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Home My WebLink About0215 PARKER ROAD vcixvim N SMEADO] No.53LOR UPC 12"3 smead.com • Made In USA 41 c Q46 o �J `af ° 169tU5®NMSil001KT1i+E SH M91 CERMo gos Application Number....6......4.C)............................................... ERA MASS. Permit Fee.................................Zoning District....RF.............. 163 TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by....... ................. ......... BUILDING PERMIT Map......... .. .............Parcel............otr7.................... APPLICATION L Section I — Owner's Information and Project Location Project Address 2-1 S 12alk-k 0Vk- —village- Owners Name hA IQ Afl— RU—\ L e/L Owners Legal Address City--- State AVA &D (3Z Owners.Cell # E-mail AA 'A JA igU (e) picJ Cot) Section 2 —Use of Struchire Use Group Commercial Structure over 35,000 cubic feet ❑ ercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction E] Move/Relocate Accessory Structure E] Change of use 0 Demo/(entire structure) ❑ finish Basement ❑ Family/Amnesty El Fire Alarm IF* 2/Adduild Deck Apartment Sprinkler System ition n Retaining wall F] Solar El 'Renovation El Pool El Foundation Only Other--Specify Section 4 - Work Description 16A &&< - elz.affl "11 LN -p— A-M O&S AYEVV"e4, I k)!.C" -tY3 W C �s kk4s C;d rJQ eA (),J dr— 10 1 ti AJ K-fm Ct I n► U� Ll Last updated: 1/31/2020 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak Section 13 — Owner's Authorization I, -1L� I c ��,( .�@,�J Lelj,_� , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to wor ' authorized by this building permit application for: (Address of job) 1 6 � i ature of r d to Print Name Last updated: 1/31/2020 Application Number........................................... Section 9- Construction Supervisor Name � e evL t Telephone Number Address t►.I City C D i✓►r State /v)dS_� Zip C17,��3 r License Number 6LJ71-413 License Type &r xpiration Date Z 4 126z-z Contractors Email C;�. r ( •G Cell # 1) -K-CC6 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Buildin Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 d the Town of Barns tab c a copy of your-license. Signature Date ko Section 10-Home Improvement Contractor Name ) '�o /k1 Telephone Number Address no yka'i,� S'l• City C &-U 1� State 4,1 A Zip nZG Registration Number Ll Expiration Date z,:s- 12 a I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780RW the Town of Barnstable. ttach a copy of your H.I.C... Signature Date d Section 11 -Home Owners License Exemption Home Owners Nam Telephone Number el ork t I understand my responsibilities under the rut d gulation or t struction Supervisor in accordance with 780 CMR the Massachusetts State Buildi ode. I erstand the construction inspection pro dt s ecific inspections and documentation required b MR and the To of Barnstable. Sign re Date APPLICANT SIGNATURE Signature Date '` A v Print Name S I>7-ev�� Telephone Number r)7)j^�W E-mail permit to: �►�� C s� S 4 �� C'om Last updated: 1/31/2020 Application Number.................................................... Section 5—Detail Cost of Proposed Construction b6b Square Footage of Project Age of Structure 1960 Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ��MA Checklist ❑ WFCM Checklist ❑ Design Section 6— Project Specifics Wiring ❑ O' Tank Storage Smoke Detectors f �umbing Gas ❑ Fire Suppression [ 'Heating System ❑ Masonry Chimney U Add/Celocat g y my y a bedroom , Water Supply Public VTPrivate Sewage Disposal ❑ Municipal L"J On Site Historic District ❑ Hyannis Historic District Old Kings Highway Debris Disposal Facility: J d1 SN4 UAck I am using.a crane ❑ Yes &No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District = Proposed Use 1 Lot Area Sq. Ft. _ 31 Total Frontage Z _Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required 2.-'5' Proposed Rear Yard Required_ Proposed 1,17 Side Yard Required_ Proposed I S. , Has this property had relief from the Zoning Board in the past? ❑ Yes Last updated: 1/31/2020 -S FL-66k Town of Barnstable/ -3-,F,h ,, ' Regulatory Services Richard V.Scali, Director,,..,. 2- 1639. ♦ / Building Division fV/ _�J dw CD�I �A1G� Paul Roma,Building Commissioner - 200.Main_Street,Hyannis,MA 02601 eL S i UN www.town.barnstabre.maxs O Office: 508-8624038 Fax: 508-790-6230 Check One: ❑Shed ❑Deck ❑Pool ❑Porch ❑Gazebo FOR ALL APPLICATIONS: ❑Determine map and parcel number and enter it on application. (This information maybe obtained from the gineering or Building Dept.) ompleted Building Permit Application A roval/sign-offs are required and can tained at 200 Main Street: storic District Commission 201d King's Highway Historic District(North of Route 6) ❑Hyannis Main St. Waterfront Historic District(see map for boundaries) ❑Historic Preservation(if applicable) ❑Health Department Hours are: 8:00-9:30 AM or 3:30—4:30 PM ❑Conservation Commission Hours are: 8:00-9:30 AM or 3:30—4:30 PM ❑Tax Collector FIT-masurer Homeowner License Exemption Form(if homeowner is acting as general contractor/builder for project) opy of Construction Supervisor's License must be submitted(except for in-ground pools) ff]WoJier's Compensation Insurance Affidavit must be submitted. Copy of Insurance Compliance 0. rop*e�rty a must be on file. Home Improvement Contractor's License(residential only if applicable) Owner must sign Property Owner Letter of Permission. ❑ A NON-REFUNDABLE Application fee is due upon receipt of application number❑ Permit fee. SHEDS/DECKS/OPEN PORCHES/GAZEBOS: ❑Plot Plan.or mortgage survey required to verify zoning co pliance. Placement of proposed structure must be sketched in and the distance from property lines indicate . The location of the.septic system should also be shown. ❑Two (2) sets of plans (8 1/2"x 1 'or 8 1/2"x 14) s owing cross section and framing schedule. ❑Mass Compliance Checklist—not n ed for dec ❑Prefab sheds require factory brochures red specifications. Engineered plans for all sheds. ❑Prefab sheds require a copy of the Construe upervisors License&Home Improvement Specialist's License unless the homeowner is applying the permi ' eir own name._ POOLS(250 sq., ft.and over or 2' deep or deeper r uire a building permit) ❑Plot.Plan or mortgage survey showing the pr posed location of pool and the distance from property lines. Plans must also show location of backwash pi/ f applicable. 0 Construction Drawings or Facto ochure& specifications. ❑ Show placement of fence, list description o �e �nd materials used. Q:bldg/wpfiles/fonns:shed-deck Rev:06/20/16 I r - oFWE,� Town of Barnstable Building Department Services 4 &AMSrnsM ' Brian Florence, CBO Masa. Building Commissioner 200 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 A Builder I, !(111�4 �_��(� ;�l�L G� ,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: Z l yQ (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 perfo d and accepted. Signature of O er S ature of Ap ant Print Name Print NalAe Date Q:FORMS:OWNERPERMSSIONPOOLS Rev:08/16/17 ry:.yy. Town of Barnstable rQ > Old King's Highway Historic District Committee DECISION` 23 . Wednesday,July 22, 2020, 6:30pm The Barnstable Committee of the Old King's Highway Historic District Committee, acting in accordance with the Old King's Highway Regional Historic District Act, Chapter 470, Acts of 1973 as amended, has held a hearing and made determinations on the following applications: APPLICATIONS_ Minucci,Albert, application submitted by Edie Vonnegut,3224 Main Street, Barnstable, Map 299, Parcel 029, built 1950 Paint gable end above Post Office light grey; install sculpture of gold striped bass (33" in center) ***Certificate of Appropriateness Approved as Submitted*** Butler, Michael &Sarah, 215 Parker Road,West Barnstable, Map 176, Parcel 0.17, Manuel Pedroz Almada House, built 1908, inventoried Construct two-story addition (24'X36'); construct two farmers porches along the northern and eastern addition elevations (30'X7' each elevation) ***Certificateof Appropriateness Approved as Submitted*** Chapman,William,39 Meadow Lane, West Barnstable, Map 133, Parcel 005/003, built 1990 Construct mudroom addition (8'X18.6')on the left of the house, materials to match existing, add one new door and windows per plan "**Certificate of Appropriateness Approved as Submitted"** Coggeshall, Melora&Champlin,James,47 aka 49 Rendezvous Lane, Barnstable, Map 270, Parcel 024, built 1994 Demolish existing main structure and porch (970sgft) retaining the south end to be relocated to the rear of the property to be used as a storage shed ***Certificate of Demolition or Relocation Approved as Submitted*"* Carswell, Robert,.&Young, Cheryl, 68 Hilliaird's Hayway,West Barnstable, Map 136, Parcel 045, .built 078 Addition of two screened in porches; re-configure window arrangement; add one door; relocate one door;replace windows and change grill pattern; replace wood shingles and trim to match existing 2-story garage structure ***Certificate of Appropriateness Approved as.Submitted*** Gallagher, Desmond&Caroline, 69 George Street, Barnstable, Map 319, Parcel 059, built 1941, Full demolition of the existing single family home and detached garage structures *"*Certificate of Demolition or Relocation Approved as Submitted*** ` � � `" SUSTAINAfltE ` INITIATIVE.:.. ;;Weyer haeuser. .......... ......... 2002 Lincoln Drive West,Suite E,Marlton,N1 08053 888-453-8358 x6112 July 20,2020 Jeremy Krauss I 'Al Falmouth Lumber ' 670 Main Street East Falmouth, MA 02536 Subject: Tech Call#116296 215 Parker Rd West Barnstable MA Attached are Trus Joist®structural member calculations.The attached calculations were prepared using accepted design values for Trus Joist®products and software analysis in conformance with accepted engineering practices.With respect to design values for Trus Joist'products as well as conditions of use,and design and installation guidance,please refer to International Code Council Evaluation Report ICC-ES ESR-1387 and ESR-1153; ICC reports can be obtained via the Internet at www.icc-es.org. I The attached calculations are provided as a supplement to the work.of the project designer.The product application, input design loads,dimensions and support information have been provided by Falmouth Lumber. I have not reviewed the project plans or field conditions.The proper authority is to review the calculation inputs and confirm they are consistent with the intent of the overall building design. If the attached calculations are not consistent with the building design,they should be rejected or returned to us to be corrected. The calculations apply only to Trus Joist®products for the referenced project. Uniformly loaded joist members verifiable through product literature span charts may not have been included in this package. Neither the undersigned engineer nor.Weyerhaeuser NR Company is acting as the engineer of record for the referenced project.Weyerhaeuser warrants that the sizing of its products as set forth in the calculations will be in accordance with Weyerhaeuser product design criteria and published design values. Please cal ny questions. ordi " <E " }` aFilm, — -- �/�` ;,.o-veyerhaeuw ou=UP EngmeMng, A: `m N a 91 6 --mew Hermann , �. z erfmaflrexeLHerman erhaeaisercom Drexe Date uso.o�m i a -0aroa Region E �NAI EN�'\� r Adobeacrabatvesn:to202MW9.2oo74 Signed for attached Forte®WEB Member Calculations dated: 7/20/2020 3:21:01 PM 4 pages I 9 F V R f E"® MEMBER REPORT PASSED Level,RIDGE BEAM 3 piece(s)13/4"x 14"2AE Microllam@ LVL Overall'Length.,36 0 0 16 2U+ o 0 0 AD locations are meastued from the amide face of left.wppat(or left cantilever end).AD dimerslons are hoAmntal. �,. ,••_.._a'� :r lion % * (Pa ) ' :Roof OPsi4R,ReSUItS ArfiraF toca m Aktoweb {Result ytDF ,toad�tbmbinatton tin System Member Reaction Ibs 12527 @ 16' 13388 6.00 Passed 94% 1.0 D+1.0 S Ail Spans) M riding Use Use:Residential Drop Beam Shear(lbs) 5882 @ 17's` 16060 Passed(37%) US 1.0 D+1.0 S(All Spans) Budding the a.19C 20 5 Bugling Cade:IBC 2015 Moment(Ft-lbs) -22746 @ 16' 41846 Passed(S4%) US 1.0 D+1.0 S(All Spans) Design Methodology:ASD Live Load Defl.(in) 0.324 @ 2V 8 5/16- 0.983 Passed(L/729) -- 1.0 D+1.0'S(Alt Spans) Member Pitch:0/12 Total Load Defl.(in) 0.482 @ 2V 9 7/16" 1.311 Passed(L/490) - L0 D+1.0 S(Alt Spans) •Deflection criteria:LL(L/240)and TL(11180). •Allowed moment does not reflect the adpztment for the beam stability factor. 01 421 ng« � Loadshto 5upp0s w ' �To1� Atraeabke Required � Dead Snow lTota�1 Accessories` fit.,six�..i„x�� „ `,�... � v �� x:�' ,xs��*,-s��,c.,h.,,xa,,'.a��r �Ka,s,x�i >. ,.�i 3�«�$''«ryv-.a „,�" `•# .,� 1-Stud wag-SPF 5.5W ' 5.50' 1.54' 1124 2318 3442 Blocking 2-Stud wag-SPF 6.00' 6.00 5.61' 4495 8033 12528 Blacking 3-Stud wag-SPF S.W. 5.50, 2.10' 1633 3043 4676 Blocking •Blocking Panels are assumed to carry no toads applied directly above them and the fug bad is applied to the member being designed. sFt—�x3'3 :& 2L'� LateralBraemg rarntgtervals Commenis '� ° Top Edge(Lu) 18'Ir e% Bottom Edge(Lu) 14'4"o/c •iardmum allowable bracing tntervats based on applied load. No }°"'ments, 0-Self Weight(PLF) 0 to 36' N/A 21.5 — 1-Undone(PSF) 0 to 36'(Fro t) 12' 15.0 30.0 Default Low „ - g fiW ClIld�t1SCT Notes _ r ti as , w e' Weyerhaeuser warrants that the sizing of its products will be in aawdance with Weyerhaeuser product design criteria and published design values.Weyerhaeuser apessly declaims any other warranties related to the software.the of ttds software is not intended to cimonvert the need for a deign professional as determined by the authority having jurisdiction.The designer of record,burWw or framer is responsible to assure that Oft motion is compatible wdh the overall prwpm Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Products manufactured at Weyerhaeuser faaTties are third-party certlAod to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by IOC-ES under evaluation reports M-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards.For current code evaluation reports,Weyerhaeuser product literature and Installation details refer to wvrvu.weywhaeuse►xoMWoodpD&KWdocu—t-library. The product application,input design Wads,dimensions and support Information have been provided by ForW&B Software Operator - � t ForteWEB software operator a sub notes 7/20/2020 3:21:01 PM UTC - FAL14OUTH W14SEt ForteWEB v3.0,Englne:V8.1.2.3,Data:V8.0.0.0 (609)977-7886 A, 18iStyK�falrnaRfilunubrv.corn vV�Rrhaeustt File Name:CENTRAL 215 PARKER RD Page 2/4 9 F O R E*® MEMBER REPORT PASSED Level,PORCH BEAM(FRONT&SIDE)) 3 piece(s)13/4"x 71/4"2.0E Microllam@ LVL' r Overall length:30 t . 0 � .0 n.. 0 7.6.. 7'6" 7'6,. AM locations are measured from the outside race of left support(or left cantilever ems}.All dimensions are horizontal 1©esi"i it�strtts sc_�_®;t ur_ahw► Airowed�/ Re,k_J ;� DF�Etw,_a c n�b_matt n�i2tte_n? r Nam": r Member Reaction fbs 1968 @ 7'6" M72 5.50° Passed 16% -- 1,0 D+0.75 Lt+0.75 5 A Spans Member-Type:Drop Beam Shear(lbs) 826 @ 6'8" 8317 Passed(10%) 1.15 1.0 D+0.75 L+ ( 0.75 S A "5 ns Building Use• rtri 5 � � ) Building Code: :IBC BC 2015 Moment(Ft-lbs) -1365 @ 7'6 12273 Passed(11%) 1.15 1.0 D+0.75 L+0.75 S(Adj Spans) Design Methodology:AsD Live Load Dell.(in) 0.016 @ 3'8 3/8" 0.239 Passed(L/999+) 1.0 D+0,75 L+0.75 S(Aft Spans) Total Load Dell.(in) 0.028 @ 3'7 5/16 0.358 Passed(L/999+) 1.0 D+0.75 L+0.75 S(Alt Spans) -Deflection criteria:U.(t/360)and TL(1./240). "Allowed moment does not reflect the adjustment for the beam stability factor. •, -, MINN.." r� .m x I � �tiearrn9 t ength � �Loads(o SuDDurt& �) � � y >"cd' ft 5tlppptrFS' F ro(a4� tVvapabtef ututredDead�vFtoort�e� fisn �otal fiB Y_9 1-Stud wag-SPF 5.V 5.SV 1.50' 347 142/-17 401 090/-17 Mocking 2-Stud wag-SPF 5—W 5.5w 1-V 924 357 1035 2316 docking 3-Stud wag-SPF 5.W 5.50' L.W 790 342 940 2072 Bodmug 4-Stud wag-SPF 5.W 55w 1.W 924 357 1035 2316 Blocking 5-Stud wag-SPF 550" 5.50' 1.5W 347 1421-17 401 M/-17 Mocking •Mocking Panels are assumed to carry no loads applied directly above them and the hull load is applied to the member being designed. La er81{BraC 9 NOa` 8 d �ssC,omtnaon £y �� <� �� Top Edge(W) 30 o/c Bottom Edge(W) 30'o1c -Maximum allowable baring intervals based on applied load. ' F��4 '�cT."��.��a. .3x ff•a,{.��k� �i 'aa•,tea. r�`r-"",w,�DC�dd 5��ft�r��'4$IIpyV'fr� '�`�� '��' -'k= t Yerti alaloads�t € _ Lotfat( �� T(i.......... utary Width t0:90) ( £r�(11> amme 0-Self Weight(w F) 0 to 30' N/A 11:1 - - 1-Uniform(PSF) 0 to 30'(Front) 4' 15.0 30.0 Default Load 2 Uniform(PSF) 0 to 30'(Front) 4'. 10.0 10.0 Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values-Weyerhaeuser expressly disclaims any other warranties related to the software.Use of this software is not Intended to circumvent the need for a design professional as determined by the authority having jursdicton.The designer of record,buliier or Kamer is responsible to assure dot this calculation is compatible with the overall project.Accessories(Rim Board.Blocking Panels and Squash Blocks)are not designed by this software.Products manufactured at Weyerhaeuser faaTities are third-party certified to s stainabie.forestry standard&Weyerhaeuser Engineered Lumber Products have been evaluated by ICC-ES under evaluation reports ESR-1153 and EM-087 and/or tested in accordance with applicable ASTM standards.For cuurre t.code evaluation repots,Weyerhaeuser product literature and Installation details refer to ;r'--, vmw.weyehaetsercorNwoodprodu�/document-library. c. The product appfiation,input design kads,dimensions and support information have been provided by ForteWEB Software operator ' r t FortewES software operator Job notes 7/20/2020 3:21:01 PM UTCW' FALMO -. ForteWEB v3.0,E Data:V8.0.0.0 FAIMOIlTH LUmset ` . •, ngine:V8.1.2.3, (6)9)97-7886 File Name:CENTRAL 215 PARKER RD J9tB4VK�,fatunmditlumt�.com Weyerhaeuser • Page 314 9 F®R T E I MEMBER REPORT PASSED Level, 1ST FL MAIN GIRT _ 4 piece(s)13/4"x 11 7/8"20E MicrollamO LVL Overall-Length:36 0 0 6' 6' 6 6' 6' 6 0 U U3 ® ® 70 AB locations are measured from the outside face of left support(or left cantilever end).Ail dimensions are hodmtal. �* ;s., 'T M• AWr! s -`-.r 3s3<'-�' 5 am a3P " Des} nResuits �� .�'Gaon . rnlFowee �Res�,c � � nF load con,brnation(natter ), Syster +: r Member Reaction lbs 28508 @ 24' 29750 10.00' Passed 96% 1.0 D+0.75 L+0.75 S Ad Spans) Member Type:Drop Beam Shear(lbs) 1469 @ 4"81/8" 15794 Passed(9%) 1.00 1.0 D+1.0 L(Ad)Spans) Building Use•Rau ntial Building Code:IBC 2015 Moment(it-lbs) -2603 @ 6' 35696 Passed(7%) 1.00 1.0 D+1.0 L(Ad)Spans) Design Methodology:A,50 Live Load Deft.(in) 0.008 @ 2'11 3/47 0.193 Passed(L/999+) -- 1.0 D+1.0 L(Aft Spans) Total Load Defl.(in) 0.010 @ 2'11 1/8" 0.290 1 Passed(t/999+) 1.0 D+1.0 L(Aft Spans) •Deflection criteria:LL(1./360)and TL(11240). •Allowed moment does not reflect the adpistment for the beam stability factor. •Member should be side-baled from loth sides of the member or traced to prevent rotation. ww.� 3 FLU"k AItiearrngLaigth� �� Loadsto 3uPDorLc(ihs);�� { { s•= .7�"w - tk'z'A .5 tze crux i �"� NOW k 'UppO[is s� z- s ° Aver+l�abfe Requireda1 oor�4ve �Snoror `Total ft=i ,.a ..w. 1-Stud wag-SPF 4 W 4A0" 150• 417 1350/-161 1161/- Blockbg 2-Stud wall-SPF 8.0(r 8.00' 1.53" 1120 3443 4563 Bbddq 3-Stud wall-SPF' 8.00' 8.w 1.50' 979 3342 4321 Bbddng 4-Stud wag-SPF 8.00" 8.00" 1.5w 1025 3420 4445 Bbddng 5-Stud wall-SPF' 10.00' 10.0o' 9.58' 10250 15994 8350 34594 Blocking 6-Stud wag-SPF &W 8.00' 1.53" 1120 3443 4563 Bloddng 7-Skull wall-SPF 4.00" 4.00" 1.50' 417 1350/-161 1161/ Bloclong •Bbddng Panels are assumed to tarty no bads applied directly above than and the fug bad's applied m the member being designed. � kk � e"�a��.c�x ..ra�, a�' � t r �y ta�ecal�8racin1 � ��=�:�ng " ' r comment 'c II� _.:E�� :. Top Edge(W) 36 o/c Bottom Edge(Lu) 36 o/c Mmmum allowable bradrg intervals based on applied bad. - Verbca!toads Lou acknn(s1de (Tributary widatg (0 90� (1 ao) t11s)�comments y 'w`�,, 0-Self Weight(PLF) 0 to 36' N/A 24.2 — — 1-Uniform(PSF) 0 to 36'(Font) 12' 12.0 40.0 Default Load 2-Point(lb) 24'(Front) N/A 9271 12652 8350 '. Weyerhaeuser warrants that the string of its products MR be In accordance with Weyerhaeuser product design criteria and published design val us-Weyerhaeuser expressly disclaims any other warmntles ,r related to the software.Use of this software Is not intended to circumvent the need for a design professional as determined by the authority having Jurisdiction.The designer of record,builder or harrier Is responsible tA'assure that this calculation is compatible with the overall project Accessories(Rim Board,Bloddkg Panels and Squash Blocks)are not designed by this software.Products manufactured at. Weyerhaeuser WWes are third-party c"fied to sustainable foresby standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC-ES under evaluation reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards.For current code evaluation reports,Weyerhaeuser product literature and installation details refer to www.weVetae,r,er.coffVwoodproducts/document-gbrayy. The product application,input design bads,dimensions and support informatiat have been provided by FerteWEB Software Operates s ForteWEB Software Operator lob(totes 7/20/2020 3:21:01 PM UTC JEREMY FALMOUTH LUMBER ForteWEB v3.0,Engine:V8.1.2.3,Data:V8.0.0.0 (609)977-7886 3EREWfK@xfakouttdumber.com Vkyednewer File Name:CENTRAL 215 PARKER RD Page 4J4 I t CS eeain 2020.1.0.2 CE19 RAL BUTLER 2ND IFL SIE L G 7-20-20 4mBeanEngine 2018.9.0.1 215 PARKER RD 11:23am MataiatsDalab=1577 W.BARNSTABLE 1 of 1 Member Data Description: Member Type:Beam Application:Floor Top Lateral Bracing:Continuous , Bottom Lateral Bracing:Continuous Standard Load: Moisture Condition:Dry Building Code:SBC ` Live Load: 40 PLF Deflection Criteria: U360 live,U240 total Dead Load: 10 PLF Deck Connection:Nailed Member Weight: 35.0 PLF Filename:CENTRAL BUR Other Loads Type Trfb. Other Dead (Description) Side Begin End Width Start End Start End Category Additional Uniform(PSF) Top 0' 0.00" 36 0.00" 12' 0.00" 40 12 Live Point BS Top 16 0.00" 8033 4495 Snow i i ,.�i•:Y•.a S.'Yf^,' 'p.eeTje �....:i":_Y!'"4I. t i9 �1:�'y'A,� j(.'� N�t'- TS }R r i 2400 ® 1200 3600 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 (Y 0.000" Wall Steel 5.500" N/A 7898# — 2 24' 0.000" Wall Steel 6.000" N/A 25023# — 3 36' 0.000" Wall Steel 5.500" N/A 1878# -3989# Ma)dmum Load Case Reactions Lbod far wo/g poht bade(a ire bads)to cwft mantels Live Snow Dead 1 5111# 1720# 2775# 2 12552# 8350# 92714 3 2771# -2m -892# Design spans 23'7.375" 11'7.375' Product: W 12 x 35(50ksi) PASSES DESIGN CHECKS Review gravity uplift reaction ford of 3989lbs at bearing 3 and ensure that the structure can resist apprWriately Design assumes continuous lateral bracing along the top chord Design assumes continuous lateral bracing along the bottom chord Actual Width &560" Actual Depth 12.50" Web Thickness 0.300" Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 53.79'kN 125.40 k# 42a/a 14.56 Odd Spans D+0.75(L+S) Negative Moment 61.25'k# 125.40'k# 48% 24 Total Load D+0.75(L+S) Shear 16.38k# 75.00k# 21% 23.99' Total Load D+0.75(L+S) LL Deflection 0.3655" 0.7872" L1T75 12.19' Odd Spans 0.75(L+S) TL Deflection 0.5790" 1.1807' U489 12.19 Odd Spans D+0.75(L+S) Control:TLDeftedton 0 A� OF M,46,2 o� DONIENIC W. yGN DeANGELO o STRUCTURAL r; A 9No.35062 'Qpf FGIS AI pmduM ranee are ladenadcs d 0eYm3peetke owrera CoVAP(Q 2016 bySbpson Sbaglia CarWM Inc.ALL RGH1S PESEM0. "Peseig is darned as Wm the manta,fbakl'st,beam or&*dom an this davkB meats apfoatb deabn cdeda la loads,L uft Congom,and Spare fisted on the shed The deskin must be rwbmA by a gialM das'M g des msWdas fa=7ovd Thh desW assures pqdxl hwwbtbn wzaft to the maul Nmes SpEcreafig. ii— ■ O R T E" 30B SUMMARY REPORT CENTRAL 215 PARKER RD Ledel Member flame Results CorrentsalufioTE C anmeots ROE BEAM Passed 3 pieoe(s)1314"x 14'2.0E MicroNam®LVL i PORCH BEAM(FRONT a SIFE)) Passed 3 piece(s)13/4'x 7 1/4'2.0E W oltam®tVL _1 ASK F�MAIN QRT__ —Pa—stred -- 4- ece(s)13/4"x 11 7/8 2.0E Wm" "eWEB Software Operator Job Notes 1BtOMY 7/20/2020 3:21:01 PM UTC FALMOUTH LUMBER (609)977-7W6 ForteWEB v3.0 IR M Ofthnouthkirtbercom Weyerhaeuser File Name:CENTRAL 215 PARKER RD Pagel/4 I I. AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 R Check Compliances 1.1 SCOPE WindSpeed(3-sec.gust)....................................................................................................................110 mph WindExposure Category................................................................... ..............................................................B 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) storie <_2 stories RoofPitch ............ .............................................................. (Fig 2)............................................n l L 12:12 MeanRoof Height...............................................................(Fig 2)..................................................2 ft 5 33' �r Building Width,W................................................................(Fig 3).................................................M ft s 80' BuildingLength, L...............................................................(Fig 3)..................................................16 ft 5 80' Building Aspect Ratio(L/W)................................................(Fig 4)................................................. 3:1 Nominal Height of Tallest Openingz:...................................(Fig 4)..............,........................................,.. �<6,8„ 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2) 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. 0/ Concrete Masonry ..................................................................... . 2.2 ANCHORAGE TO FOUNDATION1•3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general ..........................................(Table 4)............................................... in. Bolt Spacing from end/joint of plate.............................(Fig 5)..................................... IZ- in. 5 6"—12" Bolt Embedment—concrete.........................................(Fig 5)............................................... 7 in.z 7„ Bolt Embedment—masonry.........................................(Fig 5)............................................ ---irYt7S" �- PlateWasher................................................................(Fig 5)...............................................z 3"x 3"x Y4' 3.1 FLOORS / Floor framing member spans checked ................................(per 780 CMR Chapter 55) Maximum Floor Opening Dimension....................................(Fig 6)..................................................Lb ft 5 12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall.................(Fig 7).................................................... 0 ft s d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall.................(Fig 8).................................................... 0 ft s d Floor Bracing at Endwalls............................................:.......(Fig 9) Floor Sheathing Type .........................................................(per 780 CMR Chapter 55)Floor Sheathing Thickness................................................. (per 780 CMR Chapter 55). ?..................... 41 in. Floor Sheathing Fastening...................................................(Table 2)..._Cd nails at Kin edge/ 12.in field 4.1 WALLS Wall Height ' Loadbearing walls.........................................................(Fig 10 and Table 5)....................... -*ft 5 10, V/ Non-Loadbearing walls.................................................(Fig 10 and Table 5)......................:...._(&ft <_20' Loo Wall Stud Spacing .........................................................(Fig 10 and Table 5)...................L in.5 24"o.c. Wall Story Offsets .........................................................(Figs 7&8)............................................O ft <_d f 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls.........................................................(Table 5).............................2x - ft_Jg1:,in. Non-Loadbearing walls.................................................(Table 5)..:..........................2x -Oft 0 in. Gable End Wall Bracing' Full Height Endwall Studs.............................................(Fig 10) 7: WSP Attic Floor Length................................................ (Fig 11)...........................................t'6 Gypsum Ceiling Length(if WSP not used)...................(Fig 11)............................................ — and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11).............................. / or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays e/ Double Top Plate 1 Splice Length .........................................................(Fig 13 and Table 6).................................... ft Splice Connection (no. of 16d common nails)..............(Table 6).......................................................... 14 2( AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Tables 7)......................................................2 Non-Loadbearing Wall Connections /+ Lateral(no.of 16d common nails)................................(Table 8)........................................................ '2— Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans .........................................................(Table 9)....................................6 ft—6—in.<_ 11' Sill Plate Spans .........................................................(Table 9)...................................6—ft--&in.5 11, Full Height Studs (no.of studs)....................................(Table 9)...............................�� .�..aa:tJ[a r✓ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans..............................................................(Table 9)...................................�ft in.s 12' /Sill Plate Spans............................................................(Table 9).................................. ft 6 in.s 12" Full Height Studs(no.of studs).................................... (Table 9)...........................2..t349 Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening2 Sheathing Type..............................................(note 4)............................................:V//6... le1e 2� Edge Nail Spacing..........................................(Table 10 or note 4 if less)....................... in. Field Nail Spacing.......................................... (Table 10)................................................_�in. Shear Connection(no.of 16d common nails)(Table 10)........................................................ . Percent Full-Height Sheathing.......................(Table 10).....................................................�% S4 (/ 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) Maximum Building Dimension,L Nominal Height of Tallest Openin92............... ..........................................................s 6,8„ Sheathing Type..............................................(note 4)......................................7-)j.jf....... Edge Nail Spacing..........................................(Table 11 or note 4 if less)....................... oC 1n. Field Nail Spacing..........................................(Table 11)................................................ I Lin. Shear Connection (no.of 16d common nails)(Table 11)........................................................ ?t-F Percent Full-Height Sheathing....................... (Table 11).....................................................C% 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) �tf Wall Cladding Rated for Wind Speed?............................................................... o 5.1 ROOFS X Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ................................................... (Figure 19).............. 1r)ft s smaller of 2'or L/3 ' 4V Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors / Uplift.................................................(Table 12).............................................U=2.41 plf (/ Lateral..............................................(Table 12).............................................L= PIC plf Shear............................................... (Table 12).............................................S= ) ) plf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)................................T= 1114 plf Gable Rake Outlooker..........................................(Figure 20).............. 1' ft<_smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary UpConnectors...................................(Table 14).............................................U= 1'1 lb. P Lateral(no.of 16d common nails)... (Table 14)............................. .........L=14 f-lb. Roof Sheathing Type....................................................(per 780 CMR Chapters 58 aqd 59) ...., vS� Roof Sheathing Thickness........................................................................................... in.z 7/16"WS Roof Sheathing Fastening............................................(Table 2)................................. 64 e Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist.is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: 'Corporation CENTRAL CAPE CONSTRUCTION COMPANY,INC. Registration: 131841 820 MAIN ST Expiration: 09/25/2020 COTUIT,MA 02635 sCA 1 G 20M-05117 Update Address and Return Card. r'%/<'�nin►»nn�rea�/�of��riJun�itkF//J Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Registration Office of Consumer Affairs and Business Regulation 131841 09/2� 5 2020 1000 Washington Street-Suite 710 CENTRAL CAPE CONSTRUCTION COMPANY,INC. Boston,MA 02118 STEPHEN J.DEVLIN 820 MAIN ST Z��/ '/�' COTUIT,MA 02635 Undersecretary - Not V IthOUt Signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons�U&%A ypprvisor CS-047993 ti v 6tpires:02/04/2022 STEPHEN J DEVLIN ; 820 MAIN STREET COTUIT MA 0�835 ' t��l i/1�"•ia��\� Commissioner X1�.,�)[/.�- Client#:38438 2CENTRA ACORDTM CERTIFICATE OF LIABILITY INSURANCE LCA DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER6THOI20 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND NF ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER The Hilb Group of N.E.dba NAME:C Dowling&O'Neil Insurance Agy a/coN o Ext:508 775-1620 E-MAIL a/c Ne: 5087781218 P.O.BOX 1990 ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Arbella Protection Insurance CO 41360 Central Cape Construction Company,Inc. INSURER B:Associated Employers Insurance Company 11104 820 Main Street INSURER C: Cotuit,MA 02635 INSURER D: INSURER E: COVERAGES INSURER F CERTIFICATE NUMBER: rz THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM ID-AREVISON BOVE THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 LTR ADDLSUBR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY MM/DD/YYYY MM/DDNYYY LIMITS 3600067686 9/06/2019 09/06/202 EACH OCCURR CLAIMS-MADE �OCCUR cE ENCE $1 OQQ QQQ PREMISES EaoccuFence $500000 MED EXP(Any one person) $5 QQQ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $1,000 QQQ PRO- POLICY aJET IJ LOC GENERAL AGGREGATE $2,000,000 OTHER: PRODUCTS-COMP/OP AGG $2,000,QQQ AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO Ea accident OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS AUTOS HIRED NON-OWNED BODILY INJURY(Per accident) $ ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR $ EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WCC50050091992020A PER $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 5/14/2020 05/14/2021 X OTH- OFFICER/MEMBER EXCLUDED? a N/A (Mandatory In NH) E.L.EACH ACCIDENT $500 QQQ Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $500 000 D E.L.DISEASE-POLICY LIMIT $SQQ QQQ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) **Workers Comp Information** Voluntary Compensation ;Other States Coverage Proprietors/Partners/Executive Officers/Members Excluded: Steve Devlin,Pres./Treas. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Main Street Town of Sandwich SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Hall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sandwich,MA 02563 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 1 Of 2 The ACORD name and logo are registered marks of A ORD8-2015 ACORD CORPORATION.All rights reserved. #S260223/M260220 LS1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name(Business/Organization/Individual): Ce/V�qj C-Pno e, Cd ti S))W CQ 8 W Address: '2 City/State/Zip: • b7-J 1 A. 0",3 5- Phone,#: S-� /'Are you an employer?Chec the app rate box: Type of project(required): 1 1. l I am a employer with 4. I am a general contractor and I �J employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. 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 workingfor me in an capacity. employees and have workers' � y p tY comp. insurance.: 9. Building addition [No workers comp. insurance p' repairs or additions required.] 5. We are a corporation and its 10. Electrical re P 3. I am a homeowner doing all work officers have exercised their 11. 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 employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: SS o C j! 1 i el Policy#or Self-ins.Lic.#: (Ar— 6 Z 0_C1L� 2 0 L.0 }� Expiration Date: d'S 20 Job Site Address: " ,IpcwLv e� City/State/Zip: (JJ (66U k4ALe, 60dW 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 pai p nalties of perjury that the information provided above is true and correct. Signature: Date: l� Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CREScheck Software Version 4.7.0 �J( Compliance Certificate Project New Addition Energy Code: 780 CMR 51.00: Massachusetts Residential Code, 9th Edition, Energy Efficiency Location: West Barnstable, Massachusetts Construction Type: Single-family Project Type: Addition Climate Zone: 5 (6137 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 215 Parker Road Michael&Sarah Butler Steve Devlin West Barnstable, MA 02668 215 Parker Road Central Cape Construction West Barnstable, MA 02668 820 Main Street Cotuit, MA 02635 . trade-off Compliance: 4.2%Better Than Code Maximum UA: 148 Your UA: 142 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Envelope Assemblies Gross Area Cavity Cont. Perimeter Ceiling 1: Cathedral Ceiling 868 40.0 0.0 0.026 23 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 868 30.0 0.0 0.033 29 Wall 1:Wood Frame, 16" D.C. 992 21.0 0.0 0.057 48 Window 1:Vinyl/Fiberglass Frame:Double Pane with Low-E 72 0.310 22 Door 1: Solid 20 0.180 4 Door 2: Solid 20 0.220 4 Door 3: Glass 40 0.310 12 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 780 CMR 51.00: Massachusetts Residential Code, 9th Edition, Energy Efficiency requirements in REScheck Version 4.7.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklis�i �c/ /� Keith Presswood VP Xl� 1044 d/i1t9&d 07/31/2020 Name-Title Signature Date Project Notes: REScheck by Cape Cod Insulation, Inc. 18 Reardon Circle South Yarmouth, Ma. 02664 800-696-6611 # 728875 Project Title: New Addition Report date: 07/31/20 Data filename: Untitled.rck Page 1 of10 i REScheck Software Version 4.7.0 Inspection Checklist Energy Code: 780 CMR 51.00: Massachusetts Residential Code, 9th Edition, Requirements: 36.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Section Plans Verified F�eld'Yerified #. Pre-Inspection/Ptarr Review Value Value Compltes� Comments/Assumptions &Re .ID 103.1, ;Construction drawings and ❑Complies ;Requirement will be met. 103.2 ;documentation demonstrate ❑Does Not [PR ;energy code compliance for the 'building envelope.Thermal []Not Observable ; :envelope represented on ❑Not Applicable ; ;construction documents. 103.1, ;Construction drawings and ❑Complies 103.2, :documentation demonstrate ❑Does Not 403.7 ;energy code compliance for [PR3]1 ;lighting and mechanical systems. []Not Observable :Systems serving multiple []Not Applicable ; ;dwelling units must demonstrate ;compliance with the IECC :Commercial Provisions. 302 Heating and cooling equipment is;. Heating: ; Heating: ;❑Complies ; 403_:7 1 sized per ACCA Manual S based Btu/hr Btu/hr ;❑Does Not [pR2]2 on loads calculated per ACCA Cooling: Cooling: Manual J or other methods ,❑Not Observable ; i approved by the code official. ; Btu/hr ; Btu/hr :❑Not Applicable ; 103.1 ;Solar-Ready Roof: New detached ❑Complies ;Exception: Buildings do not [PR4]1 :one-and two-family dwellings, ❑Does Not j meet the conditions for a ;and multiple single-family []Not Observable ;solar-ready zone area. ;dwellings(townhouses)with >= 600 ft2 (55.74 m2) of roof area ❑Not Applicable ; ;oriented between 110 degrees and 270 degrees of true north comply with sections AU103.2 ;through AU103.8 (RB103.2 (through RB103.8). Additional Comments/Assumptions: 1 I High Impact(Tier 1) -'2 Medium Impact(Tier 2) 3'i Low Impact(Tier 3) Project Title: New Addition Report date: 07/31/20 Data filename: Untitled.rck Page 2 of10 Section. x f a {R� # Foundation pe�ct�on Complies Comments/Assumptions n;�e x ,.' xr ..a �<sMfi..N. 30d A protective covering is installed to ;❑Complies ;Exception: Requirement is not applicable. xvprotect exposed exterior insulation ;❑Does Not and extends a minimum of 6 in. belowgrade. :[--]Not Observable; ;❑Not Applicable ; 403:9_ - Snow-and ice-melting system controls;❑Complies [FO12J?} installed. ;❑Does Not ❑Not Observable; } ;❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 0- Low Impact(Tier 3) Project Title: New Addition Report date: 07/31/20 Data filename;Untitled.rck Page 3 of10 Sections,: r* x <�ku r e f T r n; 2: gi:�1 �� Plans�YberafiedsField�Yerif�ed � x � # ,Framing•/Rough in°�Inspectibn -�j - .�,�•+ � � Comptles, Comrrients/Assumptions Value Value 303.1.3 1 U-factors of fenestration products - - w r ❑Complies ;Requirement will be met: [FR4]1 !are determined in accordance n f;t ❑Does`Not (iwith the NFRC test procedure or u: , k []Not Observable - taken from the default table. ❑Not Applicable 402.1.1, ;Glazing U-factor(area-weighted ` ; U- U- 1❑Complie's ;See the Envelope Assemblies 402.3.1', laverage). ❑Does Not ;table for values. 402.3.3, 402.5 :[]Not Observable [FR2]1 :❑Not Applicable 402.1.1,. ;Glazing.SHGC value(area- SHGC: SHGC:: ❑Complies, ;See the Envelope Assemblies' 402.3.2, (weighted average). ;❑Does Not :table for values. 402.3.3 j ' :[:]Not Observable 1 402.5 [FR311 ;❑Not Applicable 1 402.1.1, ;Door U-factor. ; U- 1 U 1❑Complies :See-the Envelope Assemblies 402.3.4 I ;❑Does Not table for values. [FRJ]1 ; ,❑Not Observable 1 ❑Not Applicable 402.4.1.1 ;Air barrier and thermal barrier .' " ; ❑Complies• 'Requirement will be met. [FR23]1 :installed per manufacturer's f ❑Does Not instructions. c 1 pNotObservable ❑Not Applicable 402.4.3 ;Fenestration that is not site built � � ❑Complies ;Requirement will be met. [FR20]1 :is listed and labeled as meeting ❑Does Not IAAMA/WDMA/CSA 101/I.S.2/A440 ' I []Not Observable 1 ;or has infiltration rates per NFRC ❑Not Applicable I400 that do not exceed code . x I limits, y. - 4024 5 IC-rated recessed lighting fixtures & t ❑Complies ;Requirement will be met. [F;R16]z sealed at housing/interior finish } ❑Does Not wand labeled to indicate•<_2.0 cfm leakage at 75 Pa: Y s ; Gil ❑Not Observable , ❑Not Applicable ; 403.3.1 ;Supply and return ducts in attics ; ? ❑Complies ; . YFs [FR12]1 :insulated >= R-8 where duct is ❑Does Not I>= 3 inches in diameter and>= ^ � +� u ❑Not Observable • �R-6 where< 3 inches.Supply and i return ducts in other portions of ❑Not Applicable ; ;the building insulated >= R-6 for 1 ,. :diameter>= 3 inches and R-4.2 :for< 3 inches in diameter. 403x`3 SsBuilding cavities are not used as' ❑Complies [F R VSHMI ducts or plenums. ❑ � may Does Not l ,hd�"r'Tld� z5' - r- t "� �i ''+•' ❑Not.Observable ay r) ❑Not Applicable 404 HVAC piping conveying fluids" R- R- ;❑Complies ; [FRlg7]z above 105'QF or chilled fluids 1 ❑Does,Not below 55 QF are insulated to>R ' 1❑ 3 Not Observable I ❑Not Applicable 403.4.1 ;Protection of insulation on HVAC , ❑Complies ; [FR24]l i piping: z *s ❑Does Not } # � ❑Not Observable• I l ❑Not Applicable , 1 High;lmpact(Tier 1) 2 Medium Impact(Tier 2) 3F Low Impact(Tier 3) Project Title: New Addition Report date: 07/31/20, Data filename: Untitled.rck' Page 4 of10 Sectwn € x c a c � ttr3ON _I "GM �Ian rifled `Field Verified # Fram9(Rough In?Inspection r" Ualue Complies Comments/,Assump �ons s uAf [4Q3 53 Hot water pipes are insulated to R- ; R- ;❑Complies R-3. ❑Does•Not a h� ;❑Not Observable ; ❑Not Applicable 4036 Each dwelling unit of a residential ❑Complies ;Requirement will be met. [&Vgll building provided with ��.� ' � t? �� ❑Does Not continuously operating exhaust, i supply or balanced mechanical []Not Observable ventilation that has been site ❑Not Applicable verified to meet a minimum airflow per Section N1103.6. Additional Comments/Assumptions: i 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: New Addition Report date: 07/31/20 Data filename: Untitled.rck Page 5 of10 ,... .,.. r.F,,�:. �'�' 3 � m'.v3�+,*y`*'trni[ ' 'r�e x� � 7' xi•; ,.��` +ram �Section <1 Plans l/erified Fieldl/ertfied� n # In`sulatronlnspec�tion Ua'lue cV lue �pmpiles� Commends/Assumptions 3031f y All installed insulation is labeled # h ❑Complies ;Requirement will be met. o [I113]? or the installed R-values ❑Does Not ; y provided. • ❑Not Observable ,*�� mow. � � � ❑Not Applicable , 303.2 ;Wall insulation is installed per ❑Complies ;Requirement will be met. �,' t [IN4]1 ;manufacturer's instructions. r ❑Does Not ; ❑Not Observable ; ; ❑Not Applicable 303.2, ;Floor insulation installed per p p ❑Complies ;Requirement will be met. 402.2.7 'manufacturer's instructions and " ❑Does Not [IN2]1 in substantial contact with,the I underside of the subfloor,or floor a . []Not Observable ; :framing cavity insulation is in L ❑Not Applicable ;contact with the top side of a.•. 'sheathing, or continuous linsulation is installed on the a underside of floor framing andh extends from the bottom to the k` s• ,"_ ;top of all perimeter floor framing members. p. ;See the Envelope Assemblies 402.1:1, I Wall insulation R-value. If this is a ;R ; R ❑Complies ' 402.2.5, :mass wall with at least'/2 of the ❑ Wood ;❑ Wood Does Not table for values. ;❑ 402.2.6 ;wall insulation on the wall ❑ Mass ❑ Mass :❑Not Observable ; [IN3]1 .exterior,the exterior insulation ❑ Steel ❑ Steel j❑Not Applicable requirement applies(FR10). 402.1.1, ;Floor insulation R-value. ; R- R- ;❑Complies ;See the Envelope Assemblies 402.2.E I ;❑•Wood ;❑ Wood ❑Does Not table for values. [IN 1]1 ❑ Steel j❑ Steel ;❑Not Observable ; -„❑Not Applicable j Additional Comments/Assumptions: 1 Hi h lm act g (Tier p 1) 1 Impact(Tier 2) fi3n Low Impact(Tier 3) Project Title: New Addition Report'date: . 07/31/20 Data filename: Untitled.rck Page"6 of10 SeCtlon � � s Plain. a :. - Y 1/erlfled Fleld ` � # l x Ft Finai�Inspect 6rWgProvlsfons � Meommen scum lions: &'Re ID UYatue .M� p> 303.1.1.1,;Ceiling insulation installed per . ❑Complies ;Requirement will be met. 303.2 ;manufacturer's instructions. { ❑Does Not [FI2]1 ,Blown insulation marked every 4 F []Not Observable ; 1300 ft'. 3 ' ❑Not Applicable 3Q3 34 � aManufacturer manuals for i ❑Complies [Fwlli8l,3x;mechanical and water heating'' ""s ❑Does Not systems have been provided. �; r ff ❑Not Observable 5�� s a E s max,z a ❑Not Applicable 4013 Compliance certificate.posted. ❑Complies ;Requirement will be met. []Does Not ❑Not Observable tee' ❑Not Applicable 402.1.1, ;Ceiling insulation R-value. R- ; R ;❑Complies' ;Seethe Envelope Assemblies 402.2.1, ;❑ Wood ;❑ Wood ;❑Does Not ;table for values. 402.2.2, ❑ Steel: ; ❑ Steel, ;❑Not Observable 402.2.E , [FI1]l. []Not.Applicable ; , Vented attics with air permeable ❑Complies ;Exception:,Requi rem ent is insulation include baffle adjacent ❑Does Not :not applicable. �. ��to soffit and,eave vents that extends over insulation. ❑Not Observable ; ❑Not Applicable ; 402.2.4 ;Attic access hatch and door R- R- ❑Complies ;Requirement will'be met.' [F13]1 'insulation zR-value of the ;❑Does Not ;adjacent assembly. ; ❑Not Observable ; ❑Not Applicable 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ;. ACH 50 = ;❑Complies ;Requirement will be met. [FI17]1 ' ach in Climate Zones 1-2„and " ;❑Does Not i<=3 ach in Climate Zones 3-8. ;❑Not Observable I ;ONot Applicable . 403°1�1 Progra m ma ble,th ermostats 3 ❑Complies ; [FI9]? -'installed for control of primary t x { []Does Not " heating and cooling systems and initially set by manufacturer to []Not Observable codespecifications. ❑Not Applicable ; illr31 2 Heat pump thermostat installed., =' A `"� ❑Complies on heat pumps. . []Does Not []NotObservable>r,4 ❑Not Applicable 4 3 2� v Hot water boilers supplying heat •1 ❑Complies [F126J? through one-or two-pipe heating , z` []Does Not µ systems have outdoor.setback '> control to lower boiler water []Not Observable ; temperature based on outdoor r []Not Applicable ; temperature. 403.3.2.1 ;Air handler leakage designated ` q ❑Complies [FI24]1, Eby manufacturer at<=2%.of' ❑Does Not ; !design airflow. !" []Not Observable ❑Not Applicable 1 High Impact(Tier 1)` 2 Medium Impact(Tier 2) r3x.Low Impact(Tier 3) Project Title: New Addition Report date: 07/31/20 'Data filename: Untitled.rck Page 7 of10 Section '�� j � � ��- Y. "` '�70^ Bis<Verified =: Field Ver�fted.ro �sions al ` CoCs , �� 403.3.3 ;Ducts are pressure tested to cfm/100 cfm/100 l ;❑Complies ; [F127]1 !determine air leakage with ft2 ft2 ;❑Does Not ;either: Rough-in test:Total ; ;leakage measured with a ❑Not Observable pressure differential of 0.1 inch ❑Not Applicable ;w.g. across the system including ;the manufacturer's air handler ienclosure if installed at time of test. Postconstruction test:Total, leakage measured with a ; pressure differential of 0.1 inch w.g.across the entire system ;including the manufacturer's air, ;handier enclosure.Post ;construction or rough-in testing !and verification done by a HERS 1 ;Rater, HERS Rating Field I Inspector, or an applicable BPI (Certified Professional. 403.3.4 I Duct tightness test result of<=4 ; cfm/100 ; cfm/100 ;❑Complies ; 1' cfm/100 ft2 across the s stemor ft2 ft2 [FI4] ❑: Does Not ;<=3 cfm/100 ft2 without air (handler @ 25 Pa. For rough-in :❑Not Observable ; itests, verification may need to I , ❑Not Applicable ; occur during Framing Inspection. €403`51 _' Circulating service hot water ❑Complies ; ... .; [FI¢11a]?� systems have automatic or �`` " .s ❑Does Not accessible manual.controls. r� ". ❑Not Observable ; s� ❑Not Applicable ; 0351T: Heated water circulation systems ❑Complies ; [FI28]? ;. have a circulation pump.The w ti. f' : ❑Does Not system return pipe is a dedicated ; return pipe or a cold water supply c ❑Not Observable ; �Q pipe. Gravity and thermos a. ❑Not Applicable ; Y syphon circulation systems are not present.Controls for- circulating hot water system , pumps start the pump with signal . for hot water demand within the m * occupancy. Controls ;automatically turn off the pump when water is in circulation loop is at set-point temperature and no demand for hot water exists. u �„ 40351,3 Electric heat trace systems ry. ❑Complies. [f429]z comply with IEEE 515.1 or UL x `, .❑Does Not 515. Controls automatically adjust the energy input to the ,•. ❑Not Observable ; heat tracing to maintain the • ` ❑Not Applicable a desired water temperature in the _ 5 piping -4 5 2 Water distribution systems that ❑Complies [iFI3©]z have recirculation pumps that 't , r Oboes Not ; pump water from a heated water ap5 supply pipe back to the heated } ❑Not Observable ' water source through a cold ❑Not Applicable ; water supply pipe have a demand recirculation water a t ' system. Pumps have controls that manage operation of the , pump and limit the temperature ; of the water entering the cold . .v r r water piping to 1049F. ,. 1 High Impact(Tier 1) O2 Medium Impact(Tier 2) ,3 .Low,Impact(Tier 3) Project Title: New Addition Report date: 07/31/20 Data filename: Untitled.rck Page 8 of10 "40 f Plans Pr Yer�fied� Fleler�fied• # Finalinspection` o�visloris1 "�° 1 rF V Compes.� , comments/Assumptions Value' alue 40-35 4 Drain water heat recovery units ❑Complies [F31 f tested in accordance with CSA []Does Not B55.1. Potable water-side pressure loss of drain water heat []Not Observable. ; recovery units< 3 psi for ❑Not Applicable b,individual'units connected to one . or two showers..Potable water- side pressure loss of drain water heat recovery units <2 psi for individual units connected to. three or more showers. �4�0361 All mechanical ventilation,system y T, ❑Complies 'fans not part of tested and listed ❑Does'Not HVAC equipment meet efficacy LK ' and airflow limits. [-]Not Observable ❑NotApplicable ; 403,w6 2Mv,Installed performance of the Y ❑Complies i[F13,2]� M,mechanical ventilation system ' ❑Does Not tested and verified by a HERS ` � N�¢t ;Rater, HERS Rating Field ❑Not Observable ; rylnspector, or an applicable BPI i mow, ❑Not Applicable zs JFCert 1 ified Professional, and measured using a flow hood,flow $ ` grid, or other airflow measuring device in accordance with either RESNET Standard Chapter 8 or '' g aIACCA Standard 5. . '61,3%3h4 ,Ventilation devices and I ❑Complies ; [FF1133 I equipment are tested and' .: ❑Does Not gf (certified by Air Movement and ❑Not Observable ' h 0,Control Association ("AMCA")or []Not Applicable , Home Ventilating Institute ("HVI") and the certification label K ; I:,affixed to product. Where multiple duct sizes and/or a exterior hoods.are standard <: f NA- P options,the minimum size shall a r .. r: not be used. %03'654`- Sound ratings for fans used for ❑Complies ; (F1,34] * ,`'whole building,ventilation are ',,N ��'' , ,> ❑Does Not srated at a maximum of one Bone. ❑Not ObserJable ' V Ag,A r �r x}a ❑Not Applicable: 403 65 'aOwner and the-occupant of the ❑Complies ; [F35] dwelling unit provided with ❑Does Not' ka �information on the ventilation Y a y � tWesign and systems installed; • ❑Not Observable 1%01 including instructions on the ❑Not Applicable; , - proper operation and . maintenance of the ventilation systems.Ventilation controls. shall be labeled with regard to, their function. . 1 High Impact(Tier 1) F41 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: New Addition Report date: 07/31/20 Data filename: Untitled.rck Page 9 of10 # Fiins tionPo�vison � Plans�l/ferified FielclV er�fied� Com Iles �� Value Yalue P. a Comments/A'ssumpti'ons 4036 6 ',AII ventilation air inlets are ❑Complies ; [FI36)34unobstructed and located a ❑Does Not gg � ;minimum of 10 feet from other ' �,"� � -]Not Observable r N'Mvent openings that constitute r r' F� known contamination sources. -' ❑Not Applicable ; t ?16 W�I Outdoor forced air inlets are F covered withirodent screens..A' 4 ' � � �';whole house mechanical ' r k f 01ventilation system does not + ; NINON Re 'extract air from an unconditioned z �3 basement unless approved by a 1IVI 01 ,� registered design professional. � � ;Where wall inlet or exhaust vents { k,3'w.3'.EJ - �-!are<,7 feet above finished grade ,• �iin the area of the venting an fA M.7 identification plate is : xgcmmypermanently mounted to the � Xlexterior of the building at a >= 8un j " T Veet above grade directly in line e ,with the vent terminal. 404.1 ;75%'of lamps in permanent ❑Complies [F16]1 ;fixtures or 75%of permanent ' ¢•• ❑Does Not ;fixtures have high efficacy lamps. » Does not apply to low-voltage F ❑Not Observable,: ;lighting. R �.. ❑Not Applicable ! t � � , 404 1 1� Fuel gas lighting systems have ❑Complies [FI23j no continuous pilot light. [--]Does Not" + ❑Not Ol servable .� * g ; ❑Not Applicable Additional Comments/Assumptions: r , qk . a • r •i, •, a *. " • 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) §D, Low Impact(Tier 3)' Project Title: New Addition ' Report date: 07/31/20 Data,filename:,Untitled.rck 6 ' Page 10'010` 780 CMR 51 .00: Massachusetts Residential Code, 9th Edition, Energy Efficiency Energy Efficiency Certificate Insulation Rating_ — -.R-Value-..- Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 40.00 Ductwork (unconditioned spaces): Glass&Door Rating LI-Factor SHGC Window 0.31 Door 0.31 .. Heating System: Cooling System: Water Heater: Name: Date: Comments i Commonwealth of Massachusetts `title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 Cltyrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. inspection forms may not be altered in any way.. A. General Information 1. Inspector. Frank Nunes IiI Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Citylfown State Zip Code 508.272.6433 Telephone Number B. Certification atlon I certify that i have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. i am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further-Evaluation by the Local Approving Authority 6/24/16 Inspect4inaturegg-- 215 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority_ t, ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Parker Rd•0310 Tine 5 Official Inspection Form:Subsurram Sewage Disposal System-Page 4 or 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti 215 Parker Rd Property Address Barnard Owner's Marne West Barnstable MA 02668 6/24I16 City/town State Zip Code Date of inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Pum in suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, IUD) in the ❑ for the following statements. If"not determined,'please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 215 Parker Rd•0 3= Titte 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24116 Cityrrown State Zip Code Date of lnsp; ton B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply_ ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 215 Parker Rd-0=8 Tide 5 official Inspection Form.Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24116 City1rown State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 215 Puker Rd•03MB Title 5 official Inspection Finn:Subsurface Seviage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Titre 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Ownees Name West Barnstable MA 02668 6124116 Cityrrown State Zip Code Date of inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cunt): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. i ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. )This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either ayes"or"no"to each of the following, in addition to the Questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply \ ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well if you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 215 Parker Rd.OWN Title 5 QE6dal fnspecpon Form:Subsurface Sewage Disposal System.page 5 of 15 Commonwealth of Massachusetts ' Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 Cityrrown State Zip Code Date of fnspe on C. Checklist Check if the following have been done. You must indicate"yes"or"no'as to each of the following: Yes No z ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] 215 Parker Rd•03108 Title 5 OHidat hspecfon Forth:Subsurface Sewage Disposal*,Systain•Page 6 of-15 Commonwealth of Massachusetts j Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 Cityrrown State Zip Code Date of Inspection Q. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): well water Sump pump? ❑ Yes 0 No Last date of occupancy: Occupied Date Commercial/industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 215 Parker Rd-03= Title 5 OHidal Inspection Form:Subsurface sewage Disposa0 System•Page 7 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owners Name West Barnstable MA 02668 6/24/16 City/rown state Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped last fall per owner Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any), ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1988 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 215 Parker Rd•03MB Title 5 Official Inspection Form:Subsurface Seta Dis 98 Pool systpm•Page 8 of 15 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12" feet Material of construction: 0 concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) very good condition If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No --------------------------------------------------------------------------------------------- Dimensions: 10009 Sludge depth: trace-1" Distance from top of sludge to bottom of outlet tee or baffle '12' ' Scum thickness trace Distance from top of scum to top of outlet tee or baffle '2' Distance from bottom of scum to bottom of outlet tee or battle >2" How were dimensions determined? Measured 215 Parker Rd•03(06 Title 5 Ofidal tnspedion Form Subsurraoe Sewage Disposal System•Page 9 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 Cityrrown State Zip Code Date of inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass Q polyethylene ❑other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene El other(explain): n/a 215 Partter Rd•03M Title 5 QiGdal Inspection Form:Subsurface Seyvage Dispose!System•page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 Parker Rd Property Address Bamard Owner's Name West Barnstable MA 02668 6/24116 Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Tight or Holding Tank(cont) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is 2' below grade and in excellent condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 215 Parker Rd•03M Title 5 Official Inspection Farm:Subsurface Sewage DisposaG sy stem•Page 11 of t5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments µ 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 Cltyfrown State Zip Code Date of Inspection D. System information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System(SAS) (locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 approx. 50' ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/aftemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Perf pipe trench was video inspected and is damp at this time, it is approximately 50'long and 2' below grade, no indication of past backup 215 Parker Rd-03M Title 5 Official tnspection Fomr Subsurface Sewage Disposal p0 System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Barnard Owner's Name West Barnstable MA 02668 6/24/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic etc.)- failure, level of ponding, condition of vegetation, Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic.failure, level of ponding, condition of vegetation, etc.): n/a -715 Parker Rd•03= Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection! Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Propeity Address Barnard Owner's Name West Barnstable MA 02668 6124/16 Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �r r� r a-A r �I 215 Packer Rd.03M Tdle 5 Offidal Inspection Form Subsurlaoe Searege Disposal System Page f 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 215 Parker Rd Property Address Bamard Owner's Name West Barnstable MA 02668 6/24116 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) , Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 114" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1987 GW at 114" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above 215 Parker Rd-0308 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Application number. ......(............. .. Fee ........................... `<................... ... • R ©�� Building Inspectors Initials..... �/..... .. • �r1I p I - H Date Issued......... .......................... TO MIA, � � Map/Parcel........ �. ..... ...�.�... ...................... TOWN OF BAA &STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 21 S rke2 /Lio. ajvS,,�- dr r,,7 Sol b /�e E STREET VILLAGE Owner's Name: M/IRC g . isUTZFfZ- Phone Number 19y8 5-16 99 3 Email Address: �U�let- mA Co, Cell Phone Number Project cost$ . 2 Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize Air &:L.5, a W Z to make application for a building permit in accordance with 780 CMR Owner Signature: �i/% L L Date: TYPE OF WORK ID Siding 0 Windows (no header change) # © Insulation/Weatherization Doors (no header change)# ' - ' Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to ►T 011 n a,ry' o t8k 1910 S R 94A-Al\ L. CONTRACTOR'S INFORMATION Contractor's name 16 cm�i Home Improvement Contractors Registration(if applicable)# / 3 (attach copy) Construction Supervisor's License# C 9 2 G--4-0 (attach copy) Email of Contractor 8,P A/6,rrvi_ OoM&/ah av,(o/nPhone number 6V 6 5-)7 ALL PROPERTIES THAT HAVE STRUCTURES OVER S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. { The Commonwealth of Massachusetts 40 Department of Industrial Accidents — = Office of Investigations ' 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1— Please Print Legibly � B Name usiness/Or anization/Individual): Gc, I l�QY1,1 Address: 6 Jta id,S In W 6Um City/State/Zip: � M� O�Pho e#: D_ lT c9g L(/ Are you an employer?Check the appropriate bog: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.2 I am a sole proprietor or partner- listed on the attached sheet. 7. [KRemodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y P �'• # 9. ❑Building addition [No workers'comp.insurance comp. insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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. $Contractors 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 employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 der npaiapenalties of perjury that the information provided above is true a d correct. Si ature: Date: l Phone#: v V_ ill Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: 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 of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§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 work until acceptable evidence of compliance with 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 returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. 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 to 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 like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass..gav/dia Commonwealth of Massachusetts ®� Division of Professional Licensure Board of Building Regulations and Standards Constrq�Cfi'6rtl§b rvisor i CS-112670 p{ ires: 11/07/2021 J v MATTHEW F-BALBONI1;}�.;; 16 STANDISH:YOODS CIRCLE HARWICH MA 02645 tv 1 41 I� Commissioner �'�e �irrureo>2u�e�a�.�/Ga�a,�Wells Office of Consumer Affairs EMion HOME IMPROV . ENT CONTRACTOR Tti FEs individual Reaistratio_ Exairation 3:1]7 09/24/2020 MATTHEW BA LIB-N — I is MATTHEW F.BA'G16B0 fI 16 STANDISH WOODS=CIRCLE V HARWICH,MA 02645` Undersecretary t' I , l i a Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. A Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Registration valid for individual use only before the-expiration date. If_found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,M 02118 of id w hout signature M _ _ Town of Barnstable _µ _ Building s Post This Card So That it is Visible From the Street Approved Plans Must be Retained on Job and this Card.Must be Kept BAMSrABM ' •,� Posted Until Final Inspection Has'Been Made. 1 ¢t Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. s 1 Permit No. B-17-4120 Applicant Name: HENRY E CASSIDY Approvals Date Issued: 12/01/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 06/01/2018 Foundation: Location: 215 PARKER ROAD,WEST BARNSTABLE Map/Lot: 176-017 Zoning District: RF Sheathing: Owner on Record: BUTLER,MICHAEL J&SARAH M Contractor Name: HENRY E CASSIDY Framing: 1 Address: 215 PARKER ROAD Contractor License: CS-100988 2 WEST BARNSTABLE, MA 02668 Y - Est. Project Cost: $2,900.00 Chimney: Description: R-30 Spray Foam to 500sq ft.Crawlspace Ceiling. Permit Fee: $85.00 Insulation: Project Review Req: Fee Paid: $85.00 Date: 12/1/2017 Final: Plumbing/Gas Rough Plumbing: ---- -— Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ----- ---- ------ "" Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Vv"ork shall not proceed until the Inspector has approved the various stages of construction. Final: i "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department 's Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel A licati n ':� P pp o Health Division Date Issued Conservation Division Application Fee w Planning Dept. Permit'Fee oo Date Definitive Plan Approved by Planning Board . Historic - OKH _ Preservation / Hyannis Project Street Address �P� V G�IGI/ GV Village I-& - 'G VUi Owner Address Telephone Permit Request �� CV 46e LA&1 ((0 I Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation-2 01 4 Construction Type�`� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ,A �G Basement Finished Area (sq.ft.) Basemen�A'�5Jnfirfis'�V,�ed A ea (sq.ft) v Number of Baths: Full: existing new HPIexig new Number of Bedrooms: existing _new2 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 4 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 1(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name em Telephone Number a '77 r ' a I in Address �G�-� License# rUo "l an M41 Home Improvement Contractor# l Email V VVI �i GD I (tf � 0M l Worker's Compensation # i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT ILL BETAKEN TO YGt� SIGNATURE DATE _, Z FOR OFFICIAL USE ONLY . APPLICATION # !� q DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE z OWNER f i DATE OF INSPECTION: FOUNDATION �t FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL } PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT F > ASSOCIATION PLAN NO. r . j i - —- - —_--- --------- c. (�r Commonwealth of Massachusetts ll f/ Division of Professional Licensure -Board of Building Regulations and Cons { Standards CS-100988 ��r f ��irvisor J. `� i�lrvt ires: 11/11/2019 HENRY E CAS ip 8 SHED ROW `Y WEST YARMOijTH'GM O 1 /,SS T:JOZ�S �s•:: Commissioner 3UILDINC '9E t'. NOV 3 0 2017 TOft CAS= r Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma f$ �iusetts 02116 Home Improveme. C©'�l'tractor Registration_ g tion n! Cape Cod Insulation, Inc y -�• � ;�` `' �" r Re Is Type: Corporation Reardon g tration; e 18 Rear Circle Expiration; 12�5 7 So, Yarmouth MA 02664 n� II> 1a/2018 i I0 X. Update Address and return card, Mark reason for change, -------- �o Offlce of Consumer Affairs&Busln�s R gulatIcn, n t7n41aZ tC.� HOME IMPROVEMENT CONTRACTOR T:yO.; Corporsilon Registration valid for Individual use only •Qj- <:-:`.l °aI° before the expiration date, If foun ;••.,cam' ~•••t= Extii Offioe of Consumer Affairs end urn to; si ss Regulation 12/14/2018 10 Park Plaza• e 6170 Cape Cod Insui�dl�`'( ;I• ;? (; Boston,MA 11 HenryCassldI•'1 18 Reardon Circe.••;, ,�1 r�' So,Yarmouth,MA CS cG " Undersecretary t al hout sl atu CAPECOD-27 OYL '4�oRow CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06130/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER C ACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext: A/c No:(877)816-2156 South Dennis,MA 02660 'M I .mall@rogersgray.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:Safet Insurance Company 39454 Cape Cod Insulation,Inc. INSURER c:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 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 LTR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11000,000 CLAIMS-MADE a OCCUR CBP8263063 04/01/2017 04/01/201$ DAMAGE TO RENTED 100,000 MED EXP(Any oneperson) 5.000 PERSONAL&ADV INJURY 110001000 EN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 2,000,000 X POLICY D jteT LOC P ODUCTS-COMP/OP AGG 21000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANYf,UTO 6232707 COM 02 04/01/2017 04/01/2018 BODILY INJURY Perperson) OWNS ONLY X AUTOSULED IRE U owNEp BODILY INJURY Per accident X AUTOS ONLY X AUTOS ONLY Pe0accRdenl AMAGE C 1 UMBRELLA LIAB X OCCUR EACH OCCURRENCE 2,000,000 X EXCESS CLAIMS-MADE EXCl0006635002 04/01/2017 04/01/2018 AGGREGATE 21000,000 DED RETENTIONS D WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X ANY PROPRIETOR/PARTNER/EXECUTIVE R/O WCE00431902 06/30/2017 b6/30/2018 1,000,000 �FFICER/MEM EXCLUDED? ❑N NIA E.L.EACH ACCIDENT vlandstoryIn�I ) 1,000,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 11000,000 3UILDING OER i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) NOV 3 O L e�011 Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contrac I�t or agreement with the Certificate Holder. TOWN 0;- AJL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25/201R/Wit ...�,,, _._.. ... • The Conunon wealth of Massachusetts Department of Xndustrlal Accidents 6 1 Congress Street,Suite 100 Boston, MA 02114-2017 www,mass,gov/dla Workers, Compensation Insurance Affidavit: Bulldens/Contractors/Electriclans/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY, t rm 3UII_p1e se Print' b Name (Business/Organizador4ndlvldual): Cape Cod Insulation Address. 18 Reardon Circle 6 0 cu i l City/State/Zip: South Yermouth,MA 02664 Phone #: 508-775-1214 Are you an employer?Check the appropriate boxt Type of protect(required); I.©1 am a employer with 48 employees(full and/or parwime),* 2,01 am a sole proprietor or partnership and have no employees working for me In �' [] Now construction any capacity,(No workers'oomp,insumnoe required,) 8. [] Remodeling 3,01 am a homeowner doing ell work myself,(No workers'oomp.Insurance required,)t 9. ❑Demolition a.C]I am a homeowner and will ba hiring contractors to conduct all work on my property, I will 10 Building addition ensure that all contraoton either have workers'compensation Insumnoe or are sole proprletors with no amployeas, I,❑ Electrical repairs or additions S,C]1 am a general eontmotor and I have hired the sub-contractor listed on the attaohed shoot, 12,C]Plumbing repairs or additions These sub-contractors have employees and have worker'comp,insurance.t 13,[]Roof repairs 6,[]We are a oorporadon and Its officers have exercised their right of cxompdon par MOL o, 14. Other W eatherization 152,✓)1(4),and we have no employees, (No workers'oomp.Insurance required.) *Any applicant that checks box 1 must also fill out the seetlon below showing their workers'compensation policy Information t Homeowners who submit thfii,rPtidavlt Indicating they era doing all work and then hire outside contractors must submit a new affidavit Indicating such. tContraoton that check this box must attached an additional sheet showing the name of the sub-oontraotots and state whether or not those enddes have employees, if the sub-contractor have employees,they must provide their workers'comp,Policy number, 1 am an employer'that is providing workers'compensation Insurance for my employees. informa Below is the policy and Job site tion. Insurance Company Name: Atlantic Charter 0431902' Policy#or Self WCE0 Ins,Llo,#; Expiration Date' 06/30/2018 Job Site Address;_ 7� r, n� Z�1 /'t'VIe U/ aA City/State/Zip:uj - f3tl'Y'l J�� rri/► Attach a copy of the workers?compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under MOL c, 152, §25A Is a oriminal violation punishable by 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, A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vedfloation, I do hereby cer*under the pains and penallles of perjury that the Inf t: ormation provided bove is true and correc Henry Cassldy ��"y�yw:� ate:idIWMM1YY M.111I1 W IJI�iV WI / 508.775-1214 Offlctal use only, Do not write In this area, to be completed by city or town ofylclaL City or Townt Permit/License# Issuing Authority(circle one), 1. Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector..51 Plumbing Inspector 6,Other Contact Persons Phone#: r OWNER AUTHORIZATION FORM (Owners Name) owner of the property located at PArl 4. (Property Address) (Property Abdressl hereby authorize PE Cm -i/1SLrL ??vn to act on my behalf to obtain a buU&g permit and to perform work on my property.. k Owner's SIgnattfre k il l � / Date a, Scanned by CamScanner �fi.. 'r 7.i h'� '-' 'F-�'' -'n-.`ram..�,1.��4"1L n.q� - a-' .. .. _ • , ��--„w'.�1..b AYf�r.N'NY"'W� F � •'�, vY^YTw'F"�+µ'err'ti."1''r'-`r..rjS-.-��y+1...5.. Jw.�.t-... Town of Barnstable o� BARNSTABLE. Regulatory Services 9 MASS. 1639. Building Division �prFO MAC a, 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location 216' Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: 1 o cc .�ooT ► t� du i6/N6 (&m(7- '�'V/N� CGS S Please call: 508-862-463SIor re-inspection. Inspected.by , ,.� Date c;Us p )JLUJ 0 Wntf-UAI) ctj Xtem 200g-02511118/04 Substitute Demo/Rebuila Zoning Ordinance Amendment .Upon a motion duly made and seconded it was ORD D: . That Chap er III,Article TIT of the Town of Barnstable General Ordinaneed, the Zoning o� Ordinance,.is hereby amended by inserting paragraph 7 to Section 4-4.2 Nonconforming Lots,to read �s follows: 7) Developed Lot Protection—Demolition &.Rebuilding on Non-conforming Lots: ' Pre-existing leg non-co orating ots h h have been-improved by the-eoustruG-ion- 0 �� of a single or two-family.residence which conformed to all provisions of the zoning ordinance or bylaw at the time of constriction shall be entitled to completely demolish the old residence and construct thereon a new residence in accordance with the following. A) A.s of Right: o osed demolition andrebuildin shall be permitted as-of-ri ton a re- �'he pr p g p � p existing legal non-eonfornring lot that eontaans a minimum of 10,000 sq. I of. contiguous u-pland,provided that the Building Commissioner determines that all of the following criteria are met; 1) The proposed new structure conforms to all current use and setback requirements of the zoning district it is located in; 2) The proposed construction conforms to tl}e following requirements of lot coverage, floor area ratio and btiildingheight: a.. Lot Coverage by all buildings and all structures shall not exceed twenty ` percent(20%) or the existing lot coverage,whichever is greater; �-� b. The-Floor Area Ratio shall not exceed 0.30'or the existing Floor Area y Ratio of the structure being demolished and tebuilt,whichever is.greater; and c. The building height in feet shall not exceed'th (30) feet to the highest plate and shall contain no more than 2 %s Stones. The building height in feet shall be defined as the verdcal distance from the average grade_plane to plate. 3) Further expansion of the-rebuilt structure must conform to Section 4,4.2 7)A)2) above. B) By Special Permit: T�lt__ ____,...,,a',te,.,,,,,1;+;,.,, �„�i ,•Pl,,,;l�;,,n,.�,,,;,,+ ��+;��+1,A !•T�P.Y-ii1 a.ctahli.ehPr1 in 1) The proposed yard setbacks are equal to or greater than the yard setbacl s of the existing building; and 2) All the criteria in 4.4.2 7) A) 2) a;b & c, above is-met. 3) The proposed new dwelling would not-be' substantially more detrimental:to the ..- =�teighbeFhood- e�a�t�ng--d�ueliir�:g�• • A TRUE COPY ATTEST. - • • � ''l"vYrtpi C(� Gam-► �cc_-r , . Tb n c� tkq fig- 3�5 =70 8? Parcel Detail Page 1 of 3 017 act Law pF Logged In As: Parcel Detail Friday,August 24 2012 Parcel Lookuo Parcel Info Parcel ID 1176-OI--17 Developerr I Lotl Location 215 PARKER ROAD I Pri Frontage r296 Sec Sec Road Frontage Village IWEST BARNSTABLE I Fire District JW BARNSTABLE i Town sewer exists at this address:No I Road Index F211 Asbuilt Septic Scan: Interactive 176017_1 Map � � Owner Info Owner!ARMSTRONG, GLORIA D ESTATE OF I Co-Owner C/O GLORIA ALVES, EXECUTRIX Streetl PO BOX 248 I Street2 F I City IMARSHFIELD I State MA I Zip 02050 I Country Land Info _ Acres�0.72 use(Single Fam MDL-01 I Zoning RF Nghbd 0108 Topography Level I . Road rPaved utilities Gas,Well,Septic I Location Construction Info Building 1 of 1 Year,-,-9-00—'` I Roof Gable/Hip I Ext Wood Shingle Built Struct Wall Living 546 I Roof[Asph/F GIs/Cmp I Ac rNone Areal Cover Type Bed Style Cottage I wali Drywall I Rooms 1 Bedroom Model Residential I Floor Ior Hardwood I Bath 1 Full I , Rooms ,r r i. G Heat Total rade Below Average I None I 2 Rooms ~I Type Rooms Stories j 1 Story I Heat None Found Stone Walls Fuel I ation Gross(� Area 1546 Permit History taaeLC http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12276 8y/1__ 8/24/2012 Parcel Detail Page 2 of 3 ,r IIIssue Date I Purpose I Permit# I Amount I Insp Date I Comments II Visit History Date Who Purpose 05/11/2011 00:00:00 Denise Radley Change of Address 11/03/2008 00:00:00 Paul Talbot Cyclical Inspection 05/05/2000 00:00:00 Paul Talbot Meas/Listed-Interior Access 07/15/1991 00:00:00 IME Sales History_ Line Sale Date Owner Book/Page Sale Price 1 03/16/2011 ARMSTRONG,GLORIA D ESTATE OF #NO11 P0638EA $0 2 04/28/1954 ARMSTRONG, GLORIA D 872/39 $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2012 $42,800 $0 $0 $275,900 $318,700 2 2011 $43,600 $0 $0 $275,900 $319,500 3 2010 $46,500 $0 $0 $281,900 $328,400 4 2009 $45,100 $0 $0 $271,800 $316,900 5 2008 $44,700 $0 $0 $259,000 $303,700 7 2007 $44,700 $0 $0 $259,000 $303,700 8 2006 $39,100 $0 $0 $262,300 $301,400 9 2005 $37,600 $0 $0 $238,400 $276,000 10 2004 $30,800 $0 $0 $198,700 $229,500 11 2003 $23,000 $0 $0 $51,600 $74,600 12 2002 $23,000 $0 $0 $51,600 $74,600 13 2001 $23,000 $0 $0 $51,600 $74,600 14 2000 $25,100 $0 $0 $38,600 $63,700 15 1999 $25,100 $0 $0 $38,600 $63,700 16 1998 $25,100 $0 $0 $38,600 $63,700 17 1997 $21,700 $0 $0 $30,000 $51,700 18 1996 $21,700 $0 $0 $30,000 $51,700 19 1995 $21,700 $0 $0 $30,000 $51,700 20 1994 $24,100 $0 $0 $42,400 $66,500 21 1993 $24,100 $0 $0 $42,400 $66,500 22 1992 $27,400 $0 $0 $47,100 $74,500 23 1991 $6,700 $0 $0 $68,500 $75,200 24 1990 $6,700 $0 $0 $68,500 $75,200 25 1989 $6,700 $0 $0 $68,500 $75,200 26 1988 $11,700 $0 $0 $25,500 $37,200 27 1987 $11,700 $0 $0 $25,500 $37,200 28 11986 1 $11,700 $0 $0 $25,500 _IL7,200ji Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12276 8/24/2012 Parcel Detail Page 3 of 3 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12276 8/24/2012 Town of Barnstable * ermit# nthsfro Regulatory Services F eb � date l = K 9. Thomas F.Geiler,Director AM Building Division _ Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bastable.ma.us Office: 508-862-4038 Fax:508-790- 23 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY //nn Not Valid n a to Red X-Press Imprint Map/parcel Number i q u - V 1 t Property Address J15 ?C r K�' d . (j . 3 a r In 5�c-Ip( -e. IX Residential Value of Work S J90 6, 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address -j e r►✓I,(C r S q t-hare sP/5 Fctrker- 3909_561h/d Contractor's Name Te d 141 TGVI G O G K Telephone Number 5 O-Z- -7 7 5- 7 7(c a> Home Improvement Contractor License#(if applicable)_ &S.1/0 7 Email: f7/�G n e0 CL&.R a/ e (51n 3i Coon, Construction Supervisor's L icense#(if applicable) 0 9 9 a ❑Workman's Compensation Insurance X_pRESS PERMITCheck one: ❑ I am a sole proprietor ❑ I am the Homeowner AUG - 9 2013 ® I have Worker's Compensation Insurance Insurance Company Name Y-cL\d err TOWN OF "^NSTABLE Workman's Comp.Policy# [/A -j 6 ?9 g_?5-/ a -/ Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) kQ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to S-e T EX Cy ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement W indows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation,etc. ***Vote: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requi SIGNATURE: C:\Users\decolhk\AppData\Local\ivlicrosoft\Wtndows\Temporary Internet Files\Content.Outlook\8R76BDVAkEXPRESS.doc Revised 061313 77te Contntomvealth of Massachusetts Department of Industrial Accidents Office of Investigations vi 600 Washington Street Boston,MA 02111 tvsvrr:ntass gmVdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print 1*6bh Name(Business/OiganizatimvintividLW): �rL /t� f�- hG o C e� Address: 55-z5- L g at N . City/State/Zip: Aa,r 4 5 f-4 0(G GW R- Phone 9- -2 7 5-- `7 7 v 3 Are you an employer?Check the appropriate box: Type.of project(required): 1: 1 I i am a employer with 4. ❑ I am a general contractor and I 6. New constructionemployees(full and/orr p�-* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees These subcontractors have 8- ❑Demolition working for me in any capacity. employees and have workers' 9_ ❑Building addition (No workers'comp.insurance comp.insurance. 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 LE]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.)t c. 152,§1(4�and we have no employees.[No workers' 13.❑Other comp.insurance required.] •Any applicantchecks that ches boa#1 must also fin out the section below showing tbeu wwters'compensation policy informatian. Z Homeowners wbo submit this aflidnit indicating they are doing all watt and then hire outside contactors mast submit a new affidavit indicaung such- IContractors that check this boa mast attached an additional sheet showing the nmrke of the sub-cantroctors and stets whether or not those entities bane employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I ant an entplgy'er that is providing workers'compensation insurance for my employees. Below is the potty and job site information. hmirmce Company Name: Policy 9 or Self-ins.Uc.#: U 3 — S 5 ? 7 2 t -Z— t 3 Expiration Date: 3 I Z-O f t Job Site Address: 2 t-;7 �R/.Lc! Re City/State/Zip: , / t?ar'/t 9 tab Le v 2 C. 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 S 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 certitify rider a pains and penalties that the information provided above is trite and correct Si ture: Date: Jr g /!j Phone##: Z 7;— -7 71, 3 Official use only. Do not write in this area,to be completed by city or town of ciaL City or Town: PermitUcense 0 Issuing Authority(circle.one): 1.Board of Health 2.Building Department 3.CYtyflown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Rightfax N2-1 6/18/2013 7 :58 : 07 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: HUB INITBRNATIONAL NE LLC PHONE FAX 125 ROUTE 6A (A/C,No,Ext): (A/C,No): SANDAVICH,MA 02563 EMAIL ADDRESS: 78CN`B INSURER(S)AFFORDING COVERAGE —NA WIC 4 INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA T L HITCHCOCK CONSTRUCTION SER\rICES INC INSURER B: INSURER C: 55 LISALANE INSURER D: WEST BARNSTABLE,MA 02668 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCEUSTED BELOWHAV ISSUED TO THE INSURED NAMED ABOVE FORT E PO ICY PERI00 DMATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THEINSURANCE 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. WSR ADD SUB POLICY E F DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MIAIDDIYYYY) LIMITS GENERAL LIABILITY CH OCCURRENCE g COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR. DAMAGE TO RENTED S EMISES(Ea occurrence) VIED EXP(Any one person) S GEN'L AGGREGATE LIMIT APPLIES PER: RSONAL&ADV INJURY $ POLICY 0 PROJECT 0 LOC ENERAL AGGREGATE S ODUCTS-COMPIOPAGG S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY S SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON�OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA I.IAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE g DEDUCTIBLE S RETENTION $ S A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B692512-13 0326/2013 D326/2014 X LIMITS ANY PROPERRO�R/PARTNER/EXECLRNE N NIA OFFICERIMEIIBER EXCLUDED? E.L.EACH ACCIDENT S 100,000 (Mandatory in NH) r yes,describe under E L DISEASE-EA EMPLOYEE S 100,000 LcSCRiPTIOV OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS R13PLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTINO WORKERS COMP COVERAGE. THE POLICY DESIONATED ABOVEIS CANCELEDEFFECTIVB 062G2013 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT W- i'z .�, / •etc. �„ c*:,.. grr,o Rec a �V rT e tn1ncs r,,,nrnoD•, ?^''I"^^^- ,,,,,r�r,,,^ marks of ACORD 1988-2010 ACORD CORPORATION, A I rights reserved. lver�' Time Jun. 18, 2013 7;57AM too. 1188 1 � $ WWW,�, . Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 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 A Builder r h.R'r ,as Owner of the subject property hereby authori i to act on my behalf, in all matters relative to work authorized by this building permit application for. 2).5 pp, k, k J-.' - W --� ) m,"z (Address of Job) Signature of er D e \J e-ti, G, V- her Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side C_\Users\decollik\AppData\Local\iMicroscft\'%rindows\Temporary Internet FileslContent.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 -:1 c,a r d oT Su-:1dinc, Regulations ai�,J Off-ice of Consilmer-AlTairsi-.Bsj,pcsts,.gcgvjation-- FIOME IMPROVEMENT CONTRAr-TOF-;L.. Registration: 165907 Type: -.Cense: CSSL-099828 pExpiration: 416/2014 Pfivate,Corporatic: 'NN TED L HITCHCOCK TL HITCHCOCK '§TRLjbTION SERVICE INC. 55 LISA LANE West Barnstable MA 02668 THEODORE HITCHCOCK 55 LISA LANE WEST BAOSTABLE,MA 02668 Undersecretary 06/01/2014 :1`�, Office of Consumer Affairs&Business Regulation License or registration valid for individul use only Z'�Wmg,IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 165907 Type: Office of Consumer Affairs and Business Regulation ^' 10 Park Plaza-Suite 5170 ;Expiration: 41612014. Private Corporatic: Boston,MA 02116 TL HITCHCOCK CONSTRUCTION SERVICE INC. THEODORE HITCHCOCK 55 LISA LANE WEST BARSTABLE,MA 02668 Undersecretary Not valid without signature c 31 1410:45a Tupper Com 15087785010 p.1 CONSTRUCTION CO. LLc 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.TUPPERCO.COM �( Date. Town of Barnstable = Thomas Perry CBO 200 Main Street Hyannis, Ma .02601 _ (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # j ��gol Issued on ��l j �/ has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or. exceeds Federal and State requirements. Sincerely, Permit Address: Richard Tupper. License # CS-69058 S ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map , Parcel I Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Sar Address Telephone Permit Request �. �J4& m 4f �?-Iq f�acej j "ibera 1 a5s E �Ula2bko in IV ba,5 e%4: oei I i'vw Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationt 55 Construction Type Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure I qiOO Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: I existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric Other 1 _ Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn:2 xisting C] ne8 size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other s - o a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# cx� � Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _F J p.� Namegl'C�Orj (AD VC Telephone Number I IIIAddress AM I V 1,V License# ( �adL,t& Q 7 Home Improvement Contractor# Email Worker's Compensation #AX,(,6X;56U012D_L4A ALL CONSTRUCTIO EBR RESULTING FROM THIS PROJECT WILL BE TAKEN TO j4U A -.01 1A) SIGNATURE DATE A CLj f r FOR OFFICIAL USE ONLY APPLICATION# bATE ISSUED l MAP/PARCEL NO. i ADDRESS _ VILLAGE OWNER - i z DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL s FINAL BUILDING } DAFF CLOSED OUT i . AS__.SQIATION PLAN NO. K 1 f n The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UT 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Avghcant Information Please Print Legibly Name(Business/Organization/Individual): Tupper Construction Co. , LLC Address: 546A Higgins Crowell Rd City/State/Zip: West Yarmouth., MA 02673 Phone#: 508-778-0111 i Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' compAnsurance4 9. ❑ Building addition [No workers' comp..insurance 5. ❑ We are a corporation and is required.] officers have exercised thlir 10.❑ Electrical repairs or additions 3.`❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we hav�no 12.❑Roof repairs insurance required.]t employees. [No workers 13.EJ OtherWeatherization comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: AEI C Policy#or Self-ins.Lic.#: WCC 5 0 0 5 5 9 3 012 014A Expiration Date: 10/3/15 Job Site Address:_ !) ep aZk6� � City/State/Zip: , (fa��pQ 0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as:requimd 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 pa msldnd Jenalties of perjury that the information provided above is true and correct Sip Fnature: Date: PhoneV (508.) 778-0111 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 1 I ) CERTIFICATE OF LIABILITY INSURANCE 10/2` i2 901 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 Lora FitzGerald NAME: Southeastern Insurance Agency PHONE (508)997-6061 IFN ND.(508)990-2-131 Po-Eft 439 State Rd. I-D-D;Ess:lfitz@southeasternins.com P.O. BOX 79398 INSU S AFFORDING COVERAGE NAICX North Dartmouth MA 02747 (NSURERAArbella Protection Insurance 41360 INSURED MsuRERBBoston Insurance Brokerage Inc Tupper Construction Co LLC INSURERC: 27 Roberta Drive INSURERD: INSURER E: West Yarmouth MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER:2015 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 INSURANCEDLSUBR POLICY E POLICY EXP LIMITS LTR POLICY NUMBER MM10 MMRI GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAX COMMERCIAL GENERAL LIABILITY MISES(Ea O u 0 S 100,000 A CLAIMS-MADE ❑% OCCUR B500008743 1/1/2014 1/l/2015 MED EXP(Any one person) 5 5,000 PERSONAL&AOV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 OEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILnY COM8-IdN-WISINGI.E LIMIT S 11000,000 A ANY AUTO BODILY INJURY(Per person) S ALLrOS D g ASUTOS t ED 020009389 2/1/2013 /1/2014 BODILY INJURY(PeracddeM) S M71NO"WNED PROPERTY DAMAGE X HIREO AUTOS X AUTOS PeramdeM I5 Uninsured mowr)stBl splitthnit $ 250,000 J% UMBRELLA LIABHCLAIMS-MADE OCCUR EACH OCCURRENCE S A EXCESS UAB AGGREGATE S DED RETENTIONS 600058368 1/l/2014 1/1/2015 S $ WORKERS COMPENSATION X WC STATUI OT11 AND EMPLOYERS'LIABR(TY ANY PROPRIETORIPARTNER7EXECUTNE YIN E.L-EACH ACCIDENT S 1 000 000 (w and R/MEMNER EXCLUDED? N N 1 A CC5005593012014>> 0/3/2014 0/3/2015 E.L.DISEASE-EA EMPLOYEE S 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS belwi E.L.DISEASE-POLICY LIMB I S 11000,000 DESCRIPTION OF OPERATIONS,LOCATIONS,VENICLES(!attach ACORD 10i,Addwanal Remarks Schedule.It mare apace Is reputred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN INFORMATION PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. TUPPER CONSTRUCTION CO LLC 546 A HIGGINS CROWELL ROAD AUTHORIZED REPRESENTATIVE WEST YARMOUTH, MA 02673 Lora FitzGerald/LHL ACORD 25(201010S) 01988-2010 ACORD CORPORATION. All rights reserved. 4NSO25 rminrm%nt Thu annpn and I—ern rmniclororl-,L-c of Arnpn I t n �' raY4P+RP6—W9JM:A9Nt�yMi,kWpl.RS•� ski z-GyeTYd&-�.�.t�.v-'`:, ':;f •f.�r..rw..�z:E .�..•wr t ��4E _<o: C�J •1 511�J-TYCzd DR E. " l$•F$T l'{1Pv�liFfi i`vYh �T2G s �:.�,..� t�..._�.Pl:`4• 3�5i.z��.s DLO r.� 9 .. -• 'ti.�i'�Q�ct?i12 ofl,V-, �'a :u�r 'tv Us t 3s Ln the "-s� Ito r-• a S ,LSfice t >. '} fyaa s aa3..tiatr rti tat c 1 Viz. ,�xp,raton: 4i1°;�r; C Wpa 11 x G?4�S ivi'Pcn GC?tiSTF.UC-nONt CO.LLC. F Sty.`lr> cs.y,ti?G267 n�*er�e r 1 _ K td zugeeec:sin.ui 44 ! 5 ?.Icbat-s I sipper upper corlstric"or, i� Bti�a?^.gaafzr_r'r�4..�ss.et pp ��77��nn 81, tl S )q .....-.._-�-'�+..:y...wn_ ._..�e-ti-o 1s•.uR,.o...arr.y..aa-••v�.::LM.x'c<F-v^u+a[:.�u9/:Lt�`� .... i OWNER AUTHORIZATION FORM e- K. il" i (Owner's Name) owner of the property located at (Property Address) l✓Ps-14 /3�►��s-/s,/le . p z�68 (Property Address) hereby authorize I (Subcon Tact an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work ojpro Owner's Signa Date MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Onlv(800)392-6108,FAX(800)851-8424 7/25/2014 Form of Notice of Casualty Loss to Building Under Mass.Gen. Laws,Ch.139,Sec.36 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: EDMOND COUTURE&JENNIFER BANARD Property Address: 215 PARKER RD,WEST BARNSTABLE, MA 02668 Policy Number: 1286818 Type Loss: Lightning(not resulting in Fire) Date of Loss: 07/15/2014 Claim Number: 324787 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 Ao�10 iV° i��@U :1/ `St4\�b Af Town of Barnstable . ;�1Pe mit# Expires 6 months fr miss e e Regulatory Services Fee SARNSMLF, MASS.039. $ Richard V.Scali,Interim Director �0 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 Valid without Red X-Press Imprint Map/parcel Number " _ I. D Property Address �"�� `t�^-e�c W 1'a:141 Residential Value of Work$ 39 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address rx 2-i Contractor's Name W&'�, 1` S5 Telephone Number 37)d'-6 Home Improvement Contractor License#(if applicable) IQp Email: P"94 d c a cuA� y Construction Supervisor's License#(if applicable) or- MIT ❑Workman's Compensation Insurance Check one: DEC 13 2013 g t ImHme ors rke Compensation Insurance TOWN OF BARNSTABL Insurance Company Name ' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request.(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side acement Windows/doors/sliders.U-Value &6 (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property O)39er must sign Property Owner Letter of Permission. A co of a Hom Improvement Contractors License&Construction Supervisors License is re it SIGNATURE: QAWPFIIMTORMMbuilding permit forms0eRFSS.doc Revised 061313 The Cammonweakh ofMassachasetts Deparment of Industried Accidewy - Office of Investigations 600 Washington Street �.y Boston,AM 02111 wmv.mas&gov/dui Workers' Compensation Insurance Affidavit:BuilderslContr2chwsJElectrici2nslPlumbers Applicant Information ( Please Print lRobl Name Mudw_. lOrganiza n&&vianaiy 6�+/OAIIy ` F—+�'�— Ajddress_ CitylSta&Zip: phone$1 so26�ot� �s�� S� Are you an employer?Check the appropriate box: Type of ] (required): required): 1.El am a employer with 4- ❑ I am a general contractor and I employees(full and/or part-fiime).* have hiredthe sub-contractors 6_ ❑Nerow construction 2.❑ I am a sole proprietor orpartuer- listed on the attached sheet. 7- ❑Remodeling ship and have no employees These slob-contractors have g- ❑Demolition waddrigg for me in an capacity. employees and have workers' yI 9_ ❑Building addition [No workm' comp_insurance comp-insurance, required] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3 am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself[No workers'comp_ sight of exemption per MGL 12_❑Raofrepairs insurance required_)t c. 152, §1(4X andwehaveno employees_[No wod=s' 13_0 Other comp_insurance required_r ''Any app&csair that checim boa#1 must also fill out the section below showing they woakas'compensation policy iufmmzdmL 1 Homeowners who submit this affidavit iaeFucating they axe doing sII work dad then hue outside coutnacmrs moast submit sinew affidavit indiestmg stuh. tContmctors that deck this boa must attached au additional sheet showing the nsme of the sub-comxacton and stare whether m not these entities bwe employees. If the sub{aatataots bare employees,they must provide their workers'comp.policy number. I aivr an employer tliat isptmidhW workers'corigmisadon insurance for dry employees. Below is the policy and job,site information. Insurance Company Name: Policy#or Self-ins-Lic_ - Expiration Date: Job*Site Address: City/State/Zip; Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation 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$1,50G_00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Hine of up to$250.04 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 cermfy u t pain nd shies-a perjrrty that Me in,formati m prvv&W abmw is[rue and correct Si Date: ' Phone A- Official ase only. Do not write in this area,ib be completed by city ar town official City or Town: PermitMicense# Issuing Authority(circle one): 1.Board of Health 3.Building Department 3.CitylFown Clerk 4.Electrical Inspector 3.Plumbing Inspector 6.Other Contact Person: Phone 9: Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building.Division L►xtvsr.+ei a. ; Tom Perry,Building Commissioner Mass. 9 039� �� ' 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma:us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ZGI3 JOB.LOCATIOI+I:��fij� Pryer number street ® t� village "HOMEOWNER": d /�� nAme honfe phone# work phone# CURRENT MAILING ADDRESS: t a07,--- 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 Persou(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 Rerformed 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 undersigne omeo r"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedure requ me and that he/s a will comply with said procedures and requirements. Signature of Homeowner Appioval 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;oar 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. 0:\WPFRM\FORMS\banding permit fmms\EXPRESS.doc �TME Town of Barnstable Regulatory Services BUM t$ -Richard V.Scali,Interim Director o u+' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma'.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete. and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (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 - P;fir`-t',IS t Fi;7jil C t�., f _ „•. d THE o Barnstable Old Kings Highway Historic District Committee ELAPMABL& ; 200 Main Street,Hyannis,MA 02601, TEL: 508-862-4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)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 all categories that apply; 1. Building construction: ❑ New ❑ Addition ❑ Alteration 2. Type of Building: 19 House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding,window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date 1,014 lg2dl3 NOTE AM appGcalions must be signed by the current owner D 5� LG'V'�-&- Owner(print): /� t Telephone#: Address of Proposed Work:j /s AM4 / Village bV t Map Lot# Mailing Address(if different) -,S;-//3- Owner's Signature Description of Proposed Work: Give particulars of work to be done: Agent or Contractor(print): A�V VP Telephone#: Address: S A- Gtba J2, Contractor/Agent'signature: For committee use only. This Certificate is hereby AP. O D/D N1E ® "�® Date // i Members signatures N4V 1 ��13S. Stable Kr 5aNleewaY - Old 1 Q:Woards and Commissions101d Kings HighwaylOKHApplicationslOKH2O11 Cert Appropriateness.doc CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 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 new 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 2nd member Depth of overhang 3�'Window: (make/model)4ff ` k�� A� dr_material Gf/0� � color (Provide window schedule on plan for new buildings, maj r additions) Window grills (please c /that apply_: true divided lights erior glued grills<grills between glass removable terior None Door style and make: Color: Garage Door,Style Size of.opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Deck material: wood other material,specify Color: Skylight,type/make/model/: material Color: Size: Sign size: Type/Materials: A r"7 C�i>�1\/r m Fence Type(max 6' ) Style material: Color: N n v 9 3 7 n93 Retaining wall: Material: Ramstable Old King's Highway co Lighting,freestanding on building illuminating signee OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name 2 Q.Woards and Commissions101d Kings HighwaylOKHApplications10KH2O11 Cert Appropriateness.doc Town of Barnstable Geographic Information System October 24, 2013 197040 #0 197001002 #126 197001003 #86 197002 177002 068 #0 197001001 #96 177005002 #150 197041 177001 197042 '#25 #0 #75. 176023 177007 #212 #1644 176015 196040 176014 #240 #69 #264 176016002 • 176027 #155 176017 #165 6 1 #21.5 176013 176012 1#282 0298 176018 1960M 176011 ® #245 #115 0328 tt� ® 176016003 #159 176026 ® 196002 —176010 #315 176016001 #317 It 460 #161 U RGH ST 1#33* am 176003 • 176019 #453 #301 196029 025 176021 16121 11 �146 Feet Ad- DISCLAIMERS:This map Is for planning purposes only. It Is not adequate for legal Map:176 Parcel:017 .boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner:ARMSTRONG,GLORIA D ESTATE Total Assessed Value:$268100 Selected Parcel 1"=100'may not meal established map accuracy standards. The parcel Ilnes on this map Co-Owner:%BARNARD,JENNIFER& Acreage:0.72 acres Abutters are only graphic representations of Assessor's tax parcels. They are not true property j boundaries and do not represent accurate relationships to physical features on the map Location:215 PARKER ROAD f'. j ' such as building locations. Buffer i Page I of i � i� ,.•t - jrj•y.I�}ten., .�� (N�ti,. � �. hb, thy ! rr ,� ;lk►•l I. '' c�'�• "! f �'+r4 -� ...-•,�i _ .r� r._+tom ,. �`{��P;iM sCr �` C s- {; �J ��.'.. '-.r. �".S •Lai • . • • Page � - fit. r a .&�• fir,-►, �,�' ,-�- � --- __ ti .�.� 1••��.rF ti y!11 i . ram• �« f'- � � , , j - .;r. .' - ••r _ file:/A\isvisions\images\00\02\42\47.jpg10/24/2013 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4� �0 Map E7 ta Parcel 0 Application # 3 / Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address d ):' �Q.r d Village t Owner: l�,rP �_ /UPS Address 3L Y Zd Telephone_ INI _I qs 7A Permit Request U%4 S l� q je DK IS I,U /�-"79. ,-S or J, .. , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type F"�f bV_IGS Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family QI., Two Family 0 Multi-Family(# units) Age of Existing Structure /D Historic House: ❑Yes �LNo On Old King's Highway: VYes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 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 0 Appeal # Recorded ❑ Commercial 0 Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR OMEOWNER) Name '`"'""` �Tel hone Numbe4le 77 ta-D Address © . '1�2 License # C 5 f 1b 9 2- f . o ZM Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DE RIS R U I G FROM THIS PROJECT WILL BE TAKEN Tajl �Ut�v - SIGNATURE DATE b 3I ��' FOR OFFICIAL USE ONLY APPLICATION# i - ' DATE ISSUED MAP/PARCEL NO. :I 5, ADDRESS VILLAGE 1 OWNER DATE OF INSPECTION: FOUNDATIONOi— s FRAME INSULATION f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH - FINAL FINAL BUILDING �� •�� ' L r DATE CLOSED OUT, s ASSOCIATION PLAN NO., _ r To'F'P2r of Ba£I7:Etable . regulatory Eer r Thomas F. Geier,Director �k Building Division T$arnas Perry,..CB O,•Brfdiag Commoner 2001.��in S�act, Hy�is,MA 92,601 .tzrm-barmstable-ma { 0$-iccc 508-862-4Q38 Fax: 509-79D- M PLAN W owner: A��Es • .� Mgp/Paiu1: 1�l •D l 7 - pzIIjcetAddrp�s 2<S�iK&R k� Builder-, .., The faThWing items were noted,on regiewzng: ; j)..�L_� � `�`—u r&-tcr ,p. .c r1.� /k 3 p? ( Exc 33 <o 2: � �-�v�/ �ttE� 02�;Mall nCr.c�y �o !v' ew& G � RegieW by: Date' / The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -�q� Please Print Le 'bl ati Name(Businessiorganizon/Iudividual):. i .' IQ Address: • D, City/State/Zip: Imo` Phone.#: 7 Are you an employer? Check the appropriate box: Type of project'(required):• 1.' I am a employer with 1.) 4. .0 I.am a general contractor and I employees (frill and/or part-time). * have hired the sub-contractors 6. 0 New contraction . . 2.X I am a'sole proprietor or partner- listed on the'attached sheet: 7. ❑Remodeling ship and have no employees These sub-contractors have '8. 0 Demolition working forme in any capacity: employees and have workers' 0o insurance.# ' 9. ❑Building addition -.'[No workers' comp.insrTrance. �• required_] 5. ❑ We are a coiporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all-work � 11.❑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.M Other_ K�C� 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 an;doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors 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 employees,they must provide their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: A 3 F� Policy#or Self-ins.Lic.#: 7 PTo�``'-ICJ "�j' 12, Expiration Date: ' ZZ- 15 Job Site Address: �I rJ Qm _y_� Q� ', 2 A_kF : 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 e. 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 maybe forwarded to the Office of Iuvesti lion of the D o insur c ra e verification I do hereby ce fy un r t e s•an p alties of perjury that the information provided ove i true and correct Si afore: Date: es. 26/ Phone#: 71 0 Official use only. Do not write in this area, to be completed by city or town officiat. City or'town: Permit/License# Issuing Authority(circle one): .',Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5:Plumbing Inspector 6. Other Contact Pelson: Phone#: . Massachusetts- Department of Public Safety Board of Buildim-, Red-ulations and Standards Construction Supervisor License License: CS 74821 DENNIS L MASON , PO BOX 462 DENNIS, MA 02638 ` Expir7tionw8/201 ' ('unnnissioncr . f - THE COMMONWEALTH OF MASSACHUSETTS For OCABR Use Only. OFFICE OF CONSUMER AFFAIRS AND uI* BUSINESS REGULATION Registration No: 10 Park Plaza, Suite 5170 Boston , MA 0 2 1 1 6 Effective Date: Application for Relristration as a Home Improvement Contractor or Sub-Contractor Expiration Date: (MGL c.142A;201 CMR 18.00) t 1. NAME OF APPLICANT: (MMBE MHER AN MPMIJAL,CORPORATION,LLC,UP, M OTHER LEGAL ENTITY) 2. NUMBER OF EMPLOYEES: AUG 3. APPLICANT TYPE: VINDTVIDUAL _CORPORATION _PARTNERSHEF TRUST 28 2012 (CHECK ONE—MUST BE SAME LEGAL ENTITY AS THE ENTITY IDENTIFIED IN#1) � OFFICE OF CONSUMER AFFAIRS FEDERAL TAX ID#: 5. APPLICANT PHONE#.11q-g87•gDB( APPLICANT EMAIL ADDRESS: 1t>U*11faw��it1.�*.TWA%L.�p4� 6. MAILING ADDRESS: �. �'�c�+Z �E�:�� 1� `�► . D u+3� STREET CITY STATE ZIP 7. PERMANENT ADDRESS: 5y(�,.,ie,L��`,� ��►.� r\� • O STREET CITY STATE ZIP PLEASE NOTE THAT A P.O.BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUST LIST A STREET ADDRESS. 8. IF THE APPPLICANT IS A CORPORATION OR A PARTNERSHIP,PLEASE PROVIDE THE NAME,ADDRESS,SOCIAL SECURITY#AND TITLE OF THE INDPADUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S THE TRUST'S OR THE PARTNERSHIP'S WORK(Please review the Instructions before answering this question): LAST FIRST TITLE 9. IF APPLICANT IS DOING BUSINESS UNDER A D/B/A,PLEASE STATE THAT D/B/A,AND ATTACH A COPY OF THE FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK: DBA NAME: I� o o�J. (a)DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD ANY OTHER CONSTRUCTION-RELATED STATE; mQ a CITY OR TOWN LICENSES OR REGISTRATIONS?-YES_NO A Q Q^ (b)IF YES,PLEASE FILL IN INFORMATION BELOW.j.3 m` .ATTACH ADDITIONAL SHEETS IF NECESSARY. �Q ° 3''' LICENSE TYPE ISSUED BY LICENSE/REG.# EXP.DATE LICENSEE NAME R0 2 m and0 �+.. �F'Q cs `a ID �4121 . 3 Z613 3' m �m s 6 IQ+�,I. of ` '1• o�a o� ,m I Docket No. t ommon weat h of Massachusetts DECREE The Trial Court APPOINTMENT OF ADMINISTRATOR No11P0088EA:, and Family Court In the Estate of GWa Amm bwg Labe of.Randolph.MA 02M At the Norioo&Probate and Family Court ce TOM Norfolk Probate and Farnfly Court the Honorable Christina L Harms Presided. 35 Shawrnut Road Canton,MA 02021 a All persons irderesW ®having asserted (781)830-1200 having bean rrotiW in accordance with the law and no objections ways ode; []obf ecUwrs were made whkh were later wbdmm of stridrsn; 0 objections were made and a hearing was held; IT I3 DECREED that Alves of L-32i'1&6 shfield;MA M=-..... be appointed aftmistrawrift of the estate named above tit8t glving bond With Personal Surety for Ste due performance of eaid trust. M.13 FURTHER ORDERED that: Date: {l(aAtj l(0 2-O I Judos Christina t Her DATE I,the undersigned,HEREBY'CERTIFY,that I am the Register of Probate of the Norfolk County Division,of the Trial Coiul.Deparrment,Common Wth:of Massachusetts;that.as such I have custody.of ft records of said Court;and I do FURT 4ER.CBRTIPY that the foregoing is a photographic copy of adea ee of appoit[ttnent of 5dt�ciary;that said fiduciary has given bond as aequued by law;and that said appointment rergains in full force.,and that no appearance has-been entered against said appointment WITNESS,my hand seal of the Probate and Family Court ON=tftt of the Commonwealth of Massachusetts at f Canton. Patrick W McDermott Register of Probate Norfolk Division I EVE r'a Town .of Barnstable Regulatory Services STABM n & Thomas F..Geiler,Director Building.Division Tom Perry,Building.Commissioner 200.Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: .508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 4 j/I�C, as Owner of the subject property hereby authorize zr-06 L* C 46*46, �.�.. to act on my behalf, in all matters relative to work authorized by this building permit kk (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. Signa e of A licant .V So � �.ad''` l �''`e— Print Name Print Name S Z� ZDIL Date QTORM&OWNERPERMISSIONPOOLS 62012 RealtyInsite-Property Map Page 1 of 1 Product Comparison:About Us:Coverage: Testimonials:Contact Us:FeedBack a z � • 215 parker Road West Barnstable Print This Map Zoom Pro/4rtY 1/2 Property Property 1/8 mile 1/4 mile 1/2 mile 1 mile 2 miles 9 miles City/Town Add Text C Address(§?Dimensions Add Graphics 21 Buildings M?o Flood E3 Topography Cursor Action 4"pan '.'Identify 0: _. Assessment _'Site Info Registry Info `•- Ownership Info General Info Building Info Info Address Last Sold I Sate Price I Style I Living Area I Acreage I Bedrooms Full Baths Half Baths 215 Parker Road 4/28/1954 $0 jCampj 546 1 0.72 1 1 0 Map Satellite Hybrid t - (I .. t Privacy Policy Terns of Use ©2012 Compu-Links,Inc.All Rights Reserved http://www.realtyinsite.com/ccimis/livemap.aspx?ID=BARNSTABLE$176-017 8/28/2012 SPEC SHEET 215 Parker Road, West Barnstable MA One 6x8 and one 8x8 deck will be constructed on the same footprint as the old decks; design will not change except to meet with current Building Code. Material will be pressure treated dimension The material will be remain unfinished The rails on the deck will be a center rail which will conform to the Building Code r ! I { � I �cr SNJ , V? i I .�, P► I I I O. it- 4VI 4 1 C-.4cl n I mw" q i t !ct i I I I ) I i I � � I •f I I , '� ��11 I , I —p�w— j •o ^� —� a yy��pFI ,` Road 0.40' pubWay i Pavement Edge ' Width � S SandyStreet I 81'54'10"�23.25 \ N(Varioble i Kngwn �A Formerly N Stonewall c' w ` Pavement Edge ` \ (�: C\j —28— Parcel Area ti� o a o - ° .-75. .;� (�Je 5fSF Upland 4(6 0 t / / o 651 �4A6 ..._ .:: :::::::::::: .:. LOCATION MAP: /V . .................. ...�............. t 1 6 800fSF Wetland/ ....... . prox N��B. - 3o.s �30�— Septic \ • \ L'` 31,405�SF TOTA(/ i Scale: 1" = 20o0'f 29 System j Lawn O V ` l I .. �? o� - ..._,...� _ - 17 Parcel o w Lo' tion � .� � • ,� � 6 arce 7 - ' _ f Tank& -Box ' \'ti 1°". \ I ASSESSORS Map p 2 Lawn N 1 Wetland Limit 0 �,3� As Flagged By ZONE: Brad Hall R � o \ / / Area (min.) 87,120 SF (RPOD) Deck to,be"". \ 1 / Sep t/2019 x , ) 150 replaced by Step Setbacks: \ \ 4 19.6' / et I Fronta e min N ! Width min) 13.5' — �� o �' Front 30' I �\ Lawn a�: �.. ' t ka Side 15' _ Rear 15' ....................... \ 1 1 °�� FLOOD ZONE: Lawn \ '' ....................................................... .. :'� � / °j':� / � � Zone X (not a flood zone) As per Map #25001 C0553J �® I / /! \� July 16, 2014 Proposed Addition "?,s4�� i / AY DISTRICT: o0 1� boo � OVERLAY _ & Porch N4✓ / i0 AP - Aquifer Protection District 210 Ro� s LEGEND: R roc eeoty bre TS4Sf ti Deciduous Tree NOi it _ I 0 �a Well RICHARD R. . ^� Utility Pole L'HEUREUX NO. 34312 a — —25— — Elevation Contour C OHW— Overhead Wire O j ' 0 15 30 45 60 FEET D�:- Wetland Flag Prepared For: Notes/Revisions: Title: CapeSury Scale: 1"=30' 1.) The property line information shown was Plan Showing Proposed Additions Michael & Sarah Butler compiled from available record information. Date: t: 2.) The topographic information was obtained at 215 Parker Road in 23 West Bay Rd, Suite G C376 2G1 sp2 from an on the ground survey performed on Osterville MA 02655 1 or between 091SEP119 and 06/JUN/20. Barnstable Mass 508 420-3994 (508)420-3995 fox Dwg' 3.) The datum used approximate NAVO'88. (West Barnstable) ( ) 28/AUG/20 copesurv@copecod.net br• / t I j y � '� L .use+' •.d*. "1"��,,:,� �{Aft �� - �H vim' 6 s P- Roa d nw�� I 1 a 0 60.40' pavement Edge ` le Width As Sandy Street I 81�Cn 5410-223.25 Variab \ ram( Know "Formerly .I , / r N Stonewall - \` I pavement Edge IZZ a _ t�. N - _ —28— 1?'� Parc'l Area 46 N ......... 4,605_�SF Upland / t e�, ......... ` ......... 6 800f SF Wetland/ iLOCATION MAP: N777S 50 T.:.:::., .::.Approx 30.6 `_30—' Septic Scale: 1" = 2000'f Lawn c 29.7' _ O \ System �.' ` L: 31,1 05fF TO TA f w o ._._....._..... _ _ Lo ton , 10 \ ASSESSORS REF 2 t Tank -Box .: cv 1 2 Lawn\ Map 176, Parcel 017 ro o o N a W \ { �` '� ; Wetland Limit �'� \ %/ ; As Flagged By ZONE: Brad Hall RF Deck to be ' �' S 2019 F ( PO ) • :� � �, :� Sep t/ Area (min.) 8 replaced by Step W \ �* nta e (min) 1 50'S 1 / 4 I/ ....._........................iv — 19.6' ro l `� Width (min) 13.5' W o N �:: t' i Setbacks: t J � j �.. Lawn �. ._.......... N Side 15' � • Rear 15' Lawn \ .. : y ,� o•� ,i � FLOOD ZONE:` ._.._........... ........... ....... ° i Zone X (not a flood zone) As per Map #25001C0553J Proposed Addition "680000 ;® ,� �,r July 16, 2014 p ?'.0 I 1 OVERLAY DISTRICT: & Porch o�� p�✓2p / ire`° AP - Aquifer Protection District Rano7d R7ri-e ee �ob� 4r , LEGEND: oty✓e TTrU Y �y11A.Qf:Y1� s o Deciduous Tree 1 RICH..1 .L'HEUREU?f: IN 0 Well NO. 3d.31!2 Utility Pole — —25— — Elevation Contour OHW— Overhead Wire 0 15 30 45 60 FEET p Wetland Flag Title: Prepared For: Notes/Revisions: Plan Showing Proposed Additions CapeSury Scale: 1 =30' 1.) The property line informecor shown was Michael & Sarah Butler compiled from available record information. at 215 Parker Road in y Date: 2.) The topographic information was obtained 23 west ry Rd, Suite 5 C376_2G1 s 2 Osterville MA 02655 p from an on the ground survey performed on Barnstable (West Barnstable) Mass (508)420-3994 (508)420-3995 fox Dwg: 281AUG120 )r between 0used p� and 06/JUN/20. copesurv@copecod.net 3. The datum used approximate NAVD'88. ..___.__.--.—..._---__—_.�__...--'---...______ ..._...._...._.._...__._..er...�. --_..____----._.._._... __._._ _._...., ._.._._.._ _._.—__._..._.. .,._.,....�..........._."___...._ .__.._._.._._...-..w..._�_._,___....._.......�---.._,..... .._ PROJECT TITLE . CA - � J f �`•. 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