HomeMy WebLinkAbout0210 CAPES TRAIL i
UPC 12543
No. co
NASTINGS,'MN
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FRIEDLINE&CARTER ADJUSTMENT, INC.
436 Mani Street, P. O. Box 338
Hyannis, Massachusetts 02601
Tel. (508) 771-3232
FAX (508) 790-2344
TO: ( �uilding Commissioner or Inspector of Buildings
( ) Board of Health or Board of Selectmen BUILDING DEPT.
( ) Fire Department
AUG 18 2020
TOWN OF BARNSTABLE TOWN OF BARNSTABLE
TOWN HALL
HYANNIS, MA
RE: Insured: WOODS, William
Property Address: 210 Capes Trl
�. West Barnstable, MA 02668
Policy Number: 10636428
Type of Loss: Fire
Date of Loss: 8/4/2020
File#: 134050
Claim has been made involving loss, damage or destruction of the above captioned
property,which may either exceed$1,000.00 or cause Mass. General Laws, Chapter 143,
Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate,
please direct it to the attention of this writer and include a reference to the captioned
insured, location, policy number, date of loss and file number.
On this date, I caused copies'of this notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
B.VALENTINI
Adjuster
8/5/2020
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 0 RD Parcel Oc)P 00 77 Lo-,46 Permit# �0 9 7
Health Division Date Issued 1,R11 le
Conservation Division / Application Fee ,5-0
Tax Collector JPermit Fee 4"60 Q
Treasurer SEPTIC SYSTM MUST BE
Planning Dept. INSTALLED IN COMPLIANCE
WITH TRIE S
Date Definitive Plan Approved by Planning Board ENWRONM WALCODEAND
Historic-OKH Preservation/Hyannis
TOyiAi1IATt4�IS
Project Street Address 210 Ch Pf-5 T M L-
Village
Owner WiLL%AwM 4)nOiD5 Address 21y CAPES --QA►L-
Telephone 508 d 3 to 2- q 4-3(®
Permit Request_ iN6iVzyN !:) ao .A $Z x 8 ` L-silaPEn S��►�nm i �v�- �ao I.—
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 1 Construction Type
Lot Size 4-1, -2 2- S.r Grandfathered: O 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: hll: existing new Half:existing new
4.1
Numberof Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and-Fuel: ❑Gas O Oil ❑Electric O Other
Central Air: O:Yes ❑�No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached-garage.❑existing ❑new size Pool:❑existing O new size Barn:O existing ❑new size
Attached garage:O existing ❑new size Shed:❑existing O new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded O
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
I
BUILDER INFORMATION
Name'%f 1;W%kAAU ►„a.c, POOL SPA CA p Telephone Number -&6
Address +55 I.UAD00ri 11iasii License# 130 G 6 „
�AS 1 F K1I- MV1% Ad cn S i 4 Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO fiA1,u1AoU-rkl boa ;
SIGNATURE DATE �0�1--
! FOR OFFICIAL USE ONLY s
HERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION ®� `� PI L—
t, FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROU*, Z FINAL
f1 GAS:. ROUGE m FINAL _
rc
FINAL BUILDING
�6Np 4
DATE CLOSED OUT S 4 N
T Q
ASSOCIATION PLAN NO.
• (C . J
P
;-\
The Commonwealth of Massachusetts
m; — -' 0 Department of Industrial Accidents
600 Y3'ashin;ton Street
Boston,Mass. 02111
Workers' Co m ensation Insurance Affidavit-General Businesses
LU
name:
address: �' W
city EAr�iT C Aktlti+ ll� state•' zip- 2'�3 t'• phone# 4, 7" 71 0
work site location full address)- i
❑ I am a sole proprietor and have no one Business Type: • Retail❑Restaurant/Bar/Eating Establishment
working in any capacity. ❑Once❑Sales(including Real Estate,Autos etc.)
❑I an em loyer with em ]o es full& art time. El Other
n /O �%///y/%/// r�%G ////%/��%%//%
am an employer providing-Workers' compensation for my employees working on this job.
�r PA:
campanv name r ••6a6,&-:�.:-: ::.:.:
address �3�i •�� ,•
�� � �"`1'�t phone#..'
•: 1 ::'%1!•`� J1,�7r1. �
UY
:.�. O11C. #•-.' � •t...•-„4 r '1: '•
,Snytirance.cb:.: �. :.fib .: �::`_ 4r••
�] I am a sole proprietor and have hired the independent contractors listed below who have the following workers'
compensation polices:
com :en name: :A;A.
;•, 4' hone#.
city:. ..•.:
itisvrance co. r
/
address .
cif-:: .. hone#i
T• :.:
insurance co.' o7tcv#:
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or.
one years'imprisonment as wall as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that g
copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification.
I do hereby ce under thepains a penalties of perjury that the information provided above is true and correct
Date
Signature `
Print name J�Ei� � ' Phone#
.�..���sry`o��.�•,�•c=':ear. _ u �,+�i-�r3ts�eg�''=�'.
r official we only do not write in this area to be completed by city or town official
permit/➢cense# []Building Department
city or town: ❑Licensing Board
Office
❑check if immediate response is required ❑Selectmen's❑ Department
�? Health Department
�i contact person: phone ❑Other
(revered Sept 2003)
��&'�'Zce3��..-- r,:!s+�••9!vaRtC��EY .d'1f"�'• .
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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 representativei 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
e r e
authority. ,
Applicants
Please fill in the workers' compensation affidavit completely,by checldng the box that applies to your situation. Please
supply company name, 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 pernrit/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
UMn of Imstlgafts
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406 -
ISE Tps, Town of Barnstable
Regulatory Services
BARNSTABLE, ' Thomas F.Geiler,Director
crass.
9� s39 6 ��'p,Fn 39. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work:
bcy L. Estimated Cost 110 Q
Address of Work: A n C'A pHS 12411_
Owner's Name:
Date of Application: +
I hereby certify that:
Registration is not required for the following reason(s):
nWork excluded by law
❑Job Under$1,000
❑Building not owner-occupied
❑Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO.NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit a the agent of the er:
ik-1 Q v->0
Date Contractor Name Registration No.
OR
Date Owner's Name
Q:forms:homeaf idav
�t►Er� Town of Barnstable
Regulatory Services
MFUIMABLV. _ Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, liyannis,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, as Owner of the subject property
hereby authorize*6 Sw�r�iff it r�iU� S/1� a/SUP to act on my behalf,
in all matters relative to work authorized by this building permit application for.
c;? 5 T 4/ L
(Address of Job)
! 7C1,�'�-zl � I l- q- o 4-
Signature of Owner Date
1
Print'Name
Q:F0RMS:0WNERPER1vGSSI0N
- . -t o—euw rrc i 11;1 ti fin HLlIENTU 1 NSURME & R. E. FAX NO. 5086730734 P. 01
Dec-19-03 I0'Adim Fran-AIG IT3-319-8203 T-STd P.005/012 F-TIT
PRODUCER, THIS CERTIFICATE IS ISSUE AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Antonia F Aberto imrenc a AWr-Y HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
420 StMrtd Road ALTER THE COVERAGE AFFORDED BY THE POLICIF=S BELOW
Fall River.MA 02721-0000
COMPANIES AFFORDING INSURANCE
COMPANY A GRANITE STATE INSURANCE COMPANY
INSURED
Steve semis
(DBA)The SWimrWmg Pool and SPA Group
411 WagUOit HighwaY
E.Fetmeuth.MA 0253&0000
THIS is yo CERYIFY THAT 7HE POLICIES OF INSURANCE US =D BF19W HAvr;umm 15sUED TO THE INSURED NAMED ABOVE FOR
T)tE POUCY PERIOD INDICATED,NOIT WITMSTANDIND ANY REOUIRZM M,TERM OR CONDITION OF ANY CONTRAGT OR OTHER
DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE IssuFD OR MAY PERTAIN,THE INSURANCE AFFORDED THE
POLICIES DESCRISED HERErN 19 SUBJECT TO ALL THETERMS.EXCLUSIONS AND GONDMONS OF SUCH ROUCtEs.UM1T'S SHOWN
MAY HAVE SEEN REDUCED DY PAID CLAW.
9noyo r U r7vA8eT9 TVNr rw>6rees nouexcs�ssnveDA7tt ►ouei►m�mararoare
M'ITS
mumii ATTOR7Ln
CL 12105/204 -
;1. .
-
A00i
App9om ro Not Opwattom ONY• ACCIDCNTI��raY UWpto„ 10
CRlP7iONOFOPERATTONSIVEHICLt IBPeCiAL it
CERTIFICATE HOLDER CANCELLATION
SIOUID AM OFT HE ARM DE&CMO POUCIED BE CANCELLED 94FOAC 7NR
TOWN OFBARNSTABLE &PtRATTDN DATE nI!RAW.THE lsa>r►3COW NY WILL MI)FAwaroVAL12
307MAIN ST, DAYS wR(TIM NOTICE TOTOC60FICATIZ NO"NAMMEDTOTHELEFr.eUT
HYANNIS,MA. PAt<URETO MAIL SUCH 147ICSsw►u. NOCOUGanouORLUluturrar•
AW KM UVM'nt CONPAVY,ITC AGMM OR FAMESIMATM&
AUTHORCWO REPRESENTATNE
69-
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Application to _p
@It Regional C
Waorit Misstritt Com,, littEi L v ( 0,
In the Town of Barnstable 411l��i[E7200 i
CERTIFICATE OF APPROPRIATENESS 7oVVt4 a
— NIST�R.0
Application is hereby made, with four complete sets, 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: ❑ New ❑ 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: X Fence ❑ Wall ❑ Flagpole ❑ Other
TYPE OR PRINT LEGIBLY:
. DATE
ADDRESS OF PROPOSED WO K Z1O C.dt 4Y� w 9�PfSeEkleOR'S MAP NO.
R
OWNERG '��! ✓ ASSESSOR'S LOT NO. a9 7
LU
HOME ADDRESS _zlQ_?IQ CAP"_5 /ri � � l c:►i�ILg�'o /ALEPHONE NO.
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners cro
public street orway«(Attach additional sheet if ecessary.)
AGENT OR GONTF CTOR TELEPHONE NO.
ADDRESS
DESCRIPTION,OFcPROPOSED WORK: Give particulars of work to be done, including materials to be used. Please
include locatidns of-proposed sict' gns.
< -��Sqlv// , y
LM
.
Signed
4w4ner-Conctor-Agent
For Committee Use Only
This Certificate is hereby Date -
d
e
Co ittee Members' Si/g�natu
Q�if
I
Town of Barnstable
W Old King's Highway Historic District Committee
SPEC SHEET
FOUNDATION
SIDING TYPE COLOR
CHIMNEY TYPE COLOR
~-1
ROOF MATERIAL COLOR d
• ��� SEP 0. 2 2004 ;fir
PITCH w :
WINDOWS COLOR SIZE
TRIM COLOR
DOORS COLORS
SHUTTERS - COLORS
GUTTERS COLORS
DECKS MATERIALS
GARAGE DOORS COLORS
SKYLIGHTS SIZE COLORS
SIGNS COLORS
FENCE4a<
(1l COLOR
NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this
form are required for submittal of an application, along with Four copies of the plot plea, landscape
plan and elevation plans, when applicable.
SPECSHT
Revised 11/98
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William and Lila woods
210 Capes Trail
West Barnstable, Ma 02668
Re: Lot 7 210 Capes Trail West Barnstable Ma 02668 Olds King Highway Submission
Following are the abutters for the above referenced Lot:
Map 88, PCL 8-004 Sean and Kathryn Leaver
39 Desires Lane
West Barnstable Ma 02668
Map 88 PCL 8-8005 Peter and Carrie Nicholson
33 Desires Lane
West Barnstable Ma 02668
Map 88 PCL 8009 Jeffery and Kimberly Sollows
201 Capes Trail
West Barnstable Ma 02668
Map 88 PCL 8008 Richard and Deborah Pizzuto
211 Capes Trail
West Barnstable, Ma 02668
Map 88 PCL 8006 Paul and Jean Boucher( Lot 5Capes Trail)
4862 Bentwood Way
Granite Bay, Ca 95746
!� Sp 0, 2 2004
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` REVISIONS.
NO. DATE OM
S�4L-e
t CERTIFY TO THE HEST OF liY'
�O 1 PROFESSIONAL KNOWLEDGE.WFMMM �
, V p 1 N OE EO i
TOM OF BARNSTABLE ZONING
K REQUIREMENTS.
1 -II,
O Or ,,' �• 1 PROFESSIONAL LAND SURVEYOR DE
93
SK1 ti 2�' �,LOT6
1,922t S.F. Ao
h 1 d
CENMED
89° 1 PLOT PLM
0. 1 Uyr 6
sag* �oD cP�� st• jl CAPE TRAMS
IN
'1
o. oBARNMAME
MASSACHMERS
(BARNSTABLE COUNTY)
�kc, ! l
Am
PREPARED FOR:
h ; Mr do P WOODS
0 BOX 702
*ZmVWEST 082A6R6NB ABLE
r B7,�e
r '- CAPE �.»Group. ,�.
657 Route 28. Unit 6
TRAILS
02673 ormou►h. Mossoehusetts
L r 508 778 fists
J lltt
SCALE- " m 2W
O 23 ! f0 .®
0 to 20 .o .m
T tr c`Tn11l•T�.nC .c ,n/•11TC/1 �►. Tn►tC �` u - --- °
Jlvkm `'`� vvl I SWIM POOL & SPA GROUP
Tile. Q�,•, ckc;b drawing for: _06 A�
FILE 04130248 42'
6 8 8 8 8
2R
2R
4 2
8
81
20' DEEP 29'-8q" 42'-114" 25'-74'
12'
14'
4'_ 6'
18'
8 31'-34" 30'
j 8
2'
40"
4� DEEP
2R
6 8 8 2RR
8
LIN FT 139' 6
2
2R R
2 2
PANEL DESC13JETION LEGACY# ROYAL# QTY
8'PLAIN PANEL 04101 05102 6 8'PLASTIC STEP I
8'SKIMMER PANEL-1085 04102 05104 2
8'RETURN PANEL 04103 05108 3 16'
6'PLAIN PANEL 04106 05112 3
2'PLAIN PANEL
04114 O5161 3 ' IMPERIAL POOLS Q
2'RADIUS CORNER PANEL 04116 05161 5
2'REVERSE RADIUS PANEL 04137 05179 ,1 MANUFACTURING 8 DISTRIBUTION
S o 18S R 07 8S 1 O:1DWG_2004104130248.DWG,10/18/0404:35:06 P
ADJUS ABLE A-TFRAME 0 223 05188 1
=_- -- Board of Building Regula 'ons and Standards
One Ashburton Place - Room 1301
: 1 Boston. Massachusetts 02108
Home Improvement Contractor Registration
Req!istration: 30666
Type: DBA
Expiration: 4/6/2006
The Swim Pool Spa Sale & Ser, MaketGrp
Steven Senna
P.O. Box 3612
E. Falmouth, MA 02536
Update Address and return card.hiark reason for chang
Address �j Renewal Employment Last Card
✓21- 4097r/!&02zWea1111'o1✓l1. "Wludea
Board of Buitdiog Regulations and Standards License or registration valid for individul use only
expiration date. If found return to:
before the eu
HOME IMPROVEMENT CONTRACTOR p
Board of Building Regulations and Standards
Registration: 130666 One Ashburton Place Rm 1301
Expiration* 4162o0S
•may..-ter _ Boston,Ma.02108
Type: DBA
The Swim Pool S[SaSala;h Ser,MaketGrp
Steven Senna .3
435 Waquoit t;%tyE.Falmouth,MA 02536 Administmtor Not valid without signature
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`�;-- TOWN OF BARNSTABLE
CERTIFICATE''OF OCCUPANCT— 'Ji
PARCEL ID 000 000 142 GEOBASE ID
ADDRESS 210 CAPES TRAIL PHONE
WEST BARNSTABLE ZIP -
LOT 6 BLOCK LOT SIZE j
DBA DEVELOPMENT DISTRICT
PERMIT 44442 DESCRIPTION 30 DAY TEMPORARY CERTI ICATE OF OCCUPANCY
PERMIT TYPE BCOO TITLE !CERTIFICATE OF OCCUPAN Y
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES:
'BOND• $.00 THE
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY 1 '''""'' PRIVATE P . E;
T * BARN31'ABLE, •
MASS.
i639.
ED INIr►I A
BUIL G5A P1,WSIGN
DATE ISSUED 03/01/2000 ' EXPIRATION DATE - '-
TOWN OF BARNSTABLE '
111A. 30 DAY TEMPORARY 'OCCUPANCY PfRtfff 4--
PARCEL ID 000 D00, 142 GEOBASE ID
ADDRESS 210 CAPES TkAIL PHONE
WEST BARNSTABLE ZIP -
LOT 6 BLOCK LOT SIZE
DBA :;DEVELOPMENT DISTRICT
PERMIT 44442 DESCRIPTION 30 DAY TEMPORARY CERTIFICATE OF OCCUPANCY
PERMIT TYPE BTCOO TITLE TEMP. OCCUPANCY PERMIT
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES: SINE
BOND $.00
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY 1 PRIVATE PI a ErESTAB
* 039. �� I
• v
.BUILDING DIVISION
BY
DATES ISSUED 03/01/2000 EXPIRATION DATE r •
I � ,
= TOWN OF -BARNSTABLE
BUILDING PERMIT
PARCEL ID 000 000 142 GEOBASE ID
ADDRESS 210 CAPES TRAIL PHONE
WEST BARNSTABLE' ZIP -
.. LOT 6 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT
PERMIT 37215 DESCRIPTION FULL2ST/4BR/4BA/2CAR ATT- (99-1,42)
PERMIT TYPE BUILD TITLE NEW RESIDENTTIAL BLDG PMT
CONTRACTORS: PROPERTY OWNER Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES: $620.00
BOND $.00 CIE
CONSTRUCTION COSTS $200,000.00
101 SINGLE FAM HOME DETACHED 1 PRIVATE P ® aARuvsTAaL& s s
MASS.
�i i639.
BUILD DIVISI
BY
DATE ISSUED 03/22/1999 EXPIRATION DATE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED 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 CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST.BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARCREPT POSTED UNTIL FINAL INSPECTION 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR
ELECTRICAL,PLUMBING AND MFOR
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
ECH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
VISIBLEPOST THIS CARD SO IT IS
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
2 2 doe 2
( co fi
3 1 HEATIN I SPECTION APPROVALS ENGINE ING DEPARTMENT
,Z o2 3 �aod
BOARD OF HEALTH
" l
OTHER: SITE LAN REVIEW APPROVAL
L. >
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION.
ky� 14 Z
TOWN OF BARNSTABLE
CERTIFICATE OF OCCUPANCY
PARCEL ID 000 000 142 GEOBASE ID
ADDRESS 210 CAPES TRAIL PHONE
WEST BARNSTABLE a" ZIP
(LOT 6 BLOCK LOT SIZE
jDBA DEVELOPMENT DISTRICT
i
PERMIT 44442 DESCRIPTION SINGLE FAMILY HOME - BLDG. PMT_ #37215
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES:
THE
(BOND $.00
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY .1 PRIVATE P . FHRNSTABL L,
MASS.
16.9.
FD MI►��
BUILD I B' O
BY
I DATE ISSUED 03/01/2000 EXPIRATION DATE
TOWN OF BARNSTABLE --
CERTIFICATE OF •OCCUPANCY
PARCEL ID 000 000 142 GEOBASE ID
ADDRESS 210 CAPES TRAIL PHONE
WEST BARNSTABLE ZIP -
LOT 6 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT
PERMIT 44442 DESCRIPTION 30 DAY TEMPORARY CERTIFICATE OF OCCUPANCY
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY
I
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES:
BOND _ THE
-00
CONSTRUCTION COSTS_ $.00
�T Qi►
756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P E. ;
* STABLE, ;
MASS.
039.
Ep DA�►l A
I
BUI SION
g I
DATE ISSUED 03/01/2000 EXPIRATION DATE
a TOWN OF BARNSTABLE
BUILDING PERMIT
PARCEL ID 000 000 142 GEOBASE ID
ADDRESS 210 CAPES TRAIL PHONE
WEST BARNSTABLE' ZIP -
. LOT 6 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT
PERMIT 37215 DESCRIPTION FULL2ST/4BR/4BA/2CAR ATT_ (99-142)
PERMIT TYPE BUILD TITLE NEW RESIDENTTIAL BLDG PMT
CONTRACTORS: PROPERTY OWNER Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES: $620.00
BOND $.00
CONSTRUCTION COSTS $200,000.00 �
101 SINGLE FAM HOME DETACHED 1 PRIVATE P 4 aA�vsrAa>�,
MAO&
MIS
BU LD MSTOM
BY
DATE ISSUED 03/22/1999 EXPIRATION DATE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED 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 CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD'KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS.
4.FINAL INSPECTION BEFORE OCCUPANCY.
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
L� 16 11
2 2 'Z/� 3/,�dod 2
��� ��!
( � 1� �°°� Al
3 1 HEATIN I SPECT16N APPROVALS ENdINEFAING DEPARTMENT
O K 2� ;rA8
" l
OTHER: SITE LAN REVIEW APPROVAL
L
WORK SHALL NOT PROCEED UNTIL. PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION.
A(y`I 14 Z
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map P el �S
a- to �� Permit# 3 ��1
Health Division 64 Date Issued
/ �J�" ' I o
Conservation Division �•`�� Ml-*' ' u Fee
Tax Collector ��3,y��� SEo` a tC SYS�'E-JI FOUST BE
INSTALLED IN COMPLIANCE
Treasurer WITH TITLE 5
Planning Dept. ENVIRONMENTAL CODE AND
Date Definitive Plan Approved by Planning Board G �Q TOWN REGULATIONS
� —�y' � �e_ j
Historic-OKH Preservation/Hyannis
Project Street Addresses
Village LO
Owner �,� a LJ,�.Linv�, l�c�c�cS Address 0 zkoAqt
Telephone
Permit Request
Square feet: 1 st floor: existing proposed_131 to 2nd floor: existing proposed a 1 t Total new 314 3(a
Estimated Project Cost a coo Zoning District Flood Plain Groundwater Overlay
Construction Type VAD
Lot Size C1 (0 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: YYes ❑ No
Basement Type: *Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) F Basement Unfinished Area(sq.ft) 3�
Number of Baths: Full: existing new S Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new-
First Floor Room Count J
Heat Type and Fuel: XGas ❑Oil ❑Electric ❑OthAO(A C1-,L..
Central Air: )(Yes ❑No Fireplaces: Existing New V� Existing wood/coal stove: ❑Yes 9No
Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing Vnew size'a Cb—,, Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name elephone Number
Address <"�f� `'"'` �" — �"`�License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUR 1 / DAT "`
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTIO1. `>
..,.
FOUNDATION
FRAME
INSULATION
FIREPLACE -
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH: FINAL
GAS: ROUGH` FINAL
FINAL BUILDING
C
0
DATE CLOSED OUT
ASSOCIATION PLAN N®.'3 � I
v
............................................ ....................................................................................................................................................
DATE(MM/DDNY)
.... .F.:.111LIA 11 TY::`1N:5:` J:RA1N .....................
... .......... .......
1111 4.
... .......... ......... ........... .............. .............
X., AC0RD_ RTE'...: CATE
...................................... .................. 05/21/99
........................
................... U
.............................
.................................... ......................................................... ..............
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
iO'Brien's Centerville Ins Agy HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
259 Pine Street, P.O. Box 610 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Centerville MA 02632 COMPANIES AFFORDING COVERAGE
O'Brien's Agency Account COMPANY
Phone No. 508-775-0005 Fax No. 508-775-6772 A Assurance Company of America
INSURED COMPANY
B
Mark Grant COMPANY
d/b/a Quality Construction C
P.O. Box 8 COMPANY
East Dennis MA 02641 D
.......................
......... .............. . ................ ....... ..........
....................... . ..................................... .................................... ............ .......
....... .......
RA
............
. ............... ..... .................................................... ..................................
..... ........... .... .. ...*..................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.
Co TYPE OF INSURANCE POLICY NUM POLICY EFFECTIVE POLICY EXPIRATION
o NUMBER LIMITS
LTR DATE(MM/DDfYY) DATE(MMIDDfYY)
GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000.
A X COMMERCIAL GENERAL LIABILITY CFC 28265255 03/17/99 03/17/00 PRODUCTS-COMP/OP AGG $ 1,000,000.
CLAIMS MADE FX]OCCUR PERSONAL&ADV INJURY $ 500,000.
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 500OOO.
FIRE DAMAGE(Any one fire) $ 300,000.
MED EXP(Any one person) $ 10,000.
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
............... .....
....................................
_....................................
ANY AUTO OTHER THAN AUTO ONLY:
...............
............. ..........
EACH ACCIDENT $
• AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WC STATU- 1H• ................
................
...................
TORY LIMITS *!"i:
WORKERS COMPENSATION AND I PER
EMPLOYERS LIABILITY EL EACH ACCIDENT $
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $
OTHER
• DESCRIPTION OF OPERATIONS/LOCATIONSNELHICLES/SPECIAL ITEMS
Residential Carpentry; **Subject to Policy Terms & Conditions**
CERTIFICATE
..... ......................................................................................................................
............. ..............................................................
............................................ .......................
.......... L ............. ...........
.............................. .... . ........
..............................................................
...... :::::::CANCEL-ATIO.R""" ....... ....... ......... ............
-:HOL ........ZERTIOCATE.. .......
........................................................................................
................................................................................................................................................................................................................................................................................................... ........................
WOODBIl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Bill Wood BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P.O. Box 602
West Barnstable MA 02668 OF[ AN KIND U
P ON THE COMP
ANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZE REPRESENTATIVE
'0Brjen S
AgencY4
.. ................. ... ...........
........... .......... ....... ....:.:.... .........
.. .... ....
.............
..................................... ..... ................%..........
. .............................................
0 -9 ................................... ...................
........................
........ ......... .... -...............
............................... .................... ..........
...... ...................... ..................
,i
f -
I
MAScheck COMPLIANCE REPORT I I
Massachusetts Energy Code I Permit # I
MAScheck Software Version 2.01 I I '
I I
Checked by/Date. l
I
CITY: Barnstable
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family. Detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 5-26-1999
TITLE: Bill Woods
PROJECT INFORMATION:
210 Cape Trail
W. Barnstable, MA
COMPANY INFORMATION:
All Cape Insulation & Supply Inc.
P.O. Box 645
E. Dennis, MA 02641
COMPLIANCE: PASSES
Required UA = 455
Your Home = 312
Area or Cavity Cont. Glazing/Door ,
Perimeter ,R-Value R-Value U-Value UA
---------------------------------------------=---------------------------------
CEILINGS 2120 30.0 30.0 36
WALLS: Wood Frame, 16" O.C. 2500 13.0 13.0 121
GLAZING: Windows or Doors 165 0,310 51
DOORS 84 0.550 46
FLOORS: Over Unconditioned Space 1220 19.0 19.0 58
-------------------------------------------------------------------------------
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
1
i
i
JJ /C
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software Version 2.01
Bill Woods
DATE: 5-26-1999
B1d9. 1
Dept. 1
Use
I
CEILINGS:
[ J 1 1. R-30 + R-30
Comments/Location
WALLS:
[ ] I 1. Wood Frame. 16" O:C., R-13 + R-13
( Comments/Location
I .
WINDOWS AND GLASS DOORS:
[ ] j 1. U-value: 0.31
For windows without labeled U-values, describe features:
# Panes Frame Type______:_ Thermal Break? [ ] Yes [ ] No
Comments/Location
I DOORS:
[ ] 1 1. U-value: 0.55
1 Comments/Location
FLOORS:
[ ] 1 1. Over Unconditioned Space, R-19
I Comments/Location
I AIR LEAKAGE:
[ ] I Joints, penetrations. and all other .such openings in the building
1 envelope that are sources of air leakage must be sealed. When
I installed in the building envelope, recessed lighting fixtures
1 shall meet one of the following requirements:
I I. Type IC rated, manufactured with no penetrations between the
1 inside of 'the recessed fixture and ceiling cavity and sealed or
1 gasketed to prevent air leakage into the unconditioned space.
1 2. Type IC rated, in accordance with Standard ASTM E 283, with no
1 more than 2.0 cfm (0.999 L/s) air movement from the the
1 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.
VAPOR RETARDER:
( ] I Required on the warm-in-winter side of all non-vented framed
1 ceilings., walls, and floors.
I MATERIALS IDENTIFICATION:
I
[ ] I Materials and equipment must be identified so that compliance can
1 be determined. Manufacturer manuals for all installed heating
1 and cooling equipment and service water heating equipment must be
1 provided. Insulation R-values and glazing U-values must be clearly
1 marked on the building plans or specifications.
I •
I DUCT INSULATION:
[ ] I Ducts shall be insulated per Table J9.9.7.1.
I •
I DUCT CONSTRUCTION:
i
[ ] I All accessible joints, seams, and connections of supply and return
( ductwork located outside conditioned space, including stud bays or
( 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
not greater than 125% of the design load as specified.
I in Sections 780CMR 1310 and J4.4.
I
[•] 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:
HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F .must be insulated to the following levels (in. ):
I '
i PIPE SIZES (in.)
HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-l" 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
Steam condensate any 1.0 1.0 1.5 2.0.
COOLING SYSTEMS:
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 CIRCULATING HOT WATER SYSTEMS: .
Insulate circulating hot water pipes to the following levels (in. ):
PIPE SIZES (in.)
I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F) : RUNOUTS 0-1" ) 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 ) 0.5 1.0 1.5
100-130 0.5 I 0.5 0.5 1.0
I •
----NOTES TO FIELD (Building Department Use Only)-------------------------
1
e
- ---:. --.. The Commonwealth of Massachusetts
. -- ..• %;�� _ -� ---� Department of Industrial Accidents
�a =` Office nffnYesligat MS" - -
P� _ 600 Washington Street
�'� !Boston,Mass. 02111
` t Via«-' -,
�� mrarr�� ���������� Workers"Comye nsation Insurance davit
ad Kura
name:
ean
location:
hone#
I am a homeowner performing all work myself. M
I am 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. �.�
comonnv name:
address:
city: phone#
insur nce Co. nolicv#
//------///////////------////////%/
I am a sole proprietor, general contractor, homeowner(cir le one)and have hired the contractors listed below who
avc �, f
the folloning porkers' compensation polices:
Ccomuanv name:
ress• 1
.... :..is i::::;.;i:i}.w:�: J:iL•:... :. :.
city phone#- • - .
......
insurance cm. policy#.. ... .... ...;:.:......::.;.. .;. :.,...::L•.:..•:<.;;L:•:.:•.::.:
:.:::.;.....,::.... ..
comnanv name: .
address: •
cit`: :.. .
.. phone#?L
....................... .....
insurance co. :..:....:. .:::;:;;.:. ... ::... :;:.;....: .: ;:;,.:.:;<.;.... olicv# :....::.::::.:;;:::.:;::;;.:<::>::•::;: . :.: :::.:::. ......... ..
to seavre coverage as required under Section 25A of MGL 152 can lead to the imQosit/on of entninsl Qenaitin of a tine np to S1300.00 and/or
one vears'imprisomnent 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.
ijy under the pains and penalties ojperjury that the information provided above is tru,-turd correct
I do hereby cl
sigma tttre D
Print name \��\`C�y� 1C .� Gone4
3 C�s'33
otticiai use only do not write in this area to be completed by city or town official
city or town: permitilicense# ❑Building Department
❑Licensing Board
❑ check if immediate response is required ❑Selectmen's Office
. (]Health Department
contact person: phone It; ❑Other
(revues*93 PJA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any co=---
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 recemer
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 renew&'
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.
Y
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 io
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
0mce of lavasu0adens
600 Washington'Street
Boston; Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 eat. 406, 409 or 375
Building ivision
t�►sa
tu►stvernstE. ' 367 Main Street,Hyannis MA 02601 _
tes¢ ���
Eo .
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
HOMEOWNER LICENSE EXEMPTION
�l C� Please Print
p
DATE: 3� `1 1q
JOB LOCATION:
number street village
"HOMEOWNER": W Ayo—" u�)C>OUi
name home phone# work phone#
1 rx -U CURRENT MAILING ADDRESS: o -p
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less
and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as sullervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building e�it_(Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
uirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the
provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for
hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,
particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would
with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that hetshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used
by several towns. You may care to amend and adopt such a form/certification for use in your community.
QTORM&EXEMPT
Application to _ (A�
1 ^ O 0-�\
E� Old Kin s Highway Regional Historic District Committee /
. g Y Re g g �
in the Town of Barnstable for a
-uq Jj"! 19 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' New-y�B�uildi� ❑ Addition ❑ Alteration
Indicate type of build' g: House�,v+s'�^ [ Garage ❑ Commercial ❑ Other
Z Exterior Painting:
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
(PI ther side for explanation and requirements). ^
TYPE OR PRINT LEGIBLY aJ0 DATE C�
el
ADDRESS OF PROPOSED WORK ASSESSORS MAP NO.
OWNER ASSESSORS LOT N
HOME ADDRESS( -��/?0 TEL. NO. $3'3^95
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary).
fJ
la
AGENT OR CONTRACTOR �:�� ic A�V TEL. NO.
ADDRESS ..S127-We Ar
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 proposed
locations of new signs. (Attach additional shee , if necessary).
1;Y /r41- 1�9101. -�77 wmell /��e
.�� e Cp s,�c ���y
Sign Z&A�
Owner-Contractor-Agent
Space below line.for Committee use. c n
(,-.,,,. . .. Rteiyed by H.D.C. vtll W LK..�tl1?'Q�la'lN ..._ 9.. .,
�_ ` Date The Certificate is hereby Date r
=i Time
i
Approved ❑ IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period
provided in the Act.
h
Town of Barnstable
' Old King's Highway Historic District Committee
16e SPEC ,SHEET
FOUNDATION 1 O ZAX g,-;2— !vim��' ' ''
•t 5 ee RV 6r1i ho�-
SIDING TYPE " l �i1/ E��S COLOR n� �e
CHIMNEY TYPE � C/L COLOR no
ROOF MATERIAL��G�!/� G ��� COLOR
PITCH /� ( Ue -
WINDOWS COLOR "Ile SIZE rclz
TRIM COLOR
DOORS a el ��� �// COLORS l Ci
SHUTTERS ///D_/l/ Ci COLORS
GUTTERS �� COLORS
DECKS y 9 MATERIALS
GARAGE DOORS Z&A)o COLORS
SKYLIGHTS SIZE ` COLORS
SIGNS COLORS
FENCE COLOR
NOTES: Fill out completely, including measurements and material a/colors to be used. Three copies of this
form are required for submittal of an application, along with three copies of the plot plan,
landscape plan and elevation plans, when applicable.
SPECSHT
i
•
• /
•
�n74��/�e/a
Flo- 4
f es� �✓m2 ��<S'/�l' � Ge� �
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1
i _
REVISIONS:
NO. DATE OESC.
4
1 1 CERTIFY TO THE BEST OF MY
PROFESSIONAL KNOWLEDGE, INFORMATION
AND BELIEIg � NG � , I 0 ENSIONSF AND T SETBAC STHET TON THEE
V �� STRUCTURE AS DETERMINED BY
0 /•� ` ` I INSTRUMENT
CONFORM
Y TO THE
TOWN OF BARNSTABLE ZONING
Q�b A' �x REQUIREMENTS.
v ,I
ppN
PROFESSIONAL LAND SURVEYOR DATE
I LOT 6 v
I b 41 922t S.F. h d
CEffnFlED
\ I V) PLOT PLAN
\I ►
► LOT 6
50.B• �' Qom. I CAPE TRAILS
IN
\ I T\ I
/( �°• ��ABSASRAN/�SIfABLE
I � \ � I (BARNSTABLE COUNTY)
\ \ APR.ak I=
► \1 82.3\
PREPARED FOR:
Mr k Mrs. WILLIAM WOODS
P.0 BOX 702
•Av�O@T \ °°c WEST BARNSTABLE
\ CK 02668
w B
CAPEThe BSC Group, Inc.
TRAILS
West Yarmouth, Massachusetts
02673
L / 508 778 8919
® Im The ssc freuo.re.
SCALE r . 2D'
0 25 ! ID m
0 10 20 40
FIELD
m
THE STRUCTURE IS LOCATED IN ZONE C. PRIOd. MGR.: C. FI
AS SHOWN ON FIRM COMMUNITY PANEL FIELD: GPH/AD
250001 0015 C, EFFECTIVE DATE: AUGUST 19, 1985 CALC./OESIGN: K. HEALY
DRAWN: K. HEALY
CHECK: C. FIELD
FILE: 8040—FND
DWG. NM 5128-02
JOB. NM 4-8040.00 SHEET 1 OF 1
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SOIL TEST PIT DATA: TYPICAL SEPTIC TANK: 1 ,500 GALLON DISTRIBUTION BOX DETAIL: NOT TO SCALE TYPICAL LEACHING TRENCHES: REMSIONS
NO. DATE DESCRIPTION
NOT TO SCALE NOT TO SCALE
NOTES: 1. SEPTIC TANK SHALL BE STEEL 5. INLET AND OUTLET TEES TO SHALL BE SCHED. NO. OF OUTLETS S
40 PVC. TEES SHALL BE LOCATED UNDER 4" PERF SCH 40 PVC S=0.005'/' 12" MIN, TO 36' MAX .COVER
REINFORCED CONCRETE. MANHOLE COVER FOR EASE OF SERVICING.
2. SEPTIC TANK TO WITHSTAND H-10 LOADING 6 RECOMMENDED MANUFACTURER'-ROTONDO OR 2% MIN. FINISH GRADE FINISHED GRADE
.
UNLESS UNDER PAVEMENT, DRIVES OR APPROVED EQUAL. NOTES:
TEST PIT 98-' 98-2 TRAVELED WAYS, WHEREIN H-20 LOADING .7
TEST PIT SHALL APPLY.
GRD. EL. 94.0 GRD. EL. 92.0 3. ALL PIPE CONNECTIONS AND CONCRETE 7 MANUFACTURER. UNLESS
BE WARRANTED BY REMOVABLE 2" WALLS
COVER 1 1. DIST. BOX TO WITHSTAND H-10 LOADING
W. EL. NIA GW. EL. N A CONSTRUCTION SHALL BE WATERTIGHT. �. , ! UNLESS UNDER PAVEMENT, DRIVES OR .� . _, . . ,� �. .�. . �. ._,_, .�. ��" CAP ENDS
0" O• o :v•,v v.•,v :v•• '9• i• V 2" TRAVELED WAYS WHEREIN H-20 LOADING 4" PVC
sa a ea o oa o ea a ea o °d°C a �Q o oa a ea o e♦ o e
4. FILL ALL UNUSED KNOCKOUTS WITH a4f�!°aq °tea q�cgf�Pa,4�, e of q�9�agfCdV' a;;f
A SL, IOYR 3 2 MORTAR. SHALL APPLY. a +$e a o a e a o a o a 24" DEPTH
/ A SL, l 0YR 3/2 b$• Ac$ '""�$• �+c$ �$• 40$• ' $. b$ "40
FIBRIC RBRIC 3-24" DIA C.I. (60# MIN.) MANHOLE COVERS / aqd° air° a9!°a°tP �° a�a4� aYa4P ' ,r GENERAL NOTES:
6" B IOYR 5 6 TEE TO BE UNDER BROUGHT TO FINISH GRADE
15" 2. PROVIDE INLET TEE OR BAFFLE WHERE �' 1 I P N AN
�. / g' " SLOPE OF PIPE EXCEEDS 0.08 FT./FT OR LEVEL BOTTOM THIS LAN IS FOR DESIGN D
FRIABLE MANY 8 SL, 10YR 5/6COVER 3" 6', 5-5 OUTLETS .. IN PUMPED SYSTEM. 42'
M.H. OPENING MIN. " F 8" CONSTRUCTION
ONST UCIONOFACILITY HE mftSEWAGE
DISPO
AL
Y.
��'� ` " �/ v" + T 3. FIRST TWO FEET OF PIPE OUT OF DIST. 2. ALL CONSTRUCTION METHODS AND
ROUNDED COBBLES 6c FRIABLE, MANY 24 DIA. + e o + e o o + o
STONES, FEW BLDRS. ROUNDED COBBLES do 12'-0' RAISE BR W,L_ 6" 4" s 'a $aa, $gyp a a eat:' " PROFILE
SEWER BRICK $ 2 BOX TO BE LAID LEVEL. MATERIALS SHALL CONFORM TO MASS.
44" STONES, FEW BLDRS. `' :°� ` -:'
C S. 2.5Y 7/3 11'-0" & MORTAR '- .` �' BOTTOM ON LEVEL D.E.P TITLE 5 AND LOCAL BOARD
MEDIUM SAND, LOOSE, C S. 2.5Y 7/2 NORMAL WATER t2" STABLE BASE 6" MIN. 3/4" TO 4. RECOMMENDED MANUFACTURER-ROTOND>O 36" MAX. - 12" MIN. COVER OF HEALTH REGULATIONS.
tOx GRAVEL, FEW 55" FINE SAND, LOOSE, . 3, CROSS-SECTION 1 1/2" CRUSHED OR APPROVED EQUAL.
�` STONE BASE 3. ALL PIPES LOCATED UNDER PAVEMENT
ROUNDED COBBLES <5X GRAVEL, B0• PRECAST SEPTIC TANK 10" 20" 5. ALL PIPE CONNECTIONS AND CONCRETE; 27 MIN. FINISH GRADE 4" MIN. LOAM do SEED OR TRAVELED WAY SHALL BE SCHEDULE
SINGLE GRAINED SINGLE GRAINED
CONSTRUCTION SHALL BE WATERTIGHT, f 40 OR EQUAL.
TINLET TEE :4 q'_g"
D046. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. 3H:1V MAXIMUM 4. THERE ARE NO KNOWN PRIVATE WELLS
D04 - � _ � LOCATED WITHIN 150 FT. OF THE
5'-0' 4'-6" q'_0" MIN. evro ow 5'-4" T
15' MtN PROPOSED LEACHING FACILITY NOR
Z = ' LIQUID DEPTH a sI r r 44.- ."
2" MIN. OF 1/8` TO ANY KNOWN WELLS PROPOSED WITHIN
6'-O� 5- 30 1/2" 15 1/2" 24' 24` 1/2" WASHED STONE150' OF ANY KNOWN LEACHING FACILITY.
5. WITHIN LIMIT OF EXCAVATION REMOVE
/4" TO 1-1/2' DOUBLE ALL TOPSOIL. SUBSOIL AND OTHER
6' 2' ( WASHED STONE (NO FINES) IMPERVIOUS MATERIAL
��`•: `r' : .�':'.::�•�`• •':-�:': '.�•:-' •.-•:�- ==� � PRECAST DIST.
VIBRO-COMPACTED CRUSHED STONE 4�°c 3' BOX ( ' (rn')
132" 144' FLAN VIEW 6. REPLACE WITH CLEAN WASHED SAND
NO GROUND WATER OBS. NO GROUND WATER OBS. 6" MIN. 3/4" TO ��' �� CROSS-SECTION OR OTHER CLEAN GRANULAR SOILS
1 1/2" STONE CROSS-SECTION VIEW PLAN VIEW
CONFORMING TO THE FOLLOWING
SIEVE ANALYSIS:
SOIL CLASS: I SOIL CLASS: I
i' r
DATE: DATE: INVERT ELEVATIONS: t0 ASS No.850 EVE ALL
<10 % OF No. 4 SIEVE SHALL
11-25-98 "-25-9s FINISHED FIRST FLOOR 99.00 PASS No. 100
TEST BY: TEST BY:
„ 91 .75 C5 % OF No. 4 SIEVE SHALL
J. DONOVAN J. DONOVAN A.) 4 INVERT AT DWELLING PASS No. 200
WITNESSED BY: WITNESSED BY: \ B \ ( ) UNIFORMITY COEFFICIENT ® No. 4
JERKY DUNNING JERKY DUNNING � � S 4„ INVERT A T SEPTIC TANK I N 91 ,45 _
C• 4 INVERT AT SEPTIC TANK OUT 91 .20 SIEVE
} 69-19'74„ ) ( ) 7. EXISTING UTILITIES WHERE SHOWN
i / \ \ E " D.) 4" INVERT AT DIST. BOX (IN) 91.00 IN THE DRAWINGS ARE APPROXIMATE.
PERC. RATE: PERC. RATE: � 4 THE CONTRACTOR SHALL 6E RESPON-
_5.�_MIN./INCH `55_MIN./INCH
SOIL EVALUATOR SOIL EVALUATOR \ \ �9. E.) 4" INVERT AT DIST. BOX (OUT) 90.83 SIBLE FOR PROPERLY LOCATING AND
J. DONOVAN J. DONOVAN 7S, \ COORDINATING THE PROPOSED CON-
INVERTS AT LEACHING FACILITY: STRUCTION ACTIVITY WITH DIG-SAFE
TRENCH No. 1 2 3 AND THE APPLICABLE UTILITY
SE�q�k\ G THE
F. 4" INVERT AT BEGINING # # EASTING UTILITY SYSTEMCOMPANY AND IN SERVICE.
/ / \ ) DIG-SAFE SHALL BE NOTIFIED PER
\ OF LEACHING FIELD 90.71 90.21 89.71 THE STATE OF MASSACHUSETS
\ STATUTE CHAPTER 82, SECTION 409
INDICATES INDICATES INDICATES } I \ G.) 4" INVERT AT END AT TEL. 1-888-344-7233. THE
\ OF LEACHING TRENCH 90.50 90.00 89.50 ENGINEER DOES NOT GUARANTEE
THEIR ACCURACY OR THAT ALL
PERC. OBSERVED ESTIMATED
TEST GROUND WATER � SEASONAL NIGH
GROUND WATER o,° / H.) ELEVATION AT BOTTOM UTILITIES AND SUBSURFACE STRUCTURES
PROPOSED 87.5 87.5 87.5 ARE SHOWN. LOCATIONS AND
LOT ARFA 41- WELL LOCATION OF LEACHING TRENCH ELEVATIONS OF UNDERGROUND UTILITIES
922 � TAKEN FROM RECORD PLANS. THE
SYSTEM PROFILE: -- / i.) ESTIMATED GROUNDWATER >12' B G LOCATION AANDINVER SR OF UTILITIES
NOT TO SCALE h� / ELEVATIONS AND STRUCTURES AS REQUIRED PRIOR
NOTE: 24' CI FRAME AND h /
COVER TO FINISH GRADE � f- AGROUND WATER LEVEL 47.4 FT. BELOW TO THE START OF CONSTRUCTION.
WITH BRICK AND MORTAR. DATUM AT USGS WELL, SANDWICH 252
W 8 THE USE OF A GTHIS SYSTEM IS ARBAGE DESIGNED GR GRINDER.
4" PVC SCH 40 � ( / / A GARBAGE GRINDER IS NOT
MAX. COVER ELEVATION_93.0 / ` N RECOMMENDED DUE TO RECOGNIZED
��� 7 ` ADVERSE IMPACTS TO THE LEACHNG
DESIGN CRITERIA:
FACILITY.
4" P Q \ / �( DESIGN FLOW:
scH ao ACHING TRENCH # Q \ 5 BEDROOMS AT 110 G.P.B./D 550 G.P.D.
O � r
s INV.=91.00 INV._89.71 � INV.=89.50 1 150 / l µ *
re INV.�91.20 INV.-90.83 \ / J `�
1,500 GALLON I 7.5 Q)^ 4
?• PRECAST CONCRETE '� / h SEPTIC TANK SIZING: . � '
ec' 411
SEPTIC TANK N N WA �� = 1 ,1 00 GAL.P� \ �o`� `�° 550 G.P.D X 200% �
o GROUND TER oes. PR VS �P y' - ,500 G me BSC Group, Inc. 4k ,
vP .� SEPTIC TANK REQUIRED: - 1 L.
1 a
DATUM .-
AD 713
SIZE OF LEACHING FACILITY REQUIRED.
VERTICAL DATUM: ASSUMED �g• ti° !. ' ` DESIGN PERC. RATE: <5 MIN./ INCH 293 WASHINGTON STREET
BENCH MARK USED: FIRST FLOOR = 99.00 � �_ /� /� � � �• NORWELL, MA 02061
\ � ��Wp,Y L � � // LONG TERM APPL. RATE 0.74 G.P,D/S.F. -
p // // ,moo (781) 659 7981
�� 550 G.P.D. 0.74 G.P.D./S.F. = 743 S.F.
rl PROJECT TITLE:
r♦ I
SIZE OF LEACHING FACILITY PROVIDED:
PROPOSED �� USE 2 DEEP X 2 WIDE LEACHING TRENCHES SEWAGE DISPOSAL
D-BOX L/ // LEACHING AREA 74 SF/6 SF LF = 123 LF OF TRENCH SYSTEM DESIGN
L o / USE 3-42 LONG TRENCHES
��. �
756 SF PROVIDED > 743 SF REQUIRED
756 S.F. x 0.74 GPD/S.F = 559 GPD CAPE TRAILS
�h 9$
NOTE: ( y s� - -- 1 , / BARNSTABLE, MA
AS DATE ON
/ sr �9C�. \� O ,�NaFv,�
LOCUS PLAN :
DEPARTMENT HAS NOT ASSIGNED LOT 0 TO SCALE
NUMBERS TO THIS PARCEL. THE PARCEL ��•. ° �
` IS DEPICTED ON A DEFINITIVECRAIG
T SUBDIVISION PLAN ENTITLED "SNOW / �Q'j s�39 U' o
�. HILL ESTATES AND DATED JUNE 4, 1997
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SO A\. PREPARED FOR:
WILLIAM & LILA WOODS
sy P.O. BOX 702
W. BARNSTABLE, MA 02668
LOCUS
PROJ. MNGR. CRAIG FIELD
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CALC/DESIGN: MAM
4 (CAPE TRAILS I �PQ
CHECK: JWB
\� PLAN VIEW DRAWN: MAM
1 FIELD: RD/JD
SCALE: 1 " = 20 FEET ROE 6 FILE N0. 8040SEP.DWG
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NO, DATE DESC.
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tMENSIONS AND :SETBACKS TO THE,
-- STRUCTURE AS MINEQ S1' .
(� INSTRUMENT SURVEY CONFORM TO-THE
TOWN Off': BARNSTABLE. ZONIN
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\ GARAGE � (BARNSTABLE COUNTY
° °
\ \ MAY 159 1999
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\ 103.1' or0.
AN PREPARED FOR:
s2934, \ Mr & Mrs. WILLIAM WOODS.
�o �� `�g6.80' P.0 BOX 702
CL ��' \ Co�McR-52.50 WEST BARNSTABLE
\ ACK 02668
n 44.37.07»
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508 778 8915.
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' SCALE: 1 20'
CD
Q 2.5 5 10 uErExs
0 10 20 40 FEET
THE STRUCTURE IS LOCATED IN ZONE C.
PROD. 'MGR.: C. FIELD
AS SHOWN ON FIRM . COMMUNITY PANEL
FIELD: GPH / AD
250001 0015 C, EFFECTIVE DATE: AUGUST 19, 1985 cALc./ol=slcN: K. HALY
DRAWN-: K. HEALY
CHECK: C. FIELD
FILE: 8040-FND
DWG. NO: 5128-02
JOB. NO: 4--8040.00
SHEET 1 OF 1
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