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0174 SEVENTH AVENUE (HYANNIS)
i� i { i i i i i i ASSESSORS REF.: FLOOD ZONE: Map 245, Parcel 72 X(.2% chance of Flooding) & AE(EL12) Based on .Map # OVERLAY DISTRICT: 25001CO564J July 16, 2014 AP — Aquifer Protection District ZONE: RB Area (min.) 43,560 SF Frontage (min) 20' Width (min) 100' Setbacks: Front 20' Side 10' Rear 10' .29 0 \ Wood Deck � q aah%oO Shed CB/DH Fnd Lot 504 M8T21'36E Stockade Fence 2� ❑ ❑ Lot 506 /� F�dO Lot 551 `V 100.00' Shed rn �— W W —p `V _ -- — °hw 10' Sideyard i ? O © .... Co o I ApproxSeptic`:. i o I J �=1` �°h ! Per Asbuil t; Oo I a O N o � ct F o i #174 In o i 1 Sty w/f lb N ! Dwelling Lat s4s Lot 506 P ...... of 50 LoE 547 I 8 n• / I \ 00 tv — — — — — —ZO' Frontyord Parcel Area 8'000±SF ` BRB 20.2' Proposed � � F"d Wood. Deck \ S8 '21'36"W i ..........h.................................... 90.00 ...........fo S&I{... ars Edge of Pavement Limit of Moderate Wave Action OceanDrivu(40,:<Wide — Public Way) arc E�RE�x PLAN OF PROPOSED DECK 4 ENO 3g31� At 174 Seventh Avenue BARNSTABLE West Hyannisport NOTES: MASS. DATE: 20/MAY116 SCALE:1"=20' 1.) The structures shown were located on the 'ground 0 5 10 15 20 30 40 FEET by conventional survey methods on (or between) 29/AUG/02 and 19/MAY/16. PREPARED FOR: 2.) The property line information shown hereon was Wayne Goulet, Jacqueline Tolan, & Peter Goulet compiled from available record information. 3.) This plan is not for recording and is not to be PREPARED BY: CapeSury used for construction layout or deed description purposes. 23 West Bay Rd, Suite G Osterville MA 02855 DWG #:C479_4g1 cpp1 FIELD BY: RRL (508) 420-3994 / 420-3995fox G4� $'6 k � � ASSESSORS REF.: FLOOD ZONE: Map 245, Parcel 72 X(.2% chance of Flooding) & AE(EL12) Based on Map # OVERLAY DISTRICT. 25001 CO564J July 16, 2014 AP — Aquifer Protection District ZONE: RB Area (min.) 43,560 SF Fronta a (min) 20' Width (min) 100' Setbacks: Fron t 20' Side 10' Rear 10' .29 Wood Deck o ch ,9 00, o,>c 1,7 � Shed C810H �•� 2J Fnd Lot 504 V♦\ CB/DH stockade Fence ❑ Lot 506 /� Fnd Lot 551 M8721'36"E `u 100.00' Shed O— w w —❑ --'--'- °hµ 10' Sideyard — • — ._.__. —I ti I:....; i to I ` © c I Approx Septic;. i q O Li c Q moo/, I Per Asbuilt, 0o I a O ry f o '2 1 '#174 In � N i 1 Sty w/f ! Lot 506 Dwelling Lot. 549 . 1 .•.••., Lot 508 ..... ......,.... 21.1. �y .................................. . LoE 547 I Q I:;:;:;.:•:•:•:.; F� I JOE co z Parcel Area 8'000±SF CD BRB 20.2 Proposed F Wood Deck f \ S87 21'36"W i 180t'............................................. 90.00 ...........to ScI£...Atarsh Edge of Pavement Limit of Moderate Wave Action ocean (40' Wide Drive — Public Way) IJAS --� Ric . R. PLAN OF PROPOSED DECK v L,NEVREUX er N� 34312 �o At 174 Seventh Avenue BARNS TABLE West Hyannisport NOTES: MASS, DATE: 20/MAY116 SCALE:1"=20' 1.) The structures shown were located on the ground 05 10 15 20 30 40 FEET by conventional survey methods on (or between) 29/AUG/02 and 19/MAY/16. PREPARED FOR: 2.) The property line information shown here Wayne Goulet, Jacqueline Tolan, on was & Peter Goulet compiled from available record information. 3.) This plan is not for recording and is not to be PREPARED BY: used for construction layout or deed description CapeSury purposes. 23 West Bay Rd, Suite G Osterville MA 02655 DWG #:C479_4g1 cpp1 FIELD BY: RRL (508) 420-3994 / 420-3995fox �o �v Fral4 ji 4�,e. / Assessor's map and lot number ........ W !tit e: k ME/T 1 BE ,- INST":LL EO M COMPLIANCE Sewage Permit number ... ...... ... ...... WiTH A-I Tl-1-r- 11 STATE SAINtITARY 000E A'"D TOWN QyO*TH E?O�♦ T® O B A R \ STWffE i HAB.B9TA31LE, i "b 9. BUILDING INSPECTOR O,p�0 NPY d 9 APPLICATION FOR PERMIT TO .........C ! �L. .....s .G� C!� J d B .......................................t.R 00/tl � D �H N - Fou/Z 6v11t1d0�/S TYPEOF CONSTRUCTION ........ ......O�.R.............B..�.......-........ ....... ....... ............................................................ �R got:! /vO C- K9NGF) ......................... .......................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the foll ing information: Location ....... ...�?.........L�.. .........................r�...... C,v 2!vE.!................�.C,,L��-1` ........ ........... ProposedUse ............................................................................................................................................................................. ZoningDistrict ..�...:...........................................Fire District !�.!j.,� /V /................................................... CName of Owner �C��O/lI !� E/VIV E�Address ...............................Cn ! C/f=-��211.. D.JG�THzeg0 Name of Builder ...........Address Nameof Architect ..................................................................Address .............. .................................................................. Number of Rooms ..................................................................Foundation 1 +W"IIV(- .....................C...G...�..I�.C...�.......T...F.......S...C...9...�.3. Exterior ............& !e p�O/97TI= ...........Roofing �JSr.....E STD '�................................... !,-. Floors ky.b 60 CG! IG��S/JiGir/ �G eD .Interior .............P/ �AFL/�U. .............................................. ............... ................... ........ Heating ............................................................Plumbing ..................... Fireplace ...........................&G/Urz.........................................Approximate Cost ....................... ......................... f Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .:.... ..... ...:................. . ... Diagram of Lot and Building with Dimensions f 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 ......:.... ................... ..,��/ .............................. Bennett, G. ° ` �o I8�qm� for _____..oe..porch� �,�/ �����, �� ' �»� ---------.��.^�.���—.��a.,=/�����—������ ��� . - . _ -__ ____..`—~----------------- ^' ...................___________ Gordon G. Bennett Owner ------.--~------.------' ƒraram ' Type of Construction -------------- . ^ � -----,'---------------.----.. . Plot --�------.. �� —__.^______.. ' � ` r - ` ' | ` I� V�' + ' Permit Granted — ------lV ^ ' ------ . / i ' ~ Date of Inspection ' Date--Completed lA . ------------.. / ' ' , . . ' < ' PERMIT REFUSED ` ^ ...................................... lg / --------------------------' --------------------------' ~r � ------------------~.—.—..—.—.. . . � � ----..--.-------.---.,—.-----. � � Approved .................................................. lQ ^ ' ---------------.--.----..---. ~ . '-------`-------------~.---. , ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION / � I Map Parcel (y Application l O Health Division .� Qp� Date Issued Conservation Division - �q, , �6' Application Fe Planning Dept. `S�g6,r Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 7 z', Village Owner �ddress Telephone C�1-7 2 7 Permit Request �( Gf✓�C_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay av Project Valuation,5C�� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new 'size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name fL�-(— O —1i Telephone Number ?_17 G �'V Address I / U ckl�Cl h /�ttl License# Home Improvement Contractor# Email Abt Je,4 A4 R. 's Compensation # ALL CONSTRUCTION E BRIS ESU 7 THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / _ Z _/G 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 DATE CLOSED OUT ASSOCIATION PLAN NO. the Commornreakh qfMaysadirsetts Department ofllrrdrestrid Accidents' f}fte Of.�-M-M igatirnrrs r 600 Was jhWon Street Boston,AM OHI .. kvrv��sma��v�dia Wkw1mrs' Campensaf mtInsm-aazceAffidavit$tilders/CimtracturslFIectricians/Pluxubers. Applicant Inft32Tn, fiGu ,� �-y f please Put~n Nam',�ncmE aniMfi `/1 �1 �Q V4 tee= 7`-'/ �e�J� Aue- �. �City/sta 1 >J 4 Phone Are you an employer?Check the appropriate boy: Type of project(rufaired): 1.❑ I am a employer with. 4. ❑I am a general contractor and I 6. ❑New cansotx employees(fall at or part fiime�* have hired lfie sub-coatEactors 2.El I am a sole proprietor or partner- listed o4 the attached sheep 7- El Remodeling and have no employees . These smb-contractors,have 8- ❑Demalition wo>idn, forme is any capacafy_ employees and hare vwod=' 9- ❑Builcrmg addifica INo wodners' comp.insurance comp.insurance l 1� Elecfrzcal r or r j 5_,❑ We are a corpozafim and its ❑ ad�ons 3. am a bomeou�er doing all work ofacets]rave.exercised fhe�r 1 L❑Plumbing repairs or additit3ns workers' of exemption per Mtn. € o - . C. 1ry.._❑Roof repairs ir�a�iran�e required-]i c M§I{�andwehaveno . employees-[Na wormers' 13_❑Other camp-insurance required-) 'Aay WNcsvt:ihst cber Taos rl mast elsa ffio=tre secdaabdoa sho ng dmk vm&Ee rnmpenmif=payegit5tmsd - Hameaurnaswhosubmit this af5darui:-M—' g they smdoia-ablwatmd,di ahaeattsi&cuat3Lcmrsmastsolimitanewaffidavit indirwrim sarh fCan�acinrs t}iat chary rlu5 box mast attached as additional sheet slioRing the names of the sub-caa�•acto-s mmd state�rltethec arnot tlwse�rEes ham employees.I€thesnB-=tzamshaveempIojers&e}'mustpxaside&e7k wadEe s a-P.palivaumb-- I am art errcpla;�r flint is pratzriirtg IvorBeets'cattrpertsafirrat utsrarartce far m;}�eatplay�ex SeIotp is the paLicy ate jab site infQt7llaLiOTL Ise ce Company Nam - Poliicg,4 or Self-im Iio Expiration Ike: Job Site Address Cif ylState/Ev: Attach a copy of the W,&rkerefompenzationpolicy declaration page-(showing the policy number and expiration date). Failure to secure covera under Section 25A of MGL a 152 can lead to the imposition.of criminal penalties of a fine up#a 51,54a t7U For year itnpris well as civil penalties m the form of a STOP WORK ORDER and a fine of up to$250-Dii a ya the Be - d a copy of this statement maybe forwarded to the Office of Irrvestigaticns o DJA c c on Ida hemby in 'is and f the info tproa-&d abm a h;true and c w-red ,Sa'"vsaaf.,rF.- q Ilate: 02kzt l use enly. Do atat; Hiv in flds area,to be crratipieted by city artotr-n rrtjpdaL City or Tram: PermitUcense;ff Issuing Authority(drde one): L Board of E&21 li. y RwTding Department 3.Citytrown.Qerla 4.Electrical hispwtor 5.Plumbing Inspector 6.Other C'oatact Person: Phone#: 6 laformation and InstracOons r. M ss;acj ,=effs General Laws cT gY=152 mqu±�es all employers to prrsvide ways'ccIZIpensafion fps tbeg=PIoyees- purSa,MA-m this sfttlfr,,an M7j7Io3,I!--is defined as-- every person in the seaYice of another under any confrast ofhirB, express or i mplie,4 oral or writt=f An Mayer is defined as"an individual,partnership,association,cbrPorat[on or other legal entity,or any two or more of the foregoing engaged is a Joint=itmTr=,and inclndmg the legal ra,,eserbfivm of a deceased employer,ar the receiver or trustee of an individual,pMII=sbip,association c r other Iegal entity,employing employees However the owner of a,dwelling house having-not mote t Eum tbree aparfineuts and who resides therein,or the occ¢pant of the - dweIIing house of anoffier who employs pecans to do rrrainimance,constr�on or repay work on such dweIling house or on the grounds or burl mg app�r �tieretn shaIlnotbecause of such employmerrtbe deemed to be an emmployea." 1_�GL chapter 152,§25C(6)also stems fh�'every state or local fice=ing agency shall wrthfiold f 3.e iw an r�--or reu,ewal of a license or permit to operate a business or to construct buildings in the commGnwealth for any applicantwho has not produced ac mptable evidence of cdmpHanr-with the insurance cov'eragerequired-- Additionally,M.GL cbaptEr 152, §25CM gbti s-Teiihcr the commonwmalth nor jay ofits political subdivisions shall Mnr into any contract for the peifuirnancz ofpublic work urea acceptable evidence of compliance with the insurance, regnizeuients of this chapter have Been prweutsd to the cunt wring arigamity_" AppHcaats Please fill out tire,workers'compensation affidavit completely,by checl�g the boxes ffiat apply to your situation and,if necessary,supply sob-contractors)name(s), addresses)and Phone numbers) along with their ceriificate(s) of insurance. Limit'i-,d Liabffity,Companies(LLC)or Limited Liabi7ity'Parinesbzps(LIP)withno employees other than ft e members or partners,are not requil ed to cant'workers' coupensafion iastam<ce If ,a a LLC or LLP does have employees,a policy is required. Be advisedthatthis affidavit maybe mbr-,itft--d to the Department of Industrial Accidents for confirmation of instance coverage. Also be sure to stu and date the affidavit The affidavit should be rein ned to the city or town that the application for the putt or license is being requesiD(L not the Department of b,rfin anal A Ca riots_ Should you have any questions regarding the law or if you.are reqcM-c;d to obtain a worl=-s' compensation policy,please call the Department at the number listed below: Self-insrred companies should enter tbeir self-in m-ance license amber on fhe appropHain line. City or Town OfElcials Please be sore that the affidavit is complete and pried IegrIly. The Department has provided a.space at the,bottom of t$e affidavit for you to till Olt a th r.event the Of oflnv ohs has to contact you regarding tine applicant Pleas a be sure to fM in the permiYlicense mnaber which will be used as a mf,=ce number. In addition,m applicant that must submit mi ltipIa permitlIicease applications in airy given year,need only submit one affidavit mdicating ccn-m t p olicv in.L-o=aiion(if necessary)and under"Job Site A cIT s the applica�at should write"all Iocations n (citS'or town)-"A copy of the.affidavit thi t 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 fur future permits or limmms_ A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or putt not relate;d ta any business or commercial TftLtICM (Le. a dog license or pert to bum leaves efc.)said person is NOT reqaied to complete this affidavit The:Office of Inyesfigaii on would I1ke'to thank you is advance for youv:cooperation and should you have:any questions, please do not hesitate to give us a call The Deparimenfs address,telephone and fax number_ Tha Ca=IODnW!S.ttfiE of Mzssachnsj-,#1s , . IIega�m�t c�flad�ialAcxld�t� Of FI=of7nve&tg-afi=� 6DO wau Bagbau,MA 0�111 Tf,-L 4 617-' -4 =t4fl6 or 1-V7 MASS,F Fax#617'27 7749 R.evised¢24-47 AFYC Gudde to Woad Catzsft=dorr L7 FIB-Ir FKad Areas:11 a azph kYrrrd Zane . Massachusetts Checkligt f6F CampRance PD a41z5301,.2 I.I)l - 1.1 SCOPE. - Wind Speed{3 sea gus4- 11 D mph Wind EXpQsure G"wy — _B Wind Expostze.Category__........._.Engineering Required For Entire Proje 1.2 APPLICABILITY - Number of Buries(a roof which exams B In 12 slope shall be considered a story) slnries 5 2 sfnries - Fbof Phch (Fig 2) - Mean Roof Height (Fg2}— _ _ft �-3-T Building Widfh,W- (Fig 3) -_ it s BO, Buldh�g LengH1,L __ (Fig 3) --- _ff BD` Building Aspect Ratio(UM _ -(Fig 4} !9 3:1 Nominal Height Df Tallest Dpedmgz _ - _(Fig 4) 12 FRAh11NC;CONNECTIONS ' General caraplianca with framing aDnnecdDns_.__r_(Table 2) 2.1 FOUNDATION Foundation Walls meeting regtarernents of 7BD CMR 5434-1 r Canes__ ---•------ -- -------.._---------- ............................•-... -------- -------------- CDna�Masonry.------ — --- - 4 - 2.2 ANCHDRAGE TD FDUNDATIDMt t SIB`Anchor BOIL; mbedded or 618'Proprietary Ma4iarilafd Anchors as an aifemafive in conc:re�Dnfy Bait Spacing-general...._...................... In. BDIt SpacngmndDiphda (F } 6`-12' Bolt Embedment-mricreta-_ --(Fig 5)__ -_ iny7` _ BDIt Embedment-masonry--.-. -(Fig 5) ' _ fn.>_ Ptafe wash er (Fig 5) _ >3`x 3"x tl 3.1 F•LODRS - - F foorfiarming member spans checked (per 7B0 CMR CF;apiar SS) Madrium Floor Opening Dimension- -(Fig 6)-- _-.__ff<_12! Full Height WaU Studs at Floor Dj epwgs less fhan 2'frDm Exterior Wall(Fig 6)................... M&%irnurn Floor Joist Setbacks Suppoifng Loadbeari ng Walls or ShearwaI[- -(1=ig 7) Mwdmu:iti CazfleV:red F1oDrJDIMIS Supporarxg L-Dadbearbg Walls or Shearwall (Fig B) -- _ ft s d •F1oorBnacing at Endwalls ' _ - (Fig 9)- Floor Sheathing Type . -__-- -(per750 CMR-Ghapter55) - --_- Floor Sheering Thickness -(pf-r 780 CMR Chapter S5)__.. in_ Floor Sheathing Fasferimg (Table 2)_ d nails of in edge I_in field d f WALLS - - Wall Heigf-rt LDadbeamv walls .- (FFg 1D and Table 5)__ NDn,[_Dadl�g walls Fig 10 and Table 5) -- - ft•s 21r Wall Stud spacing .- _ (Fg 10 and Table 5) —In_s 24 a¢ Wall Story Offset; .- -(Fgs 7 1 ft s d ' 4-2 EXTFPI01-V A & Wood St ids - Laadhearing4alLs--- _ -_.- (TalafeJ}_._-________--•2c-- ft in. f1Dn-Laadbeating walls. - _._ (Tab)e5) _ -___2x --ft_irL, Gable End Wall Bracing t Full Height Fndwall ids_._ —.-.(Fig 1 D)_ _ WSP-Aific Floor Length (Fig 11} - _ ft�_-W3 dun Calling Length(if WSP not used) _(Fig l l) .-_.____ft?::D-9W - a bd 2 x 4 Canfinum s LatE!al Brain Q 6 ft axc-(Fig 11)______...._..__.._. �- or'f x 3 dung timing slips 16`spacing•min xdh 2 x 4 blocFdrng 4 ff spacing in end jWst or truss bays DDuble Tw Plafi: Splice Length (Fig 13.and Table 6) _ SpIIce Cannecnon(no.of 1Bd cornmce naills)' (Table 6) _ AT-VC guide to F-Yaod Carfstrucdan irr Aigfr lr7rfd Are s: 110 mph Wr_nd Z- c1Le Massachusetts Checker for CoMpJiaaca USo cif-RD01 2-rsjr l oadbearing Wall Connetdions o_ - - Lateral (n of I5d common naus) (Tables 7) -- Non-Lmadbear'ing Wall Conrimc one Later al(nixof 16d common nat�s) [Table s) --- Load Beating W.-d bpenings(racard Wgest opening but cheiic all openings for corripfrance to Table-9) Header Spars _ —_(Table 9) _fr_�• 11' 5tll Plate!Spans (Table 9) Full Height Studs (no. of'stzJds) (fable 9)_ Non-Load Bering Wag Openings (nerd largest opening but check all openings for compTtance to Table 9) (Table 9) _it_irL 512' S►lf Plates Spans-_. _ (Table 9)_ _ft in.512' FLA Height Studs(no.of sfzWds) - ed�riot Wall Shea$ung to Resist Upfi t and Shea[Sfmuhma ously _ M•mfmr an Building Dimarislon,W Nominal Height of Tallest DpeningZ _ . ---- ---- note Sheathing Type- ( �4) — Edge Mali Spacing— ��(Table 10 or note 4 if}ess)____� •in. Feld Nail Spacing, -- (Table 10) in. ' Shear Connection (no_of 16d common tar-is)(Table 1 D)_ _ ----- Percent Full-Height Sheathing. -(Table 1D) - —`% 5%,4dd5onal Sheathing fnr WU with Opening>31a'(Design Maximum Brulduig Dimension,L - Nomir al Height of Tallest DpeningZ-----------------------_____-----------------------_-`6'� ' Sheatding Type_ (note 4)_— Edge Nail Sparing-- _ (Table 11 or nDte 4 if less)_ Q?- Field Mail Spacing _(Table 11) - m- Shear Connection(no. of ISd common naffs)(Table 11)__. Percent Fu&Height Sheathing (Table 11)_ —% 5%Addtiionai Sheathing fr Wall with'Opening>Era' Design Conce is Waff Cladding _ Rated fnr Wind Speed7 — - S.1 ROOFS ' Roof framing member-spans chedo:d7- (For Rafters use AWC Span Tool,see BBRS Websffa) Roof Overfiang ._ __(Figure 19) _ -- fts smaller of Z or LO Truss or Rafter Connections at Loadbearing Walls ; - proprietary ConnectDrs - UpEft _--- (Table 12)_ - U= pif 'Lateral_�— __ __ (Table 12)- —_L= pff Shear._._ —(Table 12) —S= -p f Ridge Scrap Connecgws,tT collar fies not used Per page 21__ (Table 13) T= p Gable Rake Ouflooker__ _ _ (Figure 2D) .� .—__ft<_smaller of 2`or L12 ' Truss or Rafter Connections at Non4 zadbekring Walls . Proprietary Connednrs ' Uplft _ (Table 14) �. Latatal(nD.of i Bd common marls)_(Table 14)......-..-----------•----------L= . lb. Roof 5heaffirng Type _ (per7SD CMR Chapters 53 and 59)__._..._-_ - Roof'�;heathing Thickness in-_>7116*WSP Rnaf Sheathing Fastening—_. __.(fable 2) _ P NDtas: 1. _ This cd>ecKst shall be met,in is entirety,excluding Hie specific eXr-eption noted in 2,to comply wb the requirepents of 730 CMR_53D1_Z1.1 Item 1- If the checklist is met in rls entirety then the following metal straps and hold dDwris are not: required per the VVE:CM 11 D mph Guide: - a_ Sfe,-J Scraps per Fgure 5 b. 2b Gage Straps per Figure 11 - - Uplift Straps per Figure 14 _ ri An Straps per Figure 17 e_ Comer Stud Hold Downs per Rgure 1Ba and Figure 1Bb _ 2 'Exeptinrr Opening heights ofup m B fL shall be permitted when 5%is added to the percentlia-height sheathing Tequkernenis shcivwn in Tables 10 and 11. 3_ The bathnm sill plafz:in exfiior walls shalt be a minkmirn 2 frt nornhw H ckness pressure treated#2-grade. AWC Guide fa Wood Conrtrrrctiorf zrr I�isafr 1�rz'dttreas_ IIO rrtplr ff'rmdZaixe Massa chusett Checklist for Compliance(790 Cr I?aD1 2:r_I)r - 4_ - a_ From Tables 113 and 11 and locafion of waU sheathing and BuUdvrg Aspect Raflo,determine Percent Full-Height Sheathing and flail Spacing requirements I . ' b. Wood Strucb-rral Panels shall be minimum thfalmess of 7116`and be instIled as fnflows: L Panels shall be installed W h strengfh axis parallel to studs, ff. M horhnnW joints shall occur over and be nailed to framing. ta_ On single stnty cnnstrucfion,panels s-h�U be attached to botbm plates and bp inetnber of the double top plat� t iv. On two sbry minstrucfion,upper panels shall be attached to fhEi top member of the upper double top plate and to band jorst at botbrn of panel Upper affachment of lower pane)shaU be made to band jorst and lower attachment made to lowest plate at first fioar flaming. v. Hor¢nnW nail spacing at double top plates,band joists,and girders--hall-be a double row of ad staggered at 3 inCheS on �r pEr figures betow:Vertical and Hurt mnW' Na7rng for Panel Af achrnent 6_ Glazing prstc6orc a)'new house orhorizontal addiffon—required if ppjed'is 1 mile or doserto shore(generally,south of Rte_28 or north of Rte_6) b)verfical addtfon—not r aqulr6d LE-Jess there is renovation to fhe first door c)repiacementwuidours—needs.energyconswvaf}on compUafir-7-only(chap 93) H.Wond Frame Const7ucdon Manual(WFCM)for 110 MPH,Exposure B may be obtained from the American Woad Council (AWC)websfLa_ ' 1Yr•t�rTxsIDSEr�srsou. _ - . _ - AT�I— u [t [ tt - it -iI• - l i• � - t [ TI ljr / [ c r, � It s r. Ij [ i' i a ii "•I [ [t It t [ [ tt 11 t1 r tj- [! it t t �1 �{ . /. _ i t1[ jl it ' •S 1l it yl - i •4 � � F i t � � Y r rr It r - ' sear rdtYd -- � - - - - mt[ra c 61FZ-SXZ--ACM MnL - See Data$on Nad Page _ Vertical and HoramrTlaf NarTrng i�etal�' _ far'Parial AtEarhmenf v�iGal,�d Ho�rrisl Nor-I'u�g fDr Pane Aftaf rnerrf Town of Barnstable ° Regulatory Services yAMass Richard V.Scali,Director i639- Building.Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:,508-790-6230 Property Owner Must ` k ti y Complete and Sign This Section If-Us inL A Biulder. 71 as Owner of the subject property , hereby autho ' to act on my behalf, in all matters relativ o work authorized by this building permit application for. Ss'of Job) *Pool fences and alarms are the r onsibility of the applicant:-Pools are not to be filled or util zed before nce is installed and all final inspections are performed and accepte Signature of Owner • Signature of App t Print Name Print Name Date Q:F0RMS:0WNER2ERMISSI0Ie00 S Town of Barnstable Regulatory Services of roiyk Richard V.ScaIi,Director Building Division 33n31Nsc4,= Tom Perry,Building Commissioner MASS. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE ERE1VOTION DATE: P 'Please Print JOB LOCATION: q number -Hot fowr>ER ? `fi e <l 7 L f- 7 C,�337 name home phone# work phone# CURRENT hWLINGADDRFSS: •�C �� �Y�`�JE _ --- - - cityADWn state rip 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_ DEFINTI ION 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 1094yla-7 11) .`h eowner"assumes responsibility for compliance with the State Building Code and other applicable codes, gulai3ons. - "hame certifies that he/she understands the Town ofBamstable Building Department minimum inspection d that he/she will comply with said procedures and requirements. ner 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 Iast page of this issue is a form currently used by several towns. You may care t amend and adopt such a formlcertification for use in your community. r . Q:1wPFE FSTOR1AMu11dmg permit forms\EXPRESS.doc Revised 061313 \oh �i ( ! ke 1 4 y / Dwelling ,. . . . . . . . . . . . . . . . . . . . . . . . . .148°33 F j'. W i ,, 7 20'm in �`. .29) I, 121 *27" CapeSury $e ?Oiim in � 23 West Bay Rd, Suite G Osterville MA 02655 (508)420-3994 (508)420-3995 fax � t copesurv©ccpecod.net i _.. .... C479_ 04IMAYl16 0 5;; v 10 15 20 FEET Ii � 30 of t rqy, Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee • snxlvSTABLE Richard V.Scali,Director Building Division , NOV 19 2014 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 u 'iv OF 8A"STABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint i Map/parcel Number Property Address AX //-i!i S.P Residential Value of Work$ -70a Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �� /-6,./.r/ s S Contractor's Name � ,��j ,-�j�� �. �, �� -� Telephone Number 7 7 3 D 3-Z Home Improvement Contractor License#(if applicable) Email: e-pArst e p-,� pyc.6.4 A 4 •C err, Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance , Check one: ❑ I am a sole proprietor __s ❑ I am the Homeowner []-I.have Worker's Compensation Insurance Insurance Company Name /��f`�10<1e� Workman's Comp.Policy# ' Copy of Insurance Compliance Certificate must accompany each permit. ' r Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Wheie required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: 151 Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 k The Carrwz n m-- ' ofMassuchaseffs ffepartrnmt of bubutr d Accidents - R Office-o rn st�gafians 600 Wryhington Street Boston,,MA 0 111 � Wft-'11r 7fiflS��'OfSf[�IlE ' ' o:rkeas' Compensat€unlusura-ace davit:Bif lders/Cantra:ctorslF-ectriciansMumbers pUca-ut Information. Please Print Legibly Names c llj �r City/S t atrlZip: CZ:,;25 3 to Phone 4: � 7 � � 3 0 3 2 F Are you an einployer7 Check the apprapriate baz;4 Type of. ect r _ •general contractor and i l?r.o� (e�C 1.El 12 m a elvployer with 4. I am a$ 'ti_ New Tc�arz loyees(fall an-Vorgatt-dime)* liar-e bired the sub-comtrautors. 2_ I rin a sole propn:etor oipartner listed on Ilse attached sheet 7_ ❑I�rmodeliag ship ar:d have an employees Thew i, b ccafractors have g_ ❑Demolifioa u-rlL`tg far me in any c ci r_ employTes and have woik-ers' � -�. t 4_ ❑Buildzng addition o vro l ere'camp:in�t�n�e comp_it auce_ `te r 5-❑ 'We aria a corpora6anaudits 14_ ctrical repairs or additions ohs have�ercid Thei r 11_❑Plumbing airs or additions 3_❑ I a�a bflmeav<ner doing all work: �repair-_ , 1ryself NO workers'comp right of e\�.tion per Zi GL I� RDof 7 ❑ Wig' atac,franeerequtred_I F c-154 §1(4} and webz%,en°o employees_[NG workers' 1 _.❑Q.ther comp- 'Any Ep ldcmf;nztrheri-cboa'ltmstalsofilloUtthesectionbelowsh�vtheir�o$tersacotgpenssiaagoiicg:n�at3natlt� t Snmam;m_s rebo mbmh dtis s d i rn'r c taey ace acing iron and diFn Lire outride coat rs rors mm t snbvn s dsrit it n;c9 n such = nbmcmrs tLst ch_k this bmc must at adlEA an:ddiiionsl sleet s3laccino Iv n�of Sae sdt o ��md stsh=xhetLet ornnz tbusz Tuv� Emplz ems- lfThL--scl coatscw h-we employees,they must provine F.o€ke!V comp.policy number_ l urn arr�:ngivyr;r thrcf isgrr»�i��tt�ort*ers'earrz�rur<hvn artsrtrrtrtc8}'or ray err�ye� ��.tatr is fFt�grz�ie}raid}ob srlre Insurance CornpatrxName: Policy ff or Self-ins-Tdc- ExpirationI1ate_ Job Sites Address; r 7 Y SY y�-j Cityr15 tat'Yz* 130-)' Attach a copy of the-workers'compensatiron policy declaration page(showing the policy)Tamber•and-*-tion date). FailrLf--to secure coverage as reg6red under Section 2511`of MGL c 152 can lead to the imposition ofcrimival penalfies of a fine up to$I,St)Q_OD andlor one yearimpr so t,as well as civil penalties in The form of a STEP'Wr©RK ORDER and a fine of up.toe$250-00 a.day against the violator_ Be advised that a czpy of this statement may be f>arwarded to-the Office of Investigations of The Difl;far Tnvtsamce coverage 4 cation.- _Ida hereby czrfify that the inforrrtaiutnpra idsdcabtwe is bwa oral correct Simatare Bate_ r/ / ®z' / 1 t4t711L x'�-'_ t Quzciaf usz arr£}. Da not Write in this area,ta bs rampteted by Gift:or town ofi'ciaL City-or Town: PermtUcease# hs uinig An-tharity(drde one}: 1.Saard of Dezlth $udding Department I Gity,Taym Clerk 4.Electrical Inslxec#or S.Plumbing LiTector 6.Other Cob- tact Person: Thorne#_ 6 Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 t uste e 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 sucli 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 buildiags in the commonwealth for-Say 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 ofpublic work until acceptable evidence of compliance,,kit'i the in..;,nonce requirements of this chapter have been presented to the contracting authority-" Applicants — Please fill out the workers' compensational davit completely,by thee., g the boxes that apply to your situation an(i,U necessary,supply sub-contractors)nalne(s), address(es)and phone numbe,-(s) a].ong w i h theme certi:u cat c(_) of insurance. Limited.Liability Compaq its(LLC)or Limited Liability Pa117c„tips(LLP)veithno employees othher as the members or partners,are not required to carry workers' compensation insir ante- If an LLC or LLP does have employees, a policy is required. fie advised-dial this affidavit may be s,,binifttdto,the Department of industrial Accidents for confirmation o1 i=—,,nee coverage. Also be sure to sign and date the affida,;nt 'I1le a;5 ida-rit should be retumed 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 ob op a workers' compensation policy,please cell;hv Departrent at the number listed below-. Serf-insured co rap aaies sh.orld enter. their seIf-ffis rice license number oa the appropriate line. City or Torn Officials Please be sure that the affidavit is c,--iaplete and printed legibly. The Depar;m ent has pro-,Tided a space at the bottom of the affidavit for you to fill out in tLwe 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 refe-.ence rramber. In additicn, an applcant that must submit multiple permitfhc- rise applications in any given year;need only submit one aibdavit find-caung current policy information (ifaecessary)and under".lob Site Address"the applicant should v"rite"all locatio,ss ill __(cif or town)."A copy of the affidavit that has been officially stamped or marked by fie city or town may be provided to the applicant as proof that a valid afflida-�it is on file for future permits or Lcenses. A new affidavit must be filled out each year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i-e.a dog license or permit to burn leaves etc.)said person is NTOT required to complete this affidaNt_ Tb.e Office of Investigations would Eke 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_ Th Conraaa rat&of Massach-i ttt DpPartmeat of 1ndusttW AQcidrnts Mce QfIXLVestintianu GOG Wa stun o-n Sit Revised 4-24-07 Fax F" 617-727-7 74' i 4 Town of Barnstable 'DtFO MA'S A , Regulatory Services ' Richard V.ScaIi,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main street; Hyannis,MA 02601 www.town.b a rn s to b l e.m a.u s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using..A. Builder as Owner of the subjectproper l ty hereby authorize ��,C. S ! e a _ to act on my behalf, in all matters relative to work authorized by this building permit application for: dr s of Job) i Signature of Owner Date Print Name If Property Owners is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESIFORMSIbuilding permit forms\EXPRESS.doc Revised 061313 6 S . `Patio. Bedroom Kitchen :ving im Room, Bed.roo N Bedroo m Foyer. Patio . s , FLOOR PLAN (Not'to Scale) r - RS AEVIEWED : r SMOKE DETE _ 7'BLE iL G 7. BARN S ' ARTMENT y. ATE ° fIR•E � t BOTH SIGNATURES ARE REQUIRED.FOR PER11tING Towne of Barnstable *Permit# 0 Expires 6 months from issue date Regulatory Services Fee C3{ * snxtvs°rABLE « Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 PRESS www.town.barnstable.ma.us 4� Office: 508-862-4038 _ ��-n NOV, �Q� 0411 8-790-6230 EXPRESS PERMIT APPLICATION RESIDE�1°Y Q Not Valid without Red X-Press Imprint, TABLE AB C Map/parcel Number `,, `C ,L Property Address !/o` esidential Value of Work$. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address . UIP Contractor's Name �L C/t'/I/`j T , �' �� J f� Telephone Number 7 Home Improvement Contractor License#(if applicable) Email: to �dL+ Construction Supervisor's License#(if applic' le). , E5Wo_rkman's Compensation Insurance , Check one: o Pt ❑ I am a sole proprietor ❑ I a the Homeowner NOV 10 2014 have Worker's Compensation Insurance IA�LC / t flt Insurance Company Name� I /dl rG/T1�//��� TOWN Oft.�N OF BARNS G Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reques check box) e-roof(hurricane nailed)`(strippingpld shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed){not stripping. Going over + existing layers of roof) ❑ Re-side $, ❑ Replacement Windows/doors/sliders:U-Value '(maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits.required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,eta 'Note: Property Owner must sign Property Owner Letter of Permission. W A copy of the Home Improvement Contractors License&Construction Supervisors License is ed. SIGNATURE: Q:MPFILESTORMS\building permit formslEXPRES oc Revised 061313 The CommnnweaXth ofHassachusetts Department of Indusiri&Accidentis Office of Investigatfons ' 600 ]Washington Street ° Boston,MA 02ZII , www.mass go-P1&a Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly' Name(Business/organization/IndividuaI): Address: 3fhVlti V � Al-e City/State/Zip: ` Phone#: 7 76 Are you an employer? Check the appropriate box: Type of project(required): 4. I am a eaeral contractor and I l.[q I am a em Io er with ❑ g P Y 6. El New construction have hired the sub contractors employees(foil and/or part-time). 2.❑ I am a sole proprietor or partner- . listed on the attached sheet T.,E]Remodeling ship and have no employees. . These sub-contractors have g, ( Demolition working for me in any capacity. employees and have workers' 9. Bidding addition [No workers'comp,insurance. comp.insurance required_] 5. ❑ We are a corporation and its I0.0 Electrical repairs or additions •° 3.❑ I am a homeowner doing all work officers have exercised their, 11.❑Plumbing repairs or additions myself- [No workers'camp: right of exemption per MGL l2 n goof repairs insurance required_I t _ c. 152, §1(4),and we have no ° employees. No workers' 13.❑Oilier coup.,insurance required.] . . *Any applicant that checks box##I must also fill out the section below showing tries workers'compensation policy information_ t Homeowners who submit this affidavit indicating they are doing all wodc and then hue outside contractors must submit a new affidavit indir�nu such_ lContractors that check this box must attached an additional sheet showing the na.nc of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employ=,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the po$cy and job site information. Insurance Company Name: c5 �Sj7f/j�/I7 l�if Policy#or Self-ins.Lic.#: }` Expiration Date:. 4%a' dr 7 �,n7 City/State/Zip:Job Site Ad ess: - 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' fne up to$1,50-0.00 and/or one-year imprisonment;as well as civil penalties in the foroa of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised fliat a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify the pains aloes ofperjury that the information provided above is true and correct. Signature.. Date: y Phone#: 7 Official use only.Do not write in this areir,to be"completed by city or town o j'zcinL Y • City or Town: Permit/License# •° 4 Issuing Authority.(circle one) 6.Other Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Jnspector . Contact Person: Phone#; -Information and Instructions Massachusetts G& eral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 oa the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall - enter into any contract for the performance ofpublic work until acceptable evidence of compliance with.the in�Tranca. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their certificates)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 Iaw 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-instance license number on the appropriate line. City or Town Officials t 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 permMicense 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 Adoress"the applicant shop ld 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 Iicenses. 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 etn.)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 Departm.enfs address,telephone and fax number- The Commonwealth of Massachusetts Department of Industdal Accidents Office of kvestigatiow on Sfz�t 600�ashtugt Bastoo,MA 02111 Tfl.#617-727-494-0(�)t 4-06 or 1-1377 MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia r E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI DOES NOT'AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIE HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject I the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to th certificate holder in lieu of such endorsement(s). PRODUCER 01005-004 CONTACT NAME: HUB International New England PH NE 125 Route 6A A/C.No.Ext: (800)564-2444 FAx A/C.No.: EMAIL Sandwich,MA 02563 ADDRESS: paul.sugrue@hubintemational.com I URER S AFFORDING COVERAGE NAIC# INSURED INSURgB A: A.I.M.Mutual Insurance Company 26158 RLT Construction Inc NSURER B: 31 Mann!Circle I SURER c• Centerville,MA 02632 NS RER D• INS RIM 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH PERIOD RESPECT TO WHICH THIS CERTIFICATE.MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE-POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR - DDLgUBR LT TYPE OF INSURANCE INS R WVD POLICY NUMBER POLICY EFF POLICY EXP GENERAL LIABILITY MM/DD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ CLAIMS-MADE ❑OCCUR EMISE Ea occu a ce f MED EXP(Any one person) $ PERSONAL&ADV INJURY $ . i EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I OLICY ECT 0- OC PRODUCTS-COMP/OP AGG $ I IIAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO Eaaccide t $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS HIRED AUTOS NON OWNED BODILY INJURY(Per accident) $ AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR $ EXCESS LIAR CLAIMS MADE EACH OCCURRENCE $ DIED RETENTION $ AGGREGATE g WORKERS CpMPENSATION - $ AND EMPLOYERS'LIABILITY X WC STATU- OTH- ANY PROPRIETOoR/PARTNER/EXECUTIVE Y/N TORY LIMITS ER A OFFICER/MEMBER EXCLUDED? a N/A VWC-100-6015366-2014A 3/16/2014 3/16/2015 E.L.EACH ACCIDENT $ 100,000. (Mandatory In NH) If yes describe under - E.L.DISEASE-EA EMPLOYEE $ 100,000.6 DESCRIPTION OF OPERATIONS beldw E.L.DISEASE-POLICY LIMIT $ 500,000.01 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) - CERTIFICATE HOLDER CANCELLATION CJ Riley Builders Inc PO Box 382 10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t' Osterville,MA 02655 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN/ ACCORDANCE WITH THE POLICY PROVISIONS. / AUTHORIZED REPRESENTATIVE t 1988-2010 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACORD CORPORATION.k:- - r. V r Restricted To: CSSL-RF-Roofing K "' N � ommu�uaecrlG/r a�C/I�cca cuc�u� lYr .CSSL-WS Windows and Siding t •»� . ' Office of CogsUfii AffaiPV,&tBusiness Re gnl4?tfon OME OPROVEMENT CO RACTQR 4 egistrat�ori -134,, ` j.�� Top 4- 0- F' Expiration 10/2.J2015 t 'xs Corp rat ion s t ; RLT�ONST O�DBA�_ISLATJD SIDING&ROOFIN ' �• A `' RONNJE`TgY.,-LOR �� �� /� �.��; �� �;� w' Failure to possess a current edition of the Massachusetts A State Building Code is cause for revocation of this license. x, 31 IANNI CIR,LF t` �#?'d CENTERVILLE' MA.02362 Lnderseereta ? For DPS Licensing information visit: wwvv.Mass.Gov/DPS " - ''a.' fin. "* 4,.1.. ;i" :� .L' •'' '� ; K ,i •d a t �� '.. t . •� ,. ,.,,5 ,, 77 Massachusetts -Department of.,Public Safetya' Board of Building Regulations and Standardsiee�ae o"r regtstratton,vand for indrvidui` Cbnstructu) ervisor ectalY A '�be`ore the`expt'ra ion date.'If found retur o 4 Su P " W ��xOffice of.0,,nsumer Affairs and B.usm s`s� l License:,CSSL-099910., � i a PAQ iia:t ;Suite 5170t' *" " •.,, .�` 's: � i �'�" `flo�ton,,i�iA02i16 � s RONNIE L TAYLOR 31 MA)<M CIRCEE f k 4. r CENTERVMLE,,IA 02632 '� ` # ' i 81 + *+i,�' ' €JCplratlon `Fy"�'�t *Not va4d thout signature ty Commissioner ''10126/2015 F - 4 1 W Y - e,o re rsprti ron uandMt for indmdeFA g y� ;J �C the exert at on date If found retur office of srimer Affairs anil Busme§s= atlofr Z 1 �a .Plaza e 5170 Bo�J on,;1VIA 02116 k y F Not va41 thout signature —T �Kw- 4 ' HIC# 134286 Is R00_ and-Sid'- !V CSL#99910 a division_ ,.ram L2'Construction,,Inc_ 31 Manni Circfe Centervi«e, MA 02632 Phone 508.776.8914 FaX 508.420.1776 Customer: Date: /Nutt i�9 We are pleased to submit the following specifications and estimates for reroofing: Strip existing shingles and paper Install 8"white drip edge Install 3' ice and water shield Install 15 lb. paper to remaining roof Install 30 year Certainteed Landmark Architectural Grade asphalt shingles Install ridge vent Clean up and haul away all debris to landfill We hereby proposed to furnish material and labor-complete in accordance with the above specifications for the sum of: 17v TERMS: One-third deposit required.Balance in full is due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written ordered and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or,delays beyond our control. Ow o c y fire, wind damage and other necessary insurance. RLT Construction, Inc. carried Geller lability an orkman's Compensation Insurance. Certificates of Insurance provided upon reques ACCEPTANCE OF PROPOSAL: The above prices, specificatio and conditi s are sfactor nd here- by accepted. You are authorized to do the work as specified. Pay ent will be ade a tline ve. Date of Acceptance: �J _ 7 .--,/y Signature: Start Date: Signature: pic DEC 29 Mown of Barnstable *Permit 46), o � �01cs_� OF THE Tp� P Expires 6 mo hs from issue date BAHhft3 Ultory-Services Fee • snxxsTABLE, v� MASS. Richard V.Scali,Director 1639. AIFD Mp`i A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numbe v Property Address t� �• i �� 9?�esidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address / U//er✓ Contractor's Name JC G� �1✓f/ ��L 0- X(-'*'Telephone Number Home Improvement Contractor License#(if applicable) 1-? O?G 7 Email: A71,ile_ Construction Supervisor's License#(if applicable) [W�orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance _ Insurance.Company Name U //! 7/ �+G 7"IMao!� Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to • roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re ,r SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXP S.doc Revised 061313 1 � t "3 � 5 a. •" `t`,icy „�:I,"t"Hr .,.s: ..Prfi •v. '� [ w '�k; "`'� M r� '� ak . r>N e� .u� �" !L "` LlUJltff"Y?eLf-GfL{{1j ` /1,�3LI/,•12{'17r��i� 3' axe"etse by re IstYnt�4n vandfor�ndividul r IV' Ufce of Cosamer 3ffi�i nsiaess ltago 1iotF { the expiration date. If fotindM1retur I. ,d.... fi; QME IMPROVEMENT CONTRACTOR Office of C'onsumer-Affairs aiid Busii>ess� ,fation y' } ,� 't + : � 5T%pe In Plaza'-�Suite;517,0' ' egistration �134266 " , ° L t err ratN5611,4a, „a @ Y w iEfi�2�I2Q1J Boatot;1�tA�02115 + i �� yEttNration P� u .. a t it ,hEi _,' r� RLTCCINSTINNCDBA iStAND S'ffNGB ROC? INa a" �` ^� •• t t} M�A h ,m{:� �g" s k.a•'n4wt� ":.i 4 `�` T 01 t `� GtTERVILLE AMA 02362` Lde��ecreta�+ Not vaitd thout signature a -- ;,., iv (TM',,iA dux. *• �"i � �a'9 r x -.s a � s ••w,,' r V "+t f .a -.K `*� ,� Y ' a3 �' :,'9s r �; b ¢'�^ +?"'"�@ .tw '�'M "'Restricted To:CSSL-RF-Roofing ,g ' .Massa :husetts [)'eparf pint,of4i u Nic I 1 ;CSSL-WS .Windows and Siding .' Board"of Building Regulations and'StahiclAr Contitri3ction SupErF is r Spacialty License: CSSL-099910 i ��� 1j�! �. ! t - .1 •RONNIY,L TAY�LQYt P ,� s „31 MANPiI CIItGEE N CENTERVILLE:;I4IA 02- %. Failure to possess a current edition of the Massachusetts '` r State Building Code is cause for revocation of this license;, _ ? ` - t' �* �..�r tiur�` 3 f.Ex�S+irate n s �, P'� For DPS Licensi rig information visit: www.Mass.Gov/DPS Cominissioner� r . x 3 7 �fE IS ISSUED AS A MATTER OF INFORMATION NFORMATiCN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIE HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. f rPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject i Zhe terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to th certificate holder in lieu of such endorsement(s). PRODUCER 01005-004 __ CONTACT NAME: € HUB International New England FHO NE FAx 125 Route 6A A/C.No.Et): (800)564-2444 A/C.No.: Sandwich,MA 02563 ADDRess: paul.sugrue@hubintemational.com ER S A O D G COVERAGE N C INSURED ., NSURE • A.I.M.Mutual Insurance Company 26158 RLT Construction Inc I s RER B 31 Mann!Circle 1 SURER C• Centerville,MA 02632 s ER D S R R 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, N EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ICTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP INSR WVD - MM/DD MM/DD/YYYY - LIMITS GENERAL LIABILITY - - _ EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE �OCCUR M a occu a ce. $ MED EXP(Any one parson) $ PERSONAL&ADV INJURY $ , GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER:. PRODUCTS-COMP/OP AGG $ OLICY RO- OC . ECT AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO Ea accide t. $ ALL OWNED BODILY INJURY(Pet person) $ AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS - - PROPERTY DAMAGE $ Per accide t $ UMBRELLA LIAR OCCUR 7EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE' $ DED RETENTION $ AND EMPL0 ERSELIABIL ITI' - �/N - X TORY LAt�ITS OT ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YL I N/A OFFICERIMEMBER EXCLUDED?. VWC-100-6015366-2014A : 3/16/2014 21/16/2015 E:L.EACH ACCIDENT $ (Mandatory In NH) 100,000. If yes describe under E.L.DISEASE-EA EMPLOYEE $ 100,000.d _DESCRIPTION OF,OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.OI DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,.Addiuonal Remarks Schedule,.if more space Is required) CERTIFICATE HOLDER CANCELLATION CJ'Riley Builders Inc PO Box 382 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Osterville,MA 02655 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN/ ACCORDANCE WITH THE POLICY PROVISIONS. / - - - - AUTHORIZED REPRESENTATIVE �Y,-��•�_ '. @ 1988-2010 ACORD CORPORATION.A ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD .The Coninto wealth of Massachusetts Deparfrnent ofIndristrial Accidewis Offc'e of Investigations , 500 Washington Street Boston,AL4 02111 MForkeis' Compensation Insurance avit:Bmldersi nti-ac#ors[Electt cians Phunbers App]%cant Information �j Please Print Leojbly Name Otis-mes iOrganizationfInditiidual). 49- Address. .3t _12 C:itylS.ta&Z pc Phone#i: 1'276 Are youla.n employer:'Ghee the appropriate box:: T3Te of project(required: 4. am a genra contractor and I ❑ 1- I arm:a employer with. ❑ I el tt 6_ Neu core-fraction employees(full andrbrpart.tame}* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7_ ❑Remodeling These rub-contractors have Slop and have no employees $_ ❑Demolitrotz. working for me in any capa city. employees and have workers' 9_ ❑Building addition. [No workers I comp.insurance comp_insurauml required_] 5. ❑ We are a corporation and its IU_❑Electrical repairs.or additions - -3.❑ I am a homeowner doing all work offioers:liave exercised their il_❑Plumbingrepairs or additions myself[No workers'comp- rim of exemption per MGL 12..❑Roof repairs insurance required.]T c-152,§1(4);andwe have no employees-[No workers' 13.D-ther comp_insurance required] 'Any applicant fni checks box'Inn, also fill out th¢section below showing then workers'compgn on pa7icy information 1 Eameowners who submit thi&affidmirt m ating they are doing all wcair and Omn hie outsi&contractors nmst submit a new afftdavlt indicating saute =Contractors dutch iMs box mica attached an additional sheet showing the wane of the ors and state whether at not those endde✓have enVloyees. I€the sub-<ontractors have employees,they must provide their workers'comp.policy number. lam an employee fhtrrt is prosridirrg rvorkers'canrperrsrrtiort iatsrrrattce for sty enapIoyees. Beloiv is thepohicy road job site inforutation. Insurance Company Name: / lezo Policy,4+'or Self-ins.Li4-- ,4F: Dxpiratio•uDate: Job Site Address: 7� i X L.f'Citylstate zip: Attach a copy of the workers'compensation.policy declaration page(shops ng the policy number,.and expiration date). Failure to secure coverage as required under.Section 25A of MUL c. 152 can lead to the imposition of cximmal penalties of a. fine up to S 1,500.00 and-for one-Fear iimprisonment,as wrell as civil penalties in the farm of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be fmi arded to the Office of Investigations ofthe DIA for insurance coverage verification. T do hereby cerh;fjr rilteprriris ar7dnaldes of perju y.tit atthe info rrtr ago lr prouided above is true and correct Siznature: IVA4,7,4 Date: -- Phone V-: TFt Official use onl}'. Do not ivrite in this area,to be completed by city or tonvi official. City or Town: P'ermitlLicense#' Lssaing Authority(circle one): 1.Board of Health ?.Building Department 3.Cityffo au Clerk 4.Electrical Inspector 5.Plumbing hqi ec.tor 6.Othtr Contact Person: Phone#:. IsCnnd Siding and Roofing a division of ELT Cowtruction, Inc. 31 Yanni Circle Centerville, rytA 02632, Peter Goulet December.29, 2014 Re . Hyannisp Y We are pleased to submit the following specifications and estimates for residing: Remove existing siding Install,Typar Housewrap Install white cedar shingles Clean up and haul away all debris to-landfill , We hereby propose to furnish material and labor - complete in accordance with the above specification, for the sum of Eight thousand eight hundred ollars...................................... ...... ..$8,800.00 Terms: One-third deposit required. Balance in full is due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents, or delays beyond our control. Owners to carry,fire,wind damage and other necessary insurance. RLT Construction, Inc. carries General Liability' and Workman's Compensation Insurance. Certificates of Insurance,provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature iA� /Z� p , Start Date: J Signature Telephone 508.420.5243 and 508.776.8914 Facsimile 508.420.1776 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel OF BARNSTABLE Application #. ! 1079Z,1 Health Division � w ' ; sq3 �: Date Issued Conservation Division Application Fee Planning Dept. ;;' Permit Fee 67 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis IMP=roject Street Address 6 Villages " FWner_7-PE Gnc-)I Address Telephone- Pet rmi_t_Request_ 4 Square feet: 1 st floor: exi tingproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay PrPr-oValuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 4--- Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No , t Basement Type: ❑ Full rawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) � Basement Unfinished Area (sq.ft) Number of Baths: Full: existing /� 1 new Half: existing new Number of Bedrooms: existing !ew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ a�s ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes dPlo'� 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 U 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 -_ - — - = -- p - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Gnt_�� � Telephone Number Address -c 1 License # Home Improvement Contractor# Email Worker's Compensation # ALL CON TRUCTI DEBRIS I IN M IS PROJECT WILL BE TAKEN TO SIGNATURE DATE ` FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED f MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION' FRAME 1= r r INSULATION FIREPLACE ELECTRICAL:' ROUGH' FINAL PLUMBING: ROUGH FINAL- ' GAS: ROUGH FINAL FINAL BUILDING E • b - a DATE CLOSED OUT ASSOCIATION PLAN NO. r t The Cornrnonyveakh of-Uassachuseffs Dvartrt7:t?nt of buIus&ial Accidents Ogee of Investigafians s 600 Washington&reet Boston. MA 4ZI1I wnw.7nass.go' 4dia ,r Workers' Compensation Insurance Affidavit:BirildersIContracturs/Eiectric'ansMumbers Applicant Infarmation Please Print Legibly Nara (Bosme 0ygantzaton&dividual)_ P=jtzt \o`'➢, 0( )L i k City/StatfIZip: Phone Are you an employer?Check the appropriat boz: Typeof,pToject(rNluired}: - , contractor and I I-El I am a employer with 4 � I am a � 14_ NewoonsfrtreEion employees{hill and/or part-time).* have]Tired the sub--contractm. � , -2_❑ I am a sole proprietor or partner- listed on the attached sheet: 7- ❑Remodeling ship and have no employees These mb-contractors have g_ ❑Demaliti6u working for me m any capacity_ employees and have workers' g_ Building addition [No workers' coutp_insurance comp_insuratl�4 �� 5-❑ 'We are a corporation and its lf?_❑Electrical repairs or additions 3 am a hflme woes doing all work officm have exercised their 1 _.0 Plumbing repairs or additions t of exemption per MGL myself. [No workers'coiIT- ` exemp F 12.❑'Roof repairs insurance required-]F c_ 152,§1(4),and we haim rto employees-[No workers' 13_❑Other comp_insurance required,] *Any appHcant that checks box-91 mast slso fill out the section beiowshoeeing rhea workeie compensation policy infbrmxGan- �Homeowners who submit This affidzM ind catmg tbey axe doing aR vrc*and then hag outsides contr=ors mnst submit a new:affidavit mdica:in;Pia � txactorsthstcTxktlYisGmrmsst=attaelzed-sa-additions/:sheet:shveeing-the name offliesmtico xs-amd-ststPtrhethexorn6tc €�PIQY'__--If the-suG=coat�cfo—rs:liac�e-ennPloSees,-the}`-zmust-pmvide their-workers'-camp:policynumhr--� -Taman employer Matisprmiding workers'compewvadon insurance for ozy Rm Inyees. ffe&ty is the policy mrd jab sits informalim Insurance Company Name: Policy 9 or-Self-ins-I_imr-4, Expiration Date__ Job Site Address: City,Statel— Attach.a copy of the workers'compensation policy declaration page(shvNving the policy number and expiration date). Failure to secure coy a as required under Section 25A of MGL c_ 152 can head to the imposition of-criminal penalties of a fine up to 1;50 - a and! ane-year im}arisoa ,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$?50_ a day a - the vi�olal _ Be dvised that a copy of this statement maybe forwarded to the Office of Irrvestigati of the D ov e erificatitm_ I do Caere certi the.pat nd n Was ofpetjury that the information pratrtded above is true and correct Sitmature Date_ Phone#:-- 007cial use only. Do not trite in thiss area,to be completed by ci(y or town o,fficzat City or Town:. PermitUcense# Lssuing Authority(circle one}: 1.Board of Health ?.Building Department 3.Cit_fl'ossn Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: 6 Information and-Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant-to this statute, an ernployee 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 amy 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 dwelliug house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate"a business or to'conhTuct buildings.in. the com' m`on,vealth.,`.or:.)zy 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 cep.ci facate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other thaw t:he members or partners, are not required to carry workers' compensation insurance. If an LLC or LLI, does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Depart lent 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 Departeent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obt_in a workers' compensation policy,please call the Department at the number listed below. ScI 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 permMicense 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 tilled 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 Ile 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 Commonwffalth of Massachus(�-tts Departrnent of hiclustdal Accideats 4f me of%Vf,-Stiptxans 600 Washington Strut Boston,MA 02111 TeI.A 61 7-727-4-900 w 406 or 1-977-MA' E Revised 4-24-07 Fax#617-727-7749 wvw.raass;gavldia Town of Barnstable Regulatory Services �QF cxe roiyy Richard V.Scali,Director P ° Building Division rrsrAs Tom Perry,Building Commissioner erns. 1639- ��� 200 Main Street, Hyannis,MA 02601 ArEO '� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print i 70B-I OCATION: V 17 1f �eS 44__S Ali V.- number f !� A sheet village =-H0Iv QwNEW, C� G<X.)IC- 9/ 7 -2-1 G name / home phone# work phone P r,CURRBNT=MA LR,4G_ADDRF_SS:- -1 7 \]r IC CN,� 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 suhervisor- 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 hermit- (Section 109.1.1) The un gne "homeowner'has es responsibility for compliance with the State Building Code and other applicable codes, Vundcrigae re ations _ omeo�a er certrfie that he understands the Town of Barnstable Building Department minimum inspection Cc quire enut's an that e/she will comply with said procedures and requirements. ner 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,RuIes &ReguIations 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.Iicensed 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\FORKS\building permit forms\EXPRESS.doc Revised 061313 THE Tp�� Town of Barnstable Regulatory Services * RARNSCABLE, v MAS& 8 Richard V.Scali,Director Fo;- Ik Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by building permit application for. ( ddre of Job) Pool fences and A are the resp ibility of the applicant. Pools are not to be fill or utilized before fence is installed and all final inspections are erf ormed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS k 30 Patio Bedroom . Kitchen 10'N LIVfI'}g � Room Bed roo w r : edroom Foyer 1�' Patio Co 10, FLOOR PLAN (Not to Scale) Law Office of-Richard J. Butts 29.7 E. Main Street Marlborough, MA 01752 Telephoner(508) 460-1237 Facsimile: (508) 460-0433 E-mail: richardbuttslaw@aol.com VIA FACSIMILE ONLY ' richardbuttslaw@aol.com 10, 2014 Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re:Estate of Raymond O. Goulet Docket: BA14PI343EA 174 7"' Avel West Hyannisport, MA 02672 Dear Sally: Raymond 0. Goblet passed.away on June 21, 2014. In his Will he left his ro ert p P Y referenced above to his brother, Charles Goulet, which he disclaimed. By operation of the. law according to the Will the property is now owned by Jacqueline Tolan, Wayne Goulet, and Peter Goulet, as tenants in common. Attached are: • Will of Raymond 0. Goulet • Letters of Authority for Personal Representative • Disclaimer of Charles Goulet • Deed of Distribution Should you wish to discuss this matter further`detail, please call my office. Sincerely, Ri r utts En I res Docket No. Commonwealth o Massachusetts LETTERS OF AUTHORITY' FOR The Trial Court BA14P1343EA PERSONAL REPRESENTATIVE._ Probate and Family Court Barnstable Probate and Family Court Estate of: . - 3195 Main Street Raymond O Goulet PO Box 346 Barnstable, MA 02630 Date of Death: 06/21/2014 (508)376-6710 To: Jacqueline M Tolan 70 Collins Drive Marlborough, MA 01752 You have been appointed and qualified as Personal Representative In Supervised Unsupervised administration of this estate on September 15,2014 . ae These letters are proof of your authority to act pursuant to G.L.c. 1908,except.for the following restrictions if any E] The Personal Representative was.appointed before March 31,2012 as Executor'or Administrator of the estate, O " .j (Do Not Write Below This Line-For Court Use Only) CERTIFICATION I certify that It appears by the records of this Court that said appointment remains In full force and effect, IN TESTIMONY WHEREOF I have hereunto set my hand and affixed the seal of said Court. Date September 16,2014 Anastasia W Perrino, Register of Probate MPC 751 (3/31/12) COMMONWEALTH OF MASSACHUSETTS PROBATE AND FAMILY COURT BARNSTABLE COUNTY DOCKET: BA14P1343BA IN RE: RAYMOND 0. GOULET - k DISCLAIMER I, Charles A. Goulet,the undersigned, do hereby renounce and disclaim all of my rights, title,and interest in and to the real property and its contents located at 174 7"Avenue, West Hyannisport, Barnstable County,Massachusetts and recorded in the Barnstable Registry of Deeds in Book 2807 Page 201 owned by Raymond 0. Goulet which arise out of the specific gift to me identified in the THM paragraph of the Last Will and Testament dated December 30,2604 of my brother, Raymond 0. Goulet,who died on June 2 L 2014, The Will was allowed by this Court on September 16,2014. The undersigned does not renounce or disclaim by this instrument any other devise of the Last Will and Testament referenced herein,specifically any devise pursuant to paragraph SEVENTH. This disclaimer shall be irrevocable. 1, Charles A. Goulet do certify that: 1. I have not assigned,conveyed,encumbered,pledged, transferred or otherwise disposed of any property or interest.that I am hereby disclaiming, nor do I intend to do so. 2. No sale or disposition of any property or interest pursuant to judicial process has been, made. 3. I am not insolvent. Y 4.Neither I,nor my guardian or conservator for my benefit,have made a written waiver of my right to disclaim any such property. 5;I have not accepted or received operty or interest or any of the benefits ` therefrom:' REGISTER j Signed this 6 h day of October 20.14, Charles A. Go et COMMONWEALTH OF MASSACHUSETTS Middlesex, ss. Subscribed, sworn to, and acknowledged before me by the said Charles A. Goulet satisfactorily-proven to me by a Massachusetts Drivers License to be the person whose name is subscribed to the foregoing instrument,and acknowledged that such instrument was executed for the purposes and conditions therein expressed as his free act and deed. S dra R. Austin,Notary Public y Commission Expires: June 25,2015 SANDRA R.AUSTIN Notary Public commnweallh of Massachusel% . My Commission Expire[: June 25.2015 ``` �ARNSTABLE REGISTRY OF DEEDS COPY .// V� ^ram. ' d� • 'j�t/e� REGISTER Deed of Distribution M.G.L.+C. 1:905, §3.907 ; WHEREAS, Raymond 0. Goulet, of.174 7th Avenue, West Hyannis port; a j Barnstable County, Massachusetts (`.'the Decedent") died on June 21, 2014, having an interest in real estate at.174 7th Avenue, West Hyannisport, Massachusetts; and WHEREAS, the undersigned, Jacqueline Tolan, of Marlborough, Massachusetts is the duly appointed and qualified Personal Representative of the Estate of the{ Decedent in the Barnstable Probate and Farnily Court, Docket No. . _ - BA14P1343EA; and WHEREAS, the Distributees herein are: (a) [ x] the Devisees] under-the Last Will and Testament of the Decedent (see disclaimer of Charles.A. Goulet, recorded with the Barnstable Registry.of Deeds,, Book 28445, Page 187; (b) [] the Heir[slof the Decedent;, NOW, THEREFORE, the undersigned, in distribution of the estate, for no # consideration, hereby distributes,to: Wayne Goulet, of Zum Waldchen 11, Queidersbach,Germany 66851 [Distributes 1] Jacqueline Tolan of 70. CollinkDrive, Marlboro, Massachusetts, 01752 [Distributee 2] Peter Goulet, of 955 MacArthur Drive, Ballston Spa, NY 12024 [Distributes 3] 4 Each Distributee having survived the Decedent, ,+ - as TENANTS IN COMMON Such interest in the land in West Hyannisport, County of Barnstable, x Commonwealth of Massachusetts, Bounded and described as follows, Southerly by Ocean Street,�one hundred (100.00) feet; Westerly by.Seventh Avenue,'as.shown on`a'Plan„hereinafter referred to, eighty (80) feet; Northerly by Lot 551, Block.F as shown on said Plan, eighty(80) feet; Easterly by Lots 506 and 508, Block F:as shown on said Plan, eighty(80)'feet. „ F The above described'premises are shown as,Lot 547 and 549; Block F, on Plan entitled, "Plan of Seaside Park'at Hyannisport, Mass., owned by the Seaside Park Association, Boston, Mass:, August, 1893, Scale 100 feet to one inch, Fred O, Smith, E:C., which Plan is duly recorded with the Barnstable Registry of. Deeds., in:Plan Book 34,}'Page 23. A. Subject to "easements and restrictions of record, insofar as the same may in ' force and applicable. a Being the same,premises as.described in a deed of Gordon G. Bennett and Avis R. Bennett to. the Decedent dated October 4,'1970,''and recorded with the Barnstable County Registry of Deeds Book 2807, Page 201. N _ { No title examination,requested or performed at the request of the Grantor and Grantee, . Address of Premises--'1.74,7th Avenue, West Hyannisport, MA, V • r p4 _ WITNESS m hand andseal the day of November 2014. Y _ Y 2 J cqu ne Tolan, Personal Representative a's aforesaid . A ,.y, , _ x COMMONWEALTH OF MASSACHUSETTS' ' x Middlesex, ss ; On this �h day of November, 2014, before me, the undersigned notary public, personally appeared the above Jacqueline Tolan, proved to me through satisfactory'identification,..being (check whichever applies): o or other state or federal;governmental document bearing.a photographic image, o oath or affirmation:of a credible witness known'to me who knows the above signatory, or p.,my own personal knowledge of the'identityof the signatory , to,be the person whose:nam® is signed on the preceding;or attached document, and acknowledged to°me that she.signed it voluntarily for its stated purpose as Personal Representative k e Notary.Public My Commission Expires ELAINE M. VROOMAN w Notary Public,Commonwealth of Massachusetts M commission Expires March 10 2017 { k bly IV. Y P a } ,t y 297 E. Main Streetgal Marlborough, MA 01752 Office Of Phone. (508)460.1237 ..,Richard J. Butts Fax: (508) 460-0433 To: Sally , From: Richard J. Butts Fax: (508)790-6293 Date: November 10,2014 Phone: Pages: Re: PETER GOULET } 174 7t"Ave;West Hyannisport,MA ❑Urgent 0 For Review ❑ Please Comment 0 Please Reply ❑ Please'Recycle Lfi 1141012014 . 10:24 Law Office of Greg Mitrakis O:AX) - P.0031011 OF RAYMOND 0..GOULET I, RAYMOND 0. GOULET, of West Hyannisport in the County of Barnstable and Commonwealth of Massachusetts,being of sound and disposing mind and memory but knowing the uncertainty of this life,do make,publish, and declare thus to be my LAST WILL AND TESTAMENT,hereby revoking any and all wills and codicils heretofore made by me. After the payment of my just debts and funeral expenses,I dispose of my estate as follows. IRST: In making this Will I have borne in mind the various members of my family and none have been omitted by mistake or accident, and I have carefully considered all of my property, real,personal and mixed and wheresoever situated, and have made what I consider the wisest and most just distribution of my said property and it is my will that my said property shall be disposed of as hereinafter provided. SECOND: I nominate and appoint,my brother, CHARLES A. GOULET of Marlborough, Massachusetts, to be the Executor of this my Last Will and Testament and who shall not be required to furnish surety or sureties on the official bond. In the event that he predeceases me or is unable or unwilling to serve,I appoint my niece, JACQUELINE TOLAN of Marlborough, Massachusetts,to be the Alternate Executrix of this will and request that no surety be required on the official bond, In accordance with Massachusetts Genera,Laws,Chapter 192, s13, I hereby request that lily Executor and Alternate Executrix also be appointed as temporary Executor and temporary Alternate Executrix and request that he/she exercise all of the powers and duties specified in Massachusetts General Laws, Chapter 192, s14. THIRD:.I hereby give, devise and bequeath to my beloved brother, CHARLES A. GOULET the house,land and contents therein located at 174 7`h Avenua, West Hyannisport, Cape Cod, Massachusetts, if he survives me. If he does not survive me then to his children: WAYNE GOULET, JACQUELINE TOLAN and PETER GOULET, equally, share and share who survive me or the survivor(s). FQURTI : I hereby give, devise and bequeath to my beloved niece, JACQUELINE TOLAN, any automobile that I may own at my death,if she survives me. FIFTH: I hereby give, devise and bequeath to my beloved sister, CLAIRE M. GOULFT, the sum of TWO THOUSAND DOLLARS ($2,000.00), if she survives. Said sum is to be paid out of the bank account or checking account funds that I own at the time of my death or any joint account or checking account that I have established with my brother,CHARLES A. GOULET. SMH: I hereby give, devise and bequeath to ST. JOSEPH'S CHURCH in Medford, Massachusetts,IN MEMORY OF JAMES GOULET, the sum of FIVE THOUSAND DOLLARS ($5,000.00) said sum is to be paid out of the bank account or checking account funds that I own at the time of my death or any joint account or checking account that I have established with my brother, CHARLES A.GOULET. j 11110/2014 10:24 Law Office of Greg Mitrakis (FAX) P.0041011 H; I hereby give, devise and bequeath all the rest,remainder and residual of my property,real,personal and mixed,together with all of mystocks,bonds, savings accounts, checking accounts and anything else of value to which I may be entitled at my decease, wherever the same may be situated to my beloved brother, CHARLES A. GOULET, if he survives me. If he does not survive,me, then to his children; WAYNE.GOULET,JACQUELINE TOLAN and PETER GOULET, equally, share and share alike who survive me or the survivor(s). to u r this Will to dispose b sale, u r nde u the Exec P Y I hereby em ow er and authorize 1?IGHTbI. Y P private or at public auction, the whole or any part of my real and personal property as he/she deems advisable without the necessity of making petition to the Probate Court for a license to perform said act or acts. ,I NINTH: I direct that all inheritance, estate or other taxes occasioned by my death whether upon property passing under this Will or outside my Will shall be paid by my Executor or Administrator out of the general assets of my estate as a expense of administration. My Executor or Administrator shall have full power and authority to pay, compromise or settle any or all such taxes at any time, TBNTH: With reference to the legacies contained in this Will,in the event that any such legacy shall become payable to a minor person under other legal disability, I direct that my Executor may pay such legacy directly to such beneficiary or to a parent, relative or friend of such legatee and the receipt for any such payment by my Executor shall be a good and complete discharge to hire, and I request that the Probate Court dispense with the appointment of any guardian ad litem in connection with any interest that a minor or unborn or unascertained person may have or may take under this my LAST WILL AND TESTAMENT. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30th day of December,-2004. ND 0. GOUL On this 30th day of December, 2004---,RAYMOND 0. GOULET of said West annisport,Massachusetts, signed the foregoing instrument in our presence declaring it to be hi ST WILL AND TESTAMENT, and as witnesses thereof, we two do now at his request, an in his presenc and ' the presence of o her, h reto s be our names, of �-► of COMMONWEALTH OF MASSACHUSETTS County of Middlesex Before me the undersigned authority on this day personally appeared before me RAYMOND O. GOULET and Rhonda L. Crosby Bruce G. 'Ledouz to be personally known to me and to be the testator and witnesses respectively whose names are signed to the attached instrument and all of these persons being by me duly sworn,RAYMOND O. GOULET,the testator declared to me and to the witnesses in my presence that the instrument is his last will and that he willingly signed it and that he executed it as his free and voluntary act of the purposes therein expressed, and each of the witnesses stated to me in the presence of the testator that they signed the will as witness and that to the best of their knowledge the testator was ei een years of age or older, of sound mind and under no constraint or influence. Of GOULET 111/1-042014 10:25 Law Office of Greg Mitrakis SAX) Pr0051011 Subscribed and sworn to before me by the testator and the said witnesses this 301h day of December, 2004 James Golden, o My Commission Expires: ember 26,2010 r IF�gend. � Lot 502 • �. , • tot 553 - . . .....'.166 �. Lot 504 f Lot 551 a Deciduous Tree 2 Sty w/f s till Dwelling / . a Coniferous Tree q N/F ' . o Richard & Catherine Moore Deed Book 4344/38 - - ® Water Gate (round) Wood Deck N /F -. .o .' Joseph Ado Constance Toppa' © Gas Gate (round) " \ Deed Book 172971192 s _ C8/DH - concrete bound w/drill hole \ - shed �rr _ El R - Barnstable - 1CI t�mno 8 B road bound _ PO1O1 tom. o N87'21 36'E —- �� d Utility'Pole 100.00' ~1 shed Id Lot sae —ohw— Overhead Wires �' d w l,�orw ,. nd ,8x5T Field - LOCATION MAP: Q16 Lots 547` & 549 17.1' �T _ — ;`-1 Scale: t" = 2000'f —20— Major Contour �O O O /- 1t— — Minor Contour \ C F ;� \. i \ © NJ G \ Lawn \ I./ O Ga �h .. p 0 Septic Desi. n Analysis: `. o o. \ a / i `I Residential Flow: 110 gal per bedroom (110 gal x 3 bedrooms)=330 gal ASSESSORS REF.: 1 \ Sty W f 1 110.0 Min y� Y I Map 245, Parcel 72 Septic Tank Requirement: D well in ` 330 gal x 200% =660 gal ' ; Lot 549 9 1 ` . Use 1,500 gal Septic Tank H, 'G Lot 947 4'r-C, i - , OVERLAY DISTRICT: Lawn � AP - Aquifer Protection District Leaching Field Area Requirement: . ; As shown on Plan Entitled 330 gal+0.74=446 SF { zo 1 R . /oo o Revised Groundwater Protection yh yJ o �3 • • Overlay Districts" April, 1993 Leaching Field Area Provided: , z N \ /f 1 a 8'x 57'=456 SF Z FLOOD ZONE / I 'Lot 508 Zone 8 & C (see plan) y i Community Panel No. Check: 456 x 0.74=337 gal BRB Lawn 20.3 I`, #250001 0008 D t. Fnd // I �. July 2, '992' ' E 58 T21_'36"W .\ loot'--'- ----- •- 90.00' o ,� sort Marsh .- -' ,• ZONE: Area (min.) 43,560 SF Edge of Pavement Frontage (min) 20' Width (m in) t Go' Setbacks: F U 297�Eon t 20' SUVQiff Fr on ;V Side 10' . ucsl .,.,,Ocean , . , . Rear 10' - — Lot 510 Lot 545 c, FEMA Zone Lin as Shown F� on'FIRM Panel 1250i?01 6006 D y 2 0 5 10 15 20 JO ' 40 FEET NS '. Sheet # Title: Prepared By Prepared For: Notes Revisions: Septic System Upgrade Plan Sullivan Engineering, Inc. _ p Scale: . Capp, U 1.) The property line informotion shown.was "=20 P.O.Box 659 OstenAffe,MA 02655 �•A Raymond 0. Go u 1 e t compiled from available record information. of 2 At 174 Seventh Ave. 7 Parker Rood ,3� Sim son Road 2. Date: Tel: 5W 4WV44 ' Oslerville MA 02655 p ) The topographic information was obtained jtJ/NOV/04 W. Hyannisport, MA Fax.(506)42"115 Marlboro MA 01752 from an on the ground surrey performed on (508)420-39s4 (508)420=399, faz 79/AUC/02 (Elevations based on NCVD 1929) W PStd1PEOaol.Com capesurvkapecod.not C479_ Ci ------------ .. i. _ . TEST HOLE - 1 NOTES � PERFORMED BY. 1, Water Supply For This Lot Is Municipal Water, o-mar Comported Fit Fats robr4c ` SULLIVAN ENGINEERING, INC. 2. Location of Utilities Shown on This Plan Are Approx. SEP 27, 2004 At .Least 72 Hours Prior to,Any Excavation For This 2• - - +�"-112 - - - - Project the Contractor Shall Make the Required - - - ---- Pao stone SURFACE GRADE Notification to Dig Safe (1-888-344-7233) -� (per GIS) EL. 9.5 3. The Contractor'is Required to Secure Appropriate A LAYER 10YR 4/3 Permits From Town Agencies For Construction LOAMY SAND Defined by This Plan. 6• - 4'rPerforated . I 3/0-1 1/2• - 0'-9 - 6.8 4. Install Risers to Within 12'. of Finnished Grade. PVC Pipe Double Wo.1 d Stan. - B LAYER 10YR 5/6' 5.-Alt Structures Buried Four Feet or'-More or Subject MEDIUM SAND to Vehicular Traffic to be H-20 Loading. varl.e-se.Prm _ 9'-15 8.3 - G. Septic System to be Installed in Accordance With CI LAYER IOYR 6/8 310 CMR 15.00 Latest Revision and-the Town of } Cross Section Of Leaching Bed MEDIUM SAND'S'-60 ! 4.5 Barnstable Board of Health Regulations. Not to Scale 2 M U AND /3 e C LAYER 10YR 7 7 All Piping to b Sch. 40 PVC EDI M:S 8, Wherever `Sewer Lines Must Cross Water Supply 60 4.5• Lines, Both Pipes Shall Be Constructed of Class 150 Pressure Pipe And Shall Be Pressure Tested To Watertightness. ' Assure' •79 GROUNDWATER ENCOUNTERED 36' �. CLASS 1 MATERIAL. 0. ! FF ' •Design Data F.C.EL 11.27 F.C. EL. 12.J' _ ec. EL 12.5 Single Family 3 Bedroom DaRy Fdow = 110 x 3 =r 330 GPD Sffa Note a rt,a.t' Septic Tank: 330 GPD X 2007.° _ 660 GPD .1 Use 1,500, Ga ion Septic .Tank 1.500 cation Leach-in.Q. Areal. CField) Septk: Tank Top EL 9.60• T H-zo 910, Required Area (SF): werprooT/Sed Concrete Septk: Tank ./Two(2)Coots of Approved Soolont FTa.E Alzen Sot:Et. 8-60' 330 GPD / 0.74 446 SF •w EL fl.38 Sidewall = 0.0: SF Remo dt R loco-All Uneu!loble - 8eddln9 "T"a eP Bottom Area 456 -.SF ' ,�.. _. _ ,._ ..�. .... oa Per Pilo 5 SoAe WRhtn 5'of The Outer . P°rimeler of>»°snlem Total -Area Provided .(SF)� PER 310 CMR t&J0gJ)NO CORRECTION - (8'x57').-= 456 SF REQUIRED. SrS"f5 Mt THIN 300 FEET TO Ob.erved - " MHW.. GROUNDWATER ELEVATION WCHEST Glw,ndwter O ET. J.6' 085ERVEDTHROUCH FULL MOON TIDAL CYCLE . Developed Profile of Proposed Septic System check: (456 x 0,74) _' 337 gal Not to Scale Title: SITE PLAN Prepared By. Prepared For: Date:• NOV 16, 2004 L PROPOSED SEPTIC UPGRADE Sullivan Engineering, Inc. CD CD AT 31 SIMPSON ROAD PO Box 659 1, RAYMOND O. GOULET Osterville, MA 02q5 N 5' Scale: As. Noted 174 SEVENTH AVE. (508)428-3344 (508)428 J115 tax MARLBORO, MA 01752 0 BARNSTABLE, (w: Hvarn*w t)MASS oSWIPEoeal0om Pro jec f` ,# 24028 t„ 2" x G" PT OR COMPOSITE SPACED DECKING P.P. TO BE LE55 THAN 30" ABOVE GRADE xx @ ALL POINTS DECORATIVE ROPE'RAILING 4' x G" BORDER @ ALL EDGES Q BETWEEN POSTS BUTT BOARDS @ CORNERS W WHEN P055113LE / i PG� O O . \ UP 3K@G" \ 2T@ I I / PT TREADS BUILT.UP F FROM 4" x G" DECKING _ 0'z a as 5" x 5" PT POSTS a \ / EXTEND 48" ABOVE , -P.f., PYRAMID. q`'' \\ _ /' CHAMFER TOP EDGE O FLOOR PLAN . . 1/4"=1'-0" NON-BEARING 2" x 8"`RIM TAPCON'TO FDN. 2" x 8" LADDER FRAME @ I G" o.c. 5" x 5" POST TERMINATING @ T.O. JOIST, TYP. @ ALL LOCATIONS EXCEPT ANGLED EDGES OF DECK POSTS SHALL BE NOTCHED TO RECEIVE 2" x 1 2" BEAMS W � r -ir -, r2" x 1211r -Ir -Ir 9r r r2'. x 12"' r 9r -1r Q . WU O U • JL JL JL I JL '. JL JL - <J. r -1 r I r I r -1 r I r 2" x 1 2" -i r -I r o w 2" x 8" 16 O.C. Fyp.11 5 x 5" POST CONTINUING TO 48" A.F.F. TYP. @ (2) ANGLED EDGES, NOTCH-@ DECK FRAMING LEVEL TO RECEIVE 2" x 1 2" BEAMS FRAMING PLAN - • w 2 2" x G" PT OR COMPOSITE SPACED DECKING F.F. TO BE LESS THAN 30"rA15OVE GRADE j @ ALL POINTS DECORATIVE ROPE RAILING 51, 4 x 6 BORDER @ALL EDGES H o BETWEEN POSTS W U BUTT BOARDS @ CORNERS WHEN POSSIBLE �D O U Zd \. UP 3 G" _ \ 2T I I"ice PT TREADS BUILT UP F �.i FROM 4" x G" DECKING -_ [� - 7 fR� 'zHaa 5" x 5" PT POSTS i EXTEND 48" ABOVE i F.F.; PYRAMID CHAMFER TOP EDGE 0. . - O FLOOR PLAN NON-BEARING 2" x 8" RIM TAPCON TO PDN.'' 2" x 8" LADDER FRAME @ I G" o.c. 5" x 5" POST TERMINATING @ T.O. JOIST, TYP. @ ALL LOCATIONS . EXCEPT ANGLED EDGES OF DECK POSTS SHALL BE NOTCHED TO d RECEIVE 2" x 1 2" BEAMS W � r -Ir -Ir2" x 12" r -1r -ir r -Ir 't1 V / IL J L J L J L ]IL '- �. x t {{ ue 2" x 8" I G" o.c. P. x s r 5" x 5" POST CONTINUING TO 48"'A.F.F.';, - TYP. @ (2) ANGLED EDGES, NOTCH @ DECK FRAMING LEVEL TO RECEIVE 2"x 1 2" BEAMS a FRAMING PLAN 1/4"=1'-0" z_ 2 M