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0159 PERCIVAL DRIVE
a N0. 152 1/3 0_RA ter.-a®ncm�c'-•'�=.T_"�".�-'ear — - -- -- ESSLETTE W O U U i f _ __ _�--- --`--'------------- it I I i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# 06-0 / 3 Health Division � ( /0,� �=`Z" Tea BL f; Date Issued �a y Conservation Division .,.r' s - I; !"6 Application Fee Tax Collector Permit Fee_ Treasurer EXISTING SEPTIC SYSTEM Planning Dept. LIMITED TO Ll #OF BEDROOMS Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village gV, Owner YV alze Address Telephone Permit Request Square feet: 1 st floor: existing Proposed.A64- 2nd floor: exist 9 Proposed o al new Zoning District Flood Plain Groundwater Overlay J, Project Valuation 6� Oad Construction Type A)00 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ul' Two Family Cl Multi-Family(#units) Age of Existing Structure Historic House: O Yes &N-o On Old King's Highway: 0 Yes 87 No Basement Type: �II ❑Crawl ❑Walkout Cl Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft.) Number of Baths: Full: existing new �_ Half: existing 1 5- new L7 Number of Bedrooms: existing_ new y�t IQ£l � /,;ti„�,� q� ""P � -k,,,— Total Room Count(not including baths): existing _new First Floor Room Count J� Heat Type and Fuel: K Gas ❑Oil O Electric 0 Other Central Air: QYes O No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:O existing ❑new size ' Pool:O existing 0 new size — Barn:O existing 0 new size "^ Attached garage:O'existing O new size Shed:O existing Cl new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded 0 Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name h z2x• 0 Telephone Number 5Eaz` 77-1z 4-74- 9 Address GL License# D � Home Improvement Contractor# Worker's Compensation# -;�d mP/e`S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 211M✓`rte✓ SIGNATURE DATE 1 o4-- FOR OFFICIAL USE ONLY n s PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION ] FRAME I' �1. 4�L INSULATION "� � r FIREPLACE ELECTRICAL: ROUGH. = FINAL PLUMBING: ROUGHz FINAL F � - GAS: ROUG , FINAL �t e FINAL BUILDING a rr O cap DATE CLOSED OUT.. j -ASSOCIATION PLAN NO. _ Generd Not IMPORTANT-UPGRADE SMOKE DETECTORS REVIEWED STATE E.UILOING CODE REQUIRES if:c r:;n1' / 42 f 6 SMOKE DETES70RS FOR THE ENTIRE C:':EL!L:' EARN-STABLE BUILDING DEPT. 6ATIf ONE OR MORE SLEEPING AREAS ARE ADDED OR i NOTE: A SEPARATE PERMIT IS RFCl"-- FIRE DEPARTMENT DATE ' INSTALLATION OF SI.,.OKE DETECTC-�S- PERIAIT DOES NOT SATISFY T""'E'D�' BOTH SIGNATURES ARE REQUIRED FOR PERMITTING EAWW 51RXM A5PM'r ROOF fO MAKH EXI5 M wrm CWAR%NA E I..XS..COR BOAV51W. am F PON' �L�V ION Na ��M.ronM.N. om. PANE IT5. AMMON PLAN W.PAIWAM 1910 q�m�u srta�ru� rvre��Fra�►rw. 12 9 Lf.g00R [�} N41fE avM ^ 514JAk5 p�Ap �VAION _ KAW IT5, AMON PLAN W.6AMWMt a,�o, 2 of 10 1 c.w wm Ir' Q 5.� 45" I2"p Ir' �Ir' r I"XB RN�vm I"Xr'BAD iW. WMCW R ® 44JC1k5 LU CY.Nx 2,' APPMON r'Lfw W.6A1WAMZ aiae�a 5 or 10 i C P II FER I pIGHf �VA110N --- AMMON PLAN W.6AIdKW --------------------------------- r------------------------------- I I I , I I , I , OMNG FOLMA11ON FOUNPA110N PLAN I ell I FOWAnON 9'FCIFICATION5 I * 4'CONOM W/u.l.,6"1W I 20"xl2"FOFJVIEl7.CONfIMJ0115 FOOMO I , FFOLR fO WMOF EX�ISfING FOLWAnON I , I I y,,bn I I I ra xMr�. m. ----�--- ------ �, ————— ———————— 18' rt K"M5, VVMON FLAN W.13AN fW 10/2WO4 5 OF 10 "v+^-r 16'-2' 0 D051ING LAV, 6' 19'-2-1 O 4' �1�5f F000 PLAN WIWOW 5GfV,E o z��6 D1i, ffmINdyGOI" �� DOOR 50fvu: 24' FEW TO F17G1 OF F011N87A110N mm I N IN COI WVW Q.OS�f 3'0"X 6'8"9 LITE 5fM DOOR WhHN WALL,ON FOLWAAGN M5 M FIRST FLOOR O GARB 6' m 0 �T-V'4 2'� 7-61 W5, AMMON MM W.6A<WARX p,�,a 6 OF 10 9'6" 10' tr�1 ao 5'-la' 5�CONn FOR PLAN 12' Li o I wow 5ofvu 0 2452 t7N, 24310 MI.MILL LIB, CIO t7OOR 51;hEnU: © 2'8"X 6'6"M5rD PAIL © 4'0"r6'6"BI-fCW M5W PANS. IZ'6" 12'-6" 3'0"X 6'6"RA15et7 F*a 6 mmm I MWOM 2 4'2" �... �. 25' KMII;M5, AMON FLM W.PA13J9fAM ft=jXf 2'aa' 16"Of-M 25' eRv"KaNfugm MOGNMVM 276"NALER 24' —91 Ersaa+ua�s?k+ 4'-7" }---4 4'-9u `fl.I j76f2'd0" 5mr1a I6"OL.i1P. ca z7 2'1G0"RE�ON Ja5111P. �.. 2'w0"W"J015f m.' - E1051lY 519LfIiY L T FOR MAW PLAN 5�CON19 FOR, MAW PLAN A a�W5. �nmoN FLM W.Pffl6rAIAX biaevw 6 OF 10 we�sa�aa� 16..oc m Woo rmA PLAN K"W5, APP W.BA1�15fA81.�FLAN 10i28/01 9 OF IO WLT vwr IT' 2"76"ra uR*5 v,or- . 4Y' T'dd'wm 1611oL. IT' 1/T'5fN14JG R�JO 11w"50" —1/T'%W-VOAV i UM VDW vS�ME05:TPIf Tot"S%WW5 16"OG Rt6 NSRLM ON f2M 5 V T'S}0W Ntt1 apARswe 4/4 fiG9EFI00R T'da'R. J76rw"0c. R-19 Wt=51M OEM 2 W'SfID5 16"OL. 4"511.1NLY aeGN1 @DS mamwoNrapo IN EMQZ os PgWMONM16Glt w . "m. 10 MAe5 _ .. - T76"Pt.5u S1J�k/L 4,COW_fm e K"W5. 5FCf10N n�1'& An MON �nnmoN �w _ The Commonwealth of Massachusetts = _ Department of Industrial accidents _ � O�lcs e1�ed�s 600 Washington Street Boston,Mass. 02111 Workers' Com ens on Insurance davit-General Business/ / ame• u r address' state: iihong# ci work site location fu address): e, Retail[]Restanrant/Bar/Eating Establishment I am a sole proprietor and have no one Business Type: ffice❑S 0 In ' Real Est e,Antos etc,) working in any capacity. I am an em to er with em 1 es�full& art tin . Other El ovidiQ % com�nens /on/for/m/y/emplees working on�this job.... I am emp y. cam an name: }•'..'.''Q!,•Ct' .t ,e,�. .. ,' .. .I :p.,},;.r'_♦t, •C;1:r;r• :; Bddi•eSs• o•r r. •�'. : .':.�� • 1• • t• .•f •�. �'' I; ni . .. hone ll"' city: inslirance.co;rr ..'. ;.,"., .. _,•. / // / I ave hired the independent contractors listed below who have of am a sole pr6prietor and hthe following workers corttpeasation polices:In : < tip. ••t•':'.\! '•1.'' '., . . :: ••i• '•�r •r• :'.ti;;�s-.4't, ,.., ,+i 110IIe R.'. ••t: .;r. i•r� •.f�•1��,t.jt1�..' .e.l•r•,. ,. .: ,: .a 'ti t.. :�.�.e�;• ' ..>?S ��.���} r'" L•' .34 r,rUr`• Y"'•i' 't''•r•'•'o11C.t# •:}•"• ",Y• .::'•.: //. + ��/�/�.e%,///. insu,fance Co. :r•- - ' %.:. i.. �/ r// //l/// / i //%/ i t r.. ♦t•, S• _ ,1; ::ti•{:• ;.{•. r,. .r •1+•.r•:'r• Y;:'t ci.! n•!t,♦. .1i7' : com' _ . ♦1 t♦ bone S'sisdrencp eo, ^.'•, ••:_MMON /./ // %///% t///%// �/ Failure to secure ccovveerrnge�en peaealties in the form of as STOP WORT{ORDER GL 152 ism-lead to the and a Fine of$sid"Of 100 0 and y sgeiwtt me�I and�t�aad.t>nato�r. one years'imp the Office of Investigations of the DlAfor coverage verification copy of this statement may be forwarded to I do hereby ce i under a ains and penalties of perjury that the Inform ation provided above is tr an come Data Signature Phone# Print name s� � '• official we only do not write in this area to be completed by city or town official permit/IIcame it ❑Building Department ' city or town; Oficeasing Board ❑selectmen's Office ❑check if immediatarespome is required ❑Health Department , • phone ❑Other contact person (whed 9epl1Co3) e . . 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 contract of hire,express or implied, oral or written. An employer is defied 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 section 25 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,neither the commonwealth nor amy 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. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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•"lave'or if you are required to obtain a workers' cornpensationpolicy,please call the Department at the number listedbelow. City or Towns Pleasebe sure.that the affidavit is complete and printed legibly. The Department bas provided a space at the bottom of tine 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 pernvVlicense number which will Ve used as a reference number. The affidavits maybe returned to by mail or FAX unless other arrange=ts havebeen made. the Department 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. /////%M//// The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents M of Imstigafts 600 Washington Street ' Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext.406 la , OF SHE ram, Town of Barnstable Regulatory Services S saxnsTasrs, Thomas F.Geiler,Director nsass. i639• p�� Building Division QED MA'S Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. I Type of Work: Estimated Cost Address of Work: 0 ' Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law ❑Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given t7at. OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: JaeY Contractor Name Registration No. OR . Owner's Name Q:for ms:homeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 S� D • d (� Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE o D !'i square feet x$96/sq.foot= GG x.0041= ,2 3 6 . plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) 0 0 square feet x$32/sq.ft.= l of 0 0 x.0041= �' 7 ACCESSORY STRUCTURE>120,sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Parch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee '7 Projcost Rev:063004 �t t Town of Barnstable Regulatory Services ? Thomas F.Geiler,Director a►axsri►I" 0396 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma:us - Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 0- village "HOMEOWNER": n home phone# work phone# CURRENT MAnJNG ADDRESS: o cityho%M state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or-intends to reside,on which there is,or is intended to be,a•one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official.on a form acceptable to the Building Official,that he/she shall be regRonsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re,TT. M_� J60- lure o 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 Constriction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1:1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons:In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the pernrit application, that the borneowner certify that he/she understaads the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forrns:bomeexempt r 12/14/2004 TUE 16:01 FAX 508 888 4246 TURNING MILL CONSULTANTS Q 002/002 N TURNING MILL CONSULTANTS, INC. DEVELOPERS,ENGINEERS AND CONSTRUCTION MANAGERS • 1 f j December 14,2004 , t Ted Cooper All Botello Lumber. P.O.Box V Ostervill%MA 02655 r i 1 RE:' S&uctueal Engineering Sen►= xtl I • Kane Residence West Barnstable,MA Dear`W. Cooper: Turning Mill Consultants,Inc.has reviewed the plans titled"Kane Res. Addition Plan,W. Barnstable", dated 10/28/04 and has determined the following I I WA __ 1WO steel beam is required to support the second floor bedroom and bath area. The r W16x50 beam is designed for a dead load of 15#/sq.ft. and a live load of 40#/sq.ft.for the Zed soar loading,with an additional loading of 10#/sq,ft dead load aad 20#.sq.R.live load for the attic. The maximum span allowable for this beam and loading condition is 25' V. Based on the loading and clear spans as stated above the beams are in conformance with the Massachusetts State Building code Should have any questions,please feel free to contact me at(508)989 4383. ¢ Sincerely, Turning Nfill Consultants,Lick'=,:}= c. Robert L.Bodjiak P.E. ��,�� s f';• E Cil `Gr;V;,t: Engineering Manager �.aai E i I 68 Tuppm RoAD,uNrr 0,P.O.Box 1159,SANDWICH,MA 02563 TEL:(508)89&4383 FAX:(509)888-4246 1 ya. i ii , r 12/14/2004 TUE 16:01 FAX 508 888 4246 TURNING MILL CONSULTANTS 0 001/002 i ' e Turning Mill Wireless Consultants, Inc. ;��� , ,, •Ill. 68 TUPPER ROAD,UNIT 3,P.O.Box 1159 SANDWICH,MA 02563 TEL:(508)888-4383 ' FA,x:(508)888-4246' E-Maik bbodjiak@tmcwireless.com LETTER OF TRANSMITTAL TOTED COOPER FAR 508.477.7709 COMPANY ROTELLO LUMBER PHONE t ' cc FRoM BOB BODRAK PHONE 508-888-4383 t DATE it s We are transmitting the Following: r -PRINTS -SPECIFICATIONS CIIANGE ORDER _CAD DRAWINGS _SAMPLES _LETTER For the Following Action: _YOUR USR _FOR APPROVAL _REVIEW&COMMENT -REVISION&SUBMISSION -REPLY By the following Method: -MAIL _MESSENGER __O VUMGRT CARRIER _ELECTRONIC FILE -UNDER SEPARATE COVER COPIES DATE DESCRIPTION 12/14/04 KANE RESIDENCE:STRUCTURAL$EAM DESIGN Lr rrER i i COMMENTS: IF YOIJ HAVE ANY QUESTIONS PLEASE DON'T HESITATE TO CALL. i I TxANK YGIJ,BOB BODJIAK f r b tij LOT 33 C �84.199' cm No c r � d 115.2'+ M �x LOT 32 35,713 + S.F. (0.82 4 AC.) N N P LOT 31 S E P 2 3 2004 err~ roc JOB # 94-039-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP 110 PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO-OPERATIVE SCALE : 1" = 50' BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS 1N OF WSJ+ PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. y� JOHN qGy STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE 2 L G TOWN WHEN CONSTRUCTED. STRUCTURE DOES NOT LIE IN A DELMSTOR. Q r[24 OD HAZARD ZONE. o � 36859 y MAREST-McLELLAN ENGINEERING SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 DENNIS, MA. 02670-0463 8) 398-7710 DATE 4FE' 40NAL LAND SU YOR CD Application to r ®Ib ittg'� -t)igbbjap Regional 3bi#tDric Aliotritt Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS -ril .. 00 Application is hereby made,with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: ; 1. Exterior building construction: ❑ New Addition ❑ Alteration C? Indicate type of building: ❑ House Garage ❑ Commercial El Other -— 2. Exterior Painting: ❑ �- 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other l TYPE OR PRINT LEGIBLY: DATE "Pr- ADDRESS OF PROPOSED WORK 1F9 ��/��%V�� �'rASSESSOR'S MAP NO. OO OWNER ASSESSOR'S LOT NO. HOME ADDRESS TELEPHONE NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property'owners across any public street or way.. (Attach additional sheet if necessary.) U L r / Dr- t,°l— -d- � AGENT OR CONTRACTOR/ l�?�1��1 YUfL c�l� TELEPHONE NO. J" (��g / —f 7A ADDRESS /PSG/�G� ✓ GL�// � t ��� ,4�?� LJ DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. Signed �,Z S r Owner-Contractor-Agent For Committee Use Only ,This Certificate is hereby Few fat. ppe .�, E- SEP 2 3 2004 , (Committee Members' Signatures: Tr r Town-of Barnstable ' Old King's Highway Historic District Committee p SPEC SHEET FOUNDATION Vv I UV�t `.p U� Y r t Q COLOR of R SIDING TYPE L� L S _ i CHIMNEY TYPE IV .� COLOR ROOF MATERIAL I,W U ; i I I COLOR_X.0 1-,l i III LCLE v � PITCH �- ii� S E P 2 :3 2004 � WINDOWS � 1 ) COLORANt__SIZE Yd rl e..S TC :� BA.'�"ISTABLc i'":" TRIM COLOR s P ' DOORS 6 + l Q COLORS U I� .r SHATTERS - COLORS GUTTERS QI U VU II (1 IY 1 COLORS DECKS !" MATERIALS GARAGE DOORS u COLORS ' SKYLIGHTS ' 1 SIZE T� COLORS SIGNS COLORS FENCE COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Your copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when. applicable. SPECSHT 1L l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map U U U Q Parcel Permit# 7-S� 45`3 Health Division 5_?a:;L-- Date Issued leO44 Conservation Division FS 3-/ D 7 Application Fee Tax Collector — Permit Fee _ Treasurer �� J Planning Dept. ALLEC CoMP,!. 8� - �;, Date Definitive PI WM�E 5 f�N, _t e an Approved by tannin Board RO I q�664. _ v, �0(� 614 t0 TOWN REGULgTiQNS c.a Historic-OKH GY Preservation/Hyannis ' co ry r- Proiect Street Address �. � 1 " fit Village Owner ti Y ) ti Address ►�� (�I Telephone I "1 Permit Request f 11 fA� t - V (/ W, AJ M S2 LNd d ts-hm, Nome_ &.J4/1/n/ 1601 o Sow eXsT coRIVeR a Ro toe 0V/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 69 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 'Cl No Basement Type: CPull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) You Number of Baths: Full: existing new Half:existing I new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: IIGas ❑Oil ❑ Electric ❑Other Central Air: f p(es ❑No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes /)P No Detached garage:❑existing ❑new size Pool:,❑existing ❑new size Barn:❑existing ❑new size Attached garage: existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use RIOBUILDER INFORMATIONName V Telephone Number Addressvifl /Naval License# U ' �} I � I q 1 Home Improvement Contractor Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREQT� DATE n 0 ' FOR OFFICIAL USE ONLY b ;I RMIT NO. A r. DATE ISSUED 5 MAP/PARCEL NO. o ADDRESS VILLAGE l , OWNER r DATE OF INSPECTION: FOUNDATION ,} FRAME INSULATION FIREPLACE ELECTRICAL: ROU f ,N FINAL PLUMBING: ROU(2 FINAL � m GAS: ROU r s FINAL FINAL BUILDING r corn mm v _ c..f--os `? DATE CLOSED OUT �'ASS.00IATION PLAN NO. 3 e i / ll• .lt �— The Commonwealth of Massachusetts �- 0' Department of Industrial Accidents ' - -1W;f Ofll�BI/ar�sdBsd�s Fi3 p 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit-General Businesses name. address: city state: zip: phone# work site location(full address): ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an em to er with emloyees(full& art time). ❑Other %/ %%%%l//%%%%%/%%///%%�%%%%//%%%%%%%%%%%/%/ I am an employer providing workers'compensation for my employees worldng on this job. com any name' e.. addressr C\ Q 0 T e 4 + ... insurance.co:-: . olie. .#.: : . I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: company name: a'ddress:. :. city' - plione#!�, insurance co. L Rof)c":# /. ZI%%%/�/%%/O// :.:r.::. company naaie::�:; address . city:,' :•: :. :' �.': .. phone# .. . insurenee co. `• :'' ` rilicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby 115der thetnsa!rpenaltnperjury that the information provided above is true ar d car wt Signature Date Print name Phone# r official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office i ❑Health Department contact person: phone#; ❑Other (mveed Sept 2003) 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 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 section 25 also states that every state or local li:.ensing 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,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. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. 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 perrnit/license number which will be used as a reference number. The affidavits may be returned to 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: v The Commonwealth Of Massachusetts Department of Industrial Accidents Of in of inlresdgmens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 i oF�Her Town of Barnstable Regulatory Servides ansrr B IX Thomas F.Geller,Director �A sego• �•� Building Division rFD MP't • Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 • Fax: 508-790-6230 Office: 508-862-4038 • Permit no. Date AFFIDAVIT HOME IlaROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing ovrAer-occupied building containing at least one but not more than four dwelling units or to structures which are adj¢ to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. 'Type of Work: Estimated Cost Address of Work yP rL, V I —Owner's Name:_ils� Date of Application L7 3 ' �� I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME WROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Dat Owner's Name r i °F Teti Town of Barnstable Regulatory Services = B�xxs Thomas F.Geiler,Director KAM �p e16 o 9. Building Division _ Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 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 1 Q V C h-r in all matters relative to work authorized.by.this building.permit-application for: (Address of Job) 04 S' e of Owner Date Print arne .,.....n�,rc.nwnrFavFu rrrc.crnN r LOT 33 C N or o90 C 3'+_ 1152'± 115. 64. 99' sec. LOT 32 Tc-c l-- 35,713 + S.F. N (0.82 -;-AC.) o do LOT 31 I JOB # 94-039-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP 110 PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO—OPERATIVE SCALE : 1" = 50' BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 d" I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS k\AOFMA PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. ya JOHN �y STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE o Z. u, TOWN WHEN CONSTRUCTED. STRUCTURE DOES NOT LIE IN A DEM"ST�JR. f� FLOOD HAZARD ZONE. 0 No.36859 y DEMAREST-McLELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 WEST DENNIS, MA. 02670-0463 (508) 398-7710 DATE +E40NAL LAND SU YOR s /\ � l `. _ �-� � � 1 �OJkl ' ��Ia i� �2�►� Four IQ LP ------------ i I i I i II ,il r I�( CO"" Application:to.. Old King s Hi hO R iornal His ocic District Committee g Yeg in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans,drawings, or photo- graphs accompanying this application. . TYPE OR PRINT LEGIBLY DATE 15� ADDRESS OF PROPOSED WORK ,/� 'v �`� y/�- ASSESSORS MAP NO. OWNER " /Iz4 �r �. Cps � ASSESSORS LOT NO, HOME ADDRESS 151 IP.�L�IrGt/ ,�� /n/-� /�J� �/� /�/GC.;+ TEL. NO. ✓���/ //. AGENT OR CONTRACTOR ADDRESS l.�C7 i �� � �(�/� "•TlL. NO. This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. �j (2) It is within a category declared.entitled to exemption by Old King's Highway Regional Historic District Commission. ` (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot,and, if an addition is involved,show- ing location of existing building. lVd qA10,41 i SIGNED j Space below line for Committee use: . Owner-Contractor-Agent Received by H.Q.C. The Certificate is hereby V. Date I Time By Date Approved ❑ The categories of work entitled to exemption are listed on Disapproved 0 the back of this form. ��ie Panvrizoouvea�//o�/ aeaac�iugetfd Wid �OAftD.-0F58_,Fl1.LWN_,GREGUL!A�TIONS .Lic®nse: �GQNS=TRU= ON S'PERI/'8611 Nurritieti�C- O49879 f l ft 16'00 R;10.04 Tr,no; 198 Rd�"' ST�EVE•N L MFLt.�R ` 1,99,�F-NGI7 AL{ORS , W8,4RNSTiKBIeE, iMA'W2g8 mfntor ✓die TOomvnw�ziueu� a�'�/�,�reaac�r�Qeba � . Board of Building Regulations and Standards License or registration valid for indivdul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: lug Board of Building Regulations and Standards Reglstratlow 117610 One Ashburton Place Rm 1301 Expiration: i0/25/2004 ' Boston,Ma.02108 :Type: Individual STEVEN L.MELLOR.'. STEVEN MELLOR. 199 PERCIVAL DR ----- ' W BARNSTABLE,MA 02668 Administrator Not valid without signature LOT 33 0 C �e4.°� m r o i usx± M 64.99' LOT 32 35,713 ± S.F. N (0.82 -F AC.) N O ti� LOT 31 1 JOB "-039-3z CERTIFIED PLOT PLAN PREPARED FOR LOCATION :ASS MAP UO PAR 1-13 SANDWICH PERCIVAL DRIVE WIM BA.RNSTABLE CO-OPERATIVE ; SCALE : 1" = W BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS - ��NOF PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE 2� JOHZN TOWN WHEN CONSTRUCTED STRUCTURE DOES NOT LIE IN A f..R. FLOOD HAZARD ZONE. No.38859 C DBMA -M-McLELLAN ENGDMW.ING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 19W 11ES1' DENNLS, MA. 02670-0463 (508) 398-7710 DATE PJ�F40NAL LANDS OR P`OptNEip��� The Town of Barnstable . BARf1$TABLE. ' Department of Health Safety and Environmental Services 9 MASS. 0 1679. �0 .� prEOMP+� Building Division 200 Main Street,Hyannis,MA 02601, Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection 4/1 i f Location 5—q Pr-1zC i/w (` f- L Permit Number 7:2d 2 Owner /V°e Builder One notice to remain on job site,'one notice on file in Building Department. The following items need correcting: 1,e iv7 /9- 71,C '7-P p I- e A 6 /9 , 5 T 62- 0 /3 L Please call: 508-886_2-4638 for re-inspection. Inspected by ��/•� ��z� Date 0 i , POF THE►o The Town-of Barnstable N O� BAR`1STABLE. Department of Health Safety and Environmental Services 9 MASS. 0 t679• �0 p�ECM O., Building Division 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Sono Location 15�7 Pe rc" ,/a Permit Number # Z 2 Z Owner Builder One notice to remain on job site, one notice on file in Building Department. ' The Ifollowing items need J-FzAYL � correcting: Spoo vVV Please call: 508-862-4038 for re-inspection. Inspected by Date 10i ��D r °FINE► Town of Barnstable �)Ievt' of r,A;� {Jrr�®LE Regulatory Services 2003 OCT _ 9� ,STABLE�` Thomas F.Geiler,Director 2 AH /J. 24 iOlfD MA'1 a,0 Building Division Tom Perry,Building Commissioner V{S N 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR I, -�-t �JV1 ea'1 'h , owner of property located at 159 hereby certify that cUnry L Co is no longer Construction Supervisor listed on the application for the project under construction as authorized by building permit# CO 51 , issued on M GIA.� 2000.3. I understand that the project under construction must cease until a successor licensed Construction Supervisor,is submitted on the records of the Building Division. /0 2 2003 FFROPERTY OWNER DATE q/forms/newcontr reference R-5 780 CMR rev:080102 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 11®CDIb13 �aril 432. . . Permit# �� 62-2— , .� .Health Division S S- 7d� FA PDlNate Issued rnea Conservation Division c ZS 0� � ��F' 2 i; 8:Application Fee 17� Tax Collector o� r70 B -'N�- _ q1a�lpoa Permit Fee 00 Treasurer d k — /U L — °� o� 03 [+';Q SEPTIC SYSTEM P�iUST DE IN3TA:LED IN COMPLIANCE Planning Dept. TITLE 5 Date Definitive Plan Approved by Planning Board EWROlNMENYAL CODE AN:) TOWN REGU !'(JI~;- Historic-OKH Preservation/Hyannis 3ffdi e Project Street Address t5C1i�ltlt��Y1y�— Village WE4- Owner k.Dhe,n m, t_ t-Mu K",c Address 159 ? ✓C1\)6LLW0 Telephone 5D ® (o `C� t ft SV Permit Request aW tL `j 1 Square feet: 1 st floor: existing ( 2 proposed floor:floor: existing VA_ proposed — Total new ( Zoning District Flood Plain Groundwater Overlay Project Valuation $3J4 � Construction Type (A)MCA Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family er" Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Flo On Old King's Highway: ❑Yes 8 0 Basement Type: Oull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2- new O Half: existing 1 new 0 Number of Bedrooms: existing� new O Total Room Count(not including baths): existing (D new First Floor Room Count 3 .Heat Type and Fuel: dGas ❑Oil ❑Electric ❑Other Central Air: &Kes ❑No Fireplaces: Existing " 1 New Existing wood/coal stove: ❑Yes '(9'I�lo betached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:l(existing Cl new size Shed:❑existing Cl new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ell D Y Telephone Number Address g r C i y'a Df License# 0y ��� �C— , Home Improvement Contractor# Worker's Compensation# -f a6IL�J q 5 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJE1. CT WILL BE TAKEN TO LA SIGNATUREL DATEIn FOR OFFICIAL USE ONLY - - 3 PERMIT NO. i DATE ISSUED MAP/PARCEL NO. ° ADDRESS VILLAGE OWNER a t > DATE OF INSPECTION: % FOUNDATION � n � • FRAME ( INSULATION //�I7��tav3 /rlkSd I • FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH:- FINAL FINAL BUILDING Cti DATE CLOSED'OUT ° :�� s 6 S t` ASSOCIATION PLAN NO. -It LOT '33 *.� 54- o o r I , 11sx+ M 1153'± d 64. 99' 416 (r �svta l �sx LOT 32 35,713 + S.F. to (0.82 ±AC.) O ti° LOT 31 JOB # 94-039-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP UO PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO—OPERATIVE SCALE-: i" = 50' BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS �N OF lygS, PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. �� JOHN cy STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE TOWN WHEN CONSTRUCTED. STRUCTURE DOES NOT LIE IN A FLOOD HAZARD ZONE. No.3M9 ig DEMAREST--Mcj.ELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEM 3ER 17, 1997 WEST DENNL!, MA. 02670-0463 (508) 398-7710 DATE +ESVONJL LAND SUROR 1 M LOT 33 "0 �ZS �e4'09' c C o -vD LOT 32 35,713 + S.F. (0.82 +AC.) N N ,P p �O LOT 31 1 JOB # 94-038-32 CERTIFIED PLOT PLAN PREPARED FOR : LOCATION : ASES MAP 110 PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO—OPERATIVE SCALE : 1" = 50' BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS .\�OFA�gs PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. y� JOHN cti STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THETOWN FLOOD HAZARD ZONE. R. CONSTRUCTED. STRUCTURE DOES NOT LIE IN A <�IIAREST,J No.3W59 ig DEMAREST-McLELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 WEST DENNIS, MA. 02670--0463 (508) 398-7710 DATE +ESUONAL LANDS OR °F r Town of Barnstable ~ Regulatory Services BARNSTABM Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,J-k,ph�+n �- �"��`� f1UA')-e.— , as Owner of the subject property hereby authorize G6 to act on my behalf, in all matters relative to work authorized by this building permit application for: t 5CI ��rc.iy 4 , --DY I\r.(-- ., W t2A ��A le— A�- (Address of Job) IkA2� �3 S' atur of Owner Date Print Name Q:FORM&OWNERPERMISSION RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE �l _ New Buildings,Additions $50.00 �Uu Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET ~ / NEW LIVING SPACE /3 square feet x$96/sq.foot a x.0031= Z'—+— Cl0-1p(� plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= I i ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq. foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost °F114E, � Town of Barnstable Regulatory Services ■ASNSTABLE Thomas F.Geiler,Director rfo039. + Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION I MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. G,�,�A Type of Work: Estimated Cost ^� Address of Work: ,ArJ Owner's Name: STILV-9-N-, b L L Date of Application: L la., I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: IP2& 11� a Date Contractor Name Registration No. OR Date Owner's Name QIonrchomeaffidav _ The Commonwealth of Massachusetts -= Department of Industrial Accidents - ' Office offoyestfoo oos _ t 600 Washington Street -_ Boston,Mass. 02111 Workers' Com ensation Insarance davit i r�r prrr aariarryiiirr%%%%%% �/�% name S IR- h- ,, k a ,z Iocation: I' S PS n tr I PU—t..�/(� 01- city i r N �_ phone# ?�I ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workii in ca achy am an em Ioyer roviding workers' co ensation for my employees working on this job. .......... ii:F%ii?isv>.:i:>Gt:j}:;f?:•:�!i%2 , r........\..........n.., ...r. r .... ........ ... .. .. 2 yr ...... .}Y}:??;. - .. .,.......}... .. .. .: ::i%ii;•}??:3:::•..?i:r 3:•:.v::............................ .. .. .:::::m...... .... v, r. ?{� :r::?+•{:::w::.,•: ....... ........ .. ..n. :?i:i:•i�i'iY:i.YYG?.. om an{name. r ...: .: . ...:.. ... ... ...........:n..v::::w.v:::.w:.....:.:..:.:y..:.::iw:ti•i:}::.::::::..:::.:.:Y ..:4v..v ......... ............n............. u...........r............ .. ..... .....................:.v.........v:-:rn.v:r w:v:.v:.vt•:vxw:::::n•:::•.:v:.':n....•.v�::3:}}:.4ii:4'4}?:'}:•.....?t ..............::... .................. .r.n.v............ .:::•.3:::::.}:4:+•. v:•:::r:n•:nv:';?•:i::,v:::::w::?::n-::::}:::ky'{.x}'.%Y:.t::v:w::•:.v..v::::+::}:: 'i0:::•.v3::-•v:w:.:: ......:v::•:v:.:v:n•:n....................::nv: •:Y.•.r..r.........n......:v:; .... ..n.....:Y,....:. ..... ........ ....r..... ,..r.............. ..:... ..•.::...:•: ........................:.v::':v:::::w:::•.vv.:t.::.:..:::.,r...,....:..... {w::.v:.3i:;4i?:•y:5.};x••..,?.,}.,}y. ..... .r.r.:•:•.:::::.... ... ........v...... .v ......n.. ........................ .::•:•:•..,....r....................• r.....r......... rw:::r:::.v:::::v-•}w:...-y.. .::•.{•?\%{:q+.y,::{.{y..;?{::{{. .r.J,..v....... ... ................,....................v............. ...... .. .. .. 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Fafime to secuit coverage as required mtder Section 35A o[MGL 152 can lead to the imposition otcrtoninal penalties of a fine up to SI'W.0.0 aadlor one years'imprisonment as well as civfi penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me: I understand that a copy of this statement may be forwarded to the Ot$ce of Investigation+otthe DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trrup an4 correct signature Date Print name T-e Vim. M.e �I l�Y Phone ofHdal we only do not write in this area to be completed by city or town official city or town: perndt/Ucense# ❑Building Department ❑Licensing Board ❑checkifimmediate response is required ❑Selectmen's Office _ ❑Health Department contact person: phone#; ❑Other Ucvised 9/95 PJla 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 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 ofa 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 bb ecause of such employment be deemed to be an employe , MGL chapter 152 section 25 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,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 supplying company names,'address and phone numbers along with a certificate-of insurance as all affidavits may be Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of ��. +: date the affidavit. The affidavit should be returned to the city or town that the application for the pemut 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. 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 Permilllicense number which will be used as a reference number. The affidavits maybe retamed'io 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: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Invest1gaucas 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 . 07e �anvnzom�oea a�.it/utve BOARD OF BUILDING REGULATIONS a Llcense: CONSTRUCTION-SUPERVISOR I., Number CS 9879 Expfires,�O5f2=004 Tr.no: 198 STEVEN L MELLOR F =+ 11,99 PERCIVAL DR ' 1N BARNSTA9LE- MA 02fi68 7 i - Admin�strator '>"�^'f�'4� Pvwrt�`i^`�+rac...mrt1'w.-i4+:u,...T_•• -F.w•1 RI`ww�+w...... Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards :at.1 7610 One Ashburton Place Rm 1301 Expiron: 10/25/20 Boston,Ma.02108 STEVEN L.MELLOR STEVEN MELLOR 199 PERCIVAL DR l�.G--" """ -- _ — — —._ ---------- - W BARNSTABLE,MA 02668 Administrator Not valid without signature no CAR Appendix 1 Table J3.2.1b(continued) Prescriptive Packages for One and Two-FAM14 Residential Hnildingp Heated with Fossil Fuels MAXIMUM MINIMUM Glaris Glaris Ceiling Wall Floor Hasemant Slab Heating/cooling g 8 Perimeter Equipment Etlicicncyr Area'('/.) U-value= R-valud R-value' R-values wail R-value' R-value' Package 5701 to 6500 Heating Degree Days 6 Q 12% Normal 0.40 38 13 19 !0 19 19 10 6 Normal R 12% OS2 30 6 85 AFUE S 12% 0.50 38 13 19 10 NIA Normal T 15% 0.36 38 13 25 N/A 6 Normal U IS'/a 0.46 38 19 19 10 N/A 83 AFUE V 15% 0.44 38 13 25 N/A 85 AFUE 6 Oy I5% 0.52 30 19 19 10 N Normal X 19% 0.32 38 13 25 N/A Normal y 18% 0.42 38 19 25 NIA N/A 6 90 AFUE Z 18% 0.41 38 13 19 10 6 90.AFUE AA 18% 0.50 30 19 14 10 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 6 0 3. SQUARE FOOTAGE OF ALL GLAZING: 1 L) 0 4, %GLAZING AREA(93 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): 1 NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a + 780 CMR Appendix J Footnotes to Table.I8.2.Ib: d Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 f Z of decorative glass may be excluded from a building design with 300 ft of glazing area. z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. 3 The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. 'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls.. Windows'and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. .'• _� 'The R-vafue requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes elettric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency_required by the selected package. . 'For Heating Degree Day requirements of the closest c 1.ity,or town see-Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.- may have a U-value greater.than 0.35). c) If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). s. Application to- ®tI Ring'.q 3�igbbk ap 3? egianal A90tDriC �Diotritt Committee In the Town of Barnstable. CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four complete sets, for the issuance of a Certifcate of Appropriateness under Wtiow 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and onIanIn drawings, or photographs accompanying this application for. N CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ElNew 2/Addition ❑ Alteration r- o Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 1711 .n co 2. Exterior Painting: El �WJ�4LU 3. Signs or Billboards: ew Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ElFlagpole [Iti the DATE TYPE OR PRINT LEGIBLY: ADDRESS OF PROPOSED WORK j�al / Y - '►Va ASSESSOR'S MAP NO, l�I� �I Y CD OWNER �^� ASSESSOR'S LOT NO. HOME ADDRESS ,�� .� � Lei i TELEPHONE NO. hi I ' �I: FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners acro many public street or way. (Attach additional sheet if necessary.) 1i4L ��-1 w"t.+/ • � ��V(,:.t tJtcri ilk �ri�rC�' AGENT OR CONTRACTOR 6�f1 TELEPHONE NO.ADDRESSi,:9 Y DESCRIPTION OF PROPOSED WORK Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. M6 6G c� c�dC�cfi��c�l -F4. Can a.tveC(CL4 cpP�u �- �+�n►l-k�— .1 \e�se_ _(;M tli' C�c�� fit C"CL CL ttt� z-�1(1� - Signed Owner-Contractor_Agent —F�r r•ommittee Use Only This Certificate is hereby Date /D o D Approve AUG 21 2003 Co ittee Members' Signatures: T WN OF BARNS TABL LD KING'S HIGHWA ' Town of Barnstable ` Old King's Highway Historic District Committee SPEC SHEET FOUNDATION 2 N SIDING TYPE V Way 3 I .& COLOR Miy4vh m4' CHIMNEY TYPE COLOR ROOF MATERIAL ��J COLOR II� PITCH `Q I WIND OWS_Wkb V 5 - " COLOR 1�Q SIZE V of iO TRIM COLOR DOORS . U COLORS AIR SHUTTERS A COLORS GUTTERS kvKl_� V M COLORS D ECKS MATERIALS f • GARAGE DOORS - COLORS t SKYLIGHTS SIZE COLORS SIGNS �V� �7 COLORS Af FENCE iV { COLOR i NOTES: Fill out completely, including measurements and materials/colors to be used. Your copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. LOT 33 n C n2' •254 Os � or o I , 115x+ M 1153_ �qrf�' 64. 99' 416 �sx . LOT 32 35,713 + S.F. (0.82 -;-AC.) N N P p �O r �0°• LOT 31 JOB # 94-os9-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP 110 PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO—OPERATIVE SCALE : 1" = 50' BANK Rmmt c]E LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY'THAT THE STRUCTURE SH0WN ON THIS �NOFIygS PLAN IS LOCATED ON THE GROUND AS SH0WN HEREON. �� JOHN cy STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE o2 Z. l� TORN WHEN CONSTRUCTED. STRUCTURE DOES NOT LIE IN A Daww.JFL m FLOOD HAZARD ZONE. -i No.3W59cli DEMAMST-Mci ELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 WEST DENNIS, MA. 02670-0463 (508) 398-7710 DATE PqFESYONAL LANDS 0� rr If IF-1 FPONf �LFVMON Mv.02m Rev.a a EH KANE DES, APPH ION PLAN W.13AIWAME P16HT FL�VAION =0,10510, i oP I r ' LFFf FL�VMON 12 MV.02 o, w KME 5. A171 MON PLM PM, �LFVAVON W.PAW POLE o����� 2 OF I 25, � 8' J � _ L❑+J I + I �,r�I + I S. iYP 13 25' J L J F. 71 IEv.02 FOUN2MON PLAN FOLINPAIION 5PeCIFICATION5 20"OO'xl2"FOOTING GAME 12N2"FORMED&RMINFORCEP FOLlNPAIION FOOTINGS �. KANE IZE5 * 51LL 60Lf5/STRAP EACH FOOfWG PLN pI A* FOLR fO Wla-lf OF EX15TIN6 FOLWATION W.PA A17n1110N AN ` OV09/m 'J OF 7 24' 12' 4' • WINDOW 50MLE 0 2446 D.H. OL O2 2446 D,H.ALL 0. 5'0" wo"TRANSOM 24' DOOR 5C�FIALE: Q 12'0"zb'6"SLIDER LNif WITH I/2 ROLND © 2'6"x6'8"FLU aA55 DOOR /05 ��. ra n.wwi/,e�. art. rIaS FLOOa PLAN �4 I 8 KANE M5. AV121TION PLAN W.PARNWPLE ,• 0-1i05irn 4 OF 1 (3)2"XIO"GIRT J015f iINJCU51r, DRII7GING aNffg TWO'J015f fYP. 2"XIO"WON f17, (5)2"XIO"(A1Rf J015f FtAN26111'. JOI5f FMaP51w. 2"XIO"J015f .rvr'. (3)2"XIO"GIRT F1P5f FL00P, FPAME PLAN . M. KANE M5. Al' PMON PLAN W.PAIWAt3 r 5 OF eAni 6 TWO"TT.\ EXI5046 51a1CM P00F FmA PLAN mv m mva KW M5, A1712It10N ELAN W.PAIMADLE 6 OF 7 r wa vcw ASFFW.f%DaE5 2"rb"COLAR-fE . PR MR VEN',W R-50 NSU.gm . I"6"FACIA `2J� 1"0"SOFFIT� 1/2"6LIE-00PRD E"MR VLi•EER Rd5 NSLA,-,Yhd 2'44"5W5 16"O.C. 1/2"SIWAHm9Z V4"%,51EFLOOR Wrm CEDAR 90W TWO"FLOOR J019r 16"O.C. R49 NALATM P.r.2"Y6"SLL SLL NSL. (3)2"wo"QR( i•'• 4'MIN. I.PLLYCaUMN2PLC5 �1'-51, S�C110N 12 1f& APPION KANE PE5. A17 MON PLAN W,134WAPLE OV05/0� 1 OF 7 �jTOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V : -Parcel . 6 d �3 Permit# (g S�- Health Division —�.a�- `� 3� TU d?f OF I,ARHSTABLE Date Issued Conservation Division n Application Fee 150 Od M3 APR 30 M 1 : Tax Collector ;o 0� — 6 k /U L- 13 0'0� ,� Permit Fee Treasurer 0 k — L D b3 D i v f v� �' SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE: Date Definitive Plan Approved by Planning Board & VWTH TITLE 5 Historic-OKH Preservation/Hyannis ENVIRONMENTAL CODE AN[. Uffl REGULA TIONS Project Street Address 0 f MG1 ✓�J O Village Owner '� GC{'1 Address !/���� !�� Telephone Permit Request ��/,1 /'1 rl G� UC C�./ICaa(kzz �G � Square feet: 1 st floor: existing 3;? SF�ropose�ad SST nd floor: existing proposed Total new jn�l��In Zoning District_ _ Flood Plain Groundwater Overlay �Y Project Valuation 39, �L* Construction Type W0#QVLmgP Lot Size : �� ��� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure JT— l Historic House: ❑Yes Ylo 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 c2- new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing 7 new �- First Floor Room Count Heat Type and Fuel:/&Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes Mo Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes /EVNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:8"existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name �� Telephone Number 5()b =eve, WU Address i5o License# (rs dO IA / 244— e5� ���wl Home Improvement Contractor# 114111 1 3a,�-1 Gc 1ch. ItO 42S 9 Worker's Compensation# JLt Arh -g& ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO T2 SIGNATURE�✓ DATE �� FOR OFFICIAL USE ONLY h PERMIT NO. I DATE ISYbED MAP,!,PARCEL NO. 1 - „ ADDRESS VILLAGE OWNER DATE OF INSPECTION: .�' •� J ° FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: KOU&SH" FINAL PLUMBING: RO[7G44 `{_ FINAL I GAS: ROUGH "'" ` FINAL �_ �� �-> ,; FINAL BUILDING Olt DATE CLOSED OUT ASSOCIATION PLAN NO. h The Commonwealth of Massachusetts <� Department of Industrial Accidents office ofINYOS lWAVIIS Off Washington Street y Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit JIM name �''iRf��et,✓ /7Cr�l ���� f7L�" /%'�=�'�dN location / f'���L.°✓d f L�Yi -ed-�� �.o rn�37�.ae��� p p�(� Q� �[C[ city phone 7Ub--De � IoD I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job ca _ �,. s w t �Aq a K, x°v 7ts m,rnc 4 mot, F,r. .. > •'Sat "IIZ,,x1' >. •i. ��• ..`" �`_,• x,,,� .x{fF' 'ti�['Y•!{ +[ !a;k's' yj�&'It� Y,y'1>.yt/'1Y��.°''�"'au ^ "',,t, ,4"��_,a4'"trrf�- 'mot' .'u. ��2,,,t 5 , , K,a _ >s ez;,f _. '�{ i �i'!' r't' t.i i ']�'RS^j ,9JY- 'r/' ,y�.1' S s, tBy Y 4 R, ' t , .. �Li6 .. r'•5 5 k 1 h T^�Y+,x r 'G rl,,E. >.+ t t �r� s.,y,14 .t ., '�Y .7,.,N `om an. 'sine ad 5 F Y•u -.e rr t? a Se crt2rr a 3 rP�a._^: ? °x - yc .�-°m;,,;•is���.•--U��,.-..µ�u�:ra' t .,.�•••�,,,el`.+�-'r�C jt •;t`;�lMrtirl'r�'t!'w?a;'`s •G 1* 1�' + H..- �.'�'�t':yS_ •+,e�cr f��,�.,�. .r'rL'��., " l �r�q �•-,.^' �a.. '�'�� ,...s .{,.. � t�v i�� � �� ��t r�tt��b{ t'[� i�_�'.i.�.• �7��,'t.,�l��i�ai4�a�ys"~�7 .� �+tr `rkt..c�n� �'L•L.' a -' S r�.��,,�q-; .. ' i'3� s- '',�,�.,,�9Ssy�+`k'��arr�'t�.4^•ti �4:-.4�"F N aa'�44tc tr"t 9.:�'�' r''w�:tr ,..3�. - �:.'3 a,�,�a;�.3r �,f��t '' `� .y�'_f' K� t t '�'� �` t�.,4,� tt �ct t+ik 'r•�"ti'1t �.'�'. � •``.f'Tsit�r�, � 't. '•i�rtr''-'r �' !�7 �7d }�''�i' t'" ;t�`.`vt i'�.� i r �i•t'r dt "�^��M t �� .�.,4 7 (�.��ws� r� y p �,• ��4 ' F�:s r]-S" .c � � {•` F,Y`'1'E��•5. ,•sV+�)4t°Hr�' vir"f '..�fr cl v� '�rl^(t�4 f ,• lip 3 ara t i�r l "anry{ i�t5t�{5 T*t azeir� {y�,xt ry 1 ;1 am t^0�' 1LSU�'anCO' �`a"+?... �FL4Rr�•r4'J� �1Lc •. .. _,��- ,_ham.-,. ,.... � _ .... .. , .:,... .. :Oli ,`{E ��� .rs •r�r,.fiA� ��; rh� [] 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 �55y� r f MINOR r _3i~4:. `�`•'-"z.: a ?' tha 9 3)JR . y.S zJy. t T", kS "3f".`za "rt t�•".14 ur -,,,'` �`^.� t,{a °' ^e��! t a v5"'-4`'•"#. 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S ¢tXa`-s^. ,r�,Jr -`5tu,:i�'-F�'r� ��N���P��'•m � v'fi`t �? �� o p�llCl"#�-La'�•• C r.�;�''.,t�rYr:_,_.�!.,, �S S-.�ar.�:. �a..�.r,�' ��•!.i�. , yinsurance co a`= z, ��n� ��xr ' Failure to secure coverage as required under Section 25A of MGL 15Z can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the farm oC a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under .e p a ties of perjury that the information provided above is true and correct. Date Signature Print name /�.g l+✓L✓ Phone# !f3-1gd-d I&M official use only do not write in this area to be completed by city or town official city or town: permitflicense# FIBuilding Department [)Licensing Board 0 check if immediate response is required ❑Selectmen's Office ❑Health Department ,contact person: phone#; rl0ther (revised 9/95 P!A). 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 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. I • MGL chapter 152 section 25 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,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. i Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. 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 may be returned to 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 shouldyouu 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 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 �oFIME, y Town of Barnstable Regulatory Services ns�ss snaxAM = Thomas F.Geller,Director - 1639.�a`0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. / Type.of Work: oA9,1,v//1 /Zvo,fi9 Ida` °N Estimated Cost Address of Work: /s! Owner's Name: cY/C,<, W A1o/lt, k•4ivc. Date of Application: lv` 3 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED ME PENALTIES FPERJURY I hereby apply for a permit as the agent Date Contractor Name Registration No. OR Date Owner's Name r RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 — Building Permit Amendment $25.00 FEE VALUE WORBSITLEET NEW LIVING SPACE square feet x$96/sq.foot= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES (attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) . Deck x$30.00= (number) . Fireplace/Chimney x$25.00= (number) ' •Inground Swimming Pool $60.00 - Above Ground Swimming?ool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee no CMR Appaxia J 'table J3.11b(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Foss"Fuel MAXIMUM MINIMUM Glaring Glaring Ceiling Wall Floor Basemeai Slab Heating/Cooiing eat Efficiency? At='('h) U-valuer R-value' R-value' R-value' Wali 'cta � R-value R-values package 3/01 to 6500 Heating DeBm Days' 6 Normal Q I2Ya 0.40 38 13 19 10 Noal R 12% OS2 30 I9 19 10 6 rm 6 85 AFUE S 12•/0 0.50 38 13 19 10 N/A Normal T 15% 036 38 13 25 N/A Normal U 15% 0.46 38 19 19 10 6 N/A 83 AFUE 10 6 �l 15% 0.44 38 13 25 83 AFUE W 15% 0.52 30 19 19 }( 18% 0.32 38 13 23 N/A N/A Normal NIA y 18% 0.42 38 19 25 N/A Normal AFUE Z 18% 0.42 38 13 19 10 6 AA 18% 0 50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: Se�— 4, %GLAZING AREA(93 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-1980303 a 780 CMR Appendix J Footnotes to Table A2.1b: 9 Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 f'of glazing area. 1 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation,.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-flame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes elettric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see-Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value ' in Table JI.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I °FINE� Town of Barnstable y Regulatory Services BARIEA,9& E �M = Thomas F.Geiler,Director 9 ASS � 039. 39�a`' Building Division' Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A Builder I, Q V 1�,� II , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to workauthoriiea by this budding permit application for(address of job) I�q Nov (e � e d v �21 � 0 S', tur Owner at Print N e /I\V•V-1�,�+1��i.1{�_- 04/22/2003---- <5083 540-2400 FAX C508)p 760-1988 THIS CERTIFICATE 18 166UE0 A6 A MATTER OP INFORMATION Mur•r•ay & MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 406 Jones Road ~ HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE-AFFORDED BY THE POLICIES BELOW.- Falmouth, MA 02540 Douglas MacDonald INSURERS AFFORDING COVERAGE INSURED Kent Construction [INSLIRERA Liberty Mutual Ins Corp DBA: Matt Kent IN31.iR,ER6' PO Box 630 nI;LIPCPB East Sandwich, MA 02537 INSI.IREPD ' •::I,re�e COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE 'ISSUEO'TO T14nNSURVD-TAMEO'ABOVE7-DR'TF4E-PMrCV PERIOQINDICATED.NOTWITHSTANDING ANY nCOUInCMCNT,TCnM On OOIJDITION Or AIJY OONTnAOT On OTI ICn DOOUMCNT WITI I MCOPCOT TOW 11011 TI 110 OCn TIr10ATC MAY DC IOOUCD On MA.Y IG RT/LI N,TWO INSURM1l'.•C/�P RC.ReCe YV TWO n,?L I.:.•IG.0 OGlI�wIGGO MGRQIn1—SUQJQC.'T TSB A.LL TWO TCRNIC,G%L'LLIy:I CINC MIP G:I_IN DITII:INS 11F:FLlI::M POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MCLAIMOMADC C PO 1 UMD GENERALLIABILITY LIMITS FAr.H O(Y;I IRRFNr'.F $ I4 qll ITV FIRF nAMArF(Alryro.firr-) OCCUR MCD 0(P(Arty one person) $ PEPSONAL R.ADV IN JUDY ,T GCHCPAL AGGRCGATC $ sEN'L A.GPE.ATE LIMB APPLIES PER POUCH r'b' PPODUCTS.COMPIOP AGG 4 .IrI.I Loc AVTOMOOILC LIABILITV ANY AUTO L'UMGINtU'SIWJLt LIMI I $ (Ea accident) ALL OWNED AUTOS SCHEDULED ALTOS Ri,nn'rnv.ulrrr $ (Per person) HIRED AUTOS Nr,1N.!-11M•IbU ALIIUh: RONI Y IN.II IRY $ PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY ANY Al Rn AUTO 014LY-EA ACCIDENT $ 71 1'ITHt'_F.THAN FA Ar:r: $ AUTO ONLY. AGG $ cxocoo LIAoaIrY ❑ LAUI I UQQUI a:LNUL y OCCUR rL AIMS MODE vt� AGGREGATE $ 1 DEDUCTIBLE $ RETENTION $ $$ EMPLOY WORKERS COMPENSATION AND �V LILY - I riU U4�U I�CUV! V4�U 1�[UV4 TORY LIMR'J [F EMPLOYER$'LIABILITY A EL EACH AI-CIGE^IT ZOO OO - E.L.DISEASE-EA EMPLOYEE $ lOO,OO OTHER � c L.01=-=-FOUV r UIvpT s 300,000 I a I DESCRIPTION OP O19!RATION3n.00ATION3A2'HICLe31EXCLU3I0NS ADDED 8YCND0R3C1dlNTf3P!CIAL PROVISION* CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA TNQRGOP.TWO IQOUINQ L MPANY WILL T.MAIL .10 DAYS WRITTIIN NOTICE To THE rewnrlrATe HOLOEw NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICS SHALL IMPOSE NO OBLIGATION OR UABILITV 367 Main Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Ayt�b� Claudine Poutre CDP ACORD 25�S(7/97) ©ACORD CORPORATION 1988 I I MAScheck—AN(Y REPORT I 1 Mass. ch.-".Energy Cod. I Psrnit 0 I MAScheck Software Version 2.01 • I 1 1 I Chocked by/ to I I I CITY:Barmtebl. STATE:Mesa rh...it. 1®:6112 0]iST9LLTIOM TYPE: 1 or 2 Paslly.Detached —TIRO SYSTEM ME:Other(Mon-Bloctric R.aiota.ce) wre:1-21-2001 00 1AMCE:PASSIM Required UA r 91 Your lions-91 Area or Carlty Cont. Glazingi0oor Perin.tar R-Value R-Valu. U-Yalu. UA ______________________________ __-__-_------_----__---__---__-__- CE/LINGS 192 19.0 19.0 5 MALLS:Mood Preps. 16'O.C. 1.a 51.o I1.0 11 GLAZING:Windows or Door. 52 O.I10 1B DOORS I0. 0.110 16 PLONS:Over Outside Air 111 l..0 W. 11 __-____________—___________________________________________________ _ OM—IANCE STATP2@trr: The proposed building design do.aibed here Is nviatont rith tha bullding plena.ep.cilicetlono,and other celcu lo[lona submltta0 rlth the psr.lt applies[Ion. no propooad building has been designed to met the tequlr..onts of the Maseech.:,to Energy Code. The heating lead for this building.and the tooling load it approprlete. has bean deterninsd using the applicable Standard Dss lgn Conditlo�u found In the Cod.. the MVAC equipment selected to hoer or tea!the building .hall bo no greeter than 125%at the design load ee Specified in S.ttions 1B0001 1310 and 21.4. Bulld.riDeaignor Date r Y WAS hock INSPECTIR3 CMCRLIST Wageaenuaetto energy Code WAS chotk Soitrere yo Ia E.di OATS: S-2T-300) + Bldg .l • Dalt.1 I ' CSM.; R-19+F 19 - - I caeswnteilowtlnn I 1 WALLS: ( 1 I 1.Nood Prar, le•O.C..R-I)+R-13 1 Caomenta/acallon I I WINDOWS A!ID GLASS 000➢S: . (J I 1.U-value:0.32 I Pot rflul-r11hout labeled I1-vafuss.deserlbe features: ( e Pane_Prane Type Thermal SreakT[7 Yee(J No 1 Co®enl./acati.n ' I OOD s: l ) 1 1.U-va lue:0.11 I Co®ants/Loce[ion - I PIALRLS: [ ] 1 1.Over Outaldo Al[.R-30 , I Comment✓Lucall, , I ' I AIR LSAP.AOS: ( 1 I )ointo.penetration..and all other Inch opanil9 In the building I vnyelope toot a o[ef[leekega net be When - I lintel I'd In the building envelope.[ttased Ilgh sing fixte I aha 11 meet one o1 the lollwlnq requirement.: I 1. Typo IC rated.no-foctu[od rIth no pens retious betrea the I held.of the[e assed fixture a.telling-Ity end Lied or I geakated to Drwent air lI 1,ge Into the a.*,dltlonod apace. I 3. Type IC ea led, In an St rl th Standard AS1M a]6].rith no I e than 2.0 ofm 40.9rc L.1 air mwem.nt from the the - I ewondl Honed specs to the calling cavity. no lighting tixture I sheLL Aava bean tested at TS PA or 1.57!b.Itt2 pressure I difference and shall be labeled. I y.ReTARpEP: �. ( 1 I Req ul rod on the va rm-in-,into[side of all non-vented framed 1 calling..ra Lt..and floor.. I I MATERIALS IMI('IPICATIQI: ` [ 1 I Materiels end equipment must be identified go that cn:rpliante can I Do determined. Menufact.rol ru uals for all Iastalled heating I end cali,q equipment and sotvlce rotor A,eting aqulpmvnt moat M I prw lded. Insulation R-valuae end glom ing U-oaf's,met bs clearly I marked on the building piano or opeciticatianv. I i DULT IMMATICN: _ ( ) I Duct,shall be Insulated Par Table 24.4.7.1. I RICO CONSTR11CTICN: . [ 1 I All accessible Joint,.s and rn actions of supply and return 1 ductwrk loeetad outside tandltionednepetn, lnclud ing stud bey.or 1 Jolet evltioa/speca used tot naport air..hall be denied I u,ing-tic and fibrous backing tape installed according to the _ I nufacturer•e installation instructions. M..n tape may be , I omitted rher.gape ere lose than"Inch. Buct tape SI not 1 permitted. Ths MPAC system moat preside a means for balancing 1 air and vator eyseear t I TPAC'ERATt1AE CONTRR.S: [ 1 1 Therwetate e e repo/red for each Ieparata[VAC ayetem, A mnual I ..tamtle so .to partl.11y r..trlct o shut off the Aeating I and/or cooling input to each.....r if nor r.he ll be provided. I 1 Nyu EQJIPMEITT SIZI1s3: [ J I Rated output capacity of the haetiny/cooling.y.to,la I not greeter Coen lx5t of the doalgn load ae specified 1 11 Section.Te00R 1310 and 31.1. 1 ( 1 I SMIIRIW POOLS: _ i All heated wlming pool,moat have On-.1f heater.,itch and I caqulra un l.v. r_of the has Ling.orgy I.tram I non ,plotablerso.rcve.wPaol P.mpe repo::.a time clock. 1 l 1 (MVAC PIPIM IZE"TIRi: I WAC piping convoying t1.ld.above 120 P or chilled fluid. , I bales 55 P muvt bo insulated to the in lwleg levels(In.): I I PIP.SIM I KZkTIw SYSIEKS: TW(P) 2•RNOM 0-1• 1.25-2• 3.5-1• _ I Lor praesura/tamp. EOI-350 1.0 a ].0 I Lor[ampere tore 120-E00 0.5 1.0 3. 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 1 C=ING SYSTPJ6: I Chiliad eater or e0-5S 0.5 0.5 0.es 1.0 I refrigerant boles 40 2.0 1.0 1.5 1.5 1 ( 1 I clRRa.AnNc)Or WATER s,SIEME: 1 Insulate circulating hot wtar pipes to the(envelop I-l.(in.): I 1 PIPE SIM(in.I I Nwt IRWI.ATINO I CIROJLATIt*M31tJ5 s EkWTS I IBATSD WATER TENP(PI: RUNR3TS 0-1• I D-1.25• 1.5-E.a" ].0+• ,. I lT0-180 0.5 I 1.0 .I too-lea 0,5 1.0 1.5 I 300-1]0 0.5 I 0.5 0.5 1.0 . I ----N00S5 TO PIeLO(Building Department Us.Cnly)------------------------- t BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 060744 i1 Expires: 08/28/2004 Tr.no: 2751 Restricted: 00 MATTHEW J KENT 4 PRESBY FARM LN ( �* E SANDWICH, MA 02537 Administrator .�� ;//ra. G%a�n•snoru�w-all, a����l�ra�ac�%uaelLl Board of Building Regulations and Standards • r' HOME IMPROVEMENT CONTRACTOR V Registration: 114911 Expiration: 11/8/2003 Type: Individual KENT CONSTRUCTION MATTHEW KENT PO BOX 630/4 PRESBY FARM LN E.SANDWICH,MA 02537 4dministrntnr T C)WI`I Cam,,9K Application to Cy STABLE. boa Regional iotDriC Mi5striLt (tCnlnmi>t�tee' 2CO3 APR 25 0 11: 52 In the Town of Barnstable 7003 MAR 19. AM 9: 5 J CERTIFICATE OF APPROPRIATENESS-�[T,, ,—, Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section 3 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described.below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ NewAddition ❑ Alteration Indicate type of building: f'^. El House ❑ Garage El Commercial 0 Other 2. Exterior Painting: ❑ 4,1Q 3. Signs or Billboards: ❑ Ne\�Sign ❑ Existing Sign ❑ Repainting Existing Sign f 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE Q?>` 1 03 � u ` ' )OSED WORK .ADDRESS OF PROP OWNER :� . �T ' �`1�I �I r ASSESSOR'S LOT NO. `- 11 �I� Al �"�+%(i'�f TELEPHONE NO. HOME ADDRESS i ��I l r,� ��UI�I FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) ( 0 VU v A IA- 0 .i AGENT OR CONTRACTOR �� (,_�% 1 14 TELEPHONE NO. _J4+ ) ADDRESS .� � y�0 ov" l✓�i � C)L� /✓I DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. Signed w r-Contractor-Agent For Committee Use Only This Certificate is hereby DateAlo*' 11 Approved/Den' Com embers' natures l Town of Barnstable Old King's Highway Historic District Committee c X SPEC SHEET FOUNDATION JO 1'N u r I U r/� SIDING TYPE ' V G6,04 S I L(i1,6 COLOR I A AM (� CHIMNEY TYPE COLOR In r ROOF MATERIAL COLOR r t � �-.J PITCH WINDOWS ll COLOR ��( SIZE TRIM COLOR . COLORS DOORS SHUTTERS + COLORS GUTTERS �1V I COLORS f\I4 n DECKS ;V �t MATERIALS � I GARAGE DOORS COLORS p SKYLIGHTS Iy 1 �1 SIZE COLORS � In SIGNS COLORS FENCE � '� COLOR t NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT , r WEEKES CROSSING COMMUNITY ASSOCIATION BOX 834 WEST BARNSTABLE, MA 02668 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMISSION Jeffrey Wilson, Chair. 200 Main St. Hyaiuus, MA 02601 April 7, 2003 Chairman Wilson, Our Architectural Committee recently reviewed plans for an addition to the existing structure located at 159 Percival Drive,West Barnstable.The property owners, Steve and Holly Kane, are residents in the subdivision known as" Weekes Crossing Community Association". We wish to advise you that the plans submitted were approved as submitted with no request made to revise or improve them. Sincerely, Weekes Crossing Architectural Review Committee i M LOT 33 C 0 ---1152'+ � 64.99' ?6�x LOT 32 35,713 ± S.F. (0.82 ± AC.) N N C �O LOT 31 i a 1 JOB # 94-Wg--32 CERTIFIED PLOT PLAN PREPARED FOR r LOCATION : ASES MAP UO PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO-OPERATIVE SCALE : 1" = 50' BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS 00FAlgss PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. y* JOHN 9cy STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE o Z. TOWN WHEN CONSTRUCTED. STRUCTURE DOES NOT LIE IN A � (�1�IIARESTrA. 14 FLOOD HAZARD ZONE. qc� No*M59 ig DEMARESr—McLELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 PEST DENNIS: MA. 02670-0463' (508) 398-7710" ' DATE P FESUONAL LANDS OR i • LOT 33 C 284 09' °' r N O_ I O+ d 1 � O 115.2'± N 115-st 64. 99' 2 6S- �x LOT 32 35,713 + S.F. (0.82 +AC.) N N P O �O LOT 31 1 JOB # 94-039-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP 110 PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO-OPERATIVE SCALE : I" = 501 BANK REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS ,kk OFSs PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. y� JOHN 9�y STRUCTURE CONFORMS TO SETBACK REQUIREMENTS OF THE o�' Z. u, TOWN WHEN CONSTRUCTED. STRUCTURE DOES NOT LIE IN A JR. FLOOD HAZARD ZONE. o No.36859 ti DEMAREST-McLELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 WEST DENNIS, MA. 02670-0463 (508) 398-7710 DATE 4FE40NAL LAND SU YOR Parcel -/ Permit# �(drT Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) �s �� 1b1 Date Issued - / Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) �/c5 ��`�� Fee 6� Engineering Dept. (3rd floor) House# a,114E rq Planning Dept. (1st floor/School Admin. Bldg.) (� ST BE Definitive Plan Approved by Planning Board �,/ v 19 1 T LDANCE TOWN OF BARNS TABLBiNVIRONMENTALCODEAND Building Permit Application TOWN REGULATIONS Project Street Address Village S'�c— Irv_ AZc`UQ. Owner Address Telephone e5 D g- ZZ_3 9 q-10 b \ Permit Request First Floor��� square feet Second Floor IVA square feet Estimated Project Cost $ 7 �OCDO ,00 Zoning District Flood Plain Water Protection Lot Size ] ► ''� Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use ( '1�c,c_�v,:k \o-\- Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished 1/ I Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel _�\t,J _Cc)e.� Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached ©N\-Q- C ,�,s Barn None Sheds Other Builder Information Name Telephone Number Addresss License# C>-L,1,a20,7 �� • ` � v��S `M�- oaz)o Home Improvement Contractor# 13$0 Worker's Compensation#\C Sc° SSJ cfo0fS NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED LLOWING REASON(S) r FOR OFFICIAL USE ONLY PE MIT NO. DATE ISSUED ` /PARCEL NO. - t RESS VILLAGE t ' OWNER ' 4 . t DATE OF INSPECTION: FOUNDATION ?i'.� J FRAME r _ - • INSULATION -�� FIREPLACE V ELECTRICAL: ROUGH FINAL PLUMBING:^ ROU%" t!! FINAL GAS: RUI' Q FINAL FINAL BUILDING rn D_ TE CLOSED OUT iti �tA O SSOCIATIN PLA42 m s - ' A r i ` Y b LOT 33 _ C 284 09' C N G co C 115.2'± ti 115.3'+_ O 691r 64. 99' LOT 32 35,713 + S.F. (0.82 + AC.) LOT 31 OB 94-039-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION : ASES MAP 110 PAR 1-13 PERCIVAL DRIVE WEST BARNSTABLE REEF REALTY SCALE : 1" = 50' REFERENCE : LOT 32 PLAN BOOK 413 PAGE 99 OOF J" I HEREBY CERTIFY THAT THE STRUCTURE z Gn SHOWN ON THIS PLAN IS LOCATED ON THE DMAMST,'�i. GROUND AS SHOWN HEREON. v No.36859 Z9 Sul DEMAREST—McLELLAN ENGINEERING 24 SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 WEST DENNIS, MA. 02670-0463 (506) 398-7710 DATE PR SS O AL LANDS V YOR " ASSESSORS MAP ?fQ_ TEST HOLE LOGS NOTES: p PARCEL-1--13 .ccrr,Irn rDnu e1r In NCVD+ 1 f.varsrrcAL DATUM: ( !- y CURRENT ZONING:�_ ENGINEER: DOYLE ENGINEERING E.MUNICAPAL WATER KNOT AVAILABLE. Qe w� BUILDING INC.* RE WITNESS: *wnu.e u�W�cAN.RS. S.SCHEDULE 40-4'PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 9� ILDI BUILDING 5:,,�R�� DATE: •+fn-gc _ A ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 A:H-20 CB PERCOLATION RATE: 5 MIN/IN LOADING SPECIFICATIONS. 47 qW p FLOOD ZONE. C >7 n y A TH-1 61O TH-2 � S.PIPE PITCH-1C!PER FOOT(UNLESS AID L OTHERWISE). 6.FIRST P OF PIPE OUT OF D-BOY TO BE LAID LEVEL 6LEv 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE pPRSUL sLN SUBSOIL USE OF AGARBAGE DISPOSAL .. '! ` AM 6t16 B.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE a .9 FfNE- Ilms- STATE OF MASS.ENVIRONMENTAL CODE(TITLE FIVE)AND LOCAL Arralum�w 1 sAwn x SAND HEALTH REGULATIONS. LOCATION MAP ` GRAVEL 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR LOrPROPOSED �`` `+` COBS L �BBW TO CONSTRUCTION. 35,713±SF. �dLt 1D• ` 4 Grp AND rlNOR 10.PROPOSED SEPTIC SYSTEM END WELL LOCATION/S IN ACCORDANCE WITH (0$2±AC.) (rao ro LdrB AREA) SILT Nd SILT $E.3 MASTER PLAN ON FILE WITH BARNSTABLE HEALTH DBPT. `` 11.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. .2 UTILRT CLUSTER ISe' dis II! SILT a� i ` % NO CROO)IWITSB sxCGONTSRPD �. Of ` `` % \`� ` BIMCBBASINAT . + tLd7''°' SEPTIC SYSTEM DESIGN T6 PLOW EST/MATE: ` 74 A-BEDROOMS AT 11O-GAL/DAY/BEDROOM m A�GAL/DAY SISTING WBLL W (6LP TO PROPO.4ED ``yd l"B AREA) SEPTIC TANK: PROPOSED � ``• '� gqQ CAL/DAY•1.5 DAYS CAL 1 BaDRDou rs ' `� USE 1500 GALLON SEPTIC TANK WELtrxc 72 CAR LEACHING AREA: f0 ppRCB W r E By r CAR, I FLOWDIFFUSORS WITH!OF STONE ALL AROUND W / ' ® SuD it 'Tom' T UNDER (40's Ir s Z'DEEP) / w�dL T1Id�`60 PROPOSED DWELLING f SIDE AREA- 40+1212 s 2=208 SF(1H8)� 345 CAL/DAY 'i BOTTOM AREA 40 x 12-480 SP (71)-34f GAL/DAY TOTOTALCAPACITY-1fEL CAL/DAY 61 . s r' SEPTIC SYSTEM SECTION 2•PEAST0NS 4' OF HE -1 E'WA WdSHED STONN E w TOP OF FOUNDATION GAS BAFFLE AT OUTLET TEN dLW•OOB r� ` '� ``a - ` •E1 ELEV. 6T.6 ` ` `` ` - 6185 1500 CAL ELEV. D-BOY 6083 fD 58.43 ````ramie. _ ee BLfiY. SEPTIC TANK 6fA BLEV. �► .. ELEV. %` _ ,` TEE SfZBS: INLET:6'UP.TOT DOWN BLEV. 4 FLOWOIFFUSORS WITH C OF STONE OUTLET:6'UP,18'DOWN AROUND AND 10'UNDER • ,aT`` eE (�4L0t,s 12'x P DEEP) (H-PA) ` ` •m BRdAKOVIT CALC:(83-58)/45 0 ISO-1B `se `sR KEY: EXISTING CONTOUR: ——-- PROPOSED CONTOUR: . .... ..'''''' SITE AND SEWAGE PLAN EXISTING SPOT ELEVATION: 25.E PROPOSED SPOT ELEVATION:® —' LOCATION: TEST HOLE.+ T.7nT 2 ERCIVA DRIVE UTILITY POLE.� FENCEL/Nd: ' ' WL`CT RdRlJCTdR1,F.. EIA HYDRANT:<S RETAINING FALL PREPARED FUR I . Dbf DCCc ACd1Ty ` DAWAX9S7-&faL9LLAN rNGINrsRINcFF SCALE: t-Air DATE. 3-2-95 EA SCHOOL ST&ZZr P.O.Box'so REFERENCE: PEA!✓BOOK 413 PACE 99 WEST DENx OIS.AfASSACHUS=S WO fHOMAS McLaLLAN.PS. JOHN Z.DBMAREST J2,P.6S. REVISED•B�REVISED:9-4-97 DM/ TOWN OF B RNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 110 001 013 GEOBASE ID 36848` AID ESS 159 PERCIVAD DRIVE ' PHONE I W BARNSTABLE •' z� Y.;: ZIP — LOT 32 BLOCK' LOT SIZE DBA DEVELOPMENT ' DISTRICT WB PERMIT 30100 DESCRIPTION SINGLE FAMILY DWELLING (PMT.st28429) PERMIT TYPE. BC00 TITLE CERTIFICATE OF OCCUPANCY 'CONTRACTORS-:— -.--- -- ----. ----. - -- ----- - -Department of_Health, Safety- ARCHITECTS: and Environmental Services TOTAL FEES: THE BOND $.00 CONSTRUCTION COSTS $.00' ` 756 CERTIFICATE OF OCCUPANCY '* BARNSPABLF, MAS& �039. ED MA'S BUILDIN \ VISIO BY .-- DATE ISSUED 04/10/1998 EXPIRATION DATE a �.' PERT.,- ni.&.rsl. fv iA.v uu1 01:3' GAOBAS6 ,ID 3664o ,ADDRESS 159 PERCIVAL DRIVE PHONE W BARNSTABLE ZIP ' 32 BLOCK r'~ LOT SIZE DEVELOPMENT DISTRICT WB IT TYPE VILD TEITLEIPTIt?N 3EW'XRES'IDESTORA UWTACH 1 0AI2/FARMBK FACTORS: BOY, BVBRgTT W. JR. Department of Health, Safi ITECTS: and Environmental Service FEES: $403.00 $.00 Ok TRUCTION COSTS $130,000.00 101 SINGLE FAM HOME DETACHED 1 PRIVATN P '4_) ?F^' *i •ARNSTAMIM • MAS&����pp�Q 4, i63S1r•A� EoJ � i BUI � S1.DI BY� r..- - DATE ISSUED 10/20/1997 EXPIRATION DATE 'ERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.E CHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET( GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF TF :IT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. JIMUM OF FOUR CALL INSPECTIONS REQUIRED 3 ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND OUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE:. 'RIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. INAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTIO APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Z=Grwr �,��w l ey 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT r( fZ.� l.-tJ i l (b, I pA (4 ��(.L��L 2 8r�q BOARD OF HEALTH V� 'l IER: ( E LA SITE PLAN REVIEW APPROVAL c�� S�Rfgt-b' �Qc, d a /is t; -"RK c�Fn UNTIL PER IT WILL BECOME NULL AND VOID IF CON- IF_[NSPECTIONS INDICATED ON THIS '�� n72/� STARTED WITL" "'�RD CAN'F= " Z NGED,,EOR L` 4 3a 100 'T IS iec 'LE NPHC)".. N T! t:. I I ' t . % F I, Tile Coninuontivalth ( fassadliusett_s it' Departinent of Industrial Accidents _ -:1 0/I/ceollm�es118atloas • ; '� •;�' 6111111 itshinruon Street % Baston.Man. 02111 Workers' Compensation Insurance.Afridavit ARplicant ntot•mation lecntion- cin Anne# 1 am a homeowner performing all work:myself. 1 amA,sole proprietor and have no one work-in,-in any capacity am an employer providing workers' compensation for my employees working on this job. camann name `f��e� �c�w3 `--� addres . 'aLa o insurance en W\GL�•�-i�W A 1 SL, nolia# I am a sole proprietor,general contractor, or homeowner(circle one)and have hlred•the contractors listed below who ha•. the following workers' compensation polices: address: - city Rhone#• -s�--- nnticv# L .y�_ «--.,�:�.• - .:_ y r 4..•aa+�-n"'�•�"��"s'""�'c'r- -..,:, '7C�v��4T�°1?a�%""�T�.'_"'""t='"_�p'�_�.'�s__��- m v fin c• address- cif Rhone#� iIII.Mr,*1nee co, Roll[S'# ...�...- :Attach additidnal'sheet ifcie �+ d Failure to secure cos erase as required under Station'SA of MGL 152 an lad to the imposition of criminal ptmalties of a fine up to$1.500.00 andl ro unc •ears'imprisonment as Breit as civil penalties in the form of a STOP NVORK ORDER and aline of SI00.00 a day against me. 1 understand that' a copy of this statement may be forwarded to the O1ncc of investigations of the DIA for coverage verification. !do herettr seal d• i pants d penalties of peduq that the injonrtation pnvt7ded above is true and comet Sienature ate Print name — UPhone# F13c se oniv do not write in this area to be completed by city or town official permiNitense iY nBuilding Department f wn: C3ticensing Board if immediate response is required QSeltatmea's Office �lfalth Department erson• phone tY; M01her_� -Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for tltcii employees.- As quoted from the "law", an empinvee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An emplitrer is defined as an individual, partnership,association. corporation or other ;,--gal entity, or any two or more the form, 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 lion or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter i•52 section 25 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 tite commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter h. been presented to the contracting authority. t:.... '-..e—.••.� «.•=^�'^�"' .r .}, yy +.,+i:.'.\:a+;rti• .lia'Y�y.. -O%._.�r.:!.:'s: .t :r,:;. .mot,•._ i. . r{l..1T• •�Yr�. .•ir. i I!•;' .i'w�!!:Qf,-,SV x A Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying-company names. address and phone numbers as all affidavits 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. 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. Plez be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be 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 question 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 fax#: (617) 727-7749 -. phone #: (617) 7274900 eat. 406, 409 or 375 /� V/LO VOJ17/7)LIY�UVEQU/L ��/vGCWQ /,((000(4 '}��E s' C 4•t OTI DEPARSNEBf Of PUBLIC SAYEPY � F COISTBM IOE SUPERVISOR LICENSE Ium6er Expirese � r �njRes_ 'e�ed���;r00 � • i h f K BOY JR 186 M DENNIS, M 02670 r c es n - • 1 f Application to �MS�Pt�S<<N'N4N 20 8 Old King's Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: HECK CATEGORIES THAT APPLY: 1. Exterior Building Constructi • New Building ❑ Addition Q Alteration Indicate type of buildin House ❑ Garage ❑ Commercial ❑ Other 2. -Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign 4. Structure: ❑ Fence ❑ Wall Repainting existing sign ❑ Flagpole Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE_ allS ADDRESS OF PROPOSED WORK , C�I.�G`" � ` ASSESSORS MAP NO. (—lo OWNER VA, ASSESSORS LOT NO. HOME ADDRESS TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name�of adjacent property owners across an street or way. (Attach additional sheet if necessary). Y public 0 e AGENT OR CONTRACTOR TEL. N — `JD lU o. •' 2 ADDRESS \ \ �. ��S Q ( O DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional s eet, if necessary). VI C—CA qz�,ILVn cL U_ C C—1;z- 1 i �r N' '; +.� Signe r Space below line for Committee use. ner-C t ctor•Agent %ceived,by hLD.C. T Date � �� R. . . 1 The Certificate is hereby Date y Ti I oil I G TCB.y ��.. LD YtP= g�H"j,IiVtgy . Approved ❑ IMPORTANT: If Certificate is approved ap proval is subject to the 10 day appeal period Disapproved provided in the Act. ❑ 0Town of Barnstable -�1 Old King's Highway Historic District i • SPEC -SHEET FOUNDATION puts--" SIDING TYPE CHIMNEY TYPE� -__;_C COLOR ROOF MATERIAL-�� � C��� ��Cl hr l a5 COLOR L.GLS. PITCH' `Zl WINDOW SIZE TRIM COLOR DOORS_ Q�- ���2�� lea COLOR C,O� SHUTTERS GUTTERS DECK_ GARAGE DOORS L-N�� (�� �\ COLOR W NOTES: Fill outs completely,p y, including measurements and materials/colors to be used. . Three copies of thia form are required for submittal of an application, ; along with three copies each of the plot plan,. landscape plan and elevation plans, when. but should Plot plan need not be "Certified", show all structures on the lot to \{ scale.. __ - . . -- TOWN OF BARNSTABLE OLD KING'S HIGHWAY HISTORIC CONEMTTEE LOCATION: Lot 32 House#159 Percival Drive Map 110 Parcel 1-13 OWNER: Stephen & Holly Kane c/o Horsefoot Holdings P.O. Box 186 West Dennis, MA 02670 ABUTTERS: M110 P1-14 David & Patricia Boulay P.O. Box 355 W. Barnstable, MA 02668 (Lot 33 # 149 Percival) M110 P 1-12 Thomas R. O'Hearn P.O. Box 1299 Forestdale, MA 02644 (Lot 31 # 163 Percival) M110 P1-27 Michael & Hollice Looney 5223 Fairgreene Way Ijamsville, MD 21754 (Lot 50 Percival) M110 P1-28 Michael & Hollice Looney 5223 Fairgreene Way Ijamsville, MD 21754 (Lot 51 Percival) . 1 . 9 \ 19S �J' r• -r �9 u ' 99, OMMIAa 69 \ \ Q8SOdO2fd 'WO 14 \ 09 77 r \ .✓ y ,y 411 19 99 CDII � \ — ` �i9 LOI.�-ems `�Vw`G.-�n.c� G \\ \ \ .m 89 < \ \ 69 14 , - . va P...tfv R � Movl Pi�V _ = ilSPM�tT ��SM rI s. ...�•� �• • - � o�' � ���+• " �a � W.C.G.��ol.fy. +�ni'n ® .. -AL i• I I_ .t � Gll � : I xq Fas*Cs)�`I/(/W S 13°s5c-IJK.4r FDxy I--�I .» I>_ a i JI—.I u I. ,.y ,r PIN1—a sm n _ WRcn NI Pam" 91-�Y�1-o�i�.f, vR. 1 I I . 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J I I I l;ILGo'� _ P4r1'T SASH crr) I O ui _ g" cor•Ic.FL_R. lV I 4tCo+c.yo¢,per.orcr- I --7 p,rad-ro peantl- ---- 1 ----1------ I It od'�r48'xlz"cw+1-pa.(yN� - —O Cn- 1-9 1 --4 � N I 1 �y ,LI 11 r r- 1 f— 1 L... ( --1 r 1 I IT— I tit I -IL-o I_ 11 GI 1 L,I OII O pR�� c 4" sn.way over(�raF� �C _doRoe•+pvt, 417�•�o vt"5ti.eats L 1 Iry I—s•.s.��r eororKi�nyy e.t pFnK. Y P'1`YK N0.o . , . ---'— --..--- _....-' "-----_- Tn oul-41C¢ EtX�E op paN. So*+Fa�T Ifr 1 IS cc"Cex.V_e17 6`(EKrmluo(t 1•I.ta-ems, fot1NDATtON PLAN F�F 46'-0 x It,etm.ca1m41A&- 1 o .. • D.T. ..m 8tu�7 / N ASSESSORS MAP. 110 . PARCEL 1-13 TEST HOLE LOGS NOTES. 1. VERTICAL DATUM. ASSUMED FROM QUAD GVD +�—) CURRENT ZONING: RF ENGINEER: DOYLE ENGINEERING 2. MUNICAPAL (PATER IS NOT AVAILABLE. BUILDING SETBACKS: WITNESS: THOMAS McKEAN, R.S. 3. SCHEDULE 40 — 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. xfc F:30 S: 151 R: 15' DATE: 11-18-86 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 & H-20 PERCOLATION RATE: 5 MIN/IN LOADING SPECIFICATIONS. q FLOOD ZONE: C 5. PIPE PITCH = 114" PER FOOT ,(UNLESS NOTED OTHERWISE). EXISTING 75 76 77, E ' TH-1 63.0 TH-2 61.5 6. FIRST 2' OF PIPE OUT OF D—BOX TO BE LAID LEVEL. 74 ELEv ELEV 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE HELL �y ` ` ` ` c� �j TOP & TOP & LOCUS +73 `� ¢�, � SUBSOIL SUBSOIL USE OF A GARBAGE DISPOSAL. 72 `� ` �\ �.,, 'rf� 48' Ss.o ss' S85 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE 06 LOCATION MAP ` ``\ \ ` \ `\ ` '�► �'� FINE—tr t y�D y STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL 71 • SAKD WITH HEALTH REGULATIONS. ` ♦ ♦ WITH LOT 32 PROPOSED GRAVEL GRAVEL 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR � � � � 'd ` 35,713 f S.F. HELL 70, '� AND COBBLES COBBLES TO CONSTRUCTION. (0.82 ± AC.) (f8O' TO LEACH AREA) 77. 4 rG AND MINOR ` 10. PROPOSED SEPTIC SYSTEM AND WELL LOCATION IS IN ACCORDANCE WITH � ♦ � MINOR 1f0" SILT S23 MASTER PLAN ON FILE WITH BARNSTABLE HEALTH DEPT. \ X I SILT 11. D—BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. 69` ♦` \♦ \♦ `\ `♦ 77. 2 UTILI?7 CLUSTER 138" 5f5 144" 49B - \ ♦ ♦ ) /( \ ♦ ♦ poi _ \ ♦ ♦68 � �C/ � ♦ ♦ \ NO GROUNDWATER ENCOUNTERED ♦ ♦ ` ` ♦ ♦ ♦ BENCHMARK AT I ♦ ♦ ♦ ` CATCH BASIN ♦ , ELEV. _ 76.766 SEP, TIC SYSTEM DESIGN 76 65 �( 1 64 ` . ` `\ • \6 ` \ \ 75 FLOW ESTIMATE: 74 4 BEDROOMS AT 110 GAL/DAY/BEDROOM = 440 GAL/DAY ` ` ♦ ` ` ` EXISTING WELL 62 ., \ ♦ ♦ ` \ (15P TO PROPOSED • ` \ ♦' ♦ ` ♦ ♦ ` 73 LEACH AREA) SEPTIC TANK: ` ♦ •. ` ♦ ♦ ` * PROPOSED _ sf 1 t ♦ ♦ \ ` ♦ \ ♦ 4 -0 GAL/DAY 1.5 DAYS = 660 GAL 4 BEDROOM 26. r ♦ \ ♦ ♦ 72 USE 1500 GALLON SEPTIC TANK 24' DWELLING so ems, t ♦ ` ♦ \ t • ► ` ` ` ♦ LEACHING AREA: GAR. i ` r ;', r ♦ 14' PORCH 6' TH-f GAR. t \ 71 PROPOSIrD ' t ' USE 4 FLOWDIFFUSORS WITH 4 OF STONE ALL AROUND s4' � 4 BEDROOM 59 lop DtBLUNG t t 2ss r \ AND 1' UNDER (40' x 12' x Z' DEEP) t r TOP FND.-65.0 t t : t 70 PROPOSED DWELLING """'� t ; ss 1 SIDE AREA:(40 + 12)2 x 2 = 208 SF(1.66) = 345 GAL/DAY 58 t t t 64 �� r BOTTOM AREA. 40 x 12 = 480 SF (.71) = 341 GAL/DAY (20'MIN) r ► 1� `� _ _ TOTAL CAPACITY =686 GAL/DAY - 57 t i t\ `\ \\ S T i SEI TIC SYSTEM SECTION 2" PEASTONE 56 t i 69 4' OF 3/4" — 1 1/2" COVERS WITHIN 12" 55 \ \ \ ♦ \ \ \ \ �t .• `•: i c \ t 66.0 � clq OF FINISHED GRADE WASHED STONE ♦ \ \\� `� �1 `� �� �, � �� �� �,� , '•.• t, _ _ _ � `\ �` TOP OF.FOUNDATION CAS BAFFLE AT 55 \ 1` ,t t \ \ ♦ ♦ \ 68 / OUTLET TEE 62.0 62.0 � � � \ ♦ � . � . ` , � s7 ELEV. 61.4 m t` `\ ♦ ♦\ ` ` ` - _ _ F 61.65 �snn r ► ELEV. D—BOX 10' \ ♦ ` \ ` TH-2 i 66 1 w w w L, 1 , o�w o 3 mL., 58.43 ss ♦ ♦ ♦ ` ` ELEV. SEPTIC TANK 61.0 ELEV. E449 4� ELEV. N. ss ELEV. 40' \ - TEE SIZES: 60.43 ,ss s4 INLET: 6" UP, 10" DOWN ELEV. 4 FLOWDIFFUSORS WITH 4 OF STONE '57 ` ` 62 OUTLET: 6" UP, 19 DOWN ALL AROUND AND 1.)0' UNDER 61 BREAKOUT CALCE(63 ( 58)%45 x 150 = 16' \ 60 58 59 KEY: EXISTING CONTOUR: PROPOSED CONTOUR: .............................. SITE AND SEWAGE PLAN EXISTING SPOT ELEVATION: 25.5 PROPOSED SPOT ELEVATION: 25 TEST HOLE: ? LOCATION. UTILITY POLE: -O- ��°fs ,�N°F"'a�s� LOT 32 PERCIV AL DRIVE FENCE LINE: ' HYDRANT: MtEUMs . sr,. . WEST BARNST ABLE. MA CtVtL .. �_ RETAINING WALL: o 3f'71 l ` �c ``• �°� PREPARED FOR- REEF REALTY DEMAREST-McLELLAN ENGINEERING ��j�'�}1 J1`1 SCALE: 1" = 30' DATE: 3-2-95 24 SCHOOL STREET P.O. BOX 463 WEST DENNIS, MASSACHUSETTS 02670 REFERENCE: PLAN BOOK 413 PAGE 99 )M # $4—M-32 (039L32) THOMAS McLELLAN, P.E. JOHN Z. DEMAREST JR., P.L.S. REVISED: 8-25-97 REVISED: 9-4-97 i