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0018 WHITMAR ROAD
/ Y 'G(���c col! d� TOWN OFS- RNSTABLE BUILDING PERMITTAPPL:VATION Map 4�'*7— Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. ff7�� -/-y Permit Fee Date Definitive Plan Approved by Planning Board D ��G� Historic - OKH _ Preservation/ Hyannis Project Street Address / 8 UJ/i 17: /q J Village / -9 ) 6 iy s { �✓ , Owner 'B A/ Ql. 05Y/ ddress,/ hl i Telephone! °-�Z.?%' -J 9 7 � 4 I Permit Request L. I tv e G/4J5' U a/7 //" ^L� LIZ Square feet: 1 st floor: existing proposed 2nd floor: existing 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 !IY Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes No On Old,Kings Highway: ❑.Yes ❑ No ` Basement Type: I/Full ❑ Crawl ❑Walkout ❑ Other B Basement Finished Area(sq.ft.) Basement'(4 hed Area (sq.ft) Number of Baths: Full: existing new . �,,F�alf: �ellx//�i'stg new Number of Bedrooms: existing,—new TOE*Op Total Room Count (not including baths): existing new Fit Floor Room Count Heat Type and Fuel: 18`Gas ❑Oil ❑ Electric ❑ Other STgeZ$_ Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ 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 ❑ No If yes, site plan review #. Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ _ _ .. ; Name 64 L#IaUrd If rl M i ° Telephone Number Address # C. Home Improvement Contractor# 4 iv( Email Worker's Compensation # L� ,Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 410 DE 0 / X - SIGNATURE DATE I ` FOR OFFICIAL USE ONLY —APPLICATION # DATE ISSUED ; MAP/ PARCEL NO. ADDRESS VILLAGE ; ? DOWNER ` DATE OF INSPECTION: ; i s FOUNDATION f k FRAME INSULATION " FIREPLACE ELECTRICAL: ROUGH FINAL � f PLUMBING: ROUGH FINAL is GAS: ROUGH FINAL � FINAL BUILDING DATE CLOSED OOT r ASSOCIATION PLAN NO. r _ t Q �� ., J. �SS� �� j � THE FOLLOWING IS/ARE THE BEST IMAGES FROM. POOR QUALITY ORIGINALS) I M ^ DATA 9 ' MA HIC License#110123jU�, falmouthchimney@verizon.net MA CSL License #024158 ':!Y— �'7Z f��/%� falmouthchimneysweep.com CSIA Certified Sweep#361 Office:508-540-0458 ID: Agostinelli 3-16 508-737-6289 Date: 3/2/2016 Owner: Mary AgostinelliG/� mracapecodOa aol.com Mail Add: 18 Whitmar Road Job: Same Marstons Mills, MA 02648 THIS ESTIMATE IS BASED ON AN N.F.P.A LEVEL--1 CHIMNEY INSPECTION DATED: 2/26/2016 Estimate Assumes Chimney Was Built To State And Local Codes At The Time Of Construction. Additional Work Due To Improper Construction//Installation Will Be Separately Invoiced. Undetected Chimney Damage,Tile Removal,Added Masonry Work,Or Changes In This Proposal May Result In Additional Charges. Options r f Importance. Circle The Option/Options You Want Completed. option#1 � Masonry Repair $ 1,645.00 1. Stage Chimney and remove chimney cap. 2. Repair/Resurface chimney crown and top course of brick. 3. Replace approximately six spalled brick. 4. Reinstall chirr,Jra,.' Spring W rk Option#2 Water Repellent $ 600.00 1. Prep chi ey-be ying water repellent. , 2. Apply 10 n Solvent Based Water Repellent. Option#3 Gas Reline FCS $ 1,700.00 If completed with Option#1 1. Stage himne $ 2,100.00 If completed alone. c�CJ 2. Temporarily remove gas smoke pipe. 3. Install a Lifetime Warranty Stainless Steel Gas Reline System. 4. Reinstall smoke pipe to reline system. NOTE: Due to the height of your existing chimney cap the gas reline pipe may have to extend up through so, the chimney cap. NOTE: To Save On Job Costs The Customer May Obtain Permit Themselves / Falmouth Chimney Sweep Will Supply All Licenses And Insurance Certificates If F.C.S.Obtains The Permit An Additional Charge Of-$250:00 Will'Apply- -- Please Check Option Cust.To Obtain F:C.STo Obtain,_ j i ( /� �42 0 NOTE:Shipping& Restocking Fees For Return Of Custom Ordered Stock Will Apply On Jobs Cancelled At The Last Minute For Any Reason Other Than Emergency Rescheduling To Schedule Work:Sign, Date,& Indicate Options To Be Completed---Send With Deposit `Appointments Are Made Upon Receipt Of Completed Paperwork& Deposit peposit.Is 50%Of Options Chosen--Balance Due Within 30 Days of Job Co0wetion SUM: SEE OPTIONS Amt: PROPOSAL PRICES ARE SUBJECT TO UPDATE AFTER 6 MONTHS-A SUR-CHARGE OF 1.50/6 ON BALANCE OVER 30 DAYS JOSEPH BENTO JR. CUSTOMER SIGNATURE: DATE: - __._.. 3 3 jlo ofTMT, Towu'of Barnstable Regulatory Services ' E Sll4VLT1RfF i aaer�s$ THchard F.S=A DhTdor Belding WvWon TomPerrp,Buffir;Commoner 200 Mam Street;Hyais,MA 02601 WWW toWZbarnstable ma_us Office: 50M62-4.038 Fay 509-790-6230 Property Owner Must Complete and Sign This Section If Us ing'A Builder j ,L �. ,as Owner of the subject ProPeXLY heMbyM3f JaOZirZ_ � e H i' �I to act on mpbehalf, in all mailers relative to work anthoAzed bptiis binding putt application for. , /.rJ v.[/.//1J,4 (Address of Job) 'Pool fences and alarms are the responsibilityof the applicant Pools are not to be f Mod or i i i iwd before fence is instillecf and all final inspections_are performed and accepted- Signore of Ow= o P16= Print Name Priest Name I Daifi' . , QFoxnas:o oors . Town of Ramstable Regulatory Services r � Richard V.Scafi,Director , Rlar g Division t _ = Tom Perry.Sffldmg Canrmimsioncr 200 Main SEtett, Hy=iir,MA 02601 WWVVtD�PII.TT2t� �,Tr m�Us Of 508-962-4038 - F= 508-790-6730 HDIODWNaLICE=Corr DATE: ' MB I O=CybL- , anmbcr' sfrrt �ooWrtER hamcphanc9 'wM3cpboncC- . T CQRKE Tr IMAa ING ADDRESS: _ Zip Code The current exemption for`homeowners"was extended to mclnde owner-0cc�ied dweIImes of six units or Less and in al1o� homeowners to eog-,ge an;nr$vidtL for hire who does not possess a licensc,pioyided that11c owner arts as sapervisor- DXXMQ r li oBHOnFowrz�a person(s)who owns a parcel of land on which he/she resides or itt-nds to residc,on which there is,cr is ht=ded to ba,a one or two.- f onily dwelling,attar bed or detached st mctmt;s a c=s ory to such use and/or farm strnctores. A person who constucts more than me home in atwo-yearperiod shaIl notbe consid=r-dAhomeownes Stroh°homeowner".sbaIl submittn the Bm7diag Official ' aform acccptable to the Btffiamg Offal,thathe/she shaIl be responmllz for an such wor3cperfimaed Mid=ffim bmld 3.z R99 ft (Section 109.L1) The cd`,`homeowner"ass=cs respons10Y for compliance widitbs Suit;B—Iffing Coda and oar applicable codes, bylaws,roles and regc Iatmns - The md=agied`homcownee cerfifies thmtbe/sbe Llmstands the'Town ofBarn To Buildmg Depar maot=mnmm mspectton probes andrequitem�andfbathe&bc wM comply wth said Pro andregttaemenfs. 5iZM9ae afH®eaW= AppcvPsl ofBm��mgOf�c3a1 , • Note_ Three-hm3ly dwcUkp mniaming 35,000 cubic feet or lazges wM be requred to comply wif L the State BuDding Code Seddon f27.0 Ca:LvL n.CmtaE Hnn�owN��s EXEIRrmN The Code sfates that: `Any homeowner performing Work for Which a b--T permit is required shall be exempt fiom the provisions of this secfinn(Section,109_U-Licensing of constradion Stitpervisors);provided fhatif the homeowner engages a person.(;)for hire to do such work,that such Homeowner shah act as supervisor a Many homeowners who use this exemption are unaware ffiat ffieY are arc= g the responsibrTHI of a supervisor (=A.ppmr Q,Rules&Regnktimns for T i��C sn rmcfion Sirpervisors;Secfinn 215) This hark of awareness off results in serious problems,psrficularly When f e homeowner hires unlicensedpersons In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ulfimately responsible. To easure'fhat the homeowner is faIfp aware of his/her responssibiliftim many communities require,as part of fhe permit application,that the homeowner cerMy that hdshe understands the responssM701'es of a Supervisor.'On tbm last page of this issue is a form cntr•enfiy used by.several towns. You may care t amend and'adopt such a form/[ertiffca:ffDn for use in your commmaiip. pemz�§�st�aA�der '. Rmiscd 0613 33 17ze Comuzonfveahh of-Massachusetts Departtrrezzt afludusbW Accidents 00we q fiz,W.sti9atians 600 Washbigtou&reet Bastont CIA#2111 wivtnmassgvrldia Workers' Campensation Insurance Affidavit Baders/ConfractursfEIectricians/Plumbers Applicant Information ,,. .vil Please Print Leerily Na=(Basin P.O. Box.T Address- (508)540-0458 CitfStatfl Phone A!!;A an employer?Check the appropriate box: Type of project(required)- 1.Lff I am a to with 4. ❑I am a general contractor and I employer 6. ❑New construction employees(full andfor part-time)_* Dave lured the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet I- ❑Remodeling ship and have no employees . These sob-contractors have g- ❑Demolition woddrig for me iti any capacity. employees and have wodaxs' - [No od=s'comp-invxanre comp.insurance-19. ❑Building addition a- regtured_I 5. ❑ We are a zorpozatifln and its 10.❑Electrical repairs or additions 3.❑ I ama homeoumer doing all work officers have exercised their IL❑Plnmbingrepairs or additions . myseM[No workers'comp- right of egempfim per MGL 12.❑1�oo€repairs insumare required-]y c.152,§1(4h and we have no emplogem[No wo&ers' 13. Other comp.insurance required.) pi' nyapp1!,c thatchecksboxf1mastalsofill out the secdooberowshossiagfhekwmkexs'compensation policy iffon=tian_ fi Homemam who submit this af6dary; xffr g they sm doing all woA sad then him outside contmetors mast submit a new affidavit 9^a�such. zoo aaactoasthXr,beckthds box must attached=additinnsl duet showing thenameof the sub-coatmcommad state whether ornot those entitiesha— empbyem Wthesobtantractms hare emplayees,theymustpmuidetheir wcrkea'comp.policymm&ber. lain an etmpIn�er cleat is pratzdirg workers'camtperesrrh'am inrsrtrauce�or any*cnrpinS�ees Below is fhepoiicy toed jab srte fnifor inahbns Insurance Company brame- �%y g� Policy or Self-in,.Lic.�,dW `Y0 -& W Y ELpiration Date: ZJ l�YZI Job Site Addy /1 /.,(& ///� j, ,� W cityfstawzip: Attach a copy of the workers'compensationpolicy declaration page(sheaving the policy number and expiration date). Faiimre to secure coverage as requiredunder Section 25A of MGL c.157 can lead to the imposition of criminal penaffies of a fine up to$1,500 OU andror tare-year impfisonme4 as well as civil penalties.in the form of a STOP WORK ORDERand a fine of up to$250-00 a day a ainst the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations o€the DIA for insurance coverage verif<csfism.. l do hereby cadify under thapaznts and pematYes of attha ineformaliarz prf iiW abm e" bate an ect Simature: Date: Phone OfiS al use onrfy. Do nrot t;rrke in tfds area,tribe carnpteted by trip artown o frciaL City or Town: Perm*Ucense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.C yffosgn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 1haformation and lastructions M�scar-3mcetts Geheral Laws chapter I52 req�es aII employers in provide wo=keas'compensation for their employees_ Pmsuant-to this stye,an mployez is defined as."_.evmy person in the service of another under any contrast ofhi e, empress or implied,oral or wri� An etaplvyer is defined as"an mdividnaI,pa�ersTip,association,cnrpor On or other legal entity,or any two or mole of the foregoing engaged in a joint enterprise,and including the legal represmta&m of a deceased employer,or the receiver or trustee of an individual,partnership,association or other Iegal entity,employing employees. However the owner of a dwelling house having not more than tbree apartnetS and who resides therein,or the occupant of the - dweJliag house of another who employs persons to do maiotenancq construction or repair work on such dwelling house Or on tine grounds or bu mg appurtenant thereto shall not because of sash employment be deemed to be an employer." MGL chapter 152,§25C(6)also stems that"every state or local Nrm agency shall withhold ffie issuance or renewal of a license or permit to operate a business or to;consfruct b Idmgs in the commonwealth for any applicant who has notproduced acceptable evidence of cdnLpfiance,wrth;-th'e hnmxance.covexage required." Additionally,MM chapter 152,§25C(7)states¢Neither the Comm anwealth nor any of its political subdivisions shall enter mto any contract for the performance ofpublic work unI acceptable evidence of compliance with the him narice.. r ems of this chapter have been presented to the contracting aathoiity_" = Applicants , please fill oic t the workers'compensation affidavit completely,by checI®g the boxes the apply to your situation and,if necessary,supply sub-contractor(s)name(s), addresses)and phone mnmber(s) along with then certificates)of insurance. Limited Liabi74 Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or parineas,are not regfi-ed to carry workers' compensation insurance If an LLC'or LLP does have employees, a policy is required. Be advised that this a$dav$maybe sabmittDd to the Deparment of Industrial Accidents for conformation of fim=ce coverage. Also be sure to sign and date the of davit The affidavit should be retnimed to the city or town that the application for the permit or license is being requested,not the Department of aAa al A=deats. S`iauld you have any questions regzrdmg the law or ifyou are regm-ed to obtam a workers' compensation policy,please call the Department at the number listed below. Self-insetted companies should enter their self-fi s, ce license namber on the appropriate line. City or Town Officials Please be sure that the affidavit is completm and printed legibly. The Department has provided a space at the bottom of tine affidavit for you to fill out in.the event the Office of Investigations has to conduct you regarding the applicant Please be sure to fill in the pen >Wlicease number which will be used as a refwmce number. In addition,an applicant that must sabmit multiple penult/license applications in any givenyear,need.only submit one affidavit indicating nr rPnt policy i a. ration(if necessary)and under"Job Site Address"the applicant should write"all locations in (may or town)--A copy of the affidavit that has bey officially stamped or madced by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fUtore permits or licenses A new affidavit must be filled out.each year.Where a home owner ar citizen is obtaining a license or permit not related to any business or commercial venizae Cie. a dog license or permit to bum leaves etc.)said person is NOT requiced to complete this affidavit The Office of Investigations would hie to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Departnenfs address,telephone and fax Cr.n¢imb Tlhe CommmWeala eMassachuseM Degarfmmt cif IndEstcial Accidents mice of javegtgatio= ��4��ingtan - Bwton�MA EMI if Tf,-1,#617-727-4900 e t 406 Q,r 1-977-MASSAFF, Fax 9 6117 727 7749 Revised4-24-07 - gfdia DATE(MMMDIYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 8/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO-RIGHTS'UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,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 endorsemen s. PRODUCER CONTACT Martha O'Meara Lawrence Carlin Insurance Agency PHONE (508)540-7100 ac No:(50e)540-e426 230 Jones Road E-MAIL ADDRESS•martha@lawrencecarlin.com INSURERS AFFORDING COVERAGE NAIC 0 Falmouth MA 02540 INSURERAArbella Protection 41360 INSURED INSURER B.A.I.M. Mutual Falmouth Chimney Sweep, DBA: Joseph Bento Jr. INSURER C: PO BOX T—T INSURER D: INSURER E: Teaticket MA 02536 114SURERF: COVERAGES CERTIFICATE NUMBER:CL1581100879 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. INSR ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDrfYYY) [MMIDDrfYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ —1 ToRENTED CLAIMS-MADE OCCUR POEM SES Ea occurrence $ MED EXP(Any one person $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: 1 1 $ AUTOM081LE LIABILITY COMBIEa acciNED SINGLE LIMITden $ A ANY AUTO BODILY INJURY(Per person) $ 50,000 ALL OWNED I SCHEDULED 1020002033 7/11/2015 7/11/2016 BODILYINJURY(Peraccident) $ 100,000 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ 100,000 HIRED AUTOSAUTOS Per accident) PIP-Basic $ 8,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAS CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER _ ANY PROPRIETORIPARTNER/D(ECUTIVE ❑ NIA E.L.EACH ACCIDENT $ 100,000 OFFICERIMB (Mandatory In H)EXCLUDED? ANC7027074012015 8/10/2015 8/10/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Falmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 59 Town Hall Square ACCORDANCE WITH THE POLICY PROVISIONS. Falmouth, MA 02540 AUTHORIZED REPRESENTATIVE David Lawrence/MEDWAR � / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 po14o1) Chimney Safety Institute of America Massachusetts Department of Public Safety ; Certified Chimney Sweep P Board of Building Regulations and Standards License: CS-024158 '. i. CERTIFIED #361 - HIMN \ Construction Supervisor M I CKI)VI YN JOSEPH BENTO c Valid Thru PO BOX r fl �- December EAST FALMOUTH MA 0206 O 16 (' .ZZK CA— Expiration: : - • Commissioner 01/01/2018 { Falmouth Chimney Sweep Teaticket, MA \ Office of Consumer Affairs&Business Regulation- • ' -V =Fegistration: OME IMPROVEMENT CONTRACTOR: � 7149 r Type: Expi ratio (nn:-6172.01'f DBA FALMOUTH CHIMNEY-S.VIJEEP=�_ ""� --" IIJ t — ,COMMONWEALTH OF MAS. SETTS :.. — - �'1 ;' • • • • • JOSEPH BENTO JR: s •:�°i, BOAf3D F H �f 440 LOCUSTFIELD RD"� Y • SHEET A9ETALJORK�RS tf E.FALMOUTH,MA 02536 v' - = ISSUES THE FOLLOWtIJ.6 L(CENSE I tt Undersecreta STRICT'ED; !I -- -----' AS A MASTER-UNRIr j 'JOSEPH.><: Et�T4''`JR '� rY W :<..$<, W P.0 BO .I X='� ' sz<:<a`' `fit r.. TEATI{CKET MA 02536 0200 3 368554 TOWNJOF BARNSTABLE BUILDING PERMITAPPLICATiON Map Parcel Application # C0 o� Health Division Date Issued 2 Conservation Division Application Fee s� Planning Dept. ,'Perm it Fee 2� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address TMAa Ro Aj� Village 'bTb /al�s k-A WS Owner Ar,� o , Ag,oSrt \c Address IS kA\TmPJk 'Zo P c1 Telephone SOs- yIQ`9.6S o Permit Request zo-\6 Se[o NA Piooa Ako Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation4s- aI •®'1 Construction Type �h roc Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family E( Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes t(No On Old King's Highway: ❑Yes ❑ No Basement Type: &'Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area4q.ft) Q Number,of Baths: Full: existing new Half: existing aw Number of Bedrooms: existing _new OT Z 0 Total Room Count (not including baths): existing new First Floo 00 1100oun N Heat Type and Fuel: &`as ❑ Oil ❑ Electric ❑ Other � M Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wpd/coal stovvt: ❑Yes ❑ No m Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: misting ❑ 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 (BUILDER OR HOMEOWNER) Name -7�d Rbmegose Ch �"1 A��ephone Number._508- 77 61,5V o Address s 0)t 10 a License #_C 5 - Mik oQ) �2_ Home Improvement Contractor# 15 Oc L9 Email CC W 1- I,(_ jo Cow MX A gX: Worker's Compensation # W CC 50O 15011 ;-A°i5D(0IS� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO e: SIGNATURE DATE l i ° a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ' MAP/PARCEL N0. t , ADDRESS ; VILLAGE OWNER , } DATE OF INSPECTION: FOUNDATION FRAME P C i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' f PLUMBING: ROUGH FINAL I, GAS: ROUGH- FINAL , 1 FINAL BUILDING r , DATE CLOSED OUT t ASSOCIATION PLAN NO. 27te Cowynotnvealth of Massadiusetts Department of lndustrial Accidents ' - Office of Investigations '1 600 Washington Street Boston,M4 02111 fv►in mass_gov/din 'Workers' Compensation Insurance Affidavit:Builders/Contractors/EIecti icians/Plumbers Applicant Information Please Print Legibly Name(Busme&vUrganintiowbdividual): 'oN�`�p&- CVjoTO M \NJ 0 Mo Ad&ess::-1�g. S®� City/State/Zip: C �\ M l- Phone 44k `J 0 7 G S- 1 Are you an employer?Check the appropriate box: OD Z Type of project(required): 1.ETI am a employer with 3 4. ❑I am a general contractor and I employees(full andlor part-time).* have hired.the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. BILemodeling slip and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity_ employees and have workers' [No workers'comp.insurance comp.insurance,, 9. ❑Building addition. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'camp. right of exemption per MGL 12.❑Roof repairs insurance required.]i c. 152,§1(4�and we have no employees.[No workers' 13.❑Other comp.insurance required.], •clay applicant that checks box ifl most also fill out the section below shoeing their waskers''compensation policy information I Homeowners who submit this affidatrit indicating they are doing all waht and then hire outside contractors limit submit a new affidavit indicating such- 'Contractors that cbect this box must attached an additional sheet showing the nee of the sub-ca mttwA rs and state whether.w nat those entities have employees. If the sub contractors have employees,they must prmide their workers'comp.policy number. I aut an errtpioyer that is pros,ding workers'conrpensatrbrt iasurarrce for my enrploy,ees. Below is the policy and job site information Insurance Company Name: �SOe,K-Vt& Cc Policy,A or Self-ins.Lic.# LAKE 15-00 SO k 5e3tV 1 S Expiration Date: l m 12 Job Site Address: is \J t1 1-{mAN 1 A -1�-O AA City/State/Zip: 1""\All-51CiY\ I)1l\`l MA 0,�� 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 a 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andror 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 ceito,under the pair tahries ofpeduty that the information pmided abm�e.is true and correct Sit3rature: ��s;u Date: m ,'D m Phone it Ofjicial use only. Do not write in this.area,to be completed by city ortot4n official City or Town: PermitUcense# 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#: 6 r Information and Instructions' ` Ivmssachuusetts General Laws.chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this stye,an employee is deemed as."_.every person in the service of another under any contract of hire, express or implieti,oral or wui fcm- An ergpIoyer 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,partaerdup,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 Molding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sides 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 commgnwealth nor any of its political subdivisions shall enter mtn any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting auJhoiity.-" Applicants- Pleas I e fill out the workers'compensation affidavit completely,by checlang the boxes that apply to your sitnation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s) of inmmance. Limited Liability Companies(LLC)or Limited LiabilityPart nmships(LLP)with no employees other than the members or partners,are not required to cant'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 conformation of insurance coverage. Also be sure to sign and date the affidavit- The affidavit should be retume:d to the city or town that the application fur the permit or license is being requested,not the Department of Ir_dushial Accidents. Should you have any questions regarding the Iaw or if you are required to obtain a workers' compensation policy,please call the Department of the immber 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 is the permit/license number which-%U 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 (may or town)_"A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to time applicant as proof that a valid affidavit is oa 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 (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations wound like to than you is advance for your cooperation and should you have any questions, please do not hesitab-to give us a call- The Departmeafs address,telephone and fax namber: The CGMMQaWedth-of Massachusetts Deparbneat of Industdal Accidents Off ice of j•VeStjgatio= 60.0 WashingtGn Street Boston,MA(1�111 Tt,-1,if 617 727-4}00 eat 406 or 1_977-MASSAFE Fax#f 17-727-7749 Revised 4-24-07 .m _gov/dia � roiy Town of Barnstable Regulatory Services R�T,74r'IRf d• i 9 Yeas Richard P.SraIi,Dkedw Building Division Tom Perry,Bm1dmg Commbdoner 200 Main Street,Hpanais,MA 02601 www.towrib arnstableama.us Office: 508-862-4038 Fax: 508-790-6230 " •5 Property Owner Must Complete and Sign This `Section.` If Using ABuilder , as Owner of the subject property- to act on my behalf, in all matters relative to work authorized byd:is building permit application for. (Address of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be fdIed'or ut zed before fence is installed and all final inspections_are perfoffied and accepted. Sigpature of OwnerSigIlaiZIIe o App Al 5 Pn=Name Print Name Date . Q:FORMS.-OWNEUEl2 MMNPoOLS Town.of Barnstable , Regalatorp Services r � Richard P Scar;Director B>�Iduig Division c- acar �A*R •` Tom Perry,Bmaldmg Commissioner 200 11S9m , Hymnis,MA 02601 www town.barnstable.ma.us Office: 508-862-4038 Fag: 508-790-6230 HOMEOwlZER LICENSE EXXh0TION .Pl��Prmr DATE: IOB LOCATIOK nnmbcr ss<rut VMaga "HOI.ZFAWl�' name - homaphonc# wo&phonc# CURRENrMA=GADDRF-SS: -- - _ city/lawn s zip wdc 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 hirewho does not possess a license,provided that the owner acts as supervisor_ DEFIIMON OR 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`homeownee'shall submit to the Building Official on a foam acceptable to the Bmlding Official,that he/she shall be responsible fur all suchworkperfomled under the buildin>rpermit (Section 109.1.1) The undersigned`.`homeowner"assumes responsibility for compliance w$hthe State Building Code and other applicable codes, bylaws,roles and regulations. - The undersigned`homeownei"cedifies thathelshe understands the Town ofBarnstable Building Departmentmin>m=inspection procedures and requirements and that he/she will comply with said procedures and mqaiemeots. Sigaahuc of Aomcowncr , Appvyal of Brd]ding Official Note: Three family dwellings containing 35,000 cubic feet or larger will be req>tired to comply with the State Building Code Section W.0 Conslmc ion ContruL ' $on�owr�s»noN The Code states that: 'Any homeowner performing work for which a building permit is required shaIL be exempt from the provisions of this section(Section 10911-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assummg the respowffiMties of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction S4ervisors,Section.2_15) This lack of awareness often results in serious problems,purtieularly vihen the homeowner hires unrcensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a fieensed Supervisor_ The homeowner acting as Supervisor is ultImately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities requdre,as part of the permit application,that the homeowner certify that he/she understands the responsibRides of a Supervisor. On the Iast page of this issue is a form currently used by.several towns. Your may care t amend and adopt such a formleerfifica ion for use in your community. Q��7PFIIESlFOR2�'1bm7dmgPeffiitfnnasli:RF&ESS.dne • Revised 061313 t Massachusetts - Department of Public Safety �- Board of Building Regulations and Standards Construction Supervisor License: CS-051311 „ THEODORE S PgMEROYr- PO BOX 102 , Sagamore Beach MA 02562 ; - xpiration Commissioner 02/15/2017 �c�r�ooxrnzoo�roeal/�o`'C/lla�accc�usetl3 _� - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 99ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 150297 Type:. Office of Consumer Affairs and Business Regulation piration: _3/23/2U16;:: Ltd Liability Corpor10 Park Plaza-Suite 5170 _ - Boston,MA 02116 COASTAL CUSTOM INOO:DWORKS LLC THEODORE POMEROY = 2 OCEAN PINES DR �L SAGAMORE BEACH,MA 02562 Undersecretary Not valid without signature` Client#¢20662 2COASTALCU ACORD., CERTIFICATE OF LIABILITY INSURANCE r DATE(MM/DDIYYYY) 12/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,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 endorsement(s). PRODUCER CONTACT NAME: Dowling 8:O'Neil Insurance Ag PHONE 508 775-1620 FAX 5087781218 (AJ973 lyannough Rd,PO Box 1990 E-MAIL L E><t A/c,No: Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC fe INSURER A:National Grange Mutual Insuranc INSURED Coastal Custom Woodworks,LLC INSURERB:Associated Employers Insurance P.O.Box 102 INSURER C: Sagamore Beach,MA 02562 INSURER D: INSURER E: INSURER F: 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 CONTRACTOR 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. ISR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS L"TINSR WVD POLICY NUMBER MM/DD MMMD A GENERAL LIABILITY MP052143 3/22/2015 0312212016 EACH OCCURRENCE s2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED s 500 000 CLAIMS-MADE Ex—]OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY s2,000,000 GENERALAGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s4,000,000 POLICY j RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DEO I I RETENTIONS I S B WORKERS COMPENSATION WCC50050114952015A 11/13/2015 11113/2016 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMIT ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Bldg.Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street I Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S161668/M161667 LS1 COASTAL CUSTOM WOODWORKS, LLC CONTRACT CONTRACTOR: Coastal Custom Woodworks, LLC Theodore S. Pomeroy, Managing Member 2 Ocean Pines Drive P.O. Box 102 Sagamore Beach, MA 02562 Construction Supervisor's License Number: CS051311 Expiration 2/15/17 Home Improvement Contractor Registration: 150297 Expiration 3/23/16 HOMEOWNER: Mr. & Mrs. Anthony Agostinelli 18 WhitmafkRoad . Marstons Mills, MA 02648 This contract is entered into between the Contractor and Homeowner this j th day oQ. -f12016. The agreement between parties consists of this contract and any addendums heretofore attached. PROJECT: . This contract pertains to work to be done at 18 WhitmAlRoad, Marstons Mills, MA LENGTH OF CONTRACT: T�Gfi V4, �O�A �0, �� T Start Date: ^I—aD,2016 4& �7e Finish Date: ' Z h, 2016 1 49, In the event that the Contractor is delayed in the prosecution of the work by Acts of God,fire,flookr any other unavoidable casualties;or by labor strikes,late delivery of materials;or by neglect of the Homeowner;time for completion of the work shall be extended for the a same period as the delay occasioned by any of the aforementioned causes. The Homeowner hereby acknowledges and agrees that in certain remodeling work,the demolition of portions of the pre-existing structure may reveal additional defects,conditions,or the need for additional work which must be repaired,altered or carried out in order to commence or complete the work described under this contract. In such case(s)the Homeowner agrees that the duration of the work and the scheduled date of completion may differ from the dates contained in this contract and that such variation which is not avoidable by the Contractor shall not be considered to be in violation of this contract. P.O. BOX 102 • SAGAMORE BEACH, MA 02562 • PHONE: 508.888.2921 COASTAL CUSTOM WOODWORKS, LLC Any such.hidden conditions as described in the preceding paragraph may require adjustment in the overall price for the necessary work related to this contract. In such case,the Contractor shall inform the Homeowner of such conditions forthwith and where necessary a written amendment of this contract will be negotiated and executed by the parties. No contract for residential (home improvement)contract work shall require a down payment(advanced deposit)of more than 1/3 the total contract price or the total amount of all deposits or payments when the contractor must make, in advance to order and/or otherwise obtain delivery of special order materials and equipment:whichever amount is greater, SCOPE OF WORK AND MATERIALS TO BE USED: I 1. Demolition of both bathrooms on the second floor down to the studs. Protect the front entry and stairway. Labor $3,720.00, Materials $125.00 Dumpster $650.00 $4,495.00 2. Frame walls, install blocking and install underlayment in both bathrooms. { Labor $1,240.00 Materials $660.00 $1,900.00 ` 3. Insulation to both bathrooms. Exterior walls and ceiling. Labor $760.00 ` Material $590.00 $1,350.00 4. Blue board and plaster work both bathrooms. blue board, skim coat plaster, smooth. Labor $2,620.00 Dumpster $250.00 $2,870.00 5. Trim work in each bathroom including bead board. Labor $1,250.00 Material $835.00 .$2,085.00 COASTAL CUSTOM WOODWORKS, LLC 6. Install towel bars, door stops, lock sets, and toilet paper holders. Master bath 1 Gatco 24" Designer II Towel Bar pc 1 Gatco 18" Designer II Towel Bar pc 1 Gatco Designer II Robe Hook pc 1 Gatco Designer II Traditional Tissue Holder pc Door knob Schlage Georgian privacy matt black Boys bath _ 1 Gatco 24" Designer II Towel Bar pc. 2 Gatco Designer II Robe Hooks pc 1 Gatco Designer II Traditional Tissue Holder pc Door knob Schlage Georgian privacy matt black Labor $325.00 Material $296.00 $621.00 7. Electrical work both bathrooms.. Wire 2-4" remote fans Wire 2-6" LED shower lights Wire 3 bath outlets Wire 5-4" LED recessed cans Wire 6 switches Labor $2,750.00 Material and Fixtures $2,953.00 Master bath 3 Sea Gull wall sconce (Driscoll) chrome Boy's bath 2 Hinkley wall,sconce (Constance) chrome Vent fans to outside. Labor and Material $950.00 $6,653.00 8. Plumbing work both bathrooms. Plumb all items to code. Master bath 2 Undermount sinks Kohler Caxton 17x14 white 2 Kohler Forte two handle widespread faucets pc 1 Kohler Forte multifunction wall mount showerhead pc 1 Kohler Santa Rosa elongated comfort height toilet. White �, `�'< COASTAL CUSTOM WOODWORKS, LLC Boys bath 1 Undermount sink Kohler Caxton 17x14 white 1 Kohler.Forte two handle widespread faucets pc 1 Kohler Santa Rosa elongated comfort height toilet. White 1 Kohler Villager 5'tub. White 1 Kohler Awaken 24" shower hand held unit. pc 1 Kohler Forte shower head. pc Labor $4,940.00 Material and Fixtures $4,300.00 $9,240.00 Please note—if the framing members need to be changed for the new drain location of the master shower, the cost to,do so will be billed separately and is not part of this contract. 9. Tile work both bathrooms. Master bath Floor 12x24 staggered Campo Gallano sliver ; Shower walls 12x24 stacked Campo Gallano sliver Shower ceiling 6x6 at a 45 Shower floor 2x2 mosiacs i Boys bath Floor 12x24 staggered Delconcia Tudar Stone Shower walls 12x24 Staggered Shower ceiling 12x12 tu05 grey Master: Labor and Material $5,725.00 Boys: Labor and Material $4,550.00 $10,275.00 10. Glass Master bath %" Starphire Tempered glass with coating (clarvista) with polished chrome clips. Boys bath 3/8" Cardinal slider with c-10 coating bright anodized aluminum with recessed finger pull knobs. Master bath with chrome finish $41200.00 Boy's bath with finger pull $1,850.00 $6,050.00 COASTAL CUSTOM WOODWORKS, LLC 11. Paint work in bathrooms. Master: Labor and Material $2,250.00 Boys: Labor and Material $3,000.00 $5,250.00 Please note—the electrician needs to run new lines from the basement to the bathrooms. This will require patchwork and paintwork that is not included in the above price. 12. Clean Entire Second Floor $225.00 13. ' Relocate Medicine Cabinets $200.00 • Replace mirrors on cabinets T.B.D I Total on bathrooms $51,214.00 i Please note Building permit cost and time to procure are not included in the above price. CONTRACT PRICE: The Homeowner hereby agrees to pay the Contractor,for the aforesaid materials and labor,the sum of $51,214.00. In the following manner: Initial Deposit: $10,500.00 Once the work has begun the Homeowner will receive a weekly invoice for the labor and materials used the prior week. Payment is expected upon receipt. CHANGE ORDER: All changes and deviations in the work ordered by the Homeowner must be in writing. The contract sum will be increased or decreased accordingly by the Contractor. Any claims for increases in the cost of the work must be presented by the Contractor to the Homeowner in writing,and written approval by the Homeowner shall be obtained by the Contractor before proceeding with the ordered change or revision. i COASTAL CUSTOM WOODWORKS, LLC INSURANCE: A. Contractor agrees to maintain all necessary forms of insurance to help protect the Homeowner from liability for any occurrence arising from the performance of this contract. Contractor agrees that he shall cover his own employees for Worker's Compensation and carry General Liability,and that all forms of insurance carried hereunder shall be reputable companies licensed to do business in Massachusetts. Certificates of Insurance for these policies will be forwarded to the Homeowner. B. Homeowner agrees to obtain,through a "Builder's Risk Policy" or other instrument,to cover the additional risk stemming from building the addition under this agreement. HOMEOWNER'S DUTIES: A. To provide utilities for the work agreed upon. B. To perform no work on the project without written agreement with the Contractor. C. Homeowner shall notify his insurance agent of the execution of this agreement and obtain necessary riders to his current policy,such as Liability to cover the Homeowner's interests during the construction process. ASSIGNMENT OF RIGHTS: i Neither the Homeowner nor the Contractor shall have the right to assign any rights or interest occurring under this agreement without the written consent of the other, nor shall the Contractor assign any sums due or to become due,to him under the,provisions of this agreement. NOTICE: All contractors and subcontractors shall be registered by the administrator,and that any inquires about a contractor or subcontractor relating to a registration should be directed to the administrator at the following address: Director Home Improvement Contractor Registration 1 Ashburton Place, Room 1301 Boston, MA 02108 (617)727-8598 PAYMENTS: Payments as provided under this contract shall be made when due. Any payments that are not paid when due shall be subject to finance charge of 1.25%per month. If the Contractor is required to retain the services of any attorney to collect said payments,all attorney's fees and court costs shall be paid by the Homeowner in the event that judgment must be,and is, obtained to enforce this agreement or any breach thereof,or to collect said payment. f COASTAL CUSTOM WOODWORKS, LLC RIGHT OF RESCISSION: You shall cancel this agreement(contract)without penalty or obligation within three (3) business days from the above listed date. ( , 2016) If you cancel,any property traded in,any payments made by you under the contract or sale,and any negotiable instrument executed by you will be refunded within ten (10) business days upon receipt by the Contractor of your cancellation notice,and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the Contractor at your residence, in as substantially as good condition as when received,any goods delivered to you under this contract or sale,or you may, if you wish,comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expenses and risk. If the Homeowner makes the goods available to the Contractor and the Contractor does not pick them up within twenty(20)days of the date of notice of cancellation,the Homeowner may retain or dispose of the goods without any further obligation. If the Homeowner fails to make the goods available to the Contractor,or if Homeowner agrees to return the goods to the Contractor and then fails to do so,then Homeowner remains liable for performance of all obligations under the contract. 4 Any job cancelled after the three (3)day rescission period will have costs incurred that will be reduced from the deposit. The amount depends on the time and related costs associated at the time of cancellation. i I To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice to Coastal Custom Woodworks, LLC, P.O. Box 102,Sagamore Beach, MA 02562- 0102 no later the midnight of 2016. Homeowner's Signature Date: ,2016 ARBITRATION: THE CONTRACTOR AND HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT OF A DISPUTE CONCERNING THIS CONTRACTOR OR THE LABOR, MATERIALS AND EQUIPMENT SUPPLIED OR TO BE SUPPLIED HEREUNDER,THE PARTIES SHALL SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION,AS PROVIDED IN CHAPTER 142A OF THE GENERAL LAWS, PRIOR TO EITHER PARTY PROCEEDING TO LEGAL ACTION IN THE COURTS. SEVERABILITY: If any provision of the agreement is held to invalid, illegal,or unenforceable,that shall not affect or impair, in any way,the validity, legality,or enforceability of the remainder of this agreement. i COASTAL CUSTOM WOODWORKS, LLC ORAL CHANGES: This agreement may only be changed in writing signed by the Contractor and Homeowner. GOVERNING LAW: This agreement will be governed by the laws of the Commonwealth of Massachusetts. WARRANTIES: The Contractor warrants the work furnished to be free from defects and workmanship for a period of one (1)year following the completion of the job. This warranty shall not apply in the case of defects resulting from or aggravated by any neglect or failure on the part of the Homeowner to properly maintain such property in such manner as a reasonable, prudent person would be expected to do. This Warranty is not transferable, and any obligation there under shall terminate if the property is sold or shall cease to be occupied by the original Homeowner. Any manufacturer's warranty that can be assigned to the Homeowner shall be assigned by the Contractor. If said work involves pouring of the concrete foundation and/or floor,the Homeowner knows that it is not possible to prevent concrete from cracking because of the nature of the material. Therefore,cracking, pitting, and fledging can occur and are not covered,except for those foundation problems which emit water,which will be covered k, within the one(1)year general warranty. i IN WITNESS WHEREOF,the parties hereto set their hands and seals the day and year written above I ( , 2016) Theo ore S. Pomeroy Duly Authorized Managing Member,Coastal Custom Woodworks, LLC. Homeowner } Town of Barnstable �Ppjitc#;C)D 4S G Expires 6 m ' rs jr r issue d Regulatory Services Fee +� anMsTes[E, • , 16 Thomas F.Geiler,Director g 9. �� Building Division Tom Perry,CBO, Building Commissioner gQ�. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address C& w.jw� '` t W" (,Residential Value of Work gJ Minimum fee`of$35.00 for work under$6000.00 Owner's Name&Address evti�.1 ; Contractor's Name Telephone Number L-i ya S; 40 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) . C Lq ! -PRESS PERMIT ❑Workman's Compensation Insurance MAY " 3 201Z Check one: [kI am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side --�vf-dee�s ❑ Replacement Windows/doors/sliders.U-Value Lto (maximum .35)#of windows I L_ *Where required: Issuance ofthis permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 I The Commonwealth of Massachusetts Department of Mdustrial Aci cidents Office of Investigations '600 Washington Street Boston,M4 02111 www.mass.gav/dia Workers'.Compensation Inca n:ce Affidavit:Builders/Contractors/FIectrici.ai s/Plumbers Applicant Information Please Print Le bl Name(Busmess/Orgm zation/Individal): •Address: ( � c wt o 7 S a City/State/Zip: S �,. w t Lh , �o LS(,5 Phone.# -3L�'L Are you an employer? Check the appropriate bow i o.iect(required):.-1.❑ I an a employer with .4 C�I am a general contractor of Pxactor and I 6. �New cem.�t,,,rr;r,,, • employees(fall and/or part time).*. ve hired file sub=contractors 2.❑ I am a'sole proprietor or partner- listed on the-ithached sheet 7. `�Remodeling ship and have no employees ' These sub-contractors have 8. Q`Damnlition working for me>g any capacity. employees.and have workers' [No workers' comp.ins�ance c�P•.insur�mce.$ 9. Bm77ding addition required.] 5. ❑ We are a coiporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing iLwork officers have exercised their 11.❑Plumbing repairs or additions myself [No worl=' camp. rigbt 6f exemption per MGL 12.0 Roof repairs ce insuran required.]t c. 152, §1(4), and we have no 13 0 Other employees. [No workers' comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compeasafion policy information. t Homeowners who submit this affidavit indicating they axe doing all work and then hire outside contactors must submit a new affidavit indicating such. tContractors that check this box most attached an additional sheet showing the name of the sub-contactors and state whether ornot those entities have employees. If the sub-contractors have employees,they mustprvvidt their worlozs'comp.pobaynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.A Expiration Date: - Job Site Address: Chy/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 ane-year imprisonment; as Well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for ingmmice coverage verification. I do-hereby c rft�,under the pains-an es of perjury that the information provided true and correct S , ' e: Date: 3 Phone# , L'1'L O LA 00lcial use duly. Do not write in this area, tb be completed by city or.town o•f7daL City or Town: PermitUcense# •IssuingAnthority(cirde'one): 1.Bbard of Health 2.Burldiug Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: j01/05/2012 12:01 508771OE63 SCHLEGEL_INSURANCE PAGE 01/01 i CERTIFICATE 4F LIABILITY INSURANCE 01/os/2012D12 DAfE1YnY � THIS CERTIFICATE IS lSSV6D AS A MATTlR OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE OOPS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THt5 COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT' CONSTITUTE A CONTRACT BE'TWREN THE ISSUING INSURER($), AUT}iMED REPRFSRNTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER. ItIWORTA 4 the C—M holc is as I INSU i , tRs poi cylies) mus . It SU®RV ATIO IS WAIVE sa t0 the terms and o00dlbons of the policy, cenaln policies may MQUIM an a 00memenL A state 1011 an tlrle aeAifleate do05 not aOflfaT r19hM t0 the cerdfic to holder In Ceu of such erldOreMWIt(S� rkoWcaR NAbth Schlegel & SChle"3. gII1J=RnCa Br*kQrg SnC Mom �LI; ( 771 - 83UL n, 1(500) 771 - 0663 34 P&IX STPIZET ADORE,A FierJisDa»a-....., CUMOMEA ID West Xamouth, MA 02673 INDUNFt2jAFFORaIN3COVERAOE NAICM IMILIP D ._. •— DqunRRAL1=TT MUTOL Paul Gustafson INDURERaI. _ 21 M 2:9dith rid WOURERe: INSUtEA D t !'oiegtdal9, DW 02644 IAmuRER1Sr _ IAta1N1ER F: � COVFRAGES CERTIFICATE NUMBER: REVISION NUMBER: i CERTIFY -W NE POIJOIES OF IWURANGE LISTER BELOW HAVE B N ISSUED T E INSURED NAMED CVE FO . POLICY PsRIOD INDICATED. NOTWITHSTANDING ANY REOUIREMEHT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO WHICH THIS C6R-IFIcATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. t EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LlM E SHOWN MAY HAVE BEEN RBDUCEb EY PAID CLAIMS. _ t p oucy eid' 1'�r . I LYR I TYDF:OF P AURARM MR YJVD PoucY Numm IAIAYDDAYWM (�IDdYYYYI UNrfD OEUERAL UJItlIIPT+ I FACM CCCt1PR%NCE E i I iP ??(Ere �.. I CQMJ tCfAJ"MWALWOLITY I I �I OWN&A/ODE C OCCUR NED PYP(Aral We.+�JrAOA) i f— PEReOVAL m AN VlIjUR" 3 rdEN6RALAOQREDATE PRODUCT •OOW10P AGO CDR.ACEWMATE UNIT APOURS PER i 7 PDucY I .._ iEc7 V. CGItJEM) 9 AUTONOSILE LIAO&M I COWmdV 91NOL6 L'MT _ S 111 (FA a I MY AUYO O nILY INAJRY tear pawn) a ALL c.WNEO ALOPU I , eoDILY IN„tJRY tPr: ool r AcArRt e SOMF.OULED AMM f PEfrTV DAMAGE,r S � HIPE(IAVTOZ 1 i I(PreeuleenD E J R0�1)WIIGONJ►pe I;I � i � . s 'UMRELLALIaa •occuR ' t'r1CHocDURM5 s _ i f"'- EXCE9a UAe OLNNe.IJAOE I A-WREPATE 0 . QEJIICTDLE j —iIIT$ ;► LY0RKMWIPENDAT1011 IWC2-31S-359362-029 11/26/11 11/26/2012.X TOM Ukirca. ER - ANDFJRIpLOr='UABSJIr YIN ( . OXYTileTORJpMTNCRT!%ECUT YE aL.Faces Aca s 100,000 cavr _ oFr eeuAlEn�ER aeCLVDEDT ed r A . Eon E.l_dsr•A.RIJ•EA EJAFLo'fEE s 300,0 a O B yRA.drmc•IAA ueeer _ VE,MR!FTiaue=OPsuTION9edan E.L.DISEASR-roucruJAT s 800,000 OESCRIPfl"OF epQft%Ti I i.=Mon I VOW o tAracm ACCRD 101.AMW M1 Remarlm acm",1 ewfl"m IN RaWUrA01 PAUL Gvvrp i$ON MS SL>Bcmm TO BE COVE= Mt HIS WOmws COMiMSATSON PCrL2CX CERTIFICATE HOLDER CANCELLATION BRIDES 8>1ILl1' SNpQ1.0 ANY OF THE ABOvE DESCRIBt?D POLiCItEB BE CANCELLED BET'pRE 16 KIDOTQ COOMS W.LK THE EXpiRAT10H DATE THEREOF, NOTICE MALL BE 09I.NVARD IN 8A)MWICH, MA 02563 ACCCRDANCE WITHTHE POLICY PROVEIONS. AUTMORQED TEJoRF". rATN! YAX 0 1-500-420-Si41 Et9,IL Bsidea777@J:omeaat.z:Iat 4)low 1009 A-C4KWOMIRATION. All rights re9eNed. ACORD 25(2009M) The ACORD name and logo arc m9 orke of ACORfl ✓Jze CaninwoseuP.aCC/i ✓(/Laaaac/ucaeda Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR ; before the expiration date. If found return to: Registration: yA06561 . - Type: Office of Consumer Affairs and Business Regulation > Expiration: /24/2012 Individual 10 Parlt Plaza-Suite 5170 Boston,MA 02116 BR DAN WILLIA1VIcB.I IbIES Brendan Brides �" ! 16 Widow CoombsLu' Sandwich, MA 025 Undersecretary j Not valid.without signature Massachusetts -Department of Public Safety Board of Building Re 9 ulations and Standards l Construction Supervisor f7rw - I License: CS-073449 s a BRENDAN W B�tIDES;=t i I 16 WIDOW CooMBS W �� SANDWICHjYIA 02563: M `0 I. Commissioner, Expiration 04/04/2014 .r • r` ��TFIE��� � s « MUMSf"M ''Via, Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 I, SL- mo-CM AQ e> slr� \ , as Owner of the subject property hereby authorize 1- -e.- v% e•S to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owne10 Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 � ��t�,�o�� �� Town of Barnstable *Permit# Expires 6 months tw issu .d t -P R ; Regulatory Services Fee BARNSPAB, 9 M,- , ( ,$. Thomas F.Geiler,Director `16 9• �0 TOWN OF f�STABLE Building Division t►P Tom Perry,CBO, Building Commissioner 200 Main Street,.Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �� \ ' D Not Valid without Red X-Press Imprint Map/parcel Number Property Address U)- UA lvy,-J . Rj 4 Residential Value of Work%\ Tn0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address a Contractor's Name� � C� Ca.,�� ir.� Telephone Number(j y g L4 2 a 5 j 4 O Home Improvement Contractor License#(if applicable) 1 d y S y -7 c, Construction Supervisor's License#(if applicable) J C4 Ll 7 ❑Workman's Compensation Insurance Fk one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors '�-- Replacement Windows/doors/sliders.U-Value J r� (maximum.35)#of windows "L •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requi ed. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPPESS.doc Revised 072110 iN7assachusetts- Department of Public Safet* Board of Buildin!- Re-ulations and Standards Construction Supervisor License ,l License: CS 73449 Restricted to: 00 BRENDAN W BRIDES 16 WIDOW COOMBS WALK SANDWICH, MA 02563 Expiration: 4/4/2012 ('ununissiuncr Tr#: 21247 C Turner Affa`rs& ss Regulation License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y ' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: y106561 Type: Office of Consumer Affairs and Business Regulation 120 TBRDAIN Expiration: :.7•/212 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 WILLIA. B}21.DESr_(J Brendan Brides ( n 16 Widow Coombs ,. aik Sandwich, MA 02563" Q Undersecretary Not valid without signature f i the Commonwealth of Massacl'iuseft J Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 wim.atasm,govIdia Workers'Compensation.Insurance Affidavit:Btl lde.rs/Contractors/EIectricians/Plumbers Applicant Information Please Print Le ibIy Name(Busmem/Orgw=tion&dmdoai): ��_ c� cv�� U-,,L Address: I L o \kj- Co O hn CJ S w CI City/state/ap: 5 4 v A w i (Al- Ph me 4: ' 3 L4 z—v S I H I Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I full and/or s have:hired the sub-contractors 6- ❑New construction i employees( P�-�e)- 2.❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp-insuratiml required-] SXXVe are a corporation and its 10.ElElectrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised heir I LE]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance requited.]T c- 152,§1(4),and we have no ` employees.[No workers' 13.0 OtheriO i V1 cJ o iAj' comp.ins Le4uited-] R c�cQ►-aN-'r *Any applicant dMt checks boa#1 mast also fill out the section below showing their workers'compensation policy information_ T HGmeuw ers who submit this affidavit indicating they are doing all warn and then him outside contractors mast submit a new at&dn it indicating sachem tCouwictars that check this boot must attached an additional sheet showing the name of the sub-contacmrs and:mte whether at not those entities have employees. If the sob-contnctots bave employees;they must.pruv-ide their workers'camp.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 4 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 securee coverage as requited 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 insun ce.coverage verification. I do here ertify under the pains a penalties o**duty that the information prilVided boos` true and correct Si e� �'—� Date: L 1 v Phone#: O 1 Official rise only. Do not write in this area,to be completed by city or town official. - City or Town: PermitUcense# 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#: WE • ennxsTneLe. NAMLTown of Barnstable �plfD MA'S A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 I. AR"� 1'1�i os i �. I ,as Owner of the subject property hereby authorize 4-5 to act on my behalf, in all matters relative to work authorized by this building permit application for: \'AQ1•'aC��J1�•7�� 11 �� (Address of Job) y ZI Ll Signature of Owner Date Ma 3'l� C�,b S, Print Name I If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 �1nE r Town of Barnstable *Permit 4�V Expires 6 month j i r issue date Regulatory Services Fee snxxsr�►sr.E..':a PERMIT Thomas F.Geiler,Director)(;? 4 «r; Building Division Tom Perry,CBO, Building Commissioner TOWN OF B A%e200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-623 EXPRESS PERMIT APPLICATION, - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �,X Wy.e.l- ❑Residential Value of Work S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name (!DLQ,4 4"J"�-�:e�, Telephone Numbers y g L) 1- o S 14 1 Home Improvement Contractor License#(if applicable) d Cj Construction Supervisor's License#(if applicable) C-S 3 Lt 4 q ❑Workman's Compensation Insurance Check one: 0,I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy.of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: �Q C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110. I: i�anvnxaruue¢� o�,/�aaoac«uoeli✓a VRD Office of Consumer Affairs&B slness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , Registration: �1.06561 Type: Office of Consumer Affairs and Business RegulationExpiration: 7/24/2012 Individual 10 Parlc Plaza-Suite 5170Boston,MA 02116 WILLIAM=BR1_DES== rnyic:_.__ 1 fl i r • Litp C=���Zi ' i Brendan Brides r� i ..__ r ' 16 Widow Coombs 1/Valk��i� Sandwich, MA 02563� ,,`4�= r Undersecretary Not valid.without signature IVlassachusetts- Department of Public Safety Board of Building- Re gulations and Standards Construction Supervisor License License: CS 73449 Restricted to: 00 BRENDAN W BRIDES 16 WIDOW COOMBS WALK SANDWICH, MA 02563 Expiration: 4/4/2012 ('rnnmissiuncr Tr#: 21247 f The Commonwealth of Mass`achus'etts _ Department of Industrial Accidents r Office of Investigations 600 Washington.Street Boston,? 4 02111 - ' w'svwanass:gov/dia IZorkers' Compensation Insurance.Affid v%pit: Builders/Contractors/Elect iciansIPlumbers Applicant Information Please Pfint LeziblY Naine{I3usinesl'OrganiZationfln&Vidual): Address: 110 W', d -a w- C0,3 w,6 S W ,_ City/State/Zip: Phone l#: Sn%41 1 41 Are you an employer?Check the appropriate boa: TJpe of project(required):: 1.ElI am a employer with . I am a general contractor and I 6- ❑New construction employees(full and/or part-time).* ha ne hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet- 7- ❑Remodeling ship and ha.=e no employees These sub-contractors have g- ❑Demolition ..corking for the in any capacity- employees and have workers' 9. ❑Building addition [No workers'comp.insurance cam-insurance.1 required.) 5. ❑ Afe are a corporation and:its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all urork. officers have exercised their 11.❑Plumbing repairs or additions myself.[No.corkers'comp. right of exemption per NIGL 12.[_1 Roof repairs insurance required.)1 c_152,§1(4),and we have no employees-[No worker' 13.0 Other comp.insurance.required.] •Mary•appiisant that checks box#1 mast"fill out the section below showing their workers'cottapensatiaa policyinformation- 1 Homeowners who subunit 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 shirring the name of the sub-coutm-nors and stare whether or act those emities have employees. If the sub-Cantractors have employees;they must provide their workers'comp.policy number. I ant an employer that is providing it orkers'courpensation insurance for trty enrployeas. Below is the policy aitd fob site itrforinddO)L 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 IvIGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 ands or one-year imprisonment,as arell as ci.ail penalties in the.form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be.advised that a.copy of#his statement may be forwarded to the Office.of Investigations.of the DLA for insurance coverage verification. I do hereby,c _hfi,under the paints penalties of perjuq that the inforntation provide above is true and correct. Sisnature: F Date: ,O YL )O Phone;V: O,f(jicial use only. Do not write in this area'.to be completed by city or toavnt official. City or Tornm: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Toum Clerk 4.Electrical Inspector a.Plumbing Inspector 6.Other Contact.Person: Phone#: 6 CERTIFICATE OF LIABILITY INSURANCE ° �' " OB/13120,1 TM►S CERVMATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THI$ CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INBURER(S), AVTNORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; N Me Ca holdw is an ADDITIONAL INSURED, the polity mu$t be en Olga . If SUBROl4AT10N ISWAIVED. eubiect to the temms and Conditions of the policy, ce taln PolitigS may inquire an andomement. A siMment On this CaltlTetale dogs not eonfal dghb to Me ceditafC holder tniiaaof such endmsam"t(s). PRODUCER ; Schlegol i ScLl6961 Xnsoranea Brokers Inc a (508) 771 9301 NIc•R):(508) 771 - 0663 AIP. a 34 bM2N STREET MP P1. 'Pilo �- CUSTOM 10 a, Best Yarmouth, Nk 02673 PI,GURERRIAFrORp1pOCOVERACE NIUCP WSUAt;O WWKRALIIeM:ATY MUTUAL Patti Gustafson aMURIM a 21 Mosedith Rd WSURFA C: LRSVROL o I Forestdale, na 02644 ntsLIRQIE: 10MOR F: . COVERAGES CERTIFICATE NUMBER. REVIliff1011 NUMMBER: TK15 IS TO CERTIFY TFIAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AXM FOR THE POUCH PERIOD INOICATO. NOTWITHSTANDWO AJW REQUIREMENT. TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIeS DESCRBm HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH MUM.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAR)CLAIMS. LTA TYPEOFIIISURAA10E pR 7WO POLLCYNUAIaE/I �IWDO/YYrr) 6MON"" Um" "WgALUAeMTV wZ"OC*vR ENCE S COMUERGP�L CFNiiRH.11�U7Y DRa acunN anu) s —. .. CIAM&MAM C OCCUR AIED Elm Vor OW Pa" S PERSONAL S AOV DLMIY S _. GENERALACCRE(VUE $ 0MAGGREGATELfWAPPLIE9PER; "WOVOTa-COMPA7PAGG S .POLICY � LAC a AUTOM03"LtAeILM COPASMO 999GLA LIIAR ' p:aatdAwO ANTAu10 sooty I1 w*yVermtwla s _ ALLONREDAUTOS eoolLrwAlAvRaaorlallq s o01$OLA£O AUTO6 .. HIREDAUTOS "d s"NAOE S NOLLOVMEOAUTOS S s LNLVflTEIW VAa OCCUR EACHOCCURRENCE Uwe=U.= d CL/11atSA1AOE _.• ADOrtE0A7E S l DEDUCTIDLE � •...• RETENtION s s _... A w WCmv"h AngN WC],-313-359362-029 IU/ rAG911/29/202610 X A"emkoYERY LUUMUTY youTowuwm I AWPROPRkR—ARWARf XMUnvE EI.EAcHAcccENT E 100,000 OMPMRAMUM EXCUAE07 a NIA (NUWIory In NM) EL.01SE43E.EA EWLOYEE 3 100,000 vlr.a,bac:tw RnaYr CEGMPTIONOFOPERA71014pai0, EA,vmE -POUCYum" s 500,000 oEecRlPimNOPOPLMTIOHS/LOCATIOIISIVEIDQ,Eg(AtdcsACOAOlO1,Aa7lamrlRamarYaeeeLAut4;IpmnapuA:s,agWaO) PATH. WS"IlYSON WW ELECTED TO BE COMM FOR HIS i►OR1MRS CeIIt MUMION POLICY CERTIFICATE HOLDER CANCELLATION H1111=>EIS; BUILT 16 WIDM COOMRS mALK M IOULD ANY OF THE ABDVE DE6CRIBM POUCIES BE CANCELLED BEFORE THE "MRATiON DATE THEREOF, NOTIC19 WILL OF DELIVERED IN SANMICH, MA 02563 ACCORDANCE VAIN THE POLICY PROV18 ft& AUTHOROMREPRU THE VA" 508-420-5141 1 ORD ORPORATION All rights rmrVeA- ACORD 26(101IMg) The ACORD nam0 and logo are reglsWmd ms*s of ACORD F of n+e rq� wuvsTnst.e, 9� MASS, a Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us i Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I O S as Owner of the subject property hereby authorize (2-,L-P.,n to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Sign ture of Own ate Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 � U tl V uCJ c\w ET Town of Barnstable *Peemit4 -P 8T i es tit s j r i rre.da�e Regulatory Services 'e PA)NSI�ABLp 7 to s.LU�� Thomas F. Geiler, Director �A 1639. —rf0 A TOWN TABLE Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us 01.fice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION — RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number fl- Property Address Residential Value of"Work �o (�U�'e� cy Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address /"HSj. jj(2�0�—Ilf&OCZIZ Contractor's Name 'Dc'o Irt� 1/'�ZL-� Telephone Number I tome Improvement Contractor License# (if applicable) Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy # Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) Re-roof(stripping old shingles) All construction debris will be taken to V"-m t7wril r ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) 'What required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. 'Note: Property(Owner must sign Property Owner Letter of Permission. copy of the Home IQveme- t Contractors License is.required. SIGNATURE: r).'\A I'1-II.I.S+.Pt)RMS\building permit Ibrms\EXPRESS.doc Revised'100608 �i • :1 {Jry. It � i:i r ( Gf�ze Vomvrrco�uaeccl o��/l�u�Q� t License or registration valid for individul use only Office of Consumer Affairs&„Business Regulation ; before the expiration date. If found return to: i a`3 + HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation 10 Park Plaza-Stiite 5170 f Registration; .119766 Tr# 288419 Boston,MA 02116 Expiration-- .812011 j Tlug pe"-_Ihdividual y N� WEBB CRAFT DESIGN= 1 F DAVID WEBB _ 17 ACADEMY .N� --- Undersecretary Not valid without signature n FALMOUTH,MA 02540Y s .. Massachusetts - Department of Public.Safety Board of ¢u4�di,-Re„�ulations and Standards f„Constructio Supervisor License utay�lnse: CS •46189 Rebtricted to: 00 DAVID H WEBB 17 ACADEMY LN FALMOUTH, MA 02540 , Expiration: 10/29/2010 Commissioner' - Tr##: 5826 The Commonwealth ofAfassachusetts JQX Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electr icians/Plumbers Applicant Information Please Print Legjbly Name (Business/Organization/Individual): Address: City/State/Zip: �fJ��1��/�'� " Phone.#: ��' � Are you an employer? Check the appropriate_,box- Type of proj&ct(required): 1.❑ 1 am a employer with 4.appropriate am a general contractor and 1 6. ❑New construction part-timE).* have hired the sub-contractors employees(full and/or listed on the attached sheet 7. .Q Remodeling ..2:❑ I am a soleprpprietor or parhaer-' These sub-contractors have g.'❑Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'••comp.•insurance comp. insurance.$ '10. -Electrical airs or additions required.] 5. [] We are a corporation and its ❑ rep 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL i2.0 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 subrnit 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 ernployees. If the sub-contractors have errrplgyecs,they must pmvidt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Na1me: Policy#or Self ins.Lic.#p Expiration Date: lob Site Address: O w b;jrfu� �/.p� � City/Stawzip: ar4 T/tiA, 02�YT 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 crimiiia]penalties of a ell as civil penalties in the form of a•STOP WORK ORDER and a fine finq tip to$1,500.00 and/or one-year imprisonment, as w of pp to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance covers e verification. I do hereby ce t* u erthe ains•and en ti ofperjury that the information provided above is true and correct Si li.� Date: Phone Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health *2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other VEp Town of Barnstable Regulatory Services RAMNSMABpYAAES-er$, Thomas F. Geiler,Director 1619-116 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town-barnstable.tna.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, IV as Owner of the subject property Jae reby authorize `p to act on my behalf, in all matters relative to work authorized by this badi.ng permit application for. td 1 17iI,471! )e COfiU;fi .(Address of Job) Signature of Ownp- Date M0'-CV Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. : WORKERS COMPENSATION AND EMPLQYERS LIABILITY INSURANCE POLICY Information;Page �. __ .__._. . WC 0000 0'l Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00730203 1. INSURED: Prior Policy Number: WCV00730202 Tyndall Roofing, LLC Producer: 30 Jillian's Way Fredericks Insurance Agency, Marston Mills, MA 02648 Federal ID Number:204616445 Inc. Risk ID Number: 1046 Main Street Business Type: Limited Liability Osterville, MA 02655 SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/11/2009 To 7/11/2010 12:01 A.M. Standard Time 3. COVERAGES: at The Insured Mailing Address A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states liste here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates& Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 F inimum Premium: Deposit Premium: 00 $1,284 Interim Adjustment: Annually Servicing Office: Total Estimated Premium $1,217 25 New Chardon Street Surcharge(s) 67 Boston, MA 02114-4721 Total Premium and Surch rge(s $1,284 Issue Date 06/22/2009 Countersigned By: Date JUN 2 2 20 9 Copyright 1987 National Council on Compensation Insurance Form: 100m 1 • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map FT Parcel ��`C� Application# I Health D`iGis'ion i Conservation Division Permit# Tax Collector Date Issued A Treasurer Application Fee ' 00 Planning Dept. Permit Fee 5. �o? � 0 Date Definitive Plan Approved by Planning Board <�-C)� WA �J Historic-OKH Preservation/Hyannis P Project Street Address Village Co Ty Owner AN-r"91I Awl) W-9-Y Address aOC , Co7-01 Telephone J�D NZO _ q6 5 Permit Request �41rA/7 /-aar2 /! "IY /-D kew4A e II Square feet: 1 st floor:existing proposed /&.50 2nd floor:existing IOC16 proposed /X D Total new Zoning District _ Flood Plain C Groundwater Overlay Project Valuation 07V Construction Type h/&V b Lot Size j h GP-6 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. h y rr Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) <— Age of Existing Structure q g6 Historic House: ❑Yes No On Old King's Highway: :0 Yes GVo Basement Type: )/Full Crawl ❑Walkout ❑Other E.i `J ,(\ Basement Finished Area(sq.ft.) Q Basement Unfinished Area(sq.ft) �l�Z Z�n `-1 t� Number of Baths: Full:existing new Half:existing ew 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: A Yes !0P." Fireplaces: Existing I New�_ Existing wood/coal stove: ❑Yes ❑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 ❑No If yes, site plan review# Current UsesL,4& Proposed Use 54?),767_ BUILDER INFORMATION Name L° • ICI EW TV Al ;(;Ut L-D i42-eS Telephone Number Address q/q P-A'/N 50-I f-i-T License# l U rl 61 9 8' Home Improvement Contractor# 0 1. q oZ Worker's Compensation# W LA 00'7 '3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Bou" iv C oa, c SIGNATURE Ala, DATE v-� FOR OFFICIAL USE ONLY PERMIT NO. - ' DATI2ISSUED ; MAP/PARCEL NO. -ADDRESS VILLAGE OWNER DATE OF INSPECTION: s FOUNDATION FRAME 6i�0° p/�' •'G 0 f2 INSULATIONS f&7 FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ko? I-�1Y1 DATE CLOSED OUT ASSOCIATION PLAN NO. ''' Rx Date/Time DEC-14-2000(THU) 17: 21 1 508 420 9656 P. 001 Oct 11 06 09:19a Mary R. Agostinelli 1-508-420-9656 p.1 Town of Barnstable ' e� �LegpWcllry Services WAS - T novas?.Geer.Director jog BuIIdmg DW0n TomPeMs RuMug CoMslaner . 200 Vdn 8tzw $yam MA 02601 w w town barus#ablepam Feat 508 790-6230 office: 508-862-4038 Pwpedy Owner Must • Complete sud Sign This Section . If Using itBuflder T Ar�W Pc T rr t s;L1 ,as owaer of the subject pmpem �'•�'•�. S V 1 `�•�S •to act on m3rbehalf, - — 'herebyautho�== . is all nipm relative tc word authorized by dais bwYmG pares aPPlicatioa for, Tv IT s ofjo Xe> of Own r Date . I?natN=z r - Department oflndustiial Accidents Office of lnvestigations: ' a 600 Washington Street Boston,MA 02111'. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plwnbers kpplicant Information Please Print Legibly 14- a]rie (Business/Organization/Individual): , � B _. Address: t�oX 'et�, x�t✓ti�ov µ pity/State/Zip: �A t, M A� ' o Phone#: — {' -g- 9 o 1 j .re u an employer? Check the-appropriate,box: Ty7e of projeet(required): am a employer with 4 I am a general contractor and I 6. New construction employees(full and/orpart time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ` Demolition 'working for me in any capacity. workers' comp.iasuraz,Ce; 9. ®Building addition [No workere comp. insurance 5. ❑ We'area corporation and its 0Electrical rePairs or.additions • required.] � ' officers have exercised their 10. ❑ I am a homeowner doitlg all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.-[No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers- cOmp.insurance required.] 13 ❑ Other ny applicant that checks box#1 must also fill out the section below showing Their workers'compensation policy information: iomeownas.who submitthis affidavit indicating lbey are 4oing all work and then hire outside contractors must submit anew affidavit indicating such. >ntractors that check this box must attached an additional sheet showing the' of the sub-conftdors and their workers'comp.policy information. . (m an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site formation. ;urance.Company Name: CX_UL-i K36- 0N5-AL.— Ac_A`JI!N, licy•#or Self-ins.Lic..#: Expiration Date:• � 1 �Olo b Site Address: -W Cityltate/Zip: '. C y Tv. 1.� ;` 11; : :o 6 5" tach a copy of the workers' compensation policy declaration page(showing the policy number and eapfration date).. ihlre to.secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a ,e up to$1,500,00 and/or one-year imprisonment; as well as civil penalties in the form of a STOYWORK ORDER and a fine up to$250.00 a day against the violator. $c advised that a copy of this statement may'fie forwarded to the Office of iestigations of the DIA for insurance coverage verification. Whereby certtfy r the pai7ae as o perjury Atal the information provided alcove Is true and correct attire:. Date: one#: b 0.9 —`-f Official use only. Do not write in this area,to be completed by city.or town officfaL City or Town: Pernik/License# Issuing Authority(circle one): 1.Board of Health L.Building Department 3.'City/Town Clerk 4.Electrical Insp 6. Other ector 5.Plumbing Inspector Contact Person• Phone#: I Board of Buildin Regulations = One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS O46192 Expires:09/19/2007 Restricted To: 00 DAVID L NEWTON PO BOX 922 FALMOUTH, MA 02541 Tr. no: 5359.0 Keep top for receipt and change of address notification. -CAl 0 5OM-04105-PC8698 92. �00)YlYl4'IC(!/CCLLL/L dy�.•%i7.CldJCLCfLLIdC�.A BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS O46192 r Expires: 09/19/2007 Tr. no: 5359.0 Restricted: 00 DAVID L NEWTON PO BOX 922 G— / FALMOUTH, MA 02541 Commissioner Board of Building Regulat'ons and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement."Contractor Registration Registration: 107888 Type: Private Corporation == j,:, Expiration: 8/10/2008 C.H. NEWTON BUILDERS, INC. f' Newton David I PO BOX 922 Falmouth, MA 02541 ~ '" :•-'•::':-' Update Address and return card.Mark reason for change. -- Address Renewal ❑ Employment Lost Card DPSGAI 0 5OM-05/06-PC8490 Q . .. ....... �a Taa��c�itaxweal�o�✓lla�a�uJel13 Board or Buliding Regulations and Standards , License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration\107888 Board of Building Regulations and Standards Expira."Ogq/0/2008 OnT Ashburton Place R 1301 Boston,Ma.02108 _Type.:;_P�i�ate Corporation C.H.NEWTON BUILDERS„IIJC :' David Newton 549 Main Rd 28A W.Falmouth,MA 02541 Deputy Administrator Not valid without signature :T In accordan= with the provisiotu of MGL c 4Q, S 5d a Number condition of BuiIding Permit is that the debris resulting from this work shall Lc disposed of in a properly licznsed solid waste dtsFcs;;i aeliry as dclined by MGL c ill S 150A• The debris will be, disposed of in: Bourne tL=Uon of F2ciijt'r) �ratu:e of Fe:mit Applicant David L. Newton Date I Town of Barnstable Regulatory Services snxivsr,�iE. ' Thomas F.Geiler,Director i639.� °'`0 Building ildiII Division i0lfn Mpg Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IWROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with ether requirements. ' Type of Work: At I Tl l �d W_—tO A6 L Estimate lld Cost Address of Work: -Ir W h J"Vl41-fr k zi-al , Owner's Name: ( r Date of Application: r II I hereby certify that: Registration is not required for the following reason(s): [--]Work excluded by law []Job Under$1,000 C]Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 0 I _a� 94V 4_1 Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpfiles.forms:homeaffiday Rev: 060606 f `• I I MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 11 3 200 6 DATE OF PLANS: 10/27/06 TITLE: Alteration and addition to the Agostinelli Residence PROJECT INFORMATION: 18 Whitmar Road Marstons Mills, MA 02648 COMPLIANCE: PASSES Requii^ed UA..._...87 . Your Home = 87 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 358 30.0 0.0 13 WALLS: Wood Frame, 16" O•C. 398 15.0 0.0 31 GLAZING: Windows or Doors 85 0.340 29 GLAZING: Skylights 9 0`350 3 FLOORS: Over Unconditioned Space 358 30.0 0.0 12 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code• The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MA �► 4 Fti�� i ',MAS'check INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Alteration and addition to the Agostinelli Residence DATE: 11-3-2006 Bldg. I Dept• 1 Use I I I CEILINGS: E I 1 1. R-30 I Comments/Location I I WALLS: E I 1 1. Wood Frame, 16" O.C., R-15 I Comments/Location I I WINDOWS AND GLASS DOORS: E I 1 1- U-value: 0.34 1 For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? E I Yes E I No Comm.epts/Lo.cation I I SKYLIGHTS: E I 1 1. U-value: 0.35 1 For skylights without labeled U-values, describe features: I # Panes Frame Type Thermal Break? E I Yes E I No I Comments/Location I I FLOORS: E I 1 1- Over Unconditioned Space, R-30 I Comments/Location I I AIR LEAKAGE: E I I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: 1 1- Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space- 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2-0 cfm (0-944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: E I I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. i I MATERIALS IDENTIFICATION: E I I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating i and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly I marked qn the building plans or specifications. I DUCT INSULATION: E I 1 Ducts shall be insulated per Table J4.4.7.1. 1 1 DUCT CONSTRUCTION: E I I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch- Duct tape is not I permitted. The HVAC system must provide a means for balancing 1 air and water systems, i I TEMPERATURE CONTROLS: E I I Thermostats are required for each separate HVAC system. A manual ! or automatic means to partially restrict or shut off the heating_ I and/or cooling input to each zone or floor shall be provided- �_. .._.. _. . . I -HVAC-- E-QUIPME-NT--SI-Z-ING: E I I Rated output capacity of the heatinq/cooling system is I not greater than 125% of the design load as specified 1 in Sections 780C1'MR 1310 and 14.4. I E I I SWIMMING POOLS- i All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heatinq enerov is from I non-depletable sources. Pool pumps require a time clock. 11= I 1 HVAC PIPING INSULATION: 1 HVAC piping convevino fluids above 120 F or chilled fluids I below 55 FVmust be insulated to the following levels (in. ) : i i PIPE SIZES (in. ) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1-25-2" 2.5-4" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1-0 1-0 1..5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS! I Chilled water or 40-55 0.5 0.5 0.75 1.0 i r�iri n=ran! h�i nl_I un 1..n i..n 1.. G 1. G 1 E I I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in. ) : I i PIPE SIZES (in.) i NON-CiRCU ATTMr i [TRr111 ATTMr MATNT P. P11MAHTIZ I HEATED WATER TEMP (F) : RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" ! 1.70-180 n_ G I T._n 1._1; P-n 1 140-160 0.5 1 0.5 1.0 1.5 ! 1-rr-1.30 I ----NOTES TO FIELD (Building Department Use Only)------------------------- to: 1/4/2007 Timel 3:57 PM To: fe 7,15087906230 Dowling 5 O'Neil Page: 002.003 • Client#:3248 _ 2NEWTONCH ACORL),a CERTIFICATE OF LIABILITY INSURANCE 0DATE 1104/0701YYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY.THE POLJCIES BELOW. 222 West Main St.PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC I _ INSURED INSURER A: Acadia Insurance C.H. Newton Builders,Inc. INSURER 6: 98 North Washington Street,Suite 202 INSURER C: Boston,MA 02114 INSURER D: _ INSURER E: COVERAGES THE POLICIES OF INSURANCE Lk' BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR':HE POLICY PERIOD INDICATED.NOnVITHSTAIIIDLNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OT HER 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, LTR J= TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLL IRAT Y EXPION LIMITS A GENERAL LIABILITY CPA005747618 01/01/07 01/01/08 EACH OCCURRENCE $1 000 000 5D)( COMMERCIAL GENERAL�LIABILITY DAMAGE TO RENTED PREMISES(Ea cccu tenc;ej g250 000 CLAIMS MADE r X�OCCUR MED EXP(Any one peso.) $5,000 I WX -0c PERSONAL BADV INJURY $1,000000 P GENERAL AGGREGATE $2,000 000 GEN'L AGGR.EGAIF LIMIT APPLIES PFR: PRODUCTS-COMPIDP AGC $1 O0O OOO POLICY _ CT LOC A AL•TOMOSILELIABILITY BINDER251250 01/01/07 01101/08 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO la amdenty I ALL OWNED AL70S I BODILY INJURY SCHEDULED AUTOS fPer perenn) $ i X I HIREDAUTOS BOUIL'f INJURY $ X I NON-OWNED AUTOS (Peraatle.) I i X Drive Other Car PROPERTY DAMAGE $ (Per arc derd) I GARAGE LIABILITY AUTO ONLY-EA.ACCIDENT $ r�.ANY AUTO EA ACC $ DTFERTHAN AUTO ONLY: ,4GG $ A EXCESS!UMB.�LLA LIABILITY BINDER251252 01/01/07 101/01/08 E4CH!)rCURREKCE $10 000 000 X I OCCUR ❑CLAIMS MADE AGGREGATE $1 O QOO 000 DEDUCE IBI.E $ X RETENTION so _ $ A WORKERS COMPENSATION AND WCA007321114 01/01/07 01/01/08 WCSTAT.1 O - EMPLOYERS'LIABILITY i L MI S THE ` I AN)'PROPFilORIPARTNFRiEXFCUTib'E E.L.EACH ACCIDENT $SOD OOO OFFICERIMEMSER EXCLUDED? E.L.DISEASE•EA EMPLOYEEI$500 000 If yes•descri a ueder SPECIAL PRNISION$be c'w I--. E.L.DISEASE•POLICY LIMIT $5OO O00 i OTHER I DESCRIPTION OF OPERA71DNS1 LOCATIONS!VEHICLESI EX C L U 31 ON ADOED BY ENDORSEMENT J SPECIAL PROVISIONS RE: 18 Whitmar Road Cotuit,MA 02635 i Operations performed by the named insured subject to policy conditions and exclusions. ` ,t CERTIFICATE HOLDER CANCELLATION j -C- 0:) SHOULD ANY OF I HE ABOVE DESCHIUEU POLICIES BE CAN LED BEFORE THE EXVIHAYION Town of Barnstable DATE?HEREOF,THEISSUINGINSU HER WILL ENDEAVORIOF�BA in DAYSWRIT4EN 367 Main Street NOTICE TO THE CER71FICA7E HOLDER NAMED TO THE LEFT,BU r FAILURE TOMD SO Stgt' Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE NSURER,ITS AGENTS Odo REPRESENTATIVES. r— n% -AUTHORIZED REPRESENTATIVE C. ACORD 25(2001108)1 of 2 #45901 MAK cn ACORD CORPORATION 1988 I I . WISE•SURMA•JDNES•ARCHITECTS EIL 0�.m..�p 0 O n T381----------------- 1 .�oml.m..womor `�•� m�iw wuYi®�a I I 11 �� s 1 1 1 - II m.w'aw"c 0 N�IPiYMv9nIX + � . amo..rooml , 8 . = k � Revbmly unl+ouow 0 WINDOW SCHEDULE FIRST FLOOR PLAN amlme,..le oemm..m . msmmmat®a�a . .��•��••,�� 7NEAGDS11NElL RESIDENCE o.00nmwm .10 WNmlm Rood Mm9olu Mft.W 0250 nay.rau.awalmwmm�• r1r�t FIRST FLOOR PLAN sue.,c.ws ranEo MM OLTMER V.2 auva:o.lncr . + � oru1t11Ro A,0 rJram�rt + .. 1 ISSUED FOR PERMIT . � - _ ... _. "N7SE•SURMAJONES-ARCHITECTS V S� Y D. FCC s 00 aim 00 FRONT ELEVATION i THEAGOSTWEW RESIDENCE iewnm�.�aom wnmm uu.,w m�a Trr� BMWEXTERIOR ELEVATIONS SDME IB HOfm mm.ocro mn.m - rouvM:aims SIDE ELEVATION REAR ELEVATION 02 ISSUED FOR PERMrr WI�•SURMA•JONES-ARCHfiEC15 I a.i ::.;•:' 1 KITCHEN ELEVAnONS p WC HEN ISLAND ELEVATIONS ReNilw eDRESSED COLLAR TIE OEIAIL rwmauwAdai ro THE AGO5TNELU RESIDENCE Iewlw�.Nme ud.lm.�w meu INTERIOR ELEVATIONS sole:"NOTO ' wTE ottoAeN n.moe • onAw+:o,wl t - oMN1N0 NUYBm A-03 ISSUED FOR PERMIT WISE•SURMA,IONES•ARCHITECTS mm.m�oevon ...wam��rm�i .i Kwuo Em'M w�v�mv.o '� uommvenoo.uvwan l P aUy IF LJROWbo aww.m6 mav�eM� rtmeu �� M�m�ir�nomuawCwM �vtasicimauv[.• rp6rto�m Rtwrrsx - THE AGOSFINELU RESIDENCE SECTION AA fro vvhw—R NarYOm mm,W 02 M rxeaw•iv TIfIE CROSS SECTION SQ IE ASNOTED DATE OCMM V.M -� DR WMNUMBER A-04 ISSUED FOR PERMIT i I ! WISE•SURMA�JONFS-ARCHffECTS ElEl 1 ..nmlMao -_- kt �► St,PP.DCy��.\�I -------------- mneimnaau � n !�' y qqq1. J . 6XU'TY1O weeeMEM �V I `+� ub 6 � I_I ---.::�:••.-. I mowu �I 1 .FOUNDATION PLAN FIRST FLOOR FRAMING PLAN RwWpe II a— wao I 6 TYPICAL FOUNDATION DaIA ; , II m II 6 II II 8 11 7M. • A6uolba aM ALmlbm b _ THE AGOSMELLI RESDENCE ago aru aia �+�+ 181MIYm F� d .umw�owx®w.® 81an0ona WBs.Nn Pffi18 1rr� STRUCTURAL PLANS . - scue�6 norm - � 1 DA1£ocroeFJ+n.xro ROOF FRAMING PLAN wuxx wsu • >�"•-�� oanHlNo mlwfi6n S-01 ISSUED FOR PERMIT Assessor's office (1st floor): - �, y - THE v A �essor's map and'lot number !'.�: S r `� Y"° T�♦ Board of Health Ord floor): '` Z fO wage Permit number . I�� Z BAMISTABLE NABIL Engineering Department Ord floor): t4-191 S. 90o Me 9• House number �G APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING , INSPECTOR f ,- APPLICATION FOR PERMIT TO .................................................. ..........:................................. ' _ V TYPE OF CONSTRUCTION ......I1J c?P>�X. i-�1!t w1..<.........................................................:........................... .......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �-- ...... Vl,�.,`t M! -..��.� .r�l�.............f .! ...................................... .,......................... ................ .................... ProposedUse .......1.�- `? t 1� i✓L C 3� .................................................................................................................................... Zoning District ..............Fire District .....C>A-Q "....................................... K I................ ........................................ f F Name of Owner ....... l.t C..... U.l.l. .... ......Address ......�.c...... .c► ............,J.. ..`...t j vvl Name of Builder ..........Address............. ...... ..............5�.C:::...................... c� Name of.Architect ...�....1,1.........:�..1..f.,�.....�..................:.....Address ........................,.. c _ Numberof Rooms Foundation ........................................................ ................... Exlerior ... .................C5.......; ;t�1. �. ....Roofing .......A S.,k 1 ......................................................:..... r 1 T i l4. ... 12.'a�t' f ��Jy 1 i �, c: G � S Jw� Interior Floors ....�:.�1:.1�....................... .............).. ....�.........�....,..... .......... ...............1..�......... .......................-:.'....... 1 ... ..1 ...1...E .............. -- `�...a= t2 i� .�l(L - C �2 Z Xr; ('� 7...4 Heating, ...........................Plumbirig ............................�}. . ........:......... ... .... . . . .�•. u Vu Fireplace ' < ....1. ��( �: PP .. 17�� .....,��.......... .....:..................................................A Approximate Cost ......�.�.>...�............•....................................... Definitive Plan Approved by Planning Board -----19�. Area .......................................... Diagram of Lot and Building with Dimensions V Fee ✓.....:....................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i 5 r : i . r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding-tlie•'above e construction. ' Name ...... ..�A, a<..................... Construction Supervisor's License .................... �....... ... " BAYSIDE BUILDING CO. 29580 Two Story No ................. Permit for .................................... Single Family Dwelling ......................... ............................................... Lot #10, 18 Whitmar' Road Location ................................................................ Marstons Mills ................................................................................ Owner .....B.a.ysi.d.e...Building. . . ...Co .. . ...... . . .... . . ...... . .... Type of Construction ..............Frame............................ ................................................................................ Plot ..................... ........ Lot ................................... Permit Granted .....June.....2.7j, ..............19 87 Date of Inspection ........................................19 Date Completed .................. ...................19 TOWN OF BARNSTABLE Permit No. ..9.E%8.0...... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ...............: 7 Nl ,rab.'uv¢ HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY, Issued to Address �<1 0 1 st c.T1,; 'A' r_!'a1_Sar)S i.•t? a AI?:�RC`'ntt� t7i USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .. 19....R.(......... ...... .... f4.... ............. Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT rua _ �saa�T ' TOWN OFFICE BUILDING � t619' HYANNIS, MASS. 02601 �o rnr►. MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit/has been issued for the building authorized by BuildingPermit #....., C„ .. _......._.......... .........._......»........ ........................_. issuedto tr .... .....C_ '? ...._...................... _....... ... __._......_..�..__ Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A��J LI DATA .,► _.as IN PERMIT JOB WEATHER CARD ' DATE ' � � 19 '•• PERMIT NO. APPLICANT ADDRESS (NU) (STREET) (CCNTR'S LICENSE) PERMIT TO t.!".,''...'L.�.:.'.t, - ::'i .,..�• i _._. NUMBER OF (=) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) . . _ �i: ..:..:....... ... .. �... _. _ (N0.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) ' OWNER Y'Sy _ BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONnIT;O'!S OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL M;14 S(READY TO LATH 3. FINAAL FINAL INSPECTION HAS BEEN MADE. L INSPECTION BEFOREE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVAL 1 � 1 z 2 3 - OH EA T:NG 'N5?ECTING APPROVALS REFRIGERATION INSPECTION APPROVALS it BOARD-0E.AEALTH ..'DER i oct WCRK S,..A.LL NCT PROCEED UNT;L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION. iNSPECTIONS iNDICATEO ON TH!S CARD :NS?EC7.R SAS APP-%CVED 'vE VA4!CUS 'WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES JF CONSTRUCTiON. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. . a Z77, U14 iTA�,4/Z t , �P`. C. �0 P1 Y E LOCATIO" �J c No. 19334 � "��S%a/y 5 '�✓/L-L� \j$UtZ CtzRTt;=-( Tt4AT Tl-lE-. 5140%4jW �LA1.1 R�FE2c1.1GE ,AS2Ea9-z COAAPL S WIT" Tt-1r-- 51vt=..t_t► r-- 1,IJD SET CV WC-4UllZEMaWTS 01= 'rPe / .�/ .C�2 C1 ?%��r/ > RL7�_ %lam_ ow tJ olt 3 2�/S-T.4��L� At.1D is F1.111-�.1_ _ SAT CZC.G(S IZ IZ�U, t�IJ C� Sty t?v Yo k.S 44A5.5. 'STLtJ��I.IT StUCC�/G�{ ��T..IC-. UPGS�'�S 5�•�o'ulD APPI_1 C,/S.I�IT tea' _. i� �' �. :T 6L usc.p To ve:rcPMtWt:-- tsar er.Ic-t`S - Zvi C 1 b �f,, \ T` 1 1 ....'sue•l af;- Ott • L.crT -4 3 Sao 1� �� 1ti •tti � I 263,C>l PUER I�n SULt.lVAN 2)9733 ! _' 0 '-s TtrA' ^. 24043 Ss"orvnt �4;re- ro t . risaa, 2�, t�fa ` �„'.�'•�-��!� sue.�� �.i`��.���. _ iG/y UA7"Q LAS-e 1C).Z>n � F "t t= '1c>CDZ:> (Soo.LI.Ot.I. . PLTER...' SULLIVAN: S�twa.a 4�,r?-G + 1e6S r ._ ^ No::29733 r -A TO GeVisTFa�� FFssZONAL �• a t-'t' g RICHARC• `� wart- < <9r .��-rE ; �C®P �.r.,tt 2 M�►Jl,ta¢.�.�.55 '. A. o BAXTER h No.24048 • ��clSTG��p@ \b ' - 50'37 12.23•8,S �5�..����u-�axc•�.eZ�-�J�1►aL � v 4StO� ��...�3 FG. � �q,0_ fG• Sv®scm� ��.. �s�t/E�5•fo) 1 bOp .t/.G.) s •• /.i�✓. �3,O Oi57 1 O E3oX /.vim GAl-. /.w �an,►T � GrA�. .. �2,0 62.lo S.EPr>G G2.8 ',,.• ,. '��•� .o T.Q.vic� . •� Z pr .� G2.2 �2.q C.E,GT/F/E.O P�or ,��;aN IEL� SGwo �L{_S.Z�--- c•",.� �. LoC,GT/os� �a�•2STau5 . ._ 1U ,v!- w tuwr / GE,eTio� Tf/,4T'TNT- reo�as�� v,�'r � r+t A,< 1-3 t98S aAa�a '�oa S.yGW,V }�E.�Eav Gaiti/P�Y,.S !.t//T/�Th��'.S/O�•�,/./vE Bf1XTE.2�''�t/YE /NC. �.VO SETQ/7Gf� .2EQV/•�ENl�NTS O� TM4 ,C'EGisrE2cOLQ.vo.SU.e�Eya,�S �]'Ol•f/i!/ aF�A�fJ.Ss'� 1�N17 /.S it/OT G�ST�.eY/.LL.� a- ��� . aovpl�41 aAv,4.v Ta Es�1l�G/.sy Low-• G/NE,s; Assessor's office (1st floor): pL_ fJ pfTNETO Assessor's map:and lot number Beard of Health Ord floor): �� � � y Sewage Permit number ......................... ....................... UE •., SEPTIC SYSTEM M Z BaBaa LE, Engineering Department (3rd floor): t4--/, ,/ HNSTALLED IN COMP 39 House number ........................................................................ WITH TITLE 5 0 Mar APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only 9NYIR®NMENTAL CODE l-r T kUik' ULATIONS TOWN 'OF BARNS AM." BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. D Y1. .?. ... ... ,. .... ............... . ........ �� q p TYPE OF CONSTRUCTION ......U` CX....:7R.i q.W.uC:. ................................................................................ K . .rtZ. .........................19J�.e4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies'.for a permit according to the following information: Location ...... -- ..... ......."V.k., ....:Gar..�.b.t ............... L�S.�... . ................ ProposedUse ......J ! ..1 '`. .e................................................................................................................................... Zoning District ......... .. .....................................Fire District ....... ... . . Name of Owner ....... ......Address ..'Tta..Q.C).x.......1. .........0 0& uu Name of Builder .............6.4 `,L. ..................................Address .............. C..'.1.{` .1:...................................................... V - ......................Address ........... \ L.1�l�.�l`!°. Name of Archi'te'et .... ..... ........�.�... �.:�. ............... Number of Rooms ...... ........................................................Foundation ..... . C Exlerior ...�� 1... Y�[�.Fl .�`. PL.N ...... Roofing ........ 5�.!'.1 ........ Floors ....6➢.`4-1-4.,'...1.AA4 7.. JCA(2F .Tt.... �......Interior ...... 1.......Rtf.�S. ................................. 'Heating ...� .W..H.. ...............5. 1�... F�.12-�`Y�...........Plumbirig .....?.Urn. ....5.:�.�f1?./�.cx� ......Z./ ... .!4.��'t:� Fireplace ... ..................................Approximate Cost ......�.. �:.0.M Definitive Plan Approved by Planning Board ___ r� ___ -----19 Gam__. Area '-j Diagram of Lot and Building with Dimensions Fee ............/...4.. .. .......... f�IECT TO APPROVAL OF BOARD OF HEALTH 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 .. ...... .......... ......................... �ds�Ys-' Construction Supervisor's License .................... ............... %i;AYSIDE BUILDING CO. �q No ... Permit for ....TY��A�P��Y............ ..........Single Family Dwelling..................... Location ......L9t ftQ......1.8...Whitm.a.r..RRAA... . .......................jjqr!Rtqn.s...Mills.......................... Owner .......Bay:��ide Building.... ........................ ............. Type of Construction ..F.ram.e.............................. ................................................................................ Plot ............................ Lot ................................ Permit Granted ........................June 27,................19 86 Date of In s :2-7:........ ...............19 Date Complet7cl ........19 -1 4 J? i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel y Permit# ���7`� Health Division Date Issued — Conservation Division Fee /Ou ad Tax Collector L• - )�s—/" Treasurer CME SEPTIC SYST M b 5 EE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Hystarie+-AfEH- Preservation/Hyannis Project Street Address � I�1.Tl'Y)Alz _P8tf e Village VhSJ7DJl1S M t LLS Owner TD A6011/JLLLl Address (S0470 Telephone Permit Request Abh' -M jM {-kuSE FUf- 1q,X 14, 6*4 Iiu ndrn DA170 �(�SiL11� 5116 6F EX r 5TT NCA 6q-M1 LV R(rDm Square feet: 1st floor- existing` O proposed -rw 2nd floor: existing l proposed Total new Estimated Project CostA 33,v Zoning District Flood Plain Groundwater Overlay Construction Type 00-b III& Lot Size Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single FamilylT Two Family El Multi-Family(#units) Age of Existing Structure D� Historic House: El Yes P No On Old King's Highway: ❑Yes *No Basement Type: aXUII ❑Crawl El Walkout Urbther r!'ii2 ,�L and-o- adctt(Mr �[��cfc fi !�i LS r I Basement Finished Area(sq.ft.) ) 3 A I i Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 3 new Half:existing . new Number of Bedrooms: existing new & TT t?iK�fihS'f�Y► �y Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: Ql'Gas ❑Oil ❑Electric ❑Other ��� Central Air: ❑Yes ®'No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes Q O Detached gar existing ❑new size PA6�0 existing ❑new size f aftrt3 existing ❑new size Attached garage: existing ❑new size ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Nj No If yes,site plan review# Current Use Proposed Use &I (N - 1�anA BUILDER INFORMATION l/ Name C lP 1 ZZ 1 A,, // m E �iYl plZo✓Em��l T Telephone Number Address 16 � A CW 7&aW R✓ License# 03 0D-aL ai as- Home Improvement Contractor# W d? 7— Worker's Compensation# &Id Egg& ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO &,W&el�VW SIGNATU DATE �S I� FOR OFFICIAL USE ONLY PERMIT NO. , DATE ISSUED MAP/PARCEL NO.° ADDRESS VILLAGE OWNER DATE OF INSPECTIOar FOUNDATION f� FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH® FINAL GAS: ROUGH' FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. I I MAscheck COMPLIANCE REPORT I i Massachusetts Energy code I Permit # MAscheck software version 2.01 I I I checked by/Date I I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: other (Non-Electric Resistance) DATE: 3-25-1999 DATE OF PLANS: 3/25/99 TITLE: -Agostinel•l.i PROJECT INFORMATION: Mr. & Mrs. Agostinelli 18 Whitmar Road Marstons Mills, MA COMPANY INFORMATION: capizzi Home Improvment COMPLIANCE: PASSES Required UA = 56 Your Home = 46 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 196 30.0 0.0 7 WALLS: Wood Frame, 16" O.C. 336 19.0 0.0 20 GLAZING: Windows or Doors 35 0.300 11 GLAZING: skylights 6 0.370 2 FLOORS: Over outside Air 196 30.0 0.0 6 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design conditions found in the code. The HVAC equipment selected to heat or cool the building shall be no greater t. an 12 f the d i9m l9ad as specified in Sections 780CMR 13 J000 Builder/Designer Date 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAscheck software version 2.01 Agostinelli DATE: 3-25-1999 Bldg. l Dept. l use I I CEILINGS: [ ] I 1. R-30 I comments/Location I I WALLS: wood Frame, 16" O.C. , R-19 comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. u-value: 0.3 I For windows without labeled u-values, describe features: i # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I SKYLIGHTS: [ ] I 1. u-value: 0.37 For skylights without labeled u-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location I FLOORS: [ ] I 1. Over Outside Air, R-30 Comments/Location AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed , ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be a.z I' provided. Insulation R-values and glazing u-values must be clearly I marked on the building plans or specifications. I DUCT INSULATION: [ ] I Ducts shall be insulated per Table 74.4.7.1. I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HvAc system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAc system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in sections 780CMR 1310 and 14.4. I [ ] ( SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 I steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 I 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- i - ✓he -cll irzlnwealCl o1✓G`awac cXajef OEPARTiMENT :?F PUBLIC SAFETY :ONSTRUCTION SUPERVISOR ..-N-3 Number: ?i `•� cs 107454 02t24+?000 � n ✓leae Restri:Cted Tu: l9 HOME IMPROVEMENT.CONTRACTOR x /THOMAS` CAPI•'_2i :;Regi,stration' 100740 '6 6 HElJTO!JNI RO ' ;Type PRIVATE CORPORATION COTUIT, :iA a2635 Expiration ::. 06/23/00 X — ;.':*CAPIZ-ZI-.HOME IMPROVEMENT, INC G� ,�'•yhQ;�IIas.Capi.zzI.,. Sr.: ADMINISTRATOR 1645 Newton Rd. Cotuit MA. 02b35 ` +-- -- ✓lie o`, Glizaruc%u�eCC DEPARTMENT OF PUBLIC SAFETY ! CONSTRUCTION SUPERVISOR LICENSE Number: Expires: - Restiq ed-To::. 0 THOMAS'X CAPIZZI .JR rLL- 280 PERCIVAL OR rW BARNSTABLE, NA 02668 {�' "r,��.�,+�� ✓1e "%�o,��v�,zo�rziuealrl• o`'�-GCcz�rJaC�uJeCG; DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Restricted�fo 00 I _ FREDERiCK V RASCH III i 9 6 1 8 0 U R N E RO PLYMOUTH, MA 9?360 1 t p 1 o G h'yrrL4R ROAD IV DID— . Dd J O pb y o L LOT 1 fl 43, 561 S.F. RON®. QO LAM Qp 0 •�f ''jai �v - � J 9SPX 49 M PLOT PLAN OF LAND .✓--� 'TO THE BEST CF,YY MOWLEDW THE SU,ZAaM LrJCA 7L�Q IN 30 21 10 O 30 60 30 �[N SHGNN aV -HZS PLAN?S AS IT ACTUALLY EXISTS ON - - oai' MS QWWD.• BAf7NS TA BL E - MASS. - - OAYp G� SCALE SN FE£7 �u SA "J, b'+ OAMAp3.Ia img 4 PREPARED FOR 280� EDYTHE DA VINIS ,ea =`:; •�_— ,A.L.S. DAM AAR.fQ J6e9 SC4LE1'-9p FT. F;DOD 11'E C (mav- AaARO) CAPE & ISLANDS 9LWVSYrNr C-� F-ALMOU'TN - MASS. Ay SME T� . The Town of Barnstable 9 1 Department of Health Safety and Environmental Services `�°r ►`� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissior.e. For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. f f 1 1 `Ktwti\� Type of Work: 1 '1`" q a +n ext&Mc% rMM Est. Cost a 6ZS� Address of Work: W/ tJO � �� ' Owner's Name U N QS%l NE�1 Date of Permit Application: ��z5. `q I hereby certify that: Registration is not required for the following reason(s): Work excluded by law j Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. �,4 P OR Date Owner's Name _---.-.3 i tie ommo 0 2--.- Department of Industrial Accidents - . _ 600 R'ashington Street - ,1. Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: -fo P k j A 0ST/N E LL l _ location: I. 9- b �Lb,-A&-9-_-R b city M4-9s-/Ulvs W?i 1 IS phone# yo�o mSG ❑ I am a homeowner performing all work myself. a❑ I am a sole �etor and have no one rkin in city K %%am an employer providing workers' compensati n for my employees working on this job. >v: f:: ..>jg� �coZQ n n III ;: ?" �;' '� :>:';.: ::,:;�:,:. :::: ::::::': `;'' ` �` ':::.: r '�::'::::::: :: ::.: 4-4 £ ` <::::" :`:f?»:: : ' : ' '::: .:::atC':':''*` '::::, t:' <i":> i:`<i>'i i`'•> "��:� ..'% I. : >:.: ::;:'`:>1. .::::::.:::::::.:.:.:....:......:: att,,::::;:. one• .. . 4.4 i'asiirai ce ca. I tMa M - t noiicv# w ; � u ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have `- the following workers' compensation polices: :.::::::::::::::. :.::::::::..::.::.:::::::::::::::..::::::::. :.::.::.:::.::............................................................................................................ :xx >::• :compan nam .:..:.::...:..:.. >:� s:::a»::::<:»:::::>:<:>:<:>:: ..I.........:............... d r . _ :.::..-......::......:.:..:.:..................:..:......:....:.: .. ... _........_.. :><>><: :<.>:>. .. ............. ..................................... ..................... :........................................ <w3s .. e. % :M��1:....................................................................... .......... ...... ...... :.::::.:..:.:.: :.::::::::::.....:::.:::•.:...............1......... n e ... :;n:<...x:— ::..—...v::i-..-;>:??ii::y;:{:;:;:;:f:::;i:;i;i:!i':ii:i::+;i:'viii:4' v:;4F:::::::::vi:;vii::w::••i:vi:.<•i:::: :iii::?:<vii::v:;J}i}:i:;;^:•ryi;+:is::::::::::•�:.::::•::::::::::•::::.:............::ii::•:y'+iii:<;:Liiii:::i:6iii:::•iii:ii}i:Jr}i}}:Myiv':: .................................:::::::.: ...............................N:::::.v:.�:::.. .. i£... 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' ' : : :': ': ':::.... ±'::: is::'.....:< ? :: : :�' �::22'.?: ... �:'' :?.: ;:: 22::'': ' '? ::.,...I. `.? ? $ t t . coma n . >:s : ::>s" adi{ies tiara .................. ..::.:::::::::::::::.::::::::::.:.:.:::::::..::::::::::::::.::::.::.::::...:..:::...:::.:::.::.:::::::::::::.::::: efts . .... .... .... .......................................................... ......:..................:.......:. >::: :... ;.: ::..:... ..............::..........:......:.:::......................................................... :::::::::::.::............. ........I......................... :.......::...::. ................,...........:.::.::::::::.::::::..... :,.�: .I.:►.. < :»»<: > n iirsaiaca:`:::':.>: :.`:r>:s::`:<:::::`:::?<><:Y.?„:>> > :? i'< >:i ;? <_ > ....,.;.::.;..... Fame to sense.overate as regdred order Section 25A of MGL 152 cm lead to the imposition of aiadnal penalties of a one up to s1,500.0o and/or me years'lmptisomnes d as wen as dva p—Im in the form of a STOP WORK ORDER and a flne of 3100.00 a day against me. I mderstmd tad a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verfIIcittion I do hereby certify under the pains anvd p�of ppedury that the information provided above ii tru.and c`rred Sigaatnre �-Z4-G� ,I. kl? ,-, s'� Date 37, s-h2 Print name �UC 6 1 C,e_ ( - ,F f f-S C N •:11-- Phan.# / � � 9 S otIIdal use only do not write in this area to be completed by city or town ot�cial . city or Lawn: • permit/license it • ❑BuDding Department ❑I.icmmtt Board ❑check if bxxt eel atz response is required ❑Selectmen's Clam _ ❑Health Degattmad contact person: phone#; ❑Other p�9,95 PJ.0 . i •i 1 -7�!' - , r ✓R(`/JT F_LC/.lnCnI RI%NT FI.EV.17-,L',) REAP FI FVA nO I f k `!t{f i /Q6057-/aEILI ADDITIDd -P,AU) . 3-03 P By 3NARO"I MA(ONf-SOH.v)oN 50,?.77J-I:F7V rep GAPI7Z I rloME JN f/. vaa-9s/ °'"join«• cc.N c•; `� � YY ) HtM�•1. SY iTc�n tGklliE [ORN'2 cAZ.I cr) _ �I / I Eii+C�ENT I �NEw gIA.ITct TaP. .n"wi l„ ROnM y _ 5 yF)N u�10•c4 EE aJ (Yr /•I L ( I NCW Sioc P.Eccy w/aouTceea' eE)Ic.N .� . .Y DEtk 6 ALl T,RIn ON • FIREPLACE IiIALL- 43Y • V PATCH J�� STR.JCI YPAI R.CDp." Gxf Acl2t). dE•�T ' d• F � E+},n/r N•L 4.'ousr c."-P W i� w REV>fi ¢a•)n.�b ON)E MENT cRAWI.5 PACE p ' I s4wcv MQ0. I I II O".NWN 8"COW *ADD 3 J �U'-3o'-z_.-s 1 wq..y u/JL•5c 8' 'lP4 iO 3 ~RABLE �� CANT.PTL.f•�R'P .. li7Y" LF IKwT n PibNAL PAl:6'WINDOQ REPLACE C. T • •r . IA BOR LfEPEC A'Ct:\ =l L>n2 4i A.3 yy RAID DAT)n n] PL'AN.AFRO-'70'WInE x.`A'x7tix aALE %oaf-n�• LAcc'.y U�-,'-q•• b/wjs 4L�/4 x 18/!'•WOf%3 � —f .*NDTE: FLoo R D ss MAY .A)EE TD Ise 'W%'5'5*eD- ¢ia4Er CONT.sOFF?V£NT 00 NOfE THiN< UNo:; Ft•)T OFFITUFNTINb TD Ex)T•Nb(*OPTIONAL A"DD 3 rAb.,JETS WA' r; i. F1N1yHE D>. . CSEF EPERATE MEET W Pfq VRb IAE NT �I� dAI] "jTRVCTUAA 2iV6E .l 5 / 5 j� nyr•+L� dxla RA FT£¢f .77 o[. D�y RE LEDAR ROOF Tp mATCN 11 cM OC ATOP ,lol FELT yey"'y ;• ATOP 'Yu"C Dx PLy woo> LGNTCe oN SFOPE�� 3 )x6<EIu o o I y$ IA3 RAKE "T"5T5 CIL'o,' AL.- 6VTTERS 45POU75 �x4 JJVL TOP I,?FASCIA 1 Ai•N•:OW CMEDV Lf $TUD/ PLATcS IX10 SOFFIT J /4.OL, S Ix4 F'e Eza '! NUA.4tIc QG'. LI-A f) jL•ITE ?I 3 ATCN 51✓+ x GL'•�'l9 .P i S i k No&Nf C3Y Ro<e W/ tc d"O•mF ob.(MAT(N� -" INTERIOR v wh ITE CEDAR 5N•N6Lt'$ AR- }-Cook"G np. FRONT CIA/BGARO Y';rr(NAT</> . ' � ATOP 8"CDt Ix5 I,4 CO�n%E A'- aOARDII M IxY TK;M _. 5.oE ALIUWRAP . __ �i� azlP Ib'G[ 27L Rio ATOP Va"LDx PLy r\Jd+c6 PT.j1Ll SEAL %/D MDR. CRAWL SPACE ANLHOiZ BO175 4"DUSr CAP/LGNC REIe ' I � jGFla 'g LGc c,.•,( M 4-O"N GN y'[G nI, 17AP P''OoF PtL[lJ . L� WALIf W�Ib"<E` _I 6kAPE [ow. FOOTI NL. ACCC)5 +UE Nf �G.US rINe LL/ _ _FCAMIN_1'�r.ESSLOIJ PA. 74.ALE.7/u•_, CL_.. Pp_ Icy :T'Loo< 12-E-F/ 1,Ji5 H I Q6 IAJ lPrttAl7 AR�C-,4f E-A C. �• P, . FA M 1 l AA i xl3Tl N6 1 � COM 1 ,0 G :D U7- I iZL eOX� X-1-ooi2 0NDc2 CHAie 2a0AA 2 3`_d" NA I y-� NAIL T J --- ARr�A ' KITCHEN . ESIGNS •Designed For: /1114A'�l F 10ki I o'S-�«ed [ c This is an original design and must not be released or copied unless applicable fee or deposit has been paid or order placed. AND UNLIMITED BATH INC (,�(,` �� The Purchaser understands that an order has been placed and any changes in Address: 0 measurements or appliances MUST be approved by K&B Designs Unlimited. i !7 TOM F. LECKSTROM C.K.D. City: gosk;'t s h, lss State: Zip: D 6 � Approved By: A';:= (. � -' Date: Certified Kitchenmesigner Principal _ cr—O 866 Main Street,Osterville,Massachusetts 02655 Designed B A ,F� a h°f— _ Scale: 'A" = t'0" All measurements are finish measurements unless otherwise noted. Ph:508-428.3999 Fax:508.420.3640 g y' RCS ' es asftt e.�'" V3V8/S IYO— V<3��s iALL f e C� New CV.sf. 71, i Ce\\0h5 rNTu6 .7'cf"�cr -0"(JY-1 e I ti 59 T°�ti ✓"9y.1 ��FA ;�� °Ns. IlkS1 R h� Y •3-`h r( �� C,e_t TWA F. K e.CK . ... f /, C��(�►.�5�ng-�- .... REGiS- still LC go l tf flrF, FIN Its . 101� s DATE PAGE Designed For: :TC)s'/—; This is an original design and must not be released or copied unless applicable KITCHENDESIGNS fee or deposit has been paid or order placed. AND U NUMITED BATH INC (,y�`.� The Purchaser understands that an order has been placed and any changes in Address: Uv..W�le1 ��� measurements or appliances MUST be approved by K&B Designs Unlimited. TOM F. LECKSTROM C.K.D. City: �A+�4�►nS ��LState: __��- Zip: U24-4 Approved By: J4(1��<- --r Date: Certified Kitchen Designer Principal , "� 866 Main Street, 3999illF x:508-Massa 20-36 02655 Designed B �_ ;d— �6-*% -C�Scale: 'h = i'D" All measurements are finish measurements unless otherwise noted. Ph:508.428-3999 Fax:508-420-3640 g y• � i i aar,r Ce;\;tip ct;tio I � i ® It �hC4 C.US'�-®lVI ew En. 4{N� S\qy + ! ��►�•-/� �����5 the(( M. F Ins N + t, wx t.ci ILL tr C O O -- I4-P =- - - - -- -- - - - - - - - - —o— '° 0 36u CFI hove' '•. : � . . . - ...•..;' °� ys 4 &-1� � INA! 'i`t`Ai F. {_ECK$TAdfr.•� -..', 13EGISTR.PLO. .= fX. �1'. Il�wSzw "fit s� rzs-r'� r 1•`+i�'a PLEASE FtsF•ER To FLAW FOR DATE PAGE -7 a . Designed For: I� KR Ll r���'i ��5�'t ��� s This is an original design and must not be released or copied unless applicable KITCHENESIGNS fee or deposit has been paid or order placed. AND BATH U NLIM11*ED Address: 1 8 t� T WMAIVO,, - The Purchaser understands that an order has been placed and any changes in INCmeasurements or appliances MUST be approved by K&B Designs Unlimited. TOM F. LECKSTROM C.K.D. City: �.1A-Zip: ��6�-l'15 Approved B �� xJl�t "`� Certified Kitchen Designer Principal I State' pp y: Date: 866 Main Street. -3999illF Massachusetts 02655 Designed By: f—)m � LzcA-, , t .c"�Is� Scale: 'h' = t 0 All measurements are finish measurements unless otherwise noted. Ph:508.428.3999 Fax:508.420-3640 - S i CU S-(-D vv~- F Vy"e70 �s 1 �6Z R ��� � New c e �- ��tG!-� � w B2+P✓� �Q�R. �® 1 �.. � (�G�W(C). II7-1 bT. Cr µAS Cam R Pk- �FIWAL AN I S, a w .�__.... ,_-_ _. .. ,..-cam.. _....�... -....-•. �.��... +..... .ti.A.., .s.- .�,;... I i[' WA l .... IIEGISTR.NO. 60 Ile 3 DATE PAGE -7-a7- aoj!j - c . ,Designed For: � � �� ����� r he! ' 6 This is an original design and must not be released or copied unless applicable KITCHENESIGNS fee or deposit has been paid or order placed. AND U NLIMITED BATH INCAddress: $ �I.\>c�inad4t2 �'�� The Purchaser understands that an order has been placed and any changes in measurements or app;_ ces UST be approved by K&B Designs Unlimited. TOM F, LECKSTROM C.K.D. City: ritS ftl<t SState:J - ZiP Approved By: �1v`1�C. Date: Certified Kitchen Designer Principal 866 Main Street,Osterville,Massachusetts 02655 Designed By: '7n r�k z V, Scale: W., = 1,0., All measurements are finish measurements unless otherwise noted. Ph:508-428.3999 Fax:508.420.3640 ke ` rr i` - r t AZ, 1 ! I lY � Meg- Cw1oS ' tP 4b f 4 r'8s. V, . ® �ri' ' C��•n<'�i`.'•,t:�"�'�1L'�v c'� 'kr 3 }-`n�'s1S,�s'"Y .�A. 't�'�,'�{:��r3�'� .......�..k —- - l ....,.... � ..-...,.,.5...�.._._.............�.,�,.>�. ��---- +�F.i J i"l f��'• :.: 4 4A4\ � s.. . ..... :... ti� .te96 L y TOM I t,'.Gl:�;$i7id � qV Mpa sates Cam. ;n , GIs ,, PATI ST lj0�:.:�'. MCA PLAN, Folk <�-'14curw DATE PAGE ..... . .:.. .._.... ... ... a ,' f.. I a .. .._ o � PROJECT GENERAL NOTES : S .t� CONSTRUCTIO N NOTES: r f .. .• \ ... _ ._ PK NAIL FND i 1. LOCUS AREA IS COMPRISED OF . r .. 1. ALL SYSTEM CO MPONENTS PONENTS SHALL N BE INSTALLED IN ACCORDANCE_ . _ E ELE 63.02 o •. „ ,, ,._. WITH TITLE V OF THE STATE SANITARY t. _ . .. .. CODE DATED MARCH 31 ASSESSORS MAP: 57 PARCEL 110 ., -, - 63i • 1995 AS AMENDED THROUGH , ROUGH THE DATE F TE 0 THIS PLAN do• ANY y LOT 10 O PLAN BOOK 39614 PAGE B LOCAL RULES dt REGULATIONS APPLICABLE. Q s CERTIFICATE- 144009 6 0' 2. ANY CHANGE T I P 0 THIS LAN MUST P BE APPROVED e, : VEO N WRITING BY E ENGINEER. ELEVATION IN A N FORMATION U OWNER. ANTHONY do MAR1f R. AGOST1NELiJ MUST NOT BE CHANGED .. 62,8 WITHOUT WRITTEN PRIOR P_ R APPROVAL BY THE ENGINEER. 1 WH., . .. 8 RMAR ROAD-r t _ 9 _ b . 62, e. r 28 .. MARSTONS M MA 02648 r - _,. 63,0 2 T_ PRWAR'1f BENCHWARK . POINTS FROM OWN OF BARNST. o A81E ).,. R 3. WHEN CONSTRUCTION IS COMP LETED NOTIFY THE.BOARD OF (DATUM: NGVD 929 _ 1 , H A.. HEALTH GENT AN DESIGN D DES G ENGINEER FOR O EE INSPECTION AT LEAST x O , o o v O ti 48 HOURS PRIOR TO BACKFl NG.ti W THE SYSTEM SHALL NOT BE BENCHMARK . PK NAIL NORTHEAST OF _ � O PROJECT . . co .. ,.. _ . , BACK„ FILLED UNTIL INSPECTED AND APPROVED. LOT 10 H a. SHOWN HEREON. r 63 t ,. .., ELEVATION 63.07 .- • ^,.. r . ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4 SCH ...., ,_, .._ \ 3. ED 40 _ .._ .. 3A ZONING INPOTtMATION x UNLESS OTHERWISE 62.2 PVC NOTED HEREIN. r� ZONNVG OIST1iICT5. RF s 1- V' g OVERLAY DISTRICTS. RPOD esource Protection D�stnct 5. IF UNSUITABLE r , LE MATERIAL 1S ENCOUNTERED v � r �Y BELOW THE TOP OF w w _ a a o r AP Aquifer Protection Distrxt © f SAS PEASTONE ELEV EXCAVATE AS NO T a �4 Overlay ( ). NOTED 0 THE C.HORIZON , .> w, 61 Q i 6 A H FOR ORIZ. DISTANCE F o .. 0 5 SURROUNDING THE LEACHING FIELD .. .. 'fir AND REPLACE WiTH CLEAN SAND PER 310 CMR 15.255 TO THE ,;, it _._ €bl , .► ,,.�,.��, .. MIN. LOT AREA 43 560 S.F. 61,6 ,- TOP. ELEVATION OF THE SAS. f�1, S 4 l MIN. LOT FRONTAGE 150 / 61.3 O f , 7 i O ■ ? 6 ,4 s a 6. INSULATE ALL PIPES AGAINST FREEZING AS REQUIRED WHEN x 64. 3 O FRONT YARD 30 SIDE dt REAR YARD 15 Q MAP Scale: 1 2 � , LOCUS _ Sca a Oo0 , LESS THAN 3 OF CO VER. 1.5 , t i i r 64,0 / 7. THE SEPTIC 1 ES NOT - SYSTEM DESIGN DO INCLUDE GARBAGE ` O 1 , , GRINDER DISPOSALS. 61,6 , x 62,2 f 4. A TITLE SEARCH HAS NOT BEEN PETtFORMED FOR THIS/ ) SiTE. F DETERMNNED 1 63,8 63,5 O TO BE NECESSARY A TITLE SEARCH SHALL. BE PERFORMED BY OTH/ ti ERS. 8. EXISTING LEACH P 'TO 8 PUMPED R E UM ED AND FILLED WITH SAND OR 61.7 � 3 r REM 61,4 _ REMOVED. _ _ THE PROPERTY LINE INFORMATION SHOWN S A i _ ON I BASED ON CURRENT w t 1 / 5. 64,0 \ r + AVAILABLE RECORD INFORMATION CONSISTING OF PLANS AND O �. 61,8 , 63.7 DEEDS. � i i 9. THE CONTRACTOR SHALL h + k - f GAlLT14d, CONTACT DIG SAFE AT O - i THE.EXISTING MONUMENTS AND WETLAND FLAGS SHOWN.HEREON h _ 64.1 / 1 888 DIG AND UTILITY COMPANIES TO LOCATE ALL WERE OBTAINED AN ON ,yh , i - 64,4 N FROM THE GROUND FIELD SURVEY EXISTING UTi ES AT�, `b � l LITi LEAST 72 HOURS'BEFORE THE START OF PERFORMED BY BAXTER do NYE ENGINEERING dt SURVEYING FROM \ / 601� k FR k / 62,2 - ,j CONSTRUCTION. THE CONTRACTOR SHALL DETERMINE THE EXACT � � NOVEMBER 06 THROUGH NOVEMBER 26, 2006. / f 4.2 LOCATION,' BOTH HORIZONTALLY AND VERTICALLY OF ALL EXISTING 60.8 � •c ,1 i f , OR P A D UTILITIES BEFORE THE START OF ANY WORK. THE LOCATION OF VE DR ALL OTHER FEATURES TOPOGRAPHY AND AI 6I,4 62,9 IVEWAY DETAIL SHOWN IS FOR 1 IX STING UNDERGROUND UTILITIES ARE SHOWN IN AN APPROXIMATE • '� .2 � REFERENCE ONLY AND IS GIS INFORMATION OBTAINED FROM THE , x 6 \ WAY ONLY, MAY NOT BE UNITED TO THOSE SHOWN HEREON AND � ;- TOWN OF BARNSTABLE qS DEPARTMENT. 61. 6 62 ,0 _-- HAVE NOT BEEN INDEPENDENTLY VERIFIED BY THE OWNER OR ITS 61, - -• 4,5 6. LOCATION OF EXISTING SEPTIC SYSTEM TAKEN FROM INST S CARD REPRESENTATIVE. THE. CONTRACTOR AGREES TO BE FULLY - / / Y 64,2 ) ALIER TIE / 61.6 'P NS PERMIT 86-149. RESPONSIBLE FOR ANY AND ALL DAMAGES WHICH MIGHT BE / 64,6 � � . 00CASIONED BY THE CONTRACTORS FAILURE TO LOCATE THE i J 6 �49 4, ?6 8 7. Q � � , COMMUNITY PANEL NUMBER: 250001 0018 D UTILITIES EXACTLY. IF ELEVATION INFORMATION DIFFERS FROM PLAN 60. Y O 3 O THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE C.r--- 2,� S INFORMATION THE CONTRACTOR SHALL NOTIFY THE ENGINEER 64,7 4; 64,4 IMMEDIATELY FOR POSSIBLE REDESIGN. AT UTILJTY CROSSINGS, 1 a 0 GS m VERIFY IN FIELD THE LOCATION INVERTS OF ELECTRIC GAS x 4, 6 2, 8. � TELEPHONE dt DATA/COMM AND RELOCATE 1F CONFlJCTING WITH - ti r i PROPOSED INVERTS P THE �l " G J 65,0 \` PER ENGINEERS DIRECTION. THE x SITE DOES NOT N 61.3 1 APPEAR TO BE WTiIHI AN AREA OF ESTIMATED W181TAT OF RARE WILDLIFE '. � �� CONTRACTOR SHALL PRESERVE ALL UNDERGROUND UTILITIES AS II �o PER NHESP MAP OCTOBER 1 2008 'ESTIMATED W181TAT5 OF WILDLIFE' -- S �1F- Gl REQUIRED. O FOR USE WITH THE MA WETLANDS CTION REGULATIONS 310 10.0 PROTE ACT LA CMR 0 6 O 1 a• 64,9 r ,1 O � , O 6 - 1 4.9 , F 9 DOES NOT APPEAR CONTAIN A CERTIFIED VERNAL POOL PER NHESP MAP i 6 4,7 , h C oCTOBER 1, 2006 tRi1F1ED VERNAL Pools. x 6 61,E 6 , 1,3EXISTING,,'. 0 � J 66,4 x 61,2 , x N 65.0 t �1 S T1C�o i F�' SiTE DOES NOT APPEAR TO BE WITHIN A PRIORITY HABITAT PER NHESP MAP OCTOBER 1 2006 x / 61.6 ._ x TANK ( 1 'PRIORITY HABITATS OF RARE SPECIES' FOR SPECIES UNDER � 64.6 , GASTON L. LEMOINE, TR / , 4,6 R , / THE WISSACHUSETTS ENDANGERED SPECIES ACT, REGULATKNrS (321 CMR10 ADDIlt t ) 6,3' � 3 -- --- , f L � ? SITE IS NOT WITHIN A STATE APPROVED ZONE A GROUND WATER RECHARGE _...- EXI TiN PROTECTION AREA. 8 ti 3 �o x D BO 43 562 SQ. FT. , 5.0 ,6 63,5 " .� 1.00 ACRES x k , 4P ,r _ 4 O 4 O .1 REMOVE PIPE TO LEACH PIT E STiN CH T do PLUG D BOX OUTLET , ` x � A 63,8 � / 1 PERC x 6� 1 r v 1 � 4 i 6 .. - SON. L P� DATE tt/27/- Ot35 2006 / iib48 4 x 6 6 ,3 6 ,6 x, - f 63 a .a3 LEACHING AREA C G EA REQUIREMENTS s _rP 2 f , U S t BARNSTABLE -- SOIL EVALUATOR. NITROGENLNG META BOARD OF HEALTH AG NT LOAD U TION. NI A I . E !. , , 1 RE�iD ENTIAL 4 BEDROOMS � STEPHEN A. WI ON P. .LS E JONATHAN W. H(RST & DON DESMARAIS , y> T HITST , LIZABE H A.E m x x 110 6PD BEDROOM -t 4, ,6 7 TEST PIT 1 T , ti EST PIT 2 TOTAL DESIGN FLOW 440 GPD s , d- , x o -64. G.S.E. 64.5 G.S.E.h64.3 a _ o _ � GARBAGE GRINDER (NOT 1N - » r 0 INCLUDED) NIA 0 0 A 10YR2 1 SANDY -D LOAM A 10 YR 6 2 SANDY LOAM _ P / / PERC.RATE _2 MIN, INCH CLASS 1 r r 8 6 ELEV 63.8 LTAR = 0.74 GPD/S.F. ELEV 63.8 B 10 YR 5 6 SANDY B 10 YR 4 6 MIN, LEACHING AREA OF SAS, RE QUIRED LOAM SANDY LOAM / , _ / 440 G - PO 0.74 GPD S.F. 595 S.F. MIN. `x 64,9 / r 28 ELEV 62.2 32 ELEV 61.6 � ) � ) PROPOSED SYSTEM.. . 4- PLASTIC LEACHING CHAMBE RS C . 10 YR 6 4 STRATIFIED 10 C YR 6 3 MED. SAND, / WITH 4 OF STONE ON SIDE do 4 OF STONE AT ENDS MED. SAND / r » SIDEWALL AREA. 35 + 12 2 x 2 DEPTH 188 SF 132 ELEV 53.5 _ 132 ELEV 53.3 ' � ) ' BOTTOM AREA 35 x i 2 ) 420 SF TOTAL EFFECTIVE LEACHING AREA - 608 F NO..WATER AT 132 ELEV 53.5 S SYSTEM DESIGN CAPACITY - 608 SF x 0.74 - PERC ® 60 ELEV 59.5 GPD/SF 449 GPD RATE= 2 MIN IN / 1 CLASS I SOIL 18 Whitmar Road i Marstons Mills, MA 02648 DIST. UK W - PREPARED FOR cV ' .� C.H. Newton 919 Main Street r a 3/4 . 1 1/2 Osterviile MA 02655 DOUBLE WASHED STONE TITLE 7 2 , 4 4 • Proposed Septic System Repair 35 FTNsHED P p y P LEACHING TRENCH =64.5t PLAN VIEW COMPACTED FLU. e (min) Cover_ NOT TO SCALE ( ALL ONE INSPECTION PORT IN ' 3r (max) Cover " ACCORDANCE WiTH B AXTER NYE ENGINEERING & SURVEYING Y LAYER 1 81WI Y MANUFACTURERS / / RECOMMENDATIONS DOUBLE WASHED STONE OR GEATEXTKE FABRIC 3 « CULTEC [TYPE] Registered Professional LEACHING CHAMBERS g Engineers and Land Surveyors CHAMBER INV 01-612urveyo s DESIGN SCHEDULE ELEVATION 12' 78 North Street-3rd Floor, Hyannis, Massachusetts 02601 TOP OF FOUNDATION ELEVATION 65.6 tr o� y FINISHED GRADE Phone - (508) 771-7502 Fax - 508 771-7622 + EXISTING SEWER INVERT AT FOUNDATION 62.8 c ' N ( ) ♦\ ♦\ .\ N 4.�' » „ 3/4 TO 1 1/2 DOUBLE 36 MAX. 9 MIN. � � COMPACTED FILL/ � � W WASH E EXISTING INVERT INTO SEPTIC TANK 62.5 i / QN 30 0 _ 30 60 2 LAYER DOUBLE WASHED . . . - _ - - . . . - - . . . . . . . . ,� EXISTING INVERT OUT OF SEPTIC TANK 62.2 is » LEVEL BOL STONE E EV»v5o2 STONE 1/8 TO 1/2 �► �P OR GEOTEXTILE FABRIC '� » EXISTING INVERT INTO DISTRIBUTION BOX 62.1 EXISTING sals to � REI�IovE� To THE c SCALE IN FEET. w EXISTING INVERT OUT OF DISTRIBUTION BOX 61.9 SS�OAIAt E 5 MIN HORIZON - SEE CONSTRUCTION NOTE #5 , 3 4 TO 1-1/2" HEREON. / SEWER INVERT INTO LEACHING ..SYSTEM 61.2 , ®6 DATE: 12 15 06 DOUBLE WASHED 1 NO GROUNDWATER OBSERVED ELEV. 53.3 21� SCALE. 30 STONE iv BOTTOM OF LEACHING SYSTEM 59.2 SOL ABSORPTION SYSTEM (SAS) WATER TABLE: NONE OBSERVED AT EL 53.3 I I Fes-4' 4' 4'--I NTS -2 SAW 12129106 4 Bedroom SECTION -1 SAW 12/20 6 Rev►se Plan NOT TO SCALE PLASTIC LEACHING CHAMBER DETAIL No. BY DATE REMARKS DRAWING NUAIBD? 0. 2006 06 061 SURV worksht 2006-061 s 2.dw 2006-061 `