HomeMy WebLinkAbout0160 PERCIVAL DRIVE i
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of r Town of Barnstable 35
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T� Expires 6 months from issue date
Regulatory Services Feed
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• BARNSTABLE.
v� MASS.039. Richard V.Scali,Interim Director
♦0
�f0 MAr A
Building Division G
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number
-1 h ,�^ t /�Not Valid without Red X-Press imprint
F! �V 1. o
Property Address
residential Value of Work$ � Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 21 y
Contractor's Nam 7jh, 609,q—,
' Telephone Number 4��2
Home Improvement Contractor License#(if applicable)J 9�v O k,. Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance ��� � �� ��
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner FEB 112015
❑ I have Worker's Compensation Insurance
Insurance Company Name TOWN OF BARNSTABLE
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box) 2
Re-roof(hurricane nailed)(stripping old Vingles) All construction debris will be taken to
❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
copy of the Homer1rve>I ense&Construction Supervisors License is
r ui
SIGNATURE:
I AKEVIN_D\Building Changes\EXPRESS PERMIT�EXPRESS.doc
Revised 061313
The Commonwealth ofMassachusetts
Deparbnent of IndiistridAccidents
Office of Invesfigations
kv 600 Washington Street
Boston,MA 02111
www mass govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aolalicant Inf6rmation Please Print Legibly
Name(Business/Organization/Individual): Z—o it.,,of r
Address:
City/State/Zip:
' le hone#• O� �p
Are you an employer?Check the appropria*� ;
1.❑ I am a employer with 4. lam a general contractor and I Type of project(required):
employees(full and/or part-time).* ave hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.i 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11'. Plumb'
myself ❑ �repair's or additions
y [No workers comp. right of exemption per MGL 12 Roof insurance required.]t c. 152,§1(4),and we have no repairs
employees.[No workers' 3.❑Other
*Any applicant that checks box#I
comp.insurance required.] .
must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
eContractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have
employees If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: `Cr✓ l��yl f' 6vG e 6>�
Policy#or Self-ins.Lic.#:_ Expiration Date:
Job Site Address: City/StateJZ' lip
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).Failure to secure cA*--
overage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage v cation.
I do hereby certi aims oL A e informadon provided 7veisa coned
Si afore: Date: ��
Phone#: O ��
Official use only. Do not write in this area,to be conrleted by city or town offwial
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person- Phone#:
Sep 21 12 11:16a Bob
2012-09-18 14: 8 5089955798 p.2
5089955798 P 212
2We ComrnotsweaJth ofMassacr usdts
Deparhne►st of Xndustrid Accidents
Office ofAveseigations
600 Washington Street
Bvston,MA 02111
Wwx;mamgov/din
Work rs' Compeloi R001k InsuiranCe Affidavit:BuilderslContractors/E1ect�ricia�ns/piumbers
A GIG Informatlion
Please Print L b
Name,(Bu Ms 0rg=ationft&vwal): ,4 L! yc
Address: L' d u i— 67-
.
City/StatI. ,loym
A p�171/SPhoncX. 5�- 9�9g.0
Are you aulayer. Check the appropriaeL❑ Iartsa with_ 4. 4Vageneral contractor and I -Type of pi-oject(required):.
lcfn'land�orpaR-time).' have hired ttie sub cotl�actors 6• O New construction .
Z• I am a's Ie t?ropIIetor or partner- listed oa the•attached sheet 7_ Rawdeliog
Ship amd have no employees These sub-contr cbm have
worldJ08 for ME iu.any capacity. employees and have worlm, 8• �Deneolition
[NOwo s comp.ms•,aance cow.instuaace?• 9. 0 Building addition
rcq. 1 5. We ar,a t otpomtion ztnd its 10.0-Electrical crpain or additions
3. 1 am a meowaer doing all work officers have exexeased their
mYse� o workers'co r 1I.[�Pbutn ' repairs orstddii:ioas
comp. fight oEcxeon per 1rtGL -
uss required.]t c.152,§I(4),and we hsNe no 1 oof repass
employces,[No workers' 13.❑Other
- - comp.oosuraace regiuredJ .
by applicant tlta clzeela ben Al amtt ako fill ant the aeetiea below showing tTt<jr workers'wtnpaisatiat polity iflfattration.
I.
t Fiorrteowners rovh submit this sawavit'
Acftmaetor.drat ch this Sox rmeri a "are doing all work and then Aire outside contractors tnttst Subntit a new of 4aw tistdicatcig ate3.
arVloyeea. Xf dte b.�„ a°° � �.ft�t ft aamo orthe sub caruractom sue staff whuhv or trot those entities have
� �a P1 1,theymostPmide1heir wemkM)comp,policy number.
Iam as cm fo
ia�ormakoa y Cr tYtai isproviWAr WOrtilJS'eompeRsahbR inset mce for Ply emptoyeer12 Betew is rlke polley sad jnb sire
Insurance Co any Naute: L!L t
Policy#or Self ins. Lic.#:
Expiration Date:
Job Site Addre. :
_ City/State(Tp: qpf
Attack a copy 0the workers'comgen8ation polia7 declaration a c' shows itte
shore to recur cov p g ( icy Aatnber and expiration date).
as regaired under Section MA ofMCjL c. 152 can kad to the unposhim of eritniyal pet s of a
fine up tb$1,5 .00 ax&oj o�.yea imprisonment,as well as civil pedaloes;ot rite form of a STOP WORD ORDER and a a
of up to MOM a day against the violator. Be advised t6iat a
Isvesti a ons the MIA fox instuance covers a veriflcatiaz SAY of this statesnasit may be Ibrw+arded to the Office of
I do lsereby d rMe and pmailiks of perjwy th at the enforma*n provided above is trw cad corr+et
S' start:
Date: -
P6ane
fecigl use o ba tmt write fn thid area.ro be eompleled by till►or toNm.oj/rtxal
City or Tovcoo PerWVLiceuse#
issaiag Ateth sty(circle one):
J.Board of H a!t!x 2.Building Department 3.CRY/Town Clerk •4.EletxricA>� � p�
6.Other peetor 5.1?ltuaxbi IM or
Contact Pers a:
phone#:
I •
y� r%�rr,�i���rrairtrrn�(�r/nl/rlinr�nlr//j
�-trR,
ffice of Consumer Affairs&Business RegulationLicense or registration valid for iadividul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
gistration: 148688 Type: Office of Consumer Affairs and Business Regulation
Expiration: 10/18/2015 10 Park Plaza-Suite 5170
LOWE'S HOMES CENTERS INC Supplement".ard Boston,MA 02116
ROBERT ABBOTT
136 TURNPIKE RD.SUITE 100
SOUTHBOROUGH,MA 01772
Undersecretary Not vali w2outsigna!tur0e _-__
it
i
i
i
F
Massachusetts -Department of Public Safety
Board of Buildin .Re ulatio. g g ns and Standards
Con%tructiun Supercixnr
License:-CS-094688
r,
ROBERT W CHAJ&
110 CONDUIT S'C• =
ML
NEW BEDFORDIWA 02.14fy
E7 d..• " "� ` Expiration
i
Commissioner 1013112015
tea, /- rriJ/ir�Ir:r•/�'
OtYice of Consumer Affairs&Business Regulation License or registration valid for individui use only
f� E IMPROVEMENT CONTRACTOR before the expiration date, litound return to:
_ 9istration: 184094
d ;* Expiration• g/31/3p15 DeA Type: Office of Consumer Affairs and Business Regulation
• 10 Park Piara-Suite 5170
A-LINE HOME IMPROVEMENTS Boston,MA 02116
ROBERT CHASE
110 CONDtJIY ST ' V
NEWBEDFORD, �--MA 02745
Undersecretary
Not valid without signature^
i
Lowes-2376-instatis Office
2424 Cranberry Hwy.Suite 100
Wareham,Ma 02571
r
l� �hov? ,f 1,4
UVI
How-"-, -Tm pro V-e--MeA
C on 4-Ya_.Uj 0 v Z..4(,v-CS e
r
a s
9�RUWgrABM
` ,0� Town of Barnstable
. 'O�En Mop°i
Regulatory Services
Richard V.Scali,Interim Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
tY
ProP er Owner Must
Complete and Sign This Section
If Using A Builder
rr
I, ca k P" , as Owner of the subject property
hereby authorize -r 6 to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
�igAature of Owr/er Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
T:\KEVIN_D\Building Changes\EXPRESS PERMIT\EXPRESS.doc
Revised 061313
-
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LOT 51
o�
IX/
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ti
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�x
00
. M LOT 49
LOT 50
35,004 + S.F.
(0.80 ± AC.)
NX
9 s�.
JOB # 97-052
CERTIFIED PLOT PLAN PREPARED FOR
LOCATION : ASES MAP 110 PAR 1-27
PERCIVAL DRIVE WEST BARNSTABLE REEF REALTY.
SCALE : I" = 50'
REFERENCE : LOT 50 PLAN BOOK 413 PAGE 99 �`�JOHNAss9�ti
o Z. N
I HEREBY CERTIFY THAT THE-STRUCTURE 0EMAREST,JR. rs�
SHOWN ON THIS PLAN IS LOCATED ON THE o N0.36859
GROUND AS SHOWN HEREON. v
DEMAREST-McLELLAN ENGINEERING
24 SCHOOL STREET P.O. BOX 463 JULY 22, 1997
WEST DENNIS, MA. 02670-0463
(508) 398-7710 DATE P OFE IONAL.LAN AS RVEYOR
j ASSESSORS MAP, no TH—s ate, TEST HOLE LOCS NOTES:
-; �• /I- PARCEL: 1-27_ N aLLv
20 TI s NOS LOdlf 1.VERTICAL DATUM: ASSUdIED PROH QUAD(NCVD+/-)
J CURRENT ZONING: RF to tm'R�/d a/b ENGINEER:PETER BRYANTON 2.NUNICAPAL WATER IS NOT AVAILABLE.
BUILDING SETBACKS: D HORI N WITNESS: GERRY DUNNING 8 SCHEDULE 40-4 PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM.
LOAMY$�9 SAND
hi4Q_S. w R:i sr R7rR J/b DATE: 4-16-97 4.ALL PRECAST UNITS TO CONFORM WITH AASXTO H-10
dT
Re ClNORlgiON PERCOLATION RATE: <5 MIN/IN LOADING SPECIFICATIONS.
3 FLOOD ZONE:�— gW IOra s �D Sob TH-1 _ TH-Z S.PIPE PITCH- 1/9'A'1/4' PER FOOT,(UNLESS NOTED OTHERWISE).
B.FIRST P OF PIPE OUT OF D-BOX TO BB'SET LEVEL
0� MEDIUM SAND A HORIZON aar A HORIZON l" 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE
Al- LOR/B as \ IDYR 6/4 SANDY AY WW W USE OF A GARBAGE DISPOSAL
.per 1ffi 783 12 WTR 411
8T6 7 !A I J
` a ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE
e HORIZON S HORIZON
LOCATION MAP ` LOAMY AND IDAOY AND STATE OF MASS.ENVIRONMENTAL CODE(TITLE FIVE)AND LOCAL
'O l .Sp Tara a�e ggb HEALTH REGULATIONS
LOT .
3 `` of B: at a HORIZON HORIZON 9.CONTRACMR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR
SSO04 t. n S-F. �4 .,` 1 �a LOAMY SAND IDAMY SAND To CONSTRUCTION.
(OBO f AC.) Sj Q ` fOi? Mrs 5/3 azz aW WYR b/d 0 93 CZ HORIZON Cl HORIZON f0.GROUND COVER OVER ALft SEPTIC SYSTEM COMPONENTS NOT TO
MZD-MARSE SAND MED-COARSS SAND EXCEED SD'. Imo•
fora 6/6 FOYR 0/8 ff.PROPOSED WELL AND SE !C SYSTEM LOCATIONS ARE IN ACCORDANCE
y ar fa 7Rd Ise 1 1TSZ WITH MASTER PLAN ON RECORD AT THE TOWN OF BARNSTABLE HEALTH
PROPOSED WELL DEPARTMENT.
as r'f ` f� , NO CROUNDWArZR ENCOUNTERED
O1'lLDT � SEPTIC SYSTEM DESIGN
, 1 ,b• �
ClU9TER I 9 I r'' ` `` ` EJ
84 TA-0� _ .,:Sag•`` �� `�DE PLOW ESTIMATE:
�•'- ad ; t' r I ��rA�`, J-BEDROOMS AT IIQ_GAL/DAY/BEDROOM-A9.m SAL/DAY
I I I r R1
SEPTIC TANK: rU DECK
f f Oo AYSILGAL/DAY z 2 DAYS s BBO CAL
-
1 USE fSQQ-CALLON SEPTIC TANK ° 9 Ba WND /P .
` 98 f/ `- zo DWELUNC fe
`` , .` ` as LEACHING AREA: W fe
USE 3 INFILTRATORS(MAXIMIZER CHAMBERS) u
�. ` ` •0e� ` ee WITH B OF STONE ALL AROUND (30'z 1r z Z DEEP)
PROPOSED DWELLING
A
SIDE AREA:(30+1f)2 s Y 164 SF(?4)=121 CAL/DAY
e w y0 BOTTOM AREA: 30'z n m 330 SF (.74)=244 CAL/DAY
�` CAPACITY=365 CAL/DAY
�, ___ 4 SEPTIC SYSTEM SECTION
�G . ` yp, 6y Zr PEASTONE
LOVERS,WITHIN IY OF
85
88.5 Of ar INSP6ICT/ON COrRR $/�-1 1/P^
TOP OF FOUNDATION war
►ITAIN d-or GRADE) WASHED STONE
IT
78.9 r/o'.PEq P► ELEV-B49
L=L 1 PEq
�``�� ____ -� PRO➢OSED TELL BdBf _� /-'R ff
Tor a ELEV. .
7B.B >r`` 85.1E 7500 CAL D-BOX B4.41 H �� BELEV.
ELEV. SEPTIC TANK 8458 W OF ELEV. 4'
(G OF STONE UNDER OR ELEV. STONE 317—'�
RaxeaMARa Ar _ ELEV. MECHANICALLY COMPACTED) UNDER) 3 INFILTRATORS(MAXIMIZER CHAMBERS)
CONCBOUND 6e•` `B1 TEE SIZES: 8438 WITH d'OF STONE ALL AROUND
_• SLOT,790 INLET:6'UP.13•DOWN LET T9Z ELEV. (30's fT z E DEEP)
i 78.0 OUTLET:8-UP,14-DOWN ,
KEY:
0.f SITE AND SEWAGE PLAN
APPROVED BY: DATE:
' EXISTING coNTODR: ———— UTILITY CLUSTER •
PROPOSED CONTOUR: ........... LOCATrUN.
EXISTING SPOT ELEVATION: 2ss LOT 50 PERCI VAL DRIVE
PROPOSED SPOT ELEVATION:25
TEST HOLE:* WF:.C'I' RA RN.STAR E MA.
UTILITY POLE:-0- PREPARED B71R
FENCE LINE:
HYDRANT.b REEF RFA LI TY
RETAINING WALL:
TREE. DEMARE"T M.LZLLAN ENGINEERING SCALE: ry 90' DATE 5-9-97
1` L/ dA SCA001 STREET➢O.BOX AB9
i
DM; D10F91) WEST DENNIS.MASSACHUSB"S OEWVO THOLAS MGLELLAN,PA:. lOHN Z.DEMAREST JR.P.L.S.
PLAN RAUK tf9 PACE Rp
., 1
r____�� .
' �+ � � �
� 5�
s �� �
4
�.G�
I G� ✓'
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y
11�� ool o2-7 .:6
Parcel 7. Permit# "7F5 3
Conservation Office(4th floor)(8:30-9:30/1:00- 2:00) ��� Date Issued & -
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) q 7 30/ e��66 Fee 7"3T-
Engineering Dept. (3rd floor) House# 1 (0 ej)
ts
�-Lot-SO ve C'css�e &' 3 3 ?jt
Planning Dept.(1st floor/School Admin. Bldg.)
• BARNSTABLE•
Definitive Plan Approved by Planning Board 3 v 19 F� e 9. peg
ED MAy A
TOWN OF BARNSTABLE SEPTIC sys EM MUST BE
INSTALLED IN COMPLIANCE
Building Permit Application WITH'I"M S
Project Street Address ��c_: �� 1 r' C t�i DSO ENVIRONMENTAL CODE AND
TOWN REGULATIONS
Village
�G..�c--�.S
Owner ��c �� C� '� F1 ce v��Q� A ress -VI-elk w4" )A-,CIXIV\:S
Telephone ' aeool
_ I
Permit Request
ca- ('w
First Floor square feet
Second Floor square feet —/02 X
Estimated Project Cost $ N' ' C , pop. zip
Zoning District Flood Plain C--1 Water Protection
Lot Size �j�j, QO�{ S '--vV Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use �GC.rxu� \p Proposed Use
Construction Type �c, a_
Commercial Residential
Dwelling Type: Single Family vl/ Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway QJ�-3 1
r Number of Baths No. of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Oc)cLS \—\\L3 Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached �� Barn
None Sheds
Other
�o Builder Information
Name� Telephone Number �tU �U
Address O \rgLn License# d O�
Home Improvement Contractor# 6 01 I g0
Worker's Compensation# QC(-9c..cat( ?;?(0SJc 4V-
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 /I DATE
BUILDING MIT DENIED F4RLLOWING REASON(S)
I
FOR OFFICIAL USE ONLY
PERMIT NO. 2- 3 -7
DATE ISSUED
M /PARCEL NO.
RESS VILLAGE .
OWNER
.. a ._
DATE OF INSPECTION: , r
FOUNDATIONEx
r ,
FRAME, — r
INSULATION — `
FIREPLACE O
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL -
.: ray a ti • ,.
GAS: ROUGH N ' ,_ FINAL i
FINAL BUILDING nleZE
m '
IM- a f {
DATE CLOSED OUT 1
Ir t
ASSOCIATION PLAN NO. N :3 on '
m
r , f
------- - - --- _ -- - ----
- TOWN OF BARNSTABLE
CERTIFICATE OF OCCUPANCY
iPARCEL ID 110 001 027 GEOBASE ID 36862
' ADDRESS 16 PERCIVAL DRIVE 'PHONE. (508)
'W BARNSTABLE ZIP 02668- I
( LOT 50 BLOCK LOT SIZE
( DBA DEVELOPMENT DISTRICT. WB
I
PERMIT �' 26198 DESCRIPTION SINGLE FAMILY DWELLING (PMT-#23783)
PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS: Department.of Health, Safety
I ARCHITECTS: and Environmental Services
TOTAL FEES: j
BOND $.00 Ox
( CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY
* BARN3r'ABLFti ** i
MA83.
OWNER FRANCIS, STEVEN & KAREN s639. A�
ADDRESS ED IN/►� l
160 PERCIVAL DRIVE BUILDIV,I•�ON
WEST. BARNSTABLE, MA BY.
DATE ISSUED 10/08/.1997 EXPIRATION DATE
1]_0 001 027 GEOBASE ID 36862z
.I R,ESS 1_(y0 .pERCIVAL DRIVE ;.+�� ` ,rv� • PHONE
W. Barnstable ZIP
hl� BLOCK . `. •• ''LU' 'SIZE
PAT " ..
yg. DEVELOPMENT r DISTRICT WB
"'MIT 23188 DESCRIPTION NEW SINGLE F ILY RESIDENCE 63
°I*,.M1T 'rYi?F BUILD TITLE NEW RESIDENT AL BLDG :PMT
!'RAGTOR BOY , EVER. '.' �a. JR. Department of Health, S
► ' ITECZ'S and Environmental Servic
.� .
FEES. $434.00
$.00 r
TRUCT ION COSTS $1.40,000-00 - � Qi► �+�r
101 SI14GLE FAM HOME DETACHED ': 1. • :PRIVATE P : BARN3PA8
LE, w
163
ER FRP:NCIS, STEVEN&KAAHN-
r . . ;:�: Ep Mlr►I� .
181 WHITEHALL WAY{YANNI BUILD ' DIVIS N
:g'y '
`.
LATE ISSUEI' 06/16J1957... -,EXPIRATI6N .DATE
IS PER N GHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMAN
CMIT
ACH EAT ON BLI ROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.S
LEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUAN
DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
INIMUM OF FOUR CALL INSPECTIONS REQUIRED
OR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SE
FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS. ARE REQUIRE t
' 1 $2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE L OT BE ELECTRICAL,PLUMBING AN M
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
.. r�.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN.MADE.
•! 1.4.FINAL INSPECTION BEFORE OCCUPANCY.
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPR
i SY I F P'C S set/W e4 7� �• �•V- aP, i
r ' ��s- .ems
1 HRATINO INSPECTION APPROVALS• ENGINEERING DEPARTMENT °t
Y � �` p -t BOARD O HE TH
SITE PLAN REVIEW VAL
L HER: 3 F F . .
03
WOR HALL. QT eJaOCEED UNTIL. PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED 0 1 i!I
•s ' •STRUCT STA LN SIX_ 6AN BE. CF6iR
4IIONTH$f PERMI EC"AS- EPI�ONE ''
_ f NOTED _ _ N;
• :4•)
EID
PPRSV pBI-E -
WN OF BA®NT W�R�NG
a TKO-G,pS G =BVILD�NG' i
•� p�UMB�N
1
J�= The Town of Barnstable
URNSTABLL Department of Health Safety and Environmental Services
e
Building Division
367 Main Street,Hyannis,MA U2601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
i
Inspection Correction Notice
Type of Inspection
.t r�
Location - ,� r., � Permit Number
�3
Owner B-ilder t'
One notice to remain on jobsite, �`ne notice on f' a in Building Department.
The following,items need correcting
r ,
t; \
lce:�'
Please call: 508-790-6227 for re-inspection. a;
Inspected by
Date
-.�r rr....� .. ---'+`• _ l^• -.�* F .,,;..' _.;� ;. . -. '+'. j '•.-r-''' ---� e.,,t.. J' ..ti:*�r' ,�,•�. Y7..,,r.... w.
`oF,►aE'° The Town of Barnstable
o�
BARNSTABLE. • Department of Health Safety and Environmental Services _
MASS.
i
��Eo► •'0� Building Division
367 Main Street,Hyannis,MA 02601
X
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
I
Type of Inspection Prl
Location �C d 1'0�r w Y-{__ Permit Number �3
Owner Builder ��-�—
One notice to remain on jobsite, one notice on file in Building Department.
The following items need correcting:
r �p 1 f/� —
/F4-�� e
Y
A
IC'&
Please call: '508-790-6227 for re-inspection.
Inspected bye- � ,lY�-�.
Date (6Y-4 - 4 7-- -
,y s A ,
r
• '+'''� Tile Conintoll"'callli ( Atassadiuscttt
_ r,;E Department of Industrial Accidents
_ -=1 E Olnceo/lm��lgalloas '
7 _ ; ;• i';a' 600 ff"h ngton Sired
�f; ;s+• Binion.Mass. 02111
Workers' Compensation Insurance.ARdavit
ARQlicant nformation - Pleas'e IsRi1VT le I�LY �� --
Inantion-
city Anne>Y
Cl I am a homeowner performing all work myself.
(IC3 I am a sole proprietor and have no one working in any capacity
❑T 1 am an employer providing workers' compensation for my employees working on this lob.
comma name
Lim r) phone fi-
ct policy# Ott C,o7
❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who ha-
the following workers' compensation polices:
address: ,..
cih nhone#! ---
-�;;---- •' antler# . • .•. ...
L,"�"•:= ..---�::-•- -- :.. .sn•r •c:..•as+�"n-.'�'�-'.=�"te'r'�n';�'r_.= - �vF�a�eSi4°1��%?"•.1�'S��,"�r..,!"''�•_
cominav e•
address:
city: nhone#r ---
insstsance co ttelier# - _
Atiach additional•sheet if gee 7;7, : � '�-- t"'•'rr'"-rf►'— -.�... :r. r ,;,,�,
nou' re to secure coverage as required under Section SA of 51GL 152 can lad to the imposition of criminal penalties of a fine up to S1.500.00 and/at
one years'imprisonment as well as civil penalties in the form of a STOP NvORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the ORice of investigations of the D1A for coverage veriBndon.
l do hereby certij• ndcr t alas and allies ojpedurp that the information pnvrided above is true and corraz
Signatureate /e7,e-2
Print name phone# V �V-, 0 9c)
official use only do not•write in this area to be completed by city or town olQcial
permitilicense d rnBuilding Department
city or town: C3Llcensing Board
check if immediate response is required Cseleetmea's Once
1311aith Department
contact person:
phone#; nOther�_
-Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
emplo-.ces: As quoted from the "law",an empinr�ce is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An emp1(►rcr is defined as an individual. partnership,association. corporation or other :--gal entity, or any two or more
the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the
recciver 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 hou
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 1'52 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 commonn-calth 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
evidence of compliance with the insurance requirements of this chapter liz
performance of public work until acceptable
been presented to the contracting authority.
.�—w�...�.—.....+rw i.ra. tl i ': y..w 1_. a♦ I";1 .. D�•l:�w:tM:r�i���� 7��'.:r; L' :r 1.— .L .-
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.
.�►Rgw.u•.a•.•ew�RJ�� ..`,�::�'r' rye:�....:i�.i+:j.�Y.li....._�y K•y-�..yam+�'+ ,)l�f`.�'ir-..•�RuRS''\iRj�il., ,,�.. .. ..
'. .- '.di/':' ..... •. ..�. !Y' ;• :A.�..:L•':'r„::�::hr.. _. (Iv.:. .W1.. •T i'Qj� n.P•
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. Plea
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 lnvestications 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.
_ M� �_� :..�.. .r...« i.....« .••i�•a...yi..r• f .�.^,. :t•-vr.."
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 ext. 406, 409 or 375
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Application to
•'' Old Kings Highway Regional Historic =ITIMIttee
in the Town of Barnstable for a
ftq7 100
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, ld triplicate,.for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470.
Acts and Resolves of Massachusetts, 19.73, for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
CHECK CATEGORIES THAT APPLY:
1. Exterior Building Construction.: New Building ❑ .Addition Q Alteration
Indicate type of building: House arage ❑ Commercial ❑ Other
2 Exterior Painting:
3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign
4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements). "
TYPE OR+PRINT LEGIBLY DATE
ADDRESS OF PROPOSED WORK r - ASSESSORS MAP N0.
OWNER � - �n �r o`h ASSESSORS LOT NO.
HOME ADDRESS �ti �hh�S .� `WA O—Q-Q o l TEL. NO.
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary).
AGENT OR CONTRACTOR TEL. NO. '12q-3020
ADDRESS V a h Ua
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 n signs. Attach additional sheet, if necessary).
\
—�` �� sUo EY1
C�O� � moo ��ck °h
L � .c
Signed':�L
31 ( 64 r- yonamor-Agent I
Space below line for Comm se.
Received by H.D.C. "'
Ir{)
Date The tificate is hereby Date
Time
By
Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the'10 day appeal period
provided in the Act.
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-
: ,.. ..+.._... .,.�. _.. � ....._.>.<..,..a: � .,�........._.,..la'.... ...........o....eu�....iet..s...'sic.�.endris`,�lv�.uwn•::.y.c..:.a::..i::..a.:..•uu3.�-aliun.�w:�.::.:s;r...v a�es,.ltra¢K aUy:u�..vy�.:.�..:.:_:_._�...�.,..::.
_4
OTown of Barnstable
Old King's Highway Historic > ».
Q
SPEC SHEET
FOUNDATION Ou e�� CnhGe�yP
SIDING TYPE q 104)ZOLOR
CHIMNEY TYPE ��,; cL�, tUcLoA COLOR
ROOF MATERIAL �5��c�\� ��cuh��� COLOR
PITCH , 2 `Z �0
`l Iz c 0o e\1 co �,;�:
WINDOW V �21 Z SIZE Quay
TRIM COLOR
DOORS �p`� S \�p.1r�2 COLOR
SHUTTERS by COLOR
0
GUTTERS �� �;� G�\��(\ C_e\ iz,
DE
GARAGE DOORS aL\ � COLOR S a
SIGNS �fJ) COLORS
FENCE 44.91S111 COLOR
NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this
form are required for submittal of an application, along with three copies each of the plot plan,
landscape plan and elevation plans, when applicable. Plot plan need not be "Certified" except for
new homes, but should show all structures on the lot to scale.
SPECSHT
1
TOWN OF BARNSTABLE
OLD KING'S HIGHWAY HISTORIC COMMITTEE
LOCATION: Lot 50 House #160 Percival Drive West Barnstable
M110 P1-27
OWNER: Steven C. and karen A. Francis
181 Whitehall Way
Hyannis, MA 02601
ABUTTERS:
M110 P1-28 Michael Looney
5223 Fairgreene Way
Ijamsville, MD 21754
M110 P1-26 Joseph C. & Caroline Lacroix
13 Corey Drive
Yarmouthport, MA 02675
M110 P1-13 Horsefoot Holdings
24 School Street
West Dennis, MA 02670
M110 P1-12 Thomas O'Hearn
P.O. Box 1299
Forestdale,. MA 02644
M110 P1-14 David & Patricia Boulay
P.O. Box 355
W. Barnstable, MA 02668
Milo P 1-11 Randall & Jacqueline Hebditch
173 Percival Drive
West Barnstable, MA 02668
-\Coo
•;' x �C�;�� �o Low �s-�c�� a-
CnhS-�e�-��o
LOT 51
o�
' •xq,.,l'Y i�T-��a' i��n,. Oi �Y"YY��2�'a'L�'• °e
Z "Alm
r IN
yCVLOT 49
M.
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t. A��'3�"
�.�1z��54,(.•t. �� tw.d�-9•'y`���0 t 2tV'�t+.��0;'�`� i�g``
go�'<yyF'y�f�� N�•1.'4"u �.µtyT�kr. ,�4�` {�l"i`��'�k�''�.:x��,�}�L'��w..'.
• R-J
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at�'et i�•^4� F'x��rs� d,�'rlb� 3:�'•�t>•o3 5�r;✓ to
.... sp `
IN
6g
e0.
LOT 51
o�
z�y
�x
G�
LOT 49
CZ�' sago, fix.
LOT 50
35,004 + S.F.
(0.80 ±AC.)
6
JOB # 97-052
SKETCH PLAN PREPARED FOR
LOCATION : ASES MAP 110 PAR 1-27 REEF REALTY
PERCIVAL DRIVE WEST BARNSTABLE
SCALE : 1 = 50' �
L
REFERENCE : LOT 50 PLAN BOOK 413 PAGE 99 ''�'
NO►WM 4
DEMAREST—McLELLAN ENGINEERING
24 SCHOOL STREET P.O. BOX 463 MAY 8, 1997
WEST DENNIS, MA. 02670-0463
(508) 398-7710 DATE P FE NAL LAND SUR OR
ASSESSORS MAP: 110 TH-3 PARCEL: 1-27 N TEST HOLE LOGS NOTES:
88.3
A HORIZON ELEV
SANDY 1. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD +/
& `�T CURRENT ZONING: RF so' fOYR 4/2 875 ENGINEER: PETER BRYANTON
2. MUNICAPAL WATER IS NOT AVAILABLE.
BUILDING SETBACKS: B HORIZON WITNESS: GERRY DUNNING
LOAMY SAND 3. SCHEDULE 40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM.
8f k F: 30' S: 15' R: 15'
32 1oYR 518 DATE: 4-16-97
85B 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10
Cl HORIZON PERCOLATION RATE: < 5 MIN/IN LOADING SPECIFICATIONS.
FLOOD ZONE: C 96, lOY�j�D BOB TH-1 TH-2 5. PIPE PITCH = 1/8" & 11 4" PER FOOT, (UNLESS NOTED OTHERWISE).
- ' C2 HORIZON 90S 91.0 6. FIRST 2 OF PIPE OUT OF D-BOX TO BE SET LEVEL.
\0 MEDIUM SAND A HORIZON ELEV A HORIZON ELEV 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE
Locus B9 , ,1.,\ 1oYR 6/8 1rR 413 �" 89s 1r fo R 13 90D USE OF A GARBAGE DISPOSAL.
'tt \ 120" 783
B HORIZON B HORIZON B. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE
�
LOCATION MAP LOAMY SAND LOAMY SAND STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL
88 36" fOYR 5/8 f 8•s so- 10YR 5/8 88s HEALTH REGULATIONS.
LOT 50 ` s1 �,� s2 Cl HORIZON Cl HORIZON 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR
35,004 + S.F. is \ ��• LOAMY SAND I LOAMY SAND
(0.80 ± AC.) 4ti� 100- fOYR 5/3 822 80- fOYR 5/3 84 3 TO CONSTRUCTION.
w 93 C2 HORIZON ! C2 HORIZON 10. GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO
MED-COARSE SAND MED-COARSE SAND EXCEED 3.0.
�O \, 94 1OYR 6/6 fOYR 6/8 11. PROPOSED WELL AND SEPTIC SYSTEM LOCATIONS ARE IN ACCORDANCE
yti 87 1 / 148" 782 13r 79.7 WITH MASTER PLAN ON RECORD AT THE TOWN OF BARNSTABLE HEALTH
PROPOSED WELL �� �' \ TH_2 1 ► i \, I DEPARTMENT.
86, 1 \ NO GROUNDWATER ENCOUNTERED
b i , \ ` \ ♦ ` 94
-- UTILITY 85 �'Z,� ' _ , SEPTIC SYSTEM DESIGN j
CLUSTER 93
84 i i i TH-3 ♦ . ♦ ♦♦ `
3 ,, , "' , - ::;<::. RES. ` 92 FLOW ESTIMATE:
CRSA 3BEDROOMS A T 110 GAL DAY BEDROOM = 330 GAL DAY8z TH-1♦,
91
80,E ,' SEPTIC TANK. 70. DECK
79 - , , '\ ,. - - so IM CAL/DAY x 2 DAYS = 660 GAL
♦ , �� G�' n PROPOSED 12'
t�q, USE 1500 GALLON SEPTIC TANK s 3 BEDROOM
78 ♦ ♦ ♦ _ GF' 2, DUELLING 1P
/�� .
_ , ` LEACHING AREA: �
\� ,\ ♦ `` /`/\9 � ` , ` , \ USE 3 INFILTRATORS (MAXIMIZER CHAMBERS) 24' 34'
.o ♦ \ /C �oA����o�, ` 88 1 WITH 4' OF STONE ALL AROUND (30' x 11' x 2' DEEP)
\ fir$d `" ♦ �� ��
PROPOSED DWELLING I
\ \♦ ` \ ♦ ♦♦ o�, �� - ' ♦ ��. ���' SIDE AREA: (30 + 102 x 2 = 164 SF (.74) = 121 GAL/DAY
77. 8 . ` , ♦ `, ' ♦ ♦ ! BOTTOM AREA: 30' x 11' = 330 SF (74) = 244 GAL/DAY
♦ ♦ 6d a v� _ CIT = /DAY
♦ , - - -- -- CAPA Y 365 GAL —-
\7. \, 877 ♦ , ' \ _ _ _ - 86 Q� SEPTIC SYSTEM SECTION
�'0G► • ; ?moo ` ` \ \ ` \ ♦ ` q,`�' 2" PEASTONE
\♦ ` _ _ _ \ \ COVERS WITHIN 1r OF
�� ` - ♦ _ _ _ _ - - FINISHED GRADE "
♦ ♦ , � ` \ � - - 8s } 88.5 3/4 - 1 1/2"
` INSPECTION TOP OF FOUNDATION TO BE COVER GE) WASHED STONE
7 ♦ ` \ — — — — -84
76. 9
pRR pA,
� 7s. s ♦ � � �\ � /ma's'?' �/e" R ELEV: 84.9
` ♦ ` \ ♦ PROPOSED WELLZE
I 84'� RPT
\ \ LOT 49 ELEV.
ty
_ - - - - -82 LE o o
77 . ♦ 85.16 1500 GAL D-BOX\84.4182.38
76. 8 ♦ ELEV. " E� E4 > ELEV.
♦ _ _ SEPTIC TANK 84.58 (6 OF ELEV. 4 4
. ` . ,
` -+- (6" OF STONE UNDER OR ELEV. STONE 30'
BENCHMARK AT ♦ \ _ ` ELEV. MECHANICALLY COMPACTED) UNDER)
\ 84.38 3 INFILTRATORS (MAXIMIZER CHAMBERS)
CONC.BOUND. ♦ S�• 81 TEE SIZES: GASFLE WITH 4' OF STONEALL AROUND
ELEv= 79.6' ` INLET: 6" UP, 13" DOWN AT TEE ELEV. (30' x 11' x 2' DEEP)
78. 0 ` ♦ I OUTLET: 6" UP, 14" DOWN
79 'ft``*+
.EY: 8°• 1 SITE AND SEWAGE PLAN
EXISTING CONTOUR: UTILITY CLUSTER APPROVED BY: DATE:
PROPOSED CONTOUR: ........................•••••
LOCATION
LOT 50 PERCI VAL DRIVE
EXISTING SPOT ELEVATION: 25.5
PROPOSED SPOT ELEVATION: 25
TEST HOLE: j r�KMAS t
: ` �` WEST BARNSTABL� MA.
UVIL
UTILITY POLE: -p- ` _ ^ �r.;,. :
FENCE LINE: F PREPARED FOR.'
HYDRANT: -� � ��sT�` _4`• ``�'':x-<
RETAINING WALL: I x REEF REALITY
TREE: DEMAREST-McLELLAN ENGINEERING �r r' i c� '� SCALE: 1"= 30' DATE 5-9-97
24 SCHOOL STREET P.O. BOX 463
# �� � ) WEST DENNIS, MASSACHUSETTS 02670 REFERENCE: PLAN BOOK 413 PAGE 99
V D10F31 [THOMAS MCLELLAN, P.E. JOHN Z. DEMAREST JR., P.L.S.
I I
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