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Home My WebLink About1347 SERVICE ROAD OjdardNO- 152 1/3 ORA a _ i _ ,� ,�. fl ;_. � / ,� � � �� F' � � � � � �� f � � i �y� ��/ 681 - S'7 �. � �, �� 1 �,� �� , , � Citizen Web Request Page 1 of 1 BAiL\STAOM L ~�o 1 639. ,eq Citizen Request Management - Internal Use Leo UP" Request ID: 56180 Created: 5/13/2016 10:56:04 AM Status: Assigned To Staff Assigned To: Anderson, Robin Building Dept Anonymous: Yes Category: Zoning -Illegal apts E.C. Date: 5/27/2016 Created By: Parvin, Lindsay Citations: Building Dept Time Worked: 0 Response Time: 0 Requestor Details: Email: Request Location: 1347 SERVICE ROAD West Barnstable, Ma 02668 Parcel Number: Map: 152 Block: 008 Lot: 000 Request: Requestor reports that the owner built an apartment in the garage without permits. Requestor reports that it is a rental unit. Request Work History: Internal Note History: System entry on 5/13/2016 10:56:05 AM: Assigned to Anderson, Robin http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=56180 5/13/2016 ► dl 0091 Town of Barnstable *Permit# 6 nN jrom issue date Regulatory Services • snxtvsrneL& Pa ' Thomas F.Geiler,Director Building Division J A N 1 3 2010 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790=6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /S�p/00 o Property Address 1,347 Servl C I° Xaaq (/t/• 8zra sdo--i`e— [Residential Value of Work 3� DDO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 24 b-el� $6!�C,i!G6_1 y 06 $.39vt0-' l74 Yl Z)r lVoc lce5s'M D. 970IF r � CWdQ f� l_ I 7'l`f 836-6G�'�Contractor's Name CJ fi�� Ct t�O{�� i1G. Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) (�:s ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor WI am the Homeowner have Worker's Compensation Insurance Insurance Company Name C-�+rdL"-.i k-e_ Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to 2/Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Ho a Improvement Contractors License&.Construction Supervisors License is requ' ed. SIGNATURE: ,,�,L. C:\Users\decollik\AppData\Local\Micro indows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Southeastern Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 641 Main St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Hyannis,MA 2601 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED RoycroR&Kushne Builders Inc. 65 Eben Smkh Road CenterAlls,MA 02632-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT IN WHICH UBJECT TO ALLTHE TERMS.EXCLUS ONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN POLICIES DESCRIBED HEREIN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYP!Or Neu RANC! POLICYNUMBER POUCyEPPlCTNE VAR POUWf ZVIRATIOM DAM A DEMPLOYERS'LIABILITY LIMITS E PROPRETORI ARTNER&gDMCUTIVE OFFICERS ARE: ATUTORY LBARB NCL 0 EXCL 0 T435328 810612008 6/06/2010 Cp�QaAp0Iw%0MAOPwdGn§0rly. CH ACCIDENT s 80000 18EASE POLICY LIMIT s 100.00 ISEASE-EAC14 EMPLOYEE DESCRIPTION OF OPERATIONINIMIC MSPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULDANYOF THE ABOVE DESCRIBED POLCIESBE CANCELLED BEFORETHE ATTN:BLDG DEPT EXP ATION DATE THEREOF,THE 188UNG COMPANY WILL ENDEAVOR To MAIL 14 z�0 MAIN ST OAY8 WRTfTEN NOTICE TO THE CERTIFICATE HOIDERNAMED TO THE LEFT,BUT BARNSTABLE.MA 02801 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATWEB. AUTHORIZED REPRESENTATIVE f�c ieo11ljWo'elf ucallx n` 9,:jrZr1a,;dt5, -_ Board of Building Regulations and Standards Construction Supervisor License License: CS 83280 Birthdate: 11/29/1964 Expiration: 11/29/2010 Tr# 5313 Restriction: 00 SEAN J ROYCROFT 65 EBEN SMITH RD CENTERVILLE.MA 02632 Commissioner c;v� ✓die �om�n�zoozu�� a�,/�aaoac�u�aella �-\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:.. ,141225 Office of Consumer Affairs and Business Regulation Expirati6ni;`;•1/22/2012 Tr# 291967 10 Park Plaza-Suite 5170 Type " Private;Corp Boston,MA 02116 oration ROYCROFT&KUEHNE'BUILDERS, INC. Sean Roycroft ` 65 Eben Smith Road; Centerville,MA 02632 ;:'"= Undersecretary Not valid witho t i The Commonwealth of Massachusetts vDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �/ / Please Print Legibly Name(Business/Organization/Individual): -R0VCr044 , XV1CAAC- ACLI'(/GC.f' ?11C• Address: S# ,t�IYN City/State/Zip: .e, (tt Yt'C 026T Phone #: 'Tl� -$36— 66 24 Are"you an employer?Check the appropriate box: Type of project(required): 1.u I am a employer with 4. ❑ I am a general contractor and I - -* have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p �'� 9. ❑Building addition [No workers'comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 1.3.❑Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Grdkl+'-- Sial4c- T-wg . Policy#or Self-ins.Lic.#: 14 1 53 ot.$ Expiration Date: 0, (c Job Site Address: /34,7 S• 11 City/State/Zip: {,�. ;?c WA >, C-�i tC- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy Td Uep a penalties of perjury that the information provided above is true and correct Si afor43 e: Date: 1 D Phone#: 7 "i� bb 2 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r . r �THErp�f Town of Barnstable Regulatory Services �$" 'S'E$' Thomas F. Geiler,Director � 039. A`�Fo � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:. 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 7, �Fv6-r�y �&C/K "Cr, , as Owner of the sub)ect property hereby authorize c-�� X `✓)v l AP-LC, to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date P int Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION 7 Town of Barnstable *Permit# 6 �� Fapirra 6 months f vpiwue j • Regulatory Services Fee Thomas F.Geiler,Director ( , Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bantstable.ma us Office: 508-862-:38 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Property Address t s 4'1 SeY'V\LC Rd 6'2Q F,$ ($Residential Value of Work # 8 00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address paW V\ %,B4-1 S e-r ,j c� t2 ci y�l CS 2.r�n c t ab\e,KY)" 0 2 Q C-'b Contractor's Name Z-Q� t�GC y� Telephone Number CCjQ �a-Q� 'CA B Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name T h e Workman's Comp.Policy#_ G S G O V — 3 Co-3 13 \ $- Z- O G Copy of Insurance Compliance Certificate mast be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side N Replacement Windows. U-Value O o3 O (maximum.44) •VA=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. e Improvement Contractors License is required. SIGNATURE• 4 Q:Forms:expmtrg Revise071405 _ Board of Buildiog Regulations aad Standards License or registration valid for individul useo_nty:. HOME IMPFiOVEMEN P CONTRACTOR before the expiration date. If tonnd return to: Registration: 14()473 So4r-d of Building Regulations and Standards- Expiration: 1012Q/20'07 0n'4'°Murton Place Rm 1301 .Jy0e:.Ltd Liability Corporation Br' .... Ma.02108 G 8 L QUALITY HOME IMPROVEMENTS JOSEPH LARO:,QUE?.. .135 RTE 6A SANDWICH,MA Depot_.'tidllllnl9tT: Not valid wit signature 9�e ob i License: CONSTRUCTION SUPERVtSOA Numtsers CS 09C54 ` Birthdate: 08/21/1969 E 90654., xpires 08/21/2008 Tr• � ;t--� - Restrieted QO JOSEPH A LAROC& 8 FOROHAM ROAD t' r EAST FALMOUTH;MAC+02535 ' Commission4i � ;1 ' tlp� i • a�sreus, • Town of Barnstable MaSEL . Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, t�Wn ca-PV 3 ,as Owner of the subject property hereby authorize p =YY)p M&MEntS to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) i Signature of er Date Print Name Q:Forms:expmtrg Revise071405 i The Commonwealth of Massachusetts Department of Industrial Accidents Offke of Invesfigations kvi 600 Washington Street Boston,MA 02111 www tows&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organizationttndividuai): G*L Q ya\\�y No�rn e Trr�C'c�yPJr�clehtS, lS.�L Address: 135 124--e. GA p C). B o X "73" City/State/Zip:Say-Aswla),no, 02563 Phone#: 05o%)"r Q0- b1G6 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 2 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet._ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑Plumbing repairs or additions myself-[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.�Other W tMOy\I '� b .Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their worker:'comp.policy information. lam an employer that is providing workers'contpensahion insurance for my employees. Below is the policy and job site informadom Insurance Company Name: Z'1n e. H ar-11 brca Policy#or Self-ins.Lic.#: Q--5 G O y B- 3 631i 614 2-OG Expiration Date: Oci I 1 1 Olo Job Site Address:134'1 SeYN cp— Ed o .' ' ' ` City/State/Zip: V�.ga�f�s��e_�(YI� OZro6$ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerd,&A er the Pains and penalties of perjury that the information provided above is true and correct Si ell- Date: Phone#: (a ns Official use only. Do not write in this area,to be completed by city or town of kiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 08/25/2006 13:04 5088888065 GLQUALITYH0MEIMPR0%)E PAGE 01/01 hishiFax worcrosIs 8/25/z006 1 :02 PAGE ooa/ooa rax Server U Z. N, .951 fA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE octht�$Tot INS ArIcy INC HAD LAE!&I,TH TIF ATRIEDlgl&NOTPr IIE) XTEND OR COJEW 43E AFFORDED fFO L IV, E 52 WEST MAIN ST THE BELOW. 0 H N 0 IS L L y AL_'E R COMPANIES AFFORDING COVERAGE HYANNIS MA 02-601 OWPANY ?RrnR A Rnt2-rvnvn IWMMS�TpRs T,,,IWp.ANc!g rowhmv INSURED COMPANY G 6 L QUALITY HONE a TMPAOVEAMRTS LLC QOMPANy PO 3OX 733 . 0 SANDWICH MA 02563 COVIPANf D .7-77,77 THIS IS TO CERTIFY THAF'T`H`rE'_P'0'U"CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR.CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TMS, IiKCLUSIONS AND CONDITIONS OF SUCH POUCIE3,LBATTS SHOW MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE Of INSURAN011 POLICY NUNISER POLICY EFFECTIVE POLICY EXPIRATION OMITS LT n DATE(W=YY) DATE(MIIIIWD1Y) GENERAL LIABILITY aNERAL AGGREGATE i COMMERCIAL('6NERAL LIADIL" FRODUOTS-00MROP ACQ. 21_1,xli1 CLAIMS MADE�OCCUR. 9 PERSONAL&ADV.INJURY OWNER'S&CONTRAC-TOMS PROT EACH OCCURRENCE FIRE DAMAGE(Any one fire) $ MED.EXPENSE(AM one person)l III AUTOMO&Lr LIABILITY COMBINED ouc;LE ANY AUTO LIMIT ALLOWNEDAUTOS BODILY INJURY SCHEnt)(FO AUTOS (Per Paean) �IIREDAUTOS BODILY INJURY 110WOWNC11 AUTOS (Per hccidani) PROPERTY DAMAGE t GARAAZ LIABILITY AUTO ONLY-EAACCIDENT S ANY AUTO —OTHER THAN AUTO ONLY: EACH ACCIDENT q AGGREGATE EXCESS UASItri'Y EACH OCCURRENCE UM8:rtL!AF,-:)FM AGGREGATE OTHER TmAri UMBRELLA FORM WORKER3 COMMSATtONAND 7ATLFrORY UMITS `'''tic); impLoyasts unary (JIB-36391314-2-045) 09-11-05 09-11-06 EACH ACCIDENT t I no,nan THE PRQPRJEIOFV - S PARTN,rFrvUEGUTIVE[2 INC'L DISEk9E-POLICY LIMIT saftr.alu OFRCEIRS ARE: EXCL DISEASE-EACH UPLOYCE- IS W� 1-'4 4Zj;4 c PTTg4Q;.9 QkREA -41g� WORKERS CONP COVERAGS. ;ME C w SHOULD ANY OF THE ABOVE 13E=RBEo POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TRIERWr, THE ISOUING COMPANY WILL ENDEAVOR TO MAIL 10 DAys? WRDT94 NOTICE TO THE CERTIFICATE"OLDER NAMED TO THE 7.00 OF BAPNSIABLE LEFT, 5IUT FAILURE TO 11141,SUCH NOTICE *ALL IMPOSE NO OSL(OATION OR 200 MAIN ST LIABILITY OF ANY BONI)UPON THE OOMPANY,tM A6ENTS OR REPROENTA71YEOL HYANN15 MA 02601 UTNORILED REPRESENTATIVE .......... .......... Eqigiiiii� r r) Map / S_ Parcel 06 Permit# -_DU(P 6;Z'-I House# Date Issued 4/C3L0� Board of Health(3rd floor)(8:15 -9:30/ 1:00-4-M) weed Conservation Office (4th floor)(8:30-9:30/1:00-2:00) 4?la1x H%-D6pt. (1st floor/School Admin. Bldg.) S•F TIC SYSTEM M � n Approved by Planning Board 19 INSTALLED IN C® WITH TITLE BARNnAB", RNSP V TENTAL C TOWN OF'BAA- � fl�� t Building Permit Application Project Street Address /3 V? Village W-04 AciP,115NLLe, /1195s Owner Address /3f-/7 S-<Ayi< _ I✓• 4Rnst.,61-c, -Telephone e/10 a a-9 rPermitRequest ^/�,,, �.S°xa.8" A41 o�gG�a�,:2 14/,f,4 S.ecoral P/ooa WooA,,t, First Floor square feet Second Floor square feet Construction Type iy,e„A Estimated Project Cost $ ao oov°°a " d Zoning District Flood Plain Water Protection Lot Size /, 69 acc,- Grandfathered ❑Yes ❑No Dwelling Type: Single Family Og Two Family ❑ Multi-Family(#units) Age of Existing Structure /C9 H CL, Historic House ❑Yes N No On Old King's Highway ❑Yes ®No Basement Type: S Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New O Half- Existing / New C5 No.of Bedrooms: Existing New O Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: &Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes (1 No Fireplaces:Existing _LNew o Existing wood/coal stove ❑Yes 5J No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name � Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEB//RIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIER FO ;FOLLOWING REASON(S) o ` FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE .Jr OWNER DATE OF INSPECTION: _ FOUNDATION FRAME INSULATION _ FIREPLACE ELECTRICAL: RO tw- UGH : FINAL PLUMBING: C"R- �*mg FINAL t GAS: ',R FINAL FINAL BUILDING• t., C') . DATE CLOSED OIAM rL} ASSOCIATION PLAN NO. I • + + •\v +i `4 . I � - . i r E'I>tNA/t lU �6?.G E. • ',ram!. _t,1•.'',•�.+ � ASH OF � � 1./,•. �GI$lt , • .t'�y - � ...•i j• ..irk+�..� . . � I . i � I � i I i rr� I i I r , 1 I • ---------------- 2�•c. ��v v �.Si„L v�-�j� oHOF = "IL �' ✓O��c — G� 1.l' 1//7 1/:Ji 5' /Qf>aSE Jam . G/ � � � + ��`'�•"• � APE �"'91'AL LO.'i'.� _ u �hYvIV�• I I f • 1 ' � 1 j -- I I I j I •_ I I I i ( I _- ' L-- i -•1--I ---.iJ---I--.L _i-.��----�----i----�- .,w--il-----�-__.1._.__-t___1,-�..-. I I l I _i I .-i i .__.. cr vi s c J J oo - O tiK CP Y i I I I � ' off' ir ' c ' ii | . . � � | -- - � - ' � - -- - - -' ' --' � � � _-- _ - - - ' � - -- - - --- - . . � ' - - - -� ' - -- - - - - -- � - - '- --` - -- - -- - - - - - � JL . . � ��r'� ' | _--_-- � -- ' ---- ' --- - ''-- --- '-- �--�.--- - � - - - - - - - - - - - | ' | � � . . � � . . . . . � qv _771 V --4tn ------------- t _ � �� _— - e.,s � _• _I_ �� i �_ �._��:_. .. -i-�-__s_ �� I ---�--.. _L j i ' I N.-. . -- (s—-.— -—--� ---- ,� Q 7 vl I ---.. -— -- �'- ' --- ` T . s ------------- - --� s---- ---- ------�-------- � - ----- ----------..�...__ . --- .._.. .--- - -----. - .. �.... -.. . -e.__ -. ._-. __. _ ' j -,- -�- i Of ZME T� e To : . The wn of Barnstable • aAxxsfrABU& - 9�A 1659. ,0$ Department of Health Safety and Environmental Services rForrsox'' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: d O ics 8� AFF GdQ62et, Est. Cost �at y oalo• Address of Work: Sc0.dlt4, 1101 vw.es4 15�x;An s Ia6La Owner's Name L✓,//,�i',Yr. :5' �rnotq Date of Permit Application: 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: Date Contractor Name Registration No. OR Date Owner's Na e The Commonwealth of Massachusetts Ft Department of Industrial Accidents ' Office of/nsesl 9290ns ' 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: 6(1/1111/71 � location: /3 Y? /�}7�� city kt/aYf nS t�i lL // &• o a 66 f phone# t/'.3-o D / (� I am a homeowner performing all work myself. ❑ I am a sole pro netor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. company name: address city: phone#: insurance co. olicv# 1117 // // / ❑ 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: company name: address: city. phone#: insurance co - 01icv# FIN //%/,%/////////////%i company name: address: city phone#: ..,.::....:.. insurance co. Rolig# goo 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 OMce of Investigations of the DIA for coverage verification. I do hereby certify under the pains and enalties of perjury that the information provided above is true and correct Signature Date y 9 _ Print name 447�i!4 S Phone# 5,�o O 9 official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's OMce ❑Health Depar went contact person: phone#; ❑Other (revised 9/95 PIA) 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, constriction 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 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 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 renamed fr 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 Office of lovestlgationa 600 Washington Street Boston,'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 i ! r i -=, ! I i1 - J 1 _�........_ ... . I • /0 pompe� C�nc F�� i li✓a�� 6 qnc l a o fS ,oOA�V- ------ I I I —_.-- 1----...__---- ..._ L......j . ... i � i � I 1 I ! I S�G.,�ca�fc s�gs : �Q��.� ,,nc•c�v�hi m{sti� .. ! _ ...--- - I I I nl LEI Vjq - - _ n I � •I I I I I ( I I I j i I I i I I i _._� ....i. .. i I ! I . ! i i I ! I van qI I I • --LJ I i.. ! j Ion I - ! . I I I • ( I I I ' I .I. ..!. I i I I •�' Ica OF CA 16'1 oL AV 10 Li I : -I ! yci 71 ; : ! i --- - -- ��pdi • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION /3 Y 7 S_eay l GL AAA Att S4 A A n S�gl1y2 Number Street address Section of town "HOMEOWNER" 6LJI A 4A ::v " �/.�f01 S' C7 O a 96 6/7- - 3.�-F�-�O $o(? H Name Home phone Work phone PRESENT MAILING ADDRESS S-e&\JdIc C 6*�ak Wesi 83�,61ns Zc; /fioL, 0 6 City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an - in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"- shall submit to the Building Officia: on a form acgeptable to the Building Official, that he/she shall be responsiblE for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Sta= Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands . the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with sa procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a 'building permit is required shall be exempt from the provisions of this -section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owne: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities• of a supervisor (see Appendix 0, Rules and Regulations for licensing Construction' Supervisors, Section 2. 15) . This lack of awarene: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner actir as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Tier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that .he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. i , �1. Ste. i i 3 47- � e CERTIFIED PLOT PLAN LOCATION . WG-:s77 Brie vSTi}�G�` SCALE . ��=-s.�:.... DATE2 Of PLAN REFERENCE . Boa Ebwr�a Sic,/¢w.v Gti PC.BBC. L 3 Z 26100 I CERTIFY THAT THE F �S7'lit/� / v!y,Q977o�! SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF 80 W4- , . . '.WHEN CONSTRUCTED. ATE D . . . _ REGISTERED LAND SURVEY' R s Assessor's map" and lot number ../. �. :.:. SEPTIC SYSTEM MUST B OF-rm Sewage Permit number .................� INSTALLED IN COMPLIAN .':).y.u. WITH TITLE 5 'f a(9// ENVIRONMENTAL CODE STALLS, rasa House number . . ... .....1.,�.....7.....x. l.. TOWN REGULATIONS '°Aigi639'y�� + a MAX TOWN OF +.BARNSTABLE L. • - i BUILDIu INSPE TOR � APPLICATION FOR PERMIT TO .:...:......................... ..... TYPE OF CONSTRUCTION .. 17. .../ A rl,,c............. `9 le ....... ...L`.�...........�......... .�'C .�...................... .�7.... ?..7.........................t9.e TO THE INSPECTOR OF BUILDINGS: The undersigned hereby pplies for a permit according to the following information: Location ..4..� tiC:�.......< .�.G..F.f �..Awww.............W:....eeie.^�51e�.�� .................................................. ProposedUse I...............:.............................................................. nq ZoningDistrict ..................! I .........................................Fire ........................... Name of Owner r�R w ft .6r Q G} ........................ ........ :............................Address .. ...Q.... ../'!'.. .... /.......... Name of Builder .l".�A,n,� .... .... .i ��.r`�..................Address ....f7�G.....�G ��...LAB CGH ..1/�� Nameof Architect ..................................................................Address .................................................................................... Number of Rooms cO..... '�d`.'.J.��'�'�f...Foundation �y�.�� tQ .......... lQ ................................. �!! ... . .................................... Exterior y/t3 0 �vt�/../ . ......................Roofing ......jrDb,!#/..1............................................................ ........... .......... C',' Floors I'�!/�/I.TV.!f/r�(<....'.. OIJQ" /�R jl�/c�-J.......Interior ..t--aad - dR%!tii4 ......:.............................. ...... .... .... .. .... Heating A...............:�:........... ............. g ct�.l.�.!................'. .c .......... �/.�,07. Fireplace fv,4.P.y.............. t Cfr................................Approximate. Cost .......... Ov.v.............................. Definitive Plan Approved by Planning Board ---------------____-----------19_ . Area .... <.�fr........... Diagram, of Lot and Building with Dimensions Fee ... .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH aeq OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namek........'......... l./...... ............................. Construction Supervisor's License .Q...,I 2 �l3 O CAPRA, FRANK G. �' o ... Permit for ... ...S.tOr...y............. ............ pwejlin.j......... Location ..1.347 Access Road ........................................................... West Barnstable . ............................................................................... Owner .....Frank G. C a r..a .. .......................... Type of Construction ..,,Frame ........................... .. ....... ................................... ................................. .......... Plot ............ ............... Lot ................................ Permit 'Granted .......qXllY...7�................19 87 Date of Inspection .............19 Date Completed ..................... ..................19 V J '1 V DATE: HOUSE NUMBER CONFIRMATION TO : ASSESSORS DEPT. FROM D.RW/ ENG. MAP PCL. DEV. LOT: FORMERLY N O. 13_.7 RD. RD. NO. - FRONTAGE: NOW : N0. RD. RD. NO. � L FRONTAGE SEC. RD. RD.No- �SFN TAG E: VILLAGE THANK Y/OU, arc 3� �. i3 W. �— I �I jam• � .. 3GS./3 1 Iy .�I/ \ �4f•/ � 'may�. � r�_f.oi ISO+ ! ! � '' // �/' • ^ 7•• TT 70P OF iOUNDATION C CONCRETE COVER 1``, l�/•a� I / } CONCRETE COVERS LLe.' a'SCH IRON IE'YA%. OR SCHEDULE 4� ('SCHEDULE 40 PVC(ONLY) PV.H PIPE PI PC-MIIP. LEACH 1 • IITCN 1//•PER WE I/�PfR.fT. fli i LEACHING I PIT OR _ t c --•' ._ '1.... _... ...... _�-._:,r i• INVER SEPTIC T�JIK__' L... O'•T n � �e 0: M�T01 E ..._. ..I.. 1..._ .•� IN[R S INVE OIBi F BO% ... 1 i3. B •.l.?^R.....GAL. L/ INVERe �: WASNEO STONE PROFILE OF GROUND WATER TJJABLC 72 SEWAGE DISPOSAL SYSTEM NO SCALE , f .I SOIL .LOG ! WITNESSED BY: BOARD OF HEALTH I CAT :/.µt'•.t./ TIME. ..�'.�'.^: GGLV/PKi, E .YECL�/•ENGINEER ' TE3T HOLE I TEST HOLE t DESIGN DATA: I NUMBER 01 BEDROOMS . . 1 .� WEsT� Moss. i• � :~D •.e ^Io/lr.' TOTAL EST(WTEO RDW ..3So .GALLONS/ar (III /TE F'�/-r.�-• t.`'.n).�)�r.�iec6'� ,�'..."u.,.i BOTTOM LEACHING AREA LLJ. )f.'G.PlL ..0 p //.• fJ fV,00 SIDE LEACHING AREA... Y.. SO,f T/PIT I •' pwun +}D/n,vL GARBAGE DISPOSAL 150%AREA INCREASE fOrn n�•a!�' TOTAL LEACHING AREA so-FT 4/7'� • FwA .. �✓�l.w+a PERCOLATION RAT[.47i R!°'.Y"T`fr.WIN/INCH I fC'i? 2G /9L(6 ,i�ALG' /•�'•Ro --/— 74✓ ��— LEACHING AREA PER PERCOLATION RATl.4?7.•SG.fT.�'••40. i I No,WATER ENCOUNTERED I NUMBER OF LEACHING PITS HNC J , ELJWAN.LJ G .TELL G'7' � .(q...a,fLt%",of�.C•,O✓/tcG 3.Q63:,. . AIPROVLD...... ...BOARD GF HEALTH j L.4.v iJ J4aL Ve'yi•K .... ....................... Yt. M ¢ • DATE ......... 'AGENT 011 INSPECTOR CL H /1 i D /7fJ S f. 1:Y11 ,F 1 //D>L• _ LC.E'✓/I%/••�i:: RA�[•L C✓•'I I'.SSL r1L"7i �ITL�I i •• /L!./-/A/ ,QE't' = PL.tXK. 292 I Pl. 79 •.a R.c Y� 'tj Lo.^ ,_ L oF�7✓� v• �0 W� • 1 I • did ! ' 41 30- yL n-jiA ^' 0-6;1 � w✓ar`�1� y �1 :�•.. �aw.•�rs . '. •�u�,•,.yM`.. F„Rn.,cc G-�+'K�, FMrl� I �.� 1 1� Rs.%Q�b e, ell !ILOT z0—r� �A _ 3L p �Gl�♦ In �a�FFO (ONf,Q6ii wA��J ON Feu% R I II ! I/TANG Ole f?,lTS IS Al tv ( . I HID j '�o (� '• : I Wqq EC id/0,/ W2�i ,� `•-_• , APPROVED BY: DRAWN BY `VI/ -PA SCA E: T : REVIBEO DRAWING NUMBER } I A • 0.o CE t6-o f�SOr¢'6i"wit � ' •� ► /,y^/_ �. __..._ • �a � w�17"tG�a � i ..R )"07 T0.Flo, Sr 5r.. oYfff S+rVIn?ry a"' Mrlt7�.syr 6/l L�wyr>f c<pwG Its ._. suo fL.t 7+i 1tS /6 a +686 A.CS • _RF �- _ ,'/6'• . y a.rrr..Pbaolt p Ob CWOA 2Y=n S-CA�E 4y: �' 7�y S4 f1"' I Assessor's office(tit Floor): Assessor's map and,lot number.r' /:�oG t-)eq-2 ' `'' (vJ �EP'fBC SIPSTRA MUST BE Q•. �� Conservation PUANCE e Board of Health(3rd floor): ! INSTALLS N�� Sewage Permit number �� lf[f '�f" � 5 i MUST�nc Engineering Department(3rd floor): ENVIRONMENTAL CODE AND 'eo se o`. House number BRA 8 rT--e 1J;_AT10NS �o arr► Definitive Plan Approved by.Planning Board �19 APPLI'CATIONS PROCESSED 6:30-9:30 A.M.'and 1:00-2:00 P.M.only 1 TOWN . OF BARN -- BUILDING INSPECTO APPLICATION FOR PERMIT TO �-0 0qQQ TYPE OF CONSTRUCTION l,L Oci® i"�/LA✓+-,� DEG Z 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the follo g information: Location 13 7 /9'C r E- Proposed Use o Zoning District —I Fire District Name of Owner W/`yr A WL Ci`!f'Q� Address_a2 I e Name of Builder�2�'' /t l��Q� Address �U Name of Architect 'l Address Number of Rooms �k l/ Foundation P�L2Z/ fart- Exterior- u.oma Roofing Floors /I Interior '^� �OIjJ 0�%i-S J), Heating Plumbing Fireplace Approximate Cost IV Area �O �T Diagram of Lot and Building with Dimensions Fee { OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License CAPRA, WILLIAM t (Q No 34S72'1' Permit For BUILD ADDITION M Single Family Dwelling Location 137 Access Road , West Barnstable Owner. William Capra Type of Construction Wood Frame Plot, Lot Permit Granted December 3 19 91 Date ofln§pection 19 i`' c Date Co" letJ 19 Q J i T ):S l A Mi al :$ �.$ C A Assessor's map and lot number .. .. ...r?-.'.....fir.'..................' Sewage Permit number ............. �.:7 — I.............................. 33AUST&BLE, i House number ...1. ..... .° -<.......................... qo *aea p 1639. \00 �0 MAX a' TOWN OF BARNSTABLE BUILDINS INSPECTOR a� i APPLICATION FOR PERMIT TO ........................... ........ ................ _ ................. TYPE OF CONSTRUCTION ............C`��..". ..d.4'e") ZI�1...............:...... .... .7........................19.F TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .1.Q.1 ti ... l t�G..j .1.... F1a /C.! .!�..............W: �l?P^�f.%awp .......... .................................. Proposed Use ... .. 5..�".`. ..ti7rA ................................................................................. .....................:.......:.................. ,.... • .ZoningDistrict Fire District ................K/./..... .... .141s .......... .. /...................... / f...................... Name of Owner .. !2.A.w. ......U'..... !9. .........................Address.. .�....S..UP� .L/►�! .....CChT:�L�!� �...... Name of Builder r. ►Lk....G.....C�.!...�1.A.................Address ....�1.�?.....�� f?„ Ae ...�c ,.;G,ijl/��+�. Nameof Architect ...................................................................Address .................................................................................... Number of Rooms (.r1.�..............................-7d4�w°Kf ..Foundation ........... �............................. Exterior ......... /9/f ...Roofin �1...!�f�9. ..�.................g ......................................... Floors ...7... � rs- � Interior .. i.7c>Q...`......i� ................................... Heating ....Ot...... .!!2F:'d......A/v ...g...................................Plumbing �u.i°�� . /�(/ G " 7 FireplaceM ............. .............Approximate Cost.......................... , U....v.....d................................... . .. Definitive Plan Approved`by Planning Board ________________________________19__,_____. Area .... . ............... Diagram of Lot and Building with Dimensions Fee ... J. ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules, and Regulations of the Town of Barnstable regarding the above construction. Name .'4 !�.,A......61 Construction .Supervisor's License . a' ....... O y CAPRA, FRANK G. A=152-8 No ..3Q.9.5$.. Permit for ...ki...Story,.. .... ... Sin le Family Dwel,ling...... ....... Location ....13 4 7....o 9 .............. .....................Wes,t B ................... Owner ......Frank G.. CaP ........... ........... Type of Construction ...Finame.......................... ......................................................................... Plot ............................ Lot .. ......... ............ Permit Granted .......July...7.1..............19 87 Date of Inspection ...............:....................19 Date Completed .......................................:.19 75 a f � r i l 4q a�'. g► I y3I• fz�r i w p,T- I i _ - j� ter, I � i`'i''1-� '"Z_ /r• � �f tl�:.•liC' / i `n•moo, 7/n+ �� LL• - i — _ ( 412E 17 dool dpw I - 44 L TOP OF FOUNDATION z�7• �� -- CONCRETE COVER t CONCRETE COVERS ". 1 4.,CAST IRON ff2"MAX. �rrrrrr�pss 12"MAX. OR SCHEDULE 40 " 4 SCHEDULE 40 PVC.(ONLY) P.V.C. PIPE PITCH 1/4"PIER PIPE- MIN. LEACH t 3� PITCH 1/4"PER.FT PIT PRECAST .I 8 ';' .� LAV � LEACHING 1 I • t �' �• ER � �•� _ _ - - _IC T.. EL F Teo �a. EL v •:`�f' SEPT 1yK _INVERT INVERT •: w_r• 1 ; PI R j _ I INVEFI � /ow. .. GAL. ... INVERT BOX :� �'.o►=� EL..�j ..... —'� EL.'4� Z/ INVERT w 0: .�. j/4"TO IVY j � � I EL.!Zeo ! � �: - WASHED TONE ! • •• PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM �. P�� ►✓ i_/�G� /,- �C� �� NO SCALE SOIL. LOG WITNESSED BY : j I DATE ,'T�'✓,•t i9d TIME.,9:•Su .4r7 77�h.q.� •/•1C,�cn.-/' . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ET�lv�9lly L- 1[c�/• ENGINEER ELEV.,, �`':w. . .' ELEV. . C7 ov ,jj W voloolrl I a r j,,• ;;; :�a.x�r�. DESIGN DATA : NUMBER OF BEDROOMS :3 . Dl'MSb' 1�1C,YJjj �,�/�•,,;'r 6. /� E,• �,•�o �fl I;.�e' TOTAL ESTIMATED FLOW . . 3.30. . . GALLONS/DAY ri l: �. s•�No w nr Fr"✓er BOTTOM LEACHING AREA . . . . SO.FT./PIT S7 -'.P D. l �,NSC /Zo"" • 1.S j.�o SIDE LEACHING AREA . . . . . . . . . SO.FT./PIT1JY- C.r�U. GARBAGE DISPOSAL .'`+:A!< . .(50% AREA INCREASE) -,I/.,C C. SA..►. s400 TOTAL LEACHING AREA .'¢/7 8 SO.FT �'�'e's F iu�s►v PERCOLATION RATE MIN/INCH . �f'� ZC 18� J LAL I• •4 r s117r �i.VC3 LESS 71�!it/ EICf/T --- LEACHING AREA PER PERCOLATION RATE .:�7. SO"FT./�:O.O,o h 1 N9. .WATER ENCOUNTERED NUMBER OF LEACHING PITS ('^!E .�/T W/ n 2�c. LJ�wv ,.S�.c� VG�j�•�: APPROVED .. . . . . . . . . . . BOARD OF:HE.:LTH . • FCC 7.af•. wEt• o:vs•e- ,.g.L• ,I �n�..±�,; DATE . . . . . . . . : . . .{. . . . . . . � - `'�:�' `--� of AGENT OR INSPECIOR ICA `' ff1��. •tii1GC ° ` 9 O S /✓o��. - G� �.!_-" ✓/�!/:Ji .' 5 !S'ASE �� !.�• ;�.S..r[iH�•7� -�ATZ�I�-y i _ i