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0340 WILLOW STREET
543 No 53LOR HASTINGS ION - . . Town of Barnstable Building BA83V$fABLE Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept " Posted Until Final Inspection Has Been Made. Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-162 Applicant Name: JAMES N.JENSEN JENSEN LANDSCAPES Approvals Date Issued: 01/17/2020 Current Use: Structure Permit Type: Building-Demolition-Accessory Expiration Date: 07/17/2020 Foundation: Location: 340 WILLOW STREET,WEST BARNSTABLE Map/Lot: 131-026 Zoning District: RF Sheathing: Owner on Record: JENSEN,JAMES N III Contractor Name: James N Jensen, III Framing: 1 Address: 353 WILLOW STREET Contractor License: CSF��A-047490 2 WEST BARNSTABLE, MA 02668 j Est. Project Cost: $400.00 Chimney: Description: REMOVE REEMAINING OF WORKSHED f Permit Fee: $50.00 t 1 Insulation: Project Review Req: Fee Paid: $50.00 Date: 1/17/2020 Final: 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 docume}ts 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. j Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: I _ 3, 3z> Application Number.... ....... BARMA131A ?I MASS. IBUI_iD1%GDV Permit Fee.......................................Other Fee:....................... Total Fee Paid............................................................... ..... TOWN OF BARNS TP�IoEBNRNO 'Penni tApproval bytA..P................On........ BUILDING PERMIT Map............V.... J.................Parcel........ ....0................... APPLICATION Section 1 — Owner's Information and Project Location Project Address- � U), U18W St= Village Wo isT- Owners Name- ckvv\,,P- v,.- Owner§ Legal Address 1 f (&Vz- A City t- State zip Owners Cell# �05? 3G4 6axs7- E-mail vi<Z2 yL F— Section 2 -Use of Structure Use Group_ F-1 Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 - Type of Permit ❑ New Construction ❑ Move/Relocate E] Accessory Structure El Change of use Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment ❑ Sprinkler System ❑ Addition E] Retaining wall Solar El Renovation ❑ Pool El Insulation Other-Specify, Section 4 - Work Description Last updated: 11/15/2018 Application Number.............................................::..... Section 5—Detail Cost of Proposed Construction 400 Square Footage of Project 50�-" Age of Structure 4 — 100 was Dig Safe Number #'Of Bedrooms Existing C) Total#Of Bedrooms (proposed) 110 MPH Wind.Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design N Or Section 6—Project Specifics ❑ Wiring Oil Tank Storage N '- ❑ Smoke Detectors ❑ Plumbing Gas ❑ Fire Suppression ❑ Heating System N b ❑ Masonry Chimney N b Ate- ❑ Add/relocate bedroom ' Water Supply ❑ Public ❑ Privateer Sewage Disposal ❑ Municipal ❑ On Site a-� Historic District ❑ Hyannis Historic District Old Kings Highway Debris Disposal Facility: Ba�c(nSfct-61e- 9,,)a I am using a crane ❑ Yes ® No Section 7—Flood Zone Flood Zone Designation' Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 i 4 .>: ..L ter',' :�•• a*.. :�;2— eR^ w nk a , i ♦ s f t Ott 3 br�.g�°i1 Fain �•, �aA� V{; `r ,.. �' r - f 14111 Office �� ���suerA� airs & Business Regulation HOME IMPRO EMENT CONTRACTOR T, r : Individual R Ewiration .Th .4'f •V• 1 hfM•••X MA'f.". Yy.. -♦l 04/19/2021 ..{✓ >-+� �*i..aL r•�,j°•�✓-{q Y� .,4•aVJW. v+Ti J R.,r 1,., y r. , 1 JAMES i � JENSE,�-N.,-"�` , . w.,�,+a M vRrNS Nt C)"Ap, 18'1 D/B/A JENSEN.,!�" .1 . ..r�twve•�,.vvv �,ys,,..w:,srr✓t� JAI wo 353 WILLOW ST UV . BARNSTABLE , 02668 The Commonwealth of Massachuseta Department of IndustfidAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly � pl Name(Business/Organization/Individual): r i ekW\-P_.Q 1,V •� C�`C vt Address: 3S' 5��G City/State/Zip: qk± Bwe!njZ��6M Phone M r68 36 4 Are you an employer?Check t�appropriate boa: Type of project(required): 1.Ea;'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 am a sole proprietor or partner- wed 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' 9 Building addition [No workers' comp.insurance comp.insurance.: required..] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomudion. 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: t76- vin Y4 wN, k/ L&-Y u Policy#or Self-ins.Lic.#: U)(,n 'R,'S Expiration Date: cl l oZ}t ;tZ Job Site Address- 14 D W t a c.a g-t— NC-A, M City/State/Zip: -G d' 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 the pains and penalties of perjury that the information provided above is true and correct Signstore: Date: I Z, /a_z Phone#: Z6 < S 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.EIectrical 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 buuildmgs 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-fimm Ce 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 pemmit/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 1-87 -MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mam.gov/dia Farm Family Casualty AMERICAN Insurance Company An American National Company NATIONAL 344 ROUTE 9W I GLENMONT, NY 12077-2910 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE NCCI COMPANY NO. 16721 MARK SYLVIA INSURANCE AGENCY LLC POLICY NO. 2001W6073 404 MAIN ST EFFECTIVE 08/09/2019 CENTERVILLE MA,02632-2916 TRANSACTION TYPE Endorse FEIN#t 508-428-0440 JATEM 1 INSURED INSURED AND MAILING ADDRESS: JAMES N JENSEN 353 WILLOW ST WEST BARNSTABLE,MA 02668-1363 THE INSURED IS INDIVIDUAL Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 1 353 WILLOW ST 158166 W BARNSTABLE MA 02668-1363 ITEM 2.POLICY PERIOD - 7777 The policy period is from 08-09-2019 to 08-09-202012:01 A.M.Standard Time at the insured's mailing address. ITEM 3.COVERAGE A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.The limits of our liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury By Disease $500,000 each accident $500,000 policy limit $500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: All states except the states designated in item 3.A.of the information page and ND,OH,WA,and WY D. This policy includes these endorsements and schedules: WCOOOOOlA0319 WC000406A0795 Copyright 1987 National Council on Compensation Insurance PROCESSED 2019-11-21 WC000001A Edition 03-19 2001Vr6073 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE POLICY NO.2001W6073 EFFECTIVE 08/09/2019 ISSUED TO:JAMES N JENSEN ITEM 4 PREMIUM.- — `- -- -- -. - - The premium for this policy is determined by our Manuals of Rules, Classifications, Rates-and Rating Plans. All information required below is subject to verification and change by audit. Audit of premium shall be made upon policy expiration. State and Workplace Number Code Annual Rate Per$100 Annual Classification Description No. Estimated Remuneration/Per Estimated Total Capita Premiums Remuneration MA 1 LANDSCAPE GARDENING AND 0042 303,200 3.55 10,764 DRIVERS MA 1 TREE PRUNING,SPRAYING, 0106 0 10.05 0 REPAIRING,AND DRIVERS MA 1 MASONRY NOC 5022 0 9.6 0 PREMIUM FOR INCREASED LIMITS PART TWO 9807 108 TOTAL PREMIUM SUBJECT TO EXPERIENCE 10,872 MODIFICATION PREMIUM MODIFICATION TO REFLECT 10,546 EXPERIENCE MODIFICATION OF .970 FINAL TOTAL ESTIMATED STANDARD PREMIUM - 10,546 PREMIUM DISCOUNT 0063 -50 EXPENSE CONSTANT CHARGE 0900 338 TERRORISM 0.03 9740 91 MA ASSESSMENT CHARGE 366 Copyright 1987 National Council on Compensation Insurance PROCESSED 2019-11-21 WC000001A Edition 03-19 2001 MO73 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE POLICY NO.2001W6073 EFFECTIVE 08/09/2019 ISSUED TO:JAMES N JENSEN ITEM 4.PREMIUM EXTENSION SCHEQULE: ._ TOTAL ESTIMATED STANDARD PREMIUM MA 10,546 PREMIUM DISCOUNT MA 0063 -50 EXPENSE CONSTANT MA 0900 338 TERRORISM CHARGE MA 9740 91 MINIMUM PREMIUM STATE MA 500 TOTAL ESTIMATED PREMIUM 10,925 MA ASSESSMENT CHARGE 366 DEPOSIT PREMIUM 10925 PREMIUM ADJUSTMENT 2,463 MA ASSESSMENT CHARGE 86 ADJUSTMENT Copyright 1987 National Council on Compensation Insurance PROCESSED 2019-11-21 WC000001A Edition 03-19 2001V6073 WORKERS COMPENSATION AND EMPLOYERS LIABILITYINSURANCE POLICY WC 00 04 06 A ' (Ed: 7-95) PREMIUM DISCOUNT ENDORSEMENT The premium for this policy and the policies, if any, listed in Item 3 of the Schedule maybe eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium.discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule 1. State ' Estimated Eligible Premium $10,546' MA First Next Next $10,000 $190,000 $1,550,000 Balance 0.00 % 9.10 % 11.30 % 12.30 % 2. Average percentage discount: 0.47% 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: 2001 W6073 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 08-09-2019 Policy No. Endorsement No. Insured 2001 W6073 Premium Included JENSEN III, JAMES N Insurance Company Countersigned by i WC 00 04 06 A (Ed. 7-95) t ©1995 National Council on Compensation Insurance,Inc. 2001 W5073 r tir_- TIT it fam •fly,a=- �'.. +x°F� dr'. 4k, S . .. Application Number........................................... Section 9- Construction Supervisor C Name .1 ceQ_$'AA:a.S . , vLc v,, Telephone Number., Address ,3_� S� City JAL State !1/ (�_Zip 0 �G 6 License Number' F4-04?Q jb License Type -b rz Xxpiration Date a za 3 Z2 a Contractors Email `- Z �2�lSe qVt� e J( de, N Cell # _may? 16 ct z 5 �2 e"� '-th�rnl-G� g ` ��v� I understand my responsibilities under a es an a ns r icensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentati required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date_rZ f 7� Section 10—Home Improvement Contractor Name '�o AMA S �31"��p� Telephone Number Address City State Zip Registration Number l` cR :2 n Expiration Date -(Y-4 t I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature 14 Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my.responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature.- _ -- -- Date APPLICANT SIGNATURE Signature \ Date /L/oZ oZ )�.oc Print Name Telephone Number 5 c,� 3 G(4 E-mail permit to: Q1 Ma-,r— Last updated: 11/15/2018 r Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation f For commercial work,please take your plans directly to the fire department for approval j I, i Section 13 — Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) a Signature of Owner date ' Print Name t F . <I ,I { Last updated: 11/15/2018 14031 �P_� 'THE rqy, Town.of Barnstable *Permit# Expires 6 months from issue dale Regulatory Services Fee w EnaxsrAELE,MASS » 039. ' Richard V. Scali,Director '( AlFD MA'I A Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �� Not Valid without Red X-Press Imprint Map/parcel Number `Property Address— ----,3 n &N-in 5 .,I o ❑ Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Qwner's_Name..&_Address ,L on-e--S A,C=e/v� el Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ a sole proprietor 'r I am the Homeowner g mlllt� �M I have Worker's Compensation Insurance MAY 16 2014 Insurance Company Name Workman's Comp. Policy# TOWN Q���+��� Copy of Insurance Compliance Certificate must accompany each permit. LE Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ to �lacement Wuidows/doors/sliders:U-Value _I, (maximum.35)#_of_windows of_doors:_,____ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. C;SIGNAT-URE_ QAWHILESTORMS\build'.g ermit forms\EXPRES .d c Revised 061313 The Commonwealth of Massachuseft r Deparment of Indusbzal Accidents Offike of Investigations 600 Washington Street Boston,MA 02111 rvrvev.mass.gov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectri,cians/Plumbers Applicant Information Please Print lggihly Namee-Musm�nizalion4mlividaaU: a...wcAe ------�— r,l / OZ el G Cityl lStatelZip: WeS� k`6'h 5(tc�bl� Phone# 6 6 Z S 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(foil andforport-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' [No workers' comp_insurance comp.msurance.I 9_ ❑Building addition reqa ] 5. ❑ We.are a corporation and its 14-❑Electrical repairs or additions 3.Ly 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑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 wozkers'compeamdon.policy information. Homeowners who submit this.affrdavit indicating they are doing all wank and then hue outside contractors mmst submit a new affidavit indicating;such ,contractors that check this box must attached au additional sheet showing the name of the sub-ca mtractors anal state whether or not tbose entities have employees. If the sub-contractors have employees,they mast provide their workers'comp.policy number- I am an employer that is prosiding workers'compensation insurance for erty emphzylees. Below is the policy and job site information Insurance Company Name: Policy#or Self--ins.Lie.it: Expiration Bate: 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 S 1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to MOM 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 ,under the pains=dWeerjury•that the information prov ded above is tnw and correct Si ---Date_ /G Mone#: Official use only. Do not write in this area,to be completed by city or town official City or Tor%m: PermitfUcense# 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#: Town of Barnstable 1. Regulatory Services Ft TWyy Richard V.Scali,Director Building Division s BMtNSTABLE. Tom Perry,Building Commissioner MASS. 9�A 1639. `�$ 200 Main Street, Hyannis,MA 02601 TFD �A www.town.barnstable.ma.us Office: 568-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 11G Zt>1 Please Print DATE: JOB LOCATION: �{r7 �—� number Street village _ "HOMEOWNER": " dL.wIn_c V 1 �'?LA.—a-2;_ .(bq ') C CE 62 name A home phone# work phone# CURRENT MAILING ADDRESS: Ubw city7town 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. e undersigned"home caner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection cedures and require nts and that he/she will comply with said procedures and requirements. �Si ture 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 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 F tHE Tp� , * 1ARNSTABLE, � 9� ' ,0� Town of Barnstable Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building.Com missioner 200 Main Street, Hyannis,MA 02601 www.town.bainstable.ma.us Office: 508-862=4038 „ .. Fax: 508-790-6230 • `j ` Property.Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of 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. QAWPFILESTORWbuilding permit formsEXPRESS.doc Revised 061313 Town of Barnstable Old King's Highway Historic District Committee NAM 200 Main Street,Hyannis,Massachusetts 02601 R 1 D (508) 862-4787 Fax(508) 862-4784 MAY 0.5 2014 CERTIFICATE OF EXEMTTION with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter �® -47D�annes'ov�e�'s of assachusetts,1973,as amended,for proposed work as described below and on plans,drawings, or photographs accompanying this application: Date I Address of Proposed work, Assessor's Map and lot# l I D 7_a House# Street Village: ( )mac f- a,r L!3±:zj - This application is.for an exemption of the proposed construction on the grounds that work: ❑ will not be visible from any way or public place ❑., Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission 0 Other Description of Proposed Work: /Q e)JA t A Agent or contractor(please print): �CDr c Q Wl�s osevTel.no. ��C� 6 /�z Q 5 n r— Address (��� 1- Owner(please print): �(�„vim ��� ;n S, i Tel,no. Owners mailing address: a 5- S\. �-e M Signed,Owner/Contractor/Agent. j For Comes y This Certificate is hereby ' Approve enied Date: Committee Members Sign MP� a Saab\ of 0 N`9rv� y . pad Kco ee . Any conditions of approval: C.•IDocuments and SettingsldecollikV oval SettingsiTemporary Internet FilesIOLK110KHExemption Form 07.doc Andersen. Andersen Windows - Abbreviated Quote Report Andersen Project Name:,CLIFFORD-C94760 Quote#: 40760 Print Date: 04/24/2014 _ _ Quote_Date_: 04/14/2014_ iQ Version: 14.1 _ _ _ Dealer: BOTELLO LUMBER Customer: BRIAN CLIFFORD-741326 - - 26 BOWDOIN ROAD Billing MASHPEE, MA 02649 Address: 508-477-3132 Phone: Fax: Sales Rep: MIKE PROCACCINI Contact: Created By: David Greenlaw Trade ID: ' 741326 Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext. Price 0001 2 244DH2436(AA) $ 297.07 $ 594.14 —� ROSize=2'4"Wx3'6" H UnitSlze=2'31/2"Wx3' 51/2" H Unit,3 1/4"Frame Depth,White/PI White, Low E Glass, Divided Light without Spacer,Specified Equal Lite,2W1H, 3/4",Chamfer, Ext Grille-White, Int l Grille-Prefinished White(Each Sash)(Includes 4 9/16" Factory Applied Pre-finished White Complete Unit Extension Jambs) Insect Screen White Zone:Northern r ® T U-Factor:0.30, SHGC:0.29, ENERGY STAR®Qualified:Yes ul NJ ® dP `n E m-rnE oco Subtotal $__._.._.._.._._59 c Total Load Factor o Tax(6.250 ) Customer Signature 1- 0.256 — -' - Grand Total - Dealer Signature "*All graphics viewed from the exterior "Rough opening dimensions are minimums and may need to be increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or other items. C(uote#: 40760 Print Date: 04/24/2014 Page 1 Of 2 iQ Version: 14.1 if f 1� r. Vie^ APPROVED MAY 14 2014 Town of Barnstable Old King's Highway Committee �tHE t�,, TOWN OF BARNSTABLE Build I n g 201205286PermiBARNSTABLE, Issue Date: 08/31/12 t y MASS. �ArFG,39. � Applicant: HIGGINS,RICHARD F Permit Number: B 20122117 Proposed Use: SINGLE FAMILY HOME Expiration Date: 02/28/13 Location 340 WILLOW STREET Zoning District RF Permit Type: SHEET METAL RESIDENTIAL Map Parcel 131026 Permit Fee$ 48.45 Contractor HIGGINS,RICHARD F Village WEST BARNSTABLE App Fee$ 50.00 License Num 9657 Est Construction Cost$ 9,500 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND INSTALL HEATING AND A/C IN BASMENT TO SUPPLY FIRST A➢4D HIS CARD MUST BE KEPT POSTED UNTIL FINAL SECOND FLOOR NSPECTION HAS BEEN MADE. WHERE A I CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FULLER,BARBARA WEEKES& \`v BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: C/O FULLER,HAROLD INSPECTION HAS BEEN MADE. 23 PINECREST DR FORESTDALE,MA 02644 Application Entered by: RM uilding Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE 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 OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(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 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). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health Odd i 30 (9 O C, o Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 7 d� � IiARN51'ABI.E, • v� MASS, $ Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.batnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ./ Property Address 3 C-(Q b t3 ':Sf c�,�. �(ilr��g,m�j to ❑Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address o de.Wt�s N :GA_S P,Vk__ S ?� t Y&w 5fi Ul_S-r bar n Contractor's Name 0U-_)VL0_V Telephone Number_ ` 54 6 Z 8 SJ Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) X®PRESS IT ❑Workman's Compensation Insurance DEC ® 9 2013 Check one: ❑ I am a sole proprietor the Homeowner TOWN OF BARIVST ❑ I have Worker's Compensation Insurance ABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ roof(hurricane nailed)(not stripping. Going over existing layers of roof) re-side �`�^ z_oo eplacement Windows/doors/sliders.U-Value 3 D (maximum .35)#of windows S Vh #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMS\bui ing permit forms\E S.doc Revised 061313 The CammonnvaM of Massackusetfs Department of Industrial Accidents Office of Investigafions 600 Washington Street y Boston,MA 02111 wnnv.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrkians/Plumbers Applicant Information Please Print Le: ibly Name(Budme,,,vD ganization&&vidnai): Address: �X) (( �,-� fi City/Stat&Zip: t 50-.FA a �� Ph..4-- SC)d' 3 6 6 2 Are you an employer?Check the appropriate boa: 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 am a sole proprietor or partner- listed on the attached sheet. 7- Ey' deg ship and have no employees 'Mew sub-contractors have g- ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp-insurance required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions �3\[i]' am a homeowner doing all work officers have exercised their 1L❑Plumbing repairs or additions 1£ o wcukers' right of exemption per MGL �J myself �P- 12..❑Roof repairs insurance required.]T c. 152, §1(4X and we have no employees.[No wormers' 13.0 Other comp.insurance required.]' *Any applic u t that checks box#1®act also fill out the section below shay ing their wackers'compensation policy infwmatian. t ffomeawaets who submit this affidavit indicating they are doing all wadk and.then hire outside contractor'odast submit a new affidavit indicating such. TContractor that check this boa must attached an additional sheet shaming the name of the sub-conuacom and state whether ar not those entities have employees. If the sub-contractor have employees,they lmrstprovide their workers'comp.policy number. I ant art employer that ispraiidhW workers'congwisadon irtsrirance for my employees. Below is the palicy and job.site informadolL Insurance Company Name: Policy#or Self-ins-Lie.#: 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 andror one-year imprisonment,as well as ci-61 penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the-uzolator. Be advised that a copy of this statement may be finwarded to the Office of Investigations of the DIA for insurance coverage verification. I doh \rC.erWfjr he pains nd penalties of pet wy-tltat the information prm i ded abate is true and correct Si Date: Z ZZO t. Phone M o L Z Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 3.Building Department 3.CigHown Clerk 4.Electrical Inspector .Plumbing Inspector 6.Other Contact Person: Phone!!: 6 � E A Town of Barnstable Regulatory Services MUMST"erg* Richard V.Scali,Interim Director i63q. �0 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 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (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. Signature'of Owner Signature of Applicant Print Name Print Name Date n•FnTRMC•nurKmT?r=t)AATQQTnxronnT 0 1n/IZ Town of Barnstable r Regulatory Services �FfHE 1p� Richard V.Scali,Interim Director Building Division rinxrtsrnscs Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 �fDMA'1� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB.LOCATION: �4 number / street village 'HOMEOWNER":-,7�CI`V0.2c � SD -s4,�j L r,e5�' name home phone# work phone# CURRENT MAILING ADDRESS: (Uo-&-r (S&rvxC-1 w6tz M IQ� aZ� G� 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 pl ocedures and r\quirements and that he/she will comply with said procedures and requirements. Sigrla re 7oomeo4ni6 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 �= TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 2e 126Z��Z [` a o1.Z�3 � Map . Parcel Applicat' n II# Health Division Date Iss2 ) r Conservation Division Application ke _ Planning Dept. Permit Fee c Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Lf y (� DLO Village l�St -n sra t e, -Owner _�.W1e S IV - J�✓lSr�v� Address 'S�"� UJI t 0 OHO St Telephone SE) Permit Request DI WY�'L 12 T� 4UN m-ZOTS2- • &- o Sq re feet: 1 It floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 0 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 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: ❑Yes ❑ No Detached garage: ❑ existing. ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial 0 Yes 0 No. If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Q 1C -VY\,25, Telephone Number 5-uB 3 c Z Z p� ,Address SSZ UV I I Q(,Q St License# Stag(�L , M r 1� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'SIGNATURE ° DATE i l h py • FOR OFFICIAL USE ONLY AOPLICATION# D�1fE ISSUED 1 MAP/PARCEL NO. " ADDRESS VILLAGE OWNER r DATE OF INSPECTION: _F_O.UNDATION: • "A. . FRAME g[t 6g 3 'f w _ INSULATION u FIREPLACE ELECTRICAL: ROUGH FINAL y PLUMBING: ROUGH FINAL s - GAS: ROUGH FINAL FINAL BUILDING v . k` DATE CLOSED OUT ASSOCIATION PLAN NO. . , i I 77ze Commonwealth of Massachusetts Department of Industrial Accidents office of InvesfigafiOns 600 Washington,Street Boston,MA 02111 wn nvnaxLgovldia �Workm s' Compensation Insurance A�fidavi�BuilderslConiractnrsers I pl se print L b bI licant Ynform:atron /. Name( p$wiz;&onftdividual): Address: C7Z�, G 9 C.:CitylSta&Zip: 1, c �A l-e � �- Phone## Type of protect(regttu�e�- Are you an employer?Check the appropriate boa: 6 ❑New construction 4_�g a a general contractor and I 1.❑ I am a employer with have hired the sub-contractors 7 �"�'�'de�g employees(full and/or part-time)* listed on the attached sheet. 2_❑ I am a sole proprietor or partner- These sub-contractors have 8_ Demolition ship and have no employees employeesand have wod=3 9. ❑Building addition working for me in any capacity. comp-���2 [No warmers' COmP.m�mimnre 10-[J Electrical repairs or additions 5. We are a corporation and its repairs or additions L ed.] officers have exercised their 11_Q Plumbing ep a homeowner doing all work right.of exemption per IviGL J., goof repairs myself[No workers'comP. c. 152,§1(4),and we have no 13.❑Other insurance required.]I employees.[No workers' comp.insurance required-] fill out the sectio¢below showing their woakets',ompeasation policy i¢farmatiaa •p¢y appbcarrt that checks box�1 slso are all Wo$and 1hFn hitE outside contractors roust submit a new affidavid indicating 1 Homeowners Who submit this affiasvit indicating they ring the natrte o f dLe sub co >�and state Whether or not those Mies have tcdatractors diet chuck this bDX mast attached au additional sheet their workers'comp•pohq n��• � �f eptployees. If the sub-contactors here emPlay�es,�Y�provide D17 3zta I nun out etttployer that is providing nrorkers'con�ertsation insurance for MY enrpiflyeM Below isdiep�y�.�dJ information. insurance Company 6 �I �©O� SI8t1t3nDate- �q� ,a Policy#or Self-ins.Lic.# �� t G '`o. VY I ►t'6.Z�O 6 C,V/StateJZip: -t eel II^l� f' Job Site Address: the number and expiration date). asition of criminal penalties of a Attach a ropy of the workers'compensation policy declaration page(showing Policy Failure to secure coverage as required under Season 25A of MGL c. 152 can lead. the tmP tine u to 51,500.00 and/or one-Year impdisonment,as well as civil penalties in e form of a STOP WORK ORDER and a fine p the violator. Be advised that a copy of this statemesrt may be forwarded to the Office of of up to$250.00 a day against a verbcation. ---------- Investigations of the DIA for insurance_coverag . ---------- _ e ovided above is true and correct . . ..______.. . .. . . in orm�toutpr I do hereby c fy under the pains nd penalties of p�edurythatfh f a ,Date: Si tune: Phone#: - O iai use anlj� Do not write in t1lis area,to be completed by ci or town of ciat permit/license# City*or Town: Issuing Authority(circle one): actor S.Plumbing Insl►ector 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical InsP 6.Other Phone#' 6 Contact Person:. i PIKE Town of Barnstable ~� STAE Regulatory Services 9 `Xks&rEB; Thomas F.Geller,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print DATE: 7,0 1 Z _ 1 A) / JOB_LOCATION: `� c7 W t I I mil) S v z&fi a'r V�(Z t"c b(—Q- number street village HOMEOWNER �G.y�nes N. �e.�S e� a$ y 6 z �25 S01? 3 y (o Z name home phone# work phone# .CURRENT MAMING ADDRFSS:_—z S 3 W t I l ems✓ S f- _.. zct &r'A�tv_b(2 ty 1 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. DEFINTTION 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 rocedures and requ" ements and that he/she will comply with said procedures and requirements. Si ature of Homeo 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. C:\Users\de,collik\AppData.\Local\Miicrosoft\Windows\Temporary Internet Files\Content Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 °FTF{E Tot, Town of Barnstable ti °* Regulatory Services 9=nxiv SMASS. Thomas F. Geiler,Director rE1639.�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 /Bqi�lder Pr perty Oust Complet and S Section If sin as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized b building permit (Address f Job Pool fences and alarms are he respo sibility of the applicant. Pools are not to be filled or utilized efore fence 's installed and all final inspections are performed an accepted. Signature of Owner Signature of plicant Print Name Print Name Date Q:FORM&OWNERPER1v9SSIONPOOLS 6/2012 r F Town of 113arnstable Regulatory Services Thomas F. Geiler, Director 163q °rFn�u►�" Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601` www.town.barnstable.ma.us I Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR ASSUMPTION OF RESPONSIBILITY . rvisor icense # J`� , hereby certify that I have assumed responsibility for the project under is oZolZpz��ICe,_Z01WqgZ, 201ZC33�c� construction, as authorized by building permit# , issued to (property address) on 30 j , 201,Z_ The following documents are attached.: copy of my Massachusetts State Construction Supervisor's license. or Homeowner's License Exemption form (if applicable) . copy of my Home Improvement Contractor registration (if applicable) Commonwealth of-Massachusetts Workers' Compensation Insurance Affidavit. Road Bond (if applicable) . L[CE R DATE q/forms/newcontrb revA 10410 i WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE AGENT NO 3020 • OFFICE NO 3020 MARK SYLVIA INSURANCE AGENCY LLC 404 MAIN ST CENTERVILLE MA 02632-2916 FARM FAMILY CASUALTY INSURANCE COMPANY 508-428-0440 NCCI COMPANY NO. 16721 POLICY NO 2001WS073 >IT' 1« R INSURED AND MAILING ADDRESS: ADJUST RENEWAL JAMES N JENSEN EFFECTIVE 8/09/13 353 WILLOW ST W BARNSTBLE, MA 02668-1363 THE INSURED IS INDIVIDUAL Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 01 353 WILLOW ST 158166 W BARNSTABLE MA E .:..................................... ............................................................................................10 ......................................................................:.......................................................... The policy period is from 8/09/13to 8/09/14 12:01 A.M. Standard Time at the insured's mailing address. E1l+I> >: °# >« >:> «:: « :'«.........! ::><::>:>:«>:>«<:>«:>:>:«:>:>::»:»:»»:>:>«::>:»>><:><:>«:>;::>: ::<: :<<>:>:`<:>:»:<>:<:»< >«: ...................................... z................................................................................................................................................................................................................................. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury BY Accident Bodily Injury BY Disease Bodi1Y Injury BY Disease $ 500,000 each accident $ 500,000 policy limit $ 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except the states designated in item 3.A. of the information page and ND, OH, WA, and WY D. This policy includes these endorsements and schedules: WC 00 00 OOB WC 00 00 01A WC 00 03 15 WC 00 04 14 WC 00 04 22A WC 20 03 01 WC 20 03 02A WC 20 03 03D WC 20 04 05 WC 20 06 01A Copyright 1997 National Council INSURED COPY PROCESSED 08/01/13 on Compensation Insurance WC 00 00 01 A Icci jinn nffirro _ Pn Rnv RFR • AI RAKiv NFW V(1RK 197(11_(1RFR -..� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I22`` # �bbZ 14 JI Parcel V7f Application _ Health Division :5Q^�^zg� Date Issued Conservation Division < Application Fee Planning Dept._ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address W ,WQvi VJZ!YaK,--"1 l-1 02.660/5) 1 lillagW% VA �1 . n C i;� Address Owner IN � `1�� t ) Permit Request �✓ u 'n o-4jA Squar ee . fioowr: existiNg p ose 0 2n I e"x sling'- I ` proposed "�o N Zoning District _ - Flood Plain Groundwater Overlay Project Valuation .&_, = Construction Type—,= Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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 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: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: xisting U newD size_ Z Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:r23 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w i Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use CD APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ALK is-0 Telephone Number _ �C�a Q Y Address U-64/L S`I , License # Z _ Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT-.WILL BE TAKEN TO Lt-fi— )C,�^_DATE _j i FOR OFFICIAL USE ONLY APPLICATION# !D_ATF.ISSUED= <MAP/PARCEL N0. _-•i, ADDRESS VILLAGE OWNER-. DATE OF INSPECTION: EOUNDATIQN` FRAME _'INSULATIOMj - FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING a. _DATE CLOSED OUT, . ASSOCIATION PLAN NO. . The ommomvealth o• Massachus- � • - O f efts Department of Indust d Aci ddents Office of fnvesidgatdoirs ADO Washington Street. _ Boston,MA OZIII www.mass.gov/dda Workers' Compensation Insurance Affidavit;Builders/ContractorsMectriciaus/'lumbers APpficant Information Please Print LeyIbly Name 9h1siness/0 �� rO Ad.&ess: -� City/State/Zip:—�,1�rr� ( Phone-#: Are you an employer? Check the appropriate box: Type of project(required):, 1.❑.I an a employer with •4• ❑ I Mn a general contractor and I employees(full and/or part-t:ne1_ have hired the sub-contractors 6• ❑New construction . 2.❑ I am a'sole proprietor orpartner- listed on the-attached sheet: 7. ❑Remodeling ship,,andhave nn employees These sub-contractors have g, ❑Demolition working for me in any capachy employees-and have workers' [No worlrers' comp.ingmEa ce comp...instaance;# 9, ❑]3m7din addition required-] 5. ❑ we are a corporation and its 10.❑Electrical repairs or additions 'L !I am a homeowner doing iZ-work officers have exercised they I1.❑Phmmbing repairs or additions �yselt: [No works' camp. right bf exemption per MGL .12,❑Roof repaas hmaranc a req�ed]t c. 152, §1(4), and we have no . employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks boa#1 nmst also fill out the section below showing tbcir wMj='compensation policy fi farmafinn. t Homeowners who submit fbm afidxnt indicating fhey are doing all work and then hire outside contractors must subm t a new affidavit indicaturg such. $Coatraat-a that check this bmc mnst attacbed ea addict alal sheet showing the name of die sub-contractars and state whether or not those entities have ePloyees, ff the sub-oatmoc bzvo eraplayees,they=mtPnmde fi=warkz;ts'c policy numb �P•PcY er., • I am an,6nplayer.that is providing workers'compensation insurance for my employees, Below is the policy and job 5*e information. Ins zace Company Name: Policy#or Self ins.Lid.A Expiration Date: - Job Sit,Address: CUy/Statelzip Attach a copy of the workers' compensation policy dedarafion page"(showing the policy nuniber and expiration date). Faflore,tA.secure coverage as regaaedlmder Section25A ofMQ,c. 152 can lead to the imposition of crir�alpenaldes of-a fine up to$1,500.00 and/or one-year imprisanment, as weIl as-civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against ffiq violator. Be advised that a copy of this ctatr„Fr;+may be forwarded to the Office of hayesti�s of the DIA for insurance coverage verification. T)do hereby c under the pains-and penalties of perjury that the information prodded ove ' true and carrecL iQnatIIre; — Data: Phone#k • FB only. Do not write in this area to be completed bycity or•town official n: PermitUcensehority(circle one): Health 2.Building Dagartment 3.City/Town Clerk 4.Electrical Inspector 5:Plumbing Inspector son: Phone#: ., Town of Barnstable Regulatory Services t RAMSTABLE, = Thomas F.Geiler,Director 9�A i639 �� Building Division ' lE0 MAr� . 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 I ATE: JOB LOCATION: number street village "HOMEOWNER": ome I name h phone# work phone# CURRENT MAILING ADDRESS: O g aA A" 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 um inspection procedures and requirements and that he/she will comply with said procedures and iFe ements. � l igna JoHomeowner 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. i 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 I several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fbrms:homeexempt �TME Town of Barnstable . . Regulatory Services * MASS. g Thomas F.Geiler,Director 1639. �0 r � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 ell Property.Owner Must Complete and Sign This Section If Using A.Builder as Owner of the subject property J hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not-to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant. Print Name Print Name Date Q:FORMS:O W NERPER IM SIONPOOLS I 4 )o l� �r Q(/J 0OU61 e N t � � 3 J S Jp !S I t1144) RS q F F,�©© 'R t)O s 7- FlV DS r do t s I o 61 � 4& Sc l?E cJs P0 S. 7-S �'1x 7 � dc V/ AY psi UUU � = � . . I 1 ,300,000 psi l }rl)ic;�.il v�ilues Cyr -SO.titll'ertl Yclluw Pine #2 (Pressure; Trcatecl Exterior trsc; (e.-g, clecl(s) .foist Size - .Joist Spacing 2x6 2x5 WO 2x.1.2 12" S-6 .. I 1 -� a4-3 17-4 1 G„ 74 .1 U`�1" I2-4 '15-0 2U" 6-7 11 -U J 3-5 12-3 FO ? GrrE/grL� �o,��, INC, N,9 rc-;,, Jp is T GERS '25-qu c RETU p N Fit Commonwealth:of Massachusetts Sheet'Metal Permit Map Parcel-- - - -- hA/i1'�S Date: Permit Estimated Job Cost: $ Permit Fee: $ �� V Plans Submitted: YES N04 Plans Reviewed: YES NO Business License# Applicant License# Business Information: Property Owner/Job Location Information: Name: Name: Street: ®r q!j, ;�r- Street: �O City/Town: (e�2&r 61A(I\ VA 0� City/Town: Telephone: ��Cs �oS��" �� �� Telephone: ^ 01 12 �a�l Photo I.D. required/Copy of Photo I.D. attached:; YES -V1 NO Staff Initial 4-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family lz�� Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq. ft. V over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: V/ Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: �c INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 YeSNo ❑ If you have checked Xm, indicate the type of coverage by checking the appropriate box below: '\ A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement.. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments I Type of License: ly eMaster 'itle ❑ Master-Restricted ;ityrrown ❑Journeyperson Signature of Licensee 'errnit# ❑Journeyperson-Restricted License Number: ee'$ ❑ Check at www.mass.gov/dol ispector Signature of Permit Approval The Commonwealth of Massachusetts Department of Industrial Aci ddents Office of Investigations• 600 Washington Streef Boston, 4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bnsiness/orgmLntionlIndividual): r4�) i Address: A ti. r e r City/State/Zip: rv\ Phone.#:��10�"� Are you an employer? Check the appropriate box-Type-of project(regnireri):. 1.❑ I am a employer with -4. ❑ I am a general contractor and I e -time). * have hired the sub=contractors 6. ❑New construction . 2. Iempl am o a y'solese p(furopllrianetod/ror orp a prtartner- listed an the-attached sheet: 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 El Building addition [No workers' comp.insurance comp.JusU ance. ' required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.El am a homeowner doing all work 11.❑Phunbing repairs or additions niysel£ [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp,insurance required.] *Any applicant that checks box#1=st also fiU oat the section below showing their workncs'compensation policy infiarmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCout actors that check this box amst attached sa additional sheet showing the name of the sub-cantractnrs and state whether or not those entities have employees. If the sub-contcactnrs have employees,they mustprovide their workers'comp.poiicynamber. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#k ExpirationDate: lob Site Address: C,/ {e/ p: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failme•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'civ11 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. Ido hereby certify under the pains-andpenalties ofperjury that the information provided above is true and correct • �C�� P�Si tore: Date; • Phone k 0,5-GtG �6q Official use only. Do not write in this area, tb be completed by city or town offxiaL City or Town: PermitUcense# 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#: WE Town of Barnstable Re ry gulato Services . a�uvsrn, • MASS Thomas F.Geiler,Director 1639. ► ''' 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 L as Owner of the subject property hereby authorize to act on my behalf, in all'matters relative to work authorized by this building permit (Address of job) Pool fences and alarms are the -responsibilityof the applicant. Pools are not to be filled-before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. W nC L S e f Owner Signature of AppIican 5lh Print Name Print Name Date Q:FOR W:OWNMERMSSIONPOOLS �THE Town of Barnstable Regulatory Services saat�is�re, Thomas F.Geiler,Director buss. 16 39. �••� Building Division Tom Perry,Building Commissioner 200 Main Street, .Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village ' "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 Dermit (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 Homeowner Approval of Building Official r — 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 �VEzG� r7 ��'�!!T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION BAQ`Map Parcel �,, N�';I. Application0 Health Division zns-) nit I fl n;� �; � �; Date Issued a'3 t Z � Conservation Division �� Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 3 LLO t d,��l l to j cST. Village Owner r jA rA in Address 22. Telephone Perm_ it Request ' ' r sa Square feet: 1 st floor: existing proposed 2nd loor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation v 0 — Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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 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: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# -Current-Use- - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 7 Name CATelephone Number Address 12 License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE h JtVtA 14A DATE1-2 i, J� FOR—OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS, ° VILLAGE OWNER DATE OF INSPECTION: j FOUNDATION FRAME INSULATION FIREPLACE �y ` ELECTRICAL: ROUGH FINAL--, s t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 1 • FINAL BUILDING =' DATE CLOSED OUT ASSOCIATION PLAN.NO: . The Cammunwealth qfMaysackusetts Department of fn4atrial rlcczdexts Dfflce of Investigations ,' � '6t?0 Washington Street- - - Boston,M14 02M • www.mass gavldia Workers' Compensation Insurance Affiffim&. Builders/Cantractors/Electdc?ans/Plumbers A Rem't Information Please Print L Fame(Busime dO . Address: 1 ( ors City/st±ezip: Are you an employer? Check the appropriate box: 1.D I mn a •4. I am a Type of project(regui ed):: � dyer with ❑ ��cantra.ctor and I emPloyees(faIl and/or part-tame). have hired fin sub=ca��-t0m 6• ❑New constracr;�,T, . 2.❑ I am a sale gropuetor or partner- listed on the-atbmhed sheet 7. ❑Remodeling .ship and have no employees These sob-contractors have 8 Demolition working for me irt any capacity, employees-and have workers' [No workagx' comp.hmujance cdMp..:i33st¢ancc4' 9, ❑Building k dition regtmeIJ 5. ❑ We are a•corpotafim and its 10.0 Electrical repairs or addifions 3.fR;�am a homeowner doing,Il•work officers have exf;�ed their HE p�g repaii-s.or addifians nfyseI£ [No works' comp. rigbt bf exemption per MGL msraanc ❑Roof repairs e regrr¢nd_j t c- 152, §1(4), and we have no ea>p]oyeea, [146 worts' 13.❑ Other gOmp.insmmce reqidred) Airy aPPIirut ffiat-beaks box#1 must sho M out the section below showing flci�wad'compmsatim policy h f mnafioa•Homeowners wbo submit fhis affidavit fndicat¢rg they 2=doing aII work and ffim hire outside=trectoa.mast suboat anew affidavit indicafing such nhachres ffiat-heel-t3as box mast attached an additicazal sheet showing ffie name of&c sub�autracmrs and state whether ornot those enfi$es have employers. If ffic sub-coatractm have employees,they mastpravidt their w-k='comp.policynmmbcr. I am an employer that is pro-_dding workers-'compensation L%wzrarzce for my emp information. loyees, Belau'is the policy and job site Insm-ance Campauy Name: Policy#or Self ins.Lic.; FxpirationDatE: Job Siia Address: .• Ciiy/St�/Zip: . Attach a copy of the Workers' compensation Policy declar•afion pag-e'(showing the poricy mmIber and expiration date). Fahe.to.sec= coverage as regoiredunder Sectinn.25A ofMGL,c. 152 can lead to the imposition of ctirmmal fine up to $1,500.00 and/or One-year impri ,somneu as well as'ciy1 penalties in the form of a STOP WORK ORDER and o pena�ies f a of up to 0 a day against the violator Be advised that a copy of this statemmit may,be.forwarded to flee Office of ne Inve tiensaras of the IDIA far;nrance coves verification. :I'do hereby c under the pains-and penalties of perjwy that the information provided above is trAe and comet Date: Phone R — Official use only, Do rcat write in this area, to be Campleted by city or.town a�iaL ' City or Town: PermitUcense# •Issuing Antharity(circle one): 1.Board of Health 2.Balding Department 3.City/TgWn Clerk 4,ElectricaI Inspector 5,Plumbing Inspector fi. Other Conbmt Person: Phone#; --------------- I Town of Barnstable Regulatory Services i> tvsresr,E Thomas F.Geller,Director au+sa 1639. `0$ Buildin Dirviision Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:_ number street village name �p home phone# work phone# CURRENT MAILING ADDRESS:_ city/town - state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six units or less and to allow homeowners to engage an individual for hire who does not possess a lice superviso nse,provided that the owner acts as r. DEFIMTION 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 inspection procedures and requirements and that-he/she will comply with said procedures and Jignat;uf LH..ro wner e. 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•buildirig 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 fora/certification for use in your community. Q:forms:homeexempt o�TME ( To wn.of B arnstable ' . Regulatory Services * A�ANRT�Ri V s PLUM�, Thomas F.Geiler,Director s63y. � ` Building Division . Tom Perry,Building Commissioner 200'Main Street,Hyannis,MA 02601 www-town.barnstable.maxs Office:. 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A.Builder as Owner of the subject ptoperty hereby authorize to act on tap behalf, in all matters relative to work authorized by this building permit (Address of Jots) * Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and Pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant. Print Name Print Name Date Q:F0RMS:0W4ERPERMISSI0NP00LS OMS Ver.coms.01(current) Chapman,Sue-Integrity Product avallabi6tyand pricing subject to change. Chapman Integrity Quote Number.X7WA30X Stone White Exterior White Pine Interior integrity Waod-uitrexAvming-Roto Operating Bitoa�lonc CN3327 ' Rough Opening 33,X 27 So IG-]Lite \ Tempered Low E n,.v/Argon 7/8"SDL-With Spa cerBar % Rectzngubr-Special Cut 2WSH € Storte White Ext-White Int AEWW Almond Grost folding Handle Interiori luminumScreen LL— Charcoal Fiberglass Mesh Almond frost Surround As Vlewed From 6 s/ice raibs Nailing Faj.i CN 3327 ***Note: Divided lite cut alignment may not be accurately represented in the OMS drawing.Please consult RO 33°X 27 5/8" your loofriepresentauve for exact specifications. Pr -- O g I i " � I i i i i i ;i i A i . i OMS Ver.0001.05.01(Current) Processed on:5/30/201210-24:23 AM Page 10 of 10 • i 1 _ OMS Ver.WM.05.01(Current) Chapman,Sue-integrity Product availability and pricing subject to change. Chapman Integrity Quote Number:X7WA3QX 3 I Product Specs The following product and option choices were.'designated as part of this project's Product Spec.Product Specs can be over-ridden on a line item basis.Exceptions to the specification are outlined in Line Item Quotes.Please proof all units thoroughly to ensure accuracy. a - Integrity Wood-Ultrez Spec Integrity Wood Ultrex Spec cation-Exterior Color: Stone White Integrity Wood Ultrex Speccation-Interior Finish; White Divided Lite Options-Divided Lite Type :.i SDL Exterior Screen-Type Aluminum Screen Sash Lock Options-Hardware Color White Window/Door Jamb Extensions-Frame Depth Options 6 9/16" i i t i i i OMS Ver.000L05.01(Current) Processed on:5/30/201210:24.23 AM Page 2 of 10 i � � � " r I`` � - , .. I 1 i t .r i I r Models VSE and VS 140-85° 3:12-137:12 _...__.__._...._.. _._.._. .__._.. _.....:. Outside frame In. 21'/zx273/a 21'/zx383/a 21'/zx46'/. 21'/zx54's/m 30°/mx38'/e 30°/wx46'/ 30°/mx54u/e 44'/<x27'/e 44'/.x46'/< ft0ughopening In 21 x26'/e 21fx 3j.?Ie: 21 x'45'/a }2I x 54'/u'' 30'/,ax37'/e 30'IieX45'/a ;309zax54'/m 44'/<x2 44'/4x45Y4i, , _ A _. ...... _. _ _ . DayllghtArea In. 16.20.44� 16x31.5 16x39.38 16x48 25x31.5 25x39.38 25x48 30.25x20:44 39.25x39.38 VentllatlonA►ea, , ;,, sq';ft 2.60 356„ 414, 471 s , l .4.17,;;,1_ 4.751532 431. 584 Model FS 140-85° d - - 3:12-.137:12 - f � c ��..��� c,f ?. '� 'C �.� 0 0 g 0 g . 'egg. 0 t '1. i:�� 1 � A• _ ' 15Y.z 21'/zx 2P/z 1' 21'/zx54 211/2x 231/<x23 231/4x 30?/mx 30°/mx 30°/mx 30°/mx54 443/4x 44i/<z Outside frame In. 461/4 273/e 381A /4 m/m 70'/4 '/m 461/4 301/2 383/8 461A m/m 273/e 46/4 '14/zx ;`21x 21xy 21'x ;21x ,:x 441Ax 44%ax QROUghOpening ) �ln t453/a r 26/e 37,'/e 453/4 70'/4 u/w 45�74 30/ax30 37�[e 453/n 54'/ie e' 45.'%p ' �_i.:+._�a__�u.+�; ac.u_ :vu. ..: ..r-,Z,l4:. 5.+;._s..._...i _a -_,v'u..: v.,x_x.S.._._,e_..._:........_._._....:..:i. r. -.._•ii.3:.i.,x.s 5.:...v_. �lull:..r_ •. 11's/a x 42 i8 3/m x 18'/m x 181/m x 181/m x 181/m x 19 m/m x 9 6/m x 4 27'/4 x 271/4 x 'x27 Y.x 271/4 x 417/m x 417/m x' - DdylightArea In. 241/m 351/m 4215/m 515/8 677/m 201/a m/m 271/m 351/m 42% 51'/e 241/m 42m/m Model FS sizes D26 and D06 fit perfectly between root trusses. Model GDL CABRIOT"" 35.25°=5a° Model GPL 185°-55° 85:12-15:12 4:12-17:12. Outsideframe In 301/sx55 441/4x463/e Rou ho enin In 31'/<x55'/z i 45 x46'/a" Outside frame in 37'/mx99b4 a., - ss s - Daylightarea(glassf in 23/x45/ 37 /mx36 A .. Roughopening� { ,� In)��3'��4'!, 393/ax101�� `.:� Ventila4lonarea(ooeeldg) sq ft 1134�_ 1164 Daylightarea wppart! ? In 30x53'/4 Ventialtlonarea(eap) sq.In 3000 4781 F- Ddylightdrea 0owersedmn) ,In z 30x28.37 rs Net.wf(w/UA.glass): 111 123 t Ventilation area tappersectlolll sq.ft. 22.5 3Vehtilationarea(tta 1 e�� s in�'n ' r-, �367": rr � �'` ' Netwt(w/lam.glass) Ibs:'. 160 `i r • . -�IRE rho Barnstable Old Kings Highway Historic District Committee „ ,ABLL ; 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 Am . APPLICATION, CERTIFICATE OF APPROPRIATENESS 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 constriction: ElNew ElAddition I l+T""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. Sin : ❑ 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 AU applications must be signed by the a rrenat Iner Owner(print): Cs.Q, Telephone#: � Address of Proposed Work: ,,nn p- i , Village n`W_, Map Lot# �3 Mailing Address(if ent) �,01 Y�)L.�s p W, &A 1'1�V�JOI.P m R" C2� Owner's Signature Description of Proposed Work: Give particulars of work to be done: 3D vu AAA fS-ice Agent or Contractor ` Address: Contractor/Agent' signature: For committee use only. This Certificate is hereb P D4-B � 7 Date • �tlf Members sigEtatures RECEIVED JUN 0 6 2012 nit GROWTH MANAGEMENT SUN 2'1 2012 a«stable oldn of B Vi4 ay ccmm(A 1 Q.IBoards and Commissions101d Kings HighwaylOKHApplicationsl0KH2O11 Cert Appropriateness.doc l��-GIL�Sl�c3 Cry 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) (speck 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 2°d member Depth of overhang Window: (make/model) material color (Provide window schedule&rplanfor new buildings, major a ditions Window grills (please check all that apply_: true divided lights exterior glued grills grills between glass—removable interior None Door style and make: material Color: D Garage Door, Style Size of opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Old C mmittieeWay Deck material: wood other material, specify Color: Skylight,type/make/model/: V ' material V` Color:Size: 91 YLX- Sign size: Type/Materials: Color: Fence Type(max 6')Style material: Color: RECEIVED Retaining wall: Material: JUN Q 6 ZO12 Lighting,freestanding on building in ! ANAGEIVIENT um �_ OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBM=D Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name 2 Q:Woards and CommissionA01d Kings Highway10KHApp1ica1ions10Kff 2011 Cert Appropriateness.doc I Qom . fit. '• : _; + ° Barnstable Old Kings Highway Historic District Committee g } 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 NAM .63q. APPLICATION, CERTIFICATE OF APPROPRIATENESS 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 do 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/bam ❑ Shed ❑ Commercial ❑ Other 3. Exterior Pain roof ❑ new roof 0 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 R Other , 6. Pool ❑ Swimming ❑ .Other man-made pool ❑ Solar panels ❑ -Other ` Type or Print Legibly: Date TA Q3 r,tDla a NOTE All gppGaatlons trual be signtd by the Owner Owner(print): L Telephone#: �0 - Address of Proposed Work: Village Lot# (3 l �a Mailing Address(if diff nt) rr `�" Pr Owner's Signature W Description of Proposed Work: Give particulars o work to be done: C.cr 08'l r i 1✓4 S i -iD Agent or Contractor(print): Tel hone#: Address: �� �i 3 "(S.1K I n f)�,A n-�f,1AA f" Contractor/Agent'signature: 1A J For committee use only. This Certificate is hereby APPROVED/DENIED Dat Members signatures RECEIVED , APR 2 3-2012 ,-I GROW' II M d�..,`ENiEN APPROVED Town.of Barnstable 1 Q:1Bow&andCommluEora101dKbWHtghway10KHAW1t= dns10KH2OLCertA,pproprtatencssdoc Committee Old King's Highway v i l � CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 Copies Foundation ype: (Max. 12"exposed)(material., brick/cement,other) Siding Type Clapboard_ shingle_ othet 'Material: red cedar white cedar other Color. Chimney M. eiial: Color: Roof Materi (make&style) Color: Roof Pitch(s : (7/12 minimum) (speck on plans for new buildings, major additions) Window and door trim material: wood V other material,specify Size o cornerboazds size of casings(1 X 4 min.) color �"Q Rakes LA inmber 2°d member Depth of overhang Window:• (i iake/model) &&Atenal color 1��'{Qom• *(Provide winow schedule on plan for new buildings, major itions) i Window gd is (please check all that apply_: true di fided lights✓ exterior glued grills:_ grills between glass_removable interior None —. Door style aji d make: �� material,jo Color: W kA4--•Q_. Garage Doo' ,Style Size of opening Material Color Shutter Typt/Style/Material: Color. Gutter Typ aterial: Color: Deck materi :.wood other material,specify Color: Skylight,typ /make/modelk material Color: Size: Sign size: Type/Materials: Color: RECEIVED Fence Type(max 6')Style materi (�� APR. Z 3 2012 Retaining w l Material: MAY 0 q 2012 GROWTH,M ANA .;ENT Lighting, standing 011 building Town of Barnstable illuminating sign Committee OTHER ORMATION: THE ATTA D CHECK LIST MUST BE COMPLETED AND SUBAUMD i Please provi e'samples of paint colors,manufacturers brochure of windows,doors,garage door;fences,lamp posts etc i ' Print Name Signed: (pl preparer) v 2 Q.-W oards and C ions101d Kings HighwaylOKHAppli-io-10KF12O11 Cert Appropriateness.doc 5. SIGNS DiaE ram of sign,showing g4hics,size,,design and height of post,color and materials. Spec sheet. r Site :Ilan on a GIS map dr mortgage survey,OR photographs OR to-scale sketch of building elevation sho ving location of oposed sign;and any tree to be removed near a freestanding sign. Fee rding to sc ule. 6. SOLARVp1ano Dr of panels on house showing roof and panel dimensions. Sitocation of building on property. (Assessors map may be submitted) RECEIVED Heel above the roof.Col APR .2 3+1012 F' ' h:(matt or glossy) ' 7. F LISTOF ABUTTERS: PLEASE SEE H':OK STAFF GROWTH MANAGEMENT SIGNED (plan preparer) do y4APrint Date: Tel.Phone no's: ✓0 a�L l0. NOTE APP The Old Kings Highway Historic District Committee MA YDENYINCOMPLETEAPPLICATIONS bie MAY 0 g 2012 To not BamshwaY ATTENDANC AT MEETINGS: If the applicant or his/her representative is not present during the hearing is � g application j may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS PLAN PICK UP There is a to (10)day appeal period,plus a 4 day waiting period for approved plans from the date the decision is filed with Town C lerk. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's H ghway Committee. Plans approved by the Old King's Highway Historic District Committee may be picked up at Growth Management,Regulatory Division,200 Main Street,Hyannis,after expiration of the 14 day"wait"period. If the 14'b day falls on a Saturday,your plans will be available the afternoon of the following business day. DENIALS Applications that are denied may be appealed to the Old Kings Highway Regional Historic District Commission within 10 da ys lof the filing of the decision with the Town Clerk. For more information, see the Bulletin of the Old Kings Highway.District Commission. BUILDING PEP2.VHTS,OTHER AGENCY CONTACTS In most inst nces,before commencing work,a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or-demolition. Commercial work may require Site Plan approval. Demolitions the applicant should check with the Building Division as to conformance with Zoning requirements. Other Regul itory Agencies at 200 Main St,Hyannis MA 02601: Building Division 508-862-4038 Conservatio Division 508-862-4093 Health.Division 508-862-4644 QUESIONS ABOUT YOUR APPLICATION? PLEASE CALL THE BARNSTABLE OLD KINGS HIGHWAY OFFICE AT 508 862-4787 5 Q.Woards and Co ionsiold Kings Hfgh%Wj0j f App,,licatiowlOKU 2011 Cert Appropriaknm.doc Town of Bamstable Geographic Information System April 25,2012 131038 045 131061 131021 060 1301od 131020, 02E5 V0307 5� #1131062 0 15600E 027 7 � $44 ��1r 31 0210 0280 s .,9101E 9325 . 131034 oil 131089 030 1613061 191032 . 191023 00 6363 0286 131064 0236 036E • s 131016 0226 ' 1 840 340 ® S 131033 0385 13108=1. 0 15 • .131025 131024 191017 0330 0329 o is g115 • IS1027001 19106E 0 taz 131030 0205 131027002 is se4 131031 0,140 A0008 40.0 �0� 1910 19000 E a�3 , rP e to0 4 Fee rso OISCtA IERS:Me map Is for panning purposes only. It Is not adequate for legal Map:131 Parcel:028 Selected Penal F boundary determinatlon or regulatory Interpretation. Enlmgements beyond a scale of Owner.WEEKES,NORMAN E SR Total Assessed Value:S323900 VOW may not moat established map accuracy standards.The parcel Irma on this map W E ar r' e only graptdc representations of Assessor re s tax parcels.They a not true property Co-Owner.%CHAPMAN,SUZANNE W Acreage:3.13 acres Abutters boundaries and do not repms od awuate relawrrslmps to physical features on the map Location:340 WILLOW STREET Butted 'r suchas building locations. ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parc Application #C:-�, o Health Division Date Issued t Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis ,` Project Street Address Village ��,(� ECJA nstk,bu Owner S Q:,_Q4 c, 42 1 Address � 1 oho' Telephone v QWq CoS45 Permit Request Qda ba6bm Qlpspi U lrt door: exist ro sed nd fl ting pose Tot I new Zoning District ood lain " Gro ndwater . verlay Project Valuatio 0--Construction Type Lot Size 3 QjCJ`QS Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure M13 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl IdWalkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area ft) o_ Number of Baths: Full: existing new Half: existing I new `-- Number of Bedrooms: existing _new — c� 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?❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)Name Telephone Number 50� C9 `L 5 Address License # Home Improvement Contractor# , Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE . - DATE X �� FOR OFFICIAL USE ONLY � 1 z. APPLICATION# ; DATE ISSUED i MAP/PARCEL N0. fr ADDRESS VILLAGE 7 � OWNER i DATE OF INSPECTION: ; FOUNDATION �61L— t-KAME � INSULATION } `? FIREPLACE 4 ELECTRICAL: ROUGH 'FINAL PLUMBING: ROUGH I FINAL r { s GAS: ROUGH FINAL � FINAL BUILDING 1, s DATE CLQSED OUT ASSOCIATION PLAN NO. i The wmtnanwealth of Massachvsetts - :Deparlmerzt of�is�rest5^ialz�cciderztr • . . - . D,�ce of frcvestigatiorsr = WOO Washington, &eet- - ` Boston,MA 02U-1 wWw.mass gav/dia ' workers,kers, ComPensation Insm-Ance Affidavit; Builders/Contractors[Mectrician s/Plumbers AApplicant Information Please Pruett LeFaffily Name Adf$ess: SA- ' city/stwzip aAY�C�r1'7jLQ (►`1� Phone Are you an employer? Check the appropriate box: Type of project(required) ` 1.❑ I am a employer with •4• � I am a general ca�ractvr and I e�nloyees(faIl and/or part Vie). have hired$ie sub=e 6. ❑New construction , 2.❑ I am a•sole*oVrieinr or partner- listed on the'attached sheet 7. []Remodeling ship and have no employees . These sub-coutacto s have 8 Demolition working for me�any capacity. employees-and have wormers' moo. ' comp.insurance ' cam..insurae,�e#. 9. []Biding addition required.j 5. [] We are a corporation and its 10.0 Electrical repairs or adzBfims '3.[--I am a homeowner doing ilwvrk officers have erased their 11.0 Plmg repairs.or additionsmyself [No worinrs' comp. right 6f exemption per MGI,fi 12.0 Roof repairs =nm p regtrireI]t c. 152, §1(4), and we have no . employees. [No workers' 13.❑ Ofher q°mF•insurance required.] *Auy aPplirmmt that checks box A mast also M oat 6e section below showing then warktts'c p ey ' t Homeowners who submit this afndavit mdicafmg fey are onUntacbm- us mmit 'fion doing aII work and�hire outside contr�rs.must submit anew affidavitmdicafmg such. �Coahactnrs that check this box malt attached an additional sbeet showing the-name of the sub-coat[actars and suit whether urnot those entities have employees. Ef the sub-coatraetoz ha�o empluyaes,fhey mostprovidt their workers'c number. �P•P,9b cY . I am an employer that is providing workers'compensation insurance for my am in ployees. Below is tke policy and job site formation. InMU72nrp Company Name: Policy#or Self-ins.Lin.# Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy dentarafion page'(shovr ing the policy nurnber and expiration date). Fame- to.secure coverage as required under Section 25A of MOL c. 152 can lead to flee i�osition of cri�al penalties of'a fin$lip to $1,500.00 and/or one-year imprisommerd, as, eII as civil penalis in the form of a STOP WORK ORDER and a frne of up to$250.00 a day against thq violator. Be advised that a cagy-of this staternmit may,be forwarded to the Office of Iuve of the DIA for TT smmice coves verification I do hereby c nder the pains-and penalties of perjury the information provided above is true mid correct Data: Phone#: 5o kl, L 5 Ilk FB only. Do not write m this area, to be coinpleted by¢ty ar.Town a�zciaL PIi: Permit/L c=e# hority(circle one): Heap 2.Bmil iag Department 3.Chy(Town Clerk 4.IIectrical Inspector 5.Pliunbing Inspector 6. Other Contact Person: Phone#: E , Town of Barnstable • ��s "rib • Regulatory Services t > Thomas F.Geller,Director KAW Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �O Please Print DATE: 1'2— JOB LOCATION 1 � • number street village "HOMEOWNER": �., SOC/ &O (i^ name thome phone# Ll 1 "(wo�rk phone# CURRENT MAILING ADDRES 0 , 0 ci 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 jinspection procedures and requirements and that he/she will comply with said procedures and a ' ements. Ik ture f 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 lack of awareness often insults 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 can t amend and adopt such a forrn/certification for use in your community. Q:forrtns:homeexempt �TME' Town.of Barnstable . Regulatory Semees MAN ' Thomas F.Geiler,Director 1639. 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 Mus - Complete and Sign This ection If Usin A.Buil r as Owner of the subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit (Addy s of Job) Pool fences and alarms are the responsibility of the applicant. .Pools are not to be filled before ence is installed and pools are not to be utilized until all f mal ins ections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QYORM&O WNERPERMISSIONPOMS G K �o�OsAd ao� " f I� �-0 oCo v, C� *2(012 Town of Barnstable e� , #1Expires 6 monthsfrom issue dat X. ER�VVi1,1. Regulatory Services Fee Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY 2 Not Valid without Red X-Press Imprint Map/parcel Number 3 �2 Property Address ' (' U) - 0 U Residential Value of Work_ rjr OOfl ` Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone p 9R _(a6Lf Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: 5 / I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name i Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. i Permit Request(check box) ® Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [�. Re-side �� #of doors ��` � [� Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ai *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc Revised 051811 S Alk The Commanweahh of Massat,.husetts FDepartment of lmiustrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 wwrs%massgoy/din Workers' Compensation Insurance Affidavit Builders/Contractors/Ekectricians/Ph mbers Applicant Information Please Print 1*6bly Name(BusmessrbganionlfndividuaU: �CnnD QnrQJIVI�/� Address: �C Q /State/Zip_ Phone Are you an employer?Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. K I am a:general contractor and I employees(full and/or pan-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 5gyemodeling ship and have no employees These sub-contractors have 8_ ❑Demolition wotidng for me in any capacity. employees and have wadcus' [No workers'comp.insurance camp.insurance I 9. ❑Building addition required-] 5- ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL 12.❑hoof repairs insuntr ce required]T c.152, §1(4�and we have no employees.[No workers' 13.❑Other comp.insurance required.] •Any applicant fat checks boa#1 must also fill our the section below shooing their wo6ers'caution policy ndbrmrti� T liaaaeowa,ers win submit this affidavit m&cating'they are doing all woaik and then hke outside contractors oast submit a new affidavit indicating such FContractors that check this boat must attached an additional sheet showing the name of the sub-cmtrxtors and state whether oruw those entities have emphrj ees. If the nub-watactors Lave employees,they must provide their wtskeirs'romp.policy number. lam an employer that is providing workers'compensation insurance for my employeea Bdow is the policy and job site information Insurance Company Name: Policy#or Self-ins.Lie.#: 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 fi»ded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c r under thepaiins and penabYes ofpedkiy that the information-provided above fs dwe and correct Si W Date: `Z Phone;9: so Official use only. Do not unite in this area,to be completed by city or town q(freW City or?own: PermitlLicense# Issuing Authority(circle one):. 1.Board of Health 2.Building Department 3.CityfPown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 The Commonwealth of Massachusetts Depar'imerit of Industrial Accidents Office of Investigations V_j 600 Washington Street Boston,MA 02111 w►vw.mass gov/dia Workers' Compensation Insurance Affidavit- Builders/Contractars/EIectricianmumbers Applicant Information Please Print Legibly Name(Business%organizationandividua4: // e Address: City/State/Zip: t, 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 6. ❑New construction ,employees(full and/or part-time).* have hired the sub-contractors 2. . I am a sole proprietor or partner- fisted on the attached sheet. 7. ❑Remodeling slip and have no employees These sub-contractors have g_ ❑Demolition w capacity. employees and have workers' °� for me in any � t3`- I 9_ ❑Building addition [No workers'comp.insurance comp.insmanc -] 5. ❑ We.are a corporation and its ME]Electrical repairs or additions required3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself o workers' right of exemption per MGL gyp- 12.❑Roof repairs insurance rid-]T c.152, §1(4),and we have no employees.[No workers' 13.❑OtherA6 O&Qfi ke j t ` comp.insurance requited_] t 7�' t outs •tiny applicaut that checks box#1 must also fill out the section below showing they wakes'compensation policy informstion. Homeowners who submit this affidavit huhcating they are doing all stook and then hue outside contractors nmst submit a new affidavit indicating such ICouwwtors that check this boot must attached on additional sheet showing the name of the sub-conttwAots and state whethu car not those entities have employees. If the sub-contactors have employees,they must provide their workers'comp.policy number. I am an employer that isprmRding n orkers'competrsrrtfon insurance for my employees. Below is the po icy 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 fins 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 fx-mwded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby ce fi,under the pains and penalties of perjury that the information provided above is true and correct Si ture: ` Date: Phone it: 20 6�7�1� Official use only. Do not write in this area,to be completed by city or town o ffrciat City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 �tM Town of Barnstable Regulatory Services 'r'"RN LF , Thomas F. Geiler,Director `b 1659. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 77--JOB LOCATI N: c7 Lto W, (, to number street (/ village W"HOMEONER": �� a name home phone# work phone# CURRENT MAILING ADDRESS: O we, city/town s to 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 wbo 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 dersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro a lures and re ements and that he/she will comply with said procedures and requirements. A. Si re o o .owner 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:\WPFILES\FORMS\building permit forms\ENPRESS.doc Revised'051811 swaxszeace, ` ,. Town of Barnstable AIFO�.t A Regulatory Services Thomas F.Geiler,Director Building:Division Thomas Perry,CBO M1 Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L , as-Owner of the subject'property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of 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:\WPHILESTORMS\building permit formslEXPRESS.doc Revised 051811 FORM B - BUILDING AREA FORM N0. BC 86 MASSACHUSETTS HISTORICAL COMMISSION 294 WASHINGTON STREET, BOSTON, .MA 02108 TownBarnstable (Nest Barnstable-West;. Address 340 Willow Street Historic Name George S. Fish g House - -- _ Residence/private lit ` _ Use: Present Mr. and Mrs. Harold Weeks ® �� 1 �6�{l- Original Residence George S. Fish DESCRIPTION Date 1893 Source Registry of Deeds SKETCH MAP Show property's location in relation Style vernacular to nearest cross streets_ and/or . .. . geographical features. Indicate . ,..Architect : unknown all buildings between inventoried property and neare t intersection. Exterior wall fabric Green asbestos Indicate north. VILLOV shingle STREET Outbuildings N 0 2 story barn _STREAM •f O Major alterations (with dates) ^^� sided - mid 20th century ^Y V Y Moved no Date v �1 Approx. acreage 3. 13 ares 'AR EET Rec(4?ded by Hazel Meyer Setting Residential between > `�rganization Barnstable Historical Cedar St. and Lombard Commission Date May, 1983 Avenue Photo #44-14A-WBC86 (Staple additional sheets here) i ARCHITECTURAL SIGNIFICANCE (Describe important architectural features and evaluate in terms of other buildings within the community.) This two story house has a- gable roof with a dormer on the southwest roof . slope. The spindly chimney is near the peak above the dormer. The . windows are large pane 2/2 lite. There is a porch running the length -of the northeast facade and' a one story bay on the northwest gable end with four windows. The house has a low stone foundation and is located on' the southeast side of Willow Street. HISTORICAL SIGNIFICANCE (Explain the .role owners played in local or state history and how the building relates to the development of.the community.) George S. Fish .purchased the two acre parcel -in 1893 from Elisha B. Fish and built the house. Elisha Fish owned the .surrounding property�.and .lived in the house on the northwest side of Willow Street (see form W.BC-82). Elisha received the property.:from. his uncle Reuben Fish, in 1886. George S. Fish, the original owner of thehouse, was. a Deacon -:of'the West Parish Church and a mason by trade. ` PREVIOUS OWNERS 1926 . - Harold C. Weeks from Mercy A. Harding 1922 - Mercy A. Harding, daughter, from Nellie .Fish, widow of George S. Fish 1908 - Nellie' Fish by will of George S. Fish, husband 1893 - George S. Fish from Elisha B. Fish BIBLIOGRAPHY and/or REFERENCES (name of publication, author, date and publisher)- James McCarthy - original research Mr. and Mrs. Harold C. Weeks, interview, June 1983 ' Town of Barnstable assessors map #13126 Barnstable County Atlases - 1907, 1880 and 1858 Registry of Deeds - Barnstable County Registry of Probate - Barnstable County i 10M 7/82 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES LEGEND. SYSTEM DESIGN: MARKED WITH MAGNETIC TAPE OR COMPARABLE MEANS FOR FUTURE LOCATION. � oce PROVIDE MIN. 20" DU1M. WATERTIGHT (NOT TO SCALE) 1. DATUM IS APPROX. NGVD 99 - EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 6 a° 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE -9 eo X 99•1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED TOP FOUND. EL. 68.9' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS NOT AVAILABLE 65.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. EXISTING 3 BEDROOM DWELLING PER ASSESSORS MINIMUM .75' OF COVER OVER PRECAST 2X SLOPE REQUIRED OVER SYSTEM 63.5' PROPOSED CONTOUR DESIGN FLOW: 5 BEDROOMS ® 110 GPD 550 GPD 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS = PRECAST H-Io BLOCKS OR TO BE AASHO H-]Q �. 198.4] PROPOSED SPOT EL. USE A 550 GPD DESIGN FLOW RISERS (TYP.) PRECAST RISERS ao 2'0 4"OSCH40 PVC MORTAR ALL H-10 o eo 0 TH1 PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. SEPTIC TANK: 550 GPD (2) = 1100 ,. TEST HOLE '� �• (TYP.) 7 3' USE A 1500 GAL. SEPTIC TANKC. HENDSri SIDES I eeQ 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 5 ce M 2% SLOPE OF GROUND *65.5 Ip• 14" �O•`�O`�O`�O✓• . .� \\ O 'r 61 91 TEE 150o GAL N-Io TEE - ' ° ° ° ° -11NM ;°ooa°�°o• 310 CMR 15.000 (TITLE 5.) (PROP.) SEPTIC TANK 61.66 °o°o°oo °o°o°o° LEACHING: 1-0^ °°°°°°°°° s• MIN. SUMP °o°°°°°° °o°o°o°0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 4' UQ. LEVEL o°o°o°o°o° °c °o°o°o°o °o°o°o°o wII�OW 6 GAS BAFFLE 00o0000000 oc 12• MIN. INT. DIM. °o°o°o°o o 0 0 0 UTILITY POLE - ACME OR EQUAL 0 0 0 0 0 0 0 0 0 0 {f P SIDES: 2 (47.5 + 10.83) 2 (.74) - 172.6 GPD 5 7�' '°°°°°°°° :o�o�o0o� BE USED FOR LOT LINE STAKING OR ANY OTHER 5 ee{ ° ° ° ° °O°O°O°O 57.67 PURPOSE. FIRE HYDRANT BOTTOM 47.5 x 10.83 (.74) = 380.6 GPD '' Y ,. ., .' .. .. NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAMANG00 O o 0 0 0 0 0 0 0 o 0 C 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 0 0 0 0 0 0 0 0 0 0 o H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. TOTAL: 747 S.F. 553.2 GPD 000000o0o0o000� 0°0°0�000� 3/4"-1-1/2" DOUBLE WASHED STONE cocas rx° BARN SEWER INVERT PROPOSED AT EL. 62.25 t (5) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL ALL DIMENSIONS TO OUTSIDE OF STONE: 47.5 X 10.83' WITHOUT INSPECTION BY BOARD OF HEALTH AND USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) COMPACTION. (15.221 [2]) PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE WITH 2.5' STONE AT ENDS AND 3' AT SIDES MIN. 1n 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL ( 2 x SLOPE) (3.1 % SLOPE) (. % SLOPE) BUILDING SEWER OUTLETS AND DIGSAFE (1-888-344-7233) AND VERIFYING THE ELEVATIONS PRIOR TO INSTALLING ANY � LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES DWELLING 54 52.0' BOTTOM TH-1 & 2 PRIOR TO COMMENCEMENT OF WORK. LOCUS MAP PORTION OF SEPTIC SYSTEM \ SEPTIC TANK 56' D' BOX 12' LEACHING NO GROUNDWATER FOUND BARN - 17 / FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE NOT TO SCALE ' REMOVED 5' BENEATH AND AROUND THE PROPOSED MA LEACHING FACILITY. APPROVED DATE BOARD OF HEALTH 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ASSESSORS MAP 131 PARCEL 26 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 13. ABUTTING HOUSES SHOWN AS PER GIS MAP. ?o,kj -.tea OF O EXIST. WELL Rl k%qY TEST HOLE LOGS ENGINEER: ARNE H. OJALA, PE, SE WITNESS: DAVID W. STANTON, IRS V EXIST. SEPTIC REAR OF ��V / DATE: APRIL 10, 2012 DWELL. PERC. RATE _ < 2 MIN/INCH a� / , h`'' CLASS I SOILS P# 13603 ELEV. ELEV. EXIST. wELL / p" 4 63.0' 0" 63.0' p" 63.2' 0" 63. REMAINS OF SHED Ap/ Ap Ap Ap ESL ESL �SL/// �SL EXISTING WELL 63.92 (TO BE ABANDONED) I--,' 10YR 4�2 /10YR 4/2 10YR 4/2 10YR 4/2 1■6z10 67. 6.23 /LS / t ■61.6\ �LS LS LS / DWELLING// ss ■63.61 10YR 5/6 „ 10YR 5/6 10YR 5/6 „ 10YR 5/6 X/// EXISTING N / I \ 36 32 40 38 ea TOP FNDN. -PROP. HELL ELEV. 68.9'/ - �6.09 .61.71 C 1 lJ 1 C 1 I 68.94 e _ 5' REMOVAL OF UNSUITABLE SOIL REQUIRED 66.4 b b .62.51 \ AROUND PERMETER OF LEACHING FACILITY, /MS CMS /MS q 6 55 DOWN TO SUTABLE SOIL LAYER. (VARIABLE DEPTH - SEE 6� ow TEST HOLE IOGS). REPLACE MATH CLEAN MED. SAND, TO M ET 48" 10YR 6/6 50" 10YR 6/6 C 1 10YR 6 6 60 / I a ..oa \ SPECIFICATIONS OF 310 CMR 15.255(3) SILT LOAM / 2 / i / i 1 OYR 5/2 TM XSI/C2/6 '8 .66 0' ■65 6 1 SILT/LOAM SILT LOAM LOAM TREE ■6 .54 T / 52„ /10YR 5/2 58.6' S3„ 1 OYR 5/2 58.5' 84" 56.2' 63" 10YR 5/2 58.1 / /.63.�2/ C3 C3 C2 C3 s 16' CEDAR CO ' / / BENCHMARK: TOP FNDN. /lip� OF BARN EL. 66.0' s o3 �^ .64 7' Tl I / / PERC FS FS PERC F$ FS 6.08 / 3.96 /ki .. 10YR 7/3 52.0' „ 10YR 7/3 52.0' „ 10YR 7/3 52.2' �. 10YR 7/3 52. Si / 132 132 132 132 6.17 66/ BARN 4,64 64 !s 3 /'\/ / /1.68 \ 51 63Nk4 // ' NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED ROTTING 65.53 SHEDS .04 \ 63.03 \ SHED I \ PROP. BARN SEWER INVERT 65 48 AT EL. 62.25' I TITLE 5 SITE PLAN Ex1sT. ,IEULL \ / I OF NOTE: NO PORTION OF THE SEPTIC SYSTEM IS DESIGNED FOR 340 WILLOW STREET \ VEHICLE LOADING \ WEST BARNSTABLE I PREPARED FOR 15o I JOHN & SUZANNE CHAPMAN EXIST. HELL APRIL 11 , 2012 I I Scale: 1"= 30' TOTAL LOT AREA: 3.1 ACRES PER ASSESSORSOF 4f';sc. (TWO ACRES PER DEED 562 PG 30) �^ SURVEY SUGGESTED DANIEL rDANIELA 0 15 30 45 60 75 FEET JJ 36?34, THIS PLAN IS TO BE USED FOR THE EXCLUSIVE PURPOSED OJAIA ,16 OJALA �P OF PERMITTING AND INSTALLING THE SEPTIC SYSTEM SHOWN IL n 0.40 �q v 9 36? 4650 PG p �r/ 30) �(I�/��- ° �g /�o off 508-362-4541 fax 508-362-9880 .` �ti'�� � I downcape.com I E L yGs o OJA�Ja C 11- Cn OJALA ALA Cn down cap< d9ng117eeNng, inc. / pNa 465 0 �� N 40 civil engineers IL �0 Ir land surveyors 939 Main Street ( Rte 6A) 1 ,9-072 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675