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0076 CONNEMARA CIRCLE
,, F ,� i i i I �' f �1, '� c 5 a i ' � \r� '\ ��/��a ,e ��^ .t. F. "y. , ... ""� III i1 ) ,1 �'. :� V art; a;�� ��1�•y:. " 1, {''x �'9, tl�Y�', r Y tt�t rtu� Pi `NYCURTHY,`m*' y RLJCTI0N tCOs`xt ;t 5, i s tial arid�Commercial Builder ' nA K R 31 Pry 1. 11 u - r n N .yy t March 15, 2014 x Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, ti This affidavit is to certify that all work completed for permit application#201400766;Status A; Parcel 291285 at 76 Connemara Circle, Hyannis, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute(BPI) inspector. All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction z a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o��7 l Parcel ag� Application # Health Division Date Issued Z I ct ` C ipp Conservation Division Application Fee so Planning Dept. Permit Fee _ , Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 4 60V Nne r", CYY�L Village )'FX.nr.., Owner Address h Telephoner) 3 -a a// Permit Request -Square feet: 1 st 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 ❑ 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 1A Detached garage: ❑ existing, ❑ new size—Pool: ❑ existing ❑ new size _ Barn: � 'Sting hewcsize_ Z Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: .J Y Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _4 Current Use Proposed Use u � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number PO Box 52 Address West Dennis, lenni_ . 02670 License # Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �Y�• SIGNATURE DATE 2�lIlY FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAR/PARCEL NO. «a aPc y. s ADDRESS VILLAGE R r OWNER 43 DATE OF INSPECTION: FOUNDATION % FRAME INSULATION FIREPLACE I ELECTRICAL: ROUGH FINAL ! PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL FINAL BUILDING i {' DA-Ti CLOSED OUT S—Sp PLAN NO. I� 1 6 Ac�0 CERTIFICATE OF LIABILITY INSURANCE DA 10/1 DDIYYYY) •�'"' 10112013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an.endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ^ PRODUCER 01962-001 !�ONTACT AME: ............ ------.....---------- rY g y P"R (508 398=6060 - - :_ •..._•:---------- ---- B den&Sullivan Ins A c of Dennis Inc ) FAX No (508)394 2267 PO Box 1497 1 EMAILL - So Dennis,MA 02660 i ADDRESS: — T- INSURER(S)AFFORDINGC_O.VERAGE.-_,-.•__,_-.-.______ NAIC# A.I.M.Mutual Insurance Company 33758 INSURED INSURER B ----- -- --- ----- - --- ---_.._ Michael McCarthy Construction Inc �- ----- --- -- - —-- ----' ---- -- �INSURER C:----------— ----......- -- - -- - ----- P 0 Box 52 I West Dennis,MA 02670 INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,-TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT!CNS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR I -IADp 1-licg— POLLICCyy EFF PAL�ICY-E�(P--- - ---- - -- ----- LTR! TYPE OF,INSURANCE tNSR I WVD l POLICY NUMBER ((MMIDDM%) (AND/ T��)-4. LIMITS - GENERAL LIABILITY I EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I I I DAMAGE TO RENTED ;$ �-PREMI$ESLEaocpurrence)_--i--_...---------- I CLAIMS-MADE i OCCUR ( I MED EXP(Any one person) $ - rPERSONAL&ADV INJURY I$ GENERAL AGGREGATE L$ GEN L AGGREGATE LIMIT APPLIES PER. ! I PRODUCTS COMP/OP AGG $ l POLICY JE O OC L = AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED BODILY INJURY Per accident $ 1AUTOS AUTOS !' I ( _ ) ! HIRED AUTOS ; NON-OWNED i j :PROPERTY DAMAGE $ _-_ AUTOS tJeeraccide - -- -- -- - I $ . UMBRELLA LIAB i OCCUR I EACH OCCURRENCE h$ - ___ EXCESS LIAB I CLAIMS MADE I AGGREGATE $ DED RETENTION $ $ yVC g7 t� _ ,T - WpRKERS COMPENSATION I -- --- - - - - I - I X L ORY LATT OC H ... —._. _ ... AND EMPLOYERS LIABILITY I T IMI - ANy PRO RIE77poR/PARTNNE�/EXECUTIVEr/NI' I E.L.EACH ACCIDENT -il$ 500,000.00 A OFFICERPMEMBER EXCLUDED? Y �I N/A I VWC-100-6017656-2013A 17/17/2013 7/1712014 r ----- --- ----- - ---- -- (Mandatory In NH) -- I i I - � � � ;E.L.DISEASE-EA EMPLOYEEI$ $00,000.00 �DE SCRIP I%VnF OPERATIONS below t ` IE.L. ISEASE- MIT -$ 500,000.00 _. ._ _. _.. _. 1 Ei POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention:BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN \ Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE +-- ©1988-2010 ACORD CORPORATION.All rights reserved. ORD 25(2010/05) The ACORD name and logo are registered marks of ACORD OWNER AUTHORIZATION FORM % v o I,4. Y (Owner's Name) owner of the property located at %fo ! iIv►enp M/i VIA- f t Ll (Property Address) e (Property Address) -- --- a hereby authorize ��� uacontractor) 111,01 .%AA QU5J nct?1+RW%.W1 JW1 IiEai �o-eaoa-aaeyw°esr2 ^aa"aw -it vWJ sa°P UW1. y'r'c:fiiEFv`iRr3 .. �e ea�eeee eve esea� au vve see suave eve a�e�ss_ e...e eyes ee6e n.ye av eeve,Wit ...9 wv..u.. vvc.n. ay........J. - permit and to perform work on my property. Owner' Signature ®ate I_ The Commonwealth of Massachuseft Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mars.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 52110 _ `c uc - Name(Business/OrganizatiorLdndividual): PO Box 52 West Dennis, MA 02670 Address: Cell (508) 280-6964 CSL-58633 HIC-169393 City/State/Zip:. Phone#: Are y an employer?Check the a propriitte bog: Type of project(required): 1.L� I am a employer with 4. ❑ I am a general contractor and I , �/ployees(frill and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. lI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' y P tY• 9. ❑Building addition [No workers' comp. insurance. comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.D�ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and.state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address:�b Cdnhcf',,_V Cdr�'Z 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 ffisu9qe coverage verification. I do hereby certify under th i a enalties of perjury that the information provided above is true and correct Signature: 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 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 ai ndivid1W partnersliip,assoc atior3=o?®ther legal entity,employing employees. However the owner of a dwelling house having aof ddte-than three apartments and who resides therein,or the occupant of the dwelling house of another who 1em�ldys perscls'to,.�lomaintenance,construction or repair work on such dwelling house or on the grounds or building appurteit-adt tfilrrW"t 51i!allnpt because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners;are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. WWW.Mass.gov/dia IVIIVI Ir\LL IVIVVr11\11 1 1 • MICHAEL MCCARTHY °; P.O. BOX 52 � WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. SCA 1 Co 20M-05/11 Address Renewal Employment ❑ Lost Card &21e W.CwwealLLc a� aaaacLi��eGty License or registration valid for individul use only Office of Consumer Affairs&Busifibess Regulation I; y OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: A 69393 Type: Office of Consumer Affairs and Business Regulation >7 xpiration 6/1672015a Individual 10 Park Plaza,-Suite 5170 Boston,MA 02116 MICHAEL MCCARTHY MICHAEL MCCARTHY, 6 RANGLEY LN. SOUTH DENNIS, MA 02660==' - Undersecretary Not valid without signature 1 Massachusetts-Depart Board of ment of Public Safety Building Regulations and Standards Construction Supers isor License: CS-058633 o rf� PO BOX J 1�CAR_Tgy 52 7 P ° W DENNIS I#A070 r �TI'a(J.J Commissioner Expiration �—------ -- 04/10/2014 Y A� — d� '' :� y .. ,.._ .. e '« 'o -+a'��`;,r� as ..� •. °"„�,= �� .��,y-, � � �� ,�, .mt+,�s" 3��'" 77_77- ���y" � -k ram, (❑ �X ; v. l ' http: `issgl infiianet{prapdatad/Parr_elDetai{ aspx?ID=228 0 �� �a a �' �Bing a file Erit - iz •Fon ., TooasHellx: - - I- — ,r.F,u: -'�, �,_ � � , ... ,��� " -z &�� ,,a.+wr.�:. ••EEP�+;, *us.�+�" '� =a r..€ L- � � ;k . u Favorites- tes ,. .....- �.:. . . - :.;. s tea,.,._ �„ ,; ,. ,:. ,; ;:�. .. ,3_ .�,, *; *`"b`, - .. t ' „• fin.,• ;>.su` ...-_,;� ,. x...�-�-..a �. a::., ryu,.,.«*".-.r.. t.,-...._: a. °'+'v" ..3; ' Parcel Detail,_ . < • . m. ;� > I � .r - . t ------------- I d ml ; l- 44 I kz �. a-- � Rarcel Info _ x ru � t t f Parcel ID[291-285 Developer Lot LOT 66 Location 176 CONNE('v'IARA GIRDLE ---� Pri Frontage6 i 1vv� if f i Sec Road S� l Frontage village HYAhJhJIS `� Fire District!HYA IJPJh I Tovan sevier exists at this address!No _.I Road Index '0,345 ii Asbuilt Septic Scan: Interactive Map 7�. ' , 0---t jt Oviner u'HEELER, DAMES &JANE � Co-a,iner streetl 1110 BALD ROCK ROAD ) Streetz � � i City FI6ALISPELL state ft�T Zip 59�9(l1' Country t (2itemsremaining)Downloading�jeturefile:ffisuislonstmages Q04105140.jpg: t \,,,,' " -_ •.W Localiintiariet Si�Pt . Parcel Detail WindawasJ..,jj Maur§ys mMenw-PTO,., �� �Pp�cat�vnEntry Tunis..] a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.,,, Map- 9`) Parcel Application #' � 'I Health Division s Date Issued Conservation Division Appfxcatiori Fee Planning'Dept: Permit Fee; Date Definitive,Plan Approved by Planning Board Historic OKH — Preservation/ Hyannis Project Street Address CONNGwrfA Ci r Village ��Vjkm N i S Owner "T i w^C ��4 W I i �►*" S Address Telephone So S 39 4 3644 Permit Request ro Ce*i S+-%A,&r 1 O' X I of D*x-K, to r, pl�ec„ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District` Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 9' Two Family ❑ Multi-Family (# units) Age of Existing Structure 30 YES Historic House: ❑Yes A No On Old King's Highway: ❑Yes A No Basement Type: 09 Full ❑ Crawll, ❑Walkout ❑ Other Basement Finished Area(sq.ft.)i 5y SI& Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. 1 new Half: existing new Number of Bedrooms: .3 existing�_new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: N Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes W No Fireplaces: Existing New Existing wood/coal stove: "�C�Ye No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑kriiw (thze_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ • k,r4Y Commercial ❑Yes ❑ No If yes, site plan review# w 97 Current Use S%N94� Proposed Use S � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 474 -313- 6 e O a Name _� �"�O AlfirmM5 Telephone Number S08)3?1 3 to ff Address l� �d (�W N �� � License# CS 75 6 T(D / ''`��"`�� "• Home Improvement Contractor# /4 7,t Worker's Compensation # WG 03'f: IS I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9/ 1 } 102 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1'kj05 V DATE CLOSED OUT ASSOCIATION PLAN NO. ,per The Comynonwea161 ofmassachusetts \ Department oflrzdustrial,4ccidents Office of Investigations 600 Washineon Street .Boston, MA 02111 " °• www.mass.gav/did Workers' Compensation Insurance Affidavit:;Builders/Contractors/EIectricians/Plumbers ApjAicant Information A Please Print LeL-ibly Name (Businessl0rganizationandividual): (A) I jj'A4MS/ ��1��G►�IJC CO �G, Adclress: (awM 1404 . Roo.a City/State/Zip: Are you an employer? Check the appropriate box: Type of.project(required): 1.(� I am a employer with Is 4 ❑ I am a general contractor and I 6. ❑New construction . employees (full and/or partaime).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition employees and have workers' working for me in any capacity. � 9. ❑Building addition [No workers'.comp.•insurance comp. insurance. 5 [] We are a corporation and its 10.❑ Electrical repairs or additions. s required.] ' 3.❑ I am a homeowner doing all work officers have exercised their I L ]Plumbing repairs or additions myself. [No workers' comp. right of exemption per lv1GL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other .. comp,insurance required_] *Amy applicant that chccla;box#1 must also till out the section below showing their workers'compensation policy information. cow t Homn�who submit this affidavit indicating thty arc doing all work and then hire outside:contractors must submit a new affidavit indicating such. tContraetan that check this box must afbmbcd an additional sheet shovring the name of the sub-contractors and state whether or not those entitirs have employers. Ifthc subcontractors have cmploycas,they must providt their workrrs'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Beloty 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-thc imposition of criminal penalties of a fine tip to S'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 S250.00 a day against the violator. Be advised that a copy of this statement raay be forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certify under the pains-and en as of perjury that the information provided above is true and correct. Si ature: 2 Date; Phone#: Of use only. Do nut write in this area, tb be completed by city or town official City or Town: Permit/License# • Issuing Authority(circle one); - • 1. Board of Health 2. Building Departrnent 3, City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instr'uCtIORS 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 forcgoing.cngaged in a joint enterprise, and including the legal representatives of a deceased employer, or the trustee of an individual,partnership, association or other legal entity, employing employees, However the receiver or the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of dwelling house of another who,cmploys persons to do rnaiutenance construction or repair work on such dwelling house or on the grounds or building app iri:enant 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 licensiug 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 appUcntwho has not produced-acceptable evidence of compliance with the insurance coverage required." a. Additionally,MGL ohaptcr 152, §25C(7).statcs.'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliznce with the insurance rcquizer_acats 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(os) and phone numbers) along with their certificates)insurance. Limited Liability Companies*(LLC) or Limitcd Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or Lam' does have employees, a policy is required J3 e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of M'surance coverage. Also be sure to sigu and date the affidavit. The affidant 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 nurAbcr lasted below. Sclf-insured companies should enter their self-insuranco license number on the a ropna-to line. City or Towti 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 permiyhccnsc number which will be used m a rcfercnco number. In addition, an applicant that must submit multiple perrnitdicense applications in any given year, nccd only submit onp affidavit indicating current policy information(if pecessary) 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 ormarked ar ccns s�A nowe city affidavit town may it must b rulided ed to the applicant as proof that a valid affidavit is on fide for future permits or cach year.Where a home owner or citizen is obtaining a liccns c or permit not related fo any business or coMmercial venture (Le. a dog license or-permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would hke to thank you in advance for your cooperation and should you have any questions, please do not hesitato to give us a.calL The Department's.address, telephone and fax number: Thrt Commonw( a th of MassachusC-M Depzrtrnmt of lud-a t al ArcidQ�nts Offzco of Layestig tiros 600 Washi Tton Street B Qston, MA 02111 Tel: # 617,727-40.0 exC 406 or 1-87?-IvMASSAFE Fax# (517-727-7749 Revised 11-22.06 www.mass.,goY/�11a 07/24/2009 FRI 10:54 FAX 15087901677 FAIR INS Q001/002 DATE(MMfODNYYY) ACORD,,. CERTIFICATE OF LIABILITY INSURANCE .07/23/2069 PRODUCER (508)775-3131 FAX (SOS)790-.1677 THIS CERTIFICATE IS ISSUED AS A_MATTER OF INFORMATION I The Fai r Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 P.O. BOX 430 HOLDER E 10I: ALTER THIS:CATEDOES NOT AMEND,EXTEND OR ER THE COVERAGE AFFORDED BY THE POLICIES.BEL:OW, 619 Main St. Centerville., MA'0263:.2 INSURERS AFFORDING_COVERAGE NAIC# INSURED Williams Building Co Inc IWURERA: Star Insurance Cots any 196 Old Townhouse Road II&kERB: W. Yarmouth, MA 02673 INSURERC: INSURER 0: - INSURER:E: OVERAGES. i THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY:PERIOD INDICATED„NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR I MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED_HEREIN IS SUBJECT TO ALL THE TERMS,E S.A XCLUSIONND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR ADD' P.OLICYE FEC IVE P lICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE 3 COMMERCIAL GENERAL LIABILITY DAMAGE TO.RENTED $ CLAIMS MADE D OCCUR - MEDEXP(Anyone person) b PERSONAL&ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.•COMPIOP AGG S POLICY PRO• LOC JECT AUTOMOBILE.LIABILITY - - - COMBINED SINGLE LIMIT $ ANY AUTO (Ea:acGilent) ALL OWNED AUTOS BODILYTNJURY SCHEDULED AUTO$ (Perpercon) $ - HIRED.AUTOS BODILY INJURY S NON•OWNEO AUTOS (Per eciiden0 PPeROPERTY:DAMAGE S { r accident) GARAGE LIABILITY AU TO ONLY:EA ACCIDENT : S ANYAUTO OTHER THAN EA ACC` S AUTO ONLY: AGO.. EXCESSR/MBRELLA LIABILITY EACH'OCCURRENCE. E... OCCUR CLAIMS MADE AGGREGATE g DEDUCTIBLE S ;RETENTION S. _... ..3.. .. WORKERS COMPENSATION AND WCO371516' O5/2S/2009 05/25/2O'1O X'.'WCSTATU OTH EMPLOYERS'LIABILITY A ANY PROP.RIETORIPARTNERIEXECUTIVE E L._EACH ACCIDENT S 500,OOQ OFFICERIMEMBER EXCLUDED? E.L.DISEASE•.EAEMPLQYE_ S SOD,O.O It yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT. $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES f k9CLUVONS ADDED BY E46ORSEMENT/.SPECIAL PROVISIONS CERTIFICATE HOLDERcANcELLA'—rioN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER.WILL ENDEAVOR TO MAIL 15 ..DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL,IMPOSE NO OBLIGATION OR LIABILITY OFANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES:. AUTHORIZED REPRESENTATIVE lathy Silvia/FAIKAl ACORD 25(2001108) FAX: (508)362-5379 ©ACORD CORPORATION 1:988 ' • 4 f i T Boar o uil ing �egla ons an t=�rs One Ashburton Place Room 1301 Boston, Massachusetts 02108 Home ImprovementrContractor Registration Registration: 140579 Type: Private Corporation — — - r Expiration: 10/27/2009 Tr# 260384 WILLIAMS BUILDING INC TIMOTHY WILLIAMS („ 196 OLD TOWN HOUSE RD. WEST YARMOUTH, MA 02673 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card IS-CA1 is 5OM-07/07-PC8490 G.T1 &o.1nU o��'�czaoaclaeaeQa Board of Building Regulations and Standards License or registration valid for individul use only before the HOME IMPROVEMENT CON TRACTOR expiration date. If found return to: Board of Building Regulations and Standards RegistratL 140579 One Ashburton Place Rm 1301 Ezpi[atron 10/27/2009 Tr# 260384 Boston,Ma.02108 ype Private Corporation F WILLIAMS BUILD`I`NG NC�� i t TIMOTHY WILLIAMS ,i 196 OLD TOWN HOUSE RD ' - .. 0- Not valid without signature WEST YARMOUTH, 4-0- 73 Administrator o- Some Improvement Contractor Look Up nter Search terms separated by spaces. Search terms can be Town/City,Name, or License number el ct Search type: O AND O OR Search -earch Results Reg. No. Applicant Street IF City State Zip Name Title IExpiration WILLIAMS 196 OLD WEST WILLIAMS, 140579 BUILDING TOWN MA 02673 PRESIDENT 10/27/2009 INC HOUSE RD. YARMOUTH TIMOTHY Total of 1 Records matched. ✓�ie V�aairrioncueal SardorB Rg ajarsal ogonndl«�oac%uieli '! Stand d• i C66sfructi6n Sup--erviso.Lic nse 3 t pi L1 eeA� 'ee. CS 75670 i i Expiration 10/2M2'b6g. Tr# 7327 TIMOTHY(,; WILL'IAMS I 196 OLD'T NHO W YARMOUTH,MA 02673» Comm issi one i 35;000;cenclosed space _ ? lA° Masonrylonlyj F_adi1. es t i i Xe loaMoMuiMng�eg�U�i�ns an tan ar s One Ashburton Place - Room 1301 Lqn,v Boston, Massachusetts 02108 Construction Supervisor License License CS: 75670 -- -� Restriction: 00 Expiration: 10/25/2009 Tr# 7327 TIMOTHY C WILLIAMS ----- - ----- ------ _ 196 OLD TOWNHOUSE RD `_ = W YARMOUTH, MA 02673 `'tire ".4s Update Address and return card.Mark reason for change �s-cai 0 soM-o�im-Pceaso Address j Renewal Lost Card Licensed Contractor Look Up Select the search method: Name Maximum number of matches: 25 ] Enter Search terms separated by spaces. Timothy C Williams ......_._. - . _ .__ - ---- Select Search type: O AND Q OR Search Search Results City/Town Name T ic.e Lic. # Restriction Expiration Street State Zi YP P W YARMOUTH WILLIAMS, CSL 75670 00 10/25/2009 196 OLD- TIMOTHY C TOWNHOUSE RD MA 02673 Total of 1 Records matched. �0F"fktrokti Town of Barnstable .Regulatory Services vABLE, Thomas P. Geiler, Director 9'pr�6 9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.toivn.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usii7g 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) I� Signature of O ner Date Print Name If Property Owner is applying for permit please complete the homeowners License Exemption Form on th•e reverse side. Town of Barnstable yw� of ttte Regulatory Services t Thomas F. Geiler, Director HARNSTA1 3t.E, v MASS• Building Division s67P• � �ArFQ 'gyp Tom Perry,BuildingComrrussioner 200 Main Street, Hyannis., MA.02601 wwtY.town.b2rnstable.ma.us Fax; 508-790-6230- 0ffice; 508-862-4038 IjOh4EOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: street village number "HOMEOWNER": home phone N work phone# name CURRENT MAILINO ADDRESS: state zip code city/town T , current exemption for"home deers"was extended to include olyner-occupied dwellin>s 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. DEMITION OF FIOnAE01'JNER Persons) 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-farrrily 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 buildinl?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 s and that he/she will comply with said procedures and minimum inspection procedures and requirement requirements, Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section. 12TO Construction Control. ROM:90"ER'S EXEMP ION The Code states that: "Any homeowncrperforming work for which a building permit is required shall be exempt from the provisions of this section(Section 1 o9.1,1-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 arc unaware that they are assuming the responstbilitics or supervisor(sec s, art'uIQ Rules &'Rcgulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems,p Y when the homeowncr 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, sibilities of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that hdshe understands the respon certification for use in your co several towns. You may care t amend and adopt such a forrr/ mmunity. j' ter .• • 05119mland Plan Yout peck , a , ; - Iffy rmFer mr Permit Page: Level 1 a LOAD AND SUPPORT:Your deck will support a 80 PSF live load.' Posts have 30" below ground support. B DECK AND POST HEIGHT: 11114 You selected a height of 36"from the top of the decking to the ground level. The top of the deck support posts will therefore be 27.25"above ground level. Joists: Set joists on top of beams, 12';center to center. Stress Analysis: Level 1 Component PSF Joist Deflection 606 Joist Bending 133 Joist Shear 159 Joist Compression 264 Beam Deflection 104 Beam Bending 104 Beam Shear 90 Bolt Shear 1184 Post Stability 279 All rights reserved copyright©2009 DIY Technologies Page 11 f n WMA it rod .,Plan Your. ibw mp Below are the Specifications And Materials that you have selected for your deck. Overview Number of Levels: 1 Footer Depth° y J Total Square Feet: 117 Live Load: 80 psf Dead Load: 10 psf Component Size Wood Type Joists 2 x 8 Top Choice Treated Beams 2 x 8 Top Choice Treated I Posts 4 x 6 Top Choice Treated Decking 5/4 x 6 Trex Accents Railing Composite Bench None Lattice None FooterDe th Iw, ' ' Live Load 80 Psf Dead Load 10 psf All rights reserved copyright©2069 DIY Technologies Page 7 oFt , Town of Barnstable *Permit# O, Exp mont ronfjr ste date Regulatory Services F Y c 33.b }6 E N 39, `� Thomas F.Geiler,Director., 2009 Building Division -'OWN OF BA Tom Perry,CBO, Building Commissioner �N`STABLE 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 �o>tn e M a a 1,t r cte CO-6 C) Rg-esidential Value of Work 06. y L) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address / rq CUT N n1—S 1 t�lcl %D w,0 A 0u 1 /V , 1AJ �2 y M D u f yl/9 Contractor's Name i�'\Ca�n q :c<<r+9 >�, l._.c; Telephone Number 5 OY 39 V 3 4��4 Home Improvement Contractor License#(if applicable) n - Construction Supervisor's License#(if applicable)_ 1, �J 7�6 70 ❑Workman's Compensation Insurance ' Check one: ❑ I am a sole proprietor ❑ I am the Homeowner C&I have Worker's Compensation Insurance Insurance Company Name )l1S t010 A(,,p `p Workman's Comp.Policy# W(f- 6).37���1 Copy of Insurance Compliance Certificate must be on file. . Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping.. Going over existing layers of roof)" Z?"ke-side Replacement Windows/doors/sliders.U-Value ,35. (maximum;.44) *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 is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\MY7NB4IL\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office-of Investigations 600 Washington Street Boston, MA 02111.1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): A AJAA CO 1. Address: 1 Q 6 C-)I I OWN ouSe.. P-0Acl W . )w'vAowi� ✓W}, City/State/Zip: W,)Ol fMm No, 0(36a Phone.#: 50? 3?4 364 Are an employer? Check the appropriate box: Type of project(required): 1. I am a employer with . 4. 0 I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction ..2.0 I am a sole proprietor or partner-' listed on the attached sheet. T. [,S Remodeling. ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp. insurance. $ 9. Building addition required.] 5. 0 We are a corporation and its '10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant_that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. 44 Insurance Company Name: 4Tf ca_' CO, Policy#or Self-ins.Lic.M W G 03 Expiration Date: Job Site Address: Wn9�lelM'.r A City/State/Zip: 814rw4ALL /11P,.. ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage.as required under Section25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 pena of perjury that the information provided above is true and correct Signature: I 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#: r I NOTICE NOTICE TO � TO EMPLOYEES _ a EMPLOYEES W f �t Q �W ie1M SV'�� The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 (617) 727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30,this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring STAR INSURANCE COMPANY NAME OF INSURANCE COMPANY WC0371516 05/25/2009 to 05/25/2010 POLICY NUMBER EFFECTIVE DATES Renaissance Alliance Insurance Services L L C 981 Worcester Road,Wellesley,MA 02482 (781)431 9800 NAME OF INSURANCE AGENT ADDRESS PHONE Williams Building Company, Inc. 196 Old Townhouse Road West Yarmouth, MA 02673 EMPLOYER ADDRESS 05/12/2009 EMPLOYER'S WORKER'S COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Worker's Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are herby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER 7-7 r' Board of Bu Iding Regulations and Standards { ,, ' •.? Construction Supervisor License { j License: CS 75670 E_xpiratton 10/25/2009 Tr# 7k7 I Re, str�tion 00" �l ' ti 1 TIMOTHY C WILLIAMS �_'/= 196 OLD TOWNHOUSE-;RE) �-�-- W YARMOUTH,MA 02673 Commss'ione� ' 00 35,000 cf enclosed'space ' lA onry on y 1G 1,2 Family Homes Failuf'e to V ess a curFee t edition of the M skiMiset}sState B i ding Code .II 'is cause for revocahoh- f this license. i t Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrat on 140579 Board of Building Regulations and Standard_s One Ashburton Place Rm 1301 Ez pir.-atonc9�'f0/27/2009 Tr# 260384 Boston,Ma.02108 a v te Corporation WILLIAMS BUILDINGI'NC.- Ira TIMOTHY WILLIAMSS_ J 196 OLD TOWN HOUSE RD `' Not valid without signature WEST YARMOUTH,M A-02673 Administrator .. �FIM T * HARNSfABLE, MAQQ 9$ 039. ,�� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, I M o-r H Si O t'11 A M S,as Owner of the subject property hereby authorize_�� o n S T d tJ -9-f-,P-A 1 oN A P%J to act on my behalf, in all matters relative to work authorized by this building permit application for: AA (Address of Job) 200 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\AppData\Local\A4icrosoft\Windows\Temporary Intemet Files\Content:0utlook\w7NB4IL\EXPRESS.doc Revised 100608 i pEVE Toq, Town of Barnstable °^ Regulatory Services BAxxsrABLE, 9 MASS. Thomas F. Geiler, Director s6gq. ♦0 '°'E ► Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 23,2003 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L.c.111,sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code,Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code,Chapter II:Minimum Standards of Fitness for Human,Donna Z.Miorandi,R.S.,Health Inspector for the Town of Barnstable,on July 17,2003 conducted an inspection of a dwelling located at 76 Connemara Circle,Hyannis,Massachusetts. The tenant's name in that dwelling is Mr.Milton Rosenfield. Based on the results of that inspection,the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (C),the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling,which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410.750: Conditions Deemed to Endanger or Impair Health or Safety - 410.750(I) Failure to comply with any provisions of 105 CMR 410.600,410.601,or 410.602 which results in any accumulation of garbage,rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. The tenant,Milton Rosenfield,had much open food and garbage,along with rubbish strewn about in the dwelling. The above items were scattered on the counters,tables,furniture and the floors. Stacks of dirty dishes. Very filthy,unsanitary conditions in the kitchen. 410.600: Storaize of Garbage and Rubbish The occupant of any dwelling shall provide as many receptacles for the storage of garbage and rubbish as are sufficient to contain the accumulation before final collection. The tenant has much debris accumulated on the property including toxic and hazardous materials such as old rusty paint cans and r S many paint related products. Other items include old wood,old bikes,old rusty scrap metal,old lawn furniture,old grill,plastic buckets,buoys,wheel barrels,much plastic and old cardboard boxes,etc., etc. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling by August 1,2003. Mr. Milton Rosenfield has agreed to vacate the dwelling by this date and has placed a deposit on another dwelling. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated he may be forcibly removed by the local Board of Health(MGL.C. 127B),or by local police authorities at request of the board of health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. The owner and occupant have a right to a public hearing before the Board of Health. Once vacated this unit may not be occupied without the written approval of the board of health. Note: This is an important legal document, It in y affect your rights. e� Signed Cc: Mr.Milton Rosenfield,tenant Vur.Tom Perry,Building Commissioner Chief Harold Brunelle,Hyannis Fire Department Robert Smith,Town Counsel Mrs. Linda Simoneau,property owner Ms.Meg Chaffee,Housing Assistance f n I - i� # . 1561€ BUILDING ERVI E .` :::•: .::.� .. �::::� 291 285 .�� E.ALAN ..IM.. .N..� ....................:::.::.:::.::.::.::::::::::. EA RA Cy:IR.�•• € .. HYAN ............. <> •.•N IS ::...:..•::: �..:,. . OYLE AND NEIGHBORS ....nT �... ..MANY V<•>: EHICLES JUNK HOMELESS MEN LIVIN - T HE G RE- :...:........... ..:; T ENT S O B.O.H.-ALSO B.P.D. ;,{•: >... lb 1 yn ri cu- C�k r) r4A OF SME The Town of Barnstable * snarrsrnsi.E, • Department of Health Safety and Environmental Services 'OrFc �a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLEASE FORWARD THE ATTACHED PAGES TO: ty RE: FAX NO: �o a FROM: r/. r C— DATE: PAGE(S): (EXCLUDING COVER SHEET) TRANSMISSION VERIFICATION REPORT TIME: 01/"6/1955 17: 31 NAME: FAX TEL r" DATE,TIME 01/28 17:28 FAX NO./NAME 97900062 DURATION 00:02:04 PAGE(S) 03 RESULT OK MODE STANDARD ECM _ TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date Rec'd By Assessor's No. �� �,� Last Name, First Name ORIGINATOR Street Village State Zip Telephoner Home Work Description:_ _ COMPLAINT INQUIRY Requestor's Signature COMPLAINT Street Address LOCATION A= OFFICE USE ONLY INSPECTOR'S Date \4 Ins ector �Q ACTION/ COMMENTS �-(',t,c c -� 1n?� FOLLOW-UP ILL ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE — DEPARTMENT FIDE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR.) mrsm °F THE tpw : . .� The Town of Barnstable • BAMEWABU& • 059. � Department of Health Safety and Environmental Services '0ri�oMo�a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: FAX NO: r r , FROM: DATE: PAGE(S): (EXCLUDING COVER SHEET) i TOWN OF BARNSTA$I06 BUILDING DEPARTMENT- COMPLAINT/INQUIRYvePORT Date �- 7 -cJ•5 Rec'd B Assessor's No. bast Name First Name ORIGINATOR street—,-- Village State Zi. Telephone: Home Work Description: _ COMPLAINT c✓ INQUIRY Re COMPLAINT Street Address 7C, LOCATION OFFICE USE 02.ZY INSPECTORS Date G ACTION/ le, :I:n:slector COMMENTS — , h yl d / r FOLLO,d-Up ACTI02. ADDZ T ZOi:AL INFO. ATTACHED. CO?Y DISTRIEUTION: WFITE - DEPhRTY�27T FILE YELLOW - I2:SPECTOR PINK - INSPECTOR (RETURN TO OFFICE Y.GR.) iczscl R291 285. P E R M I T [PMT] ACTION[R] CARD[000] KEY 201481 00000000] PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT ?l R291 285. AP P R A I SAL DATA KEY 201481 SIMONEAU, E ALAN & LINDA M LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 25,800 52,000 1 A-COST 77,800 B-MKT 75,600 BY 00/ BY ML 10/87 C-INCOME PCA=1011 PCS=00 SIZE= 1104 JUST-VAL 77,800 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 62AC ----------------------------- NEIGHBORHOOD 62AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 10] 10 LAND-TYPE 25800] LAND-MEAN +0% 77800] 66410 IMPROVED-MEAN -22% 25% ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR]LAND LFT/IMP]ADJS/SB/FEAT STR]STRUCTURE ARR]AREA-MEASUREMENTS NOR]NOTES COM]MARKET INC]INCOME PMR]PERMITS GRR]GRAPHIC FUNCTION-[ ] STRUCTURE-CARD NO-[000] DATA-[ ] XMT[?] f .` ��, r y )C -c c_� 1 l S �`. to ;'�.• G- r - r F— .17 'r'cp_ C o a t 4� � r _':9riv2`.., 1...'a._..��..�..._...:�w..w:.+r ar�t�c+xcY=r.�-...__.u•�..r ..e w. _ 1,� .... _.was..—.r.....-.�'A..w. ..._.....�. ..:.A ilk TOWN OF BARNSTABLE, Permit No. ________21248 i Building Inspector Cash < •� 0 V OCCUPANCY PERMIT Bond _____X I_�50 "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 Gray Oafs Development ColA'adress Box 957, Hyannis lot #66 7E Connemara Circle. Hyannis Wiring Inspector F s Inspection date f� Plumbing mspect-o j Inspection date Gas Inspector f Inspection date ,/'Engineering Department - � � r�r rf� ,J 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. �/b............. Building Inspector, Asse 's map and lot number ........... ee ` 7-_ ....-. .. ...s � ypi TN E T0� Sewc Permit number Z pBAHISTADLE. i Hous` umber ............. , .............................. 90 Maas O 1639. `00 0 Mp"! TOWN OF BARNSTABLE BUILDING k-SPECTOR APPLICATION FOR PERMIT TO .- ............?� .�.a.........,F,�c /�.�.2..................... TYPE OF CONSTRUCTION ....... .......:..........................................:. ............... Z .. ........19... TO THE INSPECTOR OF BUILDINGS: The undersigned•hereby_ a ies for a permit according to the following information: // /V&9 MAAA C, /C r � � r Location f'�l r. .. .. ................... ...................................................7?:�.�.AA 2( / !Z iC � Proposed Use ......��......f{1....�.......................................................................................................:.:.....:.......... Zoning District ........................................................................Fire District Name of Owner,n � -l�/ �C) ��`:..��:f7 ... Address ...13 7... .......................... Nameof Builder ............... .......................................Address ..............5A 5A.�....................................................... Name of Architect /1 ! f1 AlSA ...Address .......... .... / /... ...-..... ................................. ............Foundation .....�� L /� �dt Number of Rooms ...........:........................ ... ..................... .. . .............:....................:. ............... . Exterior ......... :`.1..j..� ....V/�°... .�...................................Roofing ...............7. ..1 :5. `✓ `.................................. Floors i /4.o G ...................Interior .........�.Af Tp`1 �' �./Z ............... . .... .�, .................................. ............. �. .................................. Heating �, ..........Plumbing .......... / , �`f �- - ...................... ... Fireplace .............j.:7-:�.... e'��..�`%��2. ......................Approximate Cost ..... .`? ...r. .....:....... ..... ...... Definitive Plan Approved by Planning Board ________________________________19________. Areal.... ..................... Diagram of Lot and Building with Dimensions Fee _ ... .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.. Name . %�..\.�. .. .... . .............................................. Gray-Oaks Development Corp. 21248 one story Permit for 1 :.:.......... dwelling......................... t k+ e• Location 76 Connemara Circle , F �, ..................................... ........... „ ........Hyannis................................. µ Owner Gray Oaks Development Corp. f frame Type of Construction - ' ............................................................................. r ; Plot ......................... Lot ..................#66....... , l April 30 79 Permit Granted ................ .....................19 Date of Inspection ........19 Date Completed ..... . 19 m Li ` PERMIT REFUSED ................................................................ 19 ............................................................. ........................ ....................................... ... ........ ....................................................... ............................................................................... Approved ................................................ 19 e5 _ F ............................................................................. . .p, a �, � r���l���77�l�T �l��� ��o /� �� l�T�� r0� � l�Nl� �7 ' TOWN��' |`� �-��� BARN STABLE ]� /�����]����u � , � ~ � .�� N N �� 0 INSPECTOR ���� �� �� ��0NNN�NNN0�0� N�����"�~N� � NN �� ' �� ��� ���� � ����� � ����� ���� � �� �� ' ' APPL,1CATION FOR PERMIT TO ---- .............................................................................................. TYPE �� ����A - --'_'------ -----.. .--.------------_------_-- l� ` � --^^^^'7'r->/^'^'—^^^' '-'` / TO THE INSPECTOR OF BUILDINGS: � The undersigned hereby applies for o permit according to the following information: Location ..' .�./......!/..!../..--'CL'L----. �� ../Y..k/ ......................................................... - Proposed Use ....... ....... ` Zoning District - ----....-....--.------.-.Rvo District ----------,_____.____._____, � ' Nome of Owner .��/�\/'�.t, /!/|-�(`1-i�� �'�--A66rex ../7o.}�..^�.t�-7. /� ^./�/\..2./(,,_______,_. � / ������ --- �~' - - -'r - ' ' , Nome of Builder -----� �./f/2-------------A66rno ----..�.�../��-----.-------_. _,_.. ! ~Nome of Architect -' /]�, /--------Ad6res --' /1./... .�.�..�. /!�I--_________.. ' � ' Number of Rooms ---_-'<-~ -------------.Foun6oiion ..... .......i....//-.. ../--._-----___.. Ex/erior --- -(�.!-----------.RooGng --'/, /}7.f`.. ......................................... � ' /Floors ....................................................... --���L/\���'��'�����. --------------.|n�»hor ---D~/'»l/^�/_ ..................................................... . � -- �; ` Heating -_'�_/-x����----�---------.�---.-..�umbng ---..�'� .........,_.~_.___^_,___. � ^ ^ Fireplace '---|��-���.���!/v�-�y -------.Approximote Coo -.. ................................................... � Definitive Plan Approved by Planning 800nj lR----. Area ______________ ! ` Diagram of Lod and Building with Dimensions Fee _______________ � SUBJECT TO APPROVAL OF BOARD OF HEALTH � | I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable ' ~ t � � | 8 � [ � ' | ^ � � ' ' ! � � ` , regarding, the .~~,. � l N-- -7-'-- '''—'-------------'-''~ ' Gray--Oaks Development Corp. A=291-2 21248 'one story No ................. Permit for .................. .... ...... e...-Corp.t' 291-2.... .....�ng g�"Iefamily dwell'n ..,............... ....... ........... JrC Location .........7.6...Connemara i.rq. ................. . ........................ .......................H)wmis............ ....- . . ..................... Owner ........ 1e1qpmqp ...QQ.r p.. Type of Construction ............f a e................... ............................................/.............. ... Plot ............................ jot .... Permit Granted .......... 30..........19 79 Date of Inspection .................I..................19 Date Completed ............... ...................19 PERMIT IF FUSED .................................................... ........ .. 19 71" ....... .. .............. .. .......... . . .............. 7 .... ..... . .......... ................ ..... .............................. ...................... ....................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... SURVEY REFERENCE: PLAN OF LAND BY: BARNS. SURVEY CONSULTANTS ° _ 36 - DATED: JULY 1972 ft 38 24814 - 40 40` 38 34 4 , ' TH-2 32 1 4 TH-1 OF s9�y r J0 LEGEND DARRE M. i {�--1 PROPOSED CONTOUR MEYE , 0✓1140 "' ti0 _ ` ® PROPOSED SPOT GRADE �rO N toy- ��• �1 98 -- EXISTING CONTOUR, CIS(E N �Jec.� + 96.52 EXISTING SPOT GRADE 0� ��G�} 0 . W— EXISTING WATER SERVICE Existing Leachpit h EXISTING (vote 10) � TEST PIT DWELLING -36 TOP OF FNDN EL = 36.2 r - BENCH .MARK .Locus MAP N.T.S. r 34 30 TOP OF BULKHEAD $t ' it _ FOUNDATION - ELEVATION = 35. 20 { USGS DATUM ASSUMED po76.10 ft: .4 e't j '. -._ $k,vni 0� 30 s..� t �,CflnnemacaGcclp- � - IMP 291 `` tyR� �� !g iE rpaawarSt_ 32 /�6�� 4t' :! /' - ► LOT.'285 �9% Y '1 j t s,.�_ r• }isin P i Gi r^V LCP#.'C187374 M PROPOSED SEPTIC SYSTEM UPGRADE PLAN ..76 - 76 CONNEMARA CIRCLE, HYANNIS, MA j Prepared for: Williams Building Co. CONNEMARA Engineering by: Surveying by: SCALE DRAWN } DARRENM.MEYER,2S. Weller and Assoc. 1"=20' DMM L E ��X�, Route 28 '� I R � � .� ;„ EA3TSANON7CH,MAQ2597 Centerville. MA 02632 DATE: CHECKED SHEET N0. . 508-362-20M (508) 775-0735 05/26/09 DMM 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS j FINISH GRADE SHALL NOT BE < EL:31.89 ' FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 3 BR DWELLING (PROP NOT IN ZONE 11) PERIMETER OF THE SA.S. SOIL TEXTURAL CLASS: CLASS t �� OF SJ' SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S DESIGN PERCOLATION RATE: <2 MIN/IN T.O.F. EL.=36.20 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER DAILY FLOW: 330 G.P.D. D R N I`yf. rn OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. DESIGN FLOW: 330 G.P.D. �I R 4F.G. EL.=35.Ot F.G. EL.=35.25(MIN.) F.G. EL: 35.0f F,G. EL: 34.75(MAX.) GARBAGE GRINDER: No No. 1140 PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON SEPTIC TANK LEACHING AREA REQUIRED: (330) = 445.94 S.F. �� E 7a �NITAR�'� Oq 0 S=1% (MIN.) L - 30' L a 10'(MAX) ,kr DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) ( 0 S-1% (MIN.) '0 S=1% (MIDI.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40. PVC i PRIMARY S.A.S. USE 2 TRENCHES (10 TOTAL UNITS) OF 16" ADS RIODIFFUSER H-20 UNITS-NO STONE ' 10"1 - 14• 11.3" TO BOTH TRENCHES 5 UNITS EACH - 31,25' LONG INV.=32.78 4e" LIQUID INVERT BOTTOM & SIDE AREA- (GENERAL(GENERAL USE APPROVAL FOR 7.9 SF/LF OF BIODUFFUSER) PROPOSED (BIODIFFUSERS): 10 UNITS x 6.25 LF x 7.9 SF/LF = 493.75 SF GAS BAD - INV.=31.80 27TRENCHES (5 UNITS EACH(IO TOTAL) AT 6.25-/UNIT= 31.25' �. . .. . . .. . ' T a SOIL ABSORPTION SYSTEM (PROFILE) DESIGN FLOW PROVIDED O74(49375 SF) 365 GPD > 330 GPD req'd INV.=32.0 - INV.=31.50 EXISTING 1,000' GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET 75" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING _ ;" j+�s-'y-" EXISTING SUITABLE PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=31.89 MATERIAL 2) D-BOX SHALL BE SET LEVEL' AND TRUE TO INV. ELEV.= 31.5 NMI . GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 30.56 INCH CRUSHED STONE BASE, AS SPECIFIED 1N 2.83' S'66 2.83' 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF I- i 3) REPLACE EXISTING 1,000 GALLON SEPTIC T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 11.23'TANK WITH 1500 GALLON SEPTIC TANK (7.06' PROVIDED) 2-TRENCHES (5 UNITS EACH (10 TOTAL)) r 76' I IF FAILED, DAMAGED, OR UNDERSIZED. ADJUSTED GW EL.=23.50 = 06.25' PER UNIT- 31.25'/TRENCH PROFILE 4) INSTALL INLET & OUTLET TEES. AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL TRENCH SECTION - - �- - _ N.T.S. 16" GENERAL NOTES: E . SOIL LOG P#: 12567 T1.2" I' I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL I BOARD OF HEALTH AND THE DESIGN ENGINEER. �---34" -� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: MAY 2 2009 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. SOIL 'EVALUATOR: DARREN MEYER, R.S., CSE SECTION END CAP 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DAVID STANTON, RS TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE - HEALTH AGENT 6„" HIGH CAPACITY-(H-20) BIODIFFUSER UNIT DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING e th•FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. TH- Dp "'Elev. TH-2,` Dew _ MODEL 16" HICAP ,ENGINEER BEFORE CONSTRUCTION CONTINUES. 5.,ALL ELEVATIONS BASED ON ASSUMED DATUM. 34.5. A LOAMY SANG �" 34.5 A LOAMY SAND �" LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT t 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE.OF 10YR 4/2 10YR 4/2 EFFECTIVE LENGTH 75" TO'CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 33.83 8" 33.83 8" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LOAMY SAND LOAMY SAN HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. B B .D SIDE WALL HEIGHT 11.2" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10YR 5/8 10YR 5/8 OVERALL HEIGHT 16" 8.'ALL AREAS DISTURBED DURING CONSTRUCTION.SHALL BE RESTORED 1 - OVERALL WIDTH 34" 4640 TRUEMAN 8LV17 TO A CONDITION,AGREED UPON BETWEEN OWNER AND CONTRACTOR., �. 31.5 36" 131.5 _ ,- 36" _ HILUARD, OH/O 43026 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE2 , - .- . . 1, CAPACITY 13.6 CF • THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING MEDIUM MEDIUM (101.7 GAL) AOVvcm DRAINAGE S1.51EM5, INC. CONSTRUCTION. SAND SAND' 10. 'EXISTING LEACHING TO BE PUMPED. CRUSHED AND REMOVED. PERC ®30.17 REPLACE WITH CLEAN MEDIUM SAND PER TITLE V. 2.5Y 7/4 2:5Y 7/4 PROPOSED SEPTIC SYSTEM/SITE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 76 CONNEMARA CIRCLE, HYANNIS, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 23.5 132" 23.5 132" Prepared for: Williams Building Co. 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN .y("C" HORIZON) Engineering by: Surveying by- SCALE DRAWN JOB. NO. 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING: NO GROUNDWATER OBSERVED DARRENM.MEYER,R.S. Weller and Assoc. NTS D.M.M. � • - 15t ALL PIPING TO BE 4" SCH 40 O 1/8"/FT (UNLESS SPECIFIED) • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP'pursuont to 310 CMR 15.017 POSOX961 Route 28 DATE CHECKED SHEET NO. 16. PROPERTY IS NOT LOCATED WITHIN A ZONE IL to conduct soil evaluations and that the above analysis has been performed by me consistent with the E4STSANDW/CH,MA02S?7 Centerville, MA 02632 B requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Evol. Exam in October, 1999. 508382-2922 (508) 775-0735 -- 05/26/09 D.M.M. 2 Of 2 k SOIL LOG llyxidnr/✓eef.,M.,c.S=��.l`", - �.14.tP�. ��'.� f 2."PEASTONE LOAM S FILL 4" 4 C.I. DIST I°•. . o ��.��� .,•e • o I r�,t4 ��,e7C, 1000 BOX I,.°•o 0 1000 GAL. ° • ► T=-� to MIN. GAL. Ise•••s PRECAST OR ° ° �` 24SEPTI TANK 6 BLOCK � . �° e� MIN >rs� '^' Qc,uU Sf I, ee SEEPAGE • ' ° ; I r � � mo e° o • G� Pd �L` PIT • I ` I°• • . • e0 e I oC�.3��cJ�;r S+GNt� �s�'.CP 20' MIN. .;;: • df I 4 ,». e-� Gs� 1C 'FOUNDATION s'" fl 4 I I I WASHED STONE "'. TONE I I 1 ELEVATION SKETCH 10, - ' PERC. RATE SCALE I" = 4' TEST BY : ,•v' TOWN INSPECTOR ��'•J BACKHOE OPERATOR -r� �� •_�-*� s �y.•�.n-s.r S. TEST MADE ON : V 3 tfX-0 04A>J-f (,V0'e;A?Nt?9!r t'i/1°PCt)k/i0 604/09r/8 3 3ca S y S T E M• f `' s�o er,9r s = le4 s:F k z. s G,W.c/s x, -0 4 71&1, 6,#Z./o aY d / 7b 7"*/S 40-7- . p� r� ,� i �tiP APR'i N .a'' E` QO 00 I ems--- � , P s`' ,11a` _ `' \ .'•E �4' .� vo ` \ 4 \ � 61� OF 101 / ' �'o.J..�i7..Q Teo../ S'i✓u r....J../ /��k:->.z'dti*"0••/ LJ•l to �"�� Y �' U P µ G o c •v-s-�•Lj i M rv'� .."i osY fa 10 /./r'F'. Z 6, ,q 750 y . j i4•N A 6 G 3 CpO e1/e.=e�•C Wf �C•T'T� Q rQG.it. /l e>?'Qi.�r �G n•�4�'eV 7'S p!= Ti{��; �1 �.• � � �. G'r�T t:• .� 1, , 1/_ K(7 I 4' w 'mot �4` } " ./ �i ,f ✓�+"p�•erJ _ .fit r Ax ELEVATION SCHEDULE PROPOSED ,SllT,�E- PLAN I. INV. AT FOUNDATION = 99•o2. a 2. INV. INTO SEPTIC TANK SEWAGE SYSTEM DESIGN QN 3. f NV. OUT OF SEPTIC TANK = • r G.eaY .L'"/yP �'r>NN�:ayr:s•ek t.'+'..e.j'r_^Lt:: 4. INV. INTO DISTRIBUTION BOX = ', 3' SCALE: I u' .- its � 1979 5. INV. OUT OF DISTRIBUTION BOX = '1c . 9 o C _7,5-G 6. INV. INTO SEEPAGE PIT CAPE COD SURVEY CONSULTANTS ROUTE 132 7BOTTOM OF PIT , =•0o HYANNIS ,MASS. ' �\ V \��� , . � . __ . T _ .__._ r. . _ �- ------. - f � +. i I