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0016 HOMESTEAD LANE
,: .r.. - - -- - - '�,,ape) er O NJ a _ ch o �`D Z = TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6 q Parcel, 090 Permit# 0 Health Division�M � ,�� � Date Issued Q� Conservation Division Application Fee Tax Collector �� Permit Fee �9 Treasurer - oC 5 �O SEPTtw Ja Planning Dept. INSTA,L4�E ;..e�;ax Date Definitive Plan Approved by Planning Board ENVIr, - T niTIONS Historic-OKH Preservation/Hyannis Project Street Address LA-Kr-. Village Gvisr 0a-r-a si-4isLs Owner 3 zav,� 14t4ayf y Address l Telephone SO K 3 G L � '71 3 S - Permit Request jZZ►Zo;��� //3 ���o�� 4r #141YP)c1iP /4«2Ess�96 !L-i;2 > iNs��� �lrtr IA wA .v/c4"; r4fr //YfT.4<< e�/INlyIG�IP c1� O/✓ �s/�2 C�Nl/ /NST9c Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new 7)—SP Zoning District Flood Plain Groundwater Overlay Project Valuation .5p ou Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ti - u Dwelling Type: Single Family Qf Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: El Yes 0 No On Old King's Highway: El Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ItZis -+ 3 Number of Baths: Full: existing new Half: existing news Number of Bedrooms: existing newCO Total Room Count(not including baths): existing new First Floor Room Cb�t t Cn C Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric Cl Other `1 m m � Central Air: El Yes ❑ No Fireplaces: Existing New Existing wood/coal stov : ❑Yes ❑No a Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size �1 Attached garage:Pd existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No . If yes,site plan review# Current Use - — _ �� -Proposed Use BUILDER INFORMATION Name 16A-L tea✓i1 dLrTU/CN7-/u,� o,114 fa-7-1 c Telephone Number 7 f-i -`3�f 2� oy 22- Address `► AQ r y syu mat License# CS Odf2 9/ i2o C<<L a,v0 ",� v 237 o Home Improvement Contractor# /3 i 3 72 Worker's Compensation# tv c- 2 3 1 s 3 rq �r6-o (Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 61714,7,1qr, �Ct � )A& is i SIGNATURE DATE 7�s�Z FOR OFFICIAL USE ONLY PER MIT NO. ATE ISSUED APtPARCEL NO. ADDRESS. VILLAGE OWNER ' c DATE OF INSPECTION:A FOUNDATIONS FRAME INSULATION s FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL" GAS: ROUGH.` FINAL FINAL BUILDING r DATE CLOSED OUT a ASSOCIATION PLAN NO. i,A i Town of Barnstable Regulatory Services BAMSrABLE. " , Thomas F.Geiler,Director 9`bA,E a`0� 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: Ale-25 f Estimated Cost d 35;and Address of Work: // 4�_17 LI: f-719 4.It Owner's Name: a27/Ln/1 i rlemz y< Date of Application: 7�S�Z I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: / <-C -f,,, b arc 9�e��/ ✓G—. 1 3z 3 7 2- Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav . The Corrimonwealth of Massachusetts . --�- ,Department of Industrial Accidents =- Office ollnyestigadans . = - 600 Washington Street Boston,Mass. 02111 `3 Workers' Compensation Insurance Affidavit - location: ' . •-• - , hone# ❑ •I am a homeowner performing all work myself ❑ I am a sole r rietor and have no one workin in ca aci�p a sal %/%%/%////%///% % I /%%//%G%/e///S//w%////////////g/%%%%%/t///////��% I5 com ellSation"for my r� y 4} •YS.Kb:?+?li'+%Y•'"t%w}y :}:•}:{\:kv4•h },: :4 1: worke n•.v.4.,•: r>:t4{n o}t4::i 't::, #;:f::• <::?'t `•}.:}<:L:4..4x-:d:x.}w}':•';$?`r,.•:;;+,. 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FaIIure{a secure eovera=e aY requiredander Section25Abf MGL 152 canleadto theimposition of erlminom as ay of a ftnenp to 51en0.00 and/or one years+tmprisomnent as weA as civilpenalties th Otnce of Inn of, SrO of the DIA i IZR coverage vm of$10n00 a day agaiiut ma I�der� t a' copy of thi+statementmay be rorwaraea I as her17-eby�ethe�aiits - enalties-of-perjury th�the-informaliatt-pravadedabnve is�rrarid cairect Date Sigaattue r�.r .. .•:....r ���`'� :Phone# 7�1 -9�'2 -0a 2 Z pr t name' �f�9/u4J C� . omcial we only do not write in this area to be completed by city or town offidal "permitliicense# • QBuilding Department dty or town: ❑Licensing Board 08dectrnen's Office ❑checkif immediate response is required s ❑HeslfhDepartment ri c phone#; Other contactperson: r r..�iuA 9/95 P1A1 - ' .1n-formation 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 thanthree 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. er'152 section 25 also states that every state orRlocal licensing agency shall withhold the issuance brfenewal MGL chapt ' 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 performan ce of public work uutd acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. VIA Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and phone numbers along with a certificate of insurance as all affidavits may be �ply�g company names, address and 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`haw",off yQu ed,to obtain.a workers' compensation policy please callthe Depaitaierit afthe number listed below:. are requii City or.Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ofie affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please 'cense number whichill. e u wed as a reference number. lfiie affidavits racy lie'r t�',. be sure,to fill in the.permrtth .. - :; theDepartment by .9r...FAX iinles s other arrangements have been iriade. l ;• , ti _.,.,,.• The Office of Investigations would like to thank you in advance for you cooperation and should you have any�uestions, . .. ..�.a• . . .. please do not hesitate to give:us'a'call. The Department's address,telephone and fax number. :7 t'• The•Commonwealth Of Massachusetts ._Department of Industrial Accidents Office of investlgatlons 600 Washington Street , Boston,Ma. 02111 fan 0: (617) 727-7749 : phone#: (617) 727-4900 eat. 406, 409 or 375 _ RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 - Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE i square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>12.0 sq.f4 >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >150 sf- 1000 sf 75.00 >1000 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (mmnber) Deck x$30.00= (mnnber) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 - Relocation/Moving $150.00 (plus above if applicable) Permit Fee Pmjcost I • Tabls,1S3.Ih(masslaard) S P►iti�Vona Fads p}flcripttre Pseka�t for aad Tws•F��'Rs:�da: a18a33dlag MAxiMUM WNW sisb g Gl g . GLriag Cs'i1ia� w u em ' Flom Baaccd a,� Arras(%) U-rslucl R-valued R-vsiva Rrvsiw� wau ptdmcw F!E sml 5701 io 6500 Hester Des*Ds� ' 6 Nash lS 19 10 . Normal Q 12,d 0.40 3E !y 10 6 g i1'/: om 30 19 6 iS AFVE 19 (0 ' Norte g t2% 0-50 3E 13 N/A Wt T 3E !0 6 Normal l9. 19 .25AFVE U .15•/. v.4a 3i WA 13 u WA 3a as ARM v 1S'/. 0.4.4 6 a 15Y. 0-52 30 19 14 10 WA Norsaal 0.32. '31 13 13 WA Normal WA 0.42 3E 19 2S 1WA 90 ARM 13 I9 10 6 y lE•/. . OAX 3i 6 90 AFUE AA lEY. 0-50 30 l9 19 . 10 1'. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL FOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4, %GLAZING AREA(#3 DIVIDED BY#2): 5:'SELECT PACKAGE(Q—AA-see chart above):: DETERMININGODS OF ENERGY'REQUTAEMENTS NOTE: *OTHER MORE INVOLVEDASK US FOR;THIS II�FORMA ARE AVAILABLE. BUILDING INSPECTOR APPROVAL: YES: NO: g4orrns-5 803 03 a it Footnote's to Table•J5.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass'doorso skylights, and baserrient windows if located in walls that enclose conditioned saw mays X�lud d frotn the U-value requirement. area. expressed as a percentage. Up to 1/o of the total glazing with.300 ftz of lazing area. For example;3 ftl of decorative glass may be excluded from a building design €. = After January 1, 1999, glazing U-values'must be tested and documented by the manufacturer in accordance with the Naiional' Fenestration Rating Council (NFRC) test procedure, or'takea'from Table 11.5.3a. U-values are for whole units:•center-of-glass U-values cannot be used. The ceiling R-values do not assume a raised or oversized truss ccnstnicton. If the insulation achie -39 ves the full insulation thickness. over the exterior walls without eomprmsio R-.3�-c0insulation umay be substituted for of cavity insulation and R-38 insulation may be subsd). Fo for R-49 insulation.deiliiasuIatmg sheathing-must be placed between insulation plus insulating sheathing (If.used). For.ventilated ceilings,. the conditioned space and-the ventilated portion of the.roof. sheathing ( used ). Do not include Wall R-values represent the stun of the wall eavity.insulatioa plus insulating exterior siding, structural Sheathing, and interior"drywall.For example,an R-19 rzQtttrement could be met EITHER by R-19 cavity insulation OR R-13'caviry insulation plus R-6 insulating she�Wg- W� requirements apply to wood-frame or mass(concrete,masonry,log)wall construtctidas.,but do not apply to metal=frame construction. as The floor•requirements apply to floors"ovu.ch unconditioned crawlspaces,basements, er unconditioned spacts(s or garages).Floors over outside air must meet the ceiling requirements. 6 T"re entire opaque portion of any individual basement wall with an average depth 1's the 50%be.doors cf conadeditioned d' must me=t the same R-value requirement•as above-grade walls. yV'uadow5 and sliding gl b�,,ernents must be included with the other glazing. Basement doors must meet the door L1-value requirement d-scribed in Note b. The R-value requirements are for unheated slabs,Add an additional R 2 for heated slabs. If the building utilizes elet:ttic resistance heating use compliance approach 3;4, or S. if you plan to install more than one piece-of heating equipment or more*than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For"Heating Degree Day requirements of the closest city or town see Table 75.Z.1a. NOTES: a) Glazing areas and U-values are maximum acceptable. Insulation R values are minimum acceptable levels. Cmen R-value requirements are for insulation envelo a must have a U-value no greater=thaa 0.15 Door U-values must be tested b) Opaque doors in the building envelope ccdure or taken from the door U value and documented by the manufacturer is•accordance with U-value rating r that door u not available, include the in Table 11.5.3b. If a door contains glass and as aggreg. ue door U-value to determine compliance of the door.' glass area of the door with your windows and use the opaq One door may be excluded from this requirement"(i,e.,may have a U-value greater than 035). eas c) If a ceiling,wth all, floor,basement wall,slab-edge,or crawl space�'i' component raagne R valua s greater than o two or more rrequals o different insulation levels, the•component complies if the am-weighted the R-value requirement for that component. Glazing or door components comply if the area-weighted,average U- value of all windows or doors is less than or equal to the U-value requirement(0,35 for doors). .' - 43 i Board of Building Regulations and Standards HOME iM!RO-VEMENT CONTRACTOR Reais;ra€ionra;32372 l xPiWI-0,,,:f041l:7/2003 PAU'',DAVIS RESTO.RATIO!}!OF.T CHARLES 29.LISERTY.SQUARt"'-' ." P,OCKLMD,MA 02370 Administrator . 11 ` ' � ✓fee{p ,00u�r-arc o�.�/faaaacaicaP.C�a . BOARD OF BUIL-DIN"G REGULATIONS License: CONSTRUCTION SUPERVISOR j Nurn'iSeICS 065291 j ' BirMft—"./1952 1 re. 3_/ 04 Tt:no: 16423 1 Rarer Ct•iAF2L'ES C DENf � 119 BOARDMAN MELROSE. MA 0. . • ... Administrator i I Application to 9[b Ritttg'o Agigbbiaip Regionat 3bis'tDriL �Biotrirt Committee In the Town of Barnstable 2 o a 21 1.44 CERTIFICATE OF APPROPRIATENESS 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 R Addition ® Alteration . Indicate type of building: 0 House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole Q Other NAIJOIC�10 f�cc9sg X*M10 Z),'CX TYPE OR PRINT LEGIBLY: DATE 91—loo2 ADDRESS OF PROPOSED WORK /w t/o/ifS i L,q17 Ifn0E- ASSESSOR'S MAP NO. %v OWNER R Er A)r r Ylyl-v€ter ASSESSOR'S LOT NO. 'Yo HOME ADDRESS 16 /�orlr.�i d/+.� �.ov� (.y. l�otnu�re�i.r /�f� TELEPHONE NO. QS--3 2 -7~1S01 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR 4Qi4/1 TELEPHONE NO. %S'/-` -2- 0622- ADDRESS 37 9 Lai, .4'i/tie; S'u t rz ;?Q-3 PocwGfw» Mg o 2 3/0 DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include(( locations of proposed signs. �� C3) £�/tr:•1S ✓7�t /fgrrc� /� lr^en� /L���z (7UZ�l� /►OY�, I�Y.PIac¢ ;tr lTl�/ !!G=NG+i �JIfLS NLr'rfJ, Y79r�f1 I (�� T(-f.:Rr.A •'!24 F L2� �GI D17 q r / lr£S$A2? 7r�6�117Er: UJDOJ. /lrf/7J9/�nU /�E•V��/WUaD �oU(a�, .1 NSr/t�t� F{sYND.cgp /}�`r-u �8h� Signe Owner-Contractor-Agent For Committee Use Only a This Certificate is hereby Date -/v-u Z R EC / D Approved/De'ied JUN 18 2002 Committee Members' Signatures: TOWN OF BARNSTABLE HISTORIC PRESERVATION DIV. Town of Barnstable ' Old King's Highway Historic District Committee SPEC SHEET 00 2• 1 �} FOUNDATION SIDING TYPE 'Xis T:kt, -I/r/F i COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOWS COLOR SIZE TRIM COLOR Ar.;tYc�.sanl f�'�. (aUG� v2- DOORS COLORS f'e-r tawr wH Tt SHUTTERS COLORS GUTTERS COLORS W;pL �7 DECKS A•ccus (LAne MATERIALS 19rf:5us r %Rsl'i uD 006d pa" GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS r. FENCE 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 plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 gZ d. s u[ LF 1 1 i 4r W S ..o-.oz I I Z g o � l a E3 73 m m r M O O - Z Z e i o � � C) v ITI 713 D FTi 73 rn ' rn o - z J'r► OF THE T°� Town of Barnstable *P Expires 6 nronihs jro tr issrtr do Regulatory Services Fee BARNSTABLE, Q MASS. Thomas F. Geiler, Director l7 i639• �� ArFD MAy A Building ]division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Vnfid without Red X-Press Imprint k1ap/parccl Number..-... Q� 1 Property Address _� � �ITT A4 L.an1 Residential Value of Work Q Q()ID, �'� Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address k — BZ )84! k-,A.2b_[1 (Jdc-WT &A P-1, 5 /I Contractor's Name_ Telephone Number I Ionic Improvement Contractor License# (if applicable) _ Construction Supervisor's License d (if applicable) ❑Workman's Compensation Insurance ESS �" I' Check one: o�� ❑ I•am a sole proprietor M�Y �OOg 9.1 am the Homeowner ❑ I have Worker's Compensation Insurance B ' NSTABLF- TO\N►� 0F AR Insurance Company Name Workman's Comp. Policy 9 Copy of Insurance Compliance-Certificate must be on tile. Permit Request (check box) 1[N Re-roof(stripping old shingles) All construction debris will be taken to AkotOONT ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) 'Wheie required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. I'I•II.I:S':I ORMS\huilding permit forms\EXPRESS.doc Revised 100608 r- The Commonwealth of Massachusetts 02. Department oflndustrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �i1imom2 2,9,4 Address: City/State/Zip:1)j&AjAxZp Phone.#: 211 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction 2:El I am a sole proprietor or partner-' listed on the attached sheet. 7. .❑ Remodeling ship and have no employees These sub-contractors have g. '❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'-comp.-insurance comp. insurance.x required_] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI 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 fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employecs,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. 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 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 certify under the pains-and penalties of perjury that the information provided above is true and correct. Signature: 4 Date: O Phone#: Official use only. Do not write in this area,to be completed by city or town offtciaL 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more - ofthe foregoing engag in acorn ,enterpr2s`e;and rnelucirn8 the legal-represenfative§�f- deceased• i receiver or trustee of an individual,partnership, association or other legal entity, employing employees: However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public woric until acceptable cvidenee of compliance -Nzth the insurance requirements of this chapter have been presented to the contracting authority.' Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and.phone number(s) along with their certificate(s) of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials I • Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom -__.�_______ ._ cn .�_ ..> to Contact•nn rvoarA;na the annlirart, UL WC alllllaVll LUl you w uu uu/w w0 ovens w�.vu.w va ua.wub...•+ -- �-- Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would 117ce to.thank you in advance for your cooperation and should you have any questions, please do not hesitate tc give us a call The Department's address, telephone-and fax number: The Commonwealth of MassachusCUS Department of ln.dustrial Accidents Office of Iayestigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext•406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass_gov/dia DATE(MM ACORDM CERTIFICATE OF LIABILITY INSURANCE 04/21/2009) PRO-QUCE i,(508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION r' Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 43r�State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Gallagher Shields Building Co Inc. INSURERA: Central Insurance Companies 20230 1694 Falmouth Road #135 INSURERB: Merchants Insurance Group Centerville, MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM/DDIYYI GENERAL LIABILITY CLP7997489 07/08/2008 07/08/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS MADE M OCCUR MED EXP(Any one person) $ 5 000 A PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY 7AM0277013965 01/05/2009 01/05/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) B HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC799749012 07/08/2008 07/08/2009 X WC SLIMJT O7H- EMPLOYERS'LIABILITY IT RYE.L.EACH ACCIDENT $ 100 000 A ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Karen Bernier ACORD 25(2001/08) ©ACORD CORPORATION 1988 Town of Barnstable - Regulatory Services EA LF— Thomas F. Geiler,Director 'MA-95L sb Building Division 5q `0� �PlfD Tom Perry,Building Commissioner 200-Mairi.Street�Hya nis,M 026,01 www.town.barnst-able-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOi EOWNER LICENSE EXEMPTION Please Print DATE.- JOB LOCATION: f Cv �.�u. �r•+/kn t� �'l�R.✓S`�Ar�4/c" 4a lflf ��� pp number nn street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: eityhowo state np code The ctzrrent 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 HOMEO�i'NER 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 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 buildine permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,Hiles and regulations. The undersigned."homeowner;'certifies that-ha/she understands the Town of Barastable,Building Departinent 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 borrieowner performing work for which a building permit is required shall be cxcrrrpi from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner crigages a person(s)for hire to do such work that such Homeowner shall act as supervisor. Many homeowners who use this exeu'Ptim are unaware that they arc assuming the responsibilities of a supervisor(see Appaidix Q, Rules&Regulations for Licensing Conatructian Supervisors,Section 2.15) This lack of awarrncss ofleri=ul(s in serious problems,particularly when the homeowner hirrs unlicensed persons In this case,our Board cannot proomd against the unlicensed person as it Krould with n licensed supervisor. The homeowner acting is Suloc visor is ultimately responsible. To ensure that the homeowner is fully swam of his/her responsibilities,many communities require,as part of the permit application, that the homeowner ea-tify that hc1she undcmtffiidt the rtsponssibilities of a Supervisor. On the last page of this issue is a form currently used by sevual towns. You may can t amrnd and adopt such a fomileertifieation.for use in your community. Q:forms:homccxcrnpt 'EKE r, ti Town of Barnstable ° Regulatory Services Thomas F. Geller.,Director �fo � Building Division Tom Perry, Building Commissioner 260 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act oa 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. n.eno +c.ncr nrcv ovo nrcrnwr IRE►o The Town of Barnstable BA LE,MAS& Department of Health Safety and Environmental Services MASS g s639• �0 prED,AP�� 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 1% 14 /J G /< Location /6 11 onn rST"s,4 LN Permit Number / Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Af S/7 ictt �Al 7 e o /t /t T vkw e'�l 4 S i✓a. 7— T-o C VA7 L/ k />" CWTc-A/i,v Tip, s i.s i�✓ ^-7 4 19 C C f S Cody' i3c o/c Please call: 508-862-40 8 9for re-inspection. Inspected by Date /�J �o't /G oZ TOWN OF BARNSTABLE Permit No. e Building Inspector Cash ---� mod �ejp`, •'+O M►Y�'` OCCUPANCY PERMIT Bond n "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address `7y l��G '- 1 �� 1-.Qr;.art� f,am �v )_ot i� Hcncstead La. . _Z.rTu Wiring Inspector 1 _ i.,�i'i Inspection date , Plumbing Inspector/( r .Z ( V ' ? Inspection date �! Gas Inspector Inspection date /Engineering Department xj� Inspection date 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. .................. �... ....._, _ .................. ....Bizilding..Inspector v s5essor'5 map and lot number I L THE Sewage Permit number .................. 40---M I STAXLE, House number IL we 39- 0 MAX MATH TITLE 6 ANT) TOWN OF B A R N L COOF BUILDING INSPECTOR APPLICATION FOR PERM IfJO • ......P...14" T/ � ..�5 err .......................... ......... TYPEOF CONSTRUCTION ... ........................................................................................ ..................... .... 19.7? TO THE INSPECTOR OF BUILDINGS: � The undersigned hereby applies for a permit a ccording to the following information: Location c4,0.* -y?.:-.f=.....�....... ...... ............................. Proposed Use ..........S./ .Ae....... ........... ....................................................................... Zoning District ......... ....................................................Fire District ......01.......................................................... Name of Owner ......./-/2,-r-Y.-OV. ...........Address ...... Name of Builder ....... . ...............Address 7....... PAL d ic, Fa I, Name of Architect .....C.,V....... .......................Address Mal . 1 / . ..... .... ........... Number of Rooms .........J� .....................................................Foundation .......0!....... ................................... Exterior ........V1. ........ .....................................Roofing ............ .............................................. Floors ............../.....................................................................Interior ......?�-IAW,-,-Ar.......................................................... Heating .. . . qail - H& � - a - .......... ............................ . ...... .......................................... Fireplace .... ....................................................................Approximate Cost ........ ..................................... Definitive Plan Approved by Planning Board ----------------------------- Area ............. 2-S Diagram of Lot and Building with Dimensions Fee / ............................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re9 rd*ng the above construction. /� Name ... ................... .... .... . ...... ......... ............... ....... . tNoaTvey, Bernard A=109-80355...... Permit for .. e--&tory•dwel•ling ............................................................................... 'r Location ....1Qt. i .16••Home&tead••l,a: .................West..Barasta.ble............................. Owner ..........Bernard-Harvey......................... Type of Construction ............. o Cd..Frame....... % Plot ............................ Lot ......... �., ......... r> Permit Granted ...................J.une. J..: )9 79 Date of Inspection ......... ......................!..;.19 := Date Completed .....�....... -......,19 � PERMIT REFUSED #n ........ .. ....................... ... 19 .; !' �' ram. .:i ��: �r � ,'�� � r��•. ... . \r. . ............................... Approv .................... .: . ..... 19 ' n " ` .. / r � r r i ............................................................................... .I � ........................C 13AUSTABU. Engineering'Department (3rd floor): 039. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00. P.M. only BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Name of Owner Name of Builder 9.0. � Name of Architect ----------------------Ad6ress ------------------_^___^___,~ ^ Number of Rooms ----------------------Foun6ohon ------------------________ Y ,Ex/e,ior ----------------------------RooGng ----------__________________ ` Floors . ---------------------------|n�e,io, --------___________ . r � --------. Heating ---------------------------.P|vm6ing ----' ----_________________� � ' / � / �' � Fireplace ----------_----------------.App,uximo�� Co� �y'x��/��/L�'/�—��--__________. ^ � ' ' . ` -Definitive Plan Approved 6v Planning Boon] ---'--------_-_'lV' . Aus, ' | ' -_- -------------- � Diognznn of Lot and Building witk`Dimensions ' Fee _______________ ' i SUBJECT TO APPROVAL OF. BOARD OF HEALTH ~ � » . . ' n� \ . - . . . � ^, . . /' ~ . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS - ' | hereby agree to conform to all the Rules, and Regulations o; the Town of 8a,nsto6(e regor6in"g the above construction. . ` . . ' l�Nom�,��������� /�L � . ^.^—^—~°^ ---.. � \ _ -- . y ^ Construction 3upe,'viso/, License ------------ ' HARVEY, BERNARD R. & RUTHANNAf A=109-080 'No . 31737 Permit for .,Install Swimming Pool Single Family Dwelling.. . Location 16 Homestead Lane ........................ West Barnstable Owner ...Bernard. R... &. Ruthanna..Harvey Type of.Construction ...........Frame............... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....March_...24.r............19 88 Date of Inspection ....................................19 Date Completed ......................................19 o . i ti /r".. . -mod. . J Assessors map and lot numbef ......... ,�......,.. ... � pC�_ 5 �// —7Q of to ?11 E Sewage Permit number !�? ...2. �.� ......;......................... BARNSTABLE, i House number ...:............................................ (f v0 0�. ae Oo,1639• 9 'Ea MIR TOWN OF ,BARNSTABLE BUILDING INSPECTOR APPLICATION FOR. PERMIT TO ......[............................................ TYPE OF CONSTRUCTION ... ...........................................:............................................ ......................�/! ...... ..19.2 Y TO THE INSPECTOR OF BUILDINGS: } The undersigned hereby applies for a permit according to the following information: / �✓ Location ....................�....�.....�:�:.......r.T......v'.. .. .a'xt:c.-5:..F...........:................................................... ProposedUse ..........5/..Viz.9.,. ......................... .. ................. ................................................................. Zoning District .... .........................................................Fire District ......!�`..:..�........................................ Name of Owner ,� a . •.. N2�. v-... ...........Address L�r...� 07'/S r'1 la Name 9 �- ??..................................... .............. �2� /-e � '� �''e 2 CO2sT Name of Builder .f .n.l� •� / .......:Address ' Name of Architect �� S.P.G h.?^........................Address .m /......8a �-/fin o6, .................... ' Number of Rooms OG�' ". .........�.....................................•................Foundation .......!��....�..........................: �i............................ Exterior .......V�.'yl..v / �� /...................................Roofing ............ 1.!.... .(1., .. ....................................... 1 �. .........W. ....r..... � t Floors ....................................................Interior .....5 ..E:. .......................................................... .. ...... �G. ..� ....Plumbing ....` -.�"�..'.: .'4.`.� ::............................................. Fireplace ... ....................................................................Approximate Cost ........l.a: Definitive Plan Approved by Planning Board --------------------_-----------19________ . Area Diagram of Lot and Building with Dimensions Fee �--� SUBJECT TO APPROVAL OF BOARD OF HEALTH 4A�oJl. S /i I hereby agree-to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..................... ....... .................. . Harvey, Bernard A=10,9-80^ - No71355--. Permit for ..one'`mtocy'-dvell-' ----~.-------...------------.. � ` Location Lot..#. 86 ., ~=S= =*c]M ' ' ' . ^ uvvnc, �»ereareHa ` . ' ' ~ Type of Construction ~ . � ~~- � ` rm/ ` -[ . ' ' . . ^ . . Permit" " Granted Date of | - ' ~ °"'= ^" ^p'~'~" p . ^ RMI REF SD _ - � . . � lV ��� . ` . �. . \ / ~ ' -x.a---�f. 'f-.. -----------' � / ./ � -.------.. -----.-.--------.. � -------- ................................................... ----.---.. .-~.------.-------.. ' t- ^ Approved ..........................................--- lA . . ~~ / ^ . . ----.--.------.-----------.-. . ' ' ---...------.-------------..��.. ` {1 I f J r 7 7� j 4 ' 4 } A S , ever I r PP I a!"NAO T 1 o_;vf • r \ �9 Application to ' ♦ 0P C�6�MPP f�5 . Old Kin g's Highway.Regional Historic District Committee G--� 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: ❑ New Building ❑ Addition ❑ Alteration S 4"'. A Indicate type of building: ❑ House ❑ Garage ❑ Commercial JZ Other_ 4o 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 j6' DATE. ADDRESS OF PROPOSED WORK W 1:.57— /RA-xj,us ASSESSORS MAP.-ND. . OWNER bF_ p,�/;4�P►7 �,�- G�i/7�/� �' is�/ 1141/1 R V1- U ASSESSORS LOT N0. ' D S�D HOME ADDRESS A,lVo,*11,r_�S LZA17 'Z/1 {.r> _ TEL. NO.. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). 19a a t; T A_ ��,a_>. y� S'�o/-f� 'T0/-/_ _ 4'%'0AU U) Gs %WrS r ,f/ 5 i 4) Al S%f-4- Z20/t/ S'�� , ►'✓A'y 5�% J7'sT AGENT OR:CONTRACTOR 6 02! /_'S TEL. NO. _��5�� '��� •7 ADDRESS 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 sheet, if necessary). _X' U tip? - . r�1 G t u ff Port/ // _ Gv Signed Owner-Contractor-Agent Space below line for Committee use. Received by H.D..C. Date The Certificate is hereby Date 3 " /dor Ti me B Approved - IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ - s r Assessor's offioe Ost floor): Assessor's map and lot number ....... . �,�,,, • t"'�SYSM MUST R Quo or` Board of Health (3rd floor): 2�L� TALLED IN COMPLIA�I w � wage Permit number ...............�........................ ..... WITH TITLE 5 Z BABd9?SBLL, i AGL Engineering Department (3rd floor): NVIRONMENTAL CODE AN Mb 9- ... House number ................................... .................................. TOWN REGULATIONS �0�av d• APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only ��Q.L TORN OF B ARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... �..1 -....... 59.... ................... TYPE OF CONSTRUCTION ..... ........( .. . ..... . . .. ..................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..(...`®..../.../ ./j"I.[....S.T ... /V ........I,etl) .5............R/9 -1......./�'1*'........... ProposedUse ....r..... ,/...........L)..S.. .................................................................................................................. Zoning District .......... .. ......�...............................................Fire District ...W.- .tS..T....... ..1 A. IV .S..T..f )a. ...f...... Name of Owner .r. .N . . ..i'�.� . vrr�ANN ...J'I.... d s ...�. ..1. ..a.�r..! s..r/-�r�.. 9-�r:................ Name of Builder p.L t.. ?14.�1/...,p.d..O..�:S.....................Address Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................Plumbing ................. Fireplace ..................................................................................Approximate Cost .. ..l..l..f S. IJ... ...................................... Definitive Plan Approved by Planning Board --------------------------------19-------- • Area ........ Diagram of Lot and Building with Dimensions ��. Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. J�-Nam Y.l... .. ........ .......... r Construction Supervisor's License .................................... HARVEY, BERNARD R. & RUTHANNA No, Permit for ...jXjqtc-Ajj...aWijgning Pool Sincile Family DwelliT�g............ ........................................................ Location 16 Homestead Lane................................................................ West Barnstable .....................................................:......................... ' Bernard R. *& Ruthanna Harvev Owner .................................................................. Type of Construction ......Frame ........................... ....... . ............................................................................... Plot ............................. Lot ................................ Permit Granted ...March..24.,.............19 88 Date of Inspection ....................................19 Date Completed .......... 19 n M � �' L7 i4--7',-._•.._ _,, ...., - _ -._... -- _ _____ _ -._ -_ ----- -__._ _ ___. -_ - ---- - .. .. .. s - I s 9 4;-7>-e,f� P'F' 95.00 / , TYPICAL SYSTEM PROFILE ! - A R E A t1 PLAN �� FDN TOPS FINISH GRADE= bt' NOT TO SCALE f SCALE : I = � oF Nn c 94.Qb FINISH GRADE OVER TANK= 9_O0 FINISH -��•��I GRADE, OVER PIT-_____ _ q9 , wP��G� LOT -# .84 HOMESTEAD - LN.-CEDAR S T. _ Charles D. N o p No. 7468 'y I �+�� I PVC OR O O 1 • • • • • 1 1 1 ' e A�!'�STER��C�z �C. I TEES b? 90.33 1 0 • • • • 1 .'• 1 0 ,` �FfJS NAB SMT U.S �� • • • ° Tk'A �. Y E�/Y, yV' TAN S`T"AF3 1OC� , 9o•s ;4 o .': o e. '�..' a... • - - 1 • 1 1 • • .6 1 1 • 1 1 . . �4' REINFORCED DL . DIST. BOX • O,T , • . e • • • t ` 4�� • R C 8' • . 90.2 . EtE T -1r-',-rr":1,5�QRMFER . CONCRETE SE j� ONC TO BE INSTALLED ON -I L___,�z, g:\ {„{, LOT V ` •. o L LE BA CDNC ''M'PAD 0 AS5VMEP ° o ....: • 1 a e 1 • • ° 1 e�'���A . o... , yh 1 R� L.1"a�.. Vt�tO. . 1 1 1 . • 0 • • . 1 1 _+ 0 .0 o : ,. I 4 32 12 `- g 11111111110 11 ."»6.3I._; SEPTIC TAN K I : ` 1 t :�`/ s i . 97.t _ - ,~ , .. ,.- . . i I .,., . 9 Y I ,. - . °lo - EVEL STABLE 6ASE TO BE INSTALLED ON A - 0 , • } F - • ,fit. LOT. 8 -I - r - 2 /8 /2 WASHED PEASTONE ALL 11 . +'fib.t!a 2 " 1 . . - 7 BRICK &..MORTAR COURSES AS . ,. • . • e • • • 'a • i S I .1 AROUND FREE OF IRONS FINES 1 ►: ,: I .1 AND OUST iN PLACE Y �J : f. - •., e-... I '' 8 ti" . , _ ...: _. <, _ TO it � - 1� LEACHINGPIT �•� •' 3 4 TO I-12 W A,.. ' 81 �1b1, I -, / ,; I :, FR E E DETAIL STONE ALL AROUND EE OF EVEL 1j]�� ' - 24 C (. MANHOLE COVER � SHED CRUSHED �- . ; �; d.' � , t AREA; R t~'. 5 1 +95- IRONS, FINES AND DUST IN . ice. . . , - . , �K RE D �j 1. - AM SE BASE TO. BE L t _ ;;,. . - ' - , f� PLACE t,,D .a a K 1At FOR FIN. GRADE ts. . .�,,wrn .. � . � _ .A -: . gt'(' CA1JC2IiTE .. <„�, w- '�< L SYSTEM PROFILE ��t�--111�: . ,� . y}. _ SEE S 01 L A D P R S I b E Si�tAt.:1C; <. . - _ � Pia �.k N E CO L.AT, O N •:,r�Pd DATA .95 [3. 1-a :... _ _ � , ':,.;. ,• ti P` a g77 Z tA'S�",.+Ca>".tC 'T +85. q' _ PERC. RATE. q MtN./rN -� I. X,;"-,�� a,; ,. �,,. e l ICI ;T -ti• 11 ° SU � It=A, ac .P F R I V I <, " b t , G Q :d�- 4 .•' . 0 N .ELEV-SEE� 5 ... . INLET ° ° ' SYSTEM PROFILE �1 . ' TAKEN BY :A '"' " '., F:Rati1T� p - , IQD," t AN ':JGNIS .45*3 4` � : - @`��• A 1�, . 10-0 �-� OETAiL` - 4�6F.I I-V LINE ' _ � �6 _` ° MR.�uL MC3RRA`l� �G.:t�,'t• , - t �••i / •° ^ I - o OPENINGS W/4-1/81ti - WITNESSED BY: 'rat. ` "1,r� o uE•A :�rrt EICI ST, BEQ14 .,; - - ,p z .0 � � . _ _ Igo „ DATE: 2.3 OCT 1 `7P, . I 4 _ r - .` d� i OUT R DIA. & 3 0 V - %� 0 C� (4 7� , - , ' , o INSIDE DIA. e TEST PIT-GND ELEV..+87..74, i W P 45, .�; .. hl-Uht.,� , ,6 '. ° 0 TOTAL o o ,°' - `'' z I . �.-ti -f'� y, I tA' B5MT_.,AkF) ,- ° _ a o o � 3 11 , , � ti� AREA , - ,e .,- TOp Sort_ s..s. L, Q 0 , , . 0 0 0 , , N�. RlJSI' L DGF 93 0 _ 'o I �' o H t~^V-,r -RO C IG. , .. :t " -11�.�o G\�, Ga•t ° o o a Z$5 o 0 0 ° - : `` 2t coMPact .Ft E a WATF-0- 0 y { LOT t 4 w �p� 0 0 0 0 51 �R I � ` . . j = . %7;Od . - o o a , f .. 0 �, SI�tA�L ST4Al� , 1. _ I t. ,ems -,i n_ +7b 3� .a• o 0 0 0 � ti I i. J x: 2 z ,;,; } , 0 T. ., 1 .,1 F E CTi V E D I A. 11.0' BOT. PERC. HOLE . W ,� , - s (� h E F FIRM �IpN`E To �^' _ f�- , X 10 , O r t _ MEO.CLI=AAt �tfYV `DOWN �\J , ,L WA ' :4 '`' : w z LEACHING PIT SECTION 1 . . " , �, Q v . . _ NO SCALE DESIGNDATA" .. , -bi Q r , : . ,< :. tom. . I. 1. F - 1 DES G : - . -4 : ' - NOTE. DO NOT. RUN HEAVY EQUIPMENT OVER- SYSTEM - 13 : . - � ; rA+ '� i.XI N0. OF BEDROOMS t. ,L__ . - r. . '�/ .' ,.- . G DISPOSAL v . ' tt� L v �:. .- . .r �, , y r P- � EST. TOTAL DAILY EFFLU 11 ENT�_GALS. \,, M N.B _ GAS LEACHING PIT NOTES. 15T . : :I , < - Im Lt,GHT CO,, a .28 'DAYS . SEPTIC 7AN K f A GAL , f .,.: � - ..,- / E14000�P�Si ' ' t ' CONC TO 8 fit"' , I,� EINF. W 6 x 6 GA. . r + 1.f,. .,. . 2 R - s r- _. 6 W W M. - � ;: C� k•4 6 . : I'll REGAk �F'4 U N ID 3i 2 AND 4 SECTIONS ARE AVAILABLE FOR - :. . I \ _ GENERAL NOTES �� GREATER DEPTH REQUIREMENTS ( .-1-..t'.t camiNG. ' DP (NAG - ., 1. ,fin,• # ; Q,E7LEV.,a2.:42. ,- . ,,�„ Y I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED:IN .,, ,..>. �, 1 NOTE: ACCORDANCE WITH TITLE OF THE STATE SANITARY CODE ... - . s s <:::.. 1 :. � ,.;roc �.� . � b Q .. _ " _ � ... ... :. 8s.26-, ..': , >P3.4sa ,• s�• 4", +7 + t. . ,: �. _ , _ . _._ _ ,. �; <.: ! E XCAVATE TO'ELEV. 7 OR LOWER AS •. .,.. s. �. d_ o z . K-=.: DATED JULY i t977 & ANY>LOCAL RULES APPLICABLE:: ,. +� . . , t . ,. . 3r- ,,%".,i r _ I <r. '- "_>. REQUIRED .TO REMOVE ALL LOAM AND CLAY CONTAINING 1 . .w,.��� .t: ? - - „ . Q .. � a.� �'. , " 2. ANY CHANGE TO THIS PLAN M PP _. � ,!�- MATERIAL-BENEATH PIT. REPLACE EXCAVATED MATERIAL : r; B0 OF HEALTH AND CHARLES D. OH . 1 R D BY THE r,. . .:,. L_ t . n ::4 ,4 ,t�7�...,- �: Ip. , •� WITH CLEAN CLAY FREE GRAVEL MECHANICALLY W R _. , . _ n : :if :� � ; .,. . u.-t��' "L ` COMPACT DIN ACE 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO 13ACKFILLING, 14' -,� =r, ,;f 1 V .�fi• '" NOTIFY THE ENGINEER FOR INSPECTION. 1 r..., _a ,�.•_ ,r, � .:a., SIDE AREA F.�_S.F./GAL _GALS .. - nt:�� S. >.. , i ,.r.. ,:52 o '1 4. FOUNDATION ELEV, MUST BE CHECKED WHEN COMPLETED. ' if �='` � BOTTOM AREA- .F.@--- F. GAL GAL , . ' ,I3 �. � .. z..� .r ,_ .,, AREA A 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN ""-, •- .. ,,. TOTAL AREA = S. F TOTAL _ GAL "' >`3 5 2 z g �- , ,mot. , - «� ,tau: ; RO L Y CHARLES D. SPOHR. . ::h } -b.i„ ...,;, hc=;.'; �':,. '.fig` ,;i.'"'E,a' +• v _'.T,. '. +s: .�' ,.4 ', , ;, ys ": /� �'I- .�F-..� PACI7 F'R+C, . SUB- LEGEND 6. FOUNDATION INSPECTION RE 91 AD. WHEN EXCAVATED. t �, ?,,: e tr"m" .+eA"' c t rt +7"+v -.,,.i., dA ,,,,,,7f., p :;•,,.�_..,..a.: ,r,, - •��/'} ,/� - . 11 - _ ,. yA;'...j..•Ss!e3-r.�.. ,. ..,��, `r..v , .,..y,JBc•'^4"..„ +• kx:,' ..� �??:'y '.. - ..er -' I�/.J ! i,J _ ,) .. ._y . f .�. ! , .. � , , . t . BAI�>.� - ,. Port, s ay wp }Y , ,.T ,,5� • C.: IMF: - I I Q. -} 50.0 EXIST. GROUND ELEV. r _. ,t - '_,� . �. ` . ` 50.0' FINISH GROUND ELEV.��UNDERLINED�� .�r.>x. ...�,4. - !7QAM 9 J GN A M A ,:. 19" 50` PIPE INVERT. ELEV. REV. BATE DESCRIPTION 47 P NV V . .. . . _ _ . _- i Q TEST PIT LOCATION - DISPOSAL SYSTEM ^_ gU I LDER -- 19. . . . SEWAGE . . • } OVYNE' LF P T ( l• 1. o o SEPTIC TANK FOR , - • ' ►l�, RAKII.. S- Q_y i MR. BERNARD HAR tv1�2 •_,�E I'.IA- NA�2.`✓5Y_ '. 347... E'•ACdAS*T'�. �i1..1� ., ❑ DISTRIBUTION BOX - T-, ..IU C�"I"t : .TkA I v!>~i.Ar r . f _ _ = LOT 84.H MESTEAO LN. EDAR = S T- . . : - C. I . PIPE - OTI S .AI.1._ POYZC.E 13 F f 'v A 0 11 q ..�...��........�.. : . -r-�L; .. q.g75 r „ ,�� 1. R TRAM L 1�1- M. BARNSTABLE :MA. TEL, .5•4� . 551$ R PIP -TIGHT o ' toles D -fttHtifi}- 4 B IT. FIBER B E E G HT J OI N TS Iz SPOHR M.NOT E� I , . f `o No. ,�,fl DESIGNED: C.D.SPOHR DATE: 19;.•�yAW,19 DRAWING . NO , . -. i - - PROPERTY LINE w QF ,r, .301 a \�i�T�a�=���! - - . .9 9 - 8 .4 � rat L tl& -" t3AS 6�`; iQN :: ,15`t', I=t.: 'CTQIC. TRAII.t$KN�Nt�'Z - = ; �C:OtJGl2ETE.:,:PAD . _ 551fMDL't -`1.4C�.�gt�t - %y �F MIN. CODE DISTANCE °�fSS1oNALE DRAWN:' C.5� SCALE:ASSNOWN LOT BOOK SEC PG cHE I � I r . - . , I .1 � j ,r r 9� !, I. , . - , _ , _ . _ . ,. - , , ,t . - 4 ' t • i 19 ? -- ,�? 95 TYPICAL SYSTEM PROFILE ~ AREA PLAN TOP FINISH GRADE= o e NOT TO SCAB FDN { FINISH ° ' =)� FINISH GRADE OVER TANK= 9'` GRADE, OVER PIT= 3.oti SCALE : i 11= � � - of NASSq LOT -* 84 HOMESTEAD L N.�CEDAR S e �h� e N I _ ( SPOHIt . O r - s w PVC OR .b7 ••� . • • O -�• /� o •p No. 7468 9 I• �{ �a��•f`� .5.�• `' c �o V�2� �C. 1. TEES STE� ��?. . • - •. • :. . .. . i TRA11.- V ) EW. "- WEST IAA ` N `JTABI- fJso�n� .� BSMT�7, � '1t^3t�Q GAL: 4" - /� Q FLR.-__. DI ST. BOX LO'T- 82 REINFORCED ' ' ' ' ' ' • ' ' ' CONCRETE 811 . . . • • . . : • :+ . . TO -BE INSTALLED ON : :•.` A'LEVEL STABLE BASE • + • + .� . + ELMTR►C'.TRAVI51=0IZMER ""., ;•,.�::�.:. b •, ' :b CdNCRt=T� PAQ Q ASSUME° $.1�4. +LOT 8 RJEEfAR..Ft?UNO. . : + 1on.Cz;cy roa.ao +r� ,32 N 2? ,..:: 5`'�° ' SEPTIC ' TANK! TA • - ' r -. TO BE INSTALLED ON A • • • . i • • '• ;, + g7.1C� LEVEL-STABLE BASE qo , - - ►. • LOT# s. $� 2 I/8 I/2 WASHED PEASTONE ALL F NS, FINES , REOUIR D TO BRING OCOVER TO GRADE` PLACE . r . AROUND FREE OF IRO I _ AND tiUSTIN LEACHING 'PIT .: . • - - - (5 tom. -' • _ - 1� /4 "Tp -1�2"WA 24 C.I. MANHOLE COVER a 3 I SHED CRUSHED FRAME - SEE DETAIL STONE ALL AROUND FREE OF BASE TO. BE LEVEL - fR: t .1Tl~.�?1T .: '. +`95:�it.' IRONS, FINES AND DIJST IN « • a �► RED -..�- PLACE � . 1 ' FOR FIN. GRADE GRADE tST. 14 w[i?EIG `fINIG SEE SYSTEM PROFILEPERCOLATION `—- FIN BIT-���)c�c�(M'M , _ .� -- � I? ► „„ SOIL AND I b. T�f I.{e •. ` a? x'.coUC+ 411 DATA PSMO " - � �` �., i - t ,5 V �1,���~���••,_f�T�J:� r •. - ����. ter„ �- � ... 11 - MIN. I�N r. . $ _ . PERC. RATE. �, = . P•Jty T ;,,,�;:: V V SEE , e .44:t1V$ PIT- . L4 FOR IN ELE .AI.AN:-W.jo#JMS' 155�1AT� . set - U C��'f C� - e 11 TAKEN BY . ti `>� _ SYSTEM PROFILE = :. �� P I R Q1vi. ° 6 _ �.ww� /�nustw-A.�e•. .�. � INLET . r • . � ;, (�1~I; F.TT� t+- ♦. � 'C' �tL`+ :16t=.1 I:IE" LINE • �Sttal`Alsitss. � • ,� � • - ,° o OPENINGS W/4-I/81' ,'• WITNESSED BY' _. ,aT. 197 CIS'T', BE -" .p ,fir / a ` , • - a 1-3�4 e � 2.3 ' - DATE - - . t �• - .' OUTER OIA 8� � ♦$� Tre . ° ° INSIDE DIA. ° , , TEST PIT-GND ELEV-, L1..1 O a , C7` ht1N 7 .6 : ° TOTAL ° ° --t1 AREA ° a 3 ;e' O . TOP So 1 t_ s s. : RUST, L� _. Q = ''e .o 0 0 0 0 p 0 0 •``; = s H I~A' ROD,MC tiVT1EC. ° 20.1 S. ' COn4o;sr-t ^.,F.� _ , ,� �� �„ r ''7 0 0 ° :, ��' e• 51LTY OA&3D Lu 1 .BRA►') ° e ° .47 a , , SA�tAt-L:. St�tJtL: 1• �;4i ,Q� 6 " DIA. 2i + QO /��t� �L �� 1 BOT. PERC: .HOLE EFFECTIVE DIA A. 1=I�i'L�M•:. MITI E ,"t'�:� s Ltd tUED.CI FAN SDI D °bOWN $• t • Q �' t _ �H- LEACHING PIT SECTION } o .o ' x �Q' '�, NO SCALE �- DESIGN -DATA: 10 W `r �C' ,�� � NOTE:. DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM NO.. 'OF BEDROOMS - p v LEA�.HING PIT NOTES.C. `r: - GALS: 1. EST."TOtAL .DAILY EFFLUENT ' A �:(?, 1.. CO NC.C. TO 'BE E 4 0 00 P.S.t a .2 8 'DAYS. N K- A r ri 1Yf �D!3CIN�.ta;�w 7SEPTIC 7 ,. • � .. ;` REINF.'W 6 x. 6 . 6 GA. W.W. M. 3. Z AND 4 5ECTIONS ARE AVAILABLE OR. 1 IVD,.�. AT R PTH REQUIREMENTS RI~L#AR �FbV GRE E of GENERAL NOTES t +.'iNClUbllex. . , Dt�1AG l �:� „ : ..� _EY.. .: 1,. I .j ,;�}�; ALL SYSTEM COMPONENTS SHALL BE INSTALLED'-'IN Ct 1.3r-v-q �Iwt 'F` '' O ;' L. � ACCORDANCE WITH TITLE 5 OF. THE STATE SANITARY CODE •y;. tf .. - - +, I a �b ._5 ,,.. ' : NOT EXCAVATE Tp'ELEV. 7�: OR LOWER AS DATED JULY 1197T a A.NY LOCAL RULES APPLICABLE..' •' s N. �- [ .�; REQUIRED TO 'REMOVE ALL LOAM AND CLAY CONTAINING 2. ANY CHANGE TO THIS PLAN MU�T:BE- APPRD: BY THE` - ► MATI:RI AL- BENEATH PIT. REPLACE EXCAVATED MATERIAL :.: • _ � WITF, CLEAN,CLAY .FREE GRAVEL, MECHANICALLY HEALTH, A 9 3 BD: f HEAL AND CHARLES D. SPOHR.0 t� COMPACTED IN:::PLACE'. TED, PR LNG+_ . WHEN CONSTRUCTION 1S .COMPLE IDR Tfl'BACKI=ILL NOTIFY THE .ENGINEER FOR INSPECTION. , . 1, IDE AREA= ) 8 .� S. GAL �495 GALS . ay S S F S / _ 87 -� 4. FOUNDATION ELEV. MUST BE CHECKED WHEN 'COMPLETED. •- . BOTTOM .AREA- S.F.�_S.F./GAL-$--GALS , ►.: I 'a- ---' A : PL ' •' TOTAL AREA =2� s. F. TOTAL 582 GALS 5. THESE ELEVS. .MUST NOT BE CHANGED WITHOUT WRITTEN � ►Fi-..: APPROVAL BY CHARLES D. SPOHR. 6. FOUNDATION INSPECTION READ. WHEN EXCAVATED. p �b�' U iR����R�5� LEGEND ._ . . . • _ . l 'WZPl ����� ��� 1�_.Z3-OCT'7S + 50.0� EXIST. GROUND ELEV. 6y M , .-�•Y�fAL00 Z GR_1-;�:�• -T .1G.. 50.01 FINISH GROUND ELE V.4IUNDERLINEO'. L _�:..•�--`fir -- .�? ' REV. "DATE DESCRIPTIo,N - 47 50 PIPE INVERT. ELEV. Q TEST PIT LOCATION SEWAGE DI SROSAL SYSTEM . . BU 1 ALDER r a FOR O I.EL- o o SEPTIC TANK ►P,. ,MI�._. 5-rM MR BERNARD HARVEY M1Z •..'�i�2I XR0 HAQ.V�Y:. DISTRIBUTION BOX T. la aT s YkA I � YI 1..1.AE -_F MA `v LOT 8 ,#HOMESTEAD. LN: EDAR . T: ENST .T:A1_MdDT`14, M.A•., 4 " C. I . P 1 P E ,, �a ....�.........?.,....�...... OTC S .AIR:';.' VMCE. BASE, :M -. : [�15�6 ., �+ `J �` wh F` r TRA1 LV -�.W�-1�V. BARNSTACLE,:CIA. TEL.. 4, 1 ~. ��✓ L.r 11 �� I/ s1'0�7[S , �� tt+i-t+tt' 4 PIT.FIBER PIPE -TIGHT JOINTS oAt N� • �v p�Ho. At66 �. 1f DESIGNED: C•D-SPOHR DA7c:! DRAWING NO M NOT E , ; - -- - PROPERTY LINE z 301 99 .8 q , L.L VlEVS: 13A5 ON ,, X.15T. E�. CT 4G. fRAF.1$FO ME2 �` A•Ppf�Tfa���I,' DRAWN: C.S, scat.E:Ass++oW1J tJCRL�7)=:_PAD :@Z:_}�551;3�-�F.�7 E1. 7:_=I-!_t>D Qb' MIN. CODE .DISTANCE � fss,oNAV BOoK SEC I PG LOT CHECKED: C. D.•S . _.