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0019 PERCHERON WAY
1 I 1 �i I oxforcr NO. 1521/3 ORA MADE w USA 0 ESSELTE o e o • ��- i I 't �''k - Town of Barnstable *Permit# - -7" UI I Expires 6 months from issue date Regulatory Services Fee 9 tHAS& Richard V.Scali,Interim Direc � U ,3� Building Division Tom Perry,CBO,Building CommissiQ% 200 Main Street,Hyannis, A�¢�1 23 2011 www.town.bamstable.ma.us � u Office: 508-862-4038 ► /, V5 EXPRESS PERMIT APPLICATION - RESIDENTIAL 0 11 Not Valid without Red X-Press Imprint Map/parcel Number(]TOO1©,50 Property'Address P /�(Residential Value of Work$ 7 j0k2--� Minimum fee of$35.00 for work under$6000.00 , ` Owner's Name&Address LTA64 'LL", AOL)tOA-1 0? Bki ky Contractor's Name rJ t t�S lSOI� Telephone Number Home Improvement Contractor License#(if applicable) 73 Zlf� Email: Construction Supervisor's License#(if applicable) 0 7S70 7 �Worki iin's Compensation Insurance Check one: I-am a sole proprietor' \ I am the Homeowner .I have Worker's Compensation Insurance Insurance Company Name A90MA14- Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value r D (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 Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESWORMS\building permit forms\EXPRESS.doc Revised 061313 M Renewal Agreement Document and Payment Terms �� �� Andersen. dba:Renewal B Andersen of Southern New England Y B Jack and Ann Conway SON' Legal Name:Southern New England Windows,LLC 19 Percheron Way ORRi RI#36079, MA#173245, CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 wiNoow pE IACEMENT 26 Albion Rd I Lincoln,RI 02865 H:(508)420-1351 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com 7`( 00)( 0 5 -0 Customer(s)Name: Jack Conway and Ann Conway Contract Date: 01/25/17 Customer(s)Street Address: 19 Percheron Way, West Barnstable, MA 02668 Primary Telephone Number: (508)420-1351 Secondary Telephone Number: Primary Email: ann•conway19@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,Notice of Cancellation,Itemized Order Receipt,Terms and Conditions of Sale,Sales Cost Savings Program (SCSP),Lead-Safe Form(CT&MA),Important Project Information,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference (collectively,this"Agreement'). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $9,082 By signing this agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $3,027 Balance Due: $6,055 Estimated Start: Estimated Completion: Amount Financed: $6,055 6 to 8 weeks 6 to 8 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on Financing the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date Notes:Deposit Of$3027 On CC and time at a later date. Rain and extreme weather are the most common causes for balance on GS plan 2521 12 delay. month no pay no interest. Provia entry door 460 with St Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understanding changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO OWNER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. 7 YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT �'® MeBL�3� DAY AFTER THE DATE OF THIS TRANSACTION, se opSEE TH cj NOTICE OF CANC I N F FOR AN SV O HT. ��rv��—CT— Signature of Sales Person Signature Signature Paul Conboy Jack Conway Ann Conway Print Name of Sales Person Print Name Print Name I 01/25/17 Page 2 / 10 l s: Massachusetts Department of Public Safety j Board of Building Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE. CHARLTON MA 01507 Expiration: Commissioner 09108/2018 t��iGZcr��a,����J• Office of Consumer Affairs d Business Regulation yj 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvem_e'nt,Contractor Registration Registration: 173245 Type: Supplement Card L� Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDQUVSIL BRIAN DENNISON II 1 j 26 ALBION RD 1 LINCOLN,RI 02865 r 5. Update Address and return card.Mark reason for change. eCAt O mµosin ❑Address 0 Renewal Employment IRA Card C�/c rPon<mo„rurn�//c o�Or�4nJlb�n�rh3 (lire of Consumer.Affairs&Business Regulation Registration valid for individual use only before the OME IMPROVEMENT CONTRACTOR expiration date.If found return to: Office of Consumer Affairs and Business Regulation Reglstratlorr. .. Type: 10 Park Plan-Suite 5170 Expiratlon:=g/.ggj2pl t3W Supplement Card .Boston,MA 02116 SOUTHERN NEW ENGLANDWINDOWS LLC. RENEWAL$Y ANDEfiSONE W,—; BRIAN DENNISON 26ALBION-RD �">>7-��-��' �r � L INCOLN,RI 02865 Whdersecre Not valid without signature r `\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 o Boston,MA 02114-2017 s� www.mass.gov/dia «,orkers'Compensation Insurance Affidavit:Builders/contractors/Electricians/Plumbers— TO BE FILED WITH THE PERMITTING AUTfiORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Spy I(��n ��(nJ 6 IGn A (&)1'0 d QL'\/ Address: c r& 41&.0►^ City/State/Zip: L;ilc 1,-) ' I Phone#: (401 2—28 - 9 8 C)O Are you an employer?Check the appropriate box: Type of project(required): 1.Iaam a employer with )-0 * employees(full and/or part-time).` 7. ❑New construction 2.O I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 El Building addition . 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.JCC[�'bther 152,§1(4),and we have no employees.[No workers'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. II // _ Insurance Company Name: Cpr1 'i12h�A We-s r In S• Co — Policy#or Self-ins.Lic. Expiration Date: 7 Job Site Address: City/State/Zip: p - Attach a copy of the workers' compensation policy deofaration page(showing the policy number and expiration d te). Failure to secure coverage as required under MGL c. 152,§25A is a criminal 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 verification. I do hereby certify under the p i s and penalties of perjury that the information provided abov is le and correct. r Signature: Da: l Phone#: (410 I 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#: �.� SOUTNEW-01 UOWNGER CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 61291ZO16 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(iss)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 endomement(s). PRODUCER CONTACT NAM: CoBiz Insurance,Inc.-CO PHONE 303 988-0446 FAX No):(303)988-0804 821 17th St AIC No E:t.( ) Denver,CO 80202 aD ass:CoBiziRsurance@!DobWnsurance.com INSU AFFORDING COVERAGE NAIC# INSURER A:Continental Westem Insurance Company 10804 INSURED INSURER B Southern New England Windows LLC INSURER C. D/BIA Renewal by Andersen ! 26 Albion Road �IsuRERD: t Lincoln,RI 02865 INSURERE: 1 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED-BY PAID CLAIMS. I I. POLICY EXPIA IP D ENSR TPEOFINSURCE MMID LIMITS LTR VWD POLICY NUMBER! X! COMMERCIAL GENERAL LIABILITY I 1 I I t EACH OCCURRENCE !5 1,000,00 CLAIMS-MADE n OCCUR ! ICPA3136080 ; 07101/2016I 0 710 1/2 01 7!I PRE;DAMAGE R MWC8 I S 100,00 MED DIP(Arty WM pel50n) !S 10,00 t I ! PERSONAL&ADV INJURY I S 1,000,00 i�N'L AGGREGATE LIMIT APPLIES PER: ! t GENERALAGGREGATE t S 2,000,000 j K I POLICY PRO-JET LOC ! I ! I 'PRODUCTS-COMP/OPAGG i S 2,000,000 EMPLOYEE BENEFI !s 2,000,000 AUTOMOBILE UABILITY ' I I !Ea accefrIMM NGLE LIMIT Is 1,000,000 A ANY AUTO I 'CPA3136080 07101/2016i 07/01/2017I BODILY INJURY(P�Damn)_ s ALL OWNED I SCHEDULED I ( I -- -_. AUTOS 'AUTOS I i I BODILY INJURY(Per accident)j S NON-OWN t ! : !PROPERTY DAMAGE 5 ! HIRED AUTOS I I AUTOS aOO�� 1 f S I X' t UMBRELLA LIAR i X OCCUR ! i I I EACH OCCURRENCE I S 5,000,000 A EXCESS CWMSaNADEi ! ICPA3136080 107101/2016'1 07/01/2017 AGGREGATE I s 0 ! I t s 5,000,000 DED I X 1 RETENTION S I I ggregate !WORKERS COMPENSATION I I STATUTE I OT ER AND EMPLOYERS'UA BIUTY Y 1 N I I ! t ER I 1,000,000 A ANY PROPRIETORIPARTNERIEXECUTIVE � CA3136081 07/01/2016 10710112017 EL FJ1CH ACCIDFJ+IT I S OFFICER/MEMBER EXCLUDED? ❑ N 1 A 1 000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEt s + I II I E.L.DISEASE- LIJMR 5 1,000,000IDiEesSCaN nOFeOrPERATIONS belay ! DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Addidonal Remarks Schedule,may be attached It mote epaee Is requlmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION- All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit#Q 6 I E. ' es 6 months frown issue date •J1 2 RN5rA6[..B, 09 Regulatory Services 19 F1a TO � Thomas F. Geiler, Director STABLE°lFDika+�' ]Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY , / Not Valid without Red X-Press/mprint Map/parcel Number ( /�1 D Property Address / / -_"/L�G1C.i�o i(Y �/�/f !/�✓�S / /962�"S.`rt d �'e (/"l�9 ❑ Residential Value of Work rP490 ^3,_w Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address nJ efO 1ys)II Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che one: a sole proprietor FrI11*7m the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-.00f(stripping old shingles) All construction debris will be taken to Re roof(not stripping. Going over—L existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic.Conservation,etc. ***Note: Proper w r must sign Property Owner Letter of Permission. I Io Im ovement Contractors License& Construct Supervisors License is required. S I G N A T Q:\WPFIL S\FORMS\' press\EXPRESSPERMIT.DOC Revisc0604os C—) � s X�. The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston, MA 02111 •••'• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): V401#u 4J4 Address: A City/State/Zip: � n-��n,b �� Phone.#: .�;Z 8' Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6: ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or par6ner-' listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g, '❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'•comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3YI 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.WRoof 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. lContractors 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.M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to 31,500.00 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 MA for insurance coverage verification I do her c ify nder the ' ofperjury that the information provided above is true and correct. Si afar Date: P one#: 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 S.Plumbing Inspector 6. Other Contact Person: Phone#: i information and Instructions Massachusetts General Laws chapter 1 S2 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 ialon or other legal entity,employing employees. However the receiver or trustee of an individual,partnership,assoc 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«nth 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-con6actor(s)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" I.he 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 lndu.stri.al Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.govldia z ro�ti Town of Barnstable Regulatory Services 9 RARNST,AARLY,$ Thomas F. Geiler,Director E 9. n 16. Building Division 0 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 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: .(Address of rob) S ture o Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable Regulatory. Services Thomas F. Geiler,Director Building Division prFD a Tom Per ry,Building Commissioner - 200 Main Street—Hyannis;MA 02601 _....... Rrs'.town.b arnsfable_ma.us Office: S08-862-4038 Fax: S08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: / A I lue-57- �A�07,1 JOB LOCATION: number village street g "HOMEOWNER": :::To Aj[a3A� name I home phone# work phone# CURRENT MAILING ADDRESS: �Aw?e city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that be./she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned `homeowner"certifies that.he/she understands the Town of Barmstable.Buildiug Department minimum.rectlon rocedures and requirements and that he/she will comply with said procedures and re ements. igna of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the. State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEM.PTTON The Code states that: "Any horrteowner 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 cngagcs a pc sons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption arc unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Liecnsing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hire unlicensed persons. In this case,our Board cannot proceed against the unlicensed person'as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her mspanstbilitics,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 farm currently used by several towns. You may care t amrnd and adopt such a famr/ccrtifi cation.for use in your community. Assessor's offioe (1st floor); ) / _ Assessor's map and lot number, J.../...(... ' �` oFTNETo ' P� ...X ........ ..... Board of Health (3rd floor): ��. 0 y�/ JSewage Permit number .....,....................•.......... . .... . ..... Z BAHIISTADLE. i Engineering Department (3rd floor):. Yy 'moo""=i AM House number / `e.�.. ................. MAI y" APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00'P.M. only .> 1.4 TOWN OF BARNSTABLE BUILDING INSPECTOR CID �. K APPLICATION FOR PERMIT TO ®(v =........ ............... . ..... . �. ............... TYPE OF CONSTRUCTION �!t /� /C,•,¢ y �...Z .._..19.(9/f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........l.,.mfJ / /�/� 1,��. .Q ./ .......!./`.W1.............................................................;............... v ......•....•..... ..r.�. �..................... ProposedUse ......,...J.U......... .............................................................................................................. (J ZoningDistrict .......i............................................../..1...............Fire District ............................................................................... Name of Owner .......:� LiC��1 Address:.. / �f� �.��.....`.�....�..Q. . ....�......../...�...0 ..U.. / Nameof Builder .......................:............................................Address .............:...................................................................... :� ,ter-- • �_ Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .:�................................................................Foundation ....,.......................�............e..,.......... ..... Exterior .... � ........ �i l !. .../.. .../� � .Roofing ........ 1!5. 7. �! ' /,...... /! !./i . ....................... IFloors .......I/,( �.....1/.fd...F-!(../`G ......................Interior ......... >. .. ��P (_•- `................................... Heating vl� � �.... ........................Plumbing ........... ._.... G(� 2ilY r..... Fireplace ........... ....:.................................................. ..............Approximate Cost .......................................................I............ Definitive Plan Approved by Planning Board _ -------------_-------19 Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above- construction. Name ..... ...... 1....... ....................l Construction Supervisor's License ..... ° .1.29. ..,,•. GREENBRIER CORP. A=174-001 . 050 17y-JJI, OSO No Permit for Two....St9U.......... Location ........ ...P.e.r.c.he.r.9n...Way ................West jAa.rns.....ta...b.1e........................ ....... .... Owner .....Gr....e.e....n...bT...i.e..r......C...q..K p. ..................... Type of Construction ...Frame ............................ ....... .. ............................................................................... Plot ............................ Lot ................................ Permit Granted ...jAqVIAKY...22...........19 91. Date of Inspection ..........19 Date Completed .......................................19 ljl HMIT COMPLETED 111I.L' AA GMIdIN03 AMU p Parcel 00 (566 Permit# a G )�2 House# Date Iss V -7- Board of Health(3rd floor)(8:15 -9:30/1:00-49@) D- /PlfKFee Conservation Office+(4th floor)(8:30-9:30/1:00-2:00) - VMTE%I BE INSTALLED COMPLIANCE oor coo mi E 5 Board 19 ENVIR CODE AND t TO i6jq. ; TIONS TOWN OF BARNSTABLE 'F°"""`' Building Permit Application Project Street Address 1.5 Village kE�2: RWJ�6�kk Owner ' � -¢' lTQRAl oV cJ o9 Y r Address / �J � /1e yl � 4 1• _ Telephone �� Permit Request First Floor 4�/_ Y!�VFloor square feet Construction Type _ k U6_/p Estimated Project Cost $ 1W40d J Zoning District Flood Plain Water Protection Lot Size / , s 3y Sie fY, Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ANo On Old King's Highway ❑Yes No Basement Type: UFull ❑Crawl - ❑Walkout ❑Other Basement Finished Area(sq.ft.) A10 k1 E Basement Unfinished Area(sq.ft) 74 5-- 5Q Number of Baths: Full: Existing New Half: Existing New / No. of Bedrooms: Existing New Total Room Count(not including baths): Existing S New ,2- First Floor Room Count � " Heat Type and Fuel: M Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes k No Fireplaces: Existing / New Existing wood/coal stove ❑Yes QQ No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Tele hone Number Address License Home Imp r ement Contractor# Worker's Compens tion# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 SIGNATUR DATE BUILDIN PE IT DENIED FOR E OLLOWING REASON(S) A . U ✓ FOR OFFICIAL USE ONLY ° ✓ PERMIT NO. ( V DATE ISSUED MAP/PARCEL NO. AbDRESS ; VILLAGE OWNER DATE OF INSPECTION: 1 �* FOUNDATIONS i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL > � FINAL BUI VING t"s C) "1 � " "` DATE CLOSSEMUO .-T :n ASSOCIATIT. KAV(N to Y a��sL�aar�.trmu�s.�.s[o��w�r+: te:rtzc+ea�pr•�'.- ,�i"�----'-.,.�.ssv-tea-^•-"'�-ir'-yam. �FtME iq,_ The Town of Barnstable BARNSTABLE. Department of Health Safety'and Environmental Services MASS. 039' �0 Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection k2A __' Location / y �jj c�P,� o,,,� Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: n Please call: 508-790-6227 forge-inspection. ^ Inspected by • - Date Date Hour To- WHILE Y U WERE OUT M Of 91� & 4��l 046 Phone - Area Code Phone Number Telephoned Returned Call Left Package Please Call Was In Please See Me Will Call Again Will Return Important Messa e t it Signed AVERY FORM NO.50-736 PRINTED IN USA The Commonwealth of Massachusetts i J� _ Department of Industrial Accidents - • Ol/ICe Of/OYesl%981UGHS - 600 Washington Street = ;+r Boston,Mass. 02111 Workers' Corn ensation Insurance Affidavit �.�i11..17.1K in...��... '//%/O/%%%//%%%%%%%/%/'//�/////�%i "�"�' �t [ " name: --)ahW Cc A; location: / t� N(..� � dXA ,,hone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workin in any capacity /%// %/rian%///.any%%/%%//%%/%%/%%%%%%/%%%/%/%%//%/%%/%/%/%%%%%%/%%////%%%%%%%%%%%/////%%/%/O%%/%%�O/// ❑ I am an emplover providing workers' compensation for my employees working on this job. company name- address: city, hone# insurance co. olicvV1111 # %/%/ ////%!//////%////////////////////%// //////%////////////////////// /%//%////////////////%///////////////////////////%////%//////////// ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: °lcom anv name• I/siddress: d in�urnnce co. cam anv name: address- phone hone#: Insurance co. Failure to secure coverage as required under�eetion 25A of�iGL 152 can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one yeah'fmprisonmeat as well as civil penaltla in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of thb statement tray be forwarded to the Oince of Investfgatlona of the DIA for coverage verification. I do hereby c r the p and penalties of perj hat the information provided above is t� correct Signature Date ! �� Print e l �0�{Its 61N W . Phone a ofltdal use only do not write in this area to be completed by city or town official permit/license a ❑Building Department city or taws• QLicensing Board pselecnnen's Ofmce ❑cheek if immediate response is required ❑Health Department contact person phone#; ❑Other (mvHed 9J93 PJA) i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any co of hire,express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver. g '`P � . ` loyees. ,However the owner of a trustee of an individual,partnership, association or other legal entity,emplovMg emp 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 o: building appurtenant thereto shall not because of sucu ex«ploymnent be deemed.to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and hone numbers along with a certificate of insurance as all affidavits may be supplying company names, address and p 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 policv,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned t^ the Department by mail or FAX unless other.arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• please do not hesitate to give us a call. The Department's address,telephone and fax number. l , The Commonwealth Of Massachusetts Department of Industrial Accidents DMce of ImlestigaUans 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 a The Town of Barnstable Department of Health Safety and Environmental Services BuiIding Division 367 Main Street,Hyannis MA 02601 Ralph Crosson Office: 308-7904=7 Building Commission: Fax: 308-790-Q30 For office use only Permit ao. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 147A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions.along with other requirements. Type of Work: ' Est.Cost Address of Work: —" Owner's Name Date of Permit pplication- P— — — I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,000- Oilding not owner-occupied wner pulling own permit Notice is hereby given that: OWNERS .PULLING THEIROWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR��ON ROGWL I OR GUARANTY FUND UNDER MGLCABLE HOME IMPROVEMENT WORK DO O 147A T HAVE ACCESS TO THE ARB . SIGNED UNDER PENALTIES OF PERnMY I hereby apply for a.permit as the agent of the owner. Date Contractor dame Registration No. OR f wner's Name C/ oat MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 Checked b /D to CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 8-11-1998 DATE OF PLANS: TITLE: G('4 COMPLIANCE: PASSES Required UA = 338 Your Home = 332 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 320 38.0 0.0 10 WALLS: Wood Frame, 16" O.C. 369 15.0 3.0 25 GLAZING: Windows or Doors 207 0.310 64 SLAB FLOORS: Unheated, 48.0" insul. 320 6.0 233 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions' found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 8-11-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-38 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.31 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location SLAB-ON-GRADE FLOORS: [ ] 1. Unheated, 48.0" insul. , R-6 Comments/Location Slab insulation to extend down from the top of the slab to at least 48" OR down to at least the bottom of the slab then horizontally for a total distance of 48" . AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.0 W (( Q� Checked by/Date CITY: Hyannis STATE: Massachusetts ADD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 8-11-1998 DATE OF PLANS: TITLE: Cj A.-Q COMPLIANCE: PASSES Required UA = 110 Your Home = 108 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 480 30.0 0.0 17 WALLS: Wood Frame, 16" O.C. 435 15.0 3.0 29 GLAZING: Windows or Doors 92 0.310 29 DOORS 17 0.350 6 FLOORS: Over Unconditioned Space 572 19.0 27 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 .0 DATE: 8-11-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ) 1. U-value: 0.31 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------- r ON 'WAY PER L,102.�a R-6 0 9 '� 20 S�S' I LL P 45.3`t G 0 S� LOT 143 pECK� cp t1+ I LOT 141 as LOT 142 17.530 SF 110•009 OPEN SPACE JOB # 98-029 CER TIFIED PL 0 T PLAN LOCATION : 19 PERCHERON WAY WEST BARNSTABLE, MA ' SCALE : 1" 30' DATE : FEBRUARY 9, 1998 PREPARED FOR: REFERENCE : LOT 142 PB 439 PG 16 JACK CONWAY i HEREBY CERTIFY THAT THE STRUCTURE ��`tN OF wy�� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. oa ItRNE 3 ' 3 � o jown cape d4oneeris& inc. CIVEL ENGIIQEERS LAND SURVEYORS ---=—tl L --- --- ------ ------ I main sL Yarmouth, ma 02675 DATE REG. LAND SURVEYOR ON . RCHER .. , PE -102. 4 R-609 J • W _ 45.3-1 24.6 t H0 SE L. cv' S ; LOT 143 co co LOT 141co rn LOT 142. 17,530 SF 110.p0' OPEN SPACE J06 # 98-029 CER TIFIED PL 0 T PLAN LOCATION 19 PERCHERON WAY WEST BARNSTABLE, MA ' SCALE : 1" = 30' DATE : FEBRUARY 9, 1998 PREPARED FOR: REFERENCE LOT 142 PB 439 PG 16 JACK CONWAY I HEREBY CERTIFY THAT THE STRUCTURE Of SHOWN ON THIS PLAN IS (_OCATED ON THE GROUND AS SHOWN HEREON. oa'L' ARNE yG✓ oN 50e-art-4541 H'- 1 110.2 �o down cape engineering, inc. GG pp ,��� CrM ENGINEERS �`e I 0 L11 �� �! LAND SURVEYORS — --- ------- 939 main at. yc=uU% mo 02675 DATE REG. LAND SURVEYOR RESIDENTIAL ADDITIONS OR ALTERATIONS lif located North of Route 6-any work visible m outside-needs approval from OKH In Hyannis-Hwork visible from utside-Check to see if it's included in the Hyannis Historic Waterfront District-if so it needs a roval from them i APPLICATION PACKAGE MUST INCLUDE: Map/parcel number Sign-offs from Health Conservation(if 'or work) Tax Collector i Il Street adld� . Owner's name&address Permit request-lull description of proposed project Square footage proposed project q � - / Estimated project cost Complete Dwelling informatibn for Assessor's Office Builder's information Signature Plot plan 2 sets of reduced(8.5"x 11:or 8.5"x 14")plans with cross section&flaming schedule Home Improvement Contractor's Affidavit / Worker's Comp form must include: Insurance company's name&Worker's Comp policy number Energy Compliance Forznv Co License&Home Improvement Specialist's License R Homeowner Exem on Form • Fee NOTES: CTfUMMYS ` t Need Home Improvement License No plot plan required PIERS&DOCKS Need Construction Super license AND Home Improvement License Owner cannot pull own permit TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATEAV; JOB LOCATION _ Number Street address Section of town "HOMEOWNER" 2,9 A JA Name Home phone Work phone PRESENT MAILING ADDRESS �vGI�:C�'►ePO�t/ �R A/- S 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFvINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Officia- on a form acgaptable to the Building Official, that he/she shall be responsiblE for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations.. The undersigned "homeowner" certifies that he/she understands . the Town of Barnstable Building - Department minimum inspection procedures and requirements And that he/she will c y with aid procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDI gOICIAL Note: Three family dwellings 35, 000 cubic feet, or- larger, will be reuired to comply with State Building Code Section 127. 0, Construction Controlq 1 HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne_ shall act as supervisor. " Many Home Owners who use this exemption are .unaware -that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing 'Construction' Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board capnot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner: actin as supervisor is ultimately responsible. ` To ensure that the Home Owner is fully awarb"`o&f his/tier responsibilities, man communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. �}t -- :Po �—� --_------------t i I Ii r..Ir.•...•.... i I 2 ---_—___ ----------- -- -------- -- ------------- ------ li � t ...•+rrtiraN � -� -- . ------ - -1 -----;________—_______—__ ___________ • � .w.n:w+ti •s••.. t t � nty'IN4r01WATg1 t i M� t t ♦I���.Ir.�` ' � � � � 0 '� h rou"vAT1oN PI-iJJ ARM fill lvrre PLAN r:::o,...:,a....:::::. �� � ���• 4Gw14: 1,r too ...... fill w.+wA•• tlIIll6S1® A 1 00, 1� t w z d n�ur .ra.r. i tt IM •.oo Q�GAI�: 1/4". 1•-O" }. F � e f�iii . AZOO ' s V -.y.:.*�'pM+���"s1� .2�{F+%r ---- ---- ;✓;k sf:S'�iz`3`'**�e':t•,'.'�t. �`r t'f3 'Y•`,`.� :}.;+,`'.]•�w.""'` ., ' ♦r NI/r a 9 � CU I/p O ' r.. •I .. � ...�'fT'Y:JiT�P i • � VV r..L --------------- -- ---- --- --------------- (F e=4-ntp r .oaw p_ -Add �im Eli I^r o.�wJ1'loar/4. .•� rr- Nvr • A 100 1 1 v !f 7 Ntr. -M-. �WI i.rNA•Tn-.•Y•.W ` C.. ... ..•wnw.•tr.w I � �I rrY..►�x,r�.• IT..•.W.w:".µ.. - I.i... I.r►�... rw.rw......r rw..r r.r.•..rw..wvr.•vr.wi. . - .tir.r.•rr+r. .4r.r..rw+n.... .� C 92UI4ON4 O06rlOJ C-M) • t rr.•w•, rw-rww..r..+w..r.r - -_elLytrrJmi_ • iQ;j� � i �&- N4 4W-GT1oM A-I. e�teesm A400 i ® LoPE x rrn 00 DO o �z 00ml MwIWM A000 MLIIf: I/4"- t•'0' Frrni mum=1 s : I r ----- -- -------I---- ...... .. err a evr.rtoN !' I- -------------- AOOO ® t t---------=-y-------- -=-I------------ --------------------- @ 3 �11�AI:r CLGVATION � •.. f s t WON _. 11 Ki� ----------------------------------------- -------------------------------------- - OP fill �I.,LGF`T Mrw^rt0N ArVO r I. w Illttl i----------- �, � li.A •IwwwrwW� - � i � 2 �- ----- _ l 1 J --y- ---- ._..a. .... - --—-- ----- --------i - .-7.. Fit - 1 : � ••4 � i NMTN4/'AWATION I � GYM- Wiw.r�..'w 1! V � O` Lr ! --------- --- _ �I11"OuNDJ.TION F'L•I•N - , -------------- 71 ----------------------------- ............. •:`j _-, I.O M tt • ba �: 1" ! t YJbC01Y.@i . �o.r..irr�.n.N wr•n.r R l OO 1 i / _ _ s ,,.,. t t z _ . ti rev IT rlrlrT-V� IL f PO n �r o�PI.AW f,.�� � d V-o. i _ mem�aam •M •Y/ A200 3 w } °3 F�.,. ::: 0l } _ ----------------- - ---- --- --------------- - R V OO it i ...u•wrww.. �`a .Yra.ryr•►to ./rl..r..... �i.►svr�.Y � uj} r.r.•..r....e...vr..v.wr. i M1.Wr.. " � YI.....rwM.Y•..4�M - --OSCSR1LIVd- � 6 j i e�L 4 q-r-6rb4 A-A asusam A400 10011 .---------- nor e�.evfrloN --------------------- ffiff EHHAI O yy� • �fi}e, -------------------- ------ �,L Crr CL Cy/.rlOh� 1il� 1 i —----------—----------—___--� Apo tAla:1/4'" 1'-O" �............................�..................... ........................�.................. i, . '�i tt�!,`,y�.�w,n'4,�.i�1.st-ica'+'��iPr,�,al ,`sa .,v� .9"�,Ji c� SJT' �rty�;,�$� �°�.�'n5}#ya�m.�.ry�-,ro�'!.'!sl tw,a�*4i,1a. Y�, -•�'�.s„�v,.ar,;•�x s ,. , ® - rrrii a -----------y------------ ---r-------=---- - --- ----- -; 1 .. .\ GYM trM . /. CA(L Cl OVATION I._...._ Y wool 49641s: 1/4'. I'01' . 6 1 _qt Nr ---------—------- ------------------------- -------------- s ;f �fwr CLCVArWN ! I . ON PERCHER a .. 1.-102'�4 R=609' J 45.3't G 0 LOT 143 OEGK j co ' w I LOT 141 v� - LOT 142 tO 17,530 SF 110.p09 OPEN SPACE JOB # 98-029 CER TIFIED PL 0 T PLA N LOCATION : 19 PERCHERON WAY WEST BARNSTABLE, MA SCALE : 1" = 30' DATE : FEBRUARY 9, 1998 PREPARED FOR: REFERENCE : LOT 142 PB 439 PG 16 JACK CONWAY 1 HEREBYCERTIFY THAT THE STRUCTURE Of SHOWN ON THIS PLAN IS LOCATED ON THE � yy� GROUND AS SHOWN HEREON. c� ARNEoff a� f m&M 362-IM N I � Q Bona cape e4glneww9l ina crva. zNGngEERs �� b � At LAND SURVEYORS ---=-tlL - �---_-- -__--- main sL 1mmuth. ma 02675 DATE REG. LAND SURVEYOR oN �rAY PER `zol02.�� • R-609•? ' w 45.3't G U LOT 143 DECKCD ' co ct+ I W • tD . LOT 141 0 o� LOT 142 tD t4• 17.530 SF r 11 0.p09 OPEN SPACE JOB # 98-029 CER TIFIED PL 0 T PLAN LOCATION : 19 PERCHERON WAY NEST BARNSTABLE, MA ' SCALE : 1". = 30' DATE : FEBRUARY 9, 1998 PREPARED FOR: REFERENCE : LOT 142 PB 439 PG 16 JACK CONWAY I HEREBY CERTIFY THAT THE STRUCTURE ��`��Of yy�� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. ea /tpNE fiZ US 362-94M 3 N I � �O down ceps engineering, ina Cron. ENcn;L7Rs �,e b I t1 LAND SLJRVEYORS -----tl� --- ---~------ 939 main 6t. ywmouth, ma 02675 DATE REG. LAND SURVEYOR PER�gER 8 .. .. R�609• • R 45.3** G V LOT 143 • � DECK j cy) co cr+ rn w I LOT 141 c LOT 142 `o 17.530 SF 110.00. OPEN SPACE JOB # 98-029 CER TIFIED PL0 T PLAN LOCATION 19 PERCHERON WAY WEST BARNSTABLE, MA ' SCALE : 1" = 30' DATE : FEBRUARY 9. 1998 PREPARED FOR: REFERENCE LOT 142 PB 439 PG 16 JACK CONWAY I HERESY CERTIFY THAT THE STRUCTURE ��`�N Of SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON, a ARNE � H,• f fi. 3 N I down cape dkenealtI& Alm Crva. ENcn4EERs ��e b I l LAND SURVEYORS ---=—tl L ~------ 939 main sL yarmouth, mo 02675 DATE REG. LAND SURVEYOR T E Mt P R A R Y �34.1"4535 TOWN OF BARNSTABLE Permit No. BUILDING DEPARTMENT TOWN OFFICE�UILDING Cash .67p. X �rewr HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lot #14 2, 19 Percheron Way West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT-BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE,WITH TOWN REQUIREMENTS AND.IN ACCORDANCE'WITH SECTION I19:0 OF THE MASSACHUSETTS STATE' BUILDING CODE. March 25, 19 91 .....�!hf... � ... Building Inspector 1 ' �''`.ti'�-_ri"`...`,..rF„•--..,-,._.-.V.,+....\..,,,-•�__..,,rx'��i•.",,._,...,-...-^.-.y�..✓�-,..,:^.+..-(. rr(v-r`'"r.`•'.,......-•�^! �'F'l-�..r^.1 -. "+,r»."�,'.-L---`--✓. .J-..-,,. ra t i T E M P4 O R A R Y TOWN OF BARNSTABLE 34-i45 Permit No.. BUILDING DEPARTMENT i """ I TOWN OFFICE BUILDING Cash 6�9• X �''ro••r HYANNIS.MASS.02601 Bond 1. n CERTIFICATE OF USE AND OCCUPANCY C Issued to Greenbrier Corp. Address Lot #142, 19 Percheron Way �• Wepst Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS, PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL•NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING,INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE ,BUILDING CODE: . March 2 5, . l9.:.:..91.... ........... '--,� � ?�? ...-,-r Building Inspector e . 1 C5o ---------- —------ .7 -P- 7355 m �vT /�i L•o� /�3 N L aT 4- /7530t5F. t 7-i/-90 INITIAL ISSUEJA THIS PLAN IS NEITHER INTENDED No DATE DESCRIPTIONFOR, NOR SHALL IT BE USED FOR .45- 8v/LT Fo-A/DAnov �MORTGAGE LOAN PURPOSES. LoT 14ZoC M PAUL A. y� SCALE: JOB 'NO.- /440 I CERTIFY THAT THE FOUNDATION LEVY SHOWN ON PLAN IS LOCAT D No. lj:,i7 ON THE GRO D INDICA Q ti,l -- (� I.FYY,.ELDR)SDGE Ec >ifAGN%R ASSOCIATES INC. um" at.mm Pum Wm omw DATE REG STE ED LAND SURVEYOR' f 1 I u�c�cn� W W'Y+ 'l{tj x►_YT_ i!a!N S-nu:rr .. cF-Nrr:xvn.tF. Ya oze:W� 1 CAPE THE GREENBRIER CORPORATION 1550 Route 28 10 Center Place P.O.Box 510 Centerville, MA 02632 f14 (508)771 -3616 ', � i \� fir• � �`1� - _ ' - -_ _.- .-_ -- _-i i ., +'/ .�,,.{✓ SiaE�r I I L P 1�1i•��� II ® � I I o m i HIM I � I I . II I ❑ tea ,I ❑ C= o I II 3 II o t II II II it ,r + I I ..4• I ' I 1 I 1 I I , I II II 1 1 I � 1 i Un cL .I.cw aL i I ♦n ti✓i ' unG • Al 7 S Mom. I - I I � -••i p ` I I - cA w a Z � � J a N - 3 r P �9yrvuN An . � I2� hZ T .3 ou Cl— ouf ry O r t 7 o u N U L o C�l a BEDROOM BEDROOM ; 12X18 11 X18 . F�oO�Z �L�•J SE co N n JOWN OF BARNSTABLE Building e D �. �'"ation Permit Date r.' • _ - l .Nam lift ol�"- sp. of Bidgs. r • 1 r--'I 1 ypep �.wr .s•�je�� __ _ � __ I I i L— _ - _ _ sue' R.r�....,«�k�:•sr I orb 1 1 - j j 3 R �M'•v'•- - � i r 1 ♦ � . s �.! - 9�Ie� mob. I ! v..r.ti � � vim. i I bw+— Wf ��ehF•{p►;twit ' � I .-_A�f�us�ti �yrty�'ttZ':µ^(+•�CT1p� 1 ,f' fug. _� -�`-- � I I Ir L"_•r eA- v I I 1 � - ----I I •- So s sfle.ruY._:6t.5+�cxytq � 14.� " -/�i�i�l7 •�� __—... _-++c['H�+',G.t•-'i'.et f�r.+HtD I APPROO"'I' VED ZIT� GES pox all 16WN 0 BARNSTABLE • .f pw.�gr��a. , Building Inspection Department y 4 Q ©' Il�le• 1 � _ � r _ _ -i��►.p!�R-r'tti I t t i _- -PN./� ,,,,sre4fA� _.'.—'. F•.i T.•4�u*:owe rA ILiil' f�r:rA.f yrT.r%N _._..-----•r ► Ina ('�' 1�2�' .�z=i'�2�1 ... ...... . ... . . • Lyfe'h.• .y ± p,r.rtwe� �" �,�G�.,... L-teys►fG�leYa - ' ' ..c'—.F' aJw'a.F'-•r —c:,,�nGr�_;G! Mtt,tl�I;jmDt,�DS-- •- rc • ti 1 U • ` t yy JgVV"� r.aK •w•wwrr--� 7 r' Z <4+f� t� h•►4's '�'' "" .mR .corn .. 7 Z W*'1'�� I+I�NLi� ►4-s• �t.q•s�-H��S .i `.,,.e r.J wia 1L'Ni ��q. i s3 1 vita wn..sv►.1 '- •Y ����i.rrry,•(�7r�,.I %"i'PE��--'rtH� �Pam'-1^� _ - I - Qa � .: _ ; ' I , i I , I . ; � I i , ; � . ---•�/..LI'r !�I DFi�Gl �'"F�__!'Ur! .... �R��a� ��1/�T1 G1-1 . . �tl, d"4 .wc� o� .nw�+o�r. �+'� ` u'e 6-L 6� �lsDt�Ni��=M3acfaT7�It�J wcwn a ,,, .: Z4'�3i' 2 —CM�'rk1TuF� 3�R+�.?_... - .� o,....o_..o, . -�-- _� z.�� - - - � • 1 7 v � 1 i ( I ^ 1 1 t 0D r 0 oQ 1 t Ot • w.c 2�Z b /IS/�Tl� Icw® �' ��32t ZF�1 IAG� �fim+.-� �5 FSR��•) Assessor's omap (1st floor): �,j._4�}1 ® t �, ,n�SY oS rNE To`♦ Assessor's ma and lot number 7 U/ '�°�'B�jLL�®'S'r'�M� o Board of Health (3rd floor): �r- com " Sewage Permit number .......... r�. . /O/VOV-7ff i 21 9 LE, . Engineering Department (3rd,floor): Q MYIRIONM � + MA°a �+ House number ....................................f q.✓ (. ...........`..... 7'0 ' WH fMG�LATIo APPLICATIONS PROCESSED 8:30 9:30 A.M. and 1:00-2:00 P.M:,•only• r x/ 1 TOWN OF BARNSTABLE r BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......�,A. TYPE OF CONSTRUCTION ................. ,:. ........................................................... 4 ;. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor ation: Location ........�V [� r �. 1 .( ,..... .. j...... ... ...�.... ProposedUse ......( .. ..... .. ......:... . ................. ............................................................................................................. Zoning District ....... ....... ........................................................Fire District Name of Owner .....1.1-4 A. . .1...... ".Address ...f .... 5 t!� lJl�'•`E Nameof Builder ....................................................................Address ................................,................................................... Nameof Architect ..................................................................Address .................................................................................... CANumber of Rooms ........... . ....................................................Foundation' + Exterior ....... 5 lX// j..Roofing . Floors .......V .J.... .... .........................Interior .. •• i , Heating y ..�.11..�........./.......I�. .........Plumbing ................................... i Fireplace ..... .. .................................................................Approximate Cost ...... ................. : ..................... Definitive Plan Approved by Planning Board _g___ d_ ______________19 ! . Area ......216-ir ................. . Diagram of Lot and Building with Dimensions Fee ......�/�.� .��...�............... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the.Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ? ... .. C-7...;K� Construction Supervisor's license ..... . 0-0 1D GREENBRIER -4 N .....5... Permit for ... ; .t!?T-Y............... ...... Si qnle Family Dw 1...... cr................................... ...j.in:.. .g....... . Location ..... 1,9,,.Percheron Way W st Barns . ............................................t e abjg,...................... Owner ....Greenbrier...Corp,,.................... Type of Construction ....Fr cun.P.......................... . ................................................................................ Plot ............................. Lot ................................ Permit Granted ...... 22.r......19 91 "f- Inspection Date a ...... A ..........19 Date—'C'onpleted ......................................19 4Z) it Lq ;. .._. IVG PE�1 /PERMIT NSTABLE, MASSA:.H;,':�'T`� ILD .OSO _ 8i'1. Janwiry yi DATE _-79 PERMIT NO. Er ADDRESS "--�- (NO.) (STREET) (CONTR'S LICENSE) ild dwelling Z Sing1A r.aluil� dwelling NUMBER OFSTORYWELLING UNITS YPE OF IMPROVEMENT) NO. (PRC?USI!„ 1:SE) AT (LOCATION) of #142 19 Ft,.--rcheron Way,, e-S 1.' e ZONING RF (140.) (STREET) -' DISTRICT , BETWEEN, AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT m, LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY. FT. LONG BY FT. IN HEIGHT AND SHALL'CONFORM IN CONSTRUCT)) TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #90.-29 BOND AREA OR VOLUME 768 'y• ft. ' ' 45,000 53.00 F ESTIMATED COST• EEMIT (CUBIC/SQUARE FEET) OWNER Greenbrier Corp. ADDRESS P. box Diu `•it +crVl.11.i?, + 02632. BUILDING DEPT, l BY r` THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY C ► PERMANENTLY, ENCROACHMENTS R PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE .BUILDING CODE, MUST-BE Al PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINE FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOt OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. ELECTRICAL, PLUMBING AND MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRE,D,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINAL I S(RE INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE, 3, FINAL INSPECTION BEFORE ' OCCUPANCY.. r I L - POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 ha - > t� 2 2 - - �, 2-pis , mq'r+ i;j-cT J 3A `dBC.� Fo0l��SS �� HEATING INSPECTION APPROVALS ( \ ✓ ENGINEERING DEPARTMENT ` �.•� ��b+�� � !M:780aaDF HEALTH OTHER SITE PLAN REVIEW APPROVAL - WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN 1 CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTE l NOTIFICATION. BUILDING PERMIT NO. �� � / c/ ` D'- ASSESSORS PARCEL h'0. / 71/ y CONTINUATION OF ROAD BOND The undersigned owner/contractor hereby agree to maintain t:ie== road bord.ia force until the following wort{ itams ara ccWpleted to the satisfaction of the E:gineeri:.g Section of the Depar=ent of Public wars: loa= and seed shoulders as soon as weather pe=its: other (ey:mlain) G:/CONTRACTOR) (print name ) L' w c.:•:�'��.YL:,.:.I�:is L:%^.J:cIZ�TION . W OR AS 00"70 aM rtiw NOTES: 1. ALL WORKMANSHIP AND N 9?*-ORM TO D.E.QE. " TITLE 3 : THE TOWN OF ^�`•i^� . _ RULES AHD T.a rK I? 3 - AND LAT NS KIR T IS Amµ lPOSAL OF SEWAGE:IWE • — 2 WITHIN/RSOT FSANITD Y UNITS 'SHALL BE BROUGHT TO 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE iaN KK 40 PON c SHALL BE 4. COMPONENTS IN PLACE. /r Mt THE SANITARY SYSTEM SHALL BE CAPABLE I FLOW L ME r LAMM W OF WITHSTANDNiG H-10 LOADM UNLESS THEY ARE UNDER OR t WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING 3Y l = -0. 7 SHALL DE USED UNDER OR WITHIN 10 FT. OF DRIVES OR T 1 _,WL LEvIL PARKING. V-o j r*,; S. CAST IN PLACE CONCRETE TEES ARE SPECMnCALLY DISAPPROVED. MAL SANITARY TYS WHERE INOICA7M ARE REQUIRED. NOTE DISTRIBUTION 8. EFFLUENT PIf'INC FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT BOX l'1 i_c�' THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY LOCATION MAP EXTENSION WI.L NOT K ALLOWW. (;GALLON 9EPTiC TANK I. a ,, , 7. NO DETERMINATION HAS NM MADE AS TO COMPLIANCE WITH DEED RESTRICTIONS OR ZONINC REGULA7K*M OWNER/APPLICANT SHALL L + OOTAIN SUCH DETERMINAlON FROM THE APPROPfgATE AUTHORITY. SEWAGE DISPO.RAL SYSTEM PROFILE BOTTOM OF TEST HOLE 8• HORIZONTAL AND VERTICAL GON EE LEVY, ELDREDGE NOT»sCAti k WAGNER FIELD NOTEBOOK i 7 - CURRENT OSI� INTERPRETATION: DESIGN CALCULATIONS: \ vAA FRONT SETBACK cr i -MIN. NUMBER OF BEDROOMS 3 SIDE SETBACK r GARBAGE DISPOSAL UNIT f 7)� MIN. REAR SETBACK C FEET TOTAL ES'111dATED FLOW ! R (EQUHREO Ja SV TA CAPAC17Y ) • 1 CAL/bAY i ACTUAL SHZE OF SEPTIC TANK AL PERCOLATION SOIL TEST LEACHING AREA REQUWJAsENTS i SIDE1WALL AREA _,U GAL./S.F. BOTTOM AREA 1& GAL./S.F. DATE OF SOIL TEST LEACHINr CAPACITY (POTTOM + SDEWALL) YFAL % I r tt WITNESSED BY U !! �! t i i'/ y'• PERCOLATION RATE MIN./INCH 27I'( 10/9)( & )(2.5),�+It( I p/2) (1.0) GAL RESERVE IEA�?MJC CAPACITY ',� OBSERVATION HALE 1 OBSERVATION HOLE 2 Sr<1HE ELEV� BREAKOUT CALCULATION: LEGEND: vy �= �• . " EXISTING SPOT ELEVATION OOXO O - `• E f 1 T { '� (FETWB CGBITOING- 00--- FWAL SPOT ELEVATION -�_ Q{ ��(( jam; _ nNAL CONTOUR LOCAON WATER AT ELEV. . Ic:..J WATER AT ELEV. �TWATERESTT—WT1—sWaa�c lop SEPTIC TANK p DISTRIBUTION Box 0 PRIMARY LEACHING PIT 0 WATER LEVEL ADJUSTMENT: RESERVE LEAC>•ING PIT 'K' L r }�,�2 C' TEST DATE !/ ;�� WATER LEVEL ,I O / / ► "' \ N INDEX WELL -- - NO. DATE MITIAL TION ,'3 SS 17 f. ..,� WATER LEVEL RANGE ZONE \ DEPTH TO WATER LEVEL FOR INDEX WELL SITE PLAN t do �'ySE`lP`TIC DESIGN y FOR THIS MONTH `A, p�H U!V r �k �[� � -LOT I t:� -----------_--L. -_--..---- __ 1 _ WATER LEVEL ADJUSTMENT �1(. BAR -I�PtOI_OMASSACM SETTS I 1 U,• �,IT,, 1N'PTH TO HIGH WATER "" � �pJN OFMgss� -. �, SCALE _ JOB NO. _) /SPLAN v STEPHEN r\ _ O1 E V 1 / `,.. o ALLYN APPROVED: BOARD OF HEALTH o WILSON y .o ,Q No.30216�Q 4�1� "-ISTGF' F O 'ALA '�S Una 5MMI k UQU A3MM Imo. SITE PLAN DAT< AQW uw0. n Iaaalauomr c- G" 1110t MAW MEW �s to eamr i u o