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HomeMy WebLinkAbout0120 BERKSHIRE TRAIL Oxford NO. 1.52 ORA ESSELTE 10% Town of Barnstable � � ... . .. K.._ . _ . Building . : . _ n Post This Card So That it is Visible From the"Street Approved Plans Must be Retained on Job ajnd'this Card Must be Kept 1 PostedwUntil Final Inspection�,Has Beeri.Madea + s s _ Permit Where a Certificate,of Occupahcyis Required,such'Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-404 Applicant Name: Peter A Kirchner Approvals Date Issued: 03/02/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 09/02/2017 Foundation: Location: 120 BERKSHIRE TRAIL,WEST BARNSTABLE Map/Lot: 109-015-006 Zoning District: RF Sheathing: Owner on Record: MAGUIRE,WILLIAM F&JANET L Contractor e: Peter A Kirchner Framing: 1 Address: 120 BERKSHIRE TRAIL Contractor License�",.CS-076441 2 WEST BARNSTABLE,MA 02668 j � kk Est. Project Cost: $20,000.00 Chimney: Description: Install Exterior Door to Basement. Create Family Room W/no Sleeping. Permit Fee: $ 152.00 Family Room Size 12x20. 1 Insulation: Fee Paid.: $ 152.00 Project Review Req: Install Exterior Door to Basement.Create Family Room W/no Date: 3/2/2017 Final: Sleeping. Family Room Size 12x20. Plumbing/Gas Rough Plumbing: - \Buildin Official g Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within`six months after'issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which thispermit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for4public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on t i permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing � ' Rough: 2.Sheathing Inspection L___ -_ ~~—-- 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O I Parcel Application :74, -4n 4 Health Division �o�G�� Date Issued -? 0 2 /T�t'/Ll`"� Conservation Division i ���� ®�°1 Application Fee �� 5�P$�� Permit Fee Planning Dept. ,.., __.�_.. Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/ Hyannis�� 1Lre- Project Street -Address a e r Vs h W Village �+ IAQ Owner iu,11ta rh F Tarve.,+ L M A6'V126 Address Telephone g r7 A 0 2. -- 3042 Permit Request Square feet: 1 st floor: existing livproposed 2nd floor: existing proposed Total new Q — Zoriing District Flood Plain Groundwater Overlay Project Valuation` Z.0 000,D 0 Construction Type "Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family , Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ull ❑ Crawl Walkout ❑ Other VZ GA RA 6-.- Basement Finished Area(sq.ft) Basement Unfinished Area (sq.ft) /7_7S Number of Baths: Full: existing 2— new O Half: existing new Number of Bedrooms: 2- existing 0 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric •❑Other Central Air: ❑Yes gNo . Fireplaces: Existing/New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:Xexisting ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )4'No If yes, site plan review# Current Use stn e 611,114 Proposed Use 4 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name f GE1iU v 0 "!, 44 &Oa; Telephone Number SO Address 1112 OJ e License# C s -- 0-7 6 q�j AHome Improvement Contractor# Email 17/S 1rC X Ae/' �ccjt. A e7� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0&' A SA V;J5gnf1J v SIGNATURE DATE FOR OFFICIAL USE'ONLY APPLICATION # a DATE ISSUED + MAP/PARCEL NO. + -.• - ADDRESS VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION I , FRAME J 'j INSULATION ' FIREPLACE T = ELECTRICAL: ROUGH FINAL F PLUMBING: ROUGH FINAL- GAS: ROUGH FINAL r" w. FINAL BUILDING -3- DATE CLOSED OUT ASSOCIATION PLAN NO. R r The Commo7menkt of MkFsrf&mzd& Deparfmmt af, us Acddm &C . 600 Wadimgim&e& _ wiarkeers'-lipensadlIiisce �*±=Bdeislt�acrsJFdn� ,;►*h Applkant Tufamutig E Please Mint - " - - - - -----=- - Addrt= l Ll2 Old �Vp ju, ' c�Yrs� Are?au an ee Vbyer?.Checkthe appropriate ba Type of project(regime* L�1(I am a 1 wftlL 4. ❑I am a general confractar and I � * bare lired•&e sub�com 6. El New oo xut-fzosz employees firll andfof att�ime 2.❑ I am a sole pmpeietazi orpart=- fisted cadre of 6ched sheet ZXReenodehag ship and have no 1 These snb- aractars ham � ce & ❑Demnlifioa vmding forme is any capacity employew andhave Wogs' . [NO ,'CoP.incur a camp.ineremno t • . g- ❑Rnildmg ed�ou d] .5. ❑ We are a cmparafian and its lam❑Elechieai repairs or ad�eaas 3. I ama bomea officers have exercised f� ❑ doing 1L❑Flnenbiagrepairsoraddifiems mpsdf[No wmk='gip_ right of ee pfiflet per hSaC. la❑Roofsepaim msmancerequired-]i c-M,gl(41 and we lave no employees.[No Workers' 13-Dother, cow.ixss�required] '�5'BPP��a[cheds'6oz�l Est a]sa fiIIo�the sec�oabeioa shcs�ti�es�e�`m¢apA•mR,,••poTs�pi�o� . t ffameoamgs�aho s�hmm3 sus mpg�Y�d�aIf wa3��d�h�a�d�c�samst submit s nezv�ad�2 mdi�rnrh jCa�ctacs$ss[�ecYlfiis bme mast led=sd4i6�sireei shmetLe�:meoEllse steel stye arnat those emitieshse� -mPb3�--If the-&—t—, I.---TbF.-,&Y p—id•&du$ .-e pang -Tam art eercpla.W tleatfg pravMding lvarkets'Caff7mmEan irmiraerss for my emp£a}wm Bernal is ilex pa8cy and job site Frz�ormab'vn. IasmanceCompanymme: 1&M M M9 A-L- ►Nr50 K ft0 C- Paficy 4 or Self ice-Ec-k /A) 3_l_S - ��S I `2�9� v rib teAaare 120 i4's1�;� a'J c es1-8�� 61e At#ach a copy of the workers'compen$onpolicg decoration page(showing the poficp n der and expiration date}. Failnm to secam coverage as regdkedunder Section 25A of MGL a 15 can lead to the imposition of rsimmal penalties of a fine up to$!SO D andlar one-gearimprisonment as w&as civil penalties in the fo=of a STOP WORK ORDERand a 1-me, o€up tb$25OM a day against ffie vio}a>ar. Be adedsed that a copy of this stnt+=mA snag be:fixvmded fu the.Office of InvesE gations o€ffie DIA far fi=mnce mvemS5 vad5cation- I do&ex it' audsr tks geriuty Aat fit e inforemra€ioaproFided eabmw h;bus and carme t Simature- IIafe 2 /J-'//7 Phone aid� Do not emits in i�area,€a be c mpleted by city artown a,,]j`rciat City or Toms: Permiff iceme# Lmuing A�arity(drde one): L Board of Health 1 Rmffirmg Dqm meeet 3.Chyf omen(3rrk 4.IIeetrieal Inspeelnr S.Phunbing Emspecfmr 6.O•ther Contact Person: Thom it: ormAtion and instructions aSS-, eft G&O=aILaws aVbz M reggaes an enq:jU=to provide WMI=D.=33peasatiol forfhe=empIo3'ces. pmsu fa.this sue, � '�is drfined as`.every peascia in the service of muyffi Q miler any coact of h caress ar implied Dial orwif� . An erz�sFvy�is defined as`zaa 4idnal,gam,asso���Pm�Om or affim legal entity,or any two of mo¢e 1 acdmc�g the Iegal=P= of a drreased e�player,Or the oft m a Dim mploying euiplopees. Ilawevez$ie recegver or trusCee of an mavidaal,g asso or othesI may, own=of a.dwelrnzghousehavmgnotmorethanti¢ee spmtmeats mad who x dos the occopaMt ofthe- dwulrmg house of an�cr who��Pam=to do m carman.or repair work an sash dwePmg house � mg agpratroanfff=e D shaIlnotbmm=of surh employmenfbc dcemedto bean rmplcryrm" or an.the gvunds , MGL chapter 152,§25C(6)also sf s t aeverystate ar IDcal ricensrag ageacy shalE wifi�hoId ffie iQ¢aac�or renewal of a Iicease ar permit to operate a business or to construct buildings in fhe conunoawe21t3i for any applicanf mho has not praduCed acrZptable eviamcm of cd=PUxnm WKEL thr-kmrance covexmge regnfred- Adadonally,MM chapter 152,§25C('1)shdr-s-Nmi m the coa=®[wmM nor imyy ofits paIilical svb&isioms shall eft mto any contract far the perms an-zd ofpnblic wok m evidence of cmnpliancewith the insm�-ance. req==enis of this have berm pns�d to the odY APPI?cants � � e, edsaiion affidavit compleinly,by g the bates�t apply to Y� if fiIl o the wad'rAmp es c s aI with their certifi�s)of s)name(s), address( ) Phi ��� ne�ssazY,�PPI3' �i6ino e�InyeLs other�th.e insmrancc. LiaiitedLia. dMty Companies(LLC')or LinrifEdLiabTrtp`P�h�gs.(�) me bb=or p are not rbquirEd to cmIy wMJ=7e caxrpcusaf=mSDZ=Ge_ JE an LLC-or LL2 does have employees,a.policy is req�ed. Be advised affidayitmaybe smhmi, t?the Deparfinerit of Indn- a1 of;ncm�n coverage. AIsa be sin a to sigu and datethe aft Thu afhda'vk should Aceid=t for co�mati notfheDepaltm�of " be retnmed to$eY or Town the tizc app lication for the permit or&cease is being requested, SbanIdyon bay anY 4nrs'h�s rcg�tfie law or Zf yoII�r��in obtain.a�voz�s' c�pea mffi,",pofiey,please raIItb�Depat�e�atfhennmbrrlisfEdbelaQs* pelf- a�ames sbonId en riheit self-iasmrance Hcrose nmmbm on the hue_ City.or Town OM dais t ih�the affidavit is�Ie�a andF�Ieg' mly. The Depntme Chas pro4ided a ce spa at thcboti� Please be sate has{��tYo� g�appfi� of the affidavitfor youin im outinrho eve±the Office _ Pleasebesm-eiDfMinthoper/n icm=mrnberwhichwMbevsedasarefrsemccx=bcr Iu- mlzppv"cant that must mbn�multiple p=MWHC se apPaSfidns is a¢y given y�need o�Y��¢me affidavit g eat policy��atiaa Cif n�a<y)and under-Toil�A-ddr m&*the applicant should v;zip�aII Ioca�-ems in (�3' town):'A copy of the-affidavittI athas bem offi izjly stamped ar n�dbpthe ciY m t �Y be provide d ta� applicant as proof that a valid affidavit is on file for B:tm pmmij m'h=sm- A n w be filled Din each year."Where a.home owaer or ciii=is obt imng a.H= se or pamitnotirlatzdto anybusmrss or commmzIa v�nz (ie_a dog license orpcunk to,bum etc-)said pegso n is NOT r ed to�mP this affidavit Tb-m Ofa=ofTnv woBIdlilm to thank you is advances far your coapeariori and sbovldyoa have any gaEstlons, Please,do not htsi in give,us a call i The gepartmrmYs atidirss,trle�hCme and fin[numrbe� � - . -. ' . Thd Ca=xmWWME of Dcpa�mt of A t MA d11I -TPL.4 61'1-' -4 mt 4-06 Qr 1477 M S&kF F=9 617'27'749 Revised 4-24-07 mas9gaVITM T (elk A - Office of Consumer Affairs and Business Regulation .. _� 10 Park Plaza a aza-'Suite 5170 "Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 168809 Type: Individual Expiration: 4/8/2017 Trll: 263716 PETER A. KIRCHNER PETER KIRCHNER 142 OLD REDTOP RD — - BREWSTER, MA 02631 Update Address and return card.Mark reason for change. SCA 1 0 20M-05111 ` Address Renewal LJ Employment i! Lost Card ' ��e`�cin�nrniaea�/�r`'C-/�tiurcc�rt�ef/1 - _�—' ---• " _ _ -- -.Office of Consumer Affairs&Business Regulation License or registration valid for individul use only IrfOME IMPROVEMENT CONTRACTOR m ~ expiration date. If found return to: before the G� - registration: 1ggg09 Type: Office of Consumer Affairs and Business Regulation ,F- xpiration:' 4/8/2017.- Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 PETER A.KIRCHNER.'" PETER KIRCHNER 142 OLD REDTOP RD BREWSTER,MA 02631 Undersecreta ry Not val0 id without signature Massachusetts Department o'Public Safe- j� LY Board of Building Regulations and Standards License: CS-076441 !_OnSirUC iC:,.. Suntris0i .{ + .. PETER A KIRCHNER 142 OLD REDTOP ROAD BREWSTER MA 02631 ? i com, missionec 12/06/2017 Town of Barnstable Regulatory Services s,M Richard V.sal;,Director Building Division Paul Roma,Building Commissioner 200 Main Street,Hyamis,MA 02601 www.town.barustable ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Coinplete and Sign This Section If Using A Builder G(/ !�� �`7 �-,as Owner of the subject property hereby authorize G k t, -to act on my behalf, . in all matters relative to work authorized by this but7ding permit application for. Z o &fk, ,sA,rC TR •c,/ � (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted (i(. o Signature of Owner t=e of Applicant - Z4/Z 11 6pa, �0. �Gh��r Print Name Print Name -� 3J -� Date Q Foxlvrs:owNERPERMIMONPoors -orn:Central Fax Fax:(877)816-2156 To:'1 508 7 906230@rcfax.c Fax: (508)790-6230 Page 2 of 2 02/102017 9:13 AM Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrYYM 1 02/142017 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(les)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 NAME:NTACT Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC LAIC, o Ext: (508)398-7980 AIc No): ADDRESS: mail@rogersgray.com 434 ROUTE 134 INSURER(S)AFFORDING COVERAGE NAICI SOUTH DENNIS MA 02660 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: KIRCHNER BUILDING& REMODELING INC INSURERC: INSURER D: 142 OLD REDTOP ROAD INSURERS: BR EWSTER MA 02631 INSURER F: COVERAGES CERTIFICATE NUMBER: 126809 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. VTR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS S POLICY NUMBER MMIDDM'YY MMIDDNYY WGENI'L MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADEFD OCCUR PREMISES Ea occurrence $ MED EXP(Artydnye�person) 8 N/A PERSONAL&.ADV INJURY $� g ,y � GREGATE LIMIT APPLIES PER: GENERAL AGGRE4GATE ,$,� POLICY JR LOC PRODUCTS COMP/OP AGG `$ C OTHER: C AUTOMOBILE LIABILITY Ea accident $ .� ANY AUTO BODILY INJURY(�er person) Z ALL OWNED SCHEDULED N/A BODILY INJURY(;Per accident) $ --i AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY L)AM.JUt: AUTOS Per accident $ C" FN UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER PER AND EMPLOYERS'LIABILITY TH- ANYPROPRIETOR/PARTNER/EXECUTI VE Y I N E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? WA NIA NA WC231S381509037 01/122017 01/122018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace Is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwdtworkers-compensationlnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWrI Of Barnstable BUlding Dept. ACCORDANCEWITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE !� I Hyannis MA 02601 —Daniel'" C M.Cr* y,CPCU,Vice President—Residual Market—WCRI BMA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable Permit: ca<> Regulatory Services ate: I z,�ZG�, oFTKEr Thomas F.Ceiler,Director Building Division Fee: 8AF0WABM Tom Perry, Building Commissioner 1639. �� 200 Main Street, .Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF ARNSTABLE SOLID FUEL STOVE PERMIT Owner: 01 l/Ikj,2f1 &6 y 1 Phone: 3 d o� Z (o I - iff Install at: A)V l L Village: ZV L Map/Parcel: lozizf4ao 6 Date:_ Stov A. Ne /Used B. Type: adiant Circulating _ C. Manufacturer: Lab. D. Model No.: Chimney A. New xl,stin If existing,please note date of last cleaning B. Flue Size C. Are other appliances attached to Flue? A) D. Pre-fab Type and Manufacturer E. Masonry: ine nlined Hearth A. Materials: � �= B. Sub Floor Construction: Installer Name: Address: Phone: Location of Installation: H.I.0 Registration# Construction Sppervisor# OR check_Homeowner Installing,no license required APPLICANTS SIGNATURE APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 CI f r The Commonwealth of tfassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information ` > Please Print Legibly Name(Bus inesslOrganizati6djivid;11): (T� V 2. Address:- 1-5-3 Ak- S L. /�� I l t lil CA ( l City/State/Zip: /, 4/� -4 C �4/_L Phone-#: Are you an employer?Check the appropriate bor. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a We proprietor or partner-' listed on the-attached sheet T. ❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition workingfor me m an capacity. employees and have workers' Y P tY• t 9. ❑Building addition [No workers'•comp..insurance COMP.��aCe required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.gI am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself(No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.)t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required] *Any applicant.that checks box#1 must also till out the section below showing their workers'cornpensition policy inhmnation.• t Homeowners who submit this affidavit indicating 1hey are doing all work and than Lire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-conlractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of erimirial penalties of a fine tip to$1,500.00 and/or,one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the*Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p and p 11W. of perjuq that the information provided above is true and correct Si tune: Date: Phone M 3 Offuial use.only. Do not write In this area,tb be conTidid 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: Town of Barnstable „�. o Regulatory Services Thomas F. Geiler,Director Mass . Building Division PrCeD a Tom Perry,Building Commissioner 200 Main-Street,. Hyannis,MA 02601. www.town.barnstable.ma.us Office: S08-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: _ / —/ 6 j JOB LOCATION: �� d ( �-� (.� number street ` village "HOMEOWNER': Cv<I f( 6{1,c,1 �CL2 I y1k ! ,vJ name p� hoe- me phone# work phone# J? �Y/1�V 7 S CURRENT MAILING ADDRESS: � 4e K J ( \ 2 ( J s f 0-2-6 � . city/tnwo state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFAtMON OF HOMEOWNER Persons)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 constrycts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Section ID9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such wofk,that such Homeowner shall act as supervisor." Many homcowncrs who use this exemption arc unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware;of his/her responsibilities,many communities rtquirc,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homccxcmpt I r u r•..e f 1 ozHErati Town of Barnstable ` Regulatory Services • atixxsreatg, uaes. g Thomas F. Geiler,Director fn�16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us a Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION I i pFn,F Town of Barnstable *Permit# o7d� r76/d 7F p� Expires 6 months from issue drr:r sTAB �' Regulatory Services Fee M^ �' Thomas F.Geiler,Director - / 1,07 Building Division Tom Perry,CBO, Building Commissioner 1 0-7 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - R.ESIDENTIAL ONLY ,p Not Valid without Red X-Press Imprint Map/parcel Number Q 1 01 (o Property Address 2 0 Es-1 r K s h I Y.e— oResidential Value of Work ID000 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address � 04 Contractor's Name �� ,� Telephone Num�.:r� _(4 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Q ZJ4 3 a Workrtian's Comp ensation Insurance Check one: 1'''�I am a sole proprietor -P ER IT t1-1 I am the Homeowner ( I have Worker's Compensation Insurance MAR ® 9 2007 Insurance Company Name /►-' ve 1-er( /SASTOWN OF N TA BLE rkman's Comp.Policy# 03 0Q.15 b to y /mod (a py of Insurance Compliance Certificate must be on file. eetmit Request(check box) M•-Re-roof(stripping old shingles) All construction debris will be taken to {�^ lj0 t `I ❑Re-roof(not stripping. Going over existing layers of roof) . ❑ Re-side f..) I.-. ❑ Replacement Windows. U-Value (maximum.44) Lr rM *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.E i istoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 i The Commonwealth of Massachusetts Department of Industrial Accidents 1 Office of Investigations 600 Washington Street nnrr f Boston,MA 02111 ,r 3� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -� Address: 1 o a � 92 I h ST_ City/State/Zip: ©S-\erry e f\R 01(a S&one#: !Sf)a-y 2-&- ( [1-] Are you an employer?Check the appropriate box: Type of project(required): I am a employer with 12 4. ❑ 1 am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no I �Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I Y-a t/e,2(' S S Policy#or Self-ins.Lic.#: y 9j ( 4 A-O(p Expion Date: 0 0_7 61e Job Site Address:I20 r �hlre t'r,(l 11 �GC C NCity/State/Zip: F} d2 (sL� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct Signature:, Date: 1 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.Plumbing Inspector 6.Other Contact Person: Phone#• i Town of Barnstable i Regulatory Services fARNStABLE, v aUss �* Thomas F. Geiler,Director '''E�►�i' Building Division. Tom Perry, Building Commissioner 200 Main Strcct, liyannis,MA b2601 www.town.b arnstable.ma.us ffice: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Coinplete and Sign This Section If Using ABuilder as Owner of the subject• J Property hereby authorize C� ,fJ,�� j S 0, S to act on my behalf, in all matters relative to work authorized bythis building permit application for. 4� C- (Address of jot)) Signature of Owner Date LC H,Print Name — Q:FORMs:oWNERPERMISsION .% & Board of Building Regulati ns and Standards One Ashburton Place - Room 1.301 Boston. Massachusetts 02108 Home Improvement Contractor Registration. Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS', INC. ' Paul Cazeault 1031 MAIN ST _-..-_.....___.. .. OSTERVILLE, MA 02658 Update Address and return card. Mark reason for change. Q Address ❑ Renewal I.. I Employment ; .1 Lost Card DPS-CA1 a., 5OM-05/06-PC8490 rpm ✓11e -lJan"J-1,"wreath o�✓�aaaac�%�raella (Board of Building Regulations and Standards License or registration valid for individul use only — -_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration::;103714 Board of Building Regulations and Standards Expiration:'.`7/912008 One Ashburton Place Rm 1301 Boston,Ma.02108 ;Y.. Private Corporation PAUL J.CAZEAULT.B!SONS,;INC: Paul Cazeault - 1031 MAIN ST OSTERVILLE, MA 02658`"` F`' Deputy Administrator Not valid without signature Board of Building eqquiations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007. Restricted To: 00 PAUL J CAZEAULT ,.. 1031 MAIN ST s OSTERVILLE, MA 02655 Tr. no: 7696.0 Keep top for receipt and change of address notification.. DPS-CAI 0 SOM-04105-PC8698 j ✓1. &mincoouueax O�✓l�CQ06aC/LUQC�6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS. 026325 j• Birtrdate:.10/20/1959 `Expires:'10/20/2007 Tr. no: 7696.0 Restricted:-0 O PAUL J CAZEAULT``;? .'•;`,.- 1031 MAIN ST 1CTrr'Irn I f�,+n mr�� c7)� 4A: p , �li c a» is PRODUCER •THIS C7dRTIFICAT'E-IS,{SSUED .AS,A~i2:ATTER.rJF INi-Lrtiwrcty►u� : DO(YLING 6 o NEIL INS AGc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE: 22i.Y:1;ST:11F,IlJ .STi�ucT. HOLDER. THI^i CERTIFICATE DOES NOT AMEND EXTEW-1011 `PO-IiO:{ 1990 ALTER THE COVERAGEAFFORDEI2 BY THE POUCIE`(i flEL i1W_. .HYANNIS t•iA 02601 COMPANIES AFFORDING COVERAGE 2 2,LGR' Ci dJRA\L A TII.AVF[..KIiS PROPERTY CASUALTY COMPANY OF' At4k',Ii.[CA INSURED ' - COMPANY PAUL J CA'LL''AULT 6 SONS INC. B 1031 t1A,IN STREET OSTERVILLF, MA•02655 COMPANY C COMPANY `.iGOVEAGES"`"•>�; e..� :a•;, p . a.. n 1.h• ..A:.. oz'2 :":. THIS IS'To C o- ETiTi THAT 7}( ' E POLICI ES OF >ra INSURANCE LI TED'+BELOW HAVE'BEEN IS$ ED�TO'THE+'INSURED NAMED'ADOV-FbF (;:INDICATED, NOTVlITHSTANDING ANY REOUIREtdEhrT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT YJITHERESPCCT O WNICIERtHOIU t;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 HEEN REDUCE DBY PAID CCAIMS: ' VILITY OF INSURANCE =POLICYEFFECTIVE POLICY EXPIRATION POLICY NUMBERLIMITS Y) . UATE(MMUU\YY).. GENCIIALAGGIIEGAIE $ OAL GENERALUAIJOIYUUU1':. s 'AIMS MADE a OCCUR. PERSdNAI-6 ADV.IN.1"ITY y OWNE•R'S A i ON1F(A(;TOHla Rol.• FACII OCCURRGNGC IRE DAMAGE(Any one li,c) y AUTOMOBILE LIABILITYMED,.EXPENSE.(Any on"person) y, ANY AUI0 COMOINED SINGLE - y LIMIT ALL OWNED AUTOS SCHEDULED AUTOS UQP16Y INJURY (Per Person) 3 IIIRED AUTOS BODILY INJURY NON-OWNED AUTOS- ; (Per Accident) PROF[RTY DAMAGE y •` GA RAGE UABIUTY• ' 'AIJTO ONLY:EAArf;OLNt' y' ANY AUTO'' 01K.11 THAN AUTO ONI:Y: LACII ACCIUEN[. y . AGGII@GALE EXCESS UABIUTY y UM.DRELLA FORM FJ(Cll OCCIIRRFNCE . y AGGIIEGAIE ; OTHFR THAN UMUHELIA FORM A WORKER'S COMPENSATION AND - EMP.LOYEFASUAD1uTY. (LID-0095B64-A-06) 08-10-06 08-10-07 STATUTORYLUITS 'THE PROPRIETOR/ EACH ACCIDENT PARTNERSIEXECUTIVE INCL OFFICERSIVIE: EXCL DISEASE-POLICYLUMI'f y DISEASF-EACH EMPI.OYFF100.on g 1 Im L D l rT: TfIIS REPLACE, ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING Vic COMP COVE ..:�i;:F1Gq: QL Rir3<:' s,'isiil::•t` : us:i: q:3S3:a. RAGE. sY 7 f ��<. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE , Paul J,CazeaLllt 8 Sons EXPIRATION DATE THEREOF• THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ' Roofing,i:ic. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO ODUGATION OR 1031 Mai.-I Street UADILRY OF AMY'k3NB UPuNTNCCOMVA lo,RS,AGEMiS-ORRWkLS(a&TIUGS. Ostervillc;, MA 02655 AUTHORIZED REPRESENTATIVE '�t�h1Y:$%:a•i 4�nf'Z3e$.•y43. >::oa3;?:' :i:g'.ka'.i•;<: �T;i:. :.t.; ::r:t: ......... ..>v' ' ...Y..:: ....,»..:)•;•,,...,..:`.2.,0. ., .....v.:nv:i.. >:2%; :.:. .. ........... Client#:19989 2CAZEAU LTPA ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MMI D""''") " PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 222 West Main St.PO BOX 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 106 Hyannis,MA 02601 INSURED INSURERS AFFORDING COVERAGE N/'C# Paul J.Cazeault$Sons Roofinci. "1C. INSURER A: Western World 1031 Main Street INSURER B: Osterville,MA 02655 INSURERC: INSURER D: _COVERAGES INSURER E: - THE POLICIES OF INSURANCE LISTED BELOW HAVE m", N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLK PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CO'ITRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T. ',CERTIFICATE MAY BE ISSUED Of: MAY PERTAIN,THE INSURANCE AFFORDED BY THE P',:.ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <CLUSIONS AND CONDITIONS OF SUCH- POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BL•L:N REDUCED BY PAID CLAIMS. mm— LTR NSR TYPE OF INSURANCE T'-'ICY NUMBER UCI YMy�pp�E PDATE MPpDm'.DAT LIMITS A GENERAL LIABILITY NP010 i'-391 04/30/06 04/30/07 •EACH OCCURRENCE $1 QO(?OOO' X COMMERCIAL GENERAL LIABILITY 'F7 GEg RENTED $50 000 CLAIMS MADE a OCCUR BI/PD Ded:1,000 'AHED EXP(Any one person) $2 rj0(? X • PERSONAL&ADV INJURY $1 00(!OOO 7-1 GEN'L AGGRE<;ATE LIMB GENERAL AGGREGATE APPLIES PER: $200f:-• 000 POLICY P� LOC ' ODUCTS-COMPIOP AGG $1 OOU 000 AUTOMOBILE LIABILITY - ANY AUTO 'I OMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS .(tODILY INJURY $ (Per person) HIRED AUTOS -.. NON-OWNED AUTOS `tODILY INJURY $ .,accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTI Jt THAN EA ACC $ AU;)ONLY: AGG $ EXCESS(UMBRELLA UABIUTY .. :::4— EAcn OCCURRENCE $ OCCUR ❑CLAIMS MADE ' AG* REGATE $ RDEDUCTIBLE RETENTION. $ WORKERS COMPENSATION AND - $ WC STATU- OTH- EMPLOYERS'UABILIi'Y ANY PROPRIETOR/PARTNERIEXECUTIVE ,J1CH ACCIDENT, $ OFFICER/MEMBER EXCLUDED? If yes,describe under 1: DISEASE-FA EMPLOYEE $ SPECIAL PROVISIONS below - OTHER - E DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate of insurance will be issued directly by the insurance carrier. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED P.,LICIES BE CANCELLED BEFORE THE EXPIRATION Informational purposes only DATE THEREOF,THE ISSUING INSURER W11 t.ENDEAVOR TO MAIL ' In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAI'I D TO THE LEFT,BUT FAILURE TO DO SID SHALL • IMPOSE NO OBLIGATION OR LIABILITY OF. :Y KIND UPON THE INSURER,ITS.,,GENTS OR / REPRESEN7 AT[VES. AUTHORIZLJ REPRESENTATIVE ACORD 25(2001/O8)1 Of 2 #42866 LS' 0 ACORD CORD,- ATION 1988 _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-� Parcel Permit# l _ Health Division , +a —a-7 q S/41C Date Issued Conservation Division h216 Application Fee Tax Cdllector Permit Fee Treasurer Planning Dept. j r Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ' Village Owner (VI c.c,[14 m �Cc'e 01ge Address 120 Telephone Permit Request ZV?W 427 xT&!a,60/2 D&61<' Square feet: 1st 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 ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new c� Total Room Count(not including baths): existing new First Floor Room Co Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coaPs ,Z— ❑Y,s Q No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existi ig ❑new sizeD Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: CD M Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 1zhIL"fa-i11 r. ���5/1?D/LD ��/L Telephone Number AddressC2 6�O �p7'�y/ License# 025 © 1X9302— �Te/d!.) O Home Improvement Contractor# /,Mt5_.3 Worker's Compensation# p ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A$�S SIGNATURE DATE Z— 0 3 T FOR OFFICIAL USE ONLY e ' PERMIT NO'. - DATE ISSUED MAP/PARCEL NO. a ADDRESS VILLAGE OWNER k ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE 1. ELECTRICAL: ROUGH FINAL l E PLUMBING: ROUGH FINAL r _ GAS: ROUGH FINAL. FINAL.BUILDING °DATE.CLOSED OUT` ASSOCIATION PLAN NO. ` r _ The Commonwealth of Massachusetts Department of Industrial Accidents Office 01/nresti9atioffs 600 Washington Street y Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit name:f� L/f� /' /-� • location: city hone# bea homeowner performing all work myself. a sole proprietor and have no one working in any capacity _ [] I_am an employer providing workers' compensation for my employees working on this job � .{• Y3r�eu •ya d'�.'..r,j,F •,,,�. r.� '4 2. -t.}y'st'�lc•t: , w; ,i �,, 15:x'T•,*4 � `Y. Ley` ;'e4K�s •�'as Men-151 77�t ` `r-r'y" '`s �r . tf� � 1r� k 's'Y v Mr , ��u,$�••ri JF`.+."�:`it t.•+,,.t"? �.v4R2d1r�asJgNrd•,�,w. '�rY`.tL `ir^t ads�eNe;� {. 1" c},"ti5 t Yrc 4`'�l:L-,tPr^4 *tr'x7jtsitrF�` :. f 'ze; '" S7 }•`jc7+,l� r�R?tit',r�� a 'a � sP. .+r`� f�v.`i Hz� rtf7 �F3fi .+v-', J"i LJh: .�,� t s�r s,y� ,ti,"P.}ty- -4,,�, ''R7k e+� 4i�tTa�l c�i`�ir s�"�y">•i, - t .BdfI�1'eSS�s.b � ' s�'t �iw.Y[�.�ye—Sr '`H„t• 4} Y'r't'•.xr o t rt 4rW +-,-. to$�a .+4..`rk ..u.J6'�n+ ...3�. -kl .: 'N' y,r 1 tk I°4P>-+ r^C'..Lc 4`Lt .r<'tJ�'ai. ram+ �a _�''�tt'Yt�-c r•cdy .J ��,?�t#, S:P[�+L Yam( ,F• { "tLI 'rt r r1 t• f !s� �A?..�1J_ .w ,�x; -r•tra ,r^ t r Kti ,S t ems, �..s.F�"a- rt�;•; --�.rapi- .f•....tf,-� "�.?y�i .�""�.. 'L' ¢ �� A.R}, ��.,.�i r. . ,f-�rt,;4R.i Y,y°4• {� Y'�,�a�t'�t,':f1`•H.' :k^s-.'�'L�S�.4� iY^'� {f' 105UC" rC�� ,t '� � J ��� �ti--,�. ��t'T�n_t��F Lt}��'t t'r9s5 ' S,R1'tP r• ri a'� �'•'�'}u , '�C jx. "��L�_.,j :"..._ 8nCCC0� �A` h�'�I h gnat=,yr •;G,�� s� trt n + alI" 'a{��•Lwai(.+�di,�a.�.}^�t.3!e.:_..F.i. (] 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 9"P""G'p�--mt' �t s • ,h•*e "" �",a'�' ''',^t"e-'"� £'t• Fes'^#_ y:7t.'.,,tF1+.y 4.�:`.•,Ik1.' ".::lr t•Fn U-i"'.{.l y�."}�.%'YSMt�ry �t.. �ly...i'i4.t-�r' 4'4 ,t�.r ty�*�f'T'yvirlF �`Y ?l+c+? fir5�ti:r"'yw1P Aty �n•F..ts:`Xarc, a ,. ". 4j.;;Yy'"^i'iY..qr..+'��X 4 "�5�y,JN ,l.�y' w({4L' -4 `vl{P4-ritti't�� Vt�N'6 5'4 Sr4'•,-P .:br �ij�� 6a �r. 3Y 4� GG ty't9tk `.�1`a��8•�:. b C�..u7� •�4. 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YC'O�PaHYYna.mer-�- 3`tf�',§t�c`a.�•is tc •,. •. '�" a } v e 5 t , r w r pz t�...3 ��-°S'�, � � ra.. '+.,bX;.. Y,s •"4ac �F;+s-.,�ny� !'k U.k{..5"! w�y,4"`�.."' , y�S.�t x. "�.f 3��li,`td- ��,•_. �sf i�ai'ru j L^,r r} `� �<,�fi _�t: 'a�!'y,t•��.r1rtT .;,�'c-'�: �•. � •,w ���' p��5y t� f 9*��%i r• � R •+; }�,� 4•" s rrF, �, •,,� ,,,x� ;�ibxyy r � �^� ,. ,,rosy Y-c, �Qr'aP G,. §p�y�� 3,__,� t �rFY 'Jd ..�..t��-q,;t rl��`4r F7.:5'k,e�'� ;9`�4��,,,j7'F� r'��'•�cJY'�{yf+*G r���`rs�4 ..r, :✓�t� Y 'Rw u ��+� ec-4• :)x`K` �5'4•d'� -r�1y�.Sr t^i'v(u e?t s � ,�s,`-T t ,.:, fla'�IG�39. �� ��S�F??LZ + xazS f t.. �v.. "�. Y...• .T tr` Sla' +IS- s. K w--tLh�fx' .S 4;j.,+t"' ',tt'r'h-*�y, r '' "`�i„-•�L,-��rit�Y.ar'! .t�i„x.sX;>5�,se.�� 4ga"r'��, n , �"� Ss`,�• �l f s�• � �j`'Y 7 3. �q z°! � �'•��r�' ; '� J '! I f'�,� [�ey TY `Yy'l}l� 'SeR'4•� 4+t� r��"..�S d•'y <f�t !. ,�c+ N d + � Nr!-E„f �r ar'';�x'L' 1 { , r"?"y'73 ,� itii is }� �.. is ,�"�'� J• '}� �..6 �'S. a �t( �'r>.�,Y. s'ty�� � r t �} ti l r6. ,.r,; � �: Ph�n.�� � i � �:- •iY? �1.:�.§t+��1�r. ���� ..y.� IY f'ldi '7- a W Y�.••N+r }�'tri�� 1 wS .,T.-a�' S ''' t c 'gJ�•H1 Y`y,� +r.i' Isi r iv-+.r} !t�?rt�µY'; y*�v i ti+ea,{p�'F�`v a 5!£vi,y Tr�ris,T;• h"' `:�'yr t n !F?iu..t.. 4,yY Br`t +e�..�h -•c*1?+T`r' " �J�.-F`�r _•i•' •,1. �t X r r aN.1C }.: Y'c,:•r t t t,.F�t r .�L'(q(yyy .�A' `i S l,y� 4 j r L 4'ri. ;q.i• '�".�- - ",i{..; ��` �t•--..�kk �i. t �•�fi Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition o[criminal penalties of a fine up to 51,500 00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and Penalties of per' that the information provided above is true and correct ,,Signature Date Print name f /G.L/f�M !�- �[/P- �2— Phone# �- official use only do not write in this area to be completed by city or town official city or town: permit/license# MBuilding Department ❑Licensing Board []check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; FlOther I (revised 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the-"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter.have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you.have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out.in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 i `oFIME, Town of Barnstable Regulatory Services Thomas F.Geiler,Director WAS& 9`�PTf0;9.�p`°� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. y ` Type.of Work: �,b![� G� Estimated Colt ov e Address of Work:Z'AGS,Q��'ht Owner's Name: Ll / C Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit. Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMYROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the er: Date Contractor Nam Registration No. OR Date Owner's Name �oF,►,Er°,,� Town of Barnstable Regulatory Services •+ SnxtvAs& = Thomas F.Geiler,Director 9 MA$S �' f 039. �0 Building Division AlED MA'S A Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A Builder I, G( l�) ���?,j� , as Owner of the subject property hereby authorize L L/ yyf �PSIIrI�� to act on my behalf, in all matters relative to work authorized bythis building pemit application for(address of job) - 0-3 Signature of Owner Date Print Name <41 • �.- . _. , - .�1 e.�Q,�„�.,,,�uea� �,/�aeaac�u�ae� Boaid of Building Regulations and Standards { ul HOME.IMPI2,OVEMENT CONTRACTOR Regi_strat"(o `1:38536 —� 012005 ` `4it.? !. S Ig'a lvidual DEWILLIAM F. SMO.4 I ° WILLIAM DESMOhi 280 COTUIT RD. =� ` SAN'DW ICH,MA 02563 Administrator _Y, i.� fie�anzmectiuvea�k.. BOAF3D`w BUILDING REPERVISAF! License: OONSTRUC710W S>1 .= = L Numtier 042302 date /" 949 r Tr.no: `2176. WILL PAM F DESOR 4 LEON ST A and nist�ato� . C�tR�IER, MA 0233 "` 9 1 10 \ � l-�T C� 1, � . 0 4--,s�A ; S4ACOLID 4- :1_.L7 ��: ►'r �'�i p��5�. "� �'RiE:�� ' . '1R� 11 Q� � �� �_,�_1 `t tit=. �L4v�1� ��•. 1�( �,b.lt�..tl��.:��: ; IA;.. ; �� 1�.1�'�S?t�,�,.t•�c,�•t, t ��ll�lt� �.�.41t�,�':�r�: �y,, , • ��.:?! ���-J� 1 �JII���'1��F1�.� �i', .��7`�1L1 ..�I f.'•Y��..i��•1.1�'`�, ''r,.�l ��I•.i�9,�� 1 1"`.a^e-''`�1�r-." . t-1a1�u '�U�'�J.�.�-����er,�; .�'1�1s,���:j`I�FI�_��.1f'�°sa .�,���tr:"�`����j���, r�`�'���`• t'� — �U` (IJ I�i`.�,�+•:�)��•t1��..�.:�1 pia z,:,1,�;i�IC:�1`��. 12• . to it(.tY7a$''1':r'•! ;,; .) � I �o Coc C, IN All 09 �n co z ,.l 1 0 N P �. N . y C' <3 I� x N Q k � �� N 57 3 Ll Aj �� I Application to gP BEN yf+NPP'�PHS Old King's Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATION OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings,or photo- graphs accompanying this application. p TYPE OR PRINT LEGIBLY DATE �'Z ADDRESS OF PROPOSED WORK /2-0 /3E'R�sh/� f 17-fi L ASSESSORS MAP NO. ..� OWNER In ASSESSORS LOT NO, ©� HOME ADDRESS /f I c TEL. NO. AGENT OR CONTRACTOR _L�//LLl�iil9 �)Iys%'I�fZ/� f ADDR'ESS�=IFO 6AU1 eJ2 �LL!/dlJll9lUl pa,�� TEL. NO. . This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. [� (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and, if an addition Is involved, show• ing location of existing building. J /1 O v Sec,/ 3 _ C J\ec I s s i d SIGNED Space below line for Committee use. Own er•Contractor-Agent Received by H.D.C. The Certificate is hereby Date Time By Date Approved ❑ The categories of work entitled to exemption are listed on rt,e k—L, .,4.ti:..4,..... 1 SEPTIC SYSTEM MUST,BE Assessor's office(1st Floor): 0 _ ®� INSTALLE®IN ®MPLI Assessor's ma and lot number ll/e > WFTH-TITLE Conservation �--1w aaS�'*-�°1 .ENVIRONMENTAL C A Board of Health(3rd floor): Sewage Permit number io TOWN REGULATI ITULE yo tlYl Engineering Department(3rd floor): i630' House number ! Definitive Plan Approved by Planning Board 7A6 tg19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1: -24 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Construct new house TYPE OF CONSTRUCTION Wood June 1 t9 92 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot ##_20_ Ferkshi re Trai 1 . Wpst. Rarnstahl e Proposed Use Residence Zoning District eEC��C f '� Z Fire District W. Barnstable Name of Owner Holly Rogers Address 1617 Main St . w. Barnstable Name of Builder Thomas O ' Rourke Address 26 Dove Ln. Marstons Mills Name of Architect S . Malone-Johnson Address _ 494 Strawberry Hill Rd . Centerville Number of Rooms 5 Foundation Concrete - poured Exterior White Cedar Shingles Roofing Asphalt Shingles Floors Wood / Vinyl Interior Sheetrock Heating FHW Plumbing 2 baths Fireplace Yes Approximate Cost $10 0•,0 0 0 . 0 0 /-�S� Area '"�" c�. f t . Diagram of Lot and Building with Dimensions Fee 'Ho uo oV I , 3z s 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 cogstiluction. Name Construction Supervisor's License a ssrr ROGERS, HOLLY No-3 518 9 Permit For 12 Story Single Family Dwelling Location Lot #2 0 , 120 Berkshire Trail -West Barnstable o Owner' 'Holly Rogers Type of Construction Frame Plot Lot a Permit Granted July 9, 19 92 /� Date of Inspection 19 j;.eate Completed �� 19 '7 c� j ' TOWN OF BARNSTABLE, MASSACHUSETTS •• ' lILDING^ FERMI A-109-015.Uu6 i.uly 9~ 92 APPLICANT Thomas U"Rourke DATE 61 Oye Un. ,PMarstons mills 1335178 .ADDRESS 1 (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO _ wild dwelling fl ) STORY Single family dwelling NUMBER OF l (TYPE OF IMPROVEMENT) Np, I DWELLING UNITS (PROPOSED USE) AT (LOCATION) IOC 9 LO 120 Berk••,1ire Trail, West Barnstable ZONING RF (NO.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT: IN'HEIGHT AND SHALL-CONFORM IN CONSTRUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: Sewage .#92-274 (TYPE) AREA BOND OR VOLUME lLd� s4' f ESTIMATED COST $ 100,000 FEE $ 110.75 (CUBIC/SOUARE FEET) U OWNER � Holly ko •er6 '� c;-..y "• I ADDRESS 161/ IIalll Street, West bara.,)L i e,-IRA BY BUILDING DEPT. .I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINS FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT'RELEASE THE APPLICANT FROM THE CONDITIOI OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL -APPROVED PLANS MUST,BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL, -PLUMBING I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I � I v �iCi+"cvG/ G/�V Nov- ? •• S � 3 I HEATING INSPECTION APPROVALS ENGINEER) G DEPARTMENT 66.�a wp► oA a 19 S BOA2Q OF HEALTH •N OTHER SITE PLAN REVIEW APPROVAL Fp 0_ ��A((110��61C4'S7 WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN CONSTRUCTION. [PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTE NOTIFICATION. Application to ' . �P�S�t"M�tE P•IPpN4 • 0PE "E►5 Old Kin 's Highway Regional Historic District omen tee . . g g 5� in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: 2f New Building ❑ Addition ❑ Alteration Indicate type of building: [House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE 03`3IF-C1 a ADDRESS OF PROPOSED WORK L-,t' <�� I�t� `�h��2t` IfC�-J ASSESSORS MAP NO. �Q OWNER 1 `NOLL" �iG1f-1S ASSESSORS LOT NO.I`J '2®60 HOME ADDRESS TEL. NO. 10D -9Llg� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). AGENT OR CONTRACTOR Tam �``�� �`� TEL. NO. ADDRESS " �`t' C.0 - C��S f-MS Pvi, V7 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and prop sed locations of new si ns. (Attach additional sheet,if n cessar ). Ci� a S Y2- Signed l { t Owne ntractor•Agent Space below line for Committee use. , Received by H.D.C. I '., v ur i DaR E C f1 V F D The Certificate is hereby Aa A­3 Date Time MAR B Approved } If Certificate is approved, approval is subject to the 10 day appeal period Disapproved ❑ QKHRHDC provided In the Act. ! I i i •iI I.II I•I I ,III 1IWIIIII�I I . i. !I i r 1i,,jy r I i I ! !' I ., Ij; I il,, 'I I p l � l' •I:, , ''! I,'•i'III� 'I' I I � I I II il,.l 'L!� AIN f!l'I''�IIJ!' I I i ° I ; i. ' ''i iil` I :� � •i ! lll�'� '�• — I i v ' it (,l t.l .�! '!j� � o (. i�ilil it,j• I N I I, '!�I I I I v'I • lil; � ; '! ill �� I i •„art i i i;;i' — �i - _�- Ii" Y '; •I Illii'' '.,jli'II'Li I �I�1 • I � �• �I, II'I it�IIII! I •II, I � 0 � 7 l i !• I j I � �it I, � �. -•8J ..I'�i•.J• I 'Ili. i '!:�I� C � ,� � �-!_ �+ H _F- i ,:I:i,!i i•lil, .ij;.lj!!, I;I!; � 3 i t I i i•�I�,jjn�l lli,„III�Il;i I I'!�I ! � I� fiy. .... I I � ( - j jli'I I, I J . 11 e f i• � I AI— I I ' 1� � I ::: j� . .a3 i 4 I 1� i } I I 1` I F t ���� Y 0 a K R � t g ilia _ iI' - L. J b N W3 i a $ yy vo . d ° y =mod ly i Y M V a °i f j ! Q - a � a tb R 1 1 A 1 S I J s 1 1 i o 1 I V n %K F F Q J 0 o Z I` O y 1 N a av It r �� of 1 i 2aea bv9'�O U.6rt It TW,J 9n,M,yLty 3f,1 fm 30-a3lYMI3U \l -fd llvm nT+�3J-313bTaJ iaa +cy.cr x�n-2,3onn stir, Jfo at.o-n/n nnavam'w.f sora� i o-a-r j i f 1 .. .. . . ,. .��._._._-�.-- y-----�._ .-.-�----._--___..�_-_____.__�___...-_..� ; . ... -. i i i i I - -. - . . .. r ' ,� — .�:c e—� �L - �'i ��-- __ qI _ °°i I O �_ I � ® �' � - •r- w 1-e I ,�_ n 4� I _ I —-- _. I � .0 -: /� _ �� i � w � I v � I —!l I �aanW � —� o �: �, h� �� ,�: Via: I. � �" ;'� - T i � I ; e) � I II u ° � � °—---1 i _� I I ..o-o � I it �� o: i _ — —L�. i I i �� I � ® � I __ -._..—__ __,�Ch 1. (� 1 { t I f �. �. I i 1_.A F ' � r 4 a � d,a'I a E O a S I TM�> TOWN OF BARNSTABLE Permit No. ..........35M ...... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .670•9��+�+` HYANNIS.MASS.02601 Bond x I CERTIFICATE OF USE AND OCCUPANCY Issued to Holly Roder. Address Loy y20, 120 Ber%%hire Tndl ::.:jt Barn table USE GROUP FIRE GRADING OCCUPANCY LOAD i 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. liovtaaber..10! .... 19........ .2.... ........................... .+.1 .. . Building Inspector r 04 8� :z %9 ..!- ar . ,-- Est do,,, • , Ell, 49 w 00 jA tj @ � �1 _'lY\" pis - ;,,1 ..333�. >•T, - � � SE `,qI ����` � ` ,, a ;;: _� �: � � -4 � � � � .•� .� � � a 1, �I --Vv 208w1 2777, ` w: l�) Z'x�►i.t�lfaL� P`-Z� 1T\QgLkN-QQ e f 2b �oW!1 AkL* TkRiL Eki S- � w ELLS o FrMEsOcv Cr=tuaG: I NIGoAi�� KOO-KAl.TILES `J �I RC N E� Zg BU-1 ,t\Q fWD R tiMaD�I IIJCY - 5C�8 --I q 19 Q2 Matn1���T il3�J�: YoxGB ,XISS1��s___rJl.o_h1Zt:tt)�F{ . oN .�Ea�ls 1ce�10t � 1t_� �D&W -4zG..ESS , =ottck,Aand I ► _ � ►, � I J TTI 7 X 2 - --- I - t — � � .A FR f I et IDS! �ER.r=YiS.TifJc �6L �Vv�ffr " ; : L11-1� 1N U RK .� � o .t citkct_� -�tsP +��a' rk I f S , t I_G tii l-T ft e T KEEP �X1STI+tJ-Cr OSL PUNG W-1006I0{ ,. 9 U.N. GAl;rar-YE 000R. rJi=vJ 3e�,�-d� Sa,A�'C Nlt��ua;t� ! ` - �-'-- SCALE: �'// �� AVVROV ED ET: DRAWN BY f 333 _ ----� DATE: REVISED DRA�O NUMBER i j � REVISIONS Eyr .7 C� ELEVATIONSOESIGN CALClJ1.:ATIC?NS ; ,. • SEPTIC SYSTEM INVERT CROSS SECTIOI V .1h FOR A '`� •`B£DRCJOAN HOUSE WITH � :GARBAGE DISPOSAL ; ' PROPOSED TOP 5� DIST. 13OX Ili! � OF FOUNDATION 4b loCvO � DIST. 'BOX OUT' . '0. 4 SEPTIC TAIYK.r X•150 r w = - 51A-T SEPTIC TANK IN LEACHING SYSTEM IN a _ �1 b CV) t�3.�G USE A 1560 GALLON TANK Z.Ti LEACHING P/T/USfNG-Z-6 XP/T iIr/ STONE _ _ ��_n_nJ� l...alz!! r AREA , J L.._. PS5 ` y` INC 0E b C"1VAO K TO SIDEWALL HEIGHT X 2 X TT X RADIUS �` �' _�'E W t K t11_ IL' 'CF• ,: t , . z •� s t x2xrrx 5 FLOW Yi ;54 40 S.F. X GPD1S.F 4 GPD t, 80TTOM: TT(RAD/IUSJ 2 �+ } LOCUS MAP EXIT-" 58.5d SEPTIC TANK OUT LEACHING SYSTEM BOTTOM ..�—..�- : I wy x 3 :. . . 7g•� Ia -1[35 TT S•F X ' GPD/S.r GPD q0 4 S.F. Jr TOTALCZ PIZS� 1 GPD R DESIGN FLOW GPD Pitch 1/4" Per Foot(Min.) RESERVE 345.5 GPD 0 29e GRADE (Min.) _ a • u a � a i 0 --� rr :.. -.._ 2 Cf �' -./ washed stone Q 51-�jP� CJK15.�{ 2 3 Min. 2 MIn. 8 .2 OT 1 2r�Min. ¢� W 4 A, r \ - ,,. r.;.. •+ lb LEVEf6L04_S p _ Liquld DIST 90X Level a, Pitch I/8PerFoot � r�ti �'' (M1n•) < 3GALLON SEPTIC TANK ' qQ o S \�. q� 3 o `.`—I W s a /4 I /2 Q7 0 € 7) '� \ 4, Schedule 40 P.V.C. : , , (� Washed Stone Or Equivalent .`----� NOT TO SCALE LEACHING PIT TYPICAL CROSS-SECTION � ao i 1 fi ,o � oc -- , �. T Q ` r • h cam' w - 5z m 5 A a NOTES � { _ ( �� � kt z - LL ELEVATIONS SHOWN ARE/N FEET ASOVEI Q L , . ' \.._ ACCESS COVERS Of THE SEPTIC SYSTEM tt W ARE TO BE WITHIN 12 OF PRCPOSE'D GRADE, C5 4� b LL. THERE /S TO BE ONE FOOT OF GROUNDCOVER I Lu M w w , . OVER THE;SEPTIC•SYSTEM. � 7P 'tC 6(° CONSTRUCT/ON OF THE SEPT C SY T / ' / SEMSTn Q � . .r w �0' f "CO�c1�,t�TJ �Z `' '� CONFORM O H A m . � T TEST TE SANITARY CODE � (� �I {.tJ Ito r 7ME Y, AND TH46 TOWN OF R CA 1Lij 1z U BOARD OF HEALTH REGULATIONS. m , Q .JO { DESIGN LOADING OF SEPTIC SYSTEM • aw. 4 ; SEPTIC TANK r H— b STRENGTH i +(;7 ��_ . D/ST. BOX H STRENGTH c LEACHING P! •H— 1d T STRENGTH � SOIL TE,5T DATA= • " .. T _ 'FP2pP. 2- G�'x 4' P1'T 5 � ,lO, a DRAWN r r KEY ' .'DXIC t ` ,vq 1 TH S S SIGN RED, x EXISTING ELEVATION 5.56 SCALE ti THER OSSIBLE i OUT scAt.E EXISTING CONTOURS �-� bo RED F'Fk OWN RI G/ s. C E _. 0.1 JOB NO. PROPOSED CONTOURS 410,44 ER , 0 OSED TEST PIT LOCATION DAT .„ SHEET .` .. F 9 sty° a I 1 44.1 t4 ss F STE: _ CATCH BASIN �� WATER FOUND WATER FOU � ti MsJ Ian Ct ,tR TEST MADE . KNC TEST: MADE Ic 25j r WITH 61s2 7N WITH Y APR 1992 DATE ACEt4-r >�4uu .�� PERC. RATE BOARD OF HEALTH "LESS„THAN._._..._ MINUTE PER INCH D P NSTABLE! p - r -