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HomeMy WebLinkAbout0109 BETH LANE � o� �� �,� ;�:, Y Town of Barnstable P rmi �� 15�'��� le *s be t Regulatory Services • 6 months from issue date BAliNSTABIX tKAss Richard V.Scali,Director Building Division ow Paul 1 �' Paul Roma,Building Commissioner "s 200 Main Street,Hyannis,MA 02601 �7t 1C�f utivw.town.bamstable.ma.us t J Office: 508-862-4038 Fax:50030 EXP"SS PERMIT APPLICATION - RESIDENTIAL ONLY N ut ot Valid witho Red X--Press Imprint Map/parcel Number � - � ` Property Address ,01 9 k A) Residential Value of Work$ 7 B • r Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t CV�.�i��� ! 4" 4 tV/J a j�gB:S L 0 l3E4. OQtWJi5 . W ® akd Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) . Email: Construction Supervisor's License#(if applicable)' ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner ❑ I have.Worker's Compensation Insurance 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: '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: C:;:Users\decollilr.AppData\Local\Microsoft':WindowsUNetCachelContent.Outlook\L7U69LF21EXPRESS(2).doc 01/25/17 1 I MAS& Town of Barnstable Regulatory Services Richard V.Scali,Director ' Building Division Paul Roma 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 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. C:'••:Users`,decollik"AppDatalLocallMicrosoft-t indows\INetCaclielContent.Outlook\L7U69LF2•.EXPRESS(2).doc 01/25/1.7 The Commonwealth of Massachusetts Department of IndustfialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ftp�q A,)") Address: —_Ci . / /.dip: N i j Dolb0( Phone#: Are.you an employer?deck the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. 1 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 information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside conizactors 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 thepolicy 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 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: Si ature:-')h /13 Date: Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152,requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person m the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate.a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage'required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confamationof insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i,e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice 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 Depmtment of Industrial Accidents office of Investigatlow 600 Washington Street Boston,MA 02111 Tel.#617-727-4M ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 w.maw.gov/dia Town of Barnstable Regulatory Services of Richard V.Scali,Director Building Division sAxxsrABiX Paul Roma,Building Commissioner y MAss. 1es9. 200 Main Street, Hyannis,MA 02601 fps s www'.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: (� Please Print � n+ _L— /, kA) JOB LOCATION: l(, D8/�� 4 "A)) S berr n' I / street / village +�T�j �"HOME�OWNER��". A44t`�"I � R) L J 8 t0 / �J(/ 1home phone q# work phone# CURRENT MAILING ADDRESS: �Q/ N7"4 /V city.own state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less'and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts.as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requi ments and that he/she will comply with said procedures and requirements. Sienamre'ofHo w 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. HOMEONVNER'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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. C:Userstdecollik''tAppData\Local\Microsoft`,Windows\INetCacbelContent.Outlook\L7U69LF2''IXPRESS(2').doc 01/25/17 t _ : rtarrR�rR l of I a strRat Accir " C@ I� dRV 3k.Q.[lldS .. FVtE!fk.8R?iLS !?61 r11�dQf .. ... .. r ... .. '6�c�' rs' GQje a6an aace Af#"isiavrt• m de nta, etaistE teicaa s(Pla l e Apyl��antInfarrrr aafion.!.. Please.P"rdn L b ZV�me A€Wess: r . .. Cit e # Are an eplaper?C6erk the apgrapl�a#e boa . 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P:P7 .. .. .... ..,. �P�[rn a :eaaPu�j' r that spF »ays a°car asadun insger a�ccz or�,_earpdoye' 'giolf a tip ate'job sr� fnxtge Campony Naive .. PaP .#cu Self-igs Lsc; atatt�xn, e .1 b Site Addie CiEy�StatetZsp Attach: cogy of tlt workers"e€►m}ae ati€�e p®lsc�dechtrat ;p ge jslMrwing the goluy tanmber and rap t#an dnto atlnre. a segue co m e as r under Sects 25A of NICL c P52 lead tkt the asattc�aa of cr iaa�p atties of a-` ... #ine to$P,StIU attclfvr a:. weFP as dw es na the foins Gaff a STOP�`OR ORDER and a.hmme . :.per.. iaf Bp do$250.0U a eia}against.the..�n©Iat Ike aslutisesE. #a sop y ofthis sta#exnf be forwardest€o +�'i�e of Invastians vfCP}e DIA for msiksnce cotaeiae veoss I do busby �d�rer thpart�s a�dpnattas m� aur}'th la a� orM prabra .estrdrad c®rr�ct .:: Stgnah�re_ I3a P'ha ... .. . t? t-use rrxatrif��n#has'area, b�c�rsjv�etesrF by cats vr'trnwv��,Qica�tL City ur Tam P'ermitfLicense Issnatg Awnttor�t (eir rye dne) 1.Ifoo&d of,Hidth 2.Ans t3 0 Ilo�xn Qerk 4 Iectaical fns ar 5:;lambing ins eto ......: _. . .. __.......... .... .......... ......... ....... _...... __.... .. ..... . .. .. Contact I?`ersan. .FPivne#- 6 Town of Barnstable � �y ti *Permit# o - Regulatory Services Erpires6inmVisf og'suedate awaysrtists, Fee 1619- ,�� Thomas F.$ Geiler, Director ter!%MA't A Ip Building IVISIOn D' U Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsthble.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid rvi/horrt Red X Press imprint Map/parcel-Nunber Property Address `. Residential Value of Wor�C ��,�� Minimum fee of$35.00 for work under$6000.00 Owner's Name & Address M ,k4 f ��'A. f eo "� ' E ✓<< Contractor's Narne� Telephone Number Home Improvement Contractor License #(if applicable)_ ( ro i .Construction Supervisor's License #(if applicable)_ ❑Workman's Compensation Insurance Check one: I am a sole proprietor , I am the Homeowner PC ❑ I have Worker's Compensation Insurance ;/AN Insurance Company Name r� +t)� ,: r ��. CAI STABLE Workman's Cornp. Policy# Copy of.Insurance Compliance Certificate must aecompany each permit, ' Permit Request (check box) ❑. Re-roof(hurricanenailed) (stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ -side n��( Replacement Windows/doors/sliders. U-VaIUCO .S6 #of doors ✓\ (maximum .35) #of windows *Where required: issuance of this.permitdoes not exempt compliance will 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 r aired. SIGNATURE: : < Q:IWPFILESIFOR S1bui gPermit forms�EXPRESS.doe. Revised 072110 XNThe Commonwealth of Massachusetts i 1 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 . �ea www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �, Address:GbC� ls t✓ E'�dL„ City/State/Zip: C �t�uc��g-- �c_ �a6 - Phone #: `�15 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- listed on the attached sheet. t �• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. .❑ Building addition . [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and.a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Si ature 6 �`"— Date: ?c-- S_ t Phone Official use only. Do not write in this.area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4:Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: • 2 . Massachusetts- Department of Public Safety Board of Building Reif„ulutiuns and Standards �—COnstr'uction.Supervisor License ;,License:,CS 14007 t','J, - R trictedtp 00Al =tfxlf tEI FFf� t, by . a r OH N P YDUNN BOX 924180,MARIE ANN TER # a C,NTERVILLE,?MA 02632 " .. Expiration: 5/25/2012 Cunmiusioner '� Tr#: 24061 y _ l 4'.. Office of Consumer Affairs&B siness Regulation: HOME IMPROVEMENT CONTRACTOR' _ Rggfstration. 149 .. Type r `- 0,. xp Ex iration: ' 012• Individual r ;F} 0 P D.UNN On Dunn 1 0 MARIE ANN TE, Undersecretaryt F a SHE r Town of Barnstable Regulatory Services • eiler, Director . �xrrsrea�, Thomas F. G , euas. 9`���6,9• ���� Building Division ED Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 rwww.town.barnstable.ma.us 4W Fax: 508-790-6230 Office: 508-862-4038. Property Owner Must Complete and Sign This Section If Using A Builder Y' 7 as Owner of the subject property _ ' ' Dv o j to act on my behalf, hereby auth in all matte relative to work authorized by this building permit application for. (Address of Job) A; Signa e of: er Date Print Name If Property Owner is applying for permit please comple e Hom.eoners License Exemthe ption Form on the reverse side. TOWN OF BARNSTABLE Permit . ----2._1708�—I P t No — - : Building Inspector nARI.TAm ; Cash - — °" ~ OCCUPANCY PERMIT Bond - X. No building.nor structure shall be erected, and no land, building or'structure. shall.be used for a new, different, changed, or enlarged .use 'without a- Building Permit therefor. first having been obtained from the Building Inspector. No.building shall be occupied until a certificate of occupancy has been ,issued bylthF-Building Inspector." Issued to C. "& F. Builders Andress Box EE Falmouth, MA lot #42 , 10q Beth Lane.' ,Hvannis wiring Inspector E" ` �- �r Inspection date ' � E ' Plumbing Easpector�,/ LY:a e _ Inspection date ✓Gras Inspector �' Inspection date ,/Engineering Department .t 'ff F l l fiil T/ Inspe ction date,;,. 43 1E�� THIS PERMIT:WILL NOT BE VALID, AND.THE'BUILDING: SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR.'UPON SATISFACTORY .COMPLIANCE WITH TOWN REQUIREMENTS. ..................._.. ...................„, - Building Inspector TOWN OF BARNSTABLE Permit No. Building Inspector _ I aaaarr,n Cash _ OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C. rz U. 'Builders; Address 1'4x toy A? 1XII Ertl' tv-- ii'm Wiring Inspector Inspection date Plumbing Inspector f r Inspection date Gas Inspector Inspection date Engineering Department' Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .............................._..............._, 19_.... .................................... . .... .................... . .. Building Inspector `Ass`essor'A map and lot numbe .........�...... � � _ Qyo%YNero�o SEPTIC SYSTEM Sewage Permit. number MUST o INSTALLED IN COMPLIANCE t 33AW ''T LE, /o WITH ARTICLE a House number ......................:.......... ............................... LE II STATE 'o .. SANITARY CODE O z63q. •� ' AND .TOWN °yap a. TOWN OF B4RATW �- BUILDIHG 'INSPECTOR APPLICATION.FOR PERMIT TO ................ j.Cr;?. ................... .................. TYPE OF CONSTRUCTION .................... 4...... t Yr ................................................................. ...........J ........4...............19.. .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for or a ermit according lto�the following information: Location ... . ........1,B.�.1 /td...... `,fie.... .....` !. ... ............."'✓.. /�� ......&........................... ProposedUse ..... i. � �6.�12.... .......................:................................................................................................................ ZoningDistrict .......................................:................................Fire District .....................�...........................c..........,.......................... Name of Owner �..1�:J..... �C�.L.I�CX ........ ...........AddressTe.k..�EE...!.�.{7�b?G(��.,i&C .,�f�.�..�.!... Name of Builder .dld!L J„<.7.. .. j?.�:.�............Address cJ:.> .�� �..: `-.. tli !� ....L!�r. o� ." Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ........: ............... ...................................Foundation ....... D..Ya W-1 Exterior ..Gl� f ../ 1.. J.SGI.. .... , ..�G .Roofing .........�L�rS Floors hl .�/{,>...�%�.��. . ......... ....l.1.1')4'........................Interior .......�.)—y..� Heating ....I...Fi/.�............��../.................. ................Plumbing .. ., .Gl...t:�... .C7(�� .........`.. . .Z���,.................. Fireplace ............... p...........................................................Approximate Cost ........ .! :G` ...........�.. .... Definitive Plan Approved by.Planning Board ---------------____-----------19________. Area ..............�(OQ.... S.................. Diagram of Lot and Building with Dimensions Fee �� '............................................. SUBJECT TO APPROVAL, OF BOARD OF HEALTH l/ I hereby agree to conform to all ,the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... `....... .. .. ........................ V � ^ ` , C. & F. Builders . 2I708 one ory No ................. Permit for ----.�����----. l' ° ___ __ _*_, ' ~ --- _ -_' --------------------------. . . . 109 Beth Lane Locotion ---------------------. ' ^ ..i--�.----.Hyannis------------' . ' C. & F. Building [�vvnor ---.-�_—..�---.���.� ------- '. Type of Construction ------frame _------- ' ---.-----------------.---- -~ , ^ ' #42 Plot ............................ Lot,----'----- ' ' '~ ~. ' - ' ^ October 3 79 - Permit Granted ------------_lg . Do�o of Inspection --------_.�--]g ~ ` ~ ` Dote Completed ..=--�..��—.�..1---.]q ' ' -[— ~ . ' / . '% ' . ' —' l� .....~�. ..~~ � — —..� ------ —_~~—_.—.----.---~—.--.---..—.. ............................................. ' --------.----~---..�--...~----. .. - . - ^ ' - . - . ` , 'Approved ....... lA - . ' . . � -------'^----^---^^'—~---'—'-- . �| -------'---^'--------~^--~^^— . � Assessor's map and lot number- . ..�� ) �� /�C �........ ............... . �.. ... I IN ErrO� „r� Sewage Permit number ................. . :............................... /© � Z 33ARN TAMLE, i House number .......................................................................... yo Mae& « p 039. e� eMPYa` TOWN OF BARNSTABLE ?T BUILDING INSPECTOR APPLICATION FOR PERMIT TO .............. ? ►�UC' f� /� l l I�'► . ....... ...............................................................................:......... TYPE OF CONSTRUCTION �A 9 !� (' `�.................. .................................. ..... ...................................... �T / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....�. ..g........ 'S/�„A /! / a .�, P � .;/ /�� I� ( //� .......................t........................ ........... r......................................... ProposedUse ....... 1 J /a cll (,!r..j?....................................................................................................................................... - f ...............................Fire District .............................................................................. Zoning District .....................n................... {� �j, y� ,/ Name of Owner '� ..!. .r. c.. /ia ..........................Address..!.?.��.h..:�;�' lx.Qt.( 1 �t�` ���:� .. �, ....... -y) y..�....................... Name of Builder_. / �Ra;�.l,... .- ....... ?...............`........Address .,............................,.. ......... ... ....... ... ....... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ........... .J.............................................Foundation ../.... i/t�` r/-) lPr .. ........ Exlerior h� , / lf . Jd.I�-.Roofng ......... ...................................... Floors jP .... ....... ..................../ � !- 1 .... Heating .... Plumbing ........ r ` Fireplace .............. .!` ...........................................................Approximate Cost ........:2:2�.:� ................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area ` o . ........... I� Diagram of Lot and Building with Dimensions Fee ....... . r. ^�.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name41-n.... h. ..f......................... 61 C. & F. Builders � . ° . . . . ^r ` ^ � ' 2I7O8 o�e � No ------ Permit for -----.��U............ ' � ^ oiugle fami dwelI' -'---'---'------------------' IOg Betb ��ne � Locohon ---------------------. --_-..---..�Ya�����------------. Owner -^ - - ~ - � Type of Construction ....... Tame ' PlotLot Permit Granted-� Date of Insp 7 tion ....................................19 � Dote Compi /d PERMI REFUSED RM --. 9 ~-' ' - ---'' -'-' .�~^~ - --'��--'7~------'--'' _ ' � -~'-~--- --^''^-'~''------'~--- ....................N Z................................... ^ Approved � ................................................ lV -------'-'-----^~-----^-~-'-''' -------'---'----------'-^^-~'- | F. F 53, 00 TYPICAL . SYSTEM PROFILE AREA PLAN l FDN TOP ,FINISH GRADE= i�a NOT TO SCALE 51 _ SCALE : I "= .4 0 , �� • '�� FINISH GRADE OVER TANK= GRADEISOVER LOT 4 2 BET H S LANE �49.UO P V C OR O O O •` j . e e C. 1. TEES �,3 ° e • • • �% • • e e e 0 IC 0 C ��+ , .5 , V J• BSMT �. �fi �..a3C3 .; a.:. r • e e o e e _ FLR AS•00 I O Op GAL. 4"f . e e e e • • • • • • e e ;• REINFORCED D I S T. B O X • o e e • • • • e e • e l CONCRETE 8 TO BE INSTALLED ON ° ' ' ' ' • e e ' ' ° e ' A LEVEL STABLE BASE • ° e • • e e o • e e SEPTIC TANK TO BE INSTALLED ON A • • • • • e e e e LEVEL STABLE BASE 2"-1/8`!- 1/2 "WASHED PEASTONE ALL ' ' ' ' • • • ' ' ' ' s BRICK a .MORTAR COURSES AS AROUND FREE OF IRONS, FINES ° • ° • • e • • e 1 e e .. REQUIRED TO BRING COVER TO GRADE AND DUST IN PLACE '~ LEACHING PIT -- 24 C.I. MANHOLE COVER a 3/4 TO 1-1/2 WASHED CRUSHED FRAME - SEE DETAIL STONE ALL IRONS, FINES AROUND ND FREE IN BASE TO BE LEVEL ,,••' .` . -�'"'', PLACE f, i 1zC, I ) FOR FIN. GRADE SEE SYSTEM PROFILE SOIL AND PERCOLATION 4" = DATA 58" E _ s" _ - PERC. RATE : < 2 MIN.�IN. 125.Go` _ — : - n 4" FOR INV.ELEV SEE C. D. SPOHR �T O � .� PRECfiS'i' Cd�IGE�T.I L�A�MIIU� INLET SYSTEM PROFILE - TAKEN BY : - �- La CK3it3 S.`Ft G t� PITS 5 .D Tftti.5 ter PROf"fL>~ LINE ° • ° _ p 6" ° •- cd 5 �' ten, or- H�a►.�rt ' WITNESSED BY: �� � T,�.£.►,.,� 3 p OPENINGS W/4-I/8 R,R o� Pk<;CAST CA1.1G�? T� UtS'fiF:IU t'ita+�t !° ° OUTER DIA. a 1 -3/4"p _ ;, DATE: 5 U�C, i ? t AmA ro 4 0 C•t R S��VE PIT as' BOX^- Ski= Pl eaFILIF 7` p INSIDE DIA. ° TEST PIT-GND ELEV. +5 • OA 0-' ° a D 6 . ' TOTAL o (REAP) �100c `QrA- . P2ECAST C.4> CpETE -° _ p p �� Q -� SEPT%c TAMP.' -�-5EE NR.OFILE AREA ° � 3 NU _RUST L.i=DBE o p o 1_OA °l S .�' Q- 4 to' �� O P D05E6,� !<5 (� � O • p i . 0 00 0 0 2 6�S.tr i 0 0 0 - �, /Ci f?c^ O2 I N I N ' 3 e.tz. :a o p o 0 0 0 0 0 ` ' r° `: C.'OAS SALID V� 69 o 0 0 0 o 0 r- (51.Dt- i 3 =, -- LOT '4a' 12�. -�' tag � s ' 6 " DIA. HOUS Z y� «4° � 101 6 EFFECTIVE DIA. BOT. PERC. HOLE TOwN DOWN "OraLEACHING PIT - SECTION tt NO SCALE DESIGN DATA : S 15' S S' `ems s NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM -+� , � N0. OF BEDROOMS q0 12 2 DISPOAL BETH ' S LAN E_ LEACHING PIT NOTES: EST. TOTAL DASLY EFFLUENT �3Q A `G LS. I . CONC. TO BE 4000 P.S.I a 28 DAYS . SEPTIC TANK 1 0 b2 GAL. 1 2. REINF W 6 % 6 " 06 GA• W. W. M. OWNERSBU I LDER �-'�� � q 3. 2 `AND 4 ' SECTIONS ARE AVAILABLE FOR GENERAL NOTES . GREATER DEPTH REQUIREMENTS _ CL.A IZ ,- 4 FLY N i BU I L.Dl!3:_--5 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN NOTE: EXCAVATE TO ELEV. LOWER AS ACCORDANCE WITH TITLES OF THE STATE SANITARY CODE FALMOUTH, M AS:5 1 � DATED JULY 171977 a ANY LOCAL RULES APPLICABLE. REQUIRED TO -REMOVE ALL LOAM AND CLAY CONTAINING 2. ANY CHANGE TO THIS PLAN MUST BE APPR D. BY THE MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL BD. OF HEALTH,; AND CHARLES D. SPOHR. WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING of MASSq COMPACTED IN PLACE. .�� c NOTIFY THE ENGINEER FOR INSPECTION. B• �t�-r E e /� y� SIDE AREA= 1g S.F0'A S.F./GAL 495 GALS M. NOT z� Charles D. �� BOTTOM AREA=8 S.F. ' Q S. F./GAL S GALS 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. s SPOIzR N 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN ALL P_LE��/S, BASGO ON PAVE: "EMT I^D ET lo. 746E �� TOTAL AREA =285 S. F. TOTAL GALS APPROVAL BY CHARLES D. SPOHR. A" 1,0T (ci) ,q�UKAEO E EI-Ey, +SO•C`>C3' v�O,r��'`STER��G�2� LEGEND 6, FOUNDATION INSPECTION READ. WHEN EXCAVATED. OF SSIONAL 450.0 EXIST. GROUND ELEV. AREA PLAN: 50.0` FINISH GROUND ELEV."UNDERLINED" PI-AN47 50' 1 PIPE INVERT. ELEV. REV. DATE DESCRIPTION F'otiZ c. i=- •ButLDE-Rs SCALE-: I "= 40' DEC- -7 8 ZY J. P• DOYIVE tom. • L . O TEST PIT LocaTloN SEWAGE DISPOSAL SYSTEM 0 o SEPTIC TANK FOR CLARK � FLYNN BUILDERS TO�f N �`A'"�� F'-�- ❑ _ DISTRIBUTION BOX �--� - _� a, r�F h1A$S LOT 4 2 B E T H'S LANE � �n 'LB CP I TCHERS WAY) HYANN I S -ttt+t+t-H- 4"BIT. FIBER PIPE -TIGHT JOINTS i� � SPOHR ��I �� f 150 F, No. 7468 0 - -- - PROPERTY LINE vA ��'�STEQ�/C^� DESIGNED: C.D.SPOHR DATE-5 MC•'"' 1F DRAWING N0. �oF - ��. 5 1 2 8 I MAP SEC PCL LOT � •� MIN. CODE DISTANCE �/1 �----' DRAWN: C. ��'. SCALE:ASSHOWN lam' CHECKED: C. D. S . r 4