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0066 KETTLEHOLE ROAD
.ry... � �.� _._.-- �n � �C � �� . y� h�l e ��, 4 ....»,r, _.., - . Oxfi r& NO.152113 ORA LMEwUSA ESSEM �-!G� e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �3 1 Map / Parcel / � Application Health Division Date Issued Z Conservation Division Application Fee Planning Dept. Permit Fee ?7� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street/Address j�4� X!5� le hale �� 1 Village r/pt;tC�,�j�� Owner ©f�9'�Lr �5 �A�?�✓ � Address ke-fle Telephone 5243-1o/V-SW7 Permit Request h1,11F hg A; �lfl,Prs Square feet: 1 st floor: existing/2 PL proposed 2nd floor: existing.R, ' proposed — Total new Zoning District Flood Plain Groundwater Overlay Project Valuation " Construction Type f Aia i5 %,y Lot Size I Grandfathered: ❑Yes R(No If yes, attach supporting documentation. Dwelling Type: Single Family Ef Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑ Er Yes No On Old King's Highway: ❑Yes U/No Basement Type: ❑ Full ❑ Crawl Vd Walkout ❑ Other Basement Finished Area (sq.ft.)i ��o Basement Unfinished Area (sq.ft)3 � Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: dGas ❑ Oil ❑ Electric ❑ Other / Central Air: R(Yes ❑ No Fireplaces: Existing 3 New Existing wood/coal stove: ❑Yes U No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: dexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# C ;v Current Use Proposed Use cx� � APPLICANT INFORMATION m (BUILDER OR HOMEOWNER) Name �O/J9la:S «/�°'�'L� Telephone Number �O�.36 /-77 Address License # ITV. &r/t�S r� , /�� ��� Home Improvement Contractor# Email CgAze,41M, Il2II-7-R,, /.1&;t_ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE LDATE I Ir FOR OFFICIAL USE ONLY } ,APPLICATION# -- t DATE ISSUED MAP/PARCEL NO. • t f ADDRESS VILLAGE OWNER. y DATE OF INSPECTION: IT - FOUNDATION w. k FRAME F , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL '• PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING { DATE-.CLOSED OUT - ASSOCIATION PLAN NO. - Y. 6a#WmbbVtQlrt,&eat Bastarj,MA 621H rves�w masmgavldia 'Wurke& Camptn safit,:>;t Insurance Affi a $-mi#dersfC�anb7a-ctars/Efectrici-m&[Kumbers _ p cmt Infformatiun Mease Frinf Iy Address: � ffe CityfStatbl7.zp: Pho..e 4: L 5,0 Are ycfn ag ez¢pioyer?Check s-ppragriate ba= T of o.e t r L❑ I am a I with. 4_.❑ I gm a goal canfractrar=d I ?'n e I t � = employer 6_ ❑�Teu� =q:51oyem(full.wworput-time-* hav* hireafhe sub-contraciDrs -2_❑ I am a sole prapiietar orpariner- Iigted on the attached shE5ef 7- 2^1�deEag ship and have m employees These sab-oontactars have g- ❑Demolition wui isg forme is any capacit r employees and have workers' 9_ g-- Building addition 6�uw ers' comp.ius uanre comp-snc v�rc I S. ❑ We area carporaticamd its I0�Electrical rapaiis or additions I IvI I am a hcrm-auwner doing aII wo& officers ha-m exercised(heir II-El Piumbing repairs or additions �t of e2x.mptioti_per M myseEf [No">< Cd='�iP- �15� §1(4),and we ham no, 12�IZsiaf repairs rn crxan r.E -I F 13-0 o ffier =P1uees-INa W0602M, comp_msurancerequ refill ib'Amy atchedksbox#lwmstalsoft01 out the sectioab9awsLncemgi eirwo&ze r9=rnssfioupoRcyirnfu t #liomeawneir v&o srbm i-,his iff m& ffa�they zm dnmg.II r try him trniDJE--coat mcmm must snhofit a nesr aigd�rit * sack --TCaaimcmrs fW rle k this box mast st,srhEd ra:ddidanal sheet shooing the awe of tl,e sulZ Bois and state orl�ther txnot i�se err ipsh ve Smslayees. If the mb{aotmdum Inve employees thV—1 pmuide tlffir wwarl�s'comp.p trlicy avmb— firm azrz uvLoJ�.thritispt rnidfsg irorkers'c-ompensat=i r zrrrnca far y etttplpyecs. Petals is fitelro8cp arrd job szts ' irt�ormQli�rt. -a _ InS�Ce Company Name: FoRcy#or Self-iris_Lich >*xpiratto>zI}ate: Job Site Address- CitgfStafelzip: At.*ach 2t rnpy of•the Mrkers'carnpensation palm declaration page(shtrtrang the polio umber and erpnation date). Failnrz to secure,coverage as regnirednuder Secfiot>25A of1GL c I52 can lead to the imposition of criminal peaafFiss of a fine up to$L500.Oa and/or one-yearimpII'mc ut,as well as cital peaal£iss in the fuffi of a STOP WORK ORDER-and a fine of up in$250.00 a day against the violator. Be advised that a cirpy of this statement maybe fm-warded to fhi-Office of IEmiesfigatiom of the DIA far i„saranw coverage vmiEcz6Dn- I do faRt a f3' c apaizis rutdpsact3;ries ofdscdwy fhatfhe f"ornztdian prmidgd abate cs hua tmd correct rt;�,At„ r9 Date Phone ik feciuI use au£,�. Dd rtat tFrii�s i�i ffus area,,rr ba eQxrpieted by�`ur folio:s�iciaL City or Towa: permiu icense# L=�r_Lutho-ritg(mcIe nuey; . . L]3aard of$ealtif 2.$mlding Dcgartm t 3.Cit.To:-% r 0=k 4_Electncal bispector S.Phmorbfng actor 6.0-ther Cotst�ct gt rsau: Phone 9z f Massaclmst�tts General Laws chapter 152 mpims aIl employers to provide workers'compmsaion for their employees. Pnrsaa a to this staten e, an errrpfoyee is defned as'_-every person in.the service of gather under any contract ofh1m, express or bmplied, oral or written." . An m player-is defiard as'an individual,partnership,association,corporation or other legal emtify,or any two or more of the foregoing engaged in a joint enterprise,and iad ding the legal representatives of a deceased employer,-or to receiver ar trastee of an individual,partnership,association or other legal entity,employing employees. I3owever the owner of a dvelli aghanse having not mare than three apartments and who resides therein,or the occupant of the dwelling house of another who maploys persons tb do mafiitenance,construction or repair work on such dweliiag house or an the grounds or bolding appurtenarn thereto sha.Il 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 contract buildings in the cornmonwm1th for any applicant who has riot produced acceptable evidence of compliance with the insurance.coverage requirzd.7' Additionally, MCTL chapter 152, §25C(7)states`Neither the commonwealth nor any of ifspolitical subdivisions shall enter into any contract for the perfoffiance of public work until acceptable evidence of compliance vrith the in sa ance requu• mts of this chapter have been presented to the contracting authority.' APPlicaats Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to ymir situation and,if n(--cessary, supply sub-contractnr(s)name(s), addresses) and phone numbers)along with their cerdificai4s) of insurance. Limited Liability Companies(LLC)or LimitedLiabiity Partnerships(LLP)withno 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 requu•ed_ De.advised that this affidavit may be submitted to the Department of Industrial Accidents far confirmation of fiigm7ance Coverage. Also be sure to sign and date the affidavit The affidavit should be mtimmed to the city or town that the application for the pemait or license is being requested, not the Deparbnent 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 . : .. Please be s�se iha the affidavit is complete and printed.legibly. The Department has provided a space of the bo.. ' of the affidavit 6r 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. In add_dom an applicant that must submit multiple pennitllicense applit adons 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 m. (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 thaf a valid affidavit is on file for future permits or licenses. Anew affidavit must be tilled out each. year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i-e, a dog license or permit to bum leaves etc.)said person is NOT re�to complete this affidavit The Office of Investigations would like to thank you in.advance for your cooperation and should you have any questions, please do aothesitate tp given§a c L The Department's address,telephone and fax number: ` aF Co Wf_Ialth of Massachus b De-paTImcat of lidi tdal A6-_idezts ��ashzn t $astjanZ IA 02111 Tf-,I.9 617 727-4 wt 466 ar 1-R7 h E. . F=# 617-727- 4-4 Revised 4-24--07 a Town of Barnstable Regulatory Services ��oE�+E roiyy Richard V.ScaIi,Director Building Division BARNSTABM ` Tom Perry,Building Commissioner hL4-1.& i639. A 200 Main Street, Hyannis,MA 02601 ��ED Mp•( www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:��Z��� JOB LOCATION:_/p� number/ stnee village "HOMEOWNER": f/OI/GLS -3(--2`31-17 fM"`f73'�/� nam f' home phone# work phone# CURRENT MAILING ADDRESS:�� 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 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 roce es requirements and that he/she will comply with said procedures and requirements. Siy&re 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 persons)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:\WPFII.ES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 �'MET° Town of Barnstable Regulatory Services r r 11" r r � 'MASS. Richard V.Scali,Director 1 39. 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 Properly Owner Must Complete and Sign This Section If Using A'Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q TORM&O WNERPERMISSIONPOOLS f 77 I. I 5F7 OF 15 Y Recessed Lighting throught finished section Doug Colwell 66 Kettlehole Road West Barnstable, MA 44' 0 0 c 5 co New Partition co • Support Column >14'7" < a Concrete Foundation Partial Concrete Wall Rigid Foam Insulation(XPS)R10 18'4" against concrete walls Finished Area 10 m x co 0 m w 10' Minimum Ceiling Height 84" c 15 accept under duct soffit 0 m x 79"from Concrete floor to co bottom of Support Beam 7' 20 36"Door Partion Built under Support Beam Minimum Ceiling Height 84" 79" Bathroom Furnace GMP100-5 Rev B Clearances 6"min.front 1"min.side 25 I j - I Bi-Fold Louvered Door Furnace HW 24" 45'8" Heater Slider 30 m ;0 _ 1 1 5'1 m Hot Water Heater BFG6140S403NOV m = Clearances 4"min.front 0"min.side 35 Slider 1 VT Partion Built under Support Beam 36"Door I I I I L I I I -- -S - - Minimum Ceiling Heigh 79"from Concrete floor to 40 + bottom of Support Beam ( 78 I 1 Electrical Panel S1 AIRS 45 1 Gar I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map D Parcel D3 1 Application #�® C Health Division Date Issued �Z 0 Conservation Division Aj Application Fee Planning Dept. Permit Fee • 73 Date Definitive Plan Approved by Planning BoardWV _ �=- Historic - OKH _ Preservation / Hyannis Project Street Address A6 X e-if le,ko Ie A-o-,&d Village Ve5't' Qp�1A� r7j{�16 I Owner oa G� !mot/ W& Address &Wkhk, 14, hl, Telephone 78`el73 -'61�' Permit Request a,11 14 reWLA1iwVq WGc�/ �G/o.SS � rr.Ar u- e-$ d-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain , Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: \❑Yes ❑ No On Old King's Highway: es ❑ No "... Basement Type: )�Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Aree((sq.ft) o Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new c�a � Total Room Count (not including baths): existing new First Floor Room Count ' � Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: A(Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name)off S Cy Telephone Number 7_5 -j!-5LIJ ' Address eha/& A©&4� License # 14/4sf g�/'�Sf bye, HY Z ,2 - 6S Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOr��//�/ SIGNATURE DATE r 4� FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED t -.v MAP/PARCEL N0. ADDRESS VILLAGE , OWNER i DATE OF INSPECTION: { FOUNDATION FRAME 0 h- 7 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ! GAS: ROUGH FINAL' d0 O FINAL BUILDING(tti ;nit _ y/��n-k1MC�1i DATE CLOSED OUT ASSOCIATION PLAN NO. ` The Commonwealth ofMassachuset7s Department of.Industrial Accidents Office of btveshgadons 600 Washington Street Boston, MA 02III Workers' Compensation �mass'govldia Applicant Information P Insurance Affidavit: Builders/Contractors/Electricians/plumbers CName (B md Please Print Le Or�ization/Individaai): Ov G � /��/w� Address: lv� K& cityistate//zip: 13�iiv57��i ��G L2DI an employer? Phone #: df ��.,- ,g,g Check the appropriate b : a employer wifh � I am a general contractor and ITPpe of project(required): loyees(�and/orpart-time).* have hired the sub-coat actors6 ❑New coast =tion a sole proprietor orpartner- listed on the attached sheet:and have no employees These sub-c 7• 0 Remodeling king for me in an c ac' nd a ve have8. ❑Demolition Y aP rt5'• etrzployeEs and have workers'workers' co mp. imstaancecomp•iasmance.# 9. ❑Building additionired.] 5Wearea corporation and its I0.❑Electrical r a homeowner doing an work officers have exercised their eP�oradditions 'L [No workers' comp. right of exemption per MGL11.❑Plumbing repturs or additins aince required.] t c. 152, §1(4), and we have no 12•El P=frmain MPlOYces• [No workers' 13.❑Other _apphmnt r-OmP• insurance required,] t��mrAwners who submit this affidavit alro�out the section below showing their wmi=,compensation policy information• tcontractml that check this box must aa=hedmad�ona s�an wow and then hire outside conhactors mast submit a new aff davit indicating such, �PloY�s If the sib-cont�ac�rs have employees they mast piv of the sub-contractors and state whether or not those entities have a'orkets'comp,policy number, Im an'PlOYer that is providing workers'compensation insurance for f my employees Below is the pofccy and joh site hmxmce Company Name: Policy#or Self-ins,Lic.# Expiration Date: Job Site Address: Attach s copy of the workers' compensation pOlicy declaration page(showingthe policy Failure to secure coverage as requtmd under Section 25A of MGL c. 152 can lea to the number and expiration date). fine up to$1;500.00 and/or one-year nnprisomnent, as well as civil m�ositibn of crmmmal peaaldes of a Of up to $250.00 a day against the violator. Be advised that a c Penatties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance cove OPY Of this statement may be forwarded to the Office Of rage verification I do hereby nder pains and enalk=o -- jPerjury that the ixforncafion pravided above is true and correct SC � tore. I?ate: Phone.# f 001dal use only. Do not write in this area to be corxpleted by city or tmm gfjzcial City or Town: Issuing Authority(circle one): PermitUcense# L Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical 6. Other Inspector 5.Plumbing Inspector Contact Person: Phone#: /Ily ' 1 . . .�'�, « .fir... \ � � • �.\ V l I Client#:46184 CENTVAU ACORD. CERTIFICATE OF LIABILITY INSURANCE r D TE""m2019rr) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Margaret Young Rogers 8<Gray Ins.-So.Dennis PHONE 508 760 4602 Fax 508 258 2102 434 Route 134 E-MAIL Ext ac,No P.O.BOX 1601 ADDRESS: youngma@rogersgray.com R D CER CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Selective Insurance CO.Of S.C. Century Vault Co dba Maki Construction INSURER B:ACE-American Insurance Compan P.0.Box 143 Selective Insurance Company of 12572 West Barnstable,MA 02668 INSURER c: P Y INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS N POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY S1880582 01/01/2011 0110112012 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea oc .CL $100,000 CLAIMS-MADE Ex�OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- F—] LOC $ C AUTOMOBILE LIABILITY A909194500 01/01/2011 0110112012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION C46392991 01/01/2011 01/01/201 X TWC ORYLI IT OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION Doug Colwell SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 66 Kettle Hole Road THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. West Barnstable,MA 02668 AUTHORIZED REPRESENTATIVE 198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S74049/M62294 MEY I HE Town of Barnstable Regulatory Services • n•R1N<T WZr Thomas F.Geiler,Director 16 . 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: J tS ho JOB LOCATION:66 Ke d le hpte o f gc�r�SrC lc A�4 number street / / p p village "HOMEOWNER": A!� �EJ�I�iP.�( 7/1-975`6, name home phone# work phone# CURRENT MAILING ADDRESS: A26/ Ke-- I kvlp jQcaj • ctty/town /� r � ®i'�_"— state zip.code The current exemption for"homeowners"was extended to include owner-occupied dwe bgs 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 iperson 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 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 inspection procedures and requirements and that he/she will comply with said procedures and requitemen . Si re 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 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 for n/certification for use in your community, Q:forms:homeexempt { • 1 Town of Barnstable t Re ato Services � . ry ervices MASSThomas F. Geiler,Director Building Division Tom Perry,Bnflding Commissioner. 200 Main Street,Hyannis,MA 02601 www-town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Property Owner Must , Complete and Sign This Section If Usi_fig A Builder as Owner of subject property, hereby authorize C� ` to act on my,behalf, in all matters relative to work a thorized by,this building emzit (Address f Jo Pool fences and alarms ar the resp nsibility of the are not to be filled before f nce is installe and ools are no to be pools utilized until all final in ections are perfo ed and accepted. Signature of Owner Signature of A he t Pp Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOL3 i east.cape engineerin& inc. 44 Route 28 P.O. Box 1525 ' CIVIL ENGINEERING Orleans, MA 02653 LAND SURVEYING WATER RESOURCES LAND COURT ENVIRONMENTAL 508-255-7120 PHONE. - SITE PLANNING SANITARY CERTIFIED.PLANS STRUCTURAL 508-255-3176 FAX WATERFRONT WEB SITE:www.eastcapeengineering.com Doug Colwell November 4,2011 66 Kettle Hole Road West Barnstable,MA 02668 RE: Retaining wall Inspection: .66 Kettle Hole Road,West Barnstable. , East Cape Engineering,Inc was contacted to inspect the existing construction of your retaining .wall system. Based on the observed topography, soil strata,as-built wall,footing and manufacturers specifications;the following items are required to ensure a stable retaining wall system. The proposed and existing sonotubes'and strip footing proposed by the contractor is benefiting_ the retaining wall due to the slope of the embankment beyond the wall,however,due to the varying finishing of the concrete and the smooth base of the precast concrete units,there is a concern of sliding based on the manufacturers design criteria. It is recommended that a concrete shear key or steel pin is used to lock the blocks to the concrete footing. (Please refer to the attached sketch SK-01). These options prevent global sliding of the wall and engage the wall to the buried substructure. This will limit the burden to the adjacent slope. The overall construction of the block wall, sub-drain and backfill is in accordance with the manufacturers specifications. It is the responsibility of the contractor to continue to install this . wall per these specifications. In addition to the reinforcements to the footing,it is imperative that the existing bank downhill of the retaining wall is stabilized and regraded so that there is no threat for erosion. Deterioration of this bank will undermine the existing/proposed wall and will result .in an overall failure. Please refer to the comments on SK-01). Upon completion of the retaining wall,there was the concern of attaching posts to support the second floor deck. ABU or ABE style post bases manufactured by Simpson Strong Tie will allow you to drill and epoxy grout or mechanically anchor the proposed posts to the cap sections of the wall. The additional load imposed by the deck structure is negligible and will have little effect,if any on the retaining wall system. Please feel free to contact me with any questions or comments that you may have. OFL:�oS K Sincerely, '- TItP,OTNY J. BRADY '4 CIVIL c1 No.3 9 Timothy J.Brady,P. ,P.L.S. Ss�ONAL E President,East Cape Engineering, c. WArW L-`TAI,,!� ►�.g,b - Mao 51Z� lq-I�p�ap� >�,� �,►�7tuG 4.� GEt 4� I11'=ail= il' 11=1t1=►t1�111 ►1��111= i w d' d' el 71 e � •A per. v .7 t i r CGZv71¢t-T E�I,�.V6C�� /lam '(7�j�/WATt tit cF �,c.c�6cvtl ip2c Re-4✓�-�TL-� ez Pk f • i V ; ,NI HiN f east cape engineering, inc. 44 Route 28 P.O. Box 1525 CIVIL ENGINEERING Orleans, MA 0265.3 LAND SURVEYING WATER RESOURCES LAND COURT ENVIRONMENTAL 508-255-7120 PHONE SITE PLANNING SANITARY CERTIFIED,PLANS STRUCTURAL 508-255-3176 FAX WATERFRONT WEB SITE:www.eastcapeengineering.com Doug Colwell November 4, 2011 66 Kettle Hole Road. West Barnstable,MA 02668 RE: Retaining wall Inspection: 66 Kettle Hole Road,West Barnstable. East Cape Engineering, Inc was contacted to inspect the existing construction of your retaining wall system. Based on the observed topography, soil strata, as-built wall, footing and manufacturers s ecifcations;the follo�Aing items are required to_onsure a stable retaining wall system. The proposed and existing sonotubes and strip footing proposed by the contractor is benefiting the retaining wall due to the slope of the embankment beyond the wall,however, due to the varying finishing of the concrete and the smooth base of the precast concrete units, there is a concern of sliding based on the manufacturers design criteria. It is recommended that a concrete shear key or steel pin is used to lock the blocks to the concrete footing. (Please refer to the attached sketch SK-01). These options prevent global sliding of the wall and engage the wall to the buried substructure. This will limit the burden to the adjacent slope. The overall construction of the block wall, sub-drain and backfill is in accordance with the manufacturers specifications. It is the responsibility of the contractor to continue to install this wall per these specifications. In addition to the reinforcements to the footing, it is imperative that the existing bank downhill of the retaining wall is stabilized.and regraded so that there is no threat for erosion. Deterioration of this bank will undermine the existing/proposed wall and will result in an,overall failure. Please refer to the comments on SK-01). Upon completion of the retaining wall, there was the concern of attaching posts to support the second floor deck. ABU or ABE style post bases manufactured by Simpson Strong Tie will allow you to drill and epoxy grout or mechanically anchor the proposed posts to the cap sections of the walla The additional load imposed by the deck structure is negligible and will have little effect, if any on the retaining waii system. Please feel free to contact me with any questions or comments that you may have. r Sincerely, l TIh:;OTHY J. h0 yy' BRADY _ w CIVIL "' i No.3 9 Timothy J. Brady, P. ,P.L.S. sS/ONAL E President, East Cape Engineering, c. TOWN OF BARNSTABLE 201€ DEC -3 �.J i 9: € 5 Wr-ST UgQNsrs�va i. r�+r�t, 1�v'R t i. 7 A I LE-.! IS 2Ct�I,�r. ; .21- y ,c. F:ra_f7 �;ne� G.�,frrT��.1S Amp t MA�( Sce oil Iltc 111=1i+ RI_tl i�111�1+1 =. Ilt�.111\ 1,yv q - 4 17 uaX I I C d � �/�r(�6� Er�A�t. Dt�at`C� . � �•`�r�� ,,�;:-,� .� (ago 'T P,��-. �`;ou' 651104� lz 7L // (2.7) R,2- � �z /.y,�� JJw.- r� z AT.- A-4EA-X16 b�' C7jN�JSCq�7!).%/ /tfL2. �G4✓r_`�=L:77 `111A OF bfgs TI101 V� N0 TY Gis SSiONAL S� - oI or. BA-tISTABLE � �j �;rs _•u ;°i 9: 15 s y e 4 D 3967 East Calvary Road p:218-728-9481 Duluth,MN 55803 f:218-728-1730 www.worldblock.com E 0 IL7200 E E'Ll,0 011 M CONTENTS ENGINEERING SPECIFICATIONS AND ASSUMPTIONS I. Preface. . .- . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 II. Material and Soil Properties Assumed . . . . 1 INSTALLATION SPECIFICATIONS AND PROCEDURE I. Concrete . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 II. General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 III. Execution . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CONSTRUCTION DRAWINGS I. Block dimensions. . . . . . . . . . . . . . . . . . . . . . 5 11. 6'unreinforced wall height. . . . . . . . . . . . 6 111. 8' wall height . . . . . . . . . . . . . . . . . . . . . . . . . 6 IV. 20' wall height . . . . . . . . . . . . . . . . . . . . . . . . 7 . y ENGINEERING SPECIFICATIONS AND ASSUMPTIONS 0 I PREFACE C o A Assumptions were made to provide World Block Inc. with an approximate retaining ' wall height(s). These wall height(s) were calculated using assumed soil and material properties and may vary from location to location of specific jobs. Since soil conditions vary greatly from site to site,an engineering analysis should be performed on each wall installation. ED 0D I I . MATERIAL AND SOIL PROPERTIES ASSUMED 6:21 A. BACKFILL SOIL RD C;9 l Soil Type Poorly graded sand and gravel well drained, class SP �. ao 2. Soil Unit Weight 110 pcf P 3. Internal Soil Friction Angle 30 deg 921 Wall-Soil Friction Angle 20.1 deg 4. � B. BASE SOIL 0 1 Soil Type Gravel well drained and compacted 2. Soil Unit Weight 125 pcf C1 3. Internal Soil Friction Angle 38 deg o C. CONCRETE BLOCK . Unit weight 150 pcf 2. Average Compressive strength 3,000 psi 3. Concrete/Soil Friction Factor 0.67 D. FACTOR OF SAFETY ASSUMPTIONS 1 FS for wall Sliding 1.5 2. FS for overturning 2.0 3. FS for Bearing Capacity 3.0 b� e INSTALLATION SPECIFICATIONS AND PROCEDURE ?r v I CONCRETE All concrete will be mixed to achieve a minimum 3,000 psi compressive strength in 28 A' days. In areas of freeze/thaw cycles, adequate protection by air-entrainment must be provided as determined by the Engineer. I GENERAL Z • A. Work shall consist of construction of a Retaining Wall System in accordance with these v specifications and in reasonably close conformity with the lines,grades, design, and y ,dimensions shown-on-the plans B. Work includes furnishing and installing geogrid soil reinforcement of the type, size, location,and lengths designated on the construction drawings. C. Base Leveling Pad Material shall consist of a compacted crushed stone base or non- !'!7 reinforced concrete as shown and specified on the construction drawings. D. Unit Drainage Fill shall consist of clean 1" minus crushed stone or crushed gravel O meeting the following gradation tested in accordance with ASTM D-422: Sieve Size Percent Passing 1 inch 100 3/4 inch 75-100 !� No. 4 0- 10 Z No. 50 0-5 One cubic foot, minimum, of drainage fill shall be used for each square foot of ' wall face. Drainage fill shall be placed between and behind.units to meet this requirement. ai E. Reinforced.Backfill shall be free of debris and meet the following gradation tested in accordance with ASTM D-422. Sieve Size Percent Passing 2 inch 100-75 Z 3/4 inch 100-75 No. 40 0-60 No. 200 0-35 1 . The maximum aggregate size shall be limited to 3/4 inch unless field tests have been performed to evaluate potential strength reductions to the geogrid design due to damage during construction. 2. Material can be site excavated soils where the above requirements can be met. Unsuitable soils for backfill (high plastic clays or organic soils) shall hot be used in the backfill or in the reinforced soil mass. 3. Contractor shall submit reinforced fill sample and laboratory test results to the Owner's Engineer for approval prior to the use of any proposed reinforced fill material. F. Geogrid Soil Reinforcement shall consist of high tenacity geogrids or geotextiles manufactured specifically for soil reinforcement applications. The type,strength and 1 location shall be shown on the construction drawings. Drainage collection pipe shall be a perforated or slotted, PVC or corrugated HDPE pipe. The pipe and drainage aggregate may be wrapped with a geotextile fabric that will function as a filter. Drainage pipe shall conform to ASTM D-3034 and/or ASTM D-1248. r I i III . EXECUTION 3 A. Excavation Q Contractor shall excavate to the lines and grades shown on the construction y drawings. Owner's representative shall inspect the excavation and approve prior to placement of leveling material or fill soils. Proof roll foundation area as N directed to determine if remedial work is required. 2. Following excavation for the leveling pad and/or reinforced soil zone, the soil shall be examined by the Owner's Engineer to assure the actual foundation soil strength meets or exceeds the assumed designed bearing strength. Soils not Z meeting the required strength shall be removed and replaced with soil meeting Q the design criteria,as directed by the Owner's Engineer. W B. Base Leveling Pad co 1 . Leveling pad material shall be placed to the lines and grades shown on the so construction drawings,to a minimum thickness of 6 inches and extend laterally a minimum of 6"in front and behind the concrete wall unit. 2. Soil leveling pad materials shall be compacted to a minimum of 95 % of the maximum Standard Proctor density per ASTM D-698. 0 3. Leveling pad shall be prepared to insure full contact to the base surface of the concrete units. co C. Modular Unit Installation Z 1 . First course of units shall be placed on the leveling pad at the appropriate line and grade. Alignment and level shall be checked in all directions and insure that all units are in full contact with the base and properly seated. Z 2. Place the front of units side-by-side. Do not leave gaps between adjacent units. Layout of corners and curves shall be in accordance with manufacturer's recommendations. 3. Place and compact drainage fill within and behind wall units. Place and Z compact backfill soil behind drainage fill. Follow wall erection and drainage fill closely with structure backfill. 4. Maximum stacked vertical height of wall units, prior to unit drainage fill and backfill placement and compaction,shall not exceed one course. D. Structural Geogrid Installation 1 . All materials shall be installed at the proper elevation and orientation as shown in the wall detail on the construction plans or as directed by the Owner's Engineer. The wall units and geosynthetic reinforcment shall be installed in general accordance with the manufacturer's recommendations. 2. Geogrid shall be oriented with the highest strength axis perpendicular to the wall alignment. 3. Geogrid reinforcement shall be placed at the strengths,lengths,and elevations shown on the construction design drawings or as directed by the Owner's 4. The geogrid shall be-laid horizontally on compacted backfill and attached to the concrete wall units. Place the next course of modular concrete units over the geogrid. The geogrid shall be pulled taut, and anchored prior to backfill placement on the geogrid. i Jr. Geogrid reinforcements shall be continuous throughout their embedment lengths and placed side-by-side to provide 100% coverage at each level. _ Spliced connections between shorter pieces of geogrid or gaps between adjacent pieces of geogrid are not permitted. E. Reinforced Backfill Placement CA N Reinforced backfill shall be placed,spread,and compacted in such a manner that minimizes the development of slack in the geogrid and installation damage. 2. Reinforced backfill shall be placed and compacted in lifts not to exceed 6 inches where hand compaction is used, or 8 - 1 0 inches where heavy v compaction equipment is used. Lift thickness shall be decreased to achieve the required density as required. 3. Reinforced backfill shall be compacted to 95% of the maximum density as CD determined by ASTM D698.The moisture content of the backfill material prior to No and during compaction shall be uniformly distributed throughout each layer and shall be dry of optimum,+0%,-3%. 4. Only lightweight hand-operated equipment shall be allowed within 3 feet from the soil side of the modular concrete unit. Jr. Tracked construction equipment shall not be operated directly upon the 0 geogrid reinforcement. A minimum fill thickness of 6 inches is required prior to operation of tracked vehicles over the geogrid. Tracked vehicle turning should �■ be kept to a minimum to prevent tracks from displacing the fill and damaging the geogrid. 6. Rubber tired equipment may pass over geogrid reinforcement at slow speeds, Z less than 10 MPH. Sudden braking and sharp turning shall be avoided. 7. At the end of each day's operation, the Contractor shall slope the last lift of Z reinforced backfill away from the wall units to direct runoff away from wall face. The Contractor shall not allow surface runoff from adjacent areas to enter the rn wall construction site. E. As-built Construction Tolerances Z 1 . Vertical alignment:l.5"over any 10 ft.distance. Wall Batter: within 2 degrees of design batter. 2. Horizontal alignments± 1.5"over any 10 ft.distance. Corners, bends,curves± 1 ff.to theoretical location. 3. Maximum horizontal gap between erected units shall be 1/2 inch. F. Field Quality Control 1 . The Owner shall engage inspection and testing services,including independent C ►c�� laboratories, to provide quality assurance and testing services during construction. This does not relieve the Contractor from securing the necessary construction control testing during construction. 2. Testing and`in ppections-services sshall only be performed by qualified and eriencedtechnic sane and:enginee s 3. As a minimum, quality assurance testing should include foundation soil inspection, soil and backfill testing, verification of design parameters, and 0observation of construction for general compliance with design drawings and specifications. CONSTRUCTION DRAWINGS �y v I BLOCK DIMENSIONS y N rm 18 3 1m CD C -------------- co 04 24 3 20' REF Z o 2 Z N n . !�!� 12 I - --�-� I 14 u C Z 2 2 3/4' RELIEF 2 ----21' REF 25 3/4' OVERALL II . 6' UNREINFORCED WALL HEIGHT v CA (1' OFFSET)4.8'T 5�� 12 _ MAX SLOPE cog 4*0 YIN DRAINAGE PIPE ca NO SOIL REINFORCEMENT USED CID 1'1'1 _ Z III . 8' WALL HEIGHT Z (f OFFSET)4.8 MVMY 7 Fr �1 MIRAGRID 5XF SOIL REINFORCEMENT (TV) REINFORCED BACII u EXCAVATION LINE x 4*0 MIN DRAINAGE PIPE mmx If-6* SOIL REINFORCEMENT USED 9 f � f (V - 20' WALL HEIGHT REINFORCEDv (1' OFFSET)4.8' y CA z v 00 0 z MIRAGRID 5XT SOIL REINFORCEMENT (DP) LER011) 8XT SOIL REINFORCEMENT 4'4 MIN DRAINAGE PIPE SOIL REINFORCEMENT USED r - - . r ��G�Pi�G �p o�� ' U� �� . . - �� t • � , _ h/ } i 1 .. � .. � i ' , a �,._ .. ` �. 1 ... ,�•_ at- .,. .' }-vroA).r' ow ell 17 lip IVP L I C ~lW .. ..... . ..... ....... : Ir `� �� •L� 17 eZ� �..T •.�.+.� L7 _:4 ,'/� `�Y ,yam ,Y7 ..,� Yip d i • J l� P'l Ir 1-7 F-T, . ........ .... ........... ............ ..... ... .... ....... j... ............ ......... ... ... ........... ...... _ L..�.._a.. ,.-.... ...._...�... ..:-.L...+........ ...I, .!_ ...1..._....L_.....1....f.. ... . ...!. . ..!. _.L..... 1....1 _!..... ..)_. i .1.... . 1 . 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Fj- J-4. ... .... .... 'I" F t nj .......... F—V- .... ... . j.j J--J v t7 177-1 7-1 t.Y t Ooiool; 1 4- V7 IT RENEY,.. M.ORAN- & . .TIVNAN MORTGAGE- :INSPECTION: PLAN C `' REGISTERED' LAND. SURVEYORS '-NAM.DOUGLAS. E.. COLWELL tz 75 HAMMONO. STREET — FLOOR. 2 WORCfSTfR; MA 01610-1723 LOCATION 66 KETTLEHOLE- .ROAD PHONE: 508-752-8885 FAx 508-752- 95 : WEST BARN STABLE, MA. RMTG 88HSTGROUP.NET A Division of H. S. & T. Group, Inc. SCALE..,.�'" = 40..'. . DATE .1.2-22-09 . ao REGISTRY BARNSTABLE 600K/p, .242�:3/28sj .sA=auaar:DOCIAENrXM ptMMMM .v _ rA I�►+rs:� E wnE of rnE: ANo euspw o� ' 274 33 ' aQ a+nrs:�oamaoe OtSPEMM PM.�.aARt� pun . eDoK/Puw � . 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CERTIFIED TO: WELLS FARGO BANK, NA' DOUGLAS E_COLWELL' `£ s N 03 12 $4- W �y}�, ; .tF -as�'�„� 9t`'$ sz t �L3;`D r' •"fir` Y/�0 77 • .. ` - *F. t '# yaav •S.Y °'.r -5- W "Q -w{. . '.K§.k`2." '�"ata�''',-F "'R�'".w�i ? �y .ca- '-•'�' - Y ; s �. ...3 ... `"` g"g.3' '�Yr„a+,c22":*Fs't3 �ca9 •`G',R,v '% v" '' -4+3 ':1 .4r'` '- � �:. .c&X�-� 3� ` YEN , ' + ,--� t -w .r�{d �•+.%- yl .C'+re �E.C'�-£w2 a^'' min .xz{� r it p x."v.`` •s`_'-" as �v�e�'..� .y 1 .. ,� ,yam T1Yv`��°�'T 3 �' r,°' ,. �`. .,., kr 5' ,. -a�..,ys.<s� �-" r ,yf t^ F#" y Uj EN gts CA sn t3 � P Y xr r W Ni nda Y :O �.t$ Ry,'�,s ? ° � (O r.• � °"�� �- ._� a-f2�`T i'3: s�.-L `-' .:tea �� ;uzy,i, ry,.y_ -'k- '- '�'r..{.- L`. � i --� g3� LOT�16� rr � *i�o- �•��r9 lq fy a� . ;� ��t � � 35�240 s 5 F ft�_ ?ussy ^`cg Mn�-•*�� ->~ t "''rt3',.. "�'- �`u�,�r"3'' �t. `S(_50c` i�d.�"'`'f�� .... a `_ er^ a �afrt"' � m..+r x �t�3az�a- �,, � �•5et_ '$ -z'3,c�G" tt.�4 i- v � �4t1' t=2s'� '`�x3k2i' aS •c '+k" ` a'�.�'7r'� -F;• S+E 9�s." , of .. �4`�= il_x' m'�'' ..t�s rs���`'t�' �h rat.r � "k 'yam% 4�ip" -. ?-. } .s '� nM. ffi�* '{p�' Y.�3 ���������l�C'•'�`g w. :;....: : .uc:.:' EVE Barnstable Old Kings Highway Historic District Committee �y „ 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chs 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photogifgphs 4 accompanying this application for: Check all categories that apply, 1. Building construction: ❑ New ElAddition ElAlteration -'r 2. Type of Building: ❑ House ❑ Garage barn ❑ Shed ❑ Commercial P6 Other 30 3. Exterior Painting roof ❑ new roof ❑ color/material change,of trim, siding, window, door 4. Simi ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ,9Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date 9T/2lI� NOTE AU applications must be(signed by the current owner Owner(print): 1 &eq k 5 (��ta""/(��,,j1 Telephone#,�: l?�c/T 3�4q Address of Proposed Work: �6 � eyty/� Village LVr .g�✓ SMap Lot#� _ Mailing Address(if di rent Owner's Signature Description of Proposed ork: Give particulars of work to be done: t 0 �.� A!41.1 Agent or Contractor(print): Telephone#: Address: Contractor/Agent' signature: For committee use only. This Certificate is hereby APPROVED/DENIED Date IdIlw1l Members signatures �vED yAPPROVED SE? 2 2 2011 wNn1:R .. ....�. 00T 12 2011 Town of Barnstable Old i —i Committee Q.\Boardr and Commissions\Otd Kings Highwa)&OKHApplications\OKH DRAFT 2011 Cert Appropriateness DRAFT.doc 1 i CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit S Copies Foundation Type: (Max. 12"exposed)(material-brick,/cement,other) Siding Type: Clapboard_ shingle_ other Material: red cedar white cedar other Color: Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (specify on plans for neiv buildings, major additions) Window and door trim material: wood other material,specify Size of cornerboards size of casings(1 X 4 min.) color Rakes Ist member 2Id member Depth of overhang I .1L.WEIVED Window: (make/model) material color 1 (Provide window schedule on plan for new buildings, nuijor additions) Window grills(please check all that apply_: SEP 2 2 2011 true divided lights_ exterior glued grills_ grills between glass_removable�QEp.N )teµT^,� c Door style and make: material Color: Garage Door,Style Size of opening _Material _ _ Color Shutter Type/Style/Material: Color: Gutter Type/Material: ,/ Color: Deck material: wood v other material,specify Color: Skylight,type/make/modeU: material Color: Size: Sign size: Type/Materials: Color: D Fence Type(max b' )Style material: Color: AP PR Retaining wall: Material: /`�2' fP����e�' f/�� -�� � ((� OCT 12 2011 Town of Barnstable Lighting,freestanding on building illuminating sign old Wg's Highway tte" OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of t colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name �g X — QABoards and ConunissionA01d Kings Higlnva)AMI ApplicationAMI DRAFT 2011 Cert Appropriareness DRAFT doc 2 i 5. SIGNS Diagram of sign,showing graphics,size,design and height of post,color and materials. Spec sheet. Site Plan on a GIS map or mortgage survey,OR photographs OR to-scale sketch of building elevation showing location of proposed sign;and any tree to be removed near a freestanding sign. Fee according to schedule. 6. SOLAR PANELS Drawing of location of panels on house showing roof and panel dimensions. Site plan showing location of building on property. (Assessors map may be subm RECEIVED Height of solar panel above the roof. Color of panels S E P 2 2 2011 Finish(matt or glossy) TOWN OF BARNS? !3,--F- 7. FOR LIST OF ABUTTERS: PLEASE SEE OKH STAFF ? SIGNED (plan prep arcr) �' _ Print Date: ��T���� Tel.Phone no's: !!�Zs:l NOTE The Old Kings Highway Historic District Committee MAY DENY INCOMPLETE APPLICATIONS ATTENDANCE AT MEETINGS: If the applicant or hisfher representative is not present during the hearing is scheduled,the application may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS PLAN PICK UP There is a ten(10)day appeal period,plus a 4 day waiting period for approved plans from the date the decision is filed with Town Clerk. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's Highway Committee. Plans approved by the Old King's Highway Historic District Committee may be picked up at Growth Management,Regulatory Division,200 Main Street,Hyannis,after expiration of the 14 day"wait"period. If the 14d'day falls on a Saturday,your plans will be available the afternoon of the following business day. DENIALS Applications that are denied may be appealed to the Old Kings Highway Regional Historic District Commission within 10 days of the filing of the decision with the Town Clerk. For more information, see the Bulletin of the Old Kings Highway District Commission. BUILDING PERMITS,OTHER AGENCY CONTACTS In most instances,before commencing work, a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or demolition. Commercial work may require Site Plan approval. Demolitions: the applicant should check with the Building Division as to conformance with Zoning requirements. Other Regulatory Agencies at 200 Main St,Hyannis MA 02601: Building Division 508-8624038 Conservation Division 508-8624093 Health Division 508-8624644 QUESTIONS ABOUT YOUR APPLICATION? PLEASE CALL THE BARNSTABLE OLD KINGS HIGHWAY OFFICE AT 508 862-478,,E P P R OV E D OCT 12 2011 Town of Barnstable Old King's Highway 5 Q:�Boards and Canmissions\Did Kings Jlighwa}AOKHApptications\OKN DRAFT 201 J Cen Appropriateness 1)RAF7:doc Committee RENEY, MORAN & TIVNAN MORTGAGE INSPECTION PLAN REGISTERED LAND SURVEYORS NAME DOUGLAS E. COLWELL m 75 HAMMOND STREET — FLOOR 2 WORCESTER, MA 01610-1723 LOCATION 66 KETTLEHOLE ROAD PHONE: 508-752-88W FAX- 508-752-8895 WEST BARNSTABLE, MA RMTQIiSTGROUP.NET A Division of H. S. & t Group, Inc. SCALE 1" = 40 DATE 12-22--09 m REGISTRY BARNSTABLE w oE>:a BoaK/PARE 24213/286 � BLSED UPON Dooumwa m FROM=REL#ARED t47LS11RE- �� 0 Mmm wm MADE or THE nwkmx AND s snow+ OF, PWI 274 33 m �y�F; eooll/PLAN / MQUE BSDW=ARE POW AM DM'�Au �{ 4�q w[c�msr n�a TMt et�aoew(s���was nE O►DONNo RI�REBARDOiO BtRIICFLIREB To 8 DANIEL y "m NOr OFFSEFS �®po pq� O J. N SPEM%L RAW HAZARD AREA SM HUD WP: OR SHM T�Ilp W oo NOT USE� �p` r ol 'AN- � 11 D oTD07-02-92 L°Q�aa%OF OW I�HUDIB 5 EMSR � �i� �v � ROOD HAXW ZOW WB BEM DE1Q000 BY 11ME M DI COYPLJN KAM LE wM tack.WNM PROPFRIY LlK OFFSET OEF , [� OdJfIAIE UFiD. INIIVE PLANS AM OR IS VVAPr FROM%WLJQION ETFORCEaFM CS,G 6 Moi lS4ARLY A 2w WIDER WSS. D.L TOLE VO.OW.40+SEC.7 UNUMS ISSUM Or MID AND/OR A%9ff 11 CONTROL SURVEY 0 TMi ABOK C�dt11FIObgI6 WIDE WRI TIE FROV�1 M THAT _ tj���,j Z q PE7*WMM6 PRFLSSE E3E1rAt m GHHOF DE VEHASHFn. THE WOR WION FTWVDFO Q ACO MAM AND THAT 7He WS W- MM rc D AR CUR7RO AOY LOWED 04 RELMM TO THE CERTIFIED TO: WELLS FARGO BANK, NA DOUGLAS E.COLWELL 84-03'12' w Q f R UJ 3 HOUSE : Q W LOT 16 'J N 35,ZQO;S F:f W '� a 4d .. S. 8ww 12' E 4 iE CEIVED.. � SEP22 2011 TOWN 0mcm=WLEY a.cuMMwml tic aY cvFA HY: MAMME aLovErtCEIRCM eY: I wl a �t SEP 2 2 2011 TOWN 057 i 0 v bo IEc s EP 2 z 20�� APPROVE® OCT2 2o11 TONIN ov�Qgn�CT ' T kW,WO ' Town of Barnstable Old King's Highway Committee 141 E 6' cv m= - m o)E CD o� li jlrl ��Tsv '"C�+.-.a...S. `fvl�._a�"�,..,:-�c.�...�'.�.:. .����=�=wam�+'+.,r�:7���:iL�`-"�=i"� .w �� L• r 4rtw. —_ t -.� `+r r -e L O e'm� .__,_ .T__` Et�jj' � 14 1ti '"�'`r• -=�"3.� ..Kw`.w..:+w.a:.:^t`' ,e r z-h` T^.;� �'.,..s+.�:rF ye�«.+"`. r.>� .,_�y'� CONSTRUCTION DRAWINGS I BLOCK DIMENSIONS ° s 18 3 ov ---------------- vi 24 3 20' REF 2 G� I //LJA\ 14 12 II I i 2 2 3/4' RELIEF 2 -----21' REF 25 3/4' OVERALL APPROVED OCT 12 2011 Town of B Highway Old Committee i ® 6' UNREINFORCED WALL HEIGHT _7ft (1' OFFSET 4•9 5/8r- MAX SLOPE T !E — eO MIN DRAINAGE PIPE 61 NO SOIL REINFORCEMENT USED APPRO , OCT 12 2011 Town n Barnstable Highway Old Committee - -- .----;_--I 1.- - -- --- - - -- - -777 44 - -- - ---- -_ i ! L li _--- _: 19 -- --- --j--- - -- .-= - _ -- - - ___ 0 k5 rR _.-- ---- -- -- --- - i _Tow n Ot B2mstable - - -__ - - --- - - - - - - -- - -- ---- Old_Kings Highway- r _ 15 J`2 Vt AH O C p C.� C Y C.) rS ' w O � __ a, 13 All h `I I '� 1 �/ I 1 i - -- -- I A c r � [: _ y' .. Ff W �` ', L "t i �,�� R �I 7` ' � ` 4 ti ' fit•• 1 .. rit�liYwF Y 1 \ 1 - ., #�-._ .► -r r � � Tom•`"' - .. a -'� � -a...� t����r ::� �g..,�•>�.v1f�Y_ » • � .ate /., r 1. 5„<��t� 1[ /�. �7..�/�•" - a��Nrrw+► a -40 406 AW it OA Am , �� yc �8 r Parcel Detail Page 1 of 3 rvvi +BAtiI�5TARLE. MMS yip IM9. t0a I' 1 ,ry od ---M&N-e04��x Logged In As: Parcel De{-la I l Friday,September 2 2011 Parcel Lookup Parcel Info Parcel ID 109-031 l Developer Loot LOT 16 l Location 166 KETTLEHOLE ROAD l Pri Frontage 160 l Sec Road l Sec l Frontage Village IWEST BARNSTABLE l Fire District JW BARNSTABLE l Sewer Acct I Road Index 10838 l Asbuilt Septic Scan: Interactive 1090311 Map 109031_2 Owner Info Owner JCOLWELL, DOUGLAS E l Co-Owner l Streets 166 KETTLEHOLE ROAD l Street2 l City JW BARNSTABLE l StateFm—Al zip 02668 Country Land Info Acres 10.81 1 use ISingle Fam MDL-01 l zoning I RF Nghbd 0106 Topography I Level l Road Paved l Utilities I Gas,Well,Septic l Location 1parginal View l Construction Info Building 1 of 1 Year 1976 l Roof Gable/Hip l Wood Shingle l Built Struct Wallall Living 1668 Roof Ash/F Gls/Cm AC(Central711 Area l Cover' p p l Type f _ Style Saltbox �l Int Drywall l Bed 3 Bedrooms Wall Rooms ' Model Residential l Int Hardwood l Bath 2 Full l Floor Rooms . F(l5 Grade jAverage Plus l Type A Heat Hot ir l Total Rooms 7 Rooms l �RM7 t stories�— l Heat Gas l Found Typical l Fuel ation Gross Area r3548 l Permit History Issue Date Purpose Permit# Amount Insp Date Comments http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6194 9/2/2011 r Parcel Detail Page 2 of 3 �104/01/1976 I I B18322 I$0 101/15/1977 00:00:00 I WB 11/2 S II Visit History Date Who Purpose 01/05/2010 00:00:00 Denise Radley In Office Review 12/04/2009 00:00:00 Denise Radley In Office Review 07/16/2008 00:00:00 Michele Arigo In Office Review 08/09/2006 00:00:00 Paul Talbot Cyclical Inspection 12/20/2005 00:00:00 Paul Talbot Meas/Listed-Interior Access 09/02/2003 00:00:00 Paul Talbot Meas/Est 03/07/2000 00:00:00 Paul Talbot Meas/Listed-Interior Access Sales History Line Sale Date Owner Book/Page Sale Price 1 01/14/2010 COLWELL, DOUGLAS E 24303/297 $315,000 2 12/04/2009 HINGHAM,THOMAS B TR 24213/284 $255,000 3 11/10/2009 HSBC BANK USA NA TRS 24153/151 $292,500 4 04/29/2005 COURCHESNE, LEONARD G 19779/077 $401,500 5 05/11/2004 DUBUQUE,ALISON L 18577/107 $1 6 03/15/1987 DUBUQUE, GREGORY L 5604/272 $192,500 7 02/27/1976 1 FORRESTER, OTHEL T 2304/148 1 $011 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2011 $160,500 $6,000 $0 $152,100 $318,600. 2 2010 $159,700 $6,000 $0 $154,500 $320,200 3 2009 $181,400 $4,000 $0 $174,100 $359,500 4 2008 $211,900 $4,000 $0 $186,500 $402,400 6 2007 $209,100 $4,000 $0 $186,500 $399,600 7 2006 $190,500 $4,000 $0 $203,800 $398,300 8 2005 $174,500 $4,000 $0 $163,000 $341,500 9 2004 $142,400 $4,000 $0 $138,600 $285,000 10 2003 $141,500 $4,000 $0 $59,700 $205,200 11 2002 $141,500 $4,000 $0 $59,700 $205,200 12 2001 $141,500 $4,200 $0 $59,700 $205,400 13 2000 $103,800 $3,800 $0 $39,900 $147,500 14 1999 $103,800 $3,800 $0 $39,900 $147,500 15 1998 $103,800 $3,800 $0 $39,900 $147,500 16 1997 $88,800 $0 $0 $34,900 $123,700 17 1996 $88,800 $0 $0 $34,900 $123,700 18 1995 $88,800 $0 $0 $34,900 $123,700 19 1994 $88,500 $0 $0 $40,400 $128,900 20 1993 $88,500 $0 $0 $40,400 $128,900 21 1992 $100,700 $0 $0 $44,900 $145,600 22 1991 $125,700 $0 $0 $69,900 $195,600 23 1990 $125,700 $0 $0 $69,900 $195,600 24 1989 $125,700 $0 $0 $69,900 $195,600 25 1988 $91,500 $0 $0 $29,700 $121,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6194 9/2/2011 DetailParcel Pageof .00 $01 $01 $29,7001 Photos rr•SVt _. t•�t� /.y�` fye�.v .kti,6esa a�a•f`yw �?� A e v ..9 .re � -r �: x�P'�'i7�i-�*,,v�' s'�`+'s' , . t` 41� `(>�4.icc' •��,.,.ry l� �i l}. ;�lt" Ia. ilrc S /wy "/' � �yr�..� J�..,�,`�`F,��., t j,.. r �.r�,'. ��+e; f"`+ �r,r,d eN }�Aef� � �7; �r�^,�dr 1 `� �•���.. •'q T' v.�s ���•..a� Ya �. �_t.a � ��-vF� �1 n. 'i is t: a� �ti4+ � r�7 �� � eta �. :t � �� �G+: `,�a�•; �� oaro�nom f .•" �' �„��'.�'`•., TOWN OF BARNSTABLE Permit No. ---------------------------------- T 1 3AU3 Building Inspector T11f Cash 00 .ego. d OCCUPANCY PERMIT Bond ___ "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 Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. ...................................................... 19......_._ ..................................... .......... ........._....................................... . ............ .... Building Inspector TOWN OF BARNSTABLE Permit No. --------_—__________ �. , Building Inspector sAuSrau Cash OCCUPANCY PERMIT Bond 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 Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. ...................................................... 19.....! .. ......................................................................................_ Building Inspector GAT' T 1 . � a ,s:\�T ^G�``�` — 111 - L•� Ig7C� � .j , r �Q I NST LE STEM s Asse��or's ,map and .lot number ......... `�7 ......rl................. WITH p IN V ST-BE AL M ��. Cp q . SAN TARY ICLE 11 TATANCE �r ;� ° 76 AN E y r Sewage Permit number y..........:...............................:... I N 0 — �T W/ T"ET°�. TOWN OV f BARNSTABLE BAR331 DLE, q M BUILDING a INSPECTOR.. 'Fa MAI • t: rr C - i. I C t n C 1..�CC < APPLICATION FOR PERMIT TO ............I,./�.. .......................... �...... ................................... TYPE OF CONSTRUCTION ....... .V I� ..OD ........ ........................................................ ................ . .�-....ZLY,9.7..6 TO THE INSPECTOR OF'BUILDINGS: The undersigned 1 hereby applies fort a permit according to the following information: Location ..L0 ..1.w.....k��..-.�.1.4�. ..U.. .. ....� ...........:Y.'..5...3 Oi,t,-VL.S.....a....�. '�............................... L I!!.Q ) CN�'H ( 1 5�. ..d..� .G.C.... ............................ Proposed Use . . . ... ..� ..........!.�.... ... ...................................................... Zoning District ...... .......................................................Fire District ...............`.......:.. rT4........................................... 31 I 1 I ` Name of Owner .Y.....`.... ..5...... ►..D.Y e:$+e. .....Address fiD�7h. V.le.4.-e .D.N.Ik ....�`t.Gl.l.4.�'I..l�1...i1.e -S± 1 e ' Name of Builder .........G.IJn.....�...�.....�.1.1<�.5..................Address �7.�..�.�.�...�.?�G.�..��...�..:�L�+:���:,, i Nameof Architect ................Address.................................................. .................................................................................... Number of Rooms .....................Foundation .(0......ejV.gK;;77j C:.l'� �.............. ............................................. ..... .... Exierior ..���L .��.I/.a4. ....... ... .�.l..h ...e.S..Roofing v0..4!......St�t2 .................................... Floors ........................Interior ......... � L ` �v y Wdl (. Heating .I• �H►L...... `TG'li` 1'.t1. ..................Plumbing ........ ....30 . .......o......:.........................,...... 4veFireplace ....Q.0.:P........... ...... .•-........Approximate. Cost / Definitive Plan Approved by Planning Board -----------_______-----------,9_______. Area ......../ !� ..�..1.............. Diagram of Lot and Building with Dimensions Fee �. q.�S .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH. A�► 0e-Cy, 16�' -16 O s k, 5 i c y I hereby agree to conform.to all the Rules.and Regulations of the Town of Barnstable regarding the above construction. _. Name c .. ` ...... + Forrester, T. & B. � - - � Permit for .�l—l/2..stor}, __.. __. ..� .��ell _______. / ` � Location --_ ��..�et�leb�l �pmd_______ . ^ \ ----..---]J�s.t.. ..................... ' - Owner ............ ' ` Type of Construction --f VKIN......................... ' ^ -------------------'------- Plot ............................ Lot .......#l6.................. ^ � Permit_ — --—A—or ' . ' Date of Inspection ` wm*, Completed � . . � - 6.�� . ^ ' PERMIT.REFUSED -------.-------.. lA.. ' �-� , .......... ..................................... ................................ � —._--.--..----.------.-------. '--^—~^—'—''�---^—^---T—^—^---' � _-------- ^----------'----^— ' _--------------. lg . �' ----------------------~--_ . ' . . ~. -------------------..`—~.—~.... Assessor's .map and lot number ./.... .............................. Sewage Permit number ...........................�.......-................ ... t °`T"Er TORN OF BARNSTABLE BJHHSTULE, i BUILDING INSPECTOR 'EO MPY�'• _ APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION � n c Wes'......... ..... .................... ..r..........................,.................. ............... ......................'._.. :...`......... 19 i -TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following, information: Locationq.........P......r......Q................:...:......................................... ..... . . ................................ ProposedUse .1..1^ .....v�i ► ..,..............:..........:..................................................................................................... ZoningDistrict n......:.:...}..........................................................Fire Distract ...............�'�.J........... .1.r....�................................. �- P,,v lax 31� Name of Owner .!'..."� .1/I/,�,C.......1 n V v C.":; ......Address . ca l v�P�� �... .:: N(A �!�' ....... ...... .............. ................................ . . Name of Builder :C'}'a•t, 19,4:..C- .-J.!.I 1,;!;..................Address 7� r,� �, �c �a.... ... r.+� ,1� .k ' Name of Architect .. •...........................Address ..:.................Number of Rooms .......................................................Foundation �a ..,v✓� �f t'_.......... ..... ............................... Exterior 7....................�.;.!,..Q...�'.5..Roofing .INUO �! S l .('. .....................I.. ... .................................... ! 0 Floors a 1?........ ....�ra {�P .....................................Interior ..................... ..! .y.ci/O[ . ............................................. t. ...... Heating 1Ja n. c, g ..................................:............,..... ..y......................Plumbin :^. ........i..r Fireplace ....hY) _12. .........✓...'.. ... �-.- '...........Approximate. Cost .... 01.,�.�'j... . Definitive Plan Approved by Planning Board ______________----__--_-----------19 Area ....... IS 7/ �............. _____--.' Diagram of Lot and Building with Dimensions Fee �` a S'................:............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH � C.• p Y Z �_72°�. .sup 3 ,y, I hereby agree*to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... :....................`.... ...... Forrester, T. & .B. A=-109-7 No ... .18322.... Permit for ....................................I 1 2 story, - single family dwelling ............................................................................... 4 Kettlehdl�� Road i-I Location ....................... ................................ West Barnsta> le ............................................................................... T. & B. Fo ester Owner ................................................................... Type of Const(uction ... ..........frame............................. ..................................... ........................................... #16 � Plot .......................... . Lot ................................ Permit Granted ..........Apr ilpr ...2 O�.... .....1976 Date of Inspection ...... .......19 Date Completed ................ .....................19- PE IT REFUSED ............................. .......... ......................... 19 P .......T...R EFUSED.F I _U S E..D .... ........... ....... ............... ...... ..... ......... .......I. ... .............................. ................. ....................j...... ................................. . ........................................ .................. ................... Approved .............................................. 19 ............................................................................... ti ..................................................... .......... ..............