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Home My WebLink About0046 STONEWALL DRIVE s I I i 1 i i if I J0"gECYC(FD"" UPC 12543 NO 'q'n-co •. -,,-7--•......-- NOS MN i I I i � i Imo,. . �_ . ._, _ ., i Town of Barnstable _ �x�^ d Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept y MASS. a;1639,- Posted Until Final inspection Has Been Made. ° Pny.m�* .0 cl EaMa+ Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-19-2298 Applicant Name: Roland Langevin Approvals Date Issued: 08/08/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/08/2020 Foundation: Location: 46 STONEWALL DRIVE,WEST BARNSTABLE Map/Lot: 217-050-001 Zoning District: RF Sheathing: Owner on Record: TAKVORIAN,CAROL R Contractor Name: ROLAND LANGEVIN Framing: 1 Address: 42 OLD MIDDLESEX RD Contractor License: CS-103861 2 BELMONT, MA 02478 Est. Project Cost: $3,257.00 Chimney: Description: R-38 fiberglass for damming, R-30 Cellulose to open attic, Permit Fee: $85.00 weatherstrip attic hatches,ventilation chutes,vent bath fan with Insulation: hose,air sealing Fee Paid: $85.00 Final: Date: 8/8/2019 Project Review Req: ULer( Stg Plumbing/Gas Rough Plumbing: !Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after,issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL fg=24-0 ,050 001 GEOBASE ID 31995 ADDRESS 46 STONEWALL DRIVE ' ' -JONE W BARNSTABLE ZIP LOT 1 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT . 59327 DESCRIPTION CERTIFICATE OF OCCUPANCY-- BLDG.PMT.#53845 PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: De 'artment of Health Safety ARCHITECTS: and.Environmental Services TOTAL FEES: ` BOND $.00 THE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE PIK*' a BARMABLE; • MAS& 1639. Ep�l BUILDING DIVISION BY DATE ISSUED.. 02/26/2002 ' EXPIRATION DATE �� y. 1 TOWN OF BL1RI'1�� BUI LDING.'PE� t�f t"a, ' ` , r, {��. •;� - �„tea}� . _ JARGK i�Tt �17�056 001. GROBASE ID ADDRESS, 46 STONEWALL DRIVE �" A*�y'� � `} PHONE W BARNSTABLE rm�'`,-v - "r•�" ZIP . . -- LOT 1 BLOCK LOT SIZE _ DBA DEVEI;OPMNT DISTRICT WS PERMIT Li3645 ; DESCRIPTION NEW 3 BD SING.FAM.HOME SEWPT#01-234 PERMIT TYPE BUILDS TITLE NEW RESIDENTIAL. BLDG PMT I )MNTRACTORS. HALI CAPE CONSTRUCTION ` Department of Health Safety ARCHITECTS: and Environmental Services TOTAL FEES: $1,290.96 THE I, y CONSTRUCT ION COSTS $416,4=0.00 ' •� 1"0.1 Sr NGLL .FAi HOME DETACHED 1 PRIVATE P "cj'EHARNSI'ABLE. .: MASS. 163, BUILDING DIVISION BY DAM-ISSUED 06/11/2001 EXPIRATION DATE. i.u I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF EITHER TEMPORARILY OR PERMANENTLY.EN CROACHMENTS OWPUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OI ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THI: PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS -ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCC.U- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- j 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ®O�j t Ar t& mouse_ off- / /f /6`11� 2 4 •e' �Q /S [�� f� If A)Ar((S 2., 2 �� L e !z Z" 2lT� , - Need [OTHER: 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT d 0 1 [,IAL CAS .. 2 1r�� LTH SITE PLAN IEW APPROVAL tem- (AL- C C WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS"APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. ,� . � o �, ; `� �� . .� WEST BARNSTABL_E FIRE DEPARTMENT 2160 Meetinghouse Way Post Office Box 456 West Barnstable. Ma. 02668 westbarnstablei iredec)t@verizon.net DAVID PAANANEN beulehum/Fire Preven 017 Business: 508-362-3241 Fax: 508-362-3683 Emergency: 91 1 June 6, 2007 BLtilding Department 200 Main Street Hyannis.. MA 02601 Regardlm, inspection ol�property located at 46 Stotiewall Drive. West Barnstable. Nja 02668 The West Barnstable Fire Department conducted an inspection of the property located at 46 Stone)w ill Drive. West Barnstable on .lone 06, 2007 at 10 am. The inspection was requested by the property owner's realtor to sleet the requirements of M.G.J. Chapter 148. Sections 26F, 26F %, prior to sale of property. DLlf1110 the inspection ewe discovered a full 2 kitchen setup consisting of a range, dishwasher and counter with sinl: located in the basement next to the hot water heater and furnace. sug()esting a nlLlltifanlily Use. 1-he manner in \which kitchen was installed doesn't appear to meet the building code or plumbing and gas code. Your attention on this platter is appreciated. If we can be of further assistance heel tine to contact myself or the Chief of the department. A certificate of compliance was not issued for the following reasons. Smoke detector round On the jr`I 11001- OLItSide of bedroom persistent faLlltN.' activalion. Combination Smoke detector/ Carbon Monoxide alarm found on the 2"`I floor near kitchen non-complmllt Sincerely. [ t. David Paananen TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . - G Map l Parcel L 5 6 Application# a0 j Health Division 1I Conservation Division Permit# Tax Collector Date Issued -' G Treasurer , to y Application Fee PlanningDept. ' P P rmit Fee Date Definitive Plan Approve�J by Planning Board Historic-OKH Preservation/Hyannis , Project Street Address 46 5+6r#v4v%k1 4r Village _ w 2s i---- Ea v hsA--art 4— n Owner Address J4C -C Qn0-" CL111 Telephone so?5 ' 60 l Permit Request \.V14 fC c Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay 4f—Project Valuation 00 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Cl Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑,No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new D Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil Cl Electric ❑Other Central Air: ❑Yes. ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No •Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization 0—Appeal#`"* — -Recorded-El- Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use j, BUILDER INFORMATION Name Telephone Number S — al() — S lD I Address Et6§nse.# d Home Improvement Contractor# g' qCA d k ft ompensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS'PROJE;CTyWILL=BETAKEN TO SIGNATURE DATE" 06104104 FOR OFFICIAL USE ONLY \ J YY ti PE�MIT NO. DATE ISSUED- MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: s FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL- . PLUMBING: ROUGH FINAL .. ti i GAS: ROUGH CF�INAL FINAL BUILDING 1 707 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,AM 02111 www.mass.gov/dia Workers" Compensation Insurance Affidavit::Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nan1e(Business/Organization/Individual): . u Nn Q�y S • Q�s�r� . MA U�6f,$ . �Ciry/StateZp W Q.3a' QaNnScdt e. Phone.#: Sd$� 360 - b1 '} Are you an`employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a sole proprietor or partner- listed on the-attached sheet.. 7. ❑Remodeling ship and have no employees 'These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' coin insurance.$ 9 ❑Building addition [No workers comp.insurance p c�_required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their I am a homeowner-doing-ill-work 11.❑Plumbing repairs or additions m self.-[ o-workers'-co right of exemption per MGL �"` Y � n?P 12.❑Roof repairs insurance sequired.]tt. .� - c. 152, §1(4),and we have no employees. [No workers' . 13.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is..the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t pains-andpenalties ofperjury that the information provided above is true.and correct Si ature:�-.--- p �--, �---Date:-= �G 10 .0 . Phone#: So 1; 6 o _ n L Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two,or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced�acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract fu the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised'that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department,of Industrial Accidents. Should you have any questions regarding the law or if.you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter..their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not'related-to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusettts. Department of Industrial Accidents Office of Investigations 600 Was)ingtori Street Boston, MA 02111 Ter. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 11-22.06 www.mass.gov/dia v; Town-of Barnstable P Regulatory Services sAxrr6TASLE, r MASS. Thomas F.Geller,Director � g . 'a39 •� Building b1V1S1UI2 a MP'�a b Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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: 1 q1C Q n ' ^Y^^ c a ��+�•P Estimated:Cost_ :�O� ,Address-of VWork �o S "2.�a�� W 266 2q fi- �vr y.s t-a6t.c-•.��k- D _ S Date-of Application:----0 6k 44 b 1 �---- -� I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ODuilding not owner-occupied• • �('�Owner�pulling;own permit_,�� . Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITIE1 UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR )5 ate (_07ner,'s,Name� Q:fo=:homeaffldav i' Town of Barnstable Regulatory Services BAMSt•ABLE, : Thomas F. Geiler,Director 9�A MASS. A.�� Building Division RFD IVIA't Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print �' D`�_ ATE E=—&-4~jJ 6 1 o JOB=LOC—ATION: 6 number street village FIOMEOWNER —_ h (( 6Q, �66 - �� SO$ •3 �0 'SZ�(� name home phone# work phone# CURRENT MAILING ADDRESS'.) 6 !Cft _W Ck_d aV- 1,.r AA A o 6 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 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 responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature=of;Ho.meow r--� Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S 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 permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Page 1 of 3 1 i Listing Summary Listing #20611672 46 Stonewall Dr, West Barnstable, MA 02630 Pending (03/31/07) DOM/CDOM: 199/V $949,000 (LP) Beds: 4 Baths: 3 (2 1) (FH) Sq Ft: 3794 Lot Sz: 2sgft Town: Barn Yr: 2002 Remarks Picture"'��` Better then new Contemporary Cape [_ = with three levels, open floor plan, gourmet kitchen with granite countertops and all Viking appliances, very light and bright. A large Great room with k r Cathedral ceilings, floor to ceiling stone b y fireplace and French doors to a : mahogany deck. Large bedrooms with • ` r �� custom made closets and 3 with 01* balconies. There is a large 3 car garage, 3� � irrigation, central air, alarms stem and 9 y a Additional Pictures ' " z : r .. .,. fps � ' � �}, 3 �� '"'''c^� y„n✓^' # t: a`SA` _. {l � ,� 3 5 �.f`',.` j f`Y"Sic.v �'' �`�'s` !; ' .z��.:�.Df'< .i➢ ; f v� i. - x�� t Pictures(13) Attached Docs See M Agent Carole A Lange (ID:U2NG)Office:508-430-8288 Office Today Real Estate(ID:TODY3)Phone:508-430-8288, FAX:508-430-8291 Property Type Single Family Property Subtype(s) Single Family Status Pending(03/31/07). Estimated Selling Date 06/20/07- Town Barnstable Commission Sub Agent Comm. Buyer Agent Comm. Dual Agent Comm. Dual Var Comm 0% 2.5% 0% No Facilitator Comm 2.5% Listing Type Excl:Right to Sell Owner Name Patel County. Barnstable Tax ID 217050001 Beds 4 Baths (FH) 3(2 1) Approz Square Feet 3794. Sq Ft Source Owner Estimated Lot Sq Ft(approx) 2 Lot Acres(approx) 0.000 Lot Size Source (Assessors Recor Year Built 2002 Publish To Internet Yes Listing Date 09/13/06 All"Office Remarks Please call listing office for all showings.Or call my cell phone at 508-962-4999.Owners would like some notice to show. Directions To Property Route 6a to Stonewall Drive.House is on the Right.Route 132 right onto 6a,first road on the left,#46. Pending Date 03/31/07 Listing Page Commission-Other 06/' . Showing Instructions Appointment Req:,Call Listing Office http://cciriils.rapmis.corn/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 6/6/2007 I NILS Page 2 of 3 General Page Zoning Residential Year Built Desc. Actual Total Rooms 8 Total Levels 3.0 Basement Baths 0.0 Level 1 Baths 1.0 Level 2 Baths 1.0 Level 3 Baths 1.0 Basement Yes Basement Description Full,Interior Access,Walk Out Foundation Concrete Foundation Width 68 Foundation Depth 44 Fndation Wing Width 0 Fndation Wing Depth 0 Irregular Yes Lot Depth 0 Lot Width 0 Topography/Lot Desc. Level,View,Wooded Association No Annual Assoc.Fee $0 Assoc.Fee Year 0 Garage Yes #of Cars #3 Garage Description Attached,Direct Entry,Door Opener Parking Description Improved Driveway,Paved Driveway Year Round Yes Separate Living Qtrs No Waterfront No Water View No Convenient To Golf Course,Major Highway,Shopping Miles to Beach 2 Plus Water Access Beach,Harbor Beach Description Bay,Harbor Beach Ownership Public Street Description Cul-De-Sac,Paved Interior Page Fireplace Yes Number of Fireplaces #1 Master Bedroom 20x17 Level:Third Floor Mstr Bdrm Features Balcony,French/Patio Door, Private Master Bath,Walk in Closet,Wall to Wall Carpet Bedroom#2 17x17 Level:First Floor Bedroom#2 Features Balcony,Double Vanity,French/Patio Door,Private Half Bath,Walk in Closet,Wall to Wall Carpet Bedroom#3 17x17 Level:First Floor Bedroom#3 Features Balcony,Deck,Double Vanity, Private Half Bath,Walk in Closet,Wall to Wall Carpet Bedroom#4 14x17 Level:Second Floor Bedroom#4 Features Bay/Bow Windows,Closet,Wall to Wall Carpet Foyer OxO Level:First Floor Laundry Room OxO Level:Second Floor Living/Dining Combo No Living Room 26x26 Level:Second Floor Living Room Features Balcony,Cathedral Ceilings,Ceiling Fan,Deck,French/Patio Door,Gas Fireplace,HU Cable TV,Wood Floor Dining Room 14x18 Level:Second Floor Dining Room Features Deck,French/Patio Door,Wood Floor Kitchen/Dining Combo Yes Kitchen 12x18 Level:Second Floor Kitchen Features Breakfast Bar,Built-ins,Dining Area,Upgraded Cabinets,Upgraded Countertops,Wood Floor Floors Hardwood,Tile,Wall to Wall Carpet Exterior http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 6/6/2007 f MILS Page 3 of 3 1 Style Cape Style Description Contemporary Pool No Dock No Exterior Features Deck,Exterior Lighting,Prof.Landscaping,Hot Tub,Undergroud Sprklr,Yard Roof Description Asphalt,Pitched Siding Description Clapboard,Shingle Mechanical Heating/Cooling 3+Zone Heat,AC Central,Natural Gas,Gas Fireplace,Hot Water Water/Sewer/Utility Septic,Town Water Hot Water/Water Heat Natural Gas Legal/Tax Annual Tax $5594 Tax Year 2006 Land Assessments $268500 Improvement Asmt $4300 Other Assessments $498300 Total Assessments $771100 Annual Betterment $0.00 Unpaid Betterment $0.00 To Be Assessed Unknown Mass Use Code 101-Single Family Plan 382/036 Title Reference-Book 15996 Title Reference-Page 240 Land Court Cert# 0 Underground Fuel Tnk No Lead Paint No Flood Zone Unknown Information has not been verified,is not guaranteed,and is subject to change.Copyright 2006 Cape Cod&Islands Multiple Listing Service,I All rights reserved Copyright©2007 Rapattoni Corporation.All rights reserved. http://ccimis.rapmis.com/scripts/mgrqispi.dll?APPNAME=Capecod&PRGNAME= 6/6/2007 ' TOWN OF BARNSTABLE BUILDING PERMIT•APPLICATION.. r v i Map Parcel V Application# o� �� 7� / Health Division Date Issued ` as 6-7 Conservation Division Application Fee Tax Collector Permit Fee , o _ Treasurer Ok d S o 7 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ; Project Street Address to - Village Ca�� Arm) Owner -KIJl�K1 Address k Telephone '72T�10 b Permit Request �-- ` FF Az-� C>� -.1 Square feet: 1st floor:existing proposed 2nd floor:existing proposed I Tot al'new= Zoning District Flood Plain Groundwater Overlay i Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. cu / I — M Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure �0/ Historic House: ❑Yes U4 On Old King's Highway: ❑Yes wl�o Basement Type: QVfull ❑Crawl V4kout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing -7 new First Floor Room Count Heat Type and Fuel: S*Gas ❑Oil ❑ Electric ❑Other Central Air: art es ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes eNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Eglexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes v(No If yes, site plan review# Current Use e�► . Qk10_—%&J Proposed Use 5twe_ BUILDER INFORMATION Name Telephone Number Address �{,�7` q License# 65T4061 1 jz�-g OIA---&42 Home Improvement Contractor''# 5 9 Worker's Compensation# Wr iI "ZvJ S ` 3 82 0k201 7 ALL CONSTRUCTION D J IS RESULTING FROM THIS PROJECT WILL BE TAKEN T I SIGNATURE DATE q,17B'7 J \ \ FOR OFFICIAL USE ONL / . . � : . . • APPLICATION* y\ . DATE ISSUED g , . y • . . « . , - . . UAP/PARCEL NO • \ . ^ � . . \ ADDRESS ' ® VILLAGE ' . . . OWNER \ . . . . . / DATE OF INSPECTION: a . . FOUNDATION ` FRAIVIE $ , w�3 INSULATI (� FIREPLACE g . ® ELECTRICAL: ROUGH FINAL . . fPLUMBING: ROUGH FINAL . . .. / -GAS: ROUGH . FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � \ \ The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 , 'www.mass.govldia Workers" Compensation Iusuraiice.Affidavit;,Builders/Contractors/Mectricians/PIumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual):. iL- -4 V Address: 14 2 E1��A4C- City/State/Zip: Phone.#: �Are you an employer? Check the appropriate box: -Type of project(required):, 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-,time).* have hired the sub-contractors 6. ❑New construction . 2.XI 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. 10. Electrical repairs or additions required.] 5. [] We are a corporation and its ❑ P '3.El officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12•[]Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' . •13.0 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. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or notthose entities have employees. if the sub-contractors have employees,they must pravidh their workers'comp.policy number. , I am an employer that is providing workers'compensation insurance for my employees Below isthe policy and fob site information. / Insurance Company Name: (il p/ k•y Policy#or Self-ins.Lic.#: S 2 4ebo�(Zt2_ Expiration Date: ej'26•o s Job Site Address: �1�_ pLu/��-(— Jf� City/State/Zip: ,_n"recc 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 MGM 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 maybe forwarded to the Office of Investigations of the bIA f r insurance coverage verification. 16 hereby certify under 6 6 ains•and penalties of perjury that the information provided above is true and correct Sienature: Date: •/7'o Phone#: ti Official use only. Do not write in this area,Yb 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 CIerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: •i ��z►+e,gyy . Town-of Barnstable Regulatory Services $.NSTs�. r ThomasF.Geiler,Director 163g. �� B u1 ding D1Y1s1UI1 Tom Perry,Building Commissioner 200 Main Street, Hyarrr�is,MA 02601 Office: 509-862-4038 Fax; 508-7.90-6230 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 fovr 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: 1541OPC f%f22t9 _Estim4ted Cost Address of Work: 4VL � ��/,�. �?,,✓ �a� .,.� Owner's Name: Date of Application:�_�''7 Q 7 I hereby certify that: Registration is not required for the following reas on(s): E]Work excluded by law RJob Under$1,Q00 ❑Building not owner-occupied ElOwnea.pulling own permit Notice is hereby given that: OWNERS Pt1L.LING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME 1I12PROVENIENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the o d7 Date Contractor Name Registration No. OR Date Owner's Name Town of Barnstable.. Regulatory Services We�i.E,$ Thomas F. Geiler,Director 9. so* Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl a.maxs Office: 508-862-403 8 Fax: 5 08-79.0-62 3 0 Property Owner Must Complete and Sign. This Section If using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all shatters relative to work authorized by this building permit application for . n .. (Address of Job) ' Signature of Owner Date PAN=�e I QFOPVS:OwNE ERMISSION Liberty Mutual Group Liberty P.O. Box 7202 Mutualm Portsmouth,NH 03802-7202 Telephone(800)653-7893 Fax(603)-431-5693 July 31,2007 TOWN OF BARNSTABLE ATTN: BUILDING DEPT 200 MAIN ST HYANNIS, IVA 02649- RE: Certificate of Workers Compensation Insurance Insured: R ANDREW PRCHLIK DBA MAIN STREET BUILDING PO BOX 346 CENTERVILLE, NIA 02632 Policy Number: WC2-31S-362030-017 Effective: 5 /26/2007 Expiration: 5 /26/2008 Coverage afforded under Workers Compensation Law of the following state(s): MA Emplo;Jers LiabiliriLimits Sole Proprietor/Partner Coverage Election: Bodily Injury By Accident: $ 100,000 Each Accident The workers' compensation ' polic}-does not provide Bodily Injury by Disease: 100;000 Each Person coverage tor: Bodily Injury y b r Disease: R ANDRI:W PRCI u,IIC 1 1 ) ) � 500,000 � Policy Limits As of this date, the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. T'he--insurance afforded by the listed policy is subject to all the terms, exclusions and conditions, and is not altered'by alit'requirement, term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not an insurance policy and does not amend, extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty IVIutual will endeavor to notify you of such cancellation. I 6-0 AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those companies. cc: Insured: Producer of Record: R ANDREW PRCHLIK FIORGAN INSUkANCE AGENCY D13A DL1IN STREET BUILDING PO BOX 250 PO BOX 346 CENTERVILLE, MA 02632 HYANNIS, NL-1 02601 i` r GJIe Po�,>rnZo�Z.realt! o/, Qc�c/auaella t Board of Building Regulations and Standards f } Construction Supervisor License License�CS 80591 t �' Birthdate 6/28/1972 i E(piratton 6/28/2009 Tr# 14591' I RestrrcUon 00 RICHARD A PRCHLIK , PO BOX 346 CENTERVILLE,MA 02632 Commissioner i ` � ✓�ie IJomvnw7uoecrr!C�i a�./�,aaaactucoeCla '. 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: i Registration: 135897 Board of Building Regulations and Standards One Ashburton Place m 1301 Expiration:.-5/17/2008 Boston Ma.02108 ` Type: -Individual y _ .I 'RICHARD ANDREW,PRCHLIK RICHARD PRCHLIK t ' 292 FULLER RD .�Q-� CENTERVILLE,MA 02632 Dcnuty Administrator .� Not alid without.signature El - AWAVA ax;oZz, Ar • a o a I � / 01 �- -- :.. . . ........ - SHEET—OF— CABINETRY THIS DRAWING IS THE EXCLUSIVE APPROVED BY: ON:n p� O •�. 0 -/ jHIS DESIGN ESPECIALLY FOR: _ PROPERTY OF: - � 1,,I►'Jly/1 rW/ 1!'/�`O SCALE STYLE: REVISIONS: WALLS BASES E 11 U O M CARINETRY WOOD , 1. 2. FINISH NOTES: DESIGNED BY DATE HARDWARE:' AND MAY NOT BE-RELEASED DRAWN BY DATE 3' WfTHOUT PERMISSION. HINGES � DOORS DRAWERS i • G'-o� +' Sn• IG-a° �•.o" (n'_0 12,_0,� �,_o. O � ` 4 O ON _ O p 11 < �, d N io -j Q'i ! I •i I:I Po1T �4.(i. _ �STC.LI. BC:AM I<bC�A.. CD i -IO 11 ( 0 4,•A, PogT HDwiOgA��_ wl ® � it � L(y•k24 � � d 0 1 �� 11 y �jv 1 1 :-•� '� " 4"Gon1GM CTE 3LAL Iy) - - I. 1; ® I RI < '`!!I :( 1I giA o Aeo•+C 1 U t v v i .f'11 to BEDP.00M`�2 :1 j:I DECK + -- O I I •:� i '� �! WA"2x45'ruD51t+'F J A '•n O WALL O'1LY •O 70 i I z•.a hT'uo5@ ID'v.c.. OG `_° v Y 1 0 NOTE'! MOP fEC PaEy106wrGE FOP: I. • �G�op YTT►�, F-L iEFw�AUc_TIO{. S1W ,-L-IbHt1 5Fl1't,~ - -- —_ Wt,'>l'OS►,NSTI.G.L.E MJ�. To+yy GO1`OTTES.1►JCj G�UE AUO ALL LOGAL.' ON B'_a" b'- o'_.. .. 5.0" G'-a� FIn rT' FI_ooli PLA.tii 7r I.LL nIM EjPubONS 446LL !t VILMIFIEO BY i T Ow.l@ 5 I.w1 tFSS C�ENEP.AL cnwlwt.h,. bAdW�.I G`1 O•NC•�.M10. OP. DMIOP• TP THE SY/.PaT or COWIITv-.c_ 24'. O' '(IGwI IfRSZ': FLOOR PLAN - a``T'E 14L00t cl ! 4Y4a I'_ I� a _ .Mar-30. 2011 7:42AM No. 4013 P, 1 Scott E. Crosby Builder, Inc. 1112 Main Street,Unit 47..0sterville,MA 02655 Phone (508) 428-9090 Fax (508) 428-9080 FACSLMILE TRANSWTTAL SHEET TO: q FROA—. COMPANY: . DATE: � ll FAX NUMER: # OF PAGES INCLUDING COVER: LD URGENT .D FOR REVMW +i 0 FOR YOUR USE G PLEASE REPLY NOTE/COMMENTS: I :10 NATi . Ma r,.30. 2011 7:43AM No. 4013 P. 2 roWN OF BARNS-TABLE Building Application Ref: 200705919 i 191►ItNSTABLlE;, s Issue Date: 09/25/07 Permit Mass. �A 1639. .0� Applicant: PRULII�RICHARD Permit Number: B 20072340 Proposed Use: SINGLE FAMILY DOME Expiration Date: 03/24/08 Location 46 STONEWALL DRIW Zoning District RF Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 217050001 permit Fee$ 32.80 Contractor PRHL7K,RICHARD Village WEST BARNSTA BL App Fee$ 50.00 License Num 80591 Est Construction Cost$ 8,000 REynarks APPROVED PLANS MUST BE RETAINED ON JOB AND REMODEL FIRST FLOOR BATHROOM-MAKIN 1 INTO 2 THIS CARD MUST BE KEPT POSTED UNTIL FINAL ALL INTERIOR INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner oa Record: 'PATEL, KIRTIKUMAR S 81 RAGINI K BUILDING S$ALL NOT BE OCCUPIED UNTIL A rFINAL Address: 46 STONEWALL DR INSPIECTION HAS BEEN MADE. BARNSTABLE, MA 02630 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANtPART THEXtOF,EITHER TSMPOinY OR PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER Ta BUILDING CODE,MUST BE APPROVED BY THE)'UR.ISDICTION STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. TIAE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINWUM OF FOUR CALL INSPECTIONS REQUIR D FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST 17L.UE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL M1 ABERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID Ili'CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE TP!PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.I42A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS C' o 4a-F 3 I Heating hlkpeL4ion Approvals EAgineeiring Dept Fire Dept 2 Board of Health Ma r-30• 2011 7:43AM No. 4013 P. 3 °FIKE TOWN OF BARNSTABLE Building0 Application Ref: 200704663 UARNSTAIMLF, 2 Issue Date: 08/10/07 Permit MASS. Applicant: PRHLIK.,RICHARD �i°rFp Mpl°' Permit Number: B 20071905 Proposed Use: SINGLE FAMILY HOME Expiration Date: 02/07/08 Location 46 STONEWALL DRIVE Zoning District Rp Peraut Type: RESIDENTIAL ADDITION/ALTERATIO Map parcel 217050001 Permit Fee S 25.00 Contractor PRHLIK,RICHARD Village WEST BARNSTABLE APP Fee S 50.00 License Num 080591 Est Construction Cost$ 3,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND ADD SHOWER TO EXISTING BATH 'PHIS CARD MUST BE KEPT POSTED UNTIL FINAL _ INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: PAYEE,KIRTIKUMAR 5 et RAGMI K BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 46 STONEWALL DR INSPECTION)BAS$EST MADE. BARNSTABLE,MA 02630 Application Entered by: JL Building Permit Issued BY: 1 .,, f THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANY PART THEREOF,EITHER TFMPORAMY OR PERMANENTLY. ENCROACHEMLNTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THEW ING CODE,MUST BE APPROVED BY THE IMSDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS, MINIMUM OP POUR CALL INSPECTIONS REQUIRED FOR ALL CONSTTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2•ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIIUNG&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEJ BStRS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY, WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELEM- ICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). POST H • SO THATISi BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL]INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. �w Map Parcel Application# corm .(� .. Health Division Date Issued i Conservation Division Application Fee Tax Collector Permit Fee � �, OCT Treasurer 6-7 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address � y � Village r Owner Address Ll� Telephone 7el ' Permit Request o CD �F w cn Square feet: l st floor:existin 090 proposed 2nd floor:existingC proposed �? Total news Zoning District Flood Plain Groundwater Overlay iO o r Project Valuation av Construction Type ^' m Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Vk Historic House: ❑Yes P-No On Old King's Highway: ❑Yes ❑ No Basement Type: LirFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count 2- Heat Type and Fuel: 3•Gas ❑Oil ❑ Electric ❑Other Central Air: d-Yes ❑No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:trexisting ❑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 k;?& f %d{ & Telephone Number Address 2 �( 'p p License# (,s-�2o 05—g1/ �F-p-,FyI 0c.LL' bV/T 0-& Home Improvement Contractor r Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOc- SIGNATURE DATE 7 3lJ OJ r.= FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED E MAC'/PARCEL NO. " ADDRESS VILLAGE -. OWNER DATE OF INSPECTION: FOUNDATION FRAME 3 d INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL fi ;4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING NI a-c( L9 v DATE CLOSED OUT, ASSOCIATION PLAN NO. ,p~ The Commonwealth of Massachusetts Department of Industrial Accidents , Office of Investigations UV. 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers} Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/organization4ndividual): . Address:9� n,Lc-�2 �n City/State/Zip: 6fWf{ K04e,&' i Phone.#: 295, Are ou an employer? Check e appropriate box: Type of project(required):. 1.F am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the stab-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. [ 'Remodeling ship and have no employees 'These sub-contractors have 8. ❑Demolition working for me in anycapacity. employees and have workers' #• 9. ❑Building addition i [No workers' comp.insurance comp.insurance.t' Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ eP 3.❑ I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . •13.❑ Other comp.insurance required.] . *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. t Homeowner;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 isihe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: eAzw A Expiration Date: Job Site Address: City/State/Zip: U`' % ► 1�i ao�- G . 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 maybe forwarded to the Office of Investigations of the DIA for insigg2e coves e verification. I do hereby certify under the sand penalties of perjury that the information provided above is true and correct Signature: Date: 7 Phone#: v ' Official use only. Do not write in this area,to be completed by city ar 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#: w t Information and. Instructions T Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three aparhnents-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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall•withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the inrance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are regiured to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The.Department h tprovided 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 susre.to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if-necessary) and under"Job Sile Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (Le. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,'-telephane•and fax number:. - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 4.06 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia I Liberty ' 10� UING OFFICE 354' IVIUtUaI.. Workers Compensation and INFORMATION PAGE Employers Liability Policy COUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group/Boston 1-362030 0000 LIBERTY MUTUAL FIRE INSURANCE CO. POLICY NO. TD/CD SALES OFFICE CODE SALES CODE N/R 1ST 'C2-31S-362030-017 XX X WESTON 102 REPRESENTATIVE 3000 1 YEAR ASSIGNED 2007 Item 1.Name of R ANDREW PRCHLIK Insured DBA MAIN STREET BUILDING FEIN 5170535154 Address PO BOX 346 RISK ID 649731 CENTERVILLE,MA 02632 Status 01INDIVIDUAL Other workplaces not shown above: SEE ITEM 4 Mo.Day Year Mo.Day Year Item 2. Policy Period: From 05-26-07 to 05-26-08 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A.The limits-'4 our liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is subject to verification and chan e b audit. Premium Rates LINE 110 Basis Estimated Per$100 Estimated Code Total Annual of RE- Annual Classifications No. Premiums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 ( MA ) Total Estimated Annual Premium $ 500 Interim adjustment of premium shall be made: ANNUAL This policy,including all endorsements issued therewith,is hereby countersigned by Authorized Representative Date 07-10-07 I i Dividend NEW BUSINESS 07-10-07 NR MA NEW Loc.Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol.H.G. Home State GPO 4030 R1 Copyright 1987 National Council on Compensation Insurance -WC 000001A I INSURED COPY (aI�O III !1 I 11 -CpIV 1 1 - � 10 0 dCD • � 1 J i It .a- ' W • Qi t V09T Q •� j i •t � I i I © 4•.V� _-+ �SR.Ca. OCEAM I.6!1Yt.. �,•4 VoyT _� ;� GAR GARAGE 1 HdNOpoi..t '� ' O 0 Z'IQ. AWhTfip.y �� &(,," IIO o �J II y J I 12•o w v . Y•,_ �,-Q" 1 411 GONGP+ETE. 3LA,C �- _ 7 1 w(w.w.PL •• I L I ® colt 5 STEEL Bf�AM AOave.it ( N O U ? , 1 I.(•'' i .LOW �' lb to gEDRootit2 ° `� ° :I -� DECK •I 1 I I�I.o'. 1'1.T�: .. N - � - --- °- ,� ° -' � III �'I. ;, � .! Ir •p m I '1xCoS'1�1Dh 1"FlooPi , O � � �� - '.i�I :. �ASi.MENT.�T►l�'�WALL O►-�l.`t � A ,p Q A CIO ►D OTE S ESOP SEC P+ESICfcNGE Fr?v; 'I.ALL Gp1JS'1�UG"i'ION SNALL eH It�J CON- ----- _ -- STOwJw/+t..L. pglvkL FO^MA►►��E w(T"1E MI.SSAGNUSEII� — Wt�.l' Ot►�.NyT1.p.�E MI►• yTil�Tlic Dl7�LD�AIG CODE AfJO ALL L G+IL.' I.On BI_O,1 e,- O1 ....�f_o� 6,-oM zvww GOOES. 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MA:'=L:.a..l��.•.�� t,'. ' TFIIPSO PL-OOP, PLAtV SGALS 1411.i,-011 24%- IO�CONGI?,�'Tt P!'�P, c,v.c•, 40. 8 4u L4ell ofsor 411 a S r- I � ,v i l ^� i • I � _ I 1 J —1 I CI a O I Ar CGwt:;�.El'&. �j1.tiJ4 rl,'N../,'r I m O S 1 I v P• 1 �� ;(,..4 STudj _f � I lbv..,,l.AtG•.f:cr.F��/. �•, '',' 4 . IL Ito" I o I � r • � <_�._r .F I ( 8$r�I1�OCKET I I O 'I'MP iK F[,Wx.r. � I f I II -r I TtCn; 'P��7oDa Mf.l�w� ' I) !.. I D 2 1••Icy".I of FOOTrw1:� 4�I:a I I II LtlTOP OF Ff�VI.1UATI^�1.1 I� _r I OP,o{'F9GR"q t' 'T(,1• �,1.. I :1:S.l•:`�H'. I ;� -p -f ^I. I ' 10".¢Got-I G KC-1 • If- Io° ef'-t^" ls'_�° PItP" wj^-o":.^.'-<.. O 12-P•lltr.11ti l"(,aetJr 8'•O"NIC1H FCt.ItJGATlowl WAt.I.. t.(- UR F'OC.rrty :( NOTE`, '^ r l r 1 T' - r o:,o ..c:,. f:• , , I. A.U—FOUN0 ATt owl FOOTINGS ;l14.1.-1 w FOUNDED'ON UNOI��T'UM,t:rEl7 5t.11TAld_E .�. 8', , �" p,�_(o� 9'_4r1 (y'-p w• yh,e•rl�i,'rtee'..:,ML::/,•,.I: i'•t11'•i SOt 4 f. ANI ' FOLI�.IDATIn1 I PL � ....,,-J:' '.l_. •I.t:(:• I. ••�'/. ',..•.,•,.t; OPSAw•!►.ttiv+ OwC�.ND.' .Fret •• _ A.M M:.�µNIC'n: ..L ' ALL DIMEIJSIONS Aw,ET'pt.'E. vcaRtr•'tr � FOUN:DAT ION PL AN 51( T"e nw,�ty;•;�M.tlr ��:•.Nf_►^,rV•. t'.'wl GAL.@ ' 14 TPlAGTOP •t -O I-`�_001 � r'Y.t,►, i' hb,' '1" C.a�►3:.Ir.r f . ,r E,, Town-of Barnstable Regulatory Services sAar�srAB , z Thomas F.Geiler,Director 9 MASS. �prEL k� Buildinor Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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: 7-1 /g',-n. ff & Estim4ted Cost TOU!/ �Lddressof Work: T[� Owner's Name: u ! t OA,- Date of Application: 7 P I hereby certify that: Registration is not required for the following reas on(s): []Work excluded by law ❑Job Under$1,000 Building not owner-occupied MOwner.pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED PENALTIES.OF PERJURY I hereby apply for a permit as the agent of owner: Date Contractor Name Registration No. OR Date Owner's Name Q:fm=hameaffldav I_ . .,: ✓�ie VanvnzorN�rea;l� o��aeac�iicaell '� � Board of Building Regulations and Standards j License or registration valid for individul use'only41 _ — HOME IMPROVEMENT CONTRACTOR s• before the expiration date. If found return to: 1. Board of Building Regulations and Standards- Registration .135897 One Ashburton Place Rm 1301 Expiration 5/17/2008 ? Boston,Ma.02108 � Type .Individual RICHARD ANDREW PRCMLIK; RICHARD PRCHLIK* ' .292 FULLER RD CENTERVILLE, MA 02632 Deputy Administrator Not valid without signature - - 'few j I Board of Building Regulations and Standards i 4 •p ,, ,,:Construction Supervisor License � I License:�CS 80591 3 B i rt h d a te:ff6/.•28/197 2 I �T ;I ~Expiration,._612812009 Tr# 14591 I Resfriction_=00 RICHARD A PRCHLIK= - I P.O BOX 346 CENTERVILLE,MA 02632 Commissioner aoF-n�1p�y Town of Barnstable. Regulatory Services Ate'Uss Thomas F.Geiler,Director ArF ��1� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I Cy�• /� GsQ I/�� as Owner of the. , subject property hereby authorize::Y, �� 7 G �.�C�� i.1t:��6�— t to a cto$my behalf, in all matters relative to work authorized b7this bolding permit application for. . (Address of Job) Signature of Owne Date Print Name QFOPM5:0 WNF_RPEPJVMsION Ju 1. 22. 2010 3: 38PM No, 2958 P. 2 SCOTT CROSBY BLIILDEK , 1NC. . CUSTOM HOMES REMODELING• PROPERTY MwNAGEIViEhT J� P� Y (}� }J (4- ,IM OF July 22, 2010 To Barnstable Building Department I am requesting a copy of the information on file for the property at: 46 Stonewall Drive, West Barnstable Thank you, Scott Crosby 9 - N � r 2oJ • � J 1112 MAN STREET,Uri'7,OSTER'VIL E,MA 02655 e nL:508.428.9090-Fax: 508.428.9080 -SECROSBY@VERIZON.NET �t 46 Stonewall Drive West Barnstable, MA 02668 September 16, 2010 Building Inspectors West Barnstable: Please note that as of June 2010 Scott Crosby Builder; Inc of Osterviile MA has been managing the renovation of the 46 Stonewall Drive property, and they will be using Fuller Electric for electrical work and Holcomb Plumbing for the plumbing. The previous contracting, electrical and plumbing businesses are no longer working on this property. Feel free to contact me at 413 329-4658 if you have any questions regarding these changes. Yours truly, Carol R. Takvorian APPLICANT INFORMATION —7 7 V 313 p !� - - (BUILDER OR HOMEOWNER) / Name D4 LD Telephone Number "2 L I 3 2 Z l Address AD License 0 L. �, > (7 SSA_ Home Improvement Contractor# 1. t t� Get y Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Dizo DATE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION I 'Application��Map # Health Division Date Issued Conservation Division Application Fee y w Planning Dept. Permit Fee 1 Z Date Definitive Plan Approved by Planning Board ID` Historic - OKH _ Preservation /Hyannis �:-Project Street Address 6/lA 5-kyle 4-,tsf 'Rann&dtt a2,&&& Village bla -Owner Cara I R I'a l�v�, Address y2 Old /►'►.pa&1eS^ tKd afiri Telephone y1s 3 2=6 -V_t& �_c Aw ; Permit Request %�-j � ALA!.AnL C- ��j a e> Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 20ning District Flood Plain Groundwater Overlay *-Project Valuation aa�o oo, o v 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: Cl Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Y Central Air: ❑Yes ❑ No - Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new csize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: CD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0 No If yes, site plan review # Z5 na Current Use _ _ Proposed Use y -- -. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Cum t /Z 7o Telephone Number 3 zq - (16, � Address' 'f C' License# S -7 I G41eSf-7 AMS"a6Le. , 944 0;2�6tf- Home Improvement Contractor# Worker's Compensation # — ,A--,.A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE { FOR OFFICIAL USE ONLY APPLICATION# ' j -DATE ISSUED = 3 C z MAP/PARCEL NO. 7� ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: �I�FOUNDATION = = FRAME INSULATION'S { FIREPLACE ' ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL 4 . " GAS:- AF ROUGH F&7Vgs° < c.r FINAL _DATE CLOSED,OUT ASSOCIATION PLAN NO.' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street j. Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �� S `, �/L A City/State/Zip: Q c_�} s5 �� OM 4::— Phone #: `� % ( 3 (-2) Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.i�L Iam a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ 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 officers have exercised their 10.❑ Electrical repairs or additions required.] . 3.❑ I am a homeowner doing all work right of exemption per MGL 1 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 *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy #or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under ains a d penalties of perjury that the information provided above is true and correct. Signature: Date: 4C7 o . Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other. Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have.been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license.or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia r . . oFtHElp�, Town of Barnstable Regulatory Services 9 en lab Thomas F.Geiler,Director 4i'°rFo;�.�a�� 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 Tc, k'V." , as Owner of the subject property hereby authorize a n//+L7() ,, �to act on my behalf, in all matters relative to work authorized.by this building permit application for: Okve- I,J�Jf�3G✓/1SflthCQ� /yam GLGG� (Address of Job) Signature of Owner Date Print Name If Property- Owner is applying for permit.please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISSION SHE Town of Barnstable �Op Tp�y y�P Regulatory Services + BARNs,rABLE, Thomas F.Geiler,Director ,p MASS. g. ' 039• A,0 Building Division/' lEn MAC Tom Perry,Building Comnu7sstoner 200 Main Street, Hyannis,M�1 02601 www.town.barnstable./ a.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE XEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home hone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was ea en d to include owner-occupiedAwellings of six-units or less and I to allow homeowners to engage an individual for h' e who does not possess a license,provided that the owner acts as supervisor. DEFIN TIt OF HOMEOWNER Person(s)who owns a parcel of land on which h /she re§ides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or d tached st�uctures accessory to such use and/or farm structures. A person who constructs more than one home in/a two-year p�iriod shall not be considered a homeowner. Such "homeowner"shall submit to the Building 9�fficial on a form cceptable to the-Building Official, that he/she shall be responsible for all such work`perfo' med un/der the buildingpe t.`(Section 109.1:1) The undersigned"homeowner"assumes responsibility for compl\ce with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"ce/tifies that he/she understands the Town of Barnstable Building Department minimum inspection procedure /and requirements and that he/she will comply with said procedures and requirements. " Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger \berequ ed to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions j 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 permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forrns:homeexempt 1 __ - !Vlassachu�ctts- Department ul'Public Safety r 'Board ofAuildin!g Rclguhttions and Standards Construction Supervisor License License: CS 51171 DONALD DUBERGER * PO BOX 303 POCASSET, MA 02559 Expiration: 7/20/2012 Commissioner. Tr#: 5,41 r HIC Registration Lookup Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation The list is current as of Friday, December 17, 2010. '°rwu, You can search/filter the registration list by any of the criteria below. RELATED LINKS Search by Registration Number 154856 Search Registration Number Search by Registrant Name Search.by City Zip Code Search Registrants Click on the registration number to view complaint history.You can also ;c.°.:ri.iira±i'r:.;:;;1 i;nr:a ae-un::i Search Resuiss REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS DONALD DUBERGER,DONALD ;= Q=.6 866 SHORE RD. 4/10/2011 Current DUBERGER POCASSET,MA 02559 O 2010 Commonwealth of Massachusetts I Changing the Way You BuildTm Trus Joist•Microllam LVL Specifter's Guide 2020•August 2003 All Weather Gear: Microllam° LVL with WatershedTM Stability Overlay You never know when weather might bring dramatic changes to your job site. But you can bring one important material that's dressed to weather any storm! Like water off a duck's back, Trus Joist's proprietary Watershed'' overlay protects Microllam@ LVL against { cupping and swelling. Watershed'' is a high-density overlay that may be applied to Microllam® LVL mad manufactured at our eastern and southern plants. This resin-impregnated overlay bonds to the wood veneer, creating a barrier to moisture. When combined with a wax sealant on the ends and edges, it produces a protective layer like no other. Our Watershed'' overlay promotes dimensional stability and protects Microllam® LVL from the elements throughout the construction phase. So request Microllam® LVL with Watershed'' overlay for your next project and be assured that your engineered lumber will stay consistent from start to finish. For more information on Trus Joist's exclusive Watershed'' overlay, please contact your Trus Joist representative. Design Properties 1.9E Microllam@ LVL Allowable Design Stresses (100% Load Duration) Shear modulus of elasticity G = 118,750 psi Modulus of elasticity E = 1.9 x 106 psi Flexural stress Fb = 2,600 psi(1) Tension Stress Fr = 1,555 psi(2) I� Compression perpendicular to grain Fu= 750 p5i(3) Compression parallel to grain Fc11= 2,510 psi Horizontal shear parallel to grain F = 285 psi (1)For 12" depth.For others,multiply by d�o.i36 (2)Ft has been reduced to reflect the volume effects of General Assumptions for Microllam LVL length,width and thickness. • Lateral support required at bearing and 24" on-center maximum. (3)Fc.t shall not be increased for duration of load. • Bearing lengths are based on Microllam®LVL's bearing stress of 750 psi. • No camber. • All members 71/4" and less in depth are restricted to a maximum deflection Of 5/16". Microllam@ LVL is intended for dry-use " Tables on pages 4-7 include reductions applied in accordance with code. applications • 16", 18",and 20" beams require multiple plies. See page 17 for multiple-member beam connections. 13/4" 1.9E Microllam® LVL Allowable Design Properties (100% Load Duration) y Design Property Depth 51/2" 71/4" 91/4" 911z" 111/4 112/s 14 16" 18" 20" N Moment(ft-lbs) 2,125 3,555 5,600 5,885 8,070 8,925 12,130 15,555 19,375 23,580 AID( Shear(lbs) 1,830 2,410 3,075 3,160 3,740 3,950 4,655 5,320 5,985 6,650 , IV _ ___. _ _ Moment of Inertia(in.4) 24 56 115 125 208 A4 400 597 851 1,167 Weight(plf) 2.8 3.7 4.7 4.8 5.7 6.1 7.1 8.2 9.2 10.2 �� II 't_yy „O•,I'„b/4'I'S mil egA�i yak w�wa„Ix Mtn h)o4 ux�a=pd =v si ecx xKv.'.9l spuyv�Pa oa7'S ,vcw.cc+Pa W n Ix W n� uu I ra'4^rt^' . 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U • hedtad Ampdm Ledabq Le dpgad AvdrAa k.rd.Aue � P_ bed Amp lm bd.Aue A"' IV%jf C/] m4y tmbd reed+tvbd � Q braes O v rlvt bra�m ^ f �R', W dimg65s EE AU Arnp dce _ P .Y`� y a pfimdlmf�Amp 1Va^%qVT laud /r rt.". ae aAp}/ qk Amp/ub �rdib �}Prt 1>I P'%1s/d by vtktd'e.d t/rrtmµ �.A+4 teddm Amax Ad 6id:ek � a.0 Acda4e � �� PRmdwW veb/v6 e.m1 ��ui.r M.s.1 flegeey �:.s.��r bbd av A»Ioa Ard6Aebsb _ bdevW bd AedlmN�k+a Aal,.. / redeAmp Mad "-" - NA+aP�ArnF/M a1a..1�n Ladeubkd+d . �;r floorNilEt1S?ri.4l � First Floor 2 1 e/P'%1 aItl'by�t drd b drdegbdbAe bddmAdm+Ad 6dmd ' Imdwd+A.nP bdr 2d 14v by dveMo/fsebdr diwnld. b.tdbaimer t/rrta. re6q yyol.6Ad tbeebq dbdd/••. 6�edmb9 fmanbd+d fare 16rgmrq f/Y'wP�1Nee� I '.sdrd W^'c bddm AaW Ad bldrai IA ltr.bdmrybvb. l dbdd..d pgvrdE d.q6 An.V/aA d eeb9 Austd .pm tG Idw 'f8�.wdkll PG!ILiOYG Tu neddm.l.te.AdbYAmM 3/A"maple treat trill 13 A"LW ablread w/xld bedneW 5mr Pots ad Eln.tkre Ncdtq frat ad Iad to dlv.ml.FbufbAr Iinii�Y - madbiw ArRa ' 63i: Peawgxl carer pad P.dtlCerry rd`�t�5.ffr.flrtl 9 �Elevaticn"West CLI,zl�a -r4' rsi!6Cy�m.can n :Nrd Floor y Sect on th u tread - 5T'� v 1 2 3/411 dla.doer maple top rad 7 I I/4"X 21/2"ze6rawoOd subrad p p • 1I o� stainless steel tube ' as 3/8"X I"staWess steel ba• >/ram-.. 4aaabdudfm vr.ar.�N 1/2"X I"steel support +�+ 2 LMCOM 5ecum �/M'gb�q T VMtMd —d(to7& m4niLvfineq {Q 2J� 2+f M r r I bdm4q 'J Q Fascla l7etad n�y7e StrtY{cr 1 /,"LW abtremd aMN br 6"— Rld e.p t d SffMl[F" r�.W�Y,resden:e ��-'* sL�.Elevdctz,ad nerd+ IaM /G 9lYM Iv10 i 93�i ��1vxT 1/'Cfl1r Stair elevation North '°15�" " �1 5t 1 Trees�2ectl0n elevauon Nath sctle:I 1 .,'q 5T-2 i t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel c9S"�-60Application #,20WZ511 Health Division Date Issued Conservation Division Application Fee ZO Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 4qt f'4-0,UZ60a .)S/L Village "fif9�-�� Owner --T-4-k yp P—tmV Address LKD :64c2 GyoAffl J12- Telephone 530 z' 37,61 3 SM Permit Request kEw-n EXIST/lV�� 11L " �D 2c� iL//JCS All PALI JC1,5 F-4e-IA) _'L4— RVi9d 614,,1cQwceQ.P A.P— !� lA-e Q evia L A, -k �Q W az Er�.r� k.c>� -IS - ice she ' RL-pn— -will 6.e AS Ao bc� �ksfe� o slb-k ItAlamtQAa4 os �u�t - g 456 �.�v�s skoc l Squa�'rr--e feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation J�i'S,0&0 Construction Type A2 Lk A- um Ira. 4 5&� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 0 Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other {Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0-Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:Lq existing '-0 new size-- Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:— `;" -"' Zoning Board of Appeals Authorization El Appeal # Recorded ❑ Ln Commercial 0 Yes ❑ No If yes, site plan review# Current Use Proposed Use �Ai-PLC- APPLICANT INFORMATION _(BUILDER OR HOMEOWNER) r G, Name < 64tJ� Telephone Number ✓�� n_ " ^^ Address Q G )ktj2- Imo- License # '81S Df O Home Improvement Contractor# fC4 q7P Email e�&w Worker's Compensation # I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE if r' FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED w MAP 1 PARCEL NO. ` y f 1. ADDRESS ' VILLAGE OWNER f = DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE 4 ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ti FINAL BUILD.INGft: /0�J-'_ • . lJ i DATE CLOSED OUT ASSOCIATION,PLAN NO: i t > tae t onw=weatnt gmassamuseus Depair anent of Industrial Accidents Office of brvesiigations ` 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Bmlders/Contractors/EIectricians/Plmnbers Applicant Information Please Print Legibly Name(Busmess/Orgzniz onandmduaI): P4t4 Q v( Address: D to 6. Z_012— PLQ • City/StgWzip: WAa�g,4y-w,5 Phone#:6-yk �2Le S-8-2-q Are you an employer?Check the appropriate bon: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general cofactor and I Ioyees(full and/or part time). # ]nave hn ed the suh-confractors 6. ❑New construction2.MII am a sole proprietor or partner- listed on the.attached sheet. 7. ❑Remodeling ship and have no employees' Tie sub-factors have 8. ❑Demolition working for me in any capacity. employees'and have workers' 9. El Building addition [No workers'comp.insurance c� Insurance$ required..] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am.a hom�wner doing a]I woi� ' 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance wed.]t a 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required-]. *Anyapplicant that checks box#1 must also fill out the section below showing their wor1=s'compensation policy information. t Homeowncrs who submit this affidavit indicating they are doing all wodc and then hue outside mntractnrs mast submit a new affidavit indicating such. tCont adnrs that check-this box must attached an additional sheet showing the name of the sub-contractors andsw--whether or not those entities have employers. If the sub-contraetnxs have employees,they must provide their workers'comp.policy number. I a n an employer that is provid ng workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# / Expirafion Date: Job Site Address: -/State/Li .-' b 2,04 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 MGI,c. 152 can lead to the imposition of crin n 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 WORKORDER 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 certi =underthens of perjwy that the information provided above is true and correct S' Date: 5� Phone#: 50,�V '41Zg' Official use only. Do not write in this area,to be completed by city or town off dw City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Bu;lding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- Information and lInstructio., is. Mwacbbsetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statafe,an enployee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or wriften." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged m'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 therein shall not because of such employment be deemed to be an employer." MGL chapter-152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage regmr•ed." Additionally,MGL chapter 152, §25C(7)stares"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 irmwmce requirements of this chapter have been presented to the contacting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLq or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required..Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions mgardmg the law or if you are required to obtain a workers' compensation policy,please call the Department at the umber listed below. Self-insured companies should enter their self-insumce license number on the appropriate line.' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submif multiple penmittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in - (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtainurg a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etas.)said person is NOT required t D complete this affidavit. The Office of Investigations wound hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: The Commoni4Wth of Massachusetts Department of Industrial Accidents Office,of Iiavestkmfiorm (500 Washington Sreet- Bostwn,MA 02111 Tel.#617-727-4900 ext 406 or 1-$77-MASSAFE Revised 4-24-07. Fax#617-727-7749. ww w.mass gGWdia / | ' , . ' ^ ' /4TYC Giode/m Wood in High VodAreius:170anph I-Find Zone . . Massachusetts Checklist ` r Co" ojiaIlce (78DCKIR 53O1:2-Ll)/ ' cu Chmc _ ^~.p.a.~ 1.1 SCOPE. ' Wind Speed gust) 110 "+°. Wind Exposure '--'-------.......� ---- Wind Engineering RNuired For Entire Project.......................................c ---_' 1'� ' DfStDrieS / u»mf ' ez�ya�8\n�2c�poohaUbaconsidered ashon/ sbo�eo �2s�hes ^ ' �131� ' . Roo P��/ __----------�--'-'----'-----'----i�g -----`-'---------'-�----- ----' � ��I K�oanRoof H�ght -'_-'_------'-----'---L�---O�Q ----'�-'----' ----- � � ��7 BuUd�g\��.VV _'__--_'--'-'-'_'---'----'-_-V-g3V-------'�---'----------- ---- � �8O' Bu��p� .L -_------_'-----------'--,-----O�Q -------------------`'---`---' ' � ---- _ _ �31 . Building RaUo[UY� ---^----__'------_'-'-_ 4)................................................. �, ' � ��8^ Nominal Height of Tallest -_-_-'-___-'.�''(�Q4)_-'_-_-----'----..--�-_-_-_ . . 1� FRAMING CONNECTIONS � General compliance with framing connections.......-...........(Table 2)............................................................... -__- � 2'1 FOUNDATION Foundation Walls meeting requirements nf78OC1WR54Q41 Con� ........................ ' Concrete Masonry............................................................._-_.............................................................. � � � 2-2A0CHORAbETOFDOND� O0 . . ' 518*Anchor Bolts4mLedded or 5/8^ ty Mechanical Anchors as an alterhative in concrete only . � Bolt Spacing-general ........................................`[Tab|e41.................:............................. in. -__- Bolt Spa ' hnmend�o�tofp��e..-__-.-.-'__- ---------�-----'�.-- m.�o - '2 ' - � k��T^ � � Bolt Embedment-concm�'-_-_----'-------(Fig '-'---''--'----'-------' ----' . �o�Embedment-masomy'—'--__'`_---------(ng5V--'�.-../-----------_- /n'�/5 � . � Plate ' �lg5) '__��x Y z�� 3.1 FLOORS ' Floor-framingmember checked ��7OOCMR�hapb�55) .-_--- � n�� K4a�m�mF�orDpen�g��sws�n-----_-__----'_(�g _--.-----'`__�� FuUHa��htYVaUEXodnaLRoorDp�n�gsk��U�an2'h�mEx��orYVaUU'�u)-----_'�--_-_----' ' - ---- MbAMLImFIoorJoistSetbacks . SuppohingLoadbaahng Walls orSheanmall....-..........(Fig7).................................................... --ft f-d Maximum Cantilevered Floor Joists � Supporting LbadbeahngVVaUs'nv8heanoaU................ ............................................... ft 15d -F-loorl3racingntEndv*db.................................................... u/'-'-------_----------'----�--'---. � Floor Sheathing -'--.--.------------'-_'_ T8DC�RChapb�55)._.-----_-.-----' __--- � Floor S Sheathing '' mns '---_------_--._-'-'.-'-(»&r7D0 CMRChoph�55)-__--'----. ' h� Floor Sheathing FqshaFing_-..---_----_----�--..�-[[abo2)- dnaUsad �odgo/�__.hmfie� . . . ' . 4.1 WALLS ' Wall Height � LoadbeeringvaU ._- ................................. and Table __-__-_'_�___� �1� Non'Loedbeahngva|�_-�'_�_--.--'--.-�-'-'-'_ and Table --------------------- ft'--27 | Wall Stud _.---�-'_---------- and lab�5)-__.-.-_` k��zm'o.� Wall Story Spacing ................—____--_--_'_---__'_�_U�ga7&O\--_____'--'-.--'--_'�__� �d � � �n � 4-2EXJ�]� WALLS ' � Wood Studs Loadb�ahng�ha��_--__._---._--_-___'-' �)--_-'--_'—_-2x - ftk� � B 2x - in.. Gable End Wall Bracing 8buds 1 VVSP��RoorLsng�_'--_'--�:--.--.-__-'-_-(Mg11 -'--'__-'---------_-_- namou � 'Gypsum 1Y\__-_----'---__--'--- ft�O�VV ' and2x4G-bntinuoua Lateral Bna�e M)............................................................. �--_ or 1x3ceiling Wng strips @16'spacing min.with 2 x4blocking @4ft.spacing in.end joist or truss bays_ ' Double Top 9kafie Sprice Length '_-............:--� and Tab�G)-__-_..-_-___'.___ft ' 3oUoeConnac�on �o of1Gdcommonna��_._--.((auleo]........................................_.............._�_ _--� U � U " i ATVC Guide to Wood Coastructiou in High Wind Areas: 11 D fftph Wind Zorte ' Massachusetts Checklist for Compliance (780 Cii'IR5301.2.1.1)' Loadbearing Wall Connections • Lateral(no.of 16d common nails)..................................(Tables 7) Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(fable B)........................................................ Load Bearing Wall openings (record largest opening but check all openings for corripfiance to Table 9) HeaderSpans .......................................................(Table 9)..................................._ft_in.5 11' SiffPlate Spans ......................................................_.(Table 9).................................. ft in.511' Full Height Studs (no. ofstuds)....................................(Table 9).............................................. .... Non-Load Bearing Wall Openings(record largest opening bitt check all openings for compliance to Table 9) Header'Spans.........................................:........_.........(Table 9).................................. ft' in.512' Sill Plate Spans.............................................................(Table 9)................................._ft_in. 5 12' Full Height Studs (no.of studs)....................................(Table 9)...................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneouslyt Minimum Bulling Dimension,W . Nominal Height of Tallest OpeningZ .......................................................................••--.... 5 6`B" SheathingType.............................................(note.4).................................................:• Edge Nail Spacing.........................................(Table 10 or note 4 if less)............._.......... in. Feld Nail Spacing ..... able 10 Shear Connection (no.of 16d common nails)(Table 10)......................................................._ Percent Full-Height Sheathing....................:...(Table 10).................................................... % 5%Additional Sheathing for Wall with Opening>.6'87(Design Concepts).................... Maximum Building Dimension,L Nominal Height of Tallest Opening2..................................................................:...... 5 618' SheathingType..............................................(note 4).............................................-...... Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. Fiei d Nail Spacing••-•.......................................(fable 11).........................................,......... in. Shear Connection (no. of 16d common nails)(Table 11)....................................................... Percent Full-Height Sheathing....................... abie 11 ............................................ _% 5%Additional Sheathing for Wall with'Opening>6'8'(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... 5.1 ROOFS Roof framing member-spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19) ..... ....... ft s smaller of 2'or V3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).............................................U= plf Lateral.............................................(Table 12)..............................................L= pff Shear.................. (Table 12 ............................................ _ Ridge Strap Connections, if collar ties not used per page 21... (Table 13)............... ......T= plf Gable Rake Oudooker..........................................(Figure 20) ............. ft-<smaller of 2'or L/2 ' Truss or Rafter Connections at Non-Loadbearing Walls _ Proprietary Connectors Uplift---...................................••--•.--...(Table 14)............................................U= lb. Lateral(no- of 16d common nails)_._(Table 14).......................................L= lb. Roof Sheathing Type................:......._........................(per 780 CMR Chapters 58 and 59)............. Roof Sheathing Thickness...................................:...................-............................._in.>-7/16'WSP RoofSheathing Fastening............................................(Table 2)......................................................... Notes: •1. . This checkfist shall be met in its entirety,excluding the specific exception noted in 2, to comply with the requirements of 780 CMR.5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are.not nequired per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 2b Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure i8b 2. Exception:Opening heights of-up to 8 fL shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottDm sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. r r ATVC Grude to Wood Cansfructtou i71 H gh 14 ndAreas: I10 rnph 1ricidZone Massachusetts Checklist for Compliance (790 CNIRs- 3o1 1:l:i)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percer)t Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16'and be installed as follows: L Panels shall be installed with strength ads parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. ll. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of ad staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a)'new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B maybe obtained from the American Wood Council (AWC)website. WRM TNS e)tGERESTS ON FrTAMB EG USESd hKitS • 'ATe� • —� -t�—=— • u tl tt u ti tl t � ' iI 11 w AIt e t tl 1 It it o * I Q n it is 11 t { 1 1 - Y t I or r• t r t 1 !— ti it m' i i If Ir It m n i1 Z ' z Q r l tai� tr rl • �i ii� t l l - �'! i o .i i Irr i i FRAMING h11E ABS:S EDGE&CER MWTE - 1 1 Lt ' J r LI l l z s IS tl 1 1 1 r rc IsLl r - ---_�- i STAGGERED 3'my; EJA�R SPpGkxa p } NA L JW7FE N 'k PANEL rhNB — c{ QOUHu:NAIL EDGE SPAGiHG DE.TAL , See Dalai)on Next Page Vertical and Horizonlal Nailing Vert Detail - for Panel Attachment Detail and Horizontal Nailing � for Panel Attachment �VE� Town of Barnstable Regulatory Services MASS. Richard V.Scali,Director 163A `e�' ' o►u►t• 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 I,— Lai �. Q WQL�-v , as Owner of the subject property hereby authorize k4A)AOAI j S h- to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. � I Signature o Owner ignature of Appli ant Print Name Print Name Date Q TORM&O WNERPERMISSIONPOOLS i Town of Barnstable Regulatory Services roiyy Richard V.Scali,Director Building Division Tom Perry,Building Commissioner nsass. 1639- �� 200 Main Street, Hyannis,MA 02601 CEO a www.town.barnstable ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number sheet village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/to" 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 responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and brat he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S 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 Iack 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 permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILFS\FORMS\building permit foims\EXPRESS.doc Revised 061313 ' B C).► desk P-Ai . Los�lo po=�'s s'Iz • _. • IC n r 3(� MIN. f;. . .. . .... . ... �' - ....... _ � .... • IV �r � A5 i .. .... ..,am•r.:a.•rn-.:.^ru,n^�•.�v�.r_...emna�aro.a+.�avaoo�- n�r�csaars�.•�sr.:'.v- ....-vr_�.,ea...:s. _ . r Town.of Barnstable MAYMOld King's Highway Historic District Committee ""`' 200 Main Street,Hyannis,Massachusetts 02601 iyp (508) 862-4787 Fax(508)862-4784 MINOR MODIFICATION TO PRIOR APPROVED PLAN 972 CAR Rules and Regulations, Section 1.03(2), 1.03: General Procedures (2) (a) Only minor changes may be approved by the Committee without the filing of a new application and a new hearing. Minor changes include alterations that can be done without a detrimental impact on the overall appearance of the project such as altering a single window or door change or a minor change of colors. All minor changes by amendment will require the local Committee's or its.designee's approval. Submit 2 copies of the application and supporting materials an/d documentation Applicant(s),print name Address of proposed work-, 6u � L/2- bg� House No. Street Village Assessors Map and parcel no. A2 0 5—o o d/ Date of approval of Certificate of Appropriateness 1Ll�_s �l r 0/`J✓ Proposed Minor Modification: IAI ` 4`L _-5aJ2Ce f'��Gc-,4G�=� t'1 �/' .7Z4C /Z_d1,6 fZ��65 0�l �� 2 �?-�G S EG�`./o-�a.S �>4�=rGV�• d✓L D[reGP a �� t!�t E� �/Z�-y d ice l dtit-f ;lure of applicant: Paint name: /Z/ t ,�'`l '5&J 6 t:5�- tel no. nk g67 !p3.5- APPROVED/DISAPPROVED: signed //XCHAIRMAN DATE: APPROVED CC: BUILDING COMMISSIONER APR 0 8 Z015 C:IDocwnenta and SettinpidecoffiWacal Seuinp Tempwrary Internet FWAOLK110KH Minor Modification Form 07.doc Town of Bamst•ble Old King's Highi°ay Committee ! A - - _ Ej19 s AN R 1� APPBONED F APR 0 8 2015 4 u I�i Town of Barnstable r- 3 n Old King's Highway .f Committee I �pfTHE Tp�� Barnstable Old Kings Highway Historic District Committee . pp 200 Main Street, Hyannis, MA 02601,TEL: 508-862-4787 Fax 508-862-4784 AMUS& a 9-op 16.19.a�0m rFOMA� APPLICATION, CERTIFICATE OF APPROPRUTENESS Application is hereby made, with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section•6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition ❑ Alteration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof ❑ color/material change, of trim, siding,window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ® Other 6. Pool• ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE All applications must be signed by the current owner Owner(print): 2C �� / � Telephone#: 6V IF 3 5-7 Address of Proposed Work: 5T rtlgkl colt ))t2— Village `V25!tr A-21 C/y" Lp Lot# Mailing Address(if different) _"wner's Signature Description of Proposed Work: Give particulars of work to be done: /Jc4(L A41-LS Gle_c/f a 6F ,e W' Evi` l, Awulw'atvl P_,P iL Src77015 14-5 54 .cuA e-n 76i Agent or Contracto%W)� S SUU 4 Telephone#: 6I V6 42-0 Address: yG Contractor/Agent' signature: For committee use only. This Certificate is hereb PRO Date S ARmbers signatures RECEIVED P P ROV ED u c�v�Tr1 ;!i E� :.-• xEl%i 7 N T `z� ,l.. G fi,rs��- ?� v�A FEB 112015 � Sly'`T^ron of Barnstable V3 Old King's Highway e 5 �\.� `�� committee �\ 4 1 Q:IBoards and Commissions101d Kings HighwaylOKHApplications10KH2O11 Cert Appropriateness.doc CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5-copies Foundation Type: (Max. 12"exposed) (material-brick/cement, other) ' Siding Type: Clapboard_ shingle_ other Material: red cedar white cedar other Color: Chimney Material: Color: Roof Material: (make& style) Color: Roof Pitch(s): (7/12 minimum) (sped on plans for new buildings, major additions) Window and door trim material: wood other material, specify Size•of cornerboards size of casings (1 X 4 min.) color Rakes Ist member 2nd member Depth of overhang Window: (make/model) material color A P P R�VE D (Provide window schedule on plan for new buildings, major additions) Window grills (please check all that apply_. FEB 1 20�5 true divided lights_ exterior glued grills_ grills between glass_removable inte'yn.of SNoaeble Id ma's Highway Committee Door style and make: material Color: Garage Door, Style ` Size of opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Ra�ILS f�rr,tff �rf�c �F /�G'rr: de�� KN-it s y"Beck material: wood other material, specify FV-C, ,AA hill)et 14 Color: GU(L;� //J 61L i�Ct�� i:wlv�C ��.�'�Fc: �r�}Z—I�:LJit/�1i ta.w .-S.kylig", pe/make/model/: material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6') Style material: Color: Retaining wall: Material: OR,OWTH I1��1 AIGElLriEiv i Lighting, freestanding on building illuminating sign OTHER INFORMATION: THE ATTACHED CHECK LIST MIDST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts.etc Signed: (plan preparer) ,1 '�----.G �� Print Name i Q:IBoards and Commissions101d Kings HighwaylOKHApplicationslOKH2O11 Cert Appropriateness.doc t. Town of Barnstable Geographic Information System January 8,2015 2 go 217061 2 so so2t o 23-7 217052 217055WD0 t so 0s3 2170M 237065 0120 217020X01 07055�0 • 2jo as 37007001 IX 076 083 use 217041 # 0 2117048 2170 0003 21702Ox02 A 83 0 76 217043 o ® 217025X03 237007 0 61 217025X04 0 60 0 2160 217041 � 217047 � 0� 237064001 052 065 Gs 00 217042 20ti97 217050003 045 # 060 VIA 2170200004 p 2170�01 ° 217032 042A 7- 1040 217026 _ S'40A' 3 82094 217031 WA GATE LN 217049 y. -� 821 Q w 064 237 217035 217060a1 0 02110 217034 037 217036 046 JI. 018 0S5 zo 2170140a �44217033 21j° 0 02 217018 01820 029 a 72222 02026 217019600 01834 217013 2040 a 81950 217002 en 2170t5 217016 01809 217001 +� 217050002 01990 �g 1998 237041 01825 217010 7011 043 02119 ace 1850 01866 218050 �9iy. 217014 7a 2106036 aj #23 216033 .P 217012 0 1976 237042 01837 i 01894 ® 216074 002103 1 IN 216031 ��Fs ® � 216077 218076001 02085 _ 216078 02021 0 A 2071 16034 20 8 1912 -01934 _..�,.: 216038 .,__02006 ® �.. - 216052 ®Aft a 1989 216030 045 216022 216032 2871 t03 01849 0bl.8.51 216041 216053 02b 0 1945 s216039062 s 057 01895r 01871' 216042• _ o e 218029 216040 216039003 ° 216076002. 216020 218023 216024 01919 .( 02"0 21604 216076VIA0 216076B00 00 236005800 21s07o y ® 216039MI 02D51 020518 071 ` 0 028 or gloss 02240 P R/DGE odeC R � 0 22�0 ° 216067 t218047 21 �1 3 t 216071 216028 0 969 216065 w 1 / 022 is952 0951' DISCLAIMERS:This map is for planning purposes oNy. It Is not adequate for legal Map:217 Parcel:050001 a Selected Parcel N boundary determination or regWatory Interpretation. Enlargements beyond a scale o1 Owner.TAKVORIAN,CAROL R Total Assessed Value:$626000 _ 1'-IW may not meet established map sccureq standards.The parcel ones on this map .W E are only graphic representations of Assessors tax parcels.They are not true property .Co-Owner. Acreage:1.50 acres Abutters boundaries a dloong represent accurate relationships to physical features on the map Location:46 STONEWALL DRIVE such a /f!r building Buffer :�/fA Town of Barnstable Old Kines Highway Historic District Committee HAM 200 Main Street,Hyannis,Massachusetts 02601 .eso (508)862-4787 Fax(508)862-4784 MINOR MODIFICATION TO PRIOR APPROVED PLAN 972 CAM Rules and Regulations,Section 1.03(2), 1.03:General Procedures (2.) (a.) Only minor changes may be approved by the Committee without the filing of a new application and a new hearing. Minor changes include alterations that can be done without a detrimental impact on the overall appearance of the project such as altering a single window or door change or a minor change of colors. All minor changes by amendment will require the local Committee's or its designee's approval. Submit 2 copies of the application and supporting materials an/d documentation r r Applicant(s),print name [L a �4�it '9641 E ft S4 -toC Address of proposed work; f L12— House No. Street Village Assessors Map and parcel no. � 0 5—o O d/ Date of approval of Certificate of Appropriateness Proposed Minor Modification: ` ©et i2 Gyo �F /J2.E-�E� G 119-65 /�2fht/�"�5 /N t/fie `s�i9-�e. �L�GcfOG�=� u ��z 40Z lz A-1,1J�- fL �Z- Signature of applicant: Print name: /� �YZW �Gc� l Z- tel no. ��d'fzfl ��y oue APPROVED/DISAPPROVED: signed CHAIRMAN DATE: APPROVED CC: BUILDING COM MISSIONER APR 0 8 2015 C.I Domnew w d Seumpl daoLU Local SeUuWlTemporwy InurW FdaslOLK110KH Muwr Modtfi=on Fo m Oy dnc Town of Barnstable Old King's Highway Committee ��J �'��'✓I� :.Lr!`. �� t b\� ��4��)-R ��yil. �L,.�� li(I �L~n � 4-®u.�E� �� r aaI -O-v�. L RA-LL. 5t/2 . 5y2.rr I14 ly LIJ 4 2 A�:u m rrJtcrv� �gs�l" vZd ►i f o �L a� co E Arc Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS Massachusetts -Department of Public Safety Board of Buildin Construction e9ulations and Standard S p rVisor ` License: CS-010219 L G rTSH �� 10 W)RELER RDr ;. MARSTONSii NXIELS 9 ` Commissioner Expiration 02/13/2016 t cRe%rir9,cowevealC/o• P1 ffezoaac/aae&%• License or registration valid for individul use ool t Office of Consumer Affairs&Business Regulation .. ... ..... ::'before th;e expiration.datet.:I£:fo.upil:return to ;;_;:s; ;. OME IMPROVEMENT CONTRACTOR egistration: .::109470 Type: Office of Gansuiiier Affairs�nd' l�5lnessRegulation 4: 10-Park Plaza-Suite•500 xpiration:-;9/_161201:§= DBA Boston,MA02116 __ RANDALL G SWETISH BUILDER:;;':;•• i r..' i ... RANDALL SWETISH,"; 10 WHEELER ROAD ,..MARSTONS MILLS,MA 02648' Undersecretary Not valid w thout signature L fey i.� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION' ermi ""Map Parcel �` t,�#": ..•" � s Health Division am)2�9�3� ��.CN.r r.�p.� -r, �'L I �l r�f o Date, ssued' Conservation Division qhohwi 1Az 0&v o f cetA 0 rizw Fee Tax Collector 64119/0 1 t ok Treasurer''__ ��'� f SEPTIC SYSTEM MUST EE Planning Dept. i INSTALLED IN COMPLIAN a 3_ WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH y S-e� reservation/Hyannis TS E �JL .`T° i Project Street Address � �J��E ��iz-�4 t Village V-J• �Tt�+�1_.c:� Yi24 .f�- NSA' • - Owner Address 1&-,4 Telephone (�5 93 c9 - 4-7 5r-7 Permit Request e,-, eV,4 tmz_v LT 2 "A" Square feet: 1 st floor:existing proposed 12nd floor:existing propo ed �� Total new 3' - Z.- Estimated Project C Zoning District Flood Plain Groundwater Overlay Construction Type ES t>E NT%�_A, Lot Size i- IF 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: D-Y,5s' ❑No Basement Type: ❑Md"' ❑Crawl Walkout O Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) / 4- Number of Baths: Full: existing new 2 Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new� First Floor Room Count 'z, Heat Type and Fuel: C�s ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing O new size Attached garage:❑existing Ql�new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes,site plan review# Current Use Proposed Use ��- BUILDER INFORMATION Name — - Gor.► i. oTrA,%j% Telephone Number 8 g 8 4-8 3 Address ®•- ,� ( O 9D License# 4—" '*7 6 0-7 5 +r, ci7 v�I4 c.N 414 07-57!n S Home Improvement Contractor# Worker's Compensation# G S OOZ S O`7(p ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ee_.o•c `( WALK SIGNATURE DATE FOR OFFICIAL USE ONLY f PERMIT NO. DATE ISSUED ri MAP/PARCEL NO. ° ' ADDRESS <- -VILLAGE OWNER' DATE OF INSPECTION;,r� TOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL /1 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. /ter • R l� 2001 , a -o N '. Application to H _ ib`Ring'g �tgbtuap �Regionai joigtoric �igtrict �rom�il i't`t�e��err; \! It. ALE, MASS, t In the Town of Barnstable I tffl 25 Pi 2 � / 3 CERTIFICATE OF APPROPRIATENESS 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 — p Addition ❑ Alteration Indicate type of building: House Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ • 3. Signs or Billboar s: ❑ New S n ❑ Existing Sign ❑ Repainting Existing Sign -4. Structure: (Fence Tall ❑.Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK 4'(P �-jz�� iE.= v.�All_ rzw6ASSESSOR'S MAP NO.'.* O. 21 -7 :.OWNER. o ti► CO ASSESSOR'S LOT..NO`:..rJ a-1 HOME ADDRESS ? O Ole, ES: 1- '-�,c>wte--A TELEPHONE NO;. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS; including those of adjacent propertj owners across any . public street or way. (Attach additional sheet if'necessary..)�: :. 1j ie E ITT-tack E� AGENT OR CONTRACTOR TELEPHONE NO. ADDRESS 2 EAZ-.�H STp�E 1��, /�S► �At.►D W�6i-1 �� o Z52;7 DESCRIPTION OF PROPOSED WORK: Give.particulars of work to be done, including materials to be used. Please include locations of p oposed signs. 212 s-- o�1Ew 13 c G L t . Signed Owner-Contr ctor-Agent For Committee Use Only D This Certificate is hereby. D DateU nMAR Approved/Denied21 2001 Com e Members' Signatures: ' OWN OF BARNSTABLE nI n Kmin,. HIrIPJAI NI CL . r ZOol 060 Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION �{ pc�tzE 17 C pti Gam _ SIDING TYPE GL 42 e: > COLOR E N o!q CHIMNEY. TYPE !�-ij�t /k._ COLOR rR E7 ROOF MATERIAL COLOR—,-'- PITCH 1/ IZ a2evc� A.s 1z WINDOWS _!:�>u31 G_- -Au*A G COLORV4".% T-E SIZE TRIM COLOR {.N �TL. .... DOORS-b'� Co r1 x Co—S. !oy(�g COLORS l .Irt l t-a= SHUTTERS l �-i Y L. COLORS -, GUTTERS P.l -V Z-r( :COLORS V� 4 E T� D t Tj DECKS I Z a l Z MATERIALS \4j po►7 1 GARAGE DOORS COLORS � 1--1 1� SKYLIGHTS SIZE COLORS IAND ?, b�� SIGNS O� COLORS ERG FENCE 4 \,44 L4 rrE . COLOR Vv H I TT. 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 Revised 11/98 i Direct Abutters for Map 217 Parcel 050-001 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. The requestor of this �. list is responsible for ensuring the correct notification of abutters. Owner and address data taken from November 2000 Assessor's database. Mappar Ownerl Owner2 Address City Stat Zip Country 216038 BAO,LEDE&TONG,DIAN TRS 1989 MAIN STREET W BARNSTABLE MA 102668 rl6039002 OJALA,ARNE H&SARAH B 1971 MAIN ST W BARNSTABLE MA 02668 217014 ALBERS,JOHN G MARGARET C ALBERS 58 LYONS DR WESTWOOD MA 102090 USA 217015 CORSA,HELEN S 1990 OLD KINGS W BARNSTABLE MA �02668 USA HIGHWAY 217047 �CLANCY,ROBERT W/MCHUTCHISON, P O BOX 876 W BARNSTABLE MA 02668 USA SUZANNE 217049 FARRELL,FRANCIS F&PATRICIA A 99 HARBOR'S SUITE 414 ITORONTO,ONTARIO �CANADA 217050001 LONGO,MICHAEL J P O BOX 633 E SANDWICH MA 02537 21705/002 �WOJICK,JEROME&RITA -77F43 STONEWALL DR W BARNSTABLE MA 102668 217050003 IGUSTAFSON,THOMAS A&MARCIA L 503 DARTMOUTH AVE SILVER SPRING MD 20910 USA 217050004 MANZELLI,FRANCIS P&JANE A 59 STONEWALL DR W BARNSTABLE MA 102668 C) CD Q CD Wednesday,February 07,2001 Pagel of 1 `f 6 J r i D U 6 i 6 e i i 9 f J Western Surety e p E , 9 6 e p e r LICENSE AND PERMIT BOND p e For County, City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, ; Performance,Maintenance, Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond. e 6 u KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P-4 3 0 0 5 5 41 ' That we, Half Cape Construction Inc. , of the Tom of Sandwich. State of Massachusetts , as Principal, and WESTERN SURETY COMPANY, a corporation duly licensed to do business in the State of , as Surety, are held and firmly bound unto the. Town of Barnstable , State of Massachusetts , Obligee, in the amount (Valid only when a County,City,Town or Village is named as Obligee) of five thousand DOLLARS ($ 5.000.00 ), (NOT VALID FOR MORE THAN$25,000) - lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, jointly and severally. THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has been licensed as a builder by the Obligee. NQ,%y' ft,E,:'." FORE, if the Principal shall faithfully perform the duties and comply with.the laws and orctanee$.{ncluin all amendments), pertaining to the license or permit, then this obligation to be void, otii'se to remarri'ain full force and effect for a period commencing on the 18th day of �w: ark' �:� a�.,� ,n� 4,i'G*r,- 2001 , and ending on the day ofv, e+contin ou use , unless renewed by continuation certificate. ',hi 'bond rna l etterminated at any time by the Surety upon sending notice in writing to the Obligee and to Of P'C��j ncipal�iY1.Ca�e a�the Obligee or at such other address as the Surety deems reasonable, and at the expira- tion�� t ty '.e days from the mailing of notice or as soon thereafter as permitted by applicable law, whichgVepi�sylate °this bond shall terminate and the Surety shall be relieved from any liability for any subsequent acts or omissions of the Principal. Dated this 18th day of April 2001.. 'Cape -Construction Inc. Principal Principal Cou '' WESTER SU ETY CO ANY By 9Vwt cu ft' S By Resident Agent President r i ACKNOWLEDGMENT OF SURETY STATE OF SOUTH DAKOTA l (Corporate Officer) - r f ss 6 r County of Minnehaha On this 18th day of April 2nn i,before me, the undersigned officer,personally appeared Stephen T.Pate ,who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY,a corporation,and that he as such officer,being authorized so to do,executed the foregoing ; instrument for the purpose therein contained,by signing the name of;the corpo on by himself as such officer. ; IN WITNESS WHEREOF, I have hereunto set my hand and official se ; 6 e J. RHONE NOTARY PUBLIC (SEAL) SOUTH DAKOTA S � C ]Votary Public, South Dakota ; c My Commission Expires 6.12.2004 Western Surety Company • 101 S. Phillips.Ave. Form 849-A—12-97 Sioux Falls, SD 57104 • 1-605-336-0850 fi U fi U ACKNOWLEDGMENT OF PRINCIPAL fi (Individual or Partners) 4 r STATE OF ss F County of 4 n • tl n ° ' 6 On this day of ,before me personally appeared 4 ° e 4 ° f F l known to me to be the individual_' described in and who executed the foregoing instrument and 4 4 ° `• fi acknowledged to me that—he_executed the same. y My commission expires Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporate Officer) :Yy t STATE OF ss ' County of On this day of ,before me, �! personally appeared , who acknowledged himself to be the 4„ of , a corporation, ?� and that he as such officer being authorized so to do, executed the foregoing instrument for the pur- poses.therein contained by signing the-name of the corporation by himself as such officer. My commission expires Notary Public l Y A c � c r c r � r CL t r 4 a U fi 4 e N e 4 .yt r Q L 'C e V) a rn - U Ow a 7=CMR Agp uwa J `gym Table JS.2.Ib(continued) prescriptive Packages for Oue and Two-Family Residential Buildings Seated with Food Fuels 4 MAXIMUM MINIMUM GlazingQ Ceiling �g Wall Floor Basement Slab Hewing/Cooling Atea'('A) U-value= R value' it-valise R-veluJ Wall perimeter Equipment Efficience pie R-value R value' 5701 to 6500 Heating Degree Dar' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 13% 0.36 38 13 2S WA WA Norma U 150/0 0.46 38 19 19 10 6 Normal V 13•/8 0.44 38 13 2S WA WA 83 AFUE W Is% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 F 38 13 25 WA WA Normal Y 18% 0.42 38 19 25 WA WA Normal Z 12% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: r 14 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3C9-7 Lv vQ %- T- 3. SQUARE FOOTAGE OF ALL GLAZING. q1 &• a 6 R r-i 4. %GLAZING AREA(#3 DIVIDED BY#2): 1!>�0 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-t980303a r 780 CMR Appendix J Footnotes to Table J5.2.1b: ? ' 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 ft of glazing area. ' 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-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 crawispaces, 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 electric 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 J5.2.1 a 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 J1.5.3b. 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 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 � � � - �� - i 9B'L�t Ef T C y a cc go W� o� ti* • V� � � QQ or AV MON/IO.a/ a6 'tbE Q Q' IQXOt NZ Ze Az X �� t •a�� oyz W y 444 �� f ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) 04/18/2001 PRODUCER (508)888-2244 FAX (508)833-0680 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden Insurance Agency Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 125 Route 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sandwich, MA 02563 INSURERS AFFORDING COVERAGE INSURED Half Cape Construction Inc INSURER A: Maryland Casualty Company P 0 Box 1050 INSURERB: Legion Insurance Company Sandwich, MA 02563 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY RGP24659352 01/01/2001 01/01/2002 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ S0,000 CLAIMS MADE D OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY P ECRO LOC JT El AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ I - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR F CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ IkETENTION $ $ WORKERS COMPENSATION AND 0050028076 07/22/2000 07/22/2001 TORY LIMITS ER EMPLOYERS'LIABILITY B E.L.EACH ACCIDENT $ 100,000 E.L.DISEASE-EA EMPLOYE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10—DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 367 Main Street OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE n' r David Vajcovec/STEPH c The Commonwealth of Massachusetts ='O Department of Industrial Accidents Office offaFestigOONS 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit rir��ria�a�oiairrii•....r��aiia��ii/ i.�Q'��iiair•,,,,,,,,;,,,,��%/%/,,,,..... 2glrn�rcna�rarnt:nrr.„ , .. name: location: city phone 0 ❑ I am a homeowner performing all work myself. ❑ I am a sole proDrietor and have no one working in anv capacity am an employer providing workers' compensation for my employees working on this job. comnnnvname• O sj address: "ice• - 87� o �C7 :::.: ::. . »;,::...:. . _. city. ��-►�.�c t�►-� A phone#: ✓ cg , g 3 i ::.::..... insurance co. L-ic Gi or.I qO0 -7(0 i`.. .__... ❑ 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: comnanv name: address: :... .. phone dtv . insarnnce Co. ............................................... U/i/:/.;i/i///i//////////ii//////////v/////i%////////i///////iii/////ii/////////////////i/////////////////////O////////%///////// comnanv name- address: riri_ phone .:. .....:............ :;;•;:>:;:>.:;.. irtsprance Poll& > FaIIure to secure coverage n required tinder Section ISA of MGL 152 can lead to the impoaitlon of ertminal penaltln of a Me up to 51300.00 aad/or one years'Imprisonment as weU as civil penaltla in the form of a STOP WORK ORDER and a Me of S100.00 a day against me. I understand tbat a copy of thin statement may be forwarded to the Olnce of Investigations of the DIA for coverage veritleatlon. I do hereby certi nder the pains and penalties of perjury that the information provided above is truce and correct Sigmmre Date 4— Print name 31-'E t�H E.'V-► T1Ni.b.l Phone# Ccontact se only do not write in this area to be completed by city or town oMcial town: permitNcense# ❑Building Department ❑Licensing Board k if immediate response is required ❑Selectmen's Mee ❑Health Department person• phone#• ❑Other�� lmvm 9.95 P1A) 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 roan-- 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 c: the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the reces�e: 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 an such dwelling house or on the grounds c. building appurtenant thereto shall not because of such employment be deemed to be an employer. w MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: of a license or permit to operate a business or to construct buildings in the commonwealth fo_r,any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neid=..the . commonwealth nor any of its political subdivisions shall enter into any contract for the peiformaace of public work until acceptable evidence ofticomp4ance with the insurance requirements of this chapter have been presented to the con=ctinQ authority. • MINE . 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 fimuanee 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 bottatn 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 is the peimitllicease member which will be used as a reference number. The affidavits may be retuned 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 nay 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 8111ce of luesugallons 600 Washington street Boston;Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 i ) \, O /seuir •\s)1) '" sue o/v/s/o,v PLAN O AA/O \ O i XNCDr avr�ry rwr nD Xancc a wcu X,f OE[n wS[[MD Dr rX�f Orriq DYxnO . f _ / /i c><-•sr A/ASHPEE-MASS rn[c:.X.[4rs rD•,iamnc:°mnn,wD °FOOD:n�D D<xuDR Er�:4'XF n,r.'plw i J � ^'�•. BCMO OE,r.Y.DrY Or InE,1:.CX[0 iNn. PETERS -Ivr-R,- -S or CE-n /2 r!O rc.e f / /:,Soo<� 6/ =`<Z, .ir.w........�A..,e....`.sr ��✓ 9 _'8 • .• clJ'.: 5. ��G r�fy \5° rnwr°+,.. 3117171 wwceaao .1 ) �. ,p � yp,,' 1O11fi 6 at511Kf eP w �7f4�`t` 19 t 50ir 'to r:t t` ®, �` Is = .f5y5 O r' /.�4a•-:,A..�a�..�E 7J� -- 6/1�70 /:,evr<.R 2 2 /r rJ>•.,r /;roo R+ � /r rao.< /;s+>a R< ,z,saou 2` /«av« �2 /�ra)f s.r h ir,Jao� �"r tO � • " Q i° Q !2 © •2 O ii O ii Jz 82 O ,i° Jc R8 ® 22 w° ✓i Rio/!r ,.... - �,.... —s/e•./i p_,v ,..... � /inn ..... ino 3 law X t . i ESTIMA TED PROJECT COST WORKSHEET LIVING SPACE -�Value e-�o (high end construction) 3 square feet X$115/sq. foot= (above average construction) ..square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot= i _ _o 0 PORCH square feet X$20/sq. foot= 3 Z—C3 DECK 13-7 square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Value a " f �o f Bk 13514 Pg 106 05569 01-26-2001 Q 01c47p QVITCLAIMDEED GRANTOR: MICHAEL J.LONGO of 46 Stonewall Drive,West Barnstable,MA 02668 FOR CONSIDERATION OF. ONE AND N0/I00(81.00)DOLLAR GRANTS TO: MICHAEL A LONGO and RICHARD A LONSTEIN, As Joint Tenants with Rights of Survivorship • OF: 46 Stonewall Drive,West Barnstable,MA 02668 WITH QUITCLAIM COVENANTS The following described premises situated in the County of Barnstable and the State of Massachusetts to wit: WESTERLY: by Stonewall Drive,five hundred forty-two and 15/100(542.IS)feet; 0 NORTHWESTERLY: by an unnumbered parcel as shown on the hereinafter mentioned plan(supposedly lot 3)forth and 19/100(40.19)feet; NORTHERLY: by land now or formerly of Billie Rosoff,one hundred-fifty-six and 756/1000 (156.756)feet; EASTERLY: by land now or formerly of Richard S.Demerjian,in two courses,a total distance of two hundred sixty-nine and 881/10M(269.881)feet; WESTERLY: by land now or formerly of Helen S.Corsa,three hundred forty-one and 982/1000 % (341.992)feet; a SOUTHERLY: by Route 6A,Twelve and 121100(12.12)feet;and y� SOUTHWESTERLY: by the intersection of Route 6A and Stonewall Drive on a curve having a radius of 30 feet,an arc distance of forty-five and 23/100(45.23)feet. Containing 65,339 square feet more or less and being shown as L&U on a plan of land entitled"Subdivision hPlan of Land in West Barnstable,Mass.for 3M Realty Trust,Scale V=40'Jan.1984,Rev.Feb.6,1984, I* Rev.Mar.22,1984,Law&Weller,Inc.Yermoulhport,Mass.",which plan is duly recorded in the Barnstable County Registry of Deeds in Plan Book 382,Page 36. For Grantor's title see Deed of Joyce E.Gorman,Trustee dated August 23,2000 recorded at Barnstable County Registry of Deeds in Book 13212,Page 096. p Wltness my hand and seal this Id", day of T,94M04 J 2001. rlr Michael J.Lo COMMONWEALTH OF MASSACHUSETTS 1 BARNSTABLE,SS, Date: J'91 Anil 21 ,2001 Then personally appeared the above-named Michael J.Longo and acknowledged the foregoing instrument to be his free act and deed,before me a� Kft,N ry Public eooBaO� ALA �BARNSTABLE COUNTY :ME�LS Box My Commission Expires: Septer iber 21 STRY OF DEEDS A E COPY,ATTEST UARNSfA t HLui W Uf DEEDS `�-•-�- JOHN F.MEADE,REGISTER Parcel Detail Page 1 of 3 .� THEe�V ...... P. ' �". ""''9'''°y t, IL�T/IIL"� d �'.. J/......;+..r�N Y� �^...'_. i Logged In As: Pa 1"Ce I beta 1( Wednesday,A Parcel Lookup Parcel Info ............._....................................................................................._.._....................................................-......................................_.._..........._.... .........................._...._........................._._..............................- ..__._.._..__...__.............................�. Parcel Io'217-050-001 , Developer LOT 1 i Lot� Location';46 STONEWALL DRIVE I Pri Frontage; Sec Road Sec Frontage i ......._._......................... Village'WEST BARNSTABLE Fire District i W BARNSTABLE ..._.__.........._._...._._._...................._......_._...._.............._......................._......._....____..._...._....................................--'__..._.._...................... ...._............................................................................._......................................................................._............ Sewer Acct 3 Road Index i 1905 Interactive F Map - _ 4i'he L Owner Info .. ......................................................................................................................................................................................................................._...... .........._......................................................_................ owner PATEL, KIRTIKUMAR S & RAGINI K Co-owner j ..._...._......._........_..................._....._.................._......_.._.__._..._......_..................................................................................................................... ........................._.................................................................................................... ...__. Streets 46 STONEWALL DR Street2 F City":BARNSTABLE State MA Zip 02630 Country Land Info ............................................................................................................................................................................................................................................................................................................................................._..........................-- ._................................_ Acres 1.50 Use Single Fam MDL-01 zoning (I Nghbd 0107 Topography .�.x.__.�m.........._.... .,�.._.. ...) Road Utilities F—_ I Location E Construction Info Building 1 of 1 .......................... .............................. Year 2003 Roof G able/Hi .................. Ext Wood Shin le Built I Struct p wall g Effect 4371 Roof Asph/F GIs/Cm I AC Central Area Cover Type ...................................................................._.... Colonial Int Plastered Bed 3 Bedrooms Style ._..... ............. I Wall I Rooms int Bath Model Residential Floor Carpet Rooms 2 Full + 1 H Total Grade Custom Type Hot Air Rooms 7 Rooms http://lssgl/intranet/propdata/ParcelDetail.aspx?ID=15493 6/6/2007 Parcel Detail Page 2 of 3 or sa WDK PTO BAT ` W.D.K AGAR _.__. ........ _....................._................................ 0 TO Stories 2 1/2 Stones Heat Gas Found- ?.? 3s . f _ { . Fuel 3 ation LW11'K BUSK ` BMT "Yr 24 .. I'll s M. Fes,,, Permit History Issue Date Purpose Permit# Amount Insp Date Comrr 6/11/2001 New Dwelling 53845 $416,140 2/27/2002 12:00:00 AM Visit History Date Who Purpose 4/7/2003 12:00:00 AM Paul Talbot Meas/Est 7/22/2002 12:00:00 AM Martin Flynn Meas/Listed 2/13/2002 12:00:00 AM Martin Flynn Measur/New UC Under Construction Sales History Line Sale Date Owner Book/Page Sale P 1 11/27/2002 PATEL, KIRTIKUMAR S & RAGINI K 15996/240 2 8/30/2000 LONGO, MICHAEL J 13212/096 3 4/15/1993 GORMAN, JOYCE E TRUSTEE 8522/191 4 4/15/1993 GORMAN, JOYCE E 8522/190 5 8/15/1989 GORMAN, L DAVID &JOYCE E 6864/145 6 7/15/1989 STEVENS, MAXENE F 6817/073 7 0/15/1986 STEVENS, GALE P & 5297/053 8 9/15/1983 STANLEY, MARK AS TRS ETALS 3864/070 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $568,800 $4,300 $0 $245,700 2 2006 $498,300 $4,300 $0 $268,500 3, 2005 $449,900 $4,300 $0 $239,800 4 2004 $384,000 .$4,300 $0 $239,800 5 2003 $228,400 $4,300 $0 $108,000 6 2002 $0 $0 $0 $108,000 7 2001 $0 $0 $0 $108,000 8 2000 $0 $0 $0 $89,700 http://issgl/intranet/propdata/ParcelDetail.aspx?ID=15493 6/6/2007 Parcel Detail Page 3 of 3 L i 9 1999 $0 $0 $0 $89,700 10 1998 $0 $0 $0 $89,700 11 1997 $0 $0 $0 $63,300 12 1996 $0 $0 $0 $63,300 13 1995 $0 $0 $0 $63,300 14 1994 $0 $0 $0 $62,100 15 1993 $0 $0 $0 $63,000 16 1992 $0 $0 $0 $69,000 17 1991 $0 $0 $0 $92,000 18 1990 $0 $0 $0 $92,000 19 1989 $0 $0 $0 $92,000 20 1988 $0 $0 $0 $42,100 21 1987 $0 $0 $0 $42,100 22 1986 $0 $0 $0 $42,100 Photos http://issgl/intranet/propdata/ParcelDetail.aspx?ID=15493 6/6/2007 f t l i n Town of Barnstable Office of Town Manager Disposition of Request.for Hardship Exemption Michael Longo & Richard Lonstein Summary: Rendered Moot by Receipt of Building Permit in May 31, 2001 Lottery Applicant: Michael Longo&Richard Lonstein Property Address: 46 Stonewall,West Barnstable,MA Assessor's.Map/Parcel:-Map 217, Parcel 50 Date of Application: May 4, 2001 Date of Hearing: May 14, 2001 Town Manager's Designated Hardship Panel Members: Emmett Glynn,Thomas Lynch,James McGillen Request: In accordance with Paragraph 13 of the Cape Cod Commission's Decision of "Acceptance of District of Critical Planning Concern (DCPC) Nomination", dated March 15th, 2001, and the Regulations for Evaluating Hardship Applications dated March 29, 2001, the applicant has requested that the Town Manager grant a hardship exemption to allow for the issuance of a Building Permit. Materials Submitted: Application for Building Permit Exemption Based Upon Substantial Hardship dated May 4, 2001, with attachments. Application Rendered Moot By Receipt of Permit in May 31,2001 Lottery: The denial of the applicants'request for a hardship exemption by the Town Manager's Hardship Panel was rendered moot by the applicants' success in the May 31, 2001 lottery. i pFSHE The Town of Barnstable .. ... { RAWNSTABLF,m MUSS. : Office of Town Manager y rr p 367 Main Street, Hyannis MA 02601 '01 Office: 508-862-4610 John C.Klimm,Town Manager Fax: 508-790-6226 Joellen J. Daley,Assistant Town Manager Application for Building Permit Exemption Based Upon Substantial Hardship Date Received For office use only: Town Manager's Office: J�70/ Hearing Date: Decision Date: The undersigned hereby applies to the Town Manager for a Hardship Exemption, in the manner and for the reasons set forth below. � Applicant Name: �a� l J. Lo na o l h C Phone: Applicant Address: PO 60X 30^7 W &Q✓15+Z,_�je, Mig Property Location: y (c 5 fL 1)t WC, b R iv Ka,v?-r15 able-, Property Owner: j1 i c+\c,P I T Lo nr t7 C-,l R i c,,kv-,zj J. Lo i)sfe i n Address of Owner: SCt_,4�yj e 0.S ou t? Phone: Same aS a.W✓e_. If applicant differs from owner, state nature of interest: Assessor's Map/Parcel Number: a /S-O Number of Years Owned: Does the property have any existing permits issued to it? Type of Permit: Expiration Date: Type of Permit: Expiration Date: Type of Permit: Expiration Date: *If the applicant differs from owner, the applicant will be required to submit one original notarized letter, copy of a proposed purchase & sales agreement, or other.documents with the application to prove standing interest in the hardship. i -2- Have you been denied an extension of any of the above permits? Type of Permit: Denial Date: Type of Permit: Denial Date: Type of Permit: Denial Date: Building permit application submission date: O 1 Lottery date: `I - �G - 0 1 Please describe how the failure to obtain a building permit has caused substantial personal and financial hardship: We_ PL/RCAOSed Dup- 10f in W . Sf,-,blc has f sf (sC. Huth S�Zc�n GLfkC.h(rue t-� au�f h o la ns 6u i Id o- N),c) housa.., LV e so IJ a rL hOOSes (OL+inc�rY\tr)4 Via .413 10-St WOA 0-ISO . On Augosf ai,a000 we— hIQC, `k HL If r"g- C&-vsh uc.:h� SQ jb Qlf G n avid 6 ► O ou2 house Esc �n �- Lk c.k -2c9 y , a c,ht In Feb�xt 24 Lue- �SoC, h►1f-C4 wetla,�tds sc:ie Aar tic. DeC �� u2 �p l�Z �-C�. r� S ar Go R 40 RP 0 T t I — OLq C*-:� d 1.49 ,a f6cle-& n " was alsz I-e -�d in Fe- bnuaAq (a�c.hnvnt �'�). `I }u c0S+ 2 �' .DIof AICLy, t,-61, -ic2o00 . Our- "1VoffC-C o � L(�'1S�2YCcf l on 6 riUry A6 WC's Attach additi furl sheet z f necessary. P le fed o(i Fe b&o(L2y y,a�D �A Fctchmrrl 1�S an,d fi It cl 00 MaAch !,,ae, Please be sure to attach all supporting documentation to substantiate the hardship claim. C`p-)� Examples of the types of documentation that may be included appear under Section B. on the attached document entitled "The Town Manager's Regulations for Evaluating Hardship Applications Submitted During the Pendency of the DCPC Nomination." She{ c�'I�Gl1ecl Signed tinder the penalties of perjury. Signature: Date: �/y 0 Representative's _ Address: PO (3o x 307 Phone: 56 D" F YY- 4/ S 7 W. 6a.tznsjr,-ble, Mr- 11--4167 I Tl� �lYl�e 2 da fl o✓� ��1h'r�►n 'e e 20 v2d o lao�s On AP a ; I 10, o)001 a-4A8 CUrn.w� 'f'('e e �P 20 deck on P2; 1 -7 , aW 1 . 704 J A-YvAovn4 i fwes fe-c! i n h i s n 20J e cf '�1 s 7�c ►2 PuachQsc v� N CB I �C_ Co n S�1Zv I 3 � S-U O CIO+ P la,�, �:k C,;t , boo V\/e+I&Y)ds SG i C.n t S ( , 1 1 a NyS vafi-bn �I a SD -T6.xeS an d y�.a 70 7A-L. 7._-P yvJ a.r-P �o e. f CO/I V a n eed w e have s v d . y F�arzds h I ecis� ►yet-z- . w� rnusf �� coo YU� P (ace (jV o�t v,s+. 7h.e_ ©u nef,5 0� `f'V- hc�JS�e_ Ave-rive., 1✓a sf Sa�►ol� �� . 0 ��- `�-ha-� � � arc h►��t �� 1GiV� QS ke c� VS � move. �+ c �- n ( US 0� VY1 l`f S o w e- CCL4 � oil Gam• ��'1 ��S I" p 20d I I y�Q�OF THE Tp�� The Town of Barnstable B' AS&Kass. ' Office of Town Manager v M � ie39. �0 367 Main Street Hyannis MA 02601 �Fn nnA�' . Office: 508-862-4610 John C. Klimm,Town Manager Fax: 508-790-6226 Joellen J. Daley,Assistant Town Manager THE TOWN MANAGER'S REGULATIONS FOR EVALUATING HARDSHIP APPLICATIONS SUBMITTED DURING THE PENDENCY OF THE DCPC NOMINATION. Pursuant to paragraph 13 of the Cape Cod Commission's decision "Acceptance of District of Critical Planning Concern (DCPC) Nomination" dated March 15th, 2001, the Town Manager of the Town of Barnstable adopts these regulations to establish a process whereby applicants may make application for an exemption from the limitations placed upon the issuance of residential building permits based upon substantial hardship, financial or otherwise. A. All of the following threshold criteria must be satisfied before a hardship exemption will be considered by the Town Manager and or/his designee(s): 1) The applicant must have submitted a completed building permit application to the Building Commissioner. 2)The application must have been through at least one building permit lottery. 3) The applicant must complete the application for hardship on the forms provided by the Town of Barnstable and provide any documentation requested in the application form. B. If an applicant has satisfied the above threshold criteria, the applicant, at a hearing to be held by the Town Manager and/or his designee(s), must then demonstrate that the.failure to receive a building permit during the lottery process has caused the applicant substantial hardship, financial hardship or otherwise. In making that determination as to whether the applicant shall receive an exempt permit based upon substantial personal and financial hardship, the Town Manager and/or his designees) may consider the following criteria: 1) Whether the applicant has received a special permit, variance, disposal works permit, order of conditions, certificate of appropriateness or any other permit from the Town of Barnstable for the construction of a single family home on the parcel in question, which will expire or lapse unless a building permit is obtained immediately and the permit granting authority has refused to extend said permit. r : _2_ 2) Whether the applicant has signed a construction contract on or before February 28, 2001 for the construction of a single family home on the parcel in question and paid a deposit thereon, which deposit will be lost unless a building permit is obtained immediately, which loss will constitute substantial financial hardship. (Copies of the contract and a check negotiated before February 28, 2001 shall be provided). 3) Whether the inability to immediately obtain a building permit has resulted.or will result in financial insolvency. 4) Whether the applicant has entered into a purchase and sales agreement for his/her current residence before February 28, 2001 where the buyer has satisfied the mortgage and other contingencies and the applicant has executed a construction contract and has a deposit check negotiated prior to February 28, 2001 for a new single family dwelling on the parcel. (Copies of the purchase and sales agreement, executed construction contract, cancelled check and proof that the mortgage and other contingencies have been satisfied shall be provided). 5) Whether the inability to obtain a building permit immediately will jeopardize the health and safety of the applicant. 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ItLCALD q lJL I I A 1 11t.,\-, �At 10 11 j4 i*jrqF_o _j J 0 l')I-'7 S F_C7 10 5.5 @ 12..0-C. 11 VJ I_A� r-A,,rx%..00, %4umbp-p, 6 40 C O�4c pmm mc�� 6" Zol4a,"K ig I Z-10'it'w 4'--1 V40 W 0 t._jo;1, Fou-tVA"nOtIl r wirrel ble"4,-q,144. AtAQEfM_14 164t.-b 2.4 16, Y4,' KVM)kp,,jpV4 2461L D -SIM yA.1-44144 0 -_w to,& E 1ILTS, Lfb'x V I��w 0 ft Ppd,F_1,1 C-*rw to Z"Z'/,%' K -I'=V Awcmyew X 04& r-_CIT I (DNJ A -A 1 YA%L"4" Av�41DEPI)Ei-A Aw 41 Ali. 4t_IUeVA,-L_," All (-VV A-NPF_PjL-.fI A".'41 15'.Y6*K 151ya. X�4 7/614'l- L8 c,-r ovi 12- SS COVERS MUST WITHIN ACCESS C VER U T-8E . . . 9 MINIMUM. I N VER T EL E VA T I ONS : DES l GN CR I TER'l A 6' OF FINISH GRADE 3» MAXIMUM COVER INVERT AT BUILDING: 47.0 DESIGN FLOW: 51-0 FIRST 2' TO _ INVERT IN SEPTIC TANK: 46.25 4 BEDROOMS AT 1/0 G.P.O. PER BE LEVEL MIN 2' OF PEAS TONE INVERT OUT SEPTIC TANK: 46.0 BEDROOM EOUALS 440 G.P.D. - 4' D1AM PIPE lA 4567 INVERT IN D1ST. BOX; _ i L�C�S _ 3/4 1 I/2 D INVERT OUT OtST."BOX: 45.5 NO GARBAGE GRINDER v f 45.5 o DOUBLE WASHED STONE 47.0_ - 4b.0 2' � GAS 43.0 : -45.0 A $ I LAYER T I N LEACH .CHAMBER , 6 46.25 ' BAFFLE 45.67 45:0 -- SEPTIC TANK REQUIRED: oOtE _ BOTTOM OF LEACH CHAMBER: 43.0 R 3 OUTLET 3-SO GAL LEACHING CHAMBERS 440 G..P.D. X 200x - 880 GAL. D-BOX W/4- STCNE AROUND. 12.8'X 33.5'X 2' GROUND WATER: N/A SEPTIC TANK PROVIDED: 1500 GAL: MIN. ADJUSTED GROUs 1500 GAL OBSERVED GROUND WATER: _N/A SEPTIC TANK 6* CRUSHED STONE OR BOTTOM OF TEST HOLE sl: 26-8 SOIL ABSORPTION SYSTEM REQUIRED: N COMPACTED BASE p p DESIGN PERG RATE ( S MIN/INCH I l t 0F I L E NOT TO SCALE SOIL TEXTURAL CLASS I EFFLUENT LOADING RATE - 0.74 GPD/SF _ 440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED PROVIDED: 3-500 GAL LEACHING CHAMBERS L OCUS MAC W/4' STONE AROUND. A-6/4 S.F. 'I 614 S.F. x 0.74 - 454 G.P.D. 1, 500 TEST P I T DA TA INDICATES � INDICATES PERCTESTOLATION OBSERVED GROUNDWATER � p#5228 ' TPs I TP# 2 GRND EL.46. I GRND EL. 42.8 I� G.W.EL. N/A G.W.EL. N/A 0• 46. 1 0' 42.8 i WOODLOAM WOODLOAM SUBSOIL SUBSOIL CLAY CLAY l0' 32.8 MEDIUM I 6- �6• WHITE 't 15 - 12" 34. 1 12'-, SAND MEDIUM WHI TE SAND ' 35.19 BM ceiDN FND 16. NO WA TER 30. 1 16. NO WA TER 26.8 EL-36.13 LOT DATE: DECEMBER 16. 1985 !.5 f AC. TOTAL TEST BY:EDWARD E. KELLEY WITNESSED BY:JAMES CONLON PERC RATE: ( 2 MIN/INCH 35.57 IN MEDIUM SAND LAYER I T 30.85 E 1VW •5 - t ' � ' • GENERAL NOTES : I . I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL SYSTEM AND PERMITTING ONLY. 37.oo 2. VERTICAL DATUM IS NGVD., FOR BENCH MARKS J / J r SET. SEE S I TE PLAN. ISOLATED.VEGETATED wETL.4IJD i '' / /' I tl 31.71 kV* 1 3. ALL CONSTRUCTION METHODS AND MATERIALS AND I vw •2 i j / MA/NTENANCE OF THE SEPTIC SYSTEM SHALL All' CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL 1 1t I /� f ✓ f / f r / / BOARD OF HEALTH REGULATIONS. 31.23 / - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER 1VW 04 31.0/ tvw .a AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. Et CBIDH 39 42 FND - ' _` ! / ,g6 / / ! ' / ��` r j A6 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR \ -' ---� --34 / / , / / / F rALN�s r i r ! APPROVED EOUAL. i Fke 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED P.2 / ✓ ♦ N PRECAST CONCRETE AND WATERTIGHT. D-BOX SHALL „� „"�'- � BE WATER TESTED TO CHECK FOR LEVEL WHEN .:THERE -� Isa��Rr=.erHAN,�oN�,,a p I c 7. BEFORE CONSTRUCTION CALL .DIG-SAFE'. 41.82 r o" -888-DIG-SAFE AND. THE LOCAL ::WATER DEPT. ,, ,r,T'� OR L OCA T i ON OF UNDERGROUND UTILITIES. u_, �,�,,,„ / / / ''SOIL' REMOVAL O ;4 / r r SEE NOTE 8. E �• FROM 8. LL UNSUITABLE MATERIAL (TOPSOIL. CLAY. ETC. 1 - c ICK PATI� / � / �� k •--�� ' ice'META ENCOUNTERED BELOW.THE INVERT OF THE LEACHING / > � FACILITY TO BE REMOVED FOR A DISTANCE OF 5' - - 3_500 GAL AROUND AND REPLACED W l TH SAND IN ACCORDANCE __ ! ,:,.:rg•5 / ..::: "'. LEACHING CHAMBERS WITH Tf TLE S. 4 - I - - �� coo: w/4• STONE AROUND - - - -PRoppSE �: 9. NO DETERMINATION HAS BEEN MADE AS 70 ROOM 4p COMPLIANCE WITH DEED RESTRICTIONS OR ZON/NG - toF'551 ,'_r 'aoE FENS REGULATIONS. IT SHALL REMAIN THE CL I ENTS j - - _ x - _ _ �` : `. •� �� 16 St�K RESPONSIBILITY TO OBTAIN ALL PERMI TS. SPECIAL D-Box 50 -- - - - 48 -_ _ 4 - f PERMITS. ` VARIANCES ETC. FOR THIS PROJECT. -SERYI - - -/ 1 - --SEPTIC TANK -- - l 0. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY -50-- - - ` Gp - _ 50 _ J -52 TO HAVE THE PROPOSED BUILDING FOUNDATION y DESIGNED TO ACCOUNT FOR THE EXISTING GRADE AND SOIL CONDITIONS AT THE LOCATION OF THE 5;2"" PROPOSED BUILDING. S FO � � -- ANY RETAINING WALL SHOWN ON THIS PLAN l R swALE��=„ A DES l GNED IN 54 L OCA T 1 ON ONLY AND SHALL L BE ACCORDANCE WI TH STANDARD PRACTICE. __ - S -14° r 12. THE WORK LIMIT IS TO BE ES TABL I SHED WITH A SILT 51.45 I ! 56 FENCE AND/OR STAKED HAYBALES PRIOR TO CONSTRUCTION. 1kit 56 -- - - r } 1 } EXISTING } 1 } WELL t , t O 1 O 55.65 i } - a i , d \�N0FMgs .•, P S PAUL y°yG d 1 RYLL -, o0 No.32448 I � � c Nay SUR SEPT / C SYSTEM 0ES / G/V LOT / STONEWALL DR / VE . MA P 2 / 7 . PA R CEL SO WE- S T B A R /�/ S TA B L E /ILIA i SCAL E : / 20 DECEMBER / S 2000 CANAL LAND SURVEYING 306 OL D PL YMQUTH ROAD , BUZZARDS BA Y , MA 1 PROJECT /NUMBER 00 - IO 0 /0 20 40