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Home My WebLink About0289 TOBEY WAYrv, 9 F6 W� / - _ J � �� 3 �4�i� D � -�- � L��, 6 � �� :�� y ' ��.�- r i i I 1 i t I I Town of Barnstable Building +: .? ,'" »..«:.. ."' ,ram `�'`` .�E: �. _ '.. rr:=`r :s Post.This Card So That t is�V�sible From.the;:Street•-Approved,,P,,,lans.Must be Retained on Job and this Card Must;be Kept , * AS& n iI Final Ins section Has Been IVlade r `�" m �� Permit Posted U t ,. p r :y ,. �' Musa , .; y� Wherea Certificate of Occupancysltequired,such Building shall Notxbe®ccupi d til�a Final Inspctn has been made Permit No. B-19-2577 Applicant Name: ROBERT G WALSH Approvals Date issued: 08/20/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 02/20/2020 Foundation: Location: 289 TOBEY WAY,HYANNIS Map/Lot: 247-251 Zoning District: RB Sheathing: Owner on Record: ZIVE,CYNTHIA TRH. Contractor Name `,.,ROBERT G WALSH Framing: 1 Address: 682 AUDRA COURT Contractor•License CSFA-057394 2 GAHANNA,OH 43230 i Est Project Cost: $99,000.00 Chimney: M WITH VAULT.CEILING BUILD PermitFee: 554.90 Description: BUILD 16 X16 THREE SEASON ROOM $ 5'X8" FRONT FOYER ENTRY WAY BUILDING 8'X15h,FARMERS PORCH. Insulation: Fee Paid: $554.90 T NO FOUNDATION ALL ON 10 SONO UBESAND BIG FOOT TUBES -; x Final: Date ,; 8/20/2019: Project Review Req: Plumbing/Gas , 4 M. ' W, Rough Plumbing. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author i' by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documentsfor which this permit has been granted. Rough Gas: All construction alterations and changesof use of building and structu 'shall be in compliance with the local zoning=by la�wsand codes. any g res a' 6 i n" ec'tion for the entire duration of the Final Gas: for."ubl c i s i location clear) visible from access street or road and shall be maintained openp ,, p ._ ' i hall be displayed n a o This permit sY work until the completion of the same. i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by,the Bui d ng andFire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: "ff .. .: ;: Service: 1.Foundation or Footing n _ Rough: 2.Sheathing Inspection , 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons rartk@cting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire'Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT n gi► Application Number... ................... (./......q .................. BAPM * MA88AJI BUILDINGPermit Fee...............................� Other Fee:. .................. - 1639. �� FO MIS�' AUG 1019 Total Fee Paid....:........................................................... ...... TOVvev Vr G TOWN OF BARNSTABLE"o 1ABL Permit Approval by........ .on.... / g: BUILDINGPERMIT , Map...................... ...........Parce1......E�.... ........................... APPLICATION Section 1 — Owner's Information and Project Location Project Address M\p �f VJ Village.' -Alva A/VV IC. Owners Name c}-�� Owners Legal Address_ CA City State 1,noom � Zip J Owners Cell# ;t 00 E-mail Section 2 -Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure),' ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ® Deck Apartment ❑ Sprinkler System Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ] Insulation Other-Specify Section 4 - Work Description Ge o w 6 N dL f ft r✓ ` a�I ��f�� 'O)•-� v7�62:5 �^ Q��f1D!�' 6`i'u ins e T eo+....7ewA• 11/1 QMA14 i Application Number.................................................... Section 5—Detail Cost of Proposed Construction Wbc-rO, Square Footage of Project W& Age of Structure ti4-S Dig Safe Number ' I # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method O'19A Checklist e1v"Checklist P-esign 1 a Section 6—Project Specifics I Wiring ❑ Oil Tank Storage ' ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression a ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply EPublic 0 Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes t No Section 7-Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed a � Rear Yard Required Proposed r Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No 1 Last updated: 11/15/2018 The Commonwealth of Massachusetts Department of IndustridAccidenis Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 Please Print Legibly Name(Business/Organization/Individual): 1-,T'0.\ 9e N Address: Lo—t 4, -T 13 City/State/Zip: woxS M� 10' Phone#: '�'O q Z y ^ b 9 �® Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity.acit3'• employees and have workers' 9. El Building addition [No workers' comp.insurance comp.inenran�e,f 5. We are a corporation and its 10-❑Electrical repairs or additions r . l 3.El am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees.[No workers' 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their worker;'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers',compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date:- Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sigrtature Date: �d !t 1 [ 4 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requim all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant hereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate,a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants _ Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requir-ed to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the.affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant d Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: # The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 446 or.1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 WvMmaw.gov/dia f x • Caro: PROFILE : NOT To SCALE � ?4.40 � \ 24. 1�4/I C+niUvn J/1 AIRAnl stoz a nne - 1 2cArA� aAa�M t � r � � /. r � T 9 24.48 24. ! .4 9E YE 26 // V WAS B. 1994. / // /• t, . TESTP/T 1211 •ha yb �// / `s� // // / r i✓"`fib 6i, � r 1 ►- % , z� NO / RESERVE / 4' PIT 1000 AIL l 1 SEPTIC TANK / h -BOX / 10, �p // h 107.79, / 30'w f I I/ /oe I 'K OF son fA ioe Moe �� wvvz CIA O l / . �Vol ' ! 00, Or Ap 10, "_..— —,ice '� .—_.._—+►__... /�i SVA! A 10, ol .00 BUILDING DEPT ga . un-uvJ iHtSLt i 37VO$ Ol 1 ON : —7 7 �� t s ------------------- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 141991 03/02/2020 One Ashburton Place-Suite 1301 ROBERT WALSH Boston,MA 02108 D/B/A HARBORSIDE REMODELING ROBERT G.WALSH ' 250 CAPTAIN CROSBY ROAD �� — � � (✓L,f .' CENTERVILLE,MA 02632 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction-Sb,ob lsor,1 & 2 Family CSFA-057394 E-01'res: 06/02/2021 1 ROBERT G WALSH` f P.O.BOX 713' : �, MARSTONS MILLS MA 02G48 F Tt�4� Commissioner t I -- a Ik Q o'i =Any�s Pc s aye'` v !° �Ar s Barnstable Bldg. Dept. �cq Approved by: �� 4L .� Permit #: PUG �0 2019 �OWN OF BPRNS�Pg`E Z e l 7f/3 yam. Barnstable Bldg. Dept � i �y t a^ 0 Barnstable Bldg. Dept. -® v4 M Approved by:ri Permit � I a -(C9v rv� 60 T�Pq 4-e� Application Number........................................... Section 9- Construction Supervisor Name Telephone Number CT?V' q 2-0— E>%9 0 Address (sae* I i 3 City iw�,..5}0,,S i�m;NISState IM a , Zip a 2.to 4$ License Number C6-7 347 L4 License Type CSIc19 Expiration Date G I a ' :2 1 Contractors Email 1-�,._k c.. Q o o m c mo O yv e* Cell.# 4 a►®— a�rS-0- I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. 77 Signature Date Section 10 —Home Improvement,Contractor Name bril%'rt' S i Telephone Number �a Address 0 6. -713 City ,�, ,1�State i i, Zip a 26 4 1? Registration Number r H 199 Expiration Date ?'/2 2-0 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of B ble.Attach a copy of your H.LC... Signature Date (Z (a L q Section 11 —Home Owners License Exemption Home Owners Name: t Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date 9 Print Name LZob e&- tk;&_`b k Telephone Number 2C9� E-mail permit to: b LA C $b P) L W CW'0' , Nee — Last undated: 11/15/2018 Section 12 —Department Sign-Offs Health Department Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization i I, � ,�a ,��. , as Owner of the subject property hereby authorize � ,t---�- (-, to'act on my behalf, in all matters relative to work authorized by this building permit application for: _ gP PP aC�v r (Address o ob) tore of Off� ;) t cVe - Print Rale Last updated. 11/15/2018 Town of Barnstable Regulatory Services Richard V. Scali,Director A MASS.Mo Building Division �E1639. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT#c:30 I 001 FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY _w.._._ ____200 square feet or less--- � b ��s Location of shed(addr ) Villa 14,207, Pr rty owner's name Telephone number k ;!�, X g aL47aSI 1 Size of Shed Map/Parcel# �.e S e Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN . Q-forms-shedreg REV:040914 1,3 •,t /9 CO � 4• gyp. � � o �3005 � 5p Bk GE cp LU TOWN OF BA:RNSTABLE ZONI NG @� a y 3 54 c ZONE RB 0 5 SETBACKS FRONT - 20• SIDE - /0 63.2A•� REAR - l0' SEPTIC COMPONENTS TAKEN FROM AS-BUILT CARD., PLOT PLAN THE DWELL I NG DEPICTED ON THI S 289 TOBEY WAY, MAP 247, ,PARCEL 251 PLAN WAS LOCATED ON THE GROUND BfIRNST1gBLE: A. BY SURVEY ON SEPT. . 29, 2010 AND EXISTS AS SHOWN AS OF -THE SCALE: 1 "-40 OCT. 8. 20I0. DATE OF LOCATION. EAGLE SURVEY I NG , . . I NC. THIS PLAN /S FOR PLOT PLAN 923 Route SA PURPOSES ONLY AND NOT FOR fi Yarrtmuthport, not. 8132 . �' (508) 362-8132 RECORD/NG OR DEED DESCRIPTIONS. (508) 432-5333 THIS PLAN, IS VOID /F NOT. STAMPED'AND SIGNED IN RED. 0 20 40 80 PROJECT -NO. 10-103 �. T � 0� 6 cam- 0. 3 BA o 00 �aZ 0? t1 � co � s a R e Zug %sn o \ o- N o, 00 ��? TOWN OF BARNSTABLE ZONING ZONE - RB •e"' O SETBACKS FRONT - 20 SIDE - l041 ?) 2A REAR - l0 a�•G�5 SEPTIC COMPONENTS TAKEN FROM AS BUILT CARD., PLOT PLAN THE DWELL I NG DEPICTED ON THI S 289 TOBEY WAY, MAP 247, PARCEL 251 PLAN WAS LOCATED ON THE GROUND BARNSTABLE. Mk BY SURVEY ON SEPT. 29, 2010 AND EXISTS AS SHOWN AS OF .THE SCALE 1 "-40 OCT. 8. 2010 DATE OF LOCATION. EAGLE SURVEYING , :,,. . THIS PLAN'IS FOR PLOT PLAN 923 Route 8A PURPOSES ONLY AND NOT FOR Yarmouthport. MA, 02675 � {508) 362-8132 RECORDING OR DEED DESCRIPTIONS. (55N) 432-5333 THIS PLAN. IS VOID IF NOT STAMPED AND SIGNED IN RED, 0 20 40 80 PROJECT NO. l0-103 �TFIE Tpy,_ Town of Barnstable *Permit# Regulatory Services Fees 6 monthsssue date BMWSTABLE, ► ,r MAss Richard V.Scali,Director hex s63y. ♦0 f Building Division �"�'•pPP,' Paul Roma,Building Commissioner MAY 2 4 2017 200 Main Street,Hyannis,MA 02601 O www.town.bamstable.ma.us C1�''�� Office: 508-862-4038 Fax: 014-, W 39 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �-- , . Property Address_ y� /®�% pC,2 q Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 6,FA/7 F-f to 2 t V e. d 9 fa e Contractor's Name L� f!/1 W I uS K eff A-0 Telephone Number 3. 6c( 6909 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ] I have Worker's Compensation-insurance / Insurance Company Name Workman's Comp,Policy# Copy of Insurance Compliance Certificate must accompany each permit. , Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed),(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum.32)#of windows #of doors: _ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc, ***Note: Prop Owner must sign Property Owner Letter of Permission. of'the Home I ovement Contractors License&Construction Supervisors License is r/ ired. , •SIGNATURE: ✓'' LO QAWPFILES\FORMS\building permit forms\EXPRESS.doC 01/25/17 • t To-Wn of Barnstable Regulatory Services M Richard V.Scali,Director - Nua Building Division. Paul Roma,Building Commissioner 200 Man Street,.Hyannis,MA 02601 www.town.barnstable.maus Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must a Complete and Sign This Section If Using A Builder ^ 4 fYA 2 ve- as Owner of the subject property i hereb authorize . L?.// �l�n�� 1Cr'�M` �L-2to act act on m o my behalf; in all matters relative to work authorized.by this Building permit application for; (A 9 4 iLys 0 **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and.accepted. ry d tore-of Owner Signature of Applicant Prilak Name Print Name . Date QFORMS:OWNE"ERMISSIONPOOLS Town of Barnstable Regulatory Services p1F Ry._ Richard V.Scali,Director Building Division sr�a. Paul Roma,Building Commissioner KAM iy. 200 Main Street, Hyannis,MA 02601 w a www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 50,8-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ,.JOB LOCATION: number street image "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shad be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILESWORMS\building permit forms\EXPRESS.doc 06/20/16 l 2he CommoTmeakh ofMaxyadmmetfs Dquotmentafrn tr Accidenfir Office Ofhrpedwatmu 600 WashfiVi rt jir. e Boston,M4#2111 - tp!vm- ma=goP1dz'a ip cam#Tnf naf an Please Fry F �btY 'Name - e 4/Aipf2- Ad&esa+ ol IW Ciigfatetef ig ✓"/f s7-OAI5 /�l/Gl (A .S 3.6-y 6' � Are you an employer?Cheekthe,appropriate bon Type of project(reg¢n-ed): L( I am a employes vritb. 4 ❑I am a ge feral coafractm and I 6_ ❑New employees(fullandfarpart-time * hopehiredt&esole-co a oss i❑ I am a sole pmpzietar orpartaw- Tisf ed aathe attached sheet: 7. ❑Remodeling• slip and have no employees: . Mese zb•-con ractars have & ❑Demolition l andhave woAmrs' wotlaag for roe ifl.arFp capacity. �a� 9..❑B,nildmg addition ` [NQ Wod:e 'comp-M- SUMMO Comp-i lsuranrr l reT,ke -1 5.❑ We are a oorpomfiflm and its 10-❑Electrical repairs or a,dditknQ 3-❑ I am.a homeowner doing all wodc officers have exe=' ed their 1L❑YimIIbffigrepaiss or$dchfions TigU of eMmpifla per MGLmyse€IN()wades omp c. §1{ ,aehavero 17 El Roof z aus i"M=, cei a`i employees-[No VDAM& �-0 other cam-ksuramm MTxire&1 - •$ap apgffa��arcbedEs'6os�].meat also fiIIo�tire secficabeFoxreftasaas�e¢va�as'�mpeQsaiiaupnycgiafac�auob aragatrho suit dhis af fidziis fm�r they ma&.<0sr aa&ff=hae=ui&c-Tt- st mzimit s aemsffiaseit mdia�a each_ 'C=zCC rs8sft eb-Ir Ws b=mast sttadled m sddW-1 sleet sbaming the—cf rbe s¢b•t�and=ft Whe2het araatfbase ealitieshsee ' eaiplayees.Ifthesub•teshsce�pIvS�,�Y�'i'P��' '�P•F�'imzm�rez - .. lam an suiplayw flirt isprouiriirtg mcrlFers'campertsrdfart ursziraacs jcr my etnpfyrm $erviv is flrePulicy cued jab srte �,farmQlian, IT'Suracc a carapRaYIEame: "Po-ficy-44'or Self ins_Lie I gi iaziI}ate: , r b M.A 4 i �` c yrsraf : Elffach a•-oPy of the w&rk-ers'cornpensafiGapolicy delrafian page(showing the poficy number and elpnrsfron dam}. Fat7me to secure coverage as required under Sw ion 25A of I (3ff.m lR can lead to tfie imposition of criminal penalises of a fine up to$L SODOD ar,3.1or orie=yearimprisD==d.as well as civil peaaltie Jn the fora of a SMP WORK OR=and a fine of uplo$25M a #lie Mold= Be advised that a copy of this statement soaybe£o twarded fa tine Office of Iavestegafina for insurance coverageyofimtinm Ida ker-Biiy eerf thspahu and Vf pze �fhatthe frgformatavapnn**icledabvm Fs true and c m7ect phn=g_ ,OR 36V 6Fot? teal we=;F% Dv rrat iH f ib"ecr,to be evulpfetml by diy artolm a,,Xal City or Tanvn: Fcrmif &ewe f Lwain.g Auflmx ty(care one): L Bated of Health :�.Bw mg nepartment 3.My./raim Oerk d F3echical hmpectnr S.Plumbing Insped mr tx o"lrer Con#act Person: PIW#- �I: .+II.A G=tR �?■ _ .■:t•i� �•■■1�•. _1 .i■11■ ••�F [I ■x •• ■- •••S■.1G'R r•It■1■il■ :I.all ■■l to I i.nl■ ••�- 1. ■J\I ■■ i■ +, r_uu1 .n ..u • •atm�• : r•-ux G.a. . un■ �• •r- a ••■n1�1 • ■ y�Ia / •i A ■�3n■�■ : JI 11■1 \I■ .:• ■■i:F■tt• k.■rtG1■.Il rq ■• _[\.12 ■1 I i)�! -_ iirl\t • •: :■■• •'• •I r1■1 • i■- to - •.n•• �■_r- �• O _ •II inni n•w- .1■• 1■ 11 sale 1■- - .1 i�is■IYI■•w • _ • ►■ �IIOr ••�' •1 i■ a • • ■ • - • :II [l O• ■Ir •_I ■■rF• 1■ _A�.••.f J■•II ■1 •i■i - Gin[I iIIO■ •• t■: ii■O■ • •`•■ • •• In\ r•1 ■- t• ■• 11■1 - ■■-n tt1 .■■:1 1/1�IIR :■t■ •'■• GAY■- ■■ :t■■ •1 t■ •rM■[•�1■I ■■- ■ I 1■. ■\■ • ■ :1■■lI ■1 iir■1■fe of.In11i!■.t■r •1■ ■ ■ ■.1■ n •-n "■\. •Il ■ ■ ■••- 1111_ ■.■w" • ••n t■ J ■/1■• • •11 t O• .n••I tit■J■1 ■� -1• ■ 1 ■I irC■. ■ • .■ G+[O• ••n�■1 •- ■�i!U�• ■. ■' J■ !On ••i' /�� ■ rn- 1■:[ - Y 1" I -I✓- I YI[ -_ [ - 1 - ■I ■• ■ ■a I _.a a -1 ,I ■ �f I I■- Inl ■■ 1 ■- -n" ■ IwY/1:..\ ■ ■[ r1 IA■ t Y ■ it • /■ t1 fl rl 111■■ ■ • _ ■I ■ ■ ■ •••x [ 1 ■ t - ■I ■ I■ I r:.■ r"I r ■ -• t Gil r I ■H ■ - I•' - • •\ u■■. � � C'� ■J.■il Y r` r_r �Iti■w u room•1■••u. til ■• .n• • tR •• t\r. 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THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER BRYDEN&SULLIVAN INS - MAANME: 88 FALMOUTH RD PHONE I FAX HYANNIS, MA 02601 arc Not: IL ADDRESS, INSURE S AFFORDING COVERAGE NAM# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: BEL ISLANDS HOME IMPROVEMENT LLC 204 CINDERELLA TERRACE INSURERC: MARSTONS MILLS MA 02648 INSURER0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 35662520 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER IMM1DDNYYYI iMWDDMMLIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR b-AMAG TO PREMISESoccurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENL AGGREGATE LINT APPLIES PER: GENERA.AGGREGATE $ POLICY❑JERCTT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBU.ELU181LRY . COMBINEDSINGLELIMIT. $ . accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per $ UMBRELLA LIA11 HOCCUR EACH OCCURRENCE $ EXCESS LtAS CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION WC5-31S-615667-017 2/11/2017 2111/2018 1 PER OH - AND EMPLOYERS LIABILITY Y/N ✓ STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBEREXCLUDED7 FN� NIA (Liandat«li in NH) El.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarks Schedule,may be attached H more space Is requlrel) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION THOMAS J. O'NEILL INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 BATES RD 26 BOX 625 ACCORDANCE WITH THE POLICY PROVISIONS. MASHPEE MA 02649 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 35662520 1 1-615667 1 17-19 WC 1 n0270259 1 5/16/2017 12:19:49 AM (PDT) I Page 1 of 1 h9assachusetts Department of Public Safety � Board of Building Regulations and Standards r` w License: CS-105964 : Construction Supervisor IVAN V IVANIUSHENKO `+ 174 UPPER COUNTY ROAD APT } 1-14 DENNIS PORT MA.026.39 Expiration:' Commissioner 01/01/2018 ... 024e ipaorv��zarrcuealC�o�0/G �ac�i�ael�l ' —C\—Office of Consumer Affairs&Business Regulation — ME IMPROVEMENT CONTRACTOR eg istratio n_`172476M ExpiratiQ n7/2/201.8 r, TYPe 4' <,, Supplement Card l BEL ISLANDS HOME-!IMPROVEMENT IVAN IVANINSHENKO 204 CINDERELLA TER .: MARSTONS MILLS, MA 02648 Undersecretary t 0" i m l r Town of Barnstable p� Erpir`es 6 months jronr issue date Regulatory Services Fee t AMSTABLE, f 9Q� 11665 10� Richard V.Scali,Director ,orb a _ Building Division H✓ � � Tom,Perry,CBO,Building Commissioner r 1 200 Main Street,Hyannis,MA 02601 ��"'n�`�� www.town.bamstable.ma.us ° Office: 508-862-4038 Fax:508-79(-- 30 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /d V e L11)A Q Property Address _ lJrA/✓1 4 d u se Pr �' /)�/l ✓1 ( S RResidential Value of Work$ j 3.,.,2 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A r+ COY I e k Georr,c 6i(a ei C 90 f ��✓Q/I��'�t1 A OoZ�oo 1 Contractor's Name E %t�[7,.J1?)r..;I,l ( lj1Sp/1 Telephone Number(q01, O n Home Improvement Contractor License#(if applicable) 4 3 2 y S Email: Construction Supervisor's License#(if applicable) S 7 t7 7 MWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance Insurance Company Name Coat�an7gLL -e�n Jn-s Workman's Comp.Policy# WZ 6 313620 8 1 Copy of Insurance Compliance Certificate must accompany each permit. At 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) ❑ side . Replacement Windows/doors/sliders.U-Value - 2->U (maximum.32)#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 nrith other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require 0 0 SIGNATURE: C:\Users\DecolliklAppData\Loca]NicrosoftlWindoivs\Temporary Internet Files\Content.0utlook121`101 DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Art Coyle&George Evans Legal Name:Southern New England Windows,LLC 90 Townhouse Ter RI #36079, MA#173245,CT.#0634555, Lead Firm #1237 Hyannis,MA 02601 WINDOW RE IACEMENT 26 Albion Rd I Lincoln,RI 02865 H:(508)778-1915 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(508)574-8477 Buyer(s)Name: Art Coyle & George Evans Contract Date: 05/01/17 Buyer(s)Street Address: 90 Townhouse Ter, Hyannis, MA 02601 Primary Telephone Number: (508)778-1915 Secondary Telephone Number: (508)574-8477 Primary Email: coyleart@aol.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $13,209 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $4,402 Balance Due: $8,807 Estimated Start: Estimated Completion: Amount Financed: $0 8- 10 weeks 8- 10 weeks Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 1/3 paid by 2 credit cards. 2/3 upon start/completion. Taxes in Barnstable Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 05/04/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renew By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Eric Tavares Art Coyle George Evans Print Name of Sales Person Print Name Print Name UPDATED: 05/01/17 Page 2 / 12 i Massachusetts Department of Public Safetj Board of Building Regulations and Standards License: CS-095707 BRIAN D DENNISON 7 LAMBS POND CIRCLE`1'5 4 CHARLTON MA 01507,, Expiration: Commissioner Q9i0812018 ffl b h e of Consumer Affairs and business Regulation J_ 10 dark Plaza-StLie 5170 Boston,Irlassachusetts 02116 Home Improvement Contractor Reg6stration Registradon: 17 3245 Type: Supplement Card ___ Expiration: 9/1912018 SOUTHERN NEW ENGLAND WIND&-V!fLL: BRIAN DENNISON _ = - 3 26 ALBION RD LINCOLN,RI'P2865 ..' l:udnre.Mdt2ss and return card.N12rIc reason for change. —!Address i Renewal '_�Employment f Lost Card ::r:.: — .ern i_ . y RQ of Cnmumcr:Vfairs�.Bvsiaess Regmiation Regist:ariou valid for individual use only before the expiration date If found return to: SOME IMPROVEMENT CONTRACTOR `Office of Causamer Affairs and Susiness Regalatioa Reg15tradon:;�i,732A5;; Type: to Part:PL•m-Suite 51: E:piration:.,4A0j-9. Supplement Card Boston.NLA 02116 SOUTHERN NEIN ENGIANbWMDOWS L—C. RENEWAL BY ANDEASON':: BRIAN DENNISON ---- 26 ALBION RD LINCOLN.RI 02865 �.lioderseerciary Not valid without signature The Commonwealth of Massach usetts v Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia lVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 50s4e-cn, �� 'n�1 n J l�n C)L-i 5 Address: C�& 41&00 City/State/Zip: 1-;17c /li r 02g 6 Phone#: 40) Z 28 _ 9 g oO Are you an employer?Check the appropriate box: Type of project(required): l.Iaam a employer with �-� employees(full and/or part-time).* 7. New Construction 2. I am a sole proprietor or partnership and have no employees workin for me in ❑ p p p pg 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition IR I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑lam a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation I l. leC i e insurance or are sole �Electrical cal repairs or additions proprietors with no employees. 12.[:]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof p repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.El we are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ her 152,§1(4),and we have no employees.[No workers'comp.insurance required.] f,e f l a ee *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ' / Insurance Company Name: �� 'ne.-l�q Wes&rr In S. Co Policy#or Self-ins.Lic.#: W C- /j 313(,o g' I Expiration Date: Job Site Address: �f �©t.thn A d t/s-e. 2 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy numb r and expir tion date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the t s andpenalties ofperjury that the information provided above is true and correct. r � Signature: Date: t� Phone#: ( 0 1 L Z $ —,: 8 0 O Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-01 CZOLLINGER CERTIFICATE OF LIABILITY INSURANCE DAT 12912D/Y sz91zo16 s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONALJNSURED,.the policy(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: COB)z Insurance,Inc.-CO A N EI.(303)9884" FAX No (303)988-0804 821 17th St Denver,CO 80202 ADDRESS,COBizlnsumn obizinsumnce.com INSURER(S)AFFORDING COVERAGE NAICS INSURER A:Continental Western insurance Company 10804 INSURED INSURER B Southern New England Windows LLC INsuRER C DBIA Renewal by Andersen ! u1s 26 Albion Road uRREEr D Lincoln,R102865 INsut�E i INSURER:F 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:CONDMON OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY.THE.POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED-BY PAID CLAIMS_ .. .LI FFF .POUCY EXPI LIMITS L7RR TYPE OF INSURANCE 1NSp i IAIVD POLICY NUMBER I D 1 A X COMMERCIAL GENERAL LIABILITY ! I I EACH OCCURRENCE 5 1,000,E DAMAGEi CLAIMS-MADE OCCUR I ` �CPA3136O8O j 07101/20is. 07/01/2017 i PREMISES 0cctarence !s 100, MED EXP(Any one person) S 10,00 PERSONAL&ADV INJURY $ 1,000,000 ;'GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE I S 2.000,000 PRO i I I PRODUCTS-COMPlOP AGG ;S 2,000,0 00 RIX POLICY JECT L� ! 1 EMPLOYEE BENEFI !S 2,000,000 OTHER I i COMBINED SINGLE LIMIT I AUTOMOBILE LIABILITY j I E8 (S 11000,00 A XAurO i iCPA3136080 ! 07/01/2016 07/01/2017 ,BODILY INJURY(Pe'ae!".-ANY _! iALL OVVNED SCHEDULED I + !BODILY INJURY(Per acdded)i S i AUTOS ! 1 ! PROPERTY DAMAGE S HIRED AUTOS AUTOS�� Per ecddard ! s X UMBRELLA LIAR 1.X OCCUR ! i I EACH OCCURRENCE S 5;000,000 A EXCESS LIAR CLAIMS MADE i CPA3136080 07/01120161 117 I2017 AGGREGATE i s DED X RETENTIONS 0 I ( ggregate I S 5;000;00 Fi WORIi�RSCOMP@1SATON I ! 1 STATUTE ER AND EMPLOYERS LIABILITY YIN I 1,000,0 A ANY PROPRIETOR/PARTNER/EXECl1T1VE CA3136081 07/01/2016 10710112017 E.L EACH.AC 1 ENT s OFFICERRu1EMBER EXCLUDED? NIA I I i 1,000,000 (MandaRIM in BERKH) E L DISEASE-EA EMPLOY $ If es,desaibe tinder E.L.DISEASE-POLICY LIMIT S 1,000,00 . DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Add91a81 Remarks Schedule,may Ire attached B more apace Is tegalred) CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . ACCORDANCE'WITH THE POLICY PROVISIONS. AUTHORED REPRESMAME ©ISW2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD �.•-- F THE T° wti Town of Barnstable, Massachusetts r r Department of Planning and-.Development r � 'ST"B`�' a ok Office of The Planning Board 39 �. i6 �AlFO M- A` 367 Main Street, Hyannis, Massachusetts 02601 (508) 775-1120 ext. 190 July 25, 1989 c3 T. .. r�.. Aune Cahoon, Town Clerk Town of Barnstable Town Hall 367 Main Street Hyannis, MA 02601. � Re: DEFINITIVE SUBDIVISION #366 Open Space Subdivision ##366; "Washington Farms Estates" ; Subdivision Plan of Land in (West Hyannisport) Barnstable, Mass.. Prepared for George Tobey Scale 1 "=50' ; Plan dated 05/08/89, and revised 07/24/89; Down Cape Engineering; 13 lots ; located north off. Cra i gv I I I e. Beach Road, east of Strawberry Hill Road,: southwest .o.f z Old Hyannisport Road, abutting COMM property, West Hyannisport; Assessor's Map 247, Parcel 225 & 227-254. At a duly posted meeting of the Barnstable Planning Board held July 24, 1989, 'it was voted to APPROVE the issuance of a SPECIAL PERMIT pursuant to Section 3-1 .6 of the Zoning Bylaw of the Town of -Barnstable subject to the `fol`lowing: I ) , The approval as to form,, by the Town Attorney, of the materials called for under Section 3-4 .6 ( 10) (d) of the Zoning Bylaw of the Town of Barnstable, said materials including, but not limited to, the management plans for all common areas and structures; 2) The recording of the Town of Barnstable Open Space Residential District Open - Space. Restrictions and Easement Form, and evidence of that recording supplied to the Planning Board, within (ninety) 90 days after the date .the plan' is endorsed by the Planning Board . 3) That the A. applicant be granted' a waiver from Section 3- 1 .6 (6) "Bulk Regulations" of the Zonl.ng Bylaw of the Town of 'Banrstab'le, and be allowed to reduce the width; of the perimeter strip as shown on the above captioned plan; 4) That the applicant be granted a waiver from .Sectfon 3- 1 .6 (6) "Bulk Regulations" of the Zoning.- Bylaw of the Town of Barnstable, and be allowed to reduce the side and rear yard setbacks from the the ten WOk ( 10) feet normally required in the' RB - Residential District to ?seven and one half (7 112) feet. At the same July 24, 1989 meeting, it was voted to APPROVE the above captioned DEFINITIVE subdivision subject to the following: 1 ) All the recommendations of the Board of Health; 2) All the requirements of the Town of Barnstable Subdivision Rules and .Re9ulations except that the applicant be granted waivers so as to p allow them to construct Tobey Way within a thirty-five (35) foot layout where shown on the above captioned plan, and within a forty (40") foot layout where shown on the above captioned plan; 3) All the recommendations - of the Department of Public Works as follows: ay g a) That the private w out to Crai vflle Beach Road be improved to service the subdivision and that the proposed improvements :to the j road be indicated 'on the plan; j b) That the profiles and plans for the construction , of the entrance road from Craigvil.le Beach Road be.. approved by the Engineering Section of the Department -.of Public Works . prior to the endorsement of the plan; c) That areas to contain overflow runoff from the leaching. drainage systems." be installed at the road low ' points, and that overflow areas be sized to handle the design storm; 4) That the connecting road between Tobey Way (a thirty-five - (35) foot layout) and Craigville Beach Road to be within a thirty (30) foot layout. Respectfully, Jose Bartell , Chairman Barns able . Planning Board JEB:vk .f § 240-123 BARNSTABLE CODE § 240-125 E. Penalties. Anyone convicted of a violation under this chapter shall be fined not more than $300 for each offense. Each day that such violation continues shall constitute a separate offense. § 240-124. Bonds and permits. A. Performance bonds required. A performance bond of not less than $4 per foot of frontage against possible costs due to erosion or damage within passable street rights-of-way shall be required by the Building Commissioner prior to authorization of any new building, and a bond or cash security may be required by the Building Commissioner for other construction, such bond or cash security to be held by the Town Treasurer until an occupancy permit is granted as provided for in Subsection B herein. Prior to the, proceeding with construction above the foundation, a registered land surveyor shall certify that the structure has been located in compliance with all yard requirements. B. Occupancy permits. No premises and no building or structure erected, altered or in any way changed as,to construction or use, under a permit or otherwise, shall be occupied or used without an occupancy permit signed by the Building Commissioner. Such permit shall not be issued until the premises, building or structure and its uses and accessory uses comply in all respects with this chapter. § 240-125. Zoning Board of Appeals. A. Establishment of the Board. The Zoning Board of Appeals established by Chapter 215 of the Acts of 1984, as amended by Chapter 295 of the Acts of 1984 and as may be further amended from time to time, is,the Zoning Board of Appeals referred to herein. (1) Membership of the Board. The Zoning Board of Appeals shall consist of five members appointed by the Town Council of the Town of Barnstable. (2) Term of office. Members of the Zoning Board of Appeals shall be appointed for three-year terms so arranged that as nearly as possible 1/3 of the terms shall expire each year. (3) Associate Board members. The Town Council may appoint not more than six associate members for similar terms as provided in Subsection A(2). (4) Election of officers.The Zoning Board of Appeals shall elect a Chairman and clerk from its own membership each year. (5) Removal of members. Members may only be removed for cause by:the Town Council after a hearing. (6) Vacancies. In case of a vacancy, inability to act, or interest on the part of a member of the Board, the Chairman of the Zoning Board of Appeals may designate a duly appointed associate member to act to fill the vacancy. B. General powers. 240:174 05-15-Zoos `Engineering Dept. (3rd floor) Map Lf'-7 Parcel a,�- Permit# i261 y_3 House# Date Issued i 21,Z6.1 Board of Health(3rd floor)(8:15 - 9:30/1:00-4:30) G . 9 QJ W /� e Conservation Office (4th floor)(8:30-9:30/ 1:00-2:00) I gigg0,w a-, Planning Dept.(1st floor/School Admin. Bldg.) g 1HE►p�,_ Definitive Plan Approved by Planning Board r _ P' A T SE co A"' �.TO�OF BNSTABL� r Building Permit Applicaf'on EF�� Project Street Add ss �C� /� T � ' TOWN�GULAMON8r r P Village v� ,,pp p Owner cWLJ Address tAh Jo I IV em eleph a 7/ -��-�7�- Permi equest / iC, 7,, first Floor square feet Second Floor �� square feet Construction Type WJ Estimated Project Cost $ Zoning District k- Flood lain c Water Protection Lot Size X�q10? , Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-FamXNo units) Age of Existing Struct Historic House ❑Yes On Old Kin 's Highway ❑Yes 8N0 g g Y Basement Type: Full ❑Crawl / ❑yy Walkout ]Other Basement Finished Area(sq.ft.) rifl7 Basement Unfinished Area(sq.ft) Zu— Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not incl ing baths): Existing New First Floor Room Count ItHeat'Type and Fuel: Gas ❑Oil ❑Electric ❑Other CeiO;al Air ❑Yes L �O Fireplaces: Existing New Existing wood/coal stove ❑Yes 3 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) 1,Wq ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yps, site plan review# Current Use (�rx / i Proposed Use Q Builder Information �� Name CC,�X,� �/7C� Telephone Number d'�� Address t j License# WJ �� /�� _ Home Improvement Contractor# / Y/� Worker's Compensation# hX,1)(*75 f p?260 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. AA ALL CONSTRU ION DE RIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. Y ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAMES ��, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: R,0 4H FINAL As- FINAL BUILDING y•,>A• s x. DATE CLOSED OUP&, ASSOCIATION PLA�_ t • woyt:Vt:saf eyr<w T sw.rw' sRfUSs a(ssrs) +.._ 1 .. t , � • � MWAJON tlOY,D OVr � �F-0 N• ',,- --.0'.9�.6Y➢[q�. :. .,.. ,- -777— - L £G£�lLyfVOt sex[ � � 5x 08-428-6191 c @lvd 111 YStO111 y5 }t a es gns E ++ - , ResRghU ew" t Gay — ^' " :Z�o E4 T(M Z 7 _ - I '. .: se-at'utstnwr�cau.(.) r Y ] Pre+iminary plans and layouts by DC.O.are for the use of the f customers only.,,ny other use S stM1[tly P, h+Drte r-d. � 4 I r / Iataacs�_ : L r � V� _ y 44 1 I _.._. 08-428•6191 ti a; r o eviin Co3YStOfn nil A ;S � s,`•�"�`;�.x °r��,—i�tueoL�.t+:eEt�Nttatruw.ofa+- 'f - � @5�,8 n rsd K 45 ^G Rn4E f t I.: __ ... _ -. .rd-d.. ... ..::J!'.ULLL.. .9�0• r Z.. M:11'�i0`... .. _�— � - ° t`Or -�L-d ��a�.l'.- 9-d..:.. 'S.9'O 4•LI':.. I. .C�..d ..,:T.•y .. - I • 7rel,m,nary plans and layouts by DC.D.are for the use of their customers only.Any other use,s s[r,[tly proni D,te tq :=':JENNAL'(SiFIAKrI_ES � - tusw.. -vtaVc,wt-LIA* tqd C.t�Drw: iA+, rt 4 l m 05 oi S`� zuc� r42 lot lin w1_ td d ' lin r' 1 I—j—T Y LLi -A '.IGK•:ft4_ED]dt.sY cats.__ ..._........ ,......-..: 6, If � RtSllY40 71 OF fbUwsflbcftol l R3cr' . -� r 7177-11 plans and layouts by DC.D.are for the use of their customers only.Any other use is strictly prohrorte a � AL eZ«bOA/<AS:DR.TNEXW-: [e11n'ttetSlftC!•.uW:lol.t•i• - + .. 13anvtrewn•G--. 4..c5ua.tte Sraatte cswltx � - - _..__r..L�urYn�c:cAsvAcut_ tun3lAsttrttsa:ur)a1 I �INn4\K=CdI��ETAIt YM4:MJ. . ' rtlnre.a is--- ' i. t SSti.L`[�:ti7G1.S"- I 'I IC sate (M1E —�� ` 10 1t15CA\aC3lGRt;. � I•totiTl_.i[l[e75 �ly 508-428.6191 4 JO ----'- R evl in am .CK____—_._ it•C=c SC)n0.^7 .. ._.._.__.:._..._.. i C Resigns _ copyN9nt O 1KS O All RgMs - i••�—r- I i' Rtlenea s . -tanralfEfaOOF1Y:1..... __ J — .0 u 4 � prel�mrnary plans and layouts by DC.D.are for the use of the,Customers only.Any other use s srncrty prom e�te .� I -' ° 90 23542 ON AMENT OF PUBLIC SAFETY P Q Q © 235Y_: ISIAR. ONE ASHBURTON PLACE RM 1301 BOSTON, MA:02108 16181 3 Q 1QQC 3 Z CONSTRUCTION SUPERVISOR LICENSE ( p "J Number: Expires: CS 005867 11/12/1997 �'"`� Restricted To: 00 4 1 r- / n TIMOTHY PEARSON =} , ]Peach bottom, fold sign on POBX 519 M_Y =back, and laminate license card. CENTERVILLE, MA 02632 ; ;Keep .top for receipt and change '-."'.of address notification. p ------------- ;,,\ �1ie 23542 Restricted To: 00 DEPAR"HSN^: OF ?UKHC SAFS°? J C01MRUMON :,UF3RV'S0R 'iCENSS 00 - None Nymoer: Sxp'_res: ?G - 1 & 2 Family Homes estriced a: gai Failure to possess a current edition of the Hassachusetts State Buiilding Code �s cause for revocation of this license. CEN"SRV_1--H, ;lr 02632 - c (—UMMUN WLAI;I H Ur MASSACH USA 7 "I S DEI'ARrMENT OF LNDUSTRIAL ACCIDENTS 600 WASHINGTON STREET amen.: Carn=ec BOSTON, MASSACHUSEITS 02111 or-m:sscone ORKERS' COMPLISATION INSURANCE AFFIDAVIT (liccnxtJperminec) ywichan 'pal plan of business/residen at: (City/Statcr ip) do hereby certify, under the pains and penalties of perjury, that: VTl am an employer providing the following workers' eompens=rion coverage for my emplovc;s working on this job. CI (Dln ) Insurance Company Policy Number [j 1 am a sole proprietor and have no one working for me. [j 1 am a sole proprietor,general contractor or homeowner(cirde one)and have hired the contractors listed b-ox who have the following workers'Compensation insurance polio Name of Conmaor Instrana Company/Policy Number Name of Contractor Insurance Company/Policy Numbe: Ivamc of Contractor Insurance Company/Policy Numbs: 0 1 am a homeowner performing all the work myself. NOTE Ficuc be aware that while homeowners who employ persons to do maintenance,construction or repair work on: dwc?ling of not more than three units in which the homcowacr also resides or on the grounds appurtenant thereto art not gcncr:9,.- considered to be employers under the Workers'Compensation Ae:(GL C 152,aecz. 1(5)),application by a homeowner for a licc:sc or permit rnav evidence the legal status of an employer under the Workc.s'Compensation Act I undc-stzid that a copy of this statement will be forwarded to the DeparTr.-of Industrial Aeadenu'Office of Insu:anet for cove:as: Vc:1:1c2tion and that failure to secure coverage as required undo Section 25A of!u(GL 152 can lead to the imposition of criminal pc.i�u eorsisong of a finc of up to S1500.00 and/or imprisonment of up to one ye`:.,d CiQ penaldes in the form of a Stop Vork Order anc:: finc of S 100.00 a day sins: Sl fncd this day of �G, 19 Licc:iscclPc Liccasor/Pcr mill of � f a `OptNE TO The Town of Barnstable O,e BARASS- E, MASS ` Department of Health Safety and Environmental Services 'plFOMP�p`0 Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correctio otice Type of Inspection Location � � t,,t11q�.��Permit ber Owner &l.le LOD C _ � Builder � (q�,(-ta u o►-� One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: �o l S y ' t I Ut- !�I� CAS E' �� ,t8i W�� — kid n Please call: 508-790-6227 for re-inspection. r e .� Inspected by - t,4A _ Date s ' v f N 0 WAY T OBEY R'12 27 0 .00. 58 w " a 50 •�, o R•4726' LOT I J M N 269/2 + S.F. N .hb hfo s9 ♦♦`�� \ /37.04- \ N 84'03'I9-W F 24-s ay a e hh N 6 h 52.83 I07.79' a N 88.55'24'W a N 86.55'30-W 0 b O `u tl) ZONE RB I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SETBACKS KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING FRONT - 20" SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS SIDE /0' OF THE ZONING BY-LAW FOR THE R-B DISTRICT. REAR - l 0' PROPERTY LINES SHOWN HEREON WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY S FRANK ON THE GROUND. `' WNlTIfVG �1 N0.29669IST 0 THE DWELLING DEPICTED ON THIS �s�., g� PLOT PLAN PLAN WAS LOCATED ON THE GROUND , � �p�,� �� , _ . wti,,,�"� �� 1N BY SURVEY ON JAN. 6. 1997 AND BARNSTABLE. MASS. EXISTS AS SHOWN AS OF THE DATE OF LOCATION. SCALE: I'-40' JAN. 14. 1997 THIS PLAN IS FOR PLOT PLAN EAGLE SURVEYING 8 ENGINEERING.INC. PURPOSES ONLY AND NOT FOR 923 Route 6A RECORDING. DEED DESCRIPTIONS Yarmo uthpor t. JIA. 02675 OR ESTABLISHING PROPERTY LINES. (508) 362-8132 (508) 432-5333 THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. 0 20 40 80 PROJECT N0. 95-240-I3 �:- �..-- --�- - --------- f(-� `�,� _ F � ®� � y _,� � �7 � ��{ 3 �� P °-��.. �-� - � S � � -- tooni�nauoeal�i ��f�,�Q�f,�� ►' Massachusetts - Department of Public Safety Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR a t'Type Construction Supers isur - t = Registration: ,,132691 License: CS-078000 s Expiration: 3/2312013 Individual SC QUIETER SCOTT H QUELNER -Id PO BOX 727 iA W HYANN10?ORT MAC OZ672 l SCOTT QUIETER \ - 247 STRAWBERRI�\HILLIRD CENTERVILLE, MA 02632 Undersecretary 41` Expiration Commissioner 02/03/2014 ,r ,. ��.. ._ dlv►dul- use only return to or registrationva i If.found I;icense ulation irat Affairs date. usiness Reg before the e"P {fairs And'B "�" 7 office of`Consui►►er 70 10 parw-plaza-Suite 51 F•I° Boston,MA 02116 nature valid W riof thoutsig a r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. C7GV9 Parcel Application Health Division Date Issued Conservation Division Application Fe b Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �� "R"13 ' Historic - OKH Preservation/ Hyannis Project Street Address e Village Owner Address aur/&-, Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed. Total new Zoning District Flood od Plain Groundwater Overlay Project Valuation onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attachws pportinM-�1ocuEgentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# --,nits) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King,^ Highway: ❑ ❑ No I Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. ) -0 5 Number of Baths: Full: existing new Half: existing r ew Number of Bedrooms: existing —new Total Room Count (not including bath,): 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 �� /�7 C;/e�` L� Telephone Number �t1�C V/ Crc;li y/ Address Lei ,OPI icense # U +' O ome Improvement Contractor# ; (0 Worker's Compensation # /,s� "0 ��000 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS ROJECT WILL BETAKEN O \J SIGNATURE W-&-404 DATE 21 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. I k ADDRESS VILLAGE OWNER DATE OF INSPECTION: _FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. Office ofInvestigakons 600 Washington Street Boston,MA 02111 www.mass govldia Workers' Compensation Inawahce Affidavit: Builders/Contractors/EIectricians/Plumbers A .. licant Information - Please Print Le ' I . Name(Busmess/organizadM&Idividual) Address:. City/State/Zip: 1e U Phone.#: [ � 7 f Are you an employer? Check the appropriate box: Type of project'(required):• 1•❑ I am a employer with 4•❑ I am a general contractor and I emplo, s (full and/or part time).* leave hired the stab-contractors 6 0 New constraction.. 2. am a'sole proprietor or partner- listed on the'attached sheet"' 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me iii any capacity: employees and have workers' 9• Bttr7 " ' addition -.[No workers' comp.insurance•. comp,inenranceJ ❑ required,] 5. ❑-We are a corporation and its 10.❑-Electrical repairs or additions 3.❑ I am'a homeowner do' 01*w6rk officers have exercised their 11. PI❑Plumbing repairs or.additions , myself. [No workers'comp. right of exemption per MGL, 12.0 Roof repairs insurance required_]t ' c. 152, §1(4), and we have no employees.[No workers' 13.�ther ' comp.insurance required.] *Any applicant that cheeks box#1 must also fin out the section below.showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors that check this box mast attached an additional sheet showing the name of the sub canixaetors and state whether or not those entities have employees. If the sub-cmtrsctors have employees,they must provide their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# Expiration Date: � • Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Fail are.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of canal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as-well as civil penalties in.the four of a STOP WORK ORDER and a fine of up to$250:00 a day against a violator. Be advised that a copy of this statement may be forwarded to the Office of Iuvesti ons of the DIA uuance covera a verification I do hereby certify and the pains•and p es o p ury that the information provided above is true it correct S" tare: Date: r3. : Phone#: Official we.only. Do not write in this area tb be completed by city or town offieiat City or TI'awn• Permit/License# Issuing Authority(circle one): .'L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector I PIumbing Ins�ctor. 6. Outer Contact Pe�rsgn: P.hone#: .: ' Town of Barnstable - •' THE?� - * Regulatory Services ma Thomas B.Geiler,Director. Building.Division Tom Perry,Building.Commissioner 200 Mafia Street,Hyannis,MA 02601 www.town.barnstable.maa s Office: 508-862-403 8 Fax: .508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject ptoperty hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. be h��s (Address of Job **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. tore of Own Signature of Applicant ram,,0- v e; Prin Name Print Name l 0201-3 Q:FoFMS:0WNERPERWSSI0NP00L4 62012 o° 5,t900 NA 7 cZ ' 0 Gqq _ LZ � �. 4� o� DE•CK �. 5,1gG'�� . ' STAKE SET M � " . ,07 TOWN OF BARNS.TABLE. TONING 5 B - or+51. 1� 0� SETBACKS FRONT - 20' Z. SIDE - 10' Zk REAR /0' E-P-T-.L-O OMPONENTS TAKEN ct1Z .g� 7.FR64 AS BUILT CARD. _ PLOT PLAN-• lb- THE DWELLING-DEPICTED_0N-_TNI.6- =- ' _ . 289 _,OBEYL- AY, MAP 247., PARCEL 251 PLAN WAS LOCA-TED-ON FHE--GROUNDd — BY SUR+lEY.f N-SEPT. 29_ 2010 44, BARWSTf4BLE. MA, _ AND EXISTS AS SHOWN-AS-OF THE s SCALE: I '-40' OCT. 191 20/0 DATE OF LOCATION. �� a�� h AGLE SURVEYING, INC THIS PLAN IS FOR. PLOT PLAN . 923 Tcut® 8A PURPOSES.ONLY AND-NOT FOR varmouthpart, tea. 02675 (5") 362-8132 RECORDING OR DEED--DESER 1-P T-I OffS f (W8) 4a2-W33 THIS PLAN IS VOID IF. NOT STAMPED AND SIGNED IN RED. 0 20 40 80 PROJECT N0. IG-l03 x a r �a use i i r x Y6 dswk IF-A-t;rle f y .012 etOf e o6 (e { I MIS �U 'j WN I 4&4 lP . � Q � IT -- NI i 1 Y� � �r 4 I` 1 Ra 1 i . � � � A � �1 it J � � 1 s 1 I � '� .•.�s4a..�.�..e..,.:.P.. I I�,� `� � T � i� � - 1 ......� -r�,mmb�mm:..wml�s✓ wi.�t'� �a r ��, � T� ; � . �' , i 40 CL it lie 1 7 °F 7HE T own of Barnstable, MassAchusetts Department of Planning and Development ' "g`E' ` Office of The Planning Board y Mass. � , z6 � �ATFo MPt A` 367 Main Street, Hyannis, Massachusetts 02601 (508) 775-1120 ext. 190 July 25,- 1989 co 1..r r- Aune Cahoon, . Town Clerk Town of Barnstable _n " Town Hall ru ' 367 Main Street Hyannis, MA 02601 . Re: DEFINITIVE SUBDIVISION 9366 Open Space Subdivision $#366; "Washington Farms Estates"; Subdivision Plan of Land in (West Hyannisport) Barnstable, Mass . Prepared for George Tobey Scale 1 "=50' ; Plan dated 05/08/89, and revised 07/24/89; Down Cape Engineering; 13 lots ; located north off r Craigville Beach Road, ,east of Strawberry Hill Road,; southwest .o.f Old Hyannisport Road, abutting COMM property, West Hyannisport; Assessor's Map 247, Parcel 225 & 227-254. At a duly posted meeting of the Barnstable Planning Board held July 24, 1989, it was voted to APPROVE the issuance of a SPECIAL PERMIT pursuant to Section 3--1 .6 of the Zoning Bylaw of the Town of -Barnstable subject to the following: 1 ) The approval as to form, by the Town Attorney, of the materials called for. under Section 3-1 . 6 ( 10) (d) of the Zoning Bylaw of the Town of Barnstable, said materials including, but not limited to, the management plans for all common areas and structures; 2) The recording of the Town of Barnstable Open Space Residential District Open Space Restrictions and Easement Form, and evidence. of that recording supplied to the Planning Board, within (ninety) 90 days after the date the plan is endorsed by the Planning Board; .3) That the applicant be granted a waiver from Section 3- 1 .6 (6) .. "Bulk Regulations" of the Zoning Bylaw of the Town of Banrstable, and be allowed to reduce the width, of the perimeter strip as. shown on the above captioned plan; 4) That the app 1 i cant, be granted a waiver from ._Section. 3- 1 -6. (,6) ."By 1 k Regulations" of the Zoning... Bylaw of the Town of Barn.st-abte, and' be allowed to reduce the side and rear yard setbacks from the the,, ten 3 � ( 10) feet normally required in the RB - Residential District - to seven and one half (7 112) feet. At the same July 241, 1989 meeting, it was voted to APPROVE the above captioned DEFINITIVE subdivision subject to the following: 1 ) All the recommendations of the Board of Health; 2) All the requirements of the Town of Barnstable Subdivision Rules , and .Regulations, except that the applicant be granted waivers so as to. allow them to construct Tobey Way within a thirty-five (35) foot layout where . shown on the above captioned plan, and' wIthIn a forty (40) foot layout where shown on the above captioned. plan; 3) All the recommendations of the Department of Public Works as follows: a) That the private way out to Craigville Beach Road be, improved to service the subdivision and that the proposed improvements to the j 'road be i nd 1 cated 'on the plan; b) That the profiles and plans for the construction of the entrance road from Craigvil.le Beach Road be approved by the Engineering Section of the Department of Public Works prior to the endorsement of the plan; c) That areas to contain overflow runoff from the leaching drainage systems. be installed at the road low " points , and that overflow areas be sized to handle the design storm; 4) That the connecting road between Tobey Way ,(a thirty-five (35) foot layout) and Craigville Beach Road to be within a thirty (30) foot layout. Respectfully, ��CS7�cJ�t Jose Bartell , Chairman Barns able Planning Board JEB:vk § 240-123 BARNSTABLE CODE § 240-125 E. Penalties. Anyone convicted of a violation under this chapter shall be fined not more than $300 for each offense. Each day that such violation continues shall constitute a separate offense. § 240-124. Bonds and permits. A. Performance bonds required. A performance bond of not less than $4 per foot of frontage against possible costs due to erosion or damage within.passable street rights-of-way shall be required by the Building Commissioner prior to authorization of any new building, and a bond or cash security may be required by the Building Commissioner for other construction, such bond or cash security to be held by the Town Treasurer until an occupancy permit is granted as provided for in Subsection B herein. Prior to the proceeding with construction above the foundation, a registered land surveyor shall certify that the structure has been located in compliance with all yard requirements. B. Occupancy permits. No premises and no building or structure erected, altered or in any way changed as to construction or use, under a permit or otherwise, shall be occupied or used without an occupancy permit signed by the Building Commissioner. Such permit shall not be issued until the premises, building or structure and its uses and accessory uses comply in all respects with this chapter. § 240-125. Zoning Board of Appeals. A. Establishment of the Board. The Zoning Board of Appeals established by Chapter 215 of the Acts of 1984, as amended by Chapter 295 of the Acts of 1984 and as may be further amended from time to time, is the Zoning Board of Appeals referred to herein. (1) Membership of the Board. The Zoning Board of Appeals shall consist of five members appointed by the Town Council of the Town of Barnstable. (2) Term of office. Members of the Zoning Board of Appeals shall be appointed for three-year terms so arranged that as nearly as possible 1/3 of the terms shall expire each year. (3) Associate Board members. The Town Council may appoint not more than six associate members for similar terms as provided in Subsection A(2). (4) Election of officers. The Zoning Board of Appeals shall elect a Chairman and clerk from its own membership each year. (5) Removal of members. Members may only be removed for cause by the Town Council after a hearing. (6) Vacancies. In case of a vacancy, inability to act, or interest on the part of a member of the Board, the Chairman of the Zoning Board of Appeals may designate a duly appointed associate member to act to fill the vacancy. B. General powers. 240:174 05-15-200s A Details Page 1 of 1 Licensee Details Demographic Information Full Name: SCOTT H QUILTER Gender: Owner Name: License Address Information Address: Address 2: City: W HYANNISPORT State: MA ipcode: 02672 .Country: United States License Information License No: CS-078000 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 2/24/2012 Issue Date: 3/3/2010 Expiration Date: 2/3/2014 License Status: Active Today's Date: 3/8/2013 Secondary License: Doing Business As: Status Change: 18 Prere uisite Information No Prerequisite Information Discipline No Discipline Information Documentum http://elicense.chs.state.ma.usNerification/Details.aspx?agency_id=1&license_id=266949& 3/8/2013 Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation -� Home Consumer Home Improvement Contracting HIC Registration Complaints ��1111 Registration# 132691 Home Improvement Contractor Registrant Registration Home Page Name SCOTT QUILTER Address 247 STRAWBERRY HILL RD. City, State Zip CENTERVILLE, MA 02632 Expiration Date. 03/23/2013 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=32921 3/8/2013 I-OrPOESS PERMIT Town of Barnstable *Permit �d 0 ` Fxpires nths rom is a date Regulatory Services Fee ■nRrtsraers M"m' Thomas F.Geiler,Director TOWN � �639 ,� ^ !l4 TA13L.e 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 a J Not Valid without Red X-Press Imprint Map/parcel NumberC.r_ Property Address 0 esidential Value of Work 6 9A,°D Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address��/ �~T r a i tt< j C,Ba- AlIdA-a. CT _�, 4_1 I'll- Q/- V,3�?o _t5/el Contractor's Name A,, Zf.Telephone Number s_0o c? /63� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 999/ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner O have Worker's Compensation Insurance Insurance Company Name +2 Workman's Comp.Policy fin/(?Ld Copy of Insurance Compliance Certificate must accompany each permit. Permit Request check box) roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit.does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. ***Note: Property Owner must sign Property Owner Letter of Permission. 'A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppDataNLocal\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QWZUBN\EXPRESS.doc Revised 053012 i The Commonwealth of Massachusetts __ _ __ Department of Industrial Accidents - Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): D'o,G `"-te —AS �r-31 t ary ,►.x. Address: City/State/Zip: Qdi Phone #: SW ?"291 IK Are you an employer?Check the appropriate box: Type of project(required): 1.E94 6mua a employer with_J_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling- ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.[ oof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name: �"� r►,t 1,c/ S- Policy#or Self-ins.Lic.#: 1 3 V Expiration Date: ;z- Job Site Address: k&_ City/State/Zip: d., Attach a copy of the workers'com ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert6 under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 10 - lc2.. Phone#: ►�L. �7� 3.2� /63� Official use only. Do not write in this area,to be completed by city or town ofticia[ City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . . 506-326-1635 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com P.O. BOX 168 Bse. CENTERVILLE, MA 02632 Fully Licensed & Insured Construction Supervisor Lic# 99913 Doyle and Thomas Inc.Proposes to perform the following work: Location of proposed work: Mr. &Mrs.Zive 289 Tobey Way Centerville, MA 02632 Date on which construction should begin: October 2012 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $6,614.03 GAF/Elk Timberline High Definition architectural shingles(Lifetime Ltd.Warranty) In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30.00 for a carpenters laborer, plus the cost of materials. Thank You For Giving Us The Opportunity To Help You Improve -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier and synthetic roof underlayment, installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -All new 8 inch drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -Timberetex premium ridge cap to be installed -5 yard dump trailer will be needed on site;and will be removed at completion of the job -All gutters will be cleaned at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner Contractor AC40RV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°°/YYYY) 08/14/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Donna OstroWSkl Mark Sylvia Insurance Agency,LLC PHONE FAX 404 Main Street c o 508 957-2125 AIc No): E-MAIL ADDRESS: Centerville,MA 02632 INSURERS AFFORDING COVERAGE NAIC# wsURERA: Farm Family Casualty Insurance INSURED INSURER B: Doyle& Thomas Construction, Inc. INSURER C: PO Box 168 Centerville,MA 02632-0168 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A GENERAL LIABILITY 2001XO485 7/21/2012 7/21/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 CLAIMS-MADE FX] OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ hDXE ESS LIAR HCLAIMS-MADE AGGREGATE $ I I RETENTION$ $ A WORKERS COMPENSATION 2001 W6390 7/1/2012 7/1/2013 WC STATU- X OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETORIPARTNER/EXECUTIVE Y/N N A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Carpentry I CERTIFICATE HOLDER CANCELLATION (508)420-7989 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Doyle&Thomas Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD —� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME,IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 5'145954 Type: Office of Consumer Affairs and Business Regulation Expiration 3/15/20,1,3 Private Corporation 10 Park Plaza-Suite 5170 =_s==-=; Boston,MA 02116 lug EH:Y DOYLE+THOMAS CONST INC TROY THOMAS '� J 499 NOTTINGHAM DR ' ` 4 CENTERVILLE, MA 02633"- ' Undersecretary Not v id w• out signature � aft Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Super isor SpeciultN License: CSSL-099913 4. TROY A THODI iS 499 NOTTWOHA10IiDRIVE CENTERVII�LE iYIA 02632 Expiration Commissioner' 04/13/2014 - -1 .635 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com 4 P.O. BOX 168 1► CENTERVILLE, MA 02632 Fully Licensed( �:& insured Constr uction.vuN2r [sl�l Li 95.�71:3 Doyle and Thomas Inc. Proposes to perform the following work: Location of proposed work; Mr. & Mrs. Zive 289 Tobey Way Centerville, MA 02632 Date on which construction should begin: October 2012 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as,a violation of this contract: The contractor agrees..that whenSuch delays become known to.the contractor,the:contractor will advise the homeo.wne.r as soon as possible. The homeowner hereby acknowledges that.i,n certain remodeling work,the demolition process may reveal defects-in the existing structure which must be repaired,'creating,additional work which may. need to be carried out in order to complete the.work described in this contract. ln:su.ch case the homeowner agrees that the. duration of the .work:and the schedule.date of corn,pletion,may differ;:and that such variation,is not to be considered a violation of this contract. The total cost for labor and materials under this contract:. $6,614.03 GAF/Elk Timberline High Definition architectural shingles (Lifetime Ltd: Warranty.) Proposal to install Azek PVC on-all rake boards&facia would be an additional $.2;100,00 In the event that while stripping the roof or trim we find rot that needs,to be replaced,the i. homeowner then:has.to agree and authorize any replacement or restoration. Then in.a.dditio.p.to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30 OO.for a carpenters.laborer; plus the cost of materials. "hank You, Por Uiv'nq Us The Or;; o.-curilty To Heir Yot j lrnnrnv. Roof to be stripped arid Cleaned of all old shingles and debris Roof to be papered with weather watch leak barrier and synthetic roof underlayment; installed with Timberline architectural shingles using,galvanized nails. (Storm nailed) -All new 8 inch drip edge.;and pipe flan-ges to..be installed Cobra ridge vent to be installedl on ail ridges. Timberetez premium ridge cap to be installed -Azek PVC trim to be,install with Cortex screwed fastening system'as discussed -5 yard dump trailer will be needed on.site;,and will be removed at completion of the job -AIl,gutters will be cleaned Zit comp[Lation of the job -Contractor will be responsible for all building,permits needed at the property NO TICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. - Further payments under this contract are as follows- 1/2 of the estimate due at the start;and remainder due at completion of the,job. Balance of all materials andIabor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due: Any payments which are delayed shall be subject to:a finance charge of 1.5,per month. The contractorwarranties the work completed.underthis contract for a period of one year from the date of completion. During the stated.warranty period the contractor shall be,responsible for'the service of the repair or adjustment,:.but the contractor shall not be responsible.for the normal maintenance, repair due to abuse; misuse, and or normal wear and tear,whi.ch.shall be the responsibility o'f`the homeowner. All warranties for the materials supplied by the contractor shall be.passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of. ownership in order to activate such warranties, Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;.the choice.of repair of replacement shall beat the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained.in this contract are intended to complywiththe applicable portionsrofthe Mass. General:Law Chapter 142A, and regulations promulgated there under. in the event of any instance of non-compliance, only such portion shall.be invalid and,the remainder of this contract shall be iri full force effect. .ln addition,any such portion not in:compliance shall be.read-and interpreted so.as to have its intended meaning to the maximum extent allowed-under such,law and regulation. r Signed As.a sealed,instrument on'this date: Date, /a Homeow r Contractor . Town of Barnstable *Permit# O� Expires 6 mantles from issue date i Regulatory Services Feed BARNSMU 9 1 ,d� Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - .RESIDENTIAL ONLY Not VaUd without Red X-Press rint Map/parcel Number o� Property Address esidential Value of Work Alinimum fee of$35.00 for work under$6000.00 Owner's Name&Address (..., Contractor's Name- � — r Telephone Number Home Impiovement Contractor License#(if applicable)_/ 6 �9 Construction Supervisor's License#(if applicable) sir (f ac ++��++ C p� ❑Workman's Compensation Insurance X-P R E S�7 P E R IVi l Check am a sole proprietor ❑ I am the Homeowner 0 C T - '1 2.012 ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over- wdsting-layers of roof) ❑ Re-sid #of doors Replacement Windows/doors/sliders:U-Value (maximum.35)#of windows' Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required El Separate EIectrical&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 c of the Home Improv t Contractors License&Construction Supervisors License-is re. u red.. SIGNATURE: Q:VWPF=ST0RMnurlding permit forms\EQRESS.doG Revised 053012 • - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston,.MA 02111 www.mass.gov/dia Workers' Compensation Insurance -davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: P one.#: � Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer.with 4. ❑ I am a general contractor and I e yees (full and/or.part-time). * have hired the sub.-contractors 6. New construction . . 2. am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y p h'• $ . 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its . 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 131Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of.a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DJk for insurance coverage verification. I do hereby certify u er the pains and p na f rjury that the information provided above is true and correct. . �Signafore: Date: J147 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: a Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". , Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to.the Department of Industrial Accidents for conformation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their . self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perm it/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in__(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner.or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, IOTA G2111 Tel. #617-727-4900 ext 406 or 1-977-MASS.AFE i Revised 11-22-06 Fax#617;�727-7749 www.mass.gov/dia �4 oF� * BnaxSreBL& • MASS, Town of Barnstable 9 1639. Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO. Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ina.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, CA t %a," . \/(f,. , as Owner of the subject property hereby authorize Seo& Ovrl -F.#e-. to act on my behalf, in all matters relative to work authorized by this building permit application for: 2-81 To4Fy k1A 14YAwiis, MA ozfoor (Address of Job) 10 Si Ile of 0 / Date - P If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESIFORMSIbuilding permit forms\EXPRESS.dop Revised 051811 l�t �t Town of Barnstable Regulatory Services ' B IL 'tMST.,014Thomas F. Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyanni§,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 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 certifythat he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc wised 051811 Massachusetts)-.Department*of Public Safety "--- j Board of Building Regulations and Standards omen A ff uea&/o��i9 tcraQ c ' g g � Office of Consumer Affairs&B smess.Regulanon , Construction Sup�r�isur HOMEAMPROVEMENT.CON'TRACTOR License. CS-078000 Registration-.F �cT'i'S v . Expiration: TYPe: ° �2013 SCOTT H QiTIL�ER `_ "r j' Individual PO BOX 7Z7_` > ' W HYANNI*O v SCOTT QUILTER` }� 1 14j 247 STRAWBERRY`HIC CENTERVILLE, MA de;32 t41� Expiration Commissioner 02/03/2014 Undersecretary .ti:a MP PIMI ....T . -- License or registration'vand for individul use only before the expiration date If found return to: _} Office of Consumer Affairs an&Business Regulation fif 10 Park.P-laza-Suite 5170 i Bo$ton,MA 02116. si i; Not valid without.signature - t t TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 247 251 GEOBASE ID 35610 ADDRESS 289 TOBEY WAY PHONE W HYANNISPORT ZIP - LOT 13 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY g. PERMIT 24763 DESCRIP`.CION SINGLE FAMILY DWELLING (BLD PMT #20143) PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety i ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 CONSTRUCTION COSTS $.00 753 MISC_ NOT CODED ELSEWHERE * BABIVSTABM • MASS. OWNER CHANNEL, DEVELOPMENT CORP 163 A� ADDRESS FD MA'S 110 BREEDS HILL ROAD HYANN I S MA BUILDIN- O v BY DATE ISSUED 08/01/1997 EXPIRATION DATE - ---------1 �9 � r'p�^yy:� DR'SRNi�..1TXkDd:d3.`a BUILDING PERMIT %ter 4 'S s � PARCEL ID 247 251 GEOBASE ID ' 35610 :ADDRESS 289 TOBEY WAY PHONE W. Hyannisport. ZIP LOT 13, BLOCK LOT SIZE DBA DEVELOPMENT ' DISTRICT HY PERMIT 20143 DESCRIPTION SINGLE FAMILY DWELLING (SEWAGE PKT 496-_679) PERMIT TYP +. BUILD TITLE NEW RESIDENTIAL BLDG PMT � i CONTRACTORS: MARKWOOD CORPORATION Department of Health, Safety ,{ ARCHITECTS: and Environmental Services TOTAL FEES: $248.26 THE BOND $.00 CONSTRUCTION COSTS $80,080.00 - 101. SINGLE FAM HOME DETACHED 1 PRIVATE P � ABLE, •' MA83. OWNER MARKWOOD CORPORATION, i639. ADDRESS UNIT -10 �ED MfC� 110 BREED'S HILL ROAD BUILDIN� D�VI O � HYANNIS, MA BY g� DATE ISSUED 12/26/1996 EXPIRATION DAik THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO ITIS BUILDING INSPECTION APPROVALS pPLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS :Vq q7 doV D/JV/,v d"/a/Z!L ` 2 2 rjZ71 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I CE 1 2 9- 1 01 ) BOARD OSHtLTH OTHER: SITE PLAN REVIEW APPROVAL CO /40 WORK SHALL N PROCE D IL PERMIT WILL BECOME NULL AND VOID IF CON- LINSPECTIONS INDICATED ON THIS THE INSPECTOR ASAPPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX N BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS NE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. r BUILDING � PERM IT GENERAL NOTES : INVERT ELEVATIONS : DESIGN CR I TER I A : ACCESS COVERS MUST BE WITHIN INVERT AT BUILDING: 30. 0 _ DESIGN FLOW: I. THIS PLAN IS FOR THE DESIGN AND 33. 0 /2' OF FINISH GRADE 3 BEDROOMS AT / 10 G. P. D. PER CONSTRUCTION OF THE SEWAGE DISPOSAL FIRST 2 ' TO INVERT /N SEPTIC TANK: _ 29, 65 SYSTEM ONLY. BE LEVEL INVERT OUT SEP T/C TANK: 29. 0 _ BEDROOM EQUALS 330_G. P. D. - - INVERT /N DIST. BOX: 28, 8__ 2, ALL CONSTRUCTION METHODS AND MATERIALS 4' PVC -- -MIN. 2' OF NO GARBAGE GRINDER AND MAINTENANCE of THE SEPTIC SYSTEM SCHEDULE 0 0 ;r PEASTONE INVERT OUT D/ST. BOX: 28. 63 -_ SHALL CONFORM TO MASS. D.E.P. TITLE 5 0 O 1 INVERT /N LEACH PIT: 28. 0 _ AND LOCAL BOARD OF HEALTH REGULATIONS. �'�-- 3.5 3/4' - l l/2' D/A. SEPTIC TANK REQUIRED: 3 OUTLET 24 5 WASHED STONE BOTTOM OF LEACH PIT: 24. 5 330 G. P. D. X I50V - 495 GAL . J. ALL SEPTIC SYSTEM COMPONENTS LOCATED /0' MIN. 1000 GAL D-BOX ADJUSTED GROUND WATER: N/A 6�---�� SEPTIC TANK PROVIDED: l00�-GAL . UNDER AREAS SUBJECT TO VEHICULAR TRAFFIC SEPTIC TANK LEACH PIT OBSERVED GROUND WATER: N/A OR GREATER THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITHSTANDING H-20 WHEEL LOADS. PROFILE : NOT TO SCALE BOTTOM OF TEST HOLE: _ !8. 7 _ SIZE OF LEACHING FACILITY REQUIRED: 330 G. P. D. 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 - 2 MIN/I NCH DESIGN PERC RATE OR APPROVED EQUAL. 24.40 25.60 \� 1 i� i 1 V PROVIDED: I 4 'P/ T(S) W/ 3'STN. 5. BEFORE CONSTRUCTION CALL 'D/G-SAFE•. a 24.3 // \ I \ T�j A^ / j '' 1-800-322-4844 AND THE LOCAL WATER DEPT. I / I j/ j ' �/ 27.92 �/ �� S I DEWALL : 132 S. F. X- 2. 5 -_330 GPD I ( / J7.2 J CAT $AS(N I - / / �' �'4 FOR LOCATION OF UNDERGROUND UTILITIES. - ,,t II i �2/ ( I B _ /�,�/ /� I BOTTOM: 113 S. F. X l , 0 - 113 GPD I I T 0 245 F. 443 GPD TOTAL S. 6. VERTICAL DATUM /S: ASSUMED 7. FOR BENCH MARKS SET. SEE 51TE PLAN. / 24,Js `-��\ /� ��I 2s.ls 25.98 ------ SOIL JI �1 lI /1 / -_-- I I ` SOIL TEST PIT DA TA 24.4e / -----f 1 I I / I 8. NO DETERMINATION HAS BEEN MADE AS TO / / / / / / / / J1,B I I 1 / I I INDICATES �_ INDICATES COMPLIANCE WITH DEED RESTRICTIONS OR --- _ ^\ 24•6 / ' ' - I PERCOLATION _ OBSERVED I � ,/ �/ ' /� I// j +/�---_"-'- / � l TEST GROUNDWATER ZONING REGULATIONS. IT SHALL REMAIN , I �` I // // // , I / r-----J II l I P-8493 THE CLIENTS RESPONSIBILITY TO OBTAIN // / I ► 1 I / / / 1 i LOT /3 37.5 ALL PERMITS. SPECIAL PERMITS. VARIANCES /� 2s s \ I �� I I I / / +J4.a i 1 1 �- �Ln GRND EL. 30. 7 ETC. FOR THIS PROJECT. / �' _ \ I i I I I I 1 % % I I I N/A II l / I I c� i G. W.EL. 9. IT SHALL REMA/N THE CLIENT'S RESPONSIBILITY �' �'/ �' e'J`\ _ �-�' ' 2_s i i I I / / I I I �'`0 0 / I I I I / / I 30.7 TO HAVE THE PROPOSED BUILDING FOUNDATION /�/ /' --- PfI s�7FV1' I 1 i � � % � i i � o , TOPSOIL DESIGNED TO ACCOUNT FOR THE EX 1 S T I NG GRADE //' �/' - - _ -______^ /1 ! I I / I I I ► SUBSOIL AND SOIL CONDITIONS AT THE LOCATION OF THE / / .5 L 4 26 /-_ % I I L/O T 13, I I 11 2.5 ' 28.2 PROPOSED BUILDING. I /0. THIS SEPTIC SYSTEM DESIGNED IN ACCORDANCE // -_ti,__---� / / I 34 17 i / - MED 1 UM WITH 3/0 CMR: 15. 005: (5). THE SUBDIVISION WAS e n / i / � � i + // // / FINE ENDORSED BY THE PLANNING BOARD ON AUGUST 8. 1994. // / g�v /�/ I // // / I / / / +30. TES TR/T SAND +31.4 37.8 ,/L o !/' 1211 ha��O ,-'/ ,/' �% -'' ; % /'' /'' /' % \\ 3 NO WATER 18. 7 APR/L 18. 1995 m� io DA TE: I qp os / / / /37, 04 ' { +Jl.0 q h + \ N 84.03• ! -- ' h TEST BY: STEPHEN HAAS WITNESSED BY: ED BARRY +Js.J 2 M l N/!NCH Je.s PER RATE: ;o / RESERVE 4- P/STONE l ) SEPT I CC TANX/ ,/ ' // / _Box S E P T / C S Y S T E-M D E- S / C3 /B3 ' ry -- 1 /07. 79 ' L O T 1 ,3 TO B� Y WAY 4 - - M,4 / N 8B'S5'24'W / I N 86.5,�30'W S A R /V S TA B L E • /' W . HYA /V!V / SPORT PREPARED FOR _ 4 , �♦ SCAL E : / 20 OECEMBER / 8 . G jrNE'L'R I NG . I NC E'14 GL E' .S UR Y.�Y I NG 8z E'N • Ycxz 7zo u theOr t Ma ® 26' 75 G 5333 o !0 20 4o J08 N0: 95-240 FI ELD:RVB/POR CALC: SAH/CFW CHECK: CFW DRN: SAH x allill Itq lY °•y„• yy ,:.�k. �. ,. r .. ... ♦ ._i .. a. '! -may •'T •,. � .. �..y,�,,,,� g, a. ��;+ra ,yam ,.o�uy:..#a �Y�61 ....='w•'t'. ..-....._-.s-.._k- .:,+::.7.!:,B_ ... _.-...�LNc .. ,.. _