HomeMy WebLinkAbout0805 CEDAR STREET UPC 12534No.2-153LOR
HASTINGS, MN
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LOT 10
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I JOB # 95-421
E'ER TIFIED PL D T PLA N
0CATION : 805 CEDAR ST. WEST BARNSTABLE, MA
PREPARED FOR:
i SCALE : 1 = 50 DATE : MAY 23, 1996
REFERENCE LCP 40599—B LOT 11
KRISTEN NUGNES
I HEREBY CERTIFY THAT THE STRUCTURE
SHOWN ON THIS PLAN IS LOCATED ON P.iE
GROUND AS SHOWN -HEREON. ��M of
j otf 5W-362-4541 ARNE
I fox W8 W2-9M H. 4
dcwr. cape -a4loeeriug, inc.
CIVIL ENGINEERS
LAND SURVEYORS — --- --`—
939 main st. yoRnouth, ma 02675 DATE RE G. RVEYOR
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Town of Barnstable *Permit# ��►�I v�Q I O
Expires 6 months m u�Awe
Regulatory Services Fee
• BJUMSTeBIZ
v� "
039. Richard V.Scali,Interim Director
�0
j0�n unt►��'
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number
C8nr)00-7®10 Not Valid without Red X-Press Imprint
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Property Address 8 C C..��r S /V
Kesidential Value of Work$ S-000. C-" Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name -� y SAS Telephone Number �� �" 2 G73
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable) top
❑Workman's Compensation Insurance
Check one: 1�
❑ I am a sole proprietor MAY ,8 2014
ITI am the Homeowner
I have Worker's Compensation Insurance _ ®'�s
Insurance Company Name �C-� S k oV®Pb40 ,
Workman's Comp.Policy# �
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box) �� ,
Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
SeTequi
trical&Fire Permits required.
"Where ance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Nooperty O er must sign Property Owner Letter of Permission.
copy f t e Home Improvement Contractors License&Construction Supervisors License is
SIGNATURE:
Q MPFILES\FORMS\building permit fb=WEXI'RESS.doc
Revised 061313
• The Camman►veaM ofMassackusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
ti Boston,MA 02111
w►vtv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Bmlders/ContractorslEtectricians/Plumbers
Applicant Information / Please Print Umbly
Nazne(Buie.�slOrgauiratian/l�dividnai): �"%�� �.(� f
• .err
City/Staozip: 17f7�o 6 one#,- 7 7 y- 2- Z 73 c�
Are you an employer?Check the appropriate boa: Type of project(required):
1.❑ I am a employer with 4- ❑ I am a general contractor and I 6. ❑New constnxtion
employees(full andlor part-time).* have hired the sub-contractors
2.❑ lam a sole proprietor or partner-
listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors hen a g_ ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp-insurance.I
required] 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions
3j,bam a homeowner doing all work officers have exercised their 11_0 Plumbing repairs or additions
[No workers'comp. right of exemption per MGL 12_❑Roof repairs
insurance required.]i c. 152, §1(4�and we have no
employees-[No workers' 13.0 Other
comp.insurance required.]'
;Any appb3at that checks box#1 omstalwfilloratthesectionbelowshowingtheawodsas'compensation policyin€ornvtian.
Homeowners who submit this affid nit in&cating they are doing all work and then hire outside conusctors nntst submit a new off darit indicating such:
?Contractors thxt eheck this boa must attached an additions)sheet showing the nano of the sub-connacoocs and state whether or not those endties have
employees. If the sub-contactots bare employees,they anus pmvide their vtwken'comp.policy number.
I ant an ernpinysr that is prviiding workers'congmisation insurance for miy enrploy�ees. Below is the policy and,job.site
ihformation.
Insurance Company Name:
Policy#or Self-ins.Lic.9: E,piration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(shoving the policy number and expiration date).
Failure to secure c verage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,50 .00 dlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250_ a against violator. Be advised that a copy ofthis statement may be forwarded to the Office of
Investigations f thL DIA for ance coverage ti-erificatioa.
I do hereby c fy r i R 'n nd penalties of icrp that the infor magen proii dL-d abm a rs true and correct
�s / L/
Z z 6 7 -
Official use only. Do not write in this area,to be completed by city or town official,
City or Tower: PermitlLicense-9
Issuing AIIthority(circle one):
1.Board of Health 3.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
V
r '
�TME rq Town of Barnstable
Regulatory Services
�axxsrnsi.$.
MAIM, Richard V.5cali,Interim Director
039. `e$
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner M st
Complete.and Sign T Section
If Using A BuiYder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by building permit.
(Addres of Job)
**Pool fences and alarms a e the responsibility of the applicant. Pools
are not to be.filled or utilize before fence is installed and all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
/l•L`/1D 7.TC•/�II/ATZ:D DDDIdTC`QT/'IATDMT Q ifl/1'f
V
Town of Barnstable
Regulatory Services
oFtHE Richard V.Scali,Interim Director '
Building Division
�xxsres[E Tom Perry,Building Commissioner -
nUss.
9 163 � 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6250
HOMEOWNER LICENSE EXEMPTION
�---� (® Please Print
JOB.LOGATiQN:
.---,-number-,
street_ _village-
..HOMEOWNER":/;_?- C /�1 C��/`�J 7.7
name ( home phone# work phone#
CURRENT MAILING ADDRESS: �� �e�.✓.�'�2
city/town—___ -state.-_ zip code
The current exemption for"homeowners"was extended to include owner-occupied.dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The unders' d"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws, es d regulations.
The dersi ed"ho owner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
proc dur and re ements and that he/she will comply with said procedures and requirements.
Signature of H eowner -- -
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 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:\WPFILES\FORMS\building permit fonnslEXPRESS.doc
Revised 061313
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DEPARTH6NT OF PUBLIC SAYETY
CONSTRUCTION SUPERVISOR LICENSE ,
Number: Expires:
Restricted To: 1G
PETER.J NUGNES
56 NORRIS ST .
;Lev HYANNIS, RA 02601
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JJJNdhW1JMap COB Parcel 00 tl
Permit#
Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Jc U' 6 Date Issued 5 ��
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee
Engineering Dept.(3rd floor) House# '5d0, r z&�z �yFI
Planning Dept.(1st floor/School Admin. Bldg.) w'"°�' SEP-nc sy �
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Definitive'Plan Approved by Planning Board• J 'oJ.}� 19 ,CALLED IN
77
TOWN OF BARNS r--')%JTAL C
�yl9�
Building Permit Application
r.
Pro Address SOS �C4 Vq(' g+
Vil &;vWS44Ae Owner �Cri.f�`G./I i(�ies�e S Address S'6 /1lbrlY f <S� 1y,,,nJl3-
Telephone S-6 S-- 77/- 8aa6
Permit Request C'o(154 rUc+ Nte_,.s S►n-I Q nw t N cAla-- AuI
First Floor square feet
Second Floor square feet
Estimated Project Cost $ ? z
Zoning District Flood Plain Water Protection
Lot Size -/31607 + sQ.- 4- Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use 4iwF -A k
Construction Type rdoo8
Commercial Residential _X
Dwelling Type: Single Family X Two Family Multi-Family
Age of Existing Structure d17 Basement Type: Finished
Historic House 1A Unfinished X
Old King's Highway
Number of Baths 3 No.of Bedrooms 3
Total Room Count(not including baths) 1 First Floor
Heat Type and Fuel Central Air 4k Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached X Barn
None Sheds
Other
Builder Information
Name (/ Telephone Number '7 �
I
Address Z 4z& F6 License# n(, y�9
R1 r S 014. nz 6 64 Home Improvement Contractor# &867l
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENI D FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY ^'
MIT NO.
• r '
D ISSUED
/PARCEL NO. ,
r
ADDRESS VILLAGE _
OWNER
DATE OF INSPECTION:
FOUNDATdON -
FRAME
INSULATION -6J.�- °v L, 3 1� /l 6. i
FIREPLA& _ - -
ELECTRICAL:"' ROUGH FINAL
PLUMBING: ROUGH FINAL .
GAS: ROUGH FINAL
FINAL BUILDING = i1�2I be� ' r
DATE CLOSED OUT '
ASSOCIATION PLAN NO. ' '
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y`00HETp The Town of Barnstable
'9 BA MASS.LE.
MASS. o! Department of Health Safety and Environmental Services
0
039. �0 ,
PrFO,etA�� Building Division
367 Main Street, Hyannis, MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230. Building Commissioner
Inspection Correction Notice
Type of Inspection l�J
Location 0� �(. ctA �� Permit Number
Owner Builder
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
1
kCAA,
21
Please call: 508-790-6227 for reeinspection.
Inspected by �
Date ` `
dFTHE -
BARNgrA M _ The Town of Barnstable
Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508•94A-11635 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
199r
To Whom It May Concern:
Please be informed that a Certificate of Occupancy has been issued for '0'd�&'
. The Town of Barnstable has no further
i
interest in any performance bond for this property.
Sincerely,
c
i
bondrele
IN
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Tile Cuntmunil•calth of AlassachuscttI
�.;;� •j.�1 i� r Department of Industrial Accidents
z t oo
=!E OfffesOff Cwooloas
600 11ashin Inn Street
y-'N Burton.AM= 02111
�-' Workers' compensation insurance AtTidavit
location-
C �iQ �Sf
lv� s6
❑r I am a homeowner performing all work myself.
❑ l am a sole proprietor and have no one working in any capacity
vim:"
❑ I am an emplover providing workers' compensation for my employees working an this job.
addre-ts:
i, phone ift
iaatr•�nce co puller!!
❑ I am a sole proprietor,general contractor, w
omeone (circle one)and have hired the contractors listed below whL
the following workers' compensation polices:
v n C.)' `
nd re .O.
nhI phone/h sz t-- '<71-
ins
RU c,
m env na e•
■
phone Ih
in— • '' offert! . .. ..
Rump a Co. • w�■�e+w r 0 w ��
Atiaeh addldoaai'sbee[tfrieewary• ; '+"�• • •eo+•...a.... rc ��`
Failure ed to secure coverage as requir under Section 3A of AIGL 152 con lead to the imposition of criminal,ptmdties of a Ilan up to SI300.1I0 s
une years'imprisonment as-cli as civil Penalties is the forts of it STOP WORK ORDER and a.Me ofS100A0!day against me. I understand t.
copy of this statement may be forwarded to the 011icc of Investigations of the DIA for coverage vMOntion■
I do/ureter cerri u rlr r t/ie pains and penalties of
that the ittjotstsotion ptnridtd above is flat and cotmt
;�j: G 6$
Sienature Print __ II
e;Ze /VU�N�C Phone#
name � -��
offtcial•use only do not write is this am to be completed by city or town olIIeial
perinit4lecose i! r suiltling Department
city or town: DUtxttsiag hoard
OSdectmen's 01 1ce
cheek if immediate rwPonse is required Otlesith Department
phone t!: 1"tother-
contact person:
information and Instructions •,
Massachusetts General Laws chapter 152 section '_5 requires all employers to provide workers' compensation fo
employees. As quoted from the"tag+", an enrpinree is defined as every person in the service of another under all
contract of hire. express or implied. oral or%written.
An implorer is defined as an individual. partnership, association. corporation or other legal entity, or any two or
the foregoing cligni=cd in a joint enterprise, and including the legal repmsenmti%•cs of a deceased employer, or tite
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. Howev:
owner of a dweilinL house having not more than three apartments and who resides therein. or the occupant of the
d���clling house of another who employs persons to do maintenance, construction or repair wort: on such dtivelIin
or on the ;,_rounds or building appurtenant thereto shall not because of such employment be deemed to be an emp
MGL chapter 152 _,ection '_5 also states that every state or local licensing agency shall withhold the issuance c
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 chaF
been presented to the contracting authority.
.._..._..�. : . .. ti�: , . .w.,. 4.
• •�.w.._.��. ' .. .+: "T• •• 'J�r•: : . .���y.•L. .. =.,.....tip,�,�:%'{µJ..r!f..yi1'':r�.+�.:v.M,
Applicants
Please .`ill in the workers' compensation affidavit completely, by checking the box that applies to your situation r
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance cox�erage. 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 regL
to obtain a workers' compensation policy, please call the Department at the number listed below.
-- ,---.. - •_ .. ..,--�.. _. .:.• ., - _..._.... _��� ..;,...,,cam.:. •.+`•. -
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
be sure to fill in the permit/license number which will be used as a reference number. 'Ile affidavits may be return
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 que:
please do not hesitate to give us a call.
1!'Y.�.w•�w.. �,T�.,r,�..,. �i . •.rw..:. .�r�ii,_.w .`n� �:ia .ti.: ii~"V..��w-sJ{. :.`7nr: +••
.The Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
-Department of Industrial Accidents r,
Office of investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
Jj7s
TOWN OF BARNSTABLE
CERTIFICATE OF OCCUPANCY
PARCEL ID 000 000 053 GEOBASE ID
ADDRESS 805 CEDAR STREET PHONE (508)771-8226
WEST BARNSTABLE, -MA ZIP--' 02668-
LOT BLOCK LOT SIZE
ABA DEVELOPMENT DISTRICT
PERMIT 19586 DESCRIPTION SINGLE FAMILY DWELLING (PMT.#14996)
PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department of Health, Safety
ARCHITECTS: and Environmental Services
,TOTAL FEES:
BOND $.00 OxTNE
( CONSTRUCTION COSTS $.00
i
756 CERTIFICATE OF OCCUPANCY
* ■ARNSTABLE, •
MAS&
OWNER NUGNES, KRISTEN i6g9. e
ADDRESS 56 NORRI S STREET ED Mfg
HYANNIS, MA BUILDING D3VISION
BY
DATE ISSUED 11/26/1996 EXPIRATION DATE
. T- .1.....'.[_,':.. .. .... .. t_ _,.f'. .--'---.-.,_....:fs:FQ;'.,._�, ..f,. ,G,� .+-a:y-:., v..;;•.l-,.'�r-r%i'' ir%w; ..
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Department of Health, SOO,
and Environmental Services
+� L►RN31'ABY.E. +
11YIA8.4.
BUILDING DIVISION
BY.
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 APPROVED PLANS MUST BE RETAINED ON JOB AND
FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS t 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- ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OCCUPANCY.
BUILDING INSPECTION APPROVALS PLUMBING(INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
(42
2 0a�!�U �`�•``s� f d 2 �N`s� 2
V lu�G��f/6
3 / 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 14 4RANGLs r-y,�V�R41/
� `_j - I MD OF HEALTH
//
OTHER: / SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
i HE INSPECTOR HAS APPROVEDTHE 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.
Application to 1996 042
•'•� �wJa►w�tw a��' .
Old Kings Highway Regional Historic District Committee
in the Town of Barnstable for a
CE'RTI.FICATE OF.APPROPRIATENESS
Application is hereby made,'iri tripl_icate,-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 b_e164 and on plans, drawings�ot_phofograPhs"
accompanying this.application for:
CHECK CATEGORIES THAT APPLY:
1. Exterior Building Constructio 9New Buildi ❑ Addition Q- 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 Feb �qq6
ADDRESS OF PROPOSED WORK Co+ I I Co_c(4(- S+. ASSESSORS MAP NO.
OWNER fti S-k n /Q Ae S ASSESSORS LOT NO. OO apJp
HOME ADDRESS t4cc IS JAM� La nni S MIA. 62 tal TEL. N0.
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 �✓�--r ?{ro•GeSSIOAS1 I�eMe E'�1nc TEL. NO. g�3' 9(y�
ADDRESS 0. l`�oX `E 54AdwC�1 . r+'i�t. 0,�� 7
3
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 locationvbf existing signs and proposed
locations of new signs. (Attach additional sheet, if necessary).
-
+.I U
Signed Lr�6 ,A L<z
Owner-Convwtor-A
Space below line,for-Committee use.
;Received by H.D.C.
Date The to is he Date
f� 7 8 Imo. it•r `
Time
By
ed'--I BI IMPORTANT If Certificate Is'approved,approval 1s subJect to the 10 day appeal period *�
•'X-,'A w provided In the Act.
Form "A-1
r
OLD KING'S HIGHWAY HISTORIC DISTRICT
Spec Sheet
Foundation Type C�Z �
Siding Type w • e, .
Chimney Type _ Color
Roof Material — - _ - - -- ---� V . Color �__-
Pitch
Windows Size
J
Trim Color 4V
Doors f � �� ` Color
Shutters �/` ✓I a - -
—GuttersD
Deck Al'o
Garage D�ors &O(Aed (liur r"Uolor
Notes: Fill out completely, including measurements and materials/colors to:be used.
Three copies of this..form are required for submittal of an application, ,;, j.
along with three copies-each of the certified plot plan, landscape plan and
elevation plan, when applicable.
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IIIr J-Lrj 401 v 1�fl GS liv nST SE ?�PTIC OM F.;�AT 9— (WIT TO Scqj)ACCESS, 'To'w WITNE kkmum .75' OF.COVER OM r/ 4, 'ENGINEEW COVE O WTH OF ",M -vttss td�" (WA OP nN. GRADE
_;2% SLOPE REOURED OVER SYSTEM" Ss F 'FIRST 2'OR STOW DATE:RM UVEL WASM POL SEPM:. �p 7 ERC.I�RATE TANK CLASS SOILS I 'eFa2R! CRUSHED'STONE:00 tb"ck COUPACM.: (I 6.221 .'[21)DEPTH-OF-FLOW, -7!1/f DOL 3/,c TO I ' Wt WA%*:D STOW T& rl'3- cr NUT".0018 0CATIO OUTLET DEPTH,- ASSESSORS MAP ... PARCEL'BOX TIbN 't tplic.rANK Do LEACHING. : .. ''S FACILITY IFLOOD ZO NE'BUILDING to'
INE.17 /Z 7 2f SETBACKS: FRONT 4,i ',-,,SIDE BOTTO M OF, REAR T.H. c PLAN REFE RENCE:4 - k7tlY, 7 A-v UQTES;.. ....... SEPTIC DESIGN: (amm A4>7 17C 1. OATUM IS DESIGN FlOW: ;�a_ EDROOMS GPD) G P D B 2. MUNICIPAL WATE GPD DES -LOW R IS USE.A IGN 'F SEPTIC TA CPO GALLONS 3. MINIMUM PIPE PITC T.NK: R ALL PRECAST UNITS TO BE AASHO-H. 4. DESIGN LOADING FO PTIC TANK GALLON tE PIPE JOINTS TO BE MADE WATERTIGHT.6. CONSTRUCTION DETAILS TO 13E IN ACCORDANCE WITH MASS 31�jt 7-0 GPD
SIDES: EWRONMENTAL CODE TITLE V.GPD 7. THIS PLAN IS FOR PROPOSED WORK ONLY 'AND NOT TO BE TOT, GPD,BOTTOM., USED FOR LOT LINE STAKING.
S.F. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4� PVC.9. COMPONENTS NOT TO BE BACKnLLED OR CONCEALED WITHOUT OF HEALTH AND 'IDMISSION OBTAINED BOARD OF HEALTH.FROM N ass 'L��(b V PROPOSED SPOT ELEVATION 1OOxO EXISTING SPOT fti ONO PROPOSED CONTOUR R EXISTING CONTOU TIAN '0F SITE AND , , SEWAGE
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