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0050 LAFAYETTE AVENUE
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z Parcel Z� d Application # Health Division Date Issued 6 Conservation Division Application Fee Planning Dept. Permit Feed Date Definitive Plan Approved by Planning Board ` Historic - OKH — Preservation/Hyannis Project Street Address Villages �- Owner �� �Yl l.p .a—S� Address b r . Telephone 022 �l� i R Q Permit Request OX�o I,b fir 4U2, � _ . 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION �— � ' . � �( � ` \- ,� av� (BUILDER'OR-HOMEOWNER) - Name' r- �- 1S Telephone Number ���- 'AU Address `� "i'r�►`� License # W4 04 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE � � � �r 1 r FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAPJ PARCEL N0. .:e ADDRESS,'_ VILLAGE OWNER f DATE OF-INSPECTION: .,FOUNDATION-,,' `. '. FRAME INSULATION'a_ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS-4 .•E' ROUGH v -Y:- FINAL 1 � L ff DATE CLOSED OUT ASSOCIATION PLAN NO. t �4 The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston, MA 02111 0 �� =�•yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl N (Busingn/Or� tion/Individual): � .� i , Address: S '�- , City/State/Zip: r\, 5 Po n-# 5o �'� Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. I am a general contractor and 1 employees(full and/or part-tirac).* have hired the sub-contractors 6. ❑New construction 2 "I am a sole proprietor or partner-' listed on the-attached sheet, 7.. Q Remodeling ship and have no employees These sub_contractors have 8. Demolition working for me in any capacity.. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insuraace.t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 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 E Other T 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. lContractors 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. lam 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: bkjCr/N� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of lnvesti ations of the DIA for insurance covera e verifrcation. I do hereby certify under the pains and penalties of perjury that the information provided ab ve is true and rrco,rrect Si ature: I' Date: Phone#' N 1 �! 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 I S2 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." x 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 onto construct buildings in the commonwealth for any applicant who has not prod uced.acceptable evidence of compliance with the insurance coverage required." AdditionaIIy,MGL chapter 152,'§25C(7)states "Neither the commonwealth nor any of its political subdivisions shall . an contract for the erformance of public work until acceptable evidence of compliance with the insurance enter into P Y P P 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 Departmenthas provided a space at the bottom .:)f 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 ui__(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 &pplicant 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 fo any business or commercial venture ( .e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts I)epaitnent of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 61742777749 Revised 11-22-06 www.mass.gov/dia d oFSHE rq,,, Town of Barnstable Regulatory Services BAM{ f r SSMAS. Thomas-F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 i Property Owner Must .Complete and Sign This Section If Using A Builder I, r_ La vV `r. kAY-n , as Owner of the subject property hereby authorize i to act on my behalf, in all matters relative to work authorized by this building permit application for: IJ y`t. ( dd ss of Job) %A Signature of, Date . Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS DAWERPERMISS ION r Town of Barnstable Op THE Tp� o Regulatory Services aaxtJsrasr E Thomas F. Geiler,Director „ Mass. 9q,A �a39. A,�� Building Division TED MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: U �` JOB LOCATION: number street villa e "HOMEOWNER": name home phone work phone# GURRENT MAILING ADDRESS: kAnqb6 f�- o city/ n state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as Supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1,1) The undersigned"homeowner"assumes responsibility for compliance with the State.Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and equirements. Signature of Homeo er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feefor larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when,the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities.require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt DOC 08/11/2010 11:20 5085646904 PARTY CAPE COD PAGE 01 CERTIFICATE OF LIABILITY INSURANCE °" 5/24/10 Producer TH IS CERTIFICATE IS ISSUED AS A MATTER OF First Cardinal Cap. INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 10 9nVeh American Blvd. CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Latham,NY 1211M141 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WSURERS AFFORDING COVERAGE NAIL M Insured INSURER A MA Retall Merchants WC Inc PaNy Cave CDd,Inc. INSURER 8: BBO Mac Arthur Blvd. Pocesset,MA 02S59 INSURER C: INSURER D: ` INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V*UCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT IO ALL THE TERMS,EXCt.USIONS AND COIIDIIIONS CF SUCH POLICIES. AGGREGATE LIMITS HOVYN MAY HAVE BEEN DUCED BY PAID CLAIMS. POLCY ADOL 8*=TIYE OATS. POLICY E7-IRATI0N D LTR MBRD TYPE OF INBURANGE POLICY NUM19E t DATE LIMITS 4e119ML UASUTY EACH OCCURRENCE $ OOMMEROAL GENERAL LIABILITY FI RE DAMAGE(Any err Tee) s CLAM MADE O GOWR MEO 47LP(Any one Paten) : PERSONAL&ADV INAW GDIMAL AGGREGATE f GWLAGGREGATELIMIT APPLIES AM; PRODUCTS-COMPIOPAGG Pao- POLICY AM LOC AVTOMOOULIABILITY C40MeINRO9N0L.EUMR s ANY AUTO (Es eepdsnp ALL OWNED AUTOS abOILY INAMY $ ��,� SCHEDIAM AUTOS Per Parean) WRED AUTOS BODILY INJURY NON m"M AUTOS (Per gwkM 4) PROPEIM bAMAOE i (Per NX49 R) OARAOE LJAWUYY ALIrOONLY-EA ACCK)W ANY AUTO OTHER THAN EA ACC AUTOONLY AGO EX008 UAMUTY E404 OCCURRENCE : OWUR ❑ CLAIMS MADE AGGMATE : � s OEOMMUL.E S RE1'DVTION f - t' npN AND WC TW WT 8II101L0YsS LIABILITY X MY EA 0MCJ3�A4 9M0M EXCLUD®?DtEGITIVF B.L.EACH ACGIOEW $ 100,000 A If Tee,deecn6vunder NO 0140006OD406110 //01/10 biRR- eFEGAI PROVISIONS below t 100,000 F.l.DISEASE-tOI.ICYIIM : �000 OTHM 9LRI ION OF TION31 L.00A IOWW Eaa MOMS eY UCORbEMEW/SPECIAL O CERTIFICAT HOLDER ADDITIONAL INSURED:INSURER LETTER CANCELLATION Town of Samara We SNOULD ANY OF TW ABOVE DESCRIBED POLICIES BE CANMLLrrD seRM— THE EXPIRATIONDATE THEREOF,THE IsstsNGINSURERVMLL ENDEAVORTO ATTN:SLA&V Department MAIL DAYS WRrTTEN NOTICE TO THE CERTIFICATE HOLDER AWNEO 200 Mein Street TO THE LEFT,BUT FAILURE TO DO SO&HALL IMPOSE NO OBUQA110N OR Hyamis,MA 02601 UABIUTYOF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. IMTHDRIZE0 RE RESEWATIVE 08/11/2010 11:47 5085646904 PARTY CAPE COD PAGE 01 IMPORTANT DOCUMENT 5 Cercff icate of ' Resistance REGISTRATION ISSUED BY ' Date of Shipment s 3v3rlooe NUMBER EVANSVILLE, INDIANA 47725 Tint Ides"cavon MANUFACTURERS OF THE FINISHED 04536939 F 12110 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 254700 PARTY CAPE COD S 660 MACARTHUR BLVD 5 POCASSET MA 25592230 5 , SCertification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. Serial d 8106200(5) M Desoriptlon of item ce"Wed: Flame Retardant Process Used Will Not Be Removed By_ Washing And is Effective For The Life`Of The Fabric j JO HN BOYLE STATESVIUE NC si nw d, � Name of Appliestot of Flame Resistwo Finish ANCHOR INDUSTRIES INC. 9 ismcPcP WPE cP cJ��J'� �.t�P[J'[1�[Pc1cP�Pclt�J Please take this certificate of Flame Resistanre10 your local building department to attain a permit for the test installation. Massachusetts State code requires a permit for all tent installations. Please be advised that a Dig Safe inspection is also required for all teat installations. In preparation for the inspection Dig Safe require$ all sites to stake the tent area with white markings. Party Cape (,od will call you the week of your function to advise you of your inspection date. 4 � ? f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION C ON Map Parcel Applicatiori Health Division Date Issued Conservation Division Application Fee Planning Dept, ':Permit Fee Date Definitive:Plan Approved by Planning Board ' e 3 Historic _ OKH Preservation / Hyannis Project Street Address Village Owner I Y A. 4- Ct. Address i fi, Ave a,Nat c s �"Vf T Telephone S`�7g Sib ' 1 y � Permit Request b '?D LA � .. 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) jCD 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.fIF z+ ? Number of Baths: Full: existing new Half: existing nelk' Number of Bedrooms: existing —new co Hi Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑,new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name (& "I �0 ��44� Telephone Number S�6 odgf, Address C t�C,l '1 License # t turL tS 'PCje'i, K Q7��' Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ZX SIGNATURE W/Icvl DATE s FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER (y I r t DATE OF INSPECTION: FOUNDATION FRAME INSULATION y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING .r DATE CLOSED OUT ASSOCIATION PLAN NO. s L • � f t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly N�3t11e(Business/Or-ganizaiion/Individual): Address:,, . ' C ty/State/Zips 4,t4 ajljqA ® �Th o n e 1 2R6, Are you an employer? Check the appropriate her. Type of project(required): 1.El I am a employer with 4.( I am EC general contractor-and I em to ees full and/orpart-time.).* have liiredTthe-strb-contractors 6. ❑New construction 2.El I am a sole proprietor or partner- fisted on the attached_sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. F 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 -� officers have exercised their 11. Plumbing repairs or additions Dam=a-homeowner-doing all work ❑ g P �---myself [No - ers' ce. right of exemption per MGL 12.F�Roof repairs t c. 152 4 mssurance required.] , §1O, and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information._ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob 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 crimiriai 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 ofperjury that the information provided above is true and correct: � i /6 �Si attire:' (fDate: Phone#: Official use only. Do not write in this area, to be completed by city or town offtciaL City or Town: Permit/L,icense# Issuing Authority(circle one): s 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector- 6. Other Contact Person: Phone#: r ' 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 representative's 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, comtiuction 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." �.r 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,build ings 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 numbers) 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 vrll 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 or citizen is obtaining a license or permit not related to an business or commercial venture year.Where a home owner g p Y (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 Investigattions 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-S77-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www-.mass.gov/dia of 1HE rpk Town of Barnstable • BAMSTABLE, 9q, MASS. � Regulatory Services pTEo MAy a 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 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) Sig ature of er bate Print Name Q:\VRFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 � v Town of Barnstable o Regulatory Services BARNSTABLE, Thomas F.Geiler,Director y MAss. $ 039• A�ro Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 'Office: 508-862-4038 Fax: 508-790-6230 1' HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and homeowners to engage an individual for hire who does not possess a license, rovided that the owner acts as to allow homp P supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and reRnlWents. AM� Signat re of Home weer " Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC E 10 �uxrttfiaate of e rcEoas;EraEo ISSUED BY, Ras beawd alanuachyed APPa ICATM AZTEC TENTS l` > CONCERN No_ 490 ALASKA AVENUE 02200 [CAL COMB r--419-01 TD RANC 8 CA 90603 3 This is to certify that the materials described below hereof have been frame retardant treated(or are inher- ent(y nonf,Pammable). FOR PARTY CAPE CM AurraEss 66€9 MACARTHUR HLVD- CITY POCAS.SET STATE AK 02559 a. Certification is hereby trade.beat:(check"a"or a b„) ❑ (a) The articles described below this certificate have been treated with a flame retardard chemical approved { and registered by the State Free Marshal and that the application of said chemical was done in confor- mance with the taws of the State of California and the RWes and Regulations of the Slate Fire Marshal. Name of chemmical used.._.............._.... ....................Chem.Reg.No...._......______... , . Meathod of application..._._....___�.__.._._.._._ ._.____.... ._........._._ ._...... - _ (b) The articles described below hereof are made from a flame-resistant fabric or material roistered and j approved by the State re Marshal for such use;Fabric has been tested and passes NFPA701-96_ " 1 Fire Trade naive of flame-resistant fabric or material used.--__--.---_ -. __. ._._ f m X_._......_..Reg.No..._..........._._.._ The Flame Retardant Process Used MLL.NOT.... Be Removed by Washing (oval or,wM not) y David Bradley Chuck'Miller- President '. t�ss+z oiA ,ac Pm&x.�n Se ,Ernc6erd - 7aa lit. ,� Please take this certificate°®f Flame Resistance to your local building department to attain a permit for the tent installation-: Massachusetts State code requires a permit for all tent installations Please be advised that a-Dig Safe inspection is also required for all tent installations. In preparation for the inspection Dig Safe requires all sites to stake the tent area with white markings. Party Cape Cod will call you the week of your function to advise you of your inspection date. 06/10/2009 09:00 5085646904 PARTY CAPE COD PAGE 01 ATE LIABILITY 1�l�URIo►PIC ` � --f'0/o9 CERTIFICATE M - u0°{ INFORMATION ONLY AND CONFERS N0. RIGHTS UPON THE FkEtGld�et Corp. CERTIRICATE HOLMR, THIS rrATiFICA'7H DOES NCR 10 Bridsh Amirfoan SYd AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY Lunen,W 121104141 THE PO:ICIEG 915LOWA INSURERS AFFORDING COVERAGE ► S sane 1id>3URER A' MA R�taif L4arohanta WC Grou Ina Patty Ceps Cep Inc, I REA B' 66o ltAea kftCar ml INSURER G; p+ ,MA CIM INSURED!0, INSURER A: N! ! ANY REQUIRCbIcNT Ti MR OR 00W 10N OFP ANY CM 0"I1N UsfiNT T 1 -rHGT$Rri3.MUOI ICNSArNDCO D110N OF""P0001I0. , PERTAIN W INiURANCE AF/0 N 091 DYmpg Pam P f nay rOuCYAYION u l i :m nio a 011iM4LY1lLRf ARE owii n.IN Is OOMMiRi7A.0 lrrY W o iQ,A1Mi►4AT>E � UPAGc wee PRO. PRO. �'� Oq�N�xK.�tA 1lfAIT AUTOA00/liILIAIN1.17Y (!►�ppN�q j � ; FPr AUTO DOW IWjW f ki.OMw®I" Q%r p—) iCtr10UU0 AUICIC i01ylY MIrWlY , MRODAlllib! (Perexdwdl NON4VVtd�A1JfOt PRQPOenr empari S AQDCrNPI GOAAM LIABILITY OTF,MTNAN FOka A►ry AUM AM OKY Acc mi- CH c0er .-- $ uAe1UTY AaCmWATE j OGp� ❑ cddNMi NAOR CRI%147191E v � � grMM ON I A . CO■ ! X, MII go O WWIRe LAW" ANN/NOMrtllIIRIPARrHriV�K A �� $ iSAW eri�damAe wrdV NO 014000800406100 110110i t�olna p�ev�loHiarl� sa ROAM TIONu iNsau RPMWARTUr TnZAVWVCI;11J5cpkmpmIcIuffE5= b 1FNI ix/Il4 nag0ATE WERBOF THY Ii6uINSIN0U1 NA11L4 S31 OWN I>IlplAVQlt rr�p M/►IL mys 1MUTt>1N NO+RE 1$TFR CBlt1Ml90Al4Nmm NAND elrgM HU1ahAWW 1�OT1 ,C4RFj11WIII'M006d6HALLM'=N0QfI6W110N0R UAdIUTY01-AW KIND uIPOWY 1EINSURER,118AdII1df9OR RBPAMNTATIVES. OWN OF.BARNSTABLE BUILDING PERMIT APPLICATION i• k Map / Parcel Application# 09 � 1 r,'.• Health Division Date Issued- Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 50 LA fAYET7G AVF Village H,Y,4,Q 36IPOEq Owner LAW OE f. 1'�MM V T,Vhc.Y Address F. 026+7 Telephone C10 . �-�.QO R pu5 � Cdoo l lQb W 8. 410. I`6 15, Permit Request UNVER,d QQFWItftrb EA5et%0 IiJT0 F[Qkk�RCQ FLAYtZ00h 2) �e AQ.ATF,Q7 00915f .bD 1SWAOICAy, R H , YES. ATTA,CRU rLAM. Square feet: 1 st floor:existing N I H proposed 2nd floor:existing / /1 proposed 0 Total new Zoning District', F-1 Flood Plain 01 A Groundwater OverlayOverlay f1l k. Project Valuation Construction Type VJV Fk kE; :. Lot Size b .4 AMC Grandfathered: ❑Yes )q No If yes, attach supporting documentation = on Dwelling Type: Single Family % Two Family ❑ Multi-Family(#units) c} Age of Existing Structure 5)•V ezir6 Historic House: ❑Yes �4 No On Old King's Highway: ❑Yeas �Si.No Basement Type Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 55 yT Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new D Number of Bedrooms: existing_ new_ Total Room Count(not including baths):existing _ new First Floor Room Count IJ _ Heat Type and Fuel: 0 Gas ❑Oil ❑Electric ❑Other HOT A[R Central Air: )!Yes ❑No Fireplaces: Existing Q`A New A Existing wood/coal stove: ❑Yes 0 No Detached garage:❑existing ❑new size N A Pool:❑existing ❑new size fJ JA . Barn:❑existing ❑new size Attached garage:A existing ❑new size _Shed:❑existing ❑new size Other: f /A Zoning Board of Appeals Authorization ❑ Appeal# _14 A Recorded❑ Commercial ❑Yes X No If yes, site plan review# ,.,__xCurrent Use--- Proposed Use_ 4Z2 L;G�o V_ - -- .. BUILDER INFORMATION Name �� �012R1S 0,/ Cz;,OIJ , �Jr_ Telephone Number 5og. Address 117 V NdIS IJ LWE r-W' NO) -0,Vj ,0 PD.License# (;�J 10151 oe,T6 P�lyy, Home Improvement Contractor# 191014 Worker's Compensation# yV CA Q�L[104 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOJ . DATE SIGNATUR 1 l'7 200� F - G� • FOR OFFICIAL USE ONLY ` - APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER .^ DATE OF INSPECTION: FOUNDATION FRAME w INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL 1 FINAL BUILDING DATE CLOSED OUT _ y ASSOCIATION PLAN NO. -- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street > Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information n / `Please Print Legibly Name(Business/Organization/Individual): . �tt IV�%T 2 ,. NOM,4J tl Z2 0 N n ,�, Address: 112� �fER\J I liLE -- 1'JR� %A� V V Ik i City/State/Zip: Us5-ty l L' t-f i M A Phone.#: 4 n. ld wo e ou an employer? Check the appropriate box: Type of project(required):. , 1I 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'ole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance. $• required.] 5. We are a corporation and its 10.❑Electrical repairs or.additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ . g P myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is.the policy and job site information. /� A Insurance Company Name: AMP,(A �"1J Policy#or Self-ins.Lic.#: WCA• 0.1 Ll+ 6 q Expiration Date: ()15 I 0-✓J"O$ Job Site Address: 50 ��F��ETTE 1IG�' City/State/Zip: HA ► tc7fQPT jk4 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 nder th pains- pe lties of p jury that the information provided above is true and correct Signature: Date: �L 3 2D o Phone# �1�� • q 2�• ���Py Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee:of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." !VIGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the finance 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-conti-actor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need-only,submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washingtcai Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia E ri Town-of Barnstable Regulatory Services BAMaABE, Thomas F.Geller,Director . 9 MASS. �'pl�D MAC a1� B111 ding blv1S10I1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date ' AF T DAVIT. HONIE IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal,.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ,, t Type of Work: AUTER V/TT I D 0 Estimated Cost�� _ ,Address of Work: 5� [A PA YE-1 16 A,05. N`CAtJ 0 y5 l?DES�� Owner's Name: �a �� , K/1 M T �• s H Am Date of Application:_ I i3 ),p I hereby certify that: Registration is not required for the following reason(s): 7Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied• ❑Owner:pulling own pennit Notice is hereby given that: OWIdE-RS PULLING=R OWN PERMIT OR DEALING NTVITH UNREGMTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT'WORK DO NOT HAVE ACCESS'.TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER.MGL c.142A• SIGNED UNDER PENALTIES.OF.PEP=Y Grj l g 5� I hereby a ly far a permit as the agent of the owner: IO 2 Q 07 Date Contractor Name Registration No. OR Date Owner's Name Q:forns:hcmeaffidav RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 / Alterations/Renovations $50.00 Building Permit Amendment $25.00 5 FEE VALUE WORKSHEET NEW LIVING SPACE . • square feet x$96/sq.foot= x.0041= E1 plus.frombelow(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE f W V square feet x$64/sq.foot= 20, 1 a x.0041= I q plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.8. x.0041= ' ACCESSORY STRUCTURE>120,sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch' x$30.00= (number) . Deck x$30.00 JNO (number) Fireplace/Chimney x$25.00= _ (number) Inground Swimming Pool $60.00 — Above Ground Swimming Pool $25.00. Relocation/Moving $150.00 (plus above if applicable) 3 Permit Fee Projcost Rev:063004 ; -- Board of Building Re ulat ons and Standards , — g g - One Ashburton Place = Room 1301 Boston, Massachusetts 02108 Construction Supervisor License License CS: 15851 Restriction: 00 z Birthdate: 9/28/1953 Expiration: 9/28/2009 Tr# 2366 CRAIG N ASHWORTH er — -- — 385 SEA STREET' HYANNIS, MA 02601 --- — . -- _ —-- — Update Address and return card.Mark reason for change " - Address j ' Renewal Lost Card DPS-CA1 Co 5OM-04/05-PC8698 - '---� 'uIze &0fiIE//ZR•lLtGL'LL/CiL n �.�Gll!'dJlzC�tllJ ,a Board of Quildiu�Rcgulntions and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR , before the expiration.date. If found return to: - . Registration 102014' Board of Building Regulations and.Standards One Ashburton Place Rm 1301 Expiration: 6/30/2008 Boston,Ma.02108 _ Type: Private Corporation ERNEST B.NORRIS&SON INC Craig Ashworth 385 Sea Sty -- Hyannls,MA 02601 Deputy Administrator of valid without signature - } • t Client#:646400 2hORRISEB ACORDW CERTIFICATE OF LIABILITY INSURANCE 6118/MID°""'"' � . 06/18/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 973 lyanough Rd„ PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Acadia Insurance E.B.Norris&Son.,Inc. P.O.Box 486 INSURER B: - - Hyannisport,MA 02647 INSURER C: INSURER D: • INSURERE: COVERAGES 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 MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM ,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM DD DATE MMIDD - - LIMITS A GENERAL LIABILITY CPA005234518 05/03/07 05/03/08 EACH OCCURRENCE $1 000 000 NCOMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) $250 OOO CLAIMS MADE 5x]OCCUR - - MED EXP(Any one person) $5 QQQ ,I .. PERSONAL&ADV'INJURY' $1 000 000 GENERAL AGGREGATE $2 OQQ 000 GEN'L AGGREGATE LIMIT.APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY JEa LOC AUTOMOBILE LIABILITY -" COMBINED SINGLE LIMIT ANY AUTO ' (Ea accident) $ . ALL OWNED AUTOS - - - BODILY,INJURY ` $ - SCHEDULED AUTOS (Per person) HIRED AUTOS - - - - BODILY INJURY - $ NON-OWNED AUTOS (Per accident) -PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC" $ * AUTO ONLY: AGG $ E XCESSIUMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WCA0212464 05/03/07 05/03/08- WC STATU- 0, EMPLOYERS'LIABILITY � - - $50O 000 ANY PROPRIETOR/PARTNER/EXECUTIVE- � �� � E.L.EACH ACCIDENT - OFFICER/MEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYEE $5OO OOO If yes,describe under - r SPECIAL PROVISIONS below `'" .: E.L.DISEASE-.POLICY LIMIT $500,000 - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS�- Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed.to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town-Of Barnstable - - DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO.MAIL, 1 n DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601_ 6 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ` REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I. ACORD 25 2001l08)1 0f 2 ' 448083 LS1 0 ACORD CORPORATION 1988 - TOwn"gf le 3 ,am&tab ate ato ' . .. _ ,z, ; fr. 90'• �Services ; • 'Thomas :� er Director Tom?m-q, 33z&dl)zg Co sloner • �' . . ' ••240 Main. � ' .. . . , • Street,'�33�aAata,N!A 02501 �. .. ' •'rrwR.ta�,bnrustabic.�a.w . • ... . . . ... . .�•,:.. , Office: 508-852-403$ , •. .. . . Fs�; _ tS4 fAx t Property Omer Must =. Complete and Sign Tbis. Section .If Us ii n* g A.Builder . as Owner of 'the subject property nze to act on mybeha]f, . •. . • in L aim=relative zo'work va&otized by this bua &s perzh appucatiu for, , Ado ell of Job) l 27 Signs of Qwner • . Date , him Nz= • . ® � ® � HI I Isham Guest Cottage 50 Lafayette Avenue Hyannisport, MA 02647R? N,° January 17, 2002 Permit Set v ° ' 3 LDA Architects '1'--7t•,,"i��`; ,'.`,+'�f`',3 Cambridge,MA 02142 MATERIAL INDICATORS ABBREVIATIONS - WINDOW SCHEDULE DOOR SCHEDULE - - L D A t J/•:l s J/.:< ARCHITECTS, C.Mi • B0. BOTTOu 0. r-, tOt Roew ve ry J '.>-b t/l' a ., wne ./.n � tO, a • � - E ss./cuv - ,.Fiu con Do 3 +a t ]/..x t]/• tol J515 a u.i a°.[9oa, : to2 0' COtt x V Rao .nr9 x t]/•:_'t]/�ue EE cR, —E! t♦ e. U•.l t 3/•ss .. ' 6W;oO.wC -_ b 351s bc<s Lo[Son 'w Du. —CT ER E-EC cEl � L TT IT, 0 GC ClI R TOR Ou ruL—D RPoNt M .LL3v0xn - nsu[. nsuui tt ue./ouR t ]b t/=' b�./ter - n co L.e. nrFO COPPER ,tl musk wn9 •9]/•:•5 J/• b tea w.e.. -.. .- uax „b hm btl xwl x-5]/•.•-3]/� b/¢uwa no.e.,w.[9wu GRAPHIC STANDARDS /aw.. w.E,mm D o I or ocimu numE.R-------- � _ s J/•. f J/ /.e, °°. GENERAL NOTES 5 J/•. to tna cu ormuc<wm eu°n one e.o.o n° -u r/T uu D.CEIa[� ! .,5 101!O—E - _ _yp 5]/•.•s]/� ¢/b ee 9 a<eewn<e+oet e'�+J CER CETA L BUBELE R .n^a s J/•••-s 3/•' ¢/¢ - - . ODOR 0.a al,c': rarElfTlol •nu cow be¢/tb¢to `e <P o<,«t< +w<......... .. DOOR NunIy ER - R.I.I. u.r w vw�— OLnirvTL en[R OEw� - ,,,,e s 3/.,.-s 3/•' ¢/¢xn.no.<,w.E awn tea • O Dai..L r.[mBER��FIRST FLOOR PLAN opt—c ._D. o. N Ic1 3 3/...3 J/. ¢/¢wn ORrm..e.cue D4.ay.G INDICATOR ,. Fe n.DRe ne ew , e .[ewn a .. C s DETxL, _��,� . "EC c.ai ons n°.._ PROJECT wDATA��ot. R t, DCINL swEE!LDc cry�'� 5r0. - E"" (SHAM GUEST COTTAGE _ - SrRUC1. SlROeiORa u. sJ/�..s>/•' ¢/¢<..,.",e w... 50 IAFAYETTE AVE. - - •- . R . rol r<w ow x nc z _ SECTQTi OR DETAIL CUT - rRuO p.w-oww.xwb x s]/•:.s J/.' b/b HYANNISPORt,MA � c !on =bJ - - IT nRtcu R<�° o°w.xw� s]/•:•-s J/. ¢/b PROJECT: "-IL—I vt TOR DE wn.m s]/.'.i s J/• - ADDITIONS AND REMODELING OF AN EXISTING RESIDENTIAL STRUCTURE.' sn..Er n,.uoER— oS Te TILE , ZONING DISTRICT:RF-I'&A.P s J/�•>s>/•'s NTLR,On ELEVA '.0 INDICATOR E<[D<R uvD c.n. sl/.:•53/.'¢/a E<K m.<. 'OCCUPANCY TYPE:SINGLE.FAMILY , "/ s]/.:•s J/.'a/b uk+.. CODE USED:MASSACHUSETTS STATE BUILDING CODE nv ""` - ELEv.,lo, - �- xos Pu° m•v"wa x s 3/.: 3 3/• a/a s"LF*mu.no.R� SYMBOLS uSEO AS ABBREV AT ONS l"I'co'°'w' --��, -' - EXTERIOR ELEVATION INDICATOR s u:0 xtt 39.w- 5/•:J-s3/Y s ✓^} - Y M t iixx 3 ✓ y� rt-" I—It DRAWING B R LIST b s y ,y4 v I:ALL-PE NDICATOk 9�Lw<w ww.l 0 'OLELE P o.•v s U•:•'-3l/.' ¢/a k C i ,.t, TTT F J FOcu uwL J 6 C aE LE PLMI s U• a/s { N ROCu nun o.R -� E E RCO` ws(t0 OuOw) boo• s L•:• , M NAMEUE AND n'U`.IBER uLDme E. T. a s>/.'..s]/. e/¢ ` ¢R ROO RCELEv.i ans s]/.: s J/•. ,w^ L tti '. .;J. 'V/III w.�•ue[.e ,,, nnoory,vREnFOR E:ES"i Orn+s e,• s3/. a¢ \ C:.`Jr .,•T, s 1-5 ) t m.u.x 3]/...-s>/. ¢/¢°e...nte e'V ip - E J' a•ewHw s,e„ew. vnNDo;r TYPE IaDIC.+TDR •.. T - - - st-] Rao��Epu ncp Pt.n Ja szesi,dw°<,� .. AO.01 [� V V �✓' 'q I `h / coo c/ L D A 6O `\ GROG/ 1 Y / Q / ARCHITECTS x \ ��POOH ss \ 4 'o \ \� • _.... Q anwx un •RASS ,_ ........._ z.. j' GRASS/ / - 48 a _ P y� � , ---STE- LE - i b A t�� `` 52 x 1 LAN SCAPED , \ DEGK 44.2 A-REA 46.4 XiST�. FRA V.ELLING� x`__ \ F.F.E.=47.7 46.7 -- 47 x47.1 x47.7 I` GRASS�— i 0 46 / �U)/ 4/ Q`,P QP�ED 0 �gDgITION x45.6 �46.4% C N '-\. C as „x45.0 i 40 - I PROPOSED DRIVE I a � }, � x41.7\ \ x43.5 —f43� o {•./ � HM ES �� �: :fir°,y<}4 } UP 4 b . .. - N 83'1 '14" W r- I L D A ARCHITECTS . CORl Oo ] actt a_p ------------ ------- ----------------- ----------------... e o - € � � •--- - — ....ter•/._ - m - : : aefiwa �_ -i nvn m sa.u�,m rc swtto.re. / i T' - ------------- . - va.m G i i' ^ r as, if R i ................................--....... ---------------- N e e I • ----------------o...-- ..... , _ wwu[,Wrro.l .. -- 1.--......--'.............. `--------'__-_• 3 i . � oxarv[u BUu � ^� '' at us �Li•J��Jti'JW� o,e�n .-e..em.ru Al .1 31�0 L D A ARCHITECTS ...--....-------------------------- .......-- ------. ---- ------............ _ -- ---- ' C N ------------- -= ---- Mud ------------------ 0; ti p,"JSCE d�•'..ra.' t :J1'SLz. � r �y A VW � ' 3 Flao.Ren A1 .2 L D A ARCHITECTS .__.-----_------- ec, ......, SHADED AREA NEW CONSTRUCTION .._-____....................... ...................................... ------------------ _-.._.._ ^, li W _ I W El eeelo®I u.l I .,. - i emo® I I t I' -- — - --------- -- ❑ ❑ :--------------------- L N y C 8 ----------- _.. I ------------------------------------- ----------------- ---------------------------- - { ....L.... 41 :,�MN'l It"s Al .3 L D A ARCHITECTS 12 .: ......_. V ....... '' ............... .' .__..... ...._.... ...... i. i monc E L L • : :`---a --� ........... _ LC ------------ Al .4 L D A ARCHITECTS LIN �s> --------- - —'-- — --'-- '---------------'------------ r �`•` - ——— —— 0E76 — -- _ _ Eli]N I - N j 4. SOUTH ELEVATION W 2. EAST ELEVATION nn _ Co �N c -----'—'-- S 8 F.. e 7 ' I F j = -0c5 ON FIE]E LT A- , 3. WEST ELEVATION €irY \� ., NORTH ELEVATION ———— ———— —— ———— NIN \ m 4 i Iv rr SECTION 4 SECTION 2 fwa aix a _ _ —_—_—_—_ / c--------------- j I i• n• � it I � I' ibur - - _ c�..o.n.rL � vas - -------------- —•-- '+'- ------- ----------- ---- --- �T�\ -------- _ i - ITB --------------------- --------------------- iu t' �,g,9y✓�;'9�y....'-".^ ��:� a SECTION 3 �`�r a SECTION T 1� Y� �aaf_3 ki�V�`t`• �Y^ At L D A ARCHITECTS 10,n'e n ixsuu,wx. 10 1/2•&n wSOUROx. CEOhR SWROIES 0, bi tKYfYlt fEll. CE pBRGMw fxpRC /tmaux ffu. �``.\ice I-O�BEroxo�[2E'�iwi Sx \1 = ------— - —— �ullr --r oro.wn.iRw k sotfrt . l i/2'tkc BFn0 bB6"'T [oxt.GVE vfxt • ' Ku Wwxu�Ywll�➢/vWh� H i0.M9.iwu k SOfTI _ - 'l GSEYwI wumOv wryro.wa. iO� ' 2i6 Si0p5 w/�6M'� 'tip' CWxc. '. - 2-5Yxcao 1Ru /LK C 2 iM xGLFR,ttR. •:: 2 2xB xGOw.IYP. _ wur�w:,Rsox� � N I' < i Co �x C a in-Rtww0 vUwlwxc. Get ZOIS�5 w/ c RO - iuxFe wMC ROrR _ I�c x�R�,s.._o 2.2:P,7n5w. ' K� C� —-—- —. (2)/5'S.M ux 2'xtwvw tau.sua a vaw ufRnUa w.0�» I t� 9.RRaR n wxn sRitE t r l.5 n i'-�ac. � rwsx wioE '�J tax t� i^ WJxWM Ns 0,6 Ic20xwEtx'E roo°fui c°. ro E.C. ED rwem.r E0"c sua C.E (2)IS REflw,Nxt. . y••�=b G)WALL SECTION @ EXIST STRUCTURE WA ECTION Q GARAGE/BEDROOM A3.2 .\t.n.w:v,rwvun,n,U h.:n IWI, yane..,:aal.lo.+l anJ,uu bu:l,.va,wlc,p,.:iicalivna. .' •.�.. f" . :4R�Fi ITECTS EJI_DilPJe`! pr<»+r,ri_b,I •\I an',•ball A- .. - p!�Nv::vm ,u:l.nr s::IlWal i:l a'.n J:eJ aW auper:iNFr yuJ::,<tl acvv:M1n,.il T ` -1Oil L pl 54 ,e H AT FREE ENDS[IF N TJ J l d L b 1 - sawn fWALLS PROVIDE 4-15 • 1 t (MIN.)"/a<832 n T ' -----17117-----USE VERT.WALL 'HI tv< n.wnn +•w.wav :..wWi Jt+.l v.. wa•m.:w:..r.�n:.i,a.. y REINF.IF LARGER. 4HORIZ, W,u,rt,:<n rc:P+,rtJ.r wr:Jy.,s xnl:yl UaJ.a. +.r.a•.•.<r.�,n.r„upni, .,u„r.v6ury,. LAP OUTSIDE EARS OR PROVIDE CORNER BAR. <_ AS SHOWN,BAR SIZETD TO MATCH LARGERHORIZ.. HORIZ.REINF. 1rz-:.LE c..:r,,.k.::<.:u,n.0 e__�u,p„ _ eu„>,,:,c•pauJ J.,,•,,,w<_.ral v<.1,::,r v,\c,f<W O.cda c . i•v:ur an ' - REINF. (TYPJ reall:un:nl,•.iU:Nu?Im,vh::,_;vs xve ll:.ilJ:,3(':Je a::J U:e.\l'I t'rN:mcluJ:ry N. rtttevrseS run:WrJ,rl rrc:u:nv:v<ru,r,.u(.:.c:n<m.hLi:'a•:,r';„a-:Lrw:•ntN,\C'I r:y.:rcu,cn:. / S.Nc:vivcing Wn•.L!Imv:a:v:u.Ufnl ol5-,u.ti;aviiwmm fvr di.+md 6i!In xssvl lun 4,r...,¢reu / J `HORIZONTAL REINFORCEMENT OF CONCRETE WALLS T. 0 s�z.1::;a r,�y ov, ,.:JI,smu I. L�N<J•`li, ;r,J.rro•m<,�r.r<r,,.(. e re>hu•, uw Ura b.P .t a.a l".a,l, nu,.ry ill e•.,arc:v:„II,wW_ .. -. .. W v x 1Jss.I r."I V IVI 'T l3 5 IWI 1 5 t R. z " _. ul.fvbrca w,+il :wn,.:a lvo uvl,ui.a van.iiivacv- -1 \n.,r,.v.lu- v, - nN HORIZ.RFJNF. 0 1► ANGLE VARIES LL LAP OUTSIDE BARS OR PROVIDE CORNER C BARS AS SHOWN C fth 010•,I. .,y b:. Al.••<v,Y mN 4).<:i rKJ .IJvn a.ry.v e n+u a¢VrIa::x�UCO su:r!et2•.r<n�rc.:wm a 1 k J ,O Er11 me I'll uP I,or bcu::Lv aw sw:v,oJ:uuJ. �IVI aW a L.I J P :I NC I+e,el,ivnv uu.im<rurl.,,wr..., W SKEWED CONCRETE WALL I g _0 Juy L t� wht yr;< HORIZONTAL REINFORCEMENT �:,�+n - +Il yll•• JI:a: ulLv:, ,n pinw uiNJ` n<1'I�.,• �.�,�GI:,uWlur.,.Fl,�ib t'vTC[Y�P.\,H„<J`C:a:J-IIIwrr:L,I,e.:u•,all sav v.\i:,:.,::r..l - PAINT W/BOND BREAKING NATER'AL �.(�i '' 6E POLACED SENT WALL SECTION ._ +/ MIN .w, _A JW1...i viva. I.y...aJ rMa 1y•N11hwy ubl l.M� ,�,<�<.✓✓/ ✓ -+� — ' I)K\ALQs ' , C•LJI�t!lllifl-_--_1L_,� r FACE <• _— .3 =F EXTERIOR f� �< c p t J },+ CONSTRUCTION JOINTS :: ::wid • „emuv.: ueu:,n. 4W 111:!-L, tli) .� SHALL BE PROVIDED _tlMt'RN '(ny i T��1y y tij,,, AT INTERVALS OF 50 FT. 2.PROVIDE A J/CV GROOVE ! E r_ µ__�. /• A EXTERIOR FACE WHEN P'w ,a„W tU,.l,sa<�I J u!i be ;�• C 7w/{ W,y,_R 4.a/," r.. ) C ALL IS 1'-0"OR GREATER clrn.<J by N.(e: •r p:, a:.b:n ,nJ+tu!I o,u•cJ:v ` r+'? .� O r„rm,ru,l„rn ,+ter N<y<r<rc!�,,.n. +.Q," 'C ABOVE FINISH GRADE TO 'n M s.acr.rteers.uP(F�t".`%'��•,'� 6"BELOW GRADE J W y`" 6v(l�vJ" WALL CONSTRUCTION " w,<I ,NN.;.,nxw : w, ' :Ja, �)JCOOJNCRETE NT S1 .O L. D. ,A ARCHITECTS i�uew uu• - } ._----.._---------------------_.........----.-._..-.-.....-......._...__---.------------..__i.............................. --------------------- - _ C -----._...._...- 3 •- C_--- ------------- -------- _ C�x1Bon C L .-.-.--•------•..... ...................... .lots ----------------------------------._....--- xi . N�o --------------- u � f e. 3. S1 .1 L D .A ARCHITECTS FWy , ' x r 4 00 _ ......_. �' N -------------- IL t � GI CS LE S1'.2 L D A ARCHITECTS N ......... - - N mg CM LM 8 S1 .3 P`oFTHET�ti The Town of Barnstable 9ARNSTABLE. Department of Health Safety and Environmental Services MASS. a Building Division QED MA'S 367 Main Street, Hyannis, MA 02601 Office: `508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection �'12-1/% Location t _LL�����'(+�'�� Permit Number �� 2 Owner Builders � 1,5 One notice to remain on job site, one notice on file in Building Department. Re following items need correcting: t 9 cllq O LN I" 1, Please call: 508-862-40388 for re-inspection. Inspected by Date ` y i A-V } l TOWN OF BARNSTABLE,BUILDING PERMIT APP ICA N ; #Permit Map _2g7 Parcel 3 9,— Z gA '`SABI. . l0,� o. Health Division _C)o D 3 ! �����7=.}y+nj Eg ,�2 Aj� 9� 2 Date Issued ' 2 Conservation,Division a O oZ : Fee Tax Collector1S10 f �f P IC SYS VEMMUST BE C� Treasurer INSTALLED IN COMPLIANCE Planning Dept. VM TITLE 6 ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board f� T01IVN REGULATIONS Historic-OKH /� } Preservation/Hyannis /U A ° Project Street Address ;;D L A FA SET 7c & V EF - " Village S T Owner I AK1 CIF 1 S4AM Address p° $��33 4.t-r ►� oe-�' yam.. 1 Telephone D 7 tJ bR. I S Permit Request D d L G X 5 T I lc D t1 O �o LL t ET a �J s •Ft ba_ VE7cVG C.&13 9 T]qo r_ -3 Io 1 Square feet: 1st floor: existing 5 proposedg(oS 2nd floor: existing / proposed 2 149 Total new � 7f Valuation '�a�3�� Zoning District 1fE Flood Plain IJ 1 9 Groundwater Overlay Construction Type Wt;> f�4�1e- Lot Size 1-7 400- :5 P Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family 'Two Family ❑ Multi-Family(#units) Age of Existing Structure �y "�J y Historic House: ❑Yes No On Old King's Highway: O.Yes �No Basement Type:�Q Full WSJ Crawl ❑Walkout 0 Other 8LA6 &M It' 5,40_, Basement Finished Area(sq.ft.) LA Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2' new Half:existing new Number of Bedrooms: existing_. new Total Room Count(not including baths): existing JT new First Floor Room Count Heat Type and Fuel: �Gas ❑Oil ❑ Electric ❑Other N4 Central Air: XYes ❑ No Fireplaces: Existing 0 New I E fisting wood/coal stove: ❑Yes VN0 Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑existing new size2gJV7- Shed:❑existing ❑new size '4 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes XNo If yes,site plan review.# Current Use Proposed Use �� ., // BUILDER INFORMATION Name 5� UG6D 99 15 1 V J . `iy G Telephone Number D Address 3es Sex -f;— License# al 85 14" /1JLS Home Improvement Contractor# /D Z LO Worker's Compensation# aG /DDl 8� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO T x SIGNATURE DATE y c FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRES$ _ " VILLAGE, OWNER` t- DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE _. ELECTRICAL:, ROUGH FINAL PLUMBING ROUGM FINAL - M IV- GAS: ROUGE FINAL FINAL BUILDING } r C) < DATE CLOSED OUT co ' s ASSOCIATION,PLAN NO cis - S t 02l11/2002 MON 11:41. FAX 50879093,0 Linda Roderick E 10001 >IAR F n c c Ga. CUrpo ion ER O\ .N`5TAIRZyay, \\E�i.,co?,14s�sc�s��� }s 02090-9230 ELECTRIC GAS February I , 2002 Dyer Electric � The electric, service and meter at the home cif Tracy Isham ; 50 Lafayette Ave. , Hyannisport were removed sir_ February 7, 2002.. This was done' a6our request.. ` Sincerely, - Barbara Trocchi Office Administrator �. \\ +gyp a . FEB-11-2002 MON 11 : 18 AM KEYSPAN ENERGY'DELIVERY FAX NO. 5087607611 P. 02 - KeySpan Energy Dellvory Ericigy OZWay 201 Rivemluor sneer WCSI Roxbury,Massachuetls 02132 70 617 723-5512 February 11, 2002 Bob M.aglio re; 50 Lafayette Avc, W, Hyannisport, MA _ To.whoni It May-concern: .. This letter" is to confirm that the natural gas services to the above referei7ccd property have been cut and capped at the gatebox. This work was by-Lis completed b b January 31, 2002, P Y on If you have an questions Y I can be contacted _ted directly at 508 760 7503.. Sincerely; Sally Sinclair Field Operations e v FEB-11-2002 10:56 BARNSTABLE WATER COMPANY Q508 790 1313 P.01i01 B mstable ATER 47 Old Yarmouth Road P.O. Box 326 COMPANY Hyannis, Massachusetts 02601-0326 508/775-0063 ] EBRUARY 5, 2002 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN HALL HYANNIS, MA 02601. RE: 50 LAFAYETTE AVENUE TO WHOM IT MAY CONCERN; THIS IS TO CONFIRM THAT THE WATER SERVICE LOCATED AT 50 LA.FAYETTE AVENUE HAS BEEN SHUT OFF AT THE MAIN AND THE r ,. METER REMOVED FROM THE PREMISES AT THE REQUEST OF THE OWNER WHO INTENDS TO'DEMOLISH THE BUILDING THEREON. SINCERELY, SUSAN A. SKARBEK BARNSTABLE WATER COMPANY K N TOTAL' P'01' Tlr a Cvrrrr»r>>r x'callh a f. fassaclr=setts Department of Irrdust»al Accldcnrr J. , 01>7ce17f1M1r &'9affVZT ; 600 11'Wihi-ron Slrcct . Bustvfr,. fz= 02111 Workers' Compensation 1nsurance.Affidavit �Pl���nr inf rmatinn• - •• 1'le�sc 1'Tt1N1',M '• • • • name . • • . ti;�• - nh one 7V ❑ 1 am a homeowner performing all wort,myself. ❑ 1 am a sole proprietor and have no one woricina in any capacity COX 1 am an emplover provtdtn;workers' compcnsat on for my employe=working on this job. rim ERNEST B. NORRIS & SON � _ 385 SEA STREET Pslrlrc�_�• , �;�.. NYANNIS 508-Z75-0457 EASTERN CASUALTY INSURANCE COMPANY snnn 0 WCG 1000807 A ❑ ►am a sole proprietor. general contractor, or homeowner(circle one)and have hired the contactors listed below wi the following workers' compensation polices: . . . rnmnany n2inc• ttdre s ghoneff- i I. cu' fcc co •nnlirr�! address• • "u c co nolicr�! " _ �ttt ch:Jdldoasl sltcct f!'aece»err.•-.,....•,R.,�...�1'�--sr�...r�w--�:.: t-...+. 'a ' I•.�P� nr.. .. �•,....v� Fsilurr to scrare covetmge is required under Section Sl of TIGL 153 csa lead to the imposition oteriasiail pKasltlrs otrt line op to S1S00.t)t1 uric rc�n•Imprisonment its well as civil penililet is the form Of STOP 11'ORK ORDER sad s flae ofS100.00 a der aptinst me. I a-adersunc copy of this statement m2%•be forwsrded to the 01)ice of Iat•estiptions of the DIA for cvrrtxrt mi11e=tiozL ' l do he�br ccrrifj•unrk.r the pains and p eld oJpe urr ihar the infcr"=ion prtJt7ded chore is true and earners fienuur; Print r, - 2mc CRA'IG N. ASHWOR1li Fhoae 508-775-0457 omcial•use only do not it-riteis this arts to be eroraplcted by city or toga ort1t331 MY ertonn: perraiNJccrse#` riBoildlarDcp=rrraeat C3U==31 gDasr•d • ❑check irlmmcdiaae=punscis rrquirrd •• C1Sdretarr's 01ITcr, C3lf ealth Drrrtacat Town of Barnstable OFIME 1 Regulatory Services os Thomas F.Geller,Director BARNSTABM Building Division MASS. 1639• Peter F.DiMatteo, Building Commissioner TEo �A 200 Main Street, Hyannis,MA 02601 Office: 568-862-4038 Fax: 508-790-6230 Procedures for a Demolition Permit 1. The following departments, located at 200 Main Street,must sign off on the permit application: Conservation Commission Tax Collector Tr surer Q fain a"Field Card"from Assessor's Office (1st Floor Town Hall) and take it to the: 0 Historic Preservation Commission 2. Historic District Commission, 200 Main Street, approval required prior to construction/demolition for any properties located in a Historic District: ` /Iv • Old Kings Highway Historic District(north of the Mid Cape Highway) / • Hyannis Main Street Waterfront Historic District(See map for boundaries) 3. Specify on permit where demolition debris is to be disposed of. 4. Certific-ation that all utilities are shut off is required. as= �ater ©octric ❑Barnstable Engineering if on Town Sewer(no certification needed if,on-site septic system) 5 Workers Compensation Insurance Affidavit form must be submitted if more than one person will be involved in the work. 6. Fee to be paid. Note: Dumpsters with a capacity of 6 yards or greater require a permit from the Fire Department having jurisdiction pursuant to 527 CMR 34 Q:forms:demoperm 2 Rev 121801 ,,,�,�,� : The Town of. Barnstable 63q 6 Regulatory Services v s . `0� �'°'Eo►�+` Thomas F. Geiler, Director Building Division r t Ralph Crossen, Building Commissioner 367 Main Street,Hyannis.MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 29 ®Z AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL C. 142A requires that the "reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more thanfour dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 49 lO ;PV D .CJ Estimated Cost Address of Work: ✓rb L �y E r7 iff A(/6 Owner's Name: Date of Application: $ OY I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law E]Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of,the owner: / Zq o2- pip ate Contractor Name Registration No. OR Date Owner's Name q:forms:A ffida v ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J { 0 L � >= A of Applicant Name: �,Am ! Site Address: Applicant Address: . () City/Town: 1/1 e Use Group: * (� (g7 Date of Application: 2 Applicant Phone: Applicant Signature: Compliance Path(check one): Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.1b): A A Heating Degree Days(HDD65)from Table J5.2.1a: For items d. through i. fill in all values that apply from Table J5.2.lb: ( g � PP Y , a. Gross Wall Area —sq.ft f. Wall R-value. R- / 9 b. Glazing Area' 2 —sq.ft. g. Floor R-value R- / J c. Glazing%(100 x b_a) _% h. Basement wall R- f B d. Glazing U-value U- 3 6 i. Slab Perimeter R- e. Ceiling R-value R- ?J j. Heating AFUE _ ❑ Component Performance: "Manual Trade-Off'(Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.22) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet,if applicable] ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall+Ceiling Area sq.ft. b. Glazing Area' sq.ft. c. Glazing%(100 x b-a) ❑ ADDITION with Glazing% (c.)up to 40% may use 780 CMR Table J1.12.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestration' Ceiling' Wall Floor I Basement Wall I Slab Perimeter,Depth 0.39' R-37 R-13 R-19 I R-10 R-10 4 ft 1 Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior walls,and including any access openings.) ❑ "SUNROOM" addition (greater than 40% glazing-to-wall and ceiling gross area) Attach"Consumer Information Form"from 780 CMR Appendix B. Official's Name: Official's Signature:. Application Approved ❑ Denied ❑ Date of Approval/Denial: Reason(s)for Denial: (provide additional details as needed on back side) IMPORTANT MESSAGE FOR DATE �TI E� 1.1 P.M. M OF PHONE AREA COKE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED.,< PLEASE CALL CAME TO SEE 1(OU '.- WILL:CALL AGAIN WANTS TO,SEE;YOU RUSH RETURNED YOUR CALL' SPE" AL"ATTENTION MESSAGE a s e SIGNED W .hmFORM 3002S MADE IN U.S.A. �r --- � _ _ �, I , �,. ��. f r. s7 � ° Town of Barnstable . MI. 1R945A . Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MS Wayne Miller,M.D. January 31, 2002 Mr. Arne H. Ojala, P.E., PLS Down Cape Engineering, Inc. 939 Main Street, Route 6A Yarmouthport, MA 02675 RE: 63 Mountain Ash Road, Marstons Mills Dear Mr. Ojala, You are granted variances on behalf of your client, Susan Dillard, to construct a soil absorption system at 63 Mountain Ash Road, Marstons Mills. The variances granted are as follows: PART XIV SECT. 2.00: The soil absorption system will be located 133 feet away from the existing neighbor's well, in lieu of the 150 feet minimum separation distance required. PART XIV SECT. 2.00: The soil absorption system will be located 122.feet away from the.existing onsite well, in lieu of the 150 feet minimum separation distance required. The variances are granted with the following conditions: I (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type .rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) During a site visit on January 30, 2002, Daniel Ojala of Downcape Engineering Company and our health agent counted five (5) bedrooms within this dwelling. The issue of the two bedrooms constructed in the past without any building permits (located above the garage and in the basement) shall be resolved in accordance with the State Building Code Ojala4 and local health regulations. The resolution would include demolition work necessary to comply with the nitrogen loading restrictions contained within the State Environmental Code, Title V, and the Town Ordinance, Regulation of Wastewater Discharge (330 Regulation). Please contact the Town of Barnstable Building Division to ensure any demolition and/or renovation work is done in compliance with all of the State and local regulations. (3)- The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (4) The septic system shall be installed in strict accordance with the engineered plans dated December 5, 2001, signed by the designing engineer on December 17, 2001. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated December 5, 2001, signed by the designing engineer December 17, 2001. (6) The owner of this property, Susan Dillard, recently informed the Health Agent that the horse was removed from this property. Horses shall not kept or stabled on this site in the future without first receiving a valid stable permit from the Board of Health. (7) The onsite private well water shall be tested annually by a certified laboratory. These variances are granted because physical constraints at the site severely restrict the location of a soil absorption system due to the topography and the presence of other wells in the area. Town water is available in this area; however the Board was informed that the property owner possesses insufficient funds to connect to public water at this time. It is the opinion of this Board that the proposed soil absorption system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. incerely yours, an G. Rask, R.S. C Chairperson Ojala4 ��= �� Cv.uEtisi`Qne1' fig r ►Jn..a n,.0 At^ RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET LIVING SPAC _ ( square feet x$96/sq.foot x.0031= plu from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE �Jr square feet x$64/sq.foot= f 74,0 x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.fk Aj >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch$30.00 (number) Deck x$30.00 (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 ;JIA (plus above if applicable) Permit Fee prolcost fie �o���2aa2useaccfz a ✓� 1ac,/ccael, 1, t� C?Ljj. Id.i i R <a�.i..1. 11.a.:�l� ;,ilea :•t . ncl.:arC�ra —_ !'.)ilc;; F;c,')0r11 1.,-301 ?c]:.3f 0I'7 t"I<; c;c3C;Tll1.'t,f:l ..: C) '1.0a �'i C,)i it C• �.Irl r:.Y' C.,�v G rfl Ci`r1�, i,,C)rl t:.Y' cY<j'!:',C)'i T-Z c�,<:3 1 Cs t;l"J f;,.1.Ci rl r.. <.:>. ]..l") O].� { xr)irrlr.a _)1,) , 06/..1Q/%QO ? r y la�� !'I— v ar.t: HONE IMPROVEMENT CONIROCiOR �) — ? Re9istralion: 102014 r •:�a ;1r31�waY t:l l _ ! Expiration: 06/30/2002 Type: Private Corporatio mAt ERNEST B. NORRIS 6 SON INC raig AshaorIh G�c�'ri�c,p 7-> bie9S� y r ADMINISTRATOR� fj5 $ed SI Hyannis N,I 02601 ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: LAN ! Site Address: L i,�-- le A vIf Applicant Address: h City/Town: } A/I Use Group: ! Alw D4/►lt Date of Application: Z A licant Phone: 7 7S—/Z Applicant Signature:1 P 4���� �� p� na g Compliance Path(check one): Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.lb): A A Heating Degree Days(HDDGS) from Table J5.2.1 a: � (For items d. through i., fill in all values that apply from Table J5.2.lb:) a. Gross Wall Area sq.ft f. Wall R-value R- / 9 b. Glazing Area' sq.ft. g. Floor R-value R= / 7 c. Glazing%(100 x b_a)_(O_ % h. Basement wall R- t d. Glazing U-value U- 3 i. Slab Perimeter R- 6 e. Ceiling R-value R- 3 j. Heating AFUE _ g ❑ Component Performance: "Manual Trade-Off" (Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet,if applicable] ❑ MAScheek Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall+Ceiling Area sq.ft. b. Glazing Area' sq.ft. c. Glazing%(100 x b-a) —% ❑ ADDITION with Glazing % (c.)up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestration' Ceilin ' Wall Floor I Basement Wall Slab Perimeter,Depth 0.39' R-37 R-13 R-19 I R-10 R-10,4 ft 1 Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation maybe used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior walls,and including any access openings.) ❑ "SUNROOM" addition (greater than 40% glazing-to-wall and ceiling gross area) Attach"Consumer Information Form"from 780 CMR Appendix B. Official's Name:. Official's Signature: Application Approved ❑ Denied ❑ Date of Approval/Denial: Reason(s)for Denial: (provide additional details as needed on back side) 02/11/2002 15:12 5084289950 HCAICASOLI PAGE 01 GRAZUL INSURANCE . PAGE 02 C. PAW OF LIA I L.ITy INSURANCE e4Tep.xTraa,Y,,, 1�. CIR rE I>$ lew a) A!A MATT!"0 INfO A a NO AND C®RafaiTI Ttl�, FlIOp#Y8 �P� 1t4! Caggva aCATE � A, vFes �k�rapacAra �a¢i ®� AMI�kD E7CT6MD aai ALTIR ryas c�ve�saa a �f+ o�� �m TH Paps 1tb o „ Ma�Bl8�+1:1R,Afa%O CAveaeAmc - 1NouRrn it: cc mmdm laijbild pad INovplen Trr �xllell 1!l t +a+auR�Ac: , �INiupsR of .� �EdlAU � INaUPAR a POLICIES OF INSURANCE USTED BELOW NAVE BEEN ISIVED TO TM@ INquRrtb NAAaBD Aa�VE FOR Tt�E P(7�61GY PgR!Oa)INDICATED.NO1'1NITN8TANDIN(8 NY REOVIRE�+9W,TFFM OR Cd3NbTION OF ANY CONTRACT QR OTHf;n WmICtot AY PERTAIN,THE INSURANCE APROROED oY TM I Padl•ICIIcE DE8CT+19ED MER�EPP1 I$S B,IEGY Ra d��YMI��EgppS ETHIS OfMTO AND C(NODITI E MOVE UCM ICIE6.ACetREOATE CIAAITB®MOWN N1Ar HAVE®ESN REDUC&D ey pAID 0LAjM& fYPg OP TNiYT1AACY Ipy NtIxTlER I FBI PRECTII►B 1CT MAY Ex 010"j SEMINAL IIA�d1ry a,wo dACNOGGUMIfiNCaE i e� IAt OiwlolAl t1A6R�Yv PI410AWA09(My ene Ii*- a ' I CLAIA1bMADE ��OCCue1 I �_ . - �: f PaRE�NAI A AC+�IPIJUwY i 3mloW QlNERALA00AapATE GCNta69RE®ATitt#11TlPPtlfaP4tlN 31 I as'" I i"QoouCTa-COM®bPaOG a ! PGUCr r LOC r' AYiO>t�La llAilLlTT �OOAAiINCD 91NtftE LIMIT I ANY AUTO I IEe�e11) 1 i 111 A&L OWN49 AUTO! •ODIIY W AY "MO AUTOe 4"ll OV^111 AYTOTI I I Aaloo l V • eAAAQA I pTY AUTO ONLY !A ACC►DOWT I 1A ACC 6 . .ANY AVTo k wrokN�. H A®6 f a iatA Loa�oYY k. AAcn occuARSNCE e C=lm MAyi i asaweaeTs • peot/eT#la E I I RET(NYDN t - i 111oleRpol8Obf18'iNaATN1N A!p I i T Y LPA05 I ER I IfaPLwrlTs•LUISILnr �; � � ! �1.L.aAc'�1+►ocoolla+l s 'OOpy�' T.L.DlerAlt•to 9MP+OYe I #W.� 1 T.L.DIO$Aa8•NCJIfCY Ueu7 OT**m •CApTgN 6l 6mATIr c*'h"m RIMOtYDLai VCLYatOR®Alb ar EN00111loWNY/giCfY41 P"W p>�e: ovlth Street, H?>tea'lni0 12 laabel.le Roadf HTWIlydO cKMELATS HOLDIA AaaTnsaNa •pav"A W%m-! CANSKUWATO TOrt17 0>" ge1»riatsble gawkp&NY OPT"Anave mocumvp pouv"l96OAMILLID UPON THN IR o AToow 200 Main 9tt 0 oAra rMpn9p.Tu■WWWQ TNeUPaA ML►eNwAYon TO NxA ._ 0Ava W10770" 20r�r+Mae 3t 02601 94"aa To Tw Cump eATS HOLM NArao ro T11F LIFT,BUT FAIL"I To 06 ns"ALL xAiOaa 110 OKICAT1011 ON MAWTT Of ANY XNZ ,TMR AMINT!on � RaiA{laNTAT1Yii ' - WTT1oA1tt011a►hafeNlA 40ALC DC0lRPONAR1V*i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 015851 Expires: 09/28/2003 Tr.no: 5619 Restricted: 00 CRAIG N ASHWORTH _ 385 SEA STREET HYANNIS, MA,02601 Administrator a Z OO �G I< Nr > i u� ME ATE CA5 FVOK-X RAM t3Y MK a ° MOCATE E45fl'\C W&J Z � I � G e ° ED EDe e ° O xv r,IE 0 PLAYZOOM ° z I e O , FIK15NEn MFCN,PM J,� — Z EXIST�.Icrl�o � Q a rr�G� �rrEGV��TI�G j UKFIK15HEP 5fOFA6E i - e _ N I i z C A5FMFW FOR PLAN � I — I r-- M CD LAFAYETTE AVENUE, tM 1 ,5 Q N N 06`43737' E :3 CD o :3 -0 O o cz—n N 06'43'37" E 311.18' TD 126.23' CB to SB m I m m r-t- ,� - .� z � O m 176.69' 117.32' 0 16.95' i 26.41' CB to LOT COR Q o c7 N O W �l 3 (CD IV -! p Z Z O W 00 D z o z n N cNn D p r*t o � —o -0N p ncz rt 7D W _ °�m ;:0O rn 1 N �o m �D v O C-) C) n zcU \ F O U N D A T 0 ry Q o rri � r" o n o M -* 00 co rn -i~ LOCATION DATE: i 6.2' m oco (� c' n M o n 04-19-2002 N _ rO� Je in p �z D i o z� 3.0' uj m J z a� 0 a co co _ �- `'' o= v o J O D a 0 _ C14E ` Cl ca n Q Q r-t- N C o , �0. O o �• N Q 0 Z CD Z a / Q n- cL . .: c: o @ a 5 +. \� 7D41 CTJ �►. O 17.2 9 N N 9,6.9 N Z N a sl I cn S 06`37'45" W 114.22' i D cn N o n C- co m o o o o LONGWOOD AVENUE o N - • EXISTING LEGEND PROPOSED Design Schedule ELEVATION Leaching Area Requirements ��- - -- - Edge of Pavement - EXISTING FINISHED FLOOR 47.7 -- - -- - Sewer Pipe s FINISHED BASEMENT FLOOR 4 BEDROOMS AT 110 GPD/BEDROOM = 440 GPD ------- {- - Water Pipe IN - FINISHED GARAGE FLOOR -- ADDITIONAL 50% FOR GARBAGE DISPOSAL __NA__GPD Drain Pipe Gas Pipe -------------G SEWER INVERT AT FOUNDATION 45.1 _ Manhole Cover SEWER INVERT INTO SEPTIC TANK 44.9 PERC RATE = <2 MIN. / INCH (CLASS i ) Catch Basin ■ SEWER INVERT OUT 0.^ SEPTIC TANK 44.6 Water Gate N LTAR = 0.74 GPD/S.F. SEWER INVERT INTO DISTRIBUTION BOX 44.4 Light Pole r UtilityPole -■ SEWER INVERT OUT OF DISTRIBUTION BOX 44.2 MIN. LEACHING AREA OF S.A.S. -_ Contours 200 SEWER INVERT INTO L.SkCHING SYSTEM 44.0 Spot Grade BOTTOM OF LEACHING TRENCH 42.0 440 GPD/ 0.74 GPD/S.F. = 595 S.F. MIN. Test Pit WATER TABLE none observed at El. 36.2 -- PROPOSED SYSTEM 449 GPD W/LEACHING AREA OF 608 S.F. 2 . X -1s ON 4 O - 9 5 _ _ - - - - - GENERAL NOTES 4 8 _ 52.3 - _ __ _ _ G ON X '_ -'-' _.., �� gib` ,` RAy� AVE - - - _ ON \, � _ -___._. _._ `_ ,. � - __ - - _ X - --__ --- �- _- - IN ACCORDANCE WITH ALL SYSTEM COMPONENTS SHALL BE INSTALLED ��_0 � _._ � _-,-_ �^$5 _ _ " __ J � TITLE V OF THE STATE SANITARY CODE DATED a � - - - uP#18/5 4 7 _ ~ - - -- - -- _ ___ __-- 5 MARCH 31 1995 & ANY LOCAL RULES APPLICABLE. - _- GRASS - - " 51.6 W1NCH �R p ' ' D 46 ``- >`52.3 -_- cj) X AVE .N TBM = PK NAIL IN PAVEMENT �/ _ - - `STEPS ® ELEV. 43.08' ~ ~` ~ �' - ~ ` __ - -- _ - - 57 _ _ - SfTE ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING ON - rBAXTER, NYE HOLMGREN 50 LANDSCAPE AREA 49 - EL=47.3 ` 44.2 \ 6.4 _ n __. A ON FILLIN , - 3 6 Map{e`, W SNlNGT WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACK FILLING, \\ AVE NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT \ \\ \\ \ \\ \`' .` \ \ \' \ •,\ _.._._ _ --_- FOR INSPECTION. AC \\, , HUSETT A 4�\\ FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED.WOOD FRAME \ `\ ` '-_ _ - - - CCUS M WITHOUT WRITTEN \`\ DwELUNG , THESE ELEVATIONS MUST NOT BE CHANGED 2 `t';`F.F E.=47.T\ \ \\` �'''�` \ 'STONE X 46.7 - L ' AP APPROVAL BY BAXTER, NYE & HOLMGREN. \\ \ \ \• �\'; \, _ _ X 47.1 X 47.7 NOT TO SCALE �\\�\.\, • t \ PATIO ZONING DISTRICT: RF-1 & AP ASSESSORS MAP #287 ' \ ' ` x � :.` PROPOSED SEPTIC SYSTEM SETBACKS: FRONT 30' PARCEL # 39-2 ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" SCH. 40 PVC. SIDE 15' = '' \ r y ��� . 10' Min. o 8 `'`` L`*`, \\t `' BACK 15' EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING SURROUNDING THE LEACHING FIELD FOR A DISTANCE OF 5 , PER `- / 310 CMR 15.255. o 1` \`` ROPOSED ADDITIONt M O O -- f 12' 6' o � Y �4 ° ° a _ FINISHED GRADE � x7 a a a / PROJECT DATUM: N.G.V.D. 4 c X ......\ \\ PROJECT BENCHMARKS: REFER TO SITE PLAN 6 / 367MAX.- 12 MIN. / // // // // // // // // //\ii�/ / /\// COMPACTED FILL 4i NO5 �b a / 2_ \ \ \ \ \ \ \ \ \ \ \ \ \ \ PEASTONE t"7 BUSHES y I TEST PIT I r 4 .. LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND � . u a y " " SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE � k qti� � w ( ® 3 .5" 4 O 3 4 TO 1 i 2 UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. 3 �� i HEDGES ' , . / / A X 46.4 ° DOUBLE ?'ate. %� t r-i `" Pt ( ( / ° ° a _4 W i X 45.6 RESERVE AREA E W I 1 OP f WASHED STONE _ a EXISTING CESSPOOL MUST BE PUMPED, LID DEMOLISHED AND FILLED WITH SAND. o � } r ffi•. s _ '�C PLASTIC LEACHING GALLEY DETAIL G r GRASS DRIVE WAY r N.T.S. o ro 7 PERC TEST - '� Q 0 35'- r [�. GRASS 1-1.5 WASHED STONE p v -- 40 O HEDGES �� cv l X 43.5 D v �7 X 43.9 TBM = DRILL-HOLE IN STONE v ! PROPOSED DRIVE WAY - BOUND'® ELEV. 40.08' fl v v • D v PLAN OF LEA CTI CHAMBERS 50 Lafayette Avenue N.T.' . H annis Port, Massachusetts o v HEDGES PREPARED FOR - 150.0 r _ _._..� LDA Architects uP �- , » iN 831214 W TITLE Septic System Design TYPICAL SYSTEM PROFILE BAXTER, NYE & HOLMGREN, Il�C. P# 14143 FINISHED FLOOR FINISHED GRADE = 46 f SOIL LOGS DATE: 1/0912002 EL. = 47.7 ENGINEER: BOARD OF HEALTH AGENT: 11 NOT TO SCALE Stephen A. Wilson David Stanton BAXTER, NYE & HOLMGREN, INC. TEST PIT 1 TEST PIT 2 Registered Professional FINISHED GRADE OVER TANK = 46t FINISHED GRADE OVER D. BOX G.S.E. = 46.2 G.S.E. = 45.1 Engineers and Land Surveyors = 46t FINISHED GRADE OVER LEACHING TRENCH = 46.5t 3' (mi . 0 AP 812 Main Street, Ostervllle, MA 02655 4" rrPi 40 c PVC FIRST 2' (TO BE LEVEL) 6" SAN 10 YR 3/4 Phone YLOAM - (508)428-9131 Fax - (508)428-3750 ) 4" SCH. 40 PVC s.(min.) F_ (min) Cover PVC or 0L2 min 36" (max) Cover t 0" CI TEES GAS s' SUMP .. 40 PVC 10 YR 5/6 SANDY LOAM .r' CONSTRUCT ACCESS 4 SCH. L /8 t /2 20" ' MANHOLE OVER INLET l 2" Ayer 1 " of 10 O 1 O 20 TO TANK TO AT LEAST Peastone LEACHING CHAMBERS WITHIN 6' FINISH G C-1 SCALE IN FEET REINFORCED CONCRETESTONEUSHED Slope = 0.005 min MEDIUM SAND ..,.µ 4" PVC O O O cc O O O O O O O 48" 10 YR 5/6 SCALE:1 "=10' DATE: 01/11/2002 O O O cc O O O O O O O O O O O O O -2 PERC ® 60" REV. DATE: REMARKS MEDIUM SAND RATE= <2 MIN/IN BOTTOM ELEV. = 42.0 120" 10 YR 6/4 NO WATER ENCOUNTERED 1500 GALLON SEPTIC TANK DISTRIBUTION BOX 5' MIN TO BE INSTALLED ON A LEVEL STABLE BASE TO BE INSTALLED ON A LEVEL STABLE BASE 1 DRAWING NUMBER 1 No Groundwater Observed at EL. 36.2 -- PLASTIC LEACHING GALLEYS HA2001 \2001 - 103\Civil\Design\2001 -- 103sp.dw( InD 11 e)nn -1 -1 n-