rx,E ,� � tF+,a YSExtx �„' ,� a' a u .>" .' "G`.:• � � �,: .:�:� �. �` ��•�s� �' �•"^ :...�� t��> �. 2� %�� H:.' F ■ :■�ir .`:S% :k� 'fi'��?k ,S ro �tEFN .rS Owners: Sandv Terrace Association/Paul McIntire Date: 10/8/09 Address: 570 Wakebv Road 508-760-3402 Marstons Mills. MA 02648 617-504-8985 Pool Size: 20'x 60' Depth:5' Shape: Rectangular ITEM PRICE Galvanized Steel Walls,with Concrete Footing,Troweled Vermiculite Bottom and Lifetime Structural Warranty: $ 35,500" Steps-Custom Steel Full End 20' Included Liner-28-30 mil Vinyl (5-25 Year Warranty) Included Pump-Hayward Superpump 2.0 HP Included Filter-Hayward Cartridge(C4025) Included 1-Handrail& 1-Ladder Included 2-Lights-300 Watt/ 110 Volt Underwater' In 4-Skimmers,6 Returns Included 2-Anti Vortex Main Drains Included Pool Maintenance Kit&Ropes&Floats Included Salt-Chlorine Sanitization System by Goldline (Large) $ 3,500 . Phantom Robotic Cleaner&Booster Pump $ 1,750 3-Water Trucks(25,500 gallons) $ 1,400 Heater-Hayward Electric Heat Pump (11.2,000 BTU) $ 5,600 Safety Equipment(Body Hook,Throw Ring,etc.) Included Concrete Perimeter Decking with Cantilevered Edge(2,000 SF) $ 16,400 Total Price: $ 64,150 Payable As Follows: Deposit: $ 1,000 At Permit Approval: $ 6,000 At Excavation Start: $ 25,660 At Equipment Delivery: $ 22,453 At Liner Installation: $ 8,038 At Turnover&Demo: $ 1,000 , Not including:Electrical or Gas Hookups,Concrete Pumper,Fence,Rock or Clay Removal,Haul Away or Fill. . Stumps to be buried on site. 1 Signed(Owner): Date:: /1 0 2/. c Signed(Anchor Date: : ^g Page I Of 2 MEM-1 1.c.�.:. _.a-r�.•'�t�is- y,, '..�eY:.. ��x'.£'u!, ul'�,�p-�'€,'y�'v a�`�a",K ',�at�,R,� roTa :n}: �a>.rK �" �•�';cz-.,,,'��`.Y.,�s.��. .,.�x�',,»��.,°':.,`` z>,.:�<n. � ':�4� g' rs_ �.[. � ,,.xxr�>,�.,a,�s}�Kx w.,. ��:� �:;. �1�iF.,., �, kra'�« z srk.:::"ac'r _•�. '�,.y.,a d;,��',"R�' :."g .,;'oi;rf::S"-t"'�hL:, h� a`:s�.�?:�'. <�Z?x,?c 'FrS�' :.�^�4'x`"xl">?3<is �ibi. r¢'�:,. .�.�: Z'1'�. ;,,M ,•'�,�`^,2< SY;a�... 5� �„a.' 'H.. ,vr ,( : 1'g � �. .K C'r, gzj,�>.r" _ ,c�,wr.,_ ..`TC.:4„.rg.�.Y. t�`,�.r?`.vr::c<....... ,s r..,....x�.%.r�`'�i"',{.....�,..'�7'�t3 ...;d_^'f Y ,. ,.,z .�i<-`S .x�:� <..:.-&� '�i.�''$3 g�s"'E,''�.xi-; .. *��:��,..•.Y'c�rr1 r•- ��r�r�� r ry 499�Bearses�Wa ,•rH. annisMassaehusetts 02601¢-•=�5Q8,.778-6278�o Fax�508 775"5245�� °� , '4�t''';-.�.. ��'.ag...�:A�4•„.� -� �y,. ,�..<:xa_�. e .y �Y r ro � ..s. M..,z <. .�.., .rt $�', -r�.«� �.� �3� � ::��r ,��,Y�>�I�,.:.�;z t.�;. .�;�.� ., .?'asr r�� . ,�,�� m`'"��;:. '�'I.v'"_ .'� `�'�<`��''u 'rt" ' '� >,..svt�zs�.�3�;' i-.,.�J' sr .u4• wr��•� r�?�hc. d � �,.;;'i-.. .,,�y '�.. x.Y .,x,.:..... ��R�, ...m.. ,u,•u..,..ra„� ' �:z; kc2't".._ „,�.a <...�"�� .,. ..� �.«. .V,...<.>z..,:�:�a�°ux. ..��,.•. cp r •:s'rs_ ��<, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 V Parcel 6 L _ Application • I Health Division Conservation Division -�C 4Y � Permit# Tax Collector Date IssuedTreasurer C�T(itApplication Fee Cam/ G Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Q Historic-OKH Preservation/Hyannis Project Street Address _.S(010 WrAufF el QnVAa b Village �LycS145 �115' - Owner 5wo MEROW-C& Qss;oc Aam-3 Address .17"WAY.aV�YRro- dui''01 tJ us Milk M Telephone �08_` 28_q2 oct ( Permit Request Ta Coviskud 61 Rew 4 Skald 'Y>Almoorrti LvI oc, ti &S� S°iglem - Swwmg �0kiAdfVSOVA F00frBy54vr1 Ey/sINOUgC J10"p- wafg ©dlCons j c��eal ed a RAO cz.:� cud- !roc access Square feet: 1stfloor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay �- Project Valuation 000, 00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. i Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal st t e: ❑ 'Les Q No o A; Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existi g ❑n ecy'�w3 size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: co co Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ' Commercial ❑Yes ❑No If yes,site plan review# r' 3i co Current Use Proposed Use N '� X BUILDER INFORMATION Name Sum rr EA- S`(MAAf, Telephone Number6a&-2q0 -2378 Address to SSoY, SR3 License# CS 00841 O t2 L94ful N 14 (D 2"?_ Home Improvement Contractor#122 4 11 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO GF- - SIGNATUR DATE 9 MA-1 2 C07 E FOR OFFICIAL USE ONLYo PERMIT NO. DATE ISSUED MAP/PARCEL NO. ,r i ADDRESS VILLAGE - OWNER i DATE OF INSPECTION: FOUNDATION �� O� OZ D7 �Ae C FRAME r . INSULATION !� FIREPLACE ELECTRICAL: "�ROUGH- FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING nQP >. r DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts 'f' 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 Ley_ibly Name(Business/Organizationadividual): '3mgy T�QQt s �DClt ita?�S Address: f2pag(3y Q0. R© Gal-`l8 nrt3` —ks M.lS ht'k 02-&46 City/State/Zip: Nm6u`t',As 11 - O1,&Lt$ Phone.#: god-4ZM2-0 ( Are.you an employer?Check the appropriate bog: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction.. employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no'employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY , 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. �We are a corporation and its 10.❑ Electrical repairs or additions q ] officers have exercised their 11. Plumbin repairs or additions ' '3.❑ I am a homeowner doing all work ❑ . g P myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that isproviding workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: lob 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce t u er the nd penalties of perjury that the information provided above is true and correct -f�— 1 -. ---- v—Si ature: ou r"`Date:_ 8, Nj 200 — Phone#•Jt08" ZIOd2a7I Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions n Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hiie, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the rece i`-al,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced:acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented*to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-con6actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies"(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are.required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding.the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant thatmust submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,____ please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #f 17-727-4900 ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 11-22-06 vrwwmass.gov/dia f ISE r Town'of Barnstable p °^# ]Regulatory Services Thomas F:Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Tice:. 508 862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize_�1 1 r. c—6sr''jO!V to act on my behalf, in all rrattets relative to work authorited by this building p e=it application for: QZ&(rg (Address of Job) Signature of Owner Date N &STMAJ Print Name Q:FORM5;OW11ER?ER1vIISSIOAI .z ✓/LC �/pig2/172dI1,/IIC�LG(IL 0�,�/�.y�r,2{,Q��` f BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS.. 013841 - A �+ Birthdate:7 09/27/1948 Ek0ires.09/27/2007 Tr.no: 589&0 Restricted:' 00'. . JOHN G F-ASTMAN ' - PO BOX 593 S ORLEANS, MA 02662 C /� Commissioner ----- e REFERENCES o0 0• t>®hoot tot rAR mt 9 0� j 'Ce tACUB - __4 RACW MAP �5�00 YM m PAY(Q ® MAP 28 tauu a rtxe tou noeo>au c Al Dow wrta tMc ��°pp1 mte c 3-2 ®35 aom stAtMARv LONG mtow ommcr.r amot w°�` tu.for mI m,tm v.• tma for marAa uo• tmt.rxattr QteAat >e \. tsffmux r M3 3 8 - t POND * �' �tam rcnatawmA, Como�' 11 ��O �- f •an n wam wtwt taaama _ \ wrortrna ATrM na a M v SITE PLAN OF LAND spy "SANDY TERRACES" O \ APPRo7GMA C� ' APPR AREA OF °° AT �W *566 WAKEBY ROAD •� '�T�'n BPROPOS TH H S 1 MAP4 2B O -3 \ \ # 566 )> IN MARSTONS MILLS, MA \ Lows PIRPANm NN a \ geAcaEs t X� SANDY TERRACES ASSOCIATES W DATE:APRIL 13,2007 Roaal 11 , Sadst'-e0' ' � 1 OF 2 fo,5W s.t-as2-.—fox down cope engineering, #7c. 01 m CI NL ENGINEERS Aotm LAND SURVEYORS 939 Moln Sfrooe — YARMOU77-PORT, MASS Own • sea.•.m.ms.aie.o mat LEGEND SYSTEM PROFLE NOTES �,® rlDlrvnA iR <®mIYD�DrOR OYv �DD� ,® iD>Ow•o MOM IRM=SVrED 6ODr 10 /-- vb 4RFrmD D L WRRf a APA091Arz XafD `y DAIAr.ts v,ao OO 116fII Pa RrgR / �D f v a R� ra IDLp ffi f<rY m0 i 1pae�At 4°II CI rn 10aa OOSIFIO 9Pa,OFAIFSI PPO� Dm ,o®100E fe0olVk_ D > a,foam qc vinFr m W,/d.PER rmec tee-cm-a 0orRW / relAA wm ./ r W11C a®W ID.�W I°t ML tRIGBf VMIB m0000 0000 aPr[A01fB mmM MlmnaR.�Dar Ir,mwrw c o 0 0 0 0 0 0 o a mfsaue,mr OefAte ro m a A,LamArIB DM Locus b.y mA•®(m,D aD °- r 0 0 00 0 0 0[]0 I1.-°M,al7vAA fGDE nnL V. - ra olx.SC.. L<•m,,/F'DOM[,°s¢o amoE 7.nw PLW a iDe m000m„ae,aav AM HOT m a,aPm ra taT uc sT7rea7 m AN1',mmt awPoz c-L..„aD W naD a Dore rm tape s76un roux<o-<•P,C. 1 I ,RIfNR,• aL9rp,R,• �,�� a<' a oaDm7R,B NOr W E,f eAaanlaD aalorA,m reunnnao- m-awe TRa ,r error TDa— ,f —a sm ,r FAOKOr per eo01,wo°1av°ONirxOF WITH um iaoossa LOCUS MAP mre msv<aaR a,nf.vmr M fAROpre Gt[9�WIiWOmQ MllOre fA OA°N.CIDA°ULL atN�CB�1[1�CeLLne eWl 1T]neD'! CICSNC(nt�OM- Af0,£Rl1ef0 M lO0A11011 M1ESSORD yAP m'PAAm GBIf!ro<aTNtAfO rr,'Pmtmf v mOOI 111-1 Q.e<.n S ALL 11DE�AatAO D OWes/O Y1611®IDA ro U=�10aA p.0=,T AWA�eel a fMIN (EPIC 8,effY n -OC M.AD IFA°rq fMMtV D Q w,am Am ��a P/,f ,m,am m Purim AM rum rd awl We ,L AW W,9aTAef YAtERUa OIOXWOMD Sr K � s 7(-� � eaR01 w ArD A M PRROPOW 0®oral"I'PAGE ml la ra tefaFr MACE,IiGa, ,m'0P F_ a lwmm PAOMIY. ZONM SUMMARY I TEST HOLE LOGS m,Dle 06 .W�,umcT x ; MFI OWO n*OM R8 I I°l N,ffi ef.lID ea.• IaA I°T fAatTAZ Im' wmm OOB MK iReRT 41BAE% ar <:ranRaf/ fa i t t9 „K,eAR YI stt eAQ ,r x \ l amass_!. sees W"w ° �wom11°r Oter \ ��•-$/ a: Ps, Y � � =aanoal4ow rA®'r m�ecr uA GIA SYSTEM DES OM X _ /•F• .• lmv)n C IM a/a W 1tAlml$O�a Ror A,IO,ED _ 9 6 OO9°f A—FURM PM SM TOLM D OIO�B°t0 W fU.BROR[.B00 toD u u MURE itA00er0 POOL a 10 Wo MP °P�IL.ISO a'T. ,aA we a• <r M E A e»M ---- -- omd rLar "�"GRAVEL » Ta-M M O)-nor _ -"-- /DRIVE _- c c 1�A faL NaIART S M TNR t00D W.t?DerGARY®1C rNa e/O are/< �10V--N•1aT M flea 1 BENCHMARK m°Aiu to,FuvEE TAEAL• ]ee OF, am®D L \\ 1 1.\ .�' i,,' NAIL IN M1N OAKS D�111(4)mo wL Oumm(mm m EWMJ � I ,ae• eaa•,m• mar \� ,(ote :\ -�• \ osa• if ,Dr Afsabm wa ealm ar,¢Ain, •rA \ 0/A O/A — IL \ \\ \111-2 r 1a 3/2M 3/2 Pa r Ir TITLE 5 SEPTIC PLAN FOR \ v � "SANDY TERRACES' lx--x'--� ,olive ,u ,� ,mRaa #566 WAKEBY ROAD \ `� • e e MARSTONS MLL.LS. MA \ E>Q97M0 YOU m rs Ro.Am wt /°6/ x A� ��/` -SANDYASSOCIATES ES APR IL/ / I / E• L toR007 IL t[AtE ro OAI i / 20F2 ET tor• ear / x x ,o oRaRm,w,m awuno® COURT I I I rm am ae7imo f 1 down cope engineering, Inc. x I I I `/ / A O/NL ENGINEERS LAND SURVEYORS DCR#06-£84 < �D m� DAre DfuA.P.c,P.L$ 939 M°In St_t - YARMOUTHPORT• MASS • wD.i.fim.m Job Truss Truss Type Qty Ply Botello,Sandy Terrace-9/19/08-Vlad 554073 101 FINK 11 1 Job Reference(optional) Wood Structures,Inc.,Biddeford,ME 04005,Vlad 7.000 s May 29 2007 MiTek Industries,Inc. Fri Sep 12 08:46:31 2008 Page 1 7-6-4 14-2-0 20-9-12 28-4-0 7-6-4 6-7-12 6-7-12 7-6-4 Scale:114'=1' 4x8= 3 12 13 6.00 F12 1.5x4\\ 1.Sx4 2 4 11 14 10 15 1 5 I r� r dI ]l o a 4x10 Q 400 i 8 9 7 6 300 II 3x10 II 3x6= 4x6= 3x6= 11-2-01 9-8-10 , 18-7-6 , 27-2-0 J8-4-Q 1-2-0 8-6-10 8-10-13 8-6-10 1-2-0 Plate Offsets(X,Y)_[1:0-3-10,0-2-0]_[1:0-1-0,1-4-5]_[5:0-3-10,0-2-0]_[5:0-1-0,1-4-5] LOADING(psf)TCLL 25.0 SPACING 2-0-0 CSI DEFL in (loc) I/deft L/d PLATES GRIP 1 TCLL Plates Increase 1.15 TC 0.85 Vert(LL) -0.16 6-8 >999 240 MT20 197/144 (Roof Snow= 5.0) 1 0.0 B Lumber Increase 1.15 BC 0.65 Vert(TL) -0.31 5-6 >999 180 BCDL 1 Rep Stress Incr YES W 0.28 Horz(TL) 0.07 5 n/a n/a BCLL .0 *BCDL 10.0 Code IRC20031TP12002 (Matrix) Weight:118lb LUMBER BRACING TOP CHORD 2 X 4 SPF 1650F 1.5E TOP CHORD Structural wood sheathing directly applied or 3-1-9 oc purlins. BOT CHORD 2 X 6 SPF 1650F 1.5E BOT CHORD Rigid ceiling directly applied or 9-0-0 oc bracing. WEBS 2 X 4 SPF 1650F 1.5E WEDGE Left:2 X 6 SPF 1650F 1.5E,Right:2 X 6 SPF 1650F 1.5E REACTIONS(lb/size) 1=1478/0-3-8,5=1477/0-3-8 Max Horzl=-176(LC 6) N ` Max Uplifd=-562(LC 8),5=-562(LC 9) o Max Gravl=1653(LC 2),5=1652(LC 3) FORCES (lb)-Maximum Compression/Maximum Tension C7t —t TOP CHORD 1-10=-2921/1172,10-11=-2744/1174,2-11=-2586/1196,2-12=-2481/1159,3-12=-2292/1192,3-13=•2290/1192,� 4-13=-2479/1159,4-14=-2584/1196,14-15=-2743/1174,5-15=-2919/1172 BOT CHORD 1-8=-905/2451,8-9=-481/1550,7-9=-481/1550,6-7=-481/1550,5-6=-905/2450 p > WEBS 2-8=-760/448,3-8=-351/1163,3-6=-351/1161,4-6=-760/448 a NOTES (9) G1 1)Wind:ASCE 7-02;120mph;h=35ft;TCDL=6.Opsf;BCDL=6.Opsf;Category 11;Exp C;enclosed;MWFRS gable end zon and Z> C-C Exterior(2)0-1-12 to 3-1-12,Interior(1)3-1-12 to 11-2-0,Exterior(2)11-2-0 to 14-2-0,Interior(1)17-2-0 to 25-2-4 zon N cantilever left and right exposed; Lumber DOL=1.60 plate grip DOL=1.60.This truss is designed for C-C for membe and OD forces,and for MWFRS for reactions specified. 2)TCLL:ASCE 7-02;Pf=25.0 psf(flat roof snow);Category 11;Exp C;Fully Exp.;Ct=1.1 3)Unbalanced snow loads have been considered for this design. 4)This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent with any other live loads. 5)This truss requires plate inspection per the Tooth Count Method when this truss is chosen for quality assurance inspection. 6)*This truss has been designed for a live load of 20.Opsf on the bottom chord in all areas where a rectangle 3-6-0 tall by 1-0-0 wide will fit between the bottom chord and any other members. 7)Provide mechanical connection(by others)of truss to bearing plate capable of withstanding 562 lb uplift at joint 1 and 562 lb uplift at joint 5. 8)This truss is designed in accordance with the 2003 International Residential Code sections R502.11.1 and R802.10.2 and referenced standard ANSI/TPI 1. 9)Drawing prepared exclusively for manufacturing by Wood Structures Inc. LOAD CASE(S)Standard i Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs m Department of Environmental Protection Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347.508-946-2700 DEVAL L PATRICK RICHARD K.SULLIVAN JR. Governor Secretary KBUNETH L KIMMELL Commissioner June 11,2013 Ms. Carol Eastman RE: BARNSTABLE--Public Water Supply Sandy Terraces Associates Sandy Terraces Associates C �, P 0 Box 593 PWS ID#: 4020013 c South Orleans,Massachusetts 02662 Sanitary Survey p n w Dear Ms. Eastman: cn Iv .. f� r- - Please find attached the following information: Sanitary Survey Report for survey performed at the aE oge- r referenced public water system on May 16,2013. Please note that the signature on this cover letter indicates formal issuance of the attached document. If you have any questions regarding this document,please contact Charles Shurtleff at 508-946-2879. Sinc rely, Richard J. Rondeau, Chief Drinking Water Program Bureau of Resource Protection R/CS/cb cc: Barnstable Board of Health Barnstable Building Inspector Barnstable Planning Board Carol Eastman . P 0 Box 593 South Orleans, MA 02662 DWP Archive\SERO\Bamstable-4020013-Sanitary Survey-2013-06-I 1 Cshurtleff/Barnstable/13.ss.4020013 This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TDD#1-866-539-7622 or 1-617-674-6868 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper �. - � .....� fir. Jv'� , ;• , Sandy Terraces Associates Barnstable W. 4020013 ' Survey.Date: May 16,2013 Public Water System Sanitary Survey CITY: Barnstable PWSID: 4020013 PWS NAME: Sandy Terraces Associates I Survey Date: 5/16/2013 Report Date: 6/11/2013 Surveyor: Charles Shurtleff Affiliation: MassDEP Person Interviewed' Carol Eastman Title: Operator Person Interviewed: James Foley Title: Managing Director Person Interviewed: Title: `t- PUBLIC WATER SUPPLIERS: Attached is a Sanitary Survey Report for the above referenced sanitary survey site visit. At the end of the report is a Water System Compliance Plan which consists of the following (checked items only): Table A -❑ Summary of violations and Notice of Noncompliance (if violations were observed during the survey) ❑ Table B — Summary of deficiencies and required corrective actions ❑ Table C—Recommendations ❑ Water supplier response and certification. Within 30 days of receipt of this inspection report, you must complete and submit the response form if your system has TABLE A—Violations and/or TABLE B-Deficiencies. Attach a copy of each completed table listing the date that 'the corrective action was or will be taken by your system and all other applicable documentation. (310 CMR 22.04(12)) 1 � Sandy Terraces Associates Barnstable 4020013 Survey Date: May 16,2013 SYSTEM DESCRIPTION: This public water system is a Transient Non-community public water supply. This seasonal campground has primitive tent sites, camper sites, mobile home sites and rental cabins. Other permanent structures consist of a restroom/shower facility, dining shelter, sauna facility and an office at the main entrance. The system water is supplied from a four inch diameter well and a 2 '/2 inch diameter well. System storage and pressure is maintained by three hydropneumatic tanks. The system does not currently treat its water. ADMINISTRATION: General System Information Is this correct? Yes X No ❑ PWSID PWS Season Season Population Population L Service—��#Distribution Class Start End Served (Summer) (Winter) Connections Systems 14020013 TNC 05/15 09/30 30 0 2 2 Facility Address: Is this correct? Yes X No ❑ Name ca // Address Address(2) Town Zip1EMail Phone# Fax# V. SANDY TERRACES AKEBY BARNSTABLE02648 508-428- ASSOCIATES ROAD Mailing Address: Is this correct?_Yes x No ❑ Name Mailing Address Address(2) Town State Zip SANDY TERRACES ASSOCIATES P O Box 98 Marston's Mills MA '02648 Contact Information _ _Is this correct? Yes _x_No ❑ PWSID# First MI Last Address Address Town State Zip Work Home Primary (2) Phone# Phone# Contact? 4020013 Carol Eastman P O Box South MA 02662 508- Y 593 Orleans 1 246- 3018 Comments: None 2 Sandy Terraces Associates Barnstable / 4020013 Survey Date: May 16,2013 Certified Operator Information: Is this correct? Yes X No ❑ PWSID First MI Last ADDRESS ADDRESS 2 TOWN STATE ZIP WORK# HOME# I — — 4020013 CARO EASTMAN P O BOX SOUTH MA 02662 508-246- L 593 ORLEA 3018 NS PWSID First MI Last POSITION GRADE LICENSE# PRIMARY AFFILIATE 4020013 CAROL EASTMAN OPERATOR VSS 12244 Y PWSID MaxOfrREATMENT CLASS POPULATION SERVED SUM DISTRIBUTION CLASS 4020013 N/A 30 VSS PWSID DISTRIBUTION CLASS POPULATION_SERVICED 4020013 VSS 30 Does the PWS have a certified operator? (Verify that primary operator listed Yes X No ❑ in WQTS is correct PWS operator) Are operator grades appropriate for system size and/or treatment type? Yes X No ❑ Does the system have the correct staffing levels for the system size and grade? Yes X No ❑ Is certified operator or a backup operator available for emergencies? Yes X No ❑ Comments: None OPERATION AND MAINTENANCE: Is there an adequate spare parts inventory? N/A Yes ❑ No ❑ Is there an O & M Manual? N/A Yes ❑ No ❑ Is there a preventative maintenance program? Yes X No ❑ Are operational records collected appropriately? Yes X No ❑ Are records properly maintained and available for review? Yes X No ❑ Frequency of master meter readings? Daily ❑ Monthly X Other ❑ Frequency of distribution meter readings T N/A X How frequently are meters calibrated? AS NEEDED 0 The Department recommends that source meters be calibrated on an annual basis. Are emergency telephone numbers posted? Yes X No ❑ Is all critical infrastructure locked? Yes X No ❑ Does the PWS have available an emergency response plan prepared in accordance with the provisions of 310 CMR 22.04(13)? Yes X No ❑ Who performs emergency repairs? (Systems without dedicated staff) STAFF OR ON CALL CONTRACTORS Comments: Pumps and pressure tanks are available and in stock at local suppliers. i 3 �• Sandy Terraces Associates Barnstable 4020013 Survey Date: May 16,2013 TREATMENT - GENERAL: NONE Active treatment plant information listed within Department records: PLNT/SRCE ID PLNT/SRCE NAME PLNT AVAIL PLANT_CAPACITY(GD) TREATMENT_CLASS Active treatment process information listed within Department records: PLNT/SRCE PLNT/SRCE NAME PLNT OBJECTIVE PROCESS CHEMICAL_NAME COMMENT ID AVAIL Treatment listed Unapproved treatment No Treatment X above is correct ❑ installed ❑ • Unapproved treatment is subject to MassDEP permit requirements If a sediment filter is being utilized how often is the filter replaced? For sources without permanent disinfection: Is an emergency chemical injection port available? Yes ❑ No ❑ N/A X Are there any unprotected bypasses in the treatment process that could result in contamination of finished water? Yes ❑ No ❑ N/A X Is information from the manufacturer available for reference? Yes ❑ No ❑ N/A X Is chemical storage, containment, and safety equipment adequate? Yes ❑ No ❑ N/A X Is equipment properly maintained? Yes ❑ No'❑ N/A X Are alarms tested and adequate? Yes ❑ No ❑ ' N/A X Are chemical treatment forms submitted monthly as required? Yes ❑ No ❑ N/A X Are they completed properly? Yes ❑ No ❑ N/A X Is operator familiar with the treatment system and its operation? Yes ❑ No ❑ N/A X Is the treatment system providing 4-Log inactivation treatment? Yes ❑ No X Has the system experienced a loss of membrane integrity? _ Yes ❑ No ❑ N/A X Comments: 4 Log inactivation is not currently required at this facility. 4 Sandy Terraces Associates Barnstable 4020013 Survey Date: May 16,2013 SAMPLING: PWSID NO BACTERIA_SAMPLES BACTERIA_SAMPLE_FREQ NOWINTER_BACT_SAMPLES WINTER_BACT_SAMPLE_FREQ 4020013 2 QUARTERLY 2 QUARTERLY Does the system have an approved Total Coliform Sampling Plan? Yes X No ❑ Have changes been made to the system (population, configuration, storage tanks, etc.) such that the coliform sample plan does not comply with 310 CMR 22.05? Yes ❑ No X Is the system taking the correct number of bacteria samples? Yes X No ❑ Is the system using appropriate coliform sample sites? Yes X No ❑ Is the system using appropriate source sample sites? Yes X No ❑ Are raw water sample taps available for all sources? Yes X No ❑ Comments: NONE STORAGE: Maintenance and Condition '.�Tank,, 'Capacity, Last Ins ectlort,FUK st Cleaned Structdralnte ri PYVSID# Storage Tank Name Storage Type Material - G) F. 1020013 TANK I PRESSURE STEEL 100 UK GOOD 4020013 TANK 2 PRESSURE STEEL 30 UK UK FAIR 020013 TANK 3 PRESSURE STEEL 80 UK I IUK FAIR • MassDEP recommends storage tanks be inspected and cleaned every 5 years. Protection and Safety Proper : Cove-4d + ; High-Low; By-pass.-for P c��d frorra �*�k Vented/ Sam le ' Level g PWSID! STORAGE TANK NAME Overflow and p Repalr F.loodln ;( �t fenced?, Screened?4 Ta ? Control Structure? Lockeii?(3)' 7 p Cleaning? br RunofC 4020013 TANK 1 N Y N N N/A Y Y Y 4020013 ANK 2 N Y N N N/A Y Y Y �4020013 ANK 3 N Y N N N/A Y Y Y i I I 5 Sandy Terraces Associates Barnstable 4020013 Survey Date: May 16,2013 The storage tanks have nearby injection ports to allow emergency disinfection. Yes ❑ No X The storage tanks are adequately protected against vandalism. Yes X No ❑ (')Are there any holes or failures in the tank roof or structure? Yes ❑ No X (2)Have any tanks been identified as subject to flooding or run-off? Yes ❑ No X (3)Are all the tanks protected from unauthorized entry? Yes X No ❑ (4)Is proper screening in place on all overflow pipes and vents? N/A Yes ❑ No ❑ Comments: Pressure tanks do not have an overflow/vent. PUMPING STATIONS: PWSID Number LOCATION AVAILABILITY WATER GPM EMERG MOTOR HP MOTOR TYPE POWER? TYPE 4020013 1 IN THE ACTIVE RAW UK NO 0.75 SUBMERSIBLE WELL 4020013 2 WELL ACTIVE RAW UK NO 0.50 JET PUMP HOUSE Are all pump stations recorded in WQTS? Yes X No ❑ Is there flooding or standing water in the pump house? N/A Yes ❑ No ❑ Does the air/water relief valve discharge have an air gap? Yes X No ❑ Are there any open floor drains in the facility? Yes ❑ No X Are pump stations adequately maintained? Yes X No ❑ Comments: NONE Has the system submitted a distribution map to MassDEP Yes ❑ No X Are valve locations known or identified? Yes X No ❑ How many distribution systems are there? 2 Is adequate pressure being maintained? (20-60 psi) Yes X No ❑ The distribution system has 2 dead ends which are flushed - YEARLY List distribution system weaknesses or problems NONE DAILY WHEN Date of last leak detection survey: OPEN Percent of system surveyed?: 100 Are distribution valves exercised regularly? Yes X Frequency? YEARLY No ❑ Is there a hydrant maintenance program? N/A Yes ❑ No ❑ Is there an adequate flushing program? N/A Yes ❑ No ❑ • The Department recommends that the distribution system be flushed twice a year. 6 Sandy Terraces Associates Barnstable ✓ 4020013 Survey Date: May 16,2013 Comments: SYSTEM DOES NOT CURRENTLY HAVE ANY HYDRANTS NTNC & TNC only: Was a cross-connection survey conducted by a Massachusetts Yes x No ❑ N/A ❑ Certified Cross-connection Surveyor? Surveyor Name: Glen Snell Surveyor Certification#: 4483 Date of last system-wide survey 5/22/1999 Did the cross-connection survey reveal any unprotected cross- Yes ❑ 1 No,x N/A ❑ connection(s)?If yes, have all cross-connections been eliminated or properly protected? Yes ❑ No ❑ Have testable backflow prevention devices, if present, been Yes ❑ No ❑ N/A x tested in accordance with the frequency stated in 310 CMR 22.22(14)(d)? Are there Hose Bib vacuum breakers on all threaded faucets? Yes x No❑ N/A ❑ Comments: none SOURCES: PWSID #Sources %Ground %Purch %SURFACE %Purch YEAR Avg Daily Max Daily Ground Surface Demand( Demand(G) GD) 4020013 2 100 0 0 0 2012 1939 4533 Surface Water Sources: N/A SOURCE SOURCE LOCATION AVAIL TERMINAL_RESERVIOR Safe Yield Storage COMMENTS ID NAME (MGD) Capacity (MG) Groundwater Sources: Well Construction Information Is this correct? Yes X No ❑ Source ID Source Name Location Availability Well Type Depth Pump Setting Comments 4020013-OIG WELL 1 ACTIVE GRAVEL 80 UK 570 WAKEBY ROAD 4020013-02G WELL 2 570 WAKEBY ACTIVE GRAVEL 50 UK ROAD Sandy Terraces Associates Barnstable 4020013 Survey Date: May 16,2013 I Well Inspection Source ID Casing height(ft) In Pit(Y/N)? Well House? Vent Screened? Seasonal? Condition?* 4020013-02G 0.25 N N Y Y FAIR 4020013-OIG 2.0 Y N Y Y FAIR Are all wells in use approved and recorded in WQTS? Yes X No ❑ Are all of the wells listed on the sampling schedule? Yes X No ❑ Are manifolded wells reflected accurately on the schedule? Yes ❑ No ❑ N/A X *Is the wellhead damaged in a manner that would make the source susceptible to contamination , .I +Yes ❑ I No X a *Are there unprotected openings in the well cap or casing? Yes ❑ No X *Is the wellhead, cap, and/or vent subject to flooding? Yes ❑ No X Are all wells> 100 ft from the nearest surface water? (NC systems) Yes X No ❑ Is the quantity of water supply adequate? Yes X No ❑ Do any sources run dry? Yes ❑ No X If yes, during which periods and how is it handled? Comments: NONE Source Protection: SWAP Database Information Source ID Approved GPD Zone I Wellhead Zone I Zone I(ft) IWPA(ft) Pollution Volume(GD) Owned? Prot Plan Method Sources in Zone I 4020013- 1850 UK Y N FORMULA 140 441 TENT SITES, 02G GRAVEL ROADS 4020013- 1000 UK Y N FORMULA 100 422 CAMPER O1G SITES, GRAVEL ROADS 8 Sandy Terraces Associates Barnstable 4020013 Survey Date: May 16,2013 Is there'excessive use of fertilizers or chemicals in Zone I? Yes ❑ No X Are there any known or potential, sources of pollution observed in the Zone I or IWPA (other than those listed above)? Yes ❑ No X Is there an awareness of threats and an attempt to minimize them? Yes X No ❑ Is protection area posted? Yes ❑ No X Are source water protection measures adequate? Yes X No ❑ Comments: [NONE OTHER ISSUES OBSERVED: NONE Statement of Zone I Compliance X You are hereby notified that the following well(s): 4020013-01G and 4020013-02G are in non- conformance with the MassDEP's requirement (310 CMR 22.21(1)(b)(5)) that Zone I activities be limited to those directly related to the provision of public water or will have no significant adverse impact on water quality (as specified in Policy 94-03A). To the extent possible, efforts should be made to reduce or eliminate the impacts of non-conforming uses within the Zone I. Pursuant to 310 CMR 22.04(1) and 22.21(a),you must notify the DEP if you plan to modify or expand your source or to replace any wells. At the time of such notification of a proposed modification, expansion, or replacement, DEP may require you to comply with the Zone I requirement that all Zone I activities be limited to those directly related to water supply or will have no significant impact on water quality. Non-Conforming activities documented within the Zone I: TENT SITES, CAMPER SITES AND GRAVEL ROADS 9 i Sandy Terraces Associates Barnstable ` 4020013 Survey Date: May 16,2013 PRIOR OUTSTANDING ACTIONS Enforcement Actions NONE PWSID ENF ENF ENF ENF#! ENF COMMENTS ACTION ACTION MILESTONE ACTION ISSUED COMPLETE TYPE DEADLINE COMPLETE NONE Inspection Actions PWSID INS DATE DEP STAFF INS TYPE INS ACTION ACTION MILESTONE ACTION COMMENTS DEADLINE COMPLETE *Groundwater Rule Significant Deficiencies: The EPA, as part of the Groundwater Rule, required states to identify specific Significant Deficiencies that are related to the potential for fecal contamination of the water system. Significant deficiencies, when identified at a PWS that is subject to the Groundwater Rule, are regulated under the treatment technique requirements of the GWR. A PWS has 120 days to correct any significant deficiencies after notification from the state of their existence. If the deficiencies cannot be corrected within 90 days, then the PWS must enter into a MassDEP-approved correction action plan, with intermediate timelines for.compliance. Failure to have an approved corrective action plan in place within 120 days or to comply with the timelines contained within the corrective action plan, constitutes a treatment technique violation, as detailed in 310 CMR 22.26(4). If a system fails to correct any identified significant deficiencies, then the PWS will be required to provide an alternate source of water, eliminate the source of contamination, or provide treatment that reliably achieves at least 4-log inactivation of viruses. 10 i I b�QyOFTNETp�`� TOWN OF BARNSTABLE BAR33TO11LE. i Dva`�� DUILDIN"INFCTOR APPLICATION FOR PERMIT TO .........5 fil.va1...l�,f�1� �:. 5.....: ............................................. TYPE OF CONSTRUCTION Y�..oDD��' . ................................................t 9...2j TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- LLocation �Y l�or3.� ocation .............. . ........ ... ... ....... ............................... ............. .....................ii�'.!l1.. ProposedUse ............. .U.��N/_':li .C,. ,�,196"E............................................................... ......................................... Zoning District ... ........... ......... ....... Fire District �- .............................................................................. Nameof Owner ........... .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............Foundation G e/.7!N� �'� �C L Exterior ....5. //UI .S...................................................Roofing ......... a�P`l, ......r................................................ Floors ............WPO b ..................................................Interior .............iJF............................... Heating ............../*!! .....................................................Plumbing .............. .............................................. Fireplace .....................Av...........................................................vY—'- Approximate Cost 7J�� Definitive Plan Approved by Planning Board ---_------_________________19 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name /W. Sandy Terrace Terraces Trust No 15 5.... Permit for .....d qoli� welling ....... .. ........... ............................................................................... Location_% ............ lioad ............................. ...........................k:r5t.Qn5..1%a ...................... Owner ..............4nOy.Terrace..Terra.c.e&...Trust Type of Construction ...........frame................... ................................................................................ =-28-4 Plot ............................ Lot .........A....................... Permit Granted ......January..........nuary...2.........*......19 73 .... Date of Inspection ......... 19 Date Completed ....... ........................ C-0 PERMIT' REFUSED ......................... ....................................... 19 ............................................................................... . . ................................................................................ ................................................................................ ................................ ................................................ Approved ................ 19 ............................................................................... ............................................................................... J/t✓- �PC,0"2". j/� Assessor's map and lot number .g_! SEPTIC SYSTEM MUST BE ......................z.. ........... INSTALLED IN COMPLIANCE fj WITH ATICLE II STATE Sewage Permit number/.I...........................IIG-P.. SANITARY CODE AND TOWN REGULATIONS, T"ETo�` TOWN OF BARNSTABLE 9. ,,� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...............lr../�?C.G.T..S TD,�J .................................... TYPEOF CONSTRUCTION ......... OO..,D.........................................................................................:...................... .................f.../a.y................19... /. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies .f.or a permit according t.o... the following information: Location Location .......... 4.U / ......h8-. .... V & TO• ' ............ ... .. ... .......................... Proposed Use ......15.r&q.6. .......................................... i= .................................................................................................. .... .... Zoning District .R � .............................................Fire District ry T Name of Owner li�rt��-t`.. ...1��. .�� .�. .2 : Vv.�l.. lf!J S 1 .... C�Y/�IIJLT�J/7i95 .... ..........Address .... ............. .............. Nameof Builder ........./ L ..........................................Address .................................................................................... Name of Architect ... 'L.//� 4. '... 1=N..C/=...0 4)....Address .......l �l!'.��o�� .....S.f? T/�/f'Y ...................................... T L Oc/ Number of Rooms !✓�lXc......................................Foundation ...../. .l.�.�!? L4'.......... �' ...Roofin ......... ! 5 /� L Exterior .......!/'!.GqQ..... ..9.,1/..4........................................ g. 1• ....( .....! .....r............................................ Floors ?�� ' o!iq .................................................Interior �/1�OOjJ P/�il/�� Heating .........A1.0/ e_,':;........................................................Plumbing .......... U.O/Ui� .................................................... Fireplace ............../.I 4Q ..................................................Approximate Cost .................QU................................. Definitive Plan Approved by Planning Board ---------------_______________19 Area ........ ...................... Diagram of Lot and Building with Dimensions tFee ...........fA ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 2. cl i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... �� /``�fpf/.�.�C/!l� :C%ha....................... I Diggins, Charles J. 16205 storage building SW Wakeby. Road Marstons Mills Charles J. Diggins frame PERMIT REFUSED Approved ,------..--------. lg ' --------------------.----.— � ' � - ---------------------^^^—~^'' [ ~ ' | � � �oFTNEro�y TOWN OF BARNSTABLE Z BARNSTAIILE. o D 9.ae�� BUILDIN4. IHSPE T0R APPLICATION.FOR PERMIT TO .... a `� V ! �.Jl'.�I.!. ....:F...T1�l W�. ......... .. ......... ... �...... .... TYPE OF CONSTRUCTION ...eoo a...rn �. O s .-..tlr!?� ........... ................................ ........ ............. ......... ...0......19.:1.� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies' ,for a permit according to.the'following information: , Location ..... ....a '. ....W1 ��.t't..... .... :...1!`!lAT4Y1�.T>t.�!�?�•��4 ....:... ProposedUse ........ Ql vvv...... V66. ...................................................................................... ............... Zoning District j' .................................................... 1 1 .....�........................ ..................Fire District .. �.�.6�i........................................� 1 c ( rA,. Name of Owner .. Q •!QS..�1. !.5.�.�'!V ...........Address W 1 Nun..�?......wt�e..QV........ '• Atll'TI.Q!�1.!1.`......�...I` At',�. Name of Builder ...1�1.� ` `�WILS..............Address �$.. .............................................................. Nameof Architect ..............Sys.--r-...............................Address .................................................................................... Number of Rooms ................... .........................................Foundation ......PUV ..COdJ GYL`er ................... Exterior .wAT!. .<SAV.....S.'AN"Cu. ............................Roofing ........N.4.-Pl a�t 1�� .... ......................... ................................ Floors .....C;A.hq.�.�.............................................................Interior ... . !4� .1 ................................................. tee. V Heating ...... ... .L..........I Plumbing .......................... ................................................ Fireplace ..\pA......QvrT 0.. ...............................................Approximate Cost .......1`t.top.O...............................7 i7....... . 1 Definitive Plan Approved by Planning Board -----------_______-----------19 _. Diagram of Lot and Building with Dimensions 2�JLy SUBJECT TO APPROVAL OF F HEALTH tq a n WU n110 La z n zi � � o �� .� .2i U _ W W -LUC, >- a — 4 � g W Z ~ Q W jX I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. T,;01e �'�' Name ..1. ..........0..... ......... ................... DIGGINS, CHARLES. J. No 15$.Ql..... Permit for .....••......•.. S ng.19. fa?!i y.......one..sto.ry...... .. Location �.Wakaby...Rd.... :... i ................. . . ..... i. l..�. O*ner ...CharIes...J....Iiggins— Ideymout.11• Type of Construction .....frame.......................... Plot ............................ Lot ................................ Permit Granted ...19 Date of Inspection . Date Completed ..Z ..:��...z: ..::....19 3 PERMIT REFUSED R t ................................................................ 19 ............................................. ... ........................ ............................................... .... Approved ................................................ 19 ............................................................................... ............................................................................... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma �� Par . I �V T�'?!�! OF 6A°P�STA9l.E p ce Application Health Division :' !s `:`'.{ 3 A11A 9- i ' Date Issued Conservation Division Application F Planning Dept. Permit Fee ^•a,Tl rrr Tf� �b ��Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ' Project Street Address 51 WAK6, I T oAD Village r4l e y e s /til r 11 V Owner J4"D y —7 "7" ce l�sfoti-4Te,/ Address ?° box. 98 AIAgir-ons D4,Ur"e/ 4,'E1-le , ti4 N c Y 0,4,rr/e t -� ,�. Telephone Permit Request 'FEP 14ce 3 'D N Wi nAow r (U V.30) Al e w A}6CAPu& -+9µiN6/e.s 5 l ya✓esJ -l?epl��-e �d�i�e f��ar S�in� Ier o� d2: y.48l� ewes-(io p) � emorte cwlkt./ey cvr Inot, rl"w1ele eddev W111K ogee- lroo6/Y#,,Ny t'2J Square feet: 1 st floor: existing / 1 proposed 0 2nd floor: existing NA proposed A1/A Total new "f Zoning District R Flood Plain Groundwater Overlay ;F4 Nc/,4 Jr,41e Project Valuation 501000 -Ga Construction Type Lot Size 5 Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 0 Historic House: 0 Yes CYNo On Old King's Highway: ❑Yes avfVo Basement Type: ❑ Full ❑ Crawl ❑ Walkout 0 Other Basement Finished Area (sq.ft.) © Basement Unfinished Area (sq.ft) Number of Baths: Full: existing , new 0 Half: existing new Number of Bedrooms: `z' existing U new Total Room Count (not including baths): existing new 6 First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New�r 1 Existing wood/coal stove: ❑Yes LR No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0 No If yes, site plan review # Current Use Ca MP 9AVA1h A A41V lf0 aide Proposed Use u ve-r e-ex _ _._ .. _ _ . •• - APPLICANT INFORMATION-:, (BUILDER OR HOMEOWNER) Name 64110M rkl; Telephone Number SJO yam" 9ely' G � 'i Zz.i �1 uHe T—MI vov e wcx4- - tv(- CAddress License # stf 14Q Y e V e tU4au/dt k p Co rvi'r /il4 G 2(a 1<� Home Improvement Contractor# Email e l�S L (At G (0®' N c fi Worker's Compensation # I'�=� C�a a d ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE IV LI 4 e FOR OFFICIAL USE ONLY w APPLICATION# i DATEISSUED 1 MAP"%PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION J FIREPLACE ELECTRICAL: ROUGH FINAL . > j- PLUMBING: ROUGH FINAL GAS: ROUGH FINAL =y FINAL BUILDING.. ," ' DATE-CLOSED OUT ASSOCIATION PLAN NO. i Internet Explorerb -= _ _ l j? " �/ Eand Records Public Search -X rnstabledeeds.argi P�� u: f 'els Yelp �.. M Inlsox(1}-permitCcapizz$�... Yahoo Suggested Sites htitp-www.fasKon-era.mm... :4�41Lmm-Offidal Site Cape Cod,Martha's Vineyar... 0 Restraint&Seclusion-tka �) aPreevious I For help about the docurrnent view!rtg options see: Viewing Information �`JJ Page 16 of 18 - + Page 12 _ SANDY'I 2RA .S ASSOCUTES (�` �,"• MMELCATF,OW TRUSTEE f_ a `'"` "`• Wee AQyn Hall,Paul McIntire,Nancy Bartlett and Everett Snow,Trustees, of Sandy Terraces Associates,under a Declaration of Trust dated July 26, 1952,and recorded with the Barnstable County Registry of Deeds in Book 817.Page 386 (the'Trust'),certify that: t x t t. We arc the incumbent Trustees of the`Crust; t - _v t or -mil-1, It ya 2. The Trust has not been revoked or terminated and all amendments hereto have t been recorded with said Deeds; It . . . t 3. The Trust is the sole owner of the land situate in Barnstable(Marston Mills), t Barnstable County,Massachusetts,bounded and described as follows: t t Page 14 See Exhibit A attached t .� t 4. Pursuant to the Trust,when specifically authorized and directed by the t beneficiaries of the Trust,the Trustee has full right,power and authority to deal t with any property owned or held by the Trust with the same force and effect as t though such property were individually owned; 5. The Trustees,by instrument in writing signed by all the holders of beneficial interest under the'Crust,have bean duly authorized and directed to refinance the Page.15 property located at 566-7&Wakcby Road,Marstons Mills,MA 02649 which ., shall include the execution of a mortgage and any other documents necessary for - the reCunancc to The Cape Cod hive Cents Savings Bank in the amount of S 100,000.00. 6. No beneficiary is a minor,a corporation selling all,or substantially all,its Massachusetts assets,or personal representative of an estate subject to estate tax liens,or is now deceased or under any legal disability. Page . Iall e i -0 _• _-^�--�_ -_ T [AA^_ _ r, Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT pANtel �idle vialfee I/WE,JOHN EASTMAN, OWN THE PROPERTY•LOCATED AT 566 WAKEBY ROAD IN MARSTONS MILLS, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO C PT 2_T too N C— ..L m Ao U e A4(F1& LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORD NCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: . 566 Wakeby Rd., Marstons Mills, MA 02648 OWNER'S TELEPHONE: 508-240-2978 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth of Massachusetts _ Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia j l orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbees. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):CAPIZZI HOME IMPROVEMENT, INC Address: 1645 NEWTOWN ROAD City/State/Zip:COTUIT, MA 02635 Phone#:508-428-9518 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with 40 employees(full and/or part-time).' 7. construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8, �Eg] ew emodeling any capacity.[No workers'comp.insurance required.] 3.®I am a homeowner doingall work myself t 9. ❑Demolition y [No workers'comp.insurance required.] 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.®I am a general contractor and I have hired the sub-contractors listed on the Attached sheet. 13. y� of repairs These sub-contractors have employees and have workers'comp.insurance. 14. Other WI j'IDDUI,� 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. If I' V� 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AmGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/25/2015 Job Site Address: 51 4 �'V4Yw �U City/State/Zip: 141/1 4J Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). — Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against th to a .A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri ti I do hereby, un r the pains and penalties of perjury that the information provided above is true and correc Signature: Date: oZ d Phone#:508-428-9518 Official use only. Do not write in t is area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I 31.12 2014 16:49:00 Guard Irwance Girard IlLstlrance Group 1/1 I aCo�o® CERTIFICATE OF LIABILITY INSURANCE DATE(NdMfiDIY" 12 0 2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTII9ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyges)must be endorsed. ff SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: ROGERS&GRAY INSURANCE AGENCY,INC. PHONE o No: 434 Route 134 -ADDRESS; INSURER AFFORDING COVERAGE NAIL South Dennis MA 02660 INSURER AmGUARD Insurance Company INSURED -INSURERS: CAPIZZI HOME IMPROVEMENT INC INSURER C: 1645 NEWTOWN ROAD INSURERD: -INSURER E: COTUTT MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- LNTR TYPEOFINSURANCE S POUCYRUMaER MM C EF PN EXP LIRAfe GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO REF� COMMERCIAL GENERAL LIABILITY PREMISES occurrence S CLAIMS-MADE DOCCUR NED EXP(Any one persm) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGO E POLICY U LOC $ AUTOMOBILE lIA6lLfTY C N DSI G 1(Ea accident) ANY AUTO BODILY INJURY 1For person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accdcnt) $ AUTOS AUTOS HIRED AUTOS NON OWNED PROPERTY DAMAGE S AUTO; aracWcni UMBRELLALIAB OCCUR EACHOCCAJRRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED RETENTION$ 3 A WORt1ERSCOMPENSATION WCSTATU- ... OTFF AND EMPLOYERS'L1ABIWY YIN R2WC527200 12/25/2014 12/25/2:115 X. U.TS ANY PROPRIETORIPARTNBtIEXECUTNE NIA EL EACH ACCIDENT s 1,000,000 OFFICERRAMBER EXCLUDED? Ej (Mandatory In NH) E.L DISEASE•EAEMPLOYEE 5 1,000,000 If yyes,desuibe utder DESCRiP OPIOFOPERATIONSbetorn EIL DISEASE-POLICY UUT S 1,000,000 � OESCRIP110N OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD tot,AddiUgml Remarks Schedule,if more apace is regalred) Thomas Capi22i Ir is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRMEO POLICIES BE CANCELI ED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE V&L BE DELIVERED IN Hyannis,MA 02601 ACCORDANCE WRH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD V/te�(in»c�iro�rrue2lf�n�C�ZIIJJCLC�ure _ ffice of Consumer Affairs Business Regulation )License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:' Office of Consumer Afffairs and Business Regulation egistration: 100740 Type: 10 Park Plaza-Suite 5170 Expiration: 6/23/2016 Supplement Card )doston,MA 02116 CAPIZZI HOME IMPROVEMENT,INC. vj JOHN STRUMSKI 1645 Newton Rd. Cotuit, MA 02635 Undersecretary htot valid without signature 8 Massachusetts -.Department of Public Safety K Board of Building Regulations and Standards Construction Supervisor License: CS-064817 J011N T STRU Sjb ' 16 AL DEN AVE l0mards Bay big 025 2,' ' ✓��-- "' Expiration Commissioner 06/18/2016 i i J F.1 VZF 25 W6 yu I /YD T-RIUM ! T-A 274jD T6- G, I. I .Pam ' i c� j � . .n% L Rio . C. , V57L01M oo 215 k7pQ; E" { ��/� lam;r "✓ 'l L �. { i I ClLij 71ol Z b i I Ri T-C -Fo G. 4 R AIFVV�P, 01,X6 ip ff, , r� Pof o r xr � CO ZZ CONCRETE SLAB I(I ON GRADE t 24.0 r------------------ ------ ------1 I 1 r---- --- ------- - -- ---- CL ' 1. ad � SHOWER HEAD j (TYP.) Ini I I I , II � Nr VC7 I 1 1 n O ----------- - ---------------- `------------------------------- i A --------------- DRAIN EAST ELEVATION NORTH ELEVATION (TMP•) 1 • I I I • _ 1 1 P& I, I 5 XS' CONCRETE SLAB ON GRADE PLAN VIEW 00000 6� BATH HOUSE PLAN "SANDY TERRACES" =• I I AT . I---------------'F---------- - � c #566 WAKEBY ROAD SOUTH ELEVATION WEST ELEVATION IN MARSTONS MILLS, MA off 508-362-4841 PROMW fm far 508 362-8880 SANDY TERRACES down cape engineering, Inc. ASSOCIATES Sc01e:1/8 1, CIIAL ENGINEERS LAND SUAW YORS DATE: APRIL 13, 2007 0 4 s 12 16 20 FEET 9J9 Main Street — YARd90UTHPORT, MASS- PERMIT SET — NOT FOR CONSTRUCTION 06-284 06-284 SANDY TERRACES.DWG I 3 Zx 14- i X 6 Flo►.A io 3 1 i , �- 424- -1 A2 PLATKS -.— I U(.0 MN S _ 24 IZ , i u 24-- J4 -- -- i - I —'�-- - ---- - _ u 5 E 2 x 4- 5PA CE2 �4 x 5 x 24-.-= ° N u 2 PC v�f� I f LA L5 - 2x2x - - Zx (D3o�T IU o N SoNo7�,��1 Zu-z__ T-o Fi Q15 H /_. N 12 'D�ME,NS�otJ r . r-ba�VTn MA y 99�. - -1 I I I i _ I T`(PICAL 7j2uSS. 7-1 14 - - -- 24, - i i - - - ap LT T L It= 5 ED G u 0PAVILION . 7 D G� N� I i ScaL 4 = I F-T r� Y_ �•I GOD�'>zP\ I rv►2 SANDY I E� F.C�"� A��o` M S(p&> 0/Ik June 16,19S0 1 have inspected the camp cottages known as Sandy Terrace Associates on Wakeby Road, Mars tons Mills and find that the units meet the safety standards of this depattment. Joseph D. DaLuz Building Inspector '\