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HomeMy WebLinkAbout0294 TOBEY WAY ��� ��9 . � � _ .�� ,. � i �y I lj �� ,' �: t 1 I` vu f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel Application #'✓Ul Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee coo Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 2 I Village V4- 0 yAOP I s Foal Owner Mc.NamkizA. Address Telephone Permit Request Ma Dc-c It l-4on.� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _ Flood Plain Groundwater Overlay 'uu Project Valuation —Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ZZ / S Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ANo On Old King'slghway: ,,d Yeses No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Bathb: Full: existing new Half: existing newer r , C Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: CN'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: a/existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes b,.No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name "ej A&aagc� Telephone Number Address s2naal lmeej License # C S'EA 4 6a 6 5 5- Home Improvement Contractor# A509 Email ct-hP !aU,n19f) eta Worker's Compensation # JWSQ// OJ7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# k DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i�w vv��ul was-r♦a`LiiL+!-VJ tl11�JJ{4Ll i{4J L'-[iJ • "-, Department of Industrial Accidents Oise ofImpestigaduns 600 Washington Street Bostor�,MA 02111 www.mass guPMa Workers' Compensation Insurance Affidavit:Buflders/Contractorsfflectricians/Plmnbers APPlicant Information /Please Print Legibly Name(Business/Orgmmiraiion&dmduaI): "t,e_ D�2r ��l° end 4�1� IOn 1 L✓l Address: City/State/Zip: C6 It.(I -HA o;�4'3 Phone Are you an employer?Check the appropriate bow Type of project(required): 1.MJ am a employer with 4. ❑ I am a general contractor and I employees(fail and/or part time).* have hired the sub-contractors Q New Construction 2.Q I am a sole proprietor or partner- listed oa the attached sheet 7. Q Remodeling ship and have no employees' These sub-conk ctars have 8. (]Demolition woric ag for me in any capacity, employees-and have workers' [No workers'comp.ffism-ance cep•insurance$ 9. ❑Building addition req �] 5. 0 We are a corporation and its 10-Q Electrical repairs or additions officers have exercised then 3.❑ I am.a homeowner doing all work - lI.❑Plumbing repairs or additions myself- [No workers'comp- right of exemption per MGL 12.0 Roof repairs i asara„ce required_]t c,152,§1(4),and we have no employees.[No workers' 13.[]Other comp.msurancerequired..] *Any.applicant that checks box#L must also fill out the section below showing thcirworbrrs'compensation policy information- *Homrowncrs who submit this affidavit indicating they are doing all work and then hue outside contactors mist submit a new affidavit indicating such. :4Contiactors that check this box mnst attached as additional sheet showing the nine of the sub-contractors zndstd--whether or not those entities have employers. If the sob-contactors have employers,they mustprovidc their workers'comp.policy number. I am an amp loyer i of is pravuHng workers'coinpensadwn insurance for my employers Below is the policy and job site information_ Insurance Comp my Name: e8 a�eo, Fme to e rs r? Policy#or Self-ins.Lic.#: W.0 C SO// �-9 7 ExpiratioaDa -_: L f f Job Site Address:/ Y a e�j� City/Sta��/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required imder Section 25A of MGL c- 152 can lead to the imposition of crmmmal penalties of a tine 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$250.00 a day against the violator. Be advised that a copy of tbis statement may be forwarded to the Office of Investigations of the DU for insurance coverage yeri$cation. I do hereby certify under theP P ofp dud the information provided above is true and correct S Date: 4 - - Phone#: ES�e3 $ 7 7-4 9 ? 31) Official use only. Do not write in Phis area:to be cnrrrpleted by city or fawn offtedrrl City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Deparbuent 3. CitylTowa Clerk 4.Electrical Inspector 5.Plumbing Inspector G Other Contact Person: Phone ff: Information and Instructions' "V t , Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pusuant to this statute,an employee is defined as"_.every person in the service of another under aay contract of ltire, express or implied,oral or written." An employer is defined as�as individual,partnership,association,corporation or other legal entity,or any two or more of the foregomg engaged in a joint enterprise,and including the legal represeatatives of.a deceased employez 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 tbree apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal 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 vvho has not produced.acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor aay of its political subdivisions shall enter into any contracf for the perfuffiance of public work unfit acceptable evidence of compliance with the insurance re pirmmimts of this chapter have been presented to the contracting authority." Applicants PIease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certficate(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 as 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 Accidcnts. 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-insurrn z license number oatbe appropriate lin(-,. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Dep aliment has provided a space at the bottom of the affidavit for you to ER out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill is the permit/license number which will be used as a reference number. Ia addition,an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information Cif 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. Anew 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 CLu. a dog license or permit to bun leaves eta_)said person is NOT required to complete this affidavit The Office of Investigations would hkt to drank you in advance for yom cooperation and should you.have any questions, please do not hesitate to give us a call. The Departm(--nt's address,telephone and fax number: The Commonwealth of Massachusf,-tts - Df--par6nent of Industrial Ac cUdent� Llirice of Iavestig dam 600 Washinton met Baffin.,MA 02111 T,e-L#617-727-4g4Q e)a 4QG or 1-M-MA-SSAFE Revised 4-24-07 Fax#617-727^7749- .u=g,gGv1dia r / t%AA. . ,� ��:rr� �.,• l.,av sc.^-r-wS ic�rfn� vcdGn- �i'� or.c 1�vvsF [zXcojL�G� ('typ� ��1 S Sc„ 1C. O.0 C, i r, ` . J t 4 BARNS TABLE Ito P� f ;� tr kw awl O of 126, <ori ...� ��� It I7 �VE r ti Town of Barnstable Regulatory Services vsnx ASS cs Richard V.Scali,Director 16.396 a�FDNIA�16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, Ste►l,K �V\L�M�IL.. , as Owner of the subject property hereby authorize fv-i ac- to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address fjob) 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 ections are performed and accepted. Signature of Owner ature Applic t Print Name Print Name Dae Q:FORMS:O WNERPERMISS IONPOOLS Town of Barnstable Regulatory Services Doti roiyk Richard V_ScaIi,Director Building Division r Tom Perry,Building Commissioner 1M 3& tia� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 J HOMEOWNER LICENSE EXEMPTION � v Please Print /y DATE: JOB LOCATION: 2 9 `r 1 v'�/v y1 l4V pr l�►N 1 S kpolo ( 1Anumber �st t village "HOMEOWNER": S ` A c W f t A, 4c name home phone# work phone# CURRENT MAILING ADDRESS: cityltown 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 fans 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. _ R The undersi ed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedur and requirements and that he/she will comply with said procedures and requirements. Sign e o omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes&Regulations for Licensing Construction Supervisors,Section 2.15) This Iack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities.require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILFSIFORMSIbuilding permit formslEXPRESS.doc Revised 061313 ' s . V JTAS ".OVEI g PaS _BLE Pi" nm 13 PM Q: 40 _Innovative Structural Engineering s M. Veitas P.E. s N. Veitas P.E. S 'l IN . s J. Dabrila P.E. ck A Wood P.E. November 10,2009 Town of Barnstable W Department of Building Inspection 200 Main Street Hyannis,MA 02601 Re: Helical Pile Underpinning and Wall Stab 294`TobeY4, ay West Hyanisport,MA To Whom it May Concern: Don't Settle.00For Less We have reviewed the installation logs prepar� _ rk at the above referenced property has been completed in accordance with_the stamped engineering plans prepared by this office dated October 21, 2009. All piles have been installed to the required capacity and length as indicated in the plans. Please feel free to call with any questions. Sincerely, Veitas&Veitas Engineers, Inc. Rimas Vei s,P.I 'A OF Prigs 9 File: V&V Closeout Letter RiMANT V, rt g S C� — c. 3 -028 St"_'liC`C7r_l 1'l7211e(.T1Rg • lill:1liiif3 Jc2EPCE • �tStici:;ier:t i_P,S ct101?S • Jesic3al';zui1d c11Ci `•l'ei1_?S "Fl1CJ).Tlee:s. T1c.��r_ 639 Granite;St.reet • $rabit.ree, .MH 02:1.84 • T.' 78:1.-843-2863 • 781-849-2065 • iA7wvT.veitdS.co111 C IDS . geopier® ica i We set it straight! Helical piles • Underpinning • Grouting • Innovative solutions Chad Graybill 639 Granite Street, Braintree,MA 02184 T. 781-848-2110 C:617-719-1092 F: 781-849-2065 Don't Settle For Less 1 chad@helicaldrilling.com • helicaldrilling.com •*• V ET TA S3. V E I FgI STABLE 4 e iA a iS y(q =10? 13 PM Q* 40 Innovative Structural Engineering I Rimas M.Veitas P.E. I � i r Romualdas M.Veitas P.E. >,....' Lims J. Dabrila P.E. _ vi i Jack A.Wood P.E. November 10,2009 r Town of Barnstable y Department of Building Inspection 200 Main Street Hyannis,MA 02601 ' - f Re: Helical Pile Underpinning and Wall Stabilization 294 Tobey Way, West Hyanisport,MA ' To Whom it May Concern: We have reviewed the installation logs prepared by Helical Drilling, Inc. and it is our opinion that the work at the above referenced property has been completed in accordance with the stamped engineering plans prepared by this office dated October 21, 2009. All piles have been installed to the required capacity and length as indicated in the plans. Please feel free to call with any questions. Sincerely, Veitas&Veitas Engineers,Inc. Rimas Vei s,P. 'rA OF MqS 9 File: V&V Closeout Letter + RIMANT' V rn S CT A -c o. 3 028 Structural Engineering • Building Science • Structural Inspections • Design/Build Veitas and Veitas Engineers, Inc. 639 Granite Street • Braintree, MA 02184 9 T: 781-843-2863 • F: 781-849-2065 • www.veitas.com <geopier® ft lical-D 11 � Delivering the Geopier® Foundation System We set it straight! Helical piles • Underpinning • Grouting • Innovative solutions ' November 10, 2009 Annellen McNamara 294 Tobey Way West Hyannisport Re: Foundation Settlement Investigation 294 Tobey Way West Hyannisport Dear Annellen, We have completed the work at the above referenced project. All piles have been installed in accordance with the plans prepared by Veitas and Veitas Engineers dated October 21, 2009. The piles were installed to the proper length and capacity. The piles were connected to the foundation walls and the addition leveled as much as possible. This work will prevent the exterior foundation walls of the addition from further settlement. Per your request,we warrant that the underpinned foundations will not settle more than inches over the next 7 years. It was a pleasure working with you and feel free to call with any questions. Sincerely, Helical Drilling, Inc. LAUJ Chad Graybill File: McNamara Closeout 111009 Helical Drilling Inc. • 639 Granite Street, Braintree, MA 02184 • T: 781-848-21 10 9 F: 781-849-2065 • helicaldrilling.com 1 _ T Town of Barnstable *Permit# Expires 6 months fr m is e Regulatory Services ' Fee srnsr.$ �. Thomas F.Geiler,Director A>ED�s d8�o NM '� B d is / � ullding Dlvision CD 6 Itoz Tom Perry,CBO, Building Commissioner Nn� 200 Main Street,Hyannis,MA 02601 AIM: www.town.barnstable:ma.us �Na" Fax: 508-790-6230 E RMIT APPLICATION = RESIDENTIAL ONLY l f Not Valid without Red X Press Imprint Map/parcel Number Property Address (j.J 4 n 0%► S - esidential Value of Work /� 5 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address AWW rllto me /e r,� R a a !6e p Contractor's Name Telephone Number. <09 Home Improvement Contractor License#(if applicable) Construction.Supervisor's License#(if applicable) ❑Workman's Compensation Insurance. Check one: ❑ I am a sole proprietor ❑ I amthe Homeowner ave Worker's Compensation Insurance Insurance Company Name / 04�`''`'� iN+ Workman's Comp.Policy.# Copy of Insurance Compliance Certificate must.acco,mpany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) . e-side #of doors ❑. Replacement Windows/doors/sliders:U-Value (maximum.35)#of windows *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 red: _ SIGNATURE: QAWPHLESTOR Wbuilding perinit:forms\EXPRESS.doc Revised 05.1811 . 07/06/2011 15:40 5084209227 MARK W SYLVIA PAGE 01 C��a CERTIFICATE OF LIABILITY INSURANCE OAT7M612011 L� a71o6rzo11 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(les)must be endorsed. ff 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 endonsem s. PRODUCER T Mark SYNia Insurance Agency LLC vHlxRe FAX 771 Main Street „dam:(508}4, 94M40VVIA Osterviffe,MA 02655 — INSURERIS)AFFORDINGCOVERAGE NAIL* INSURED INgtiRERA: Form Faff*CB9ueHy IneurHnce Doyle& Thomas Construction,Inc, INSURER a PO Box 166, - --- CenterWlle,MA 02B'32-0166 INSURERC '"MRER D: . INBUM E: _.. .. INBUREH F' - - COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 85EN ISSUED TO THE INSURED.NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTYMMSTANDING 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 POLIDIE0,LIMITS SHOVMI MAY HAVE BEEN REDUCED BY PAID CLAIMS. RNBR TYPEOFIN9URANCR PDLICYNUNBER POD (e N fJfP — LIMITS A oENERALL1AaILTrY 0OIX0405 7/2112411 7/21/2012 EACH OCCURRENCE / 1,000,000 T RE X COMMERCIAL GENERALLII►BILITv PREl dlEa�caarenee� ! 6000D CLAIMS-MADE LJ OCCUR MIA EXP(AM am pwm) 9 51000- �, PERSONAL A ADV INJURY E GENERAL AGGREGATE I)• 2.000,000 GEWL AGGREGATE UMn'APPLIES PER PRODUCTS-COMPA7P AGO a 2,OOa 0a0 X POLICY --Ljg PRcT LDC 0 AuTomoeme Lwnwr COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per pereat) S ALL OWNED AUTOS ODDLY INJURY(Per deeltlaM) _ SCHEDULED AUTOS PROPERTY DAMAGE _ HIRED AUTO$ (Pt mmddono i NON-OWNED AUTOS ! -- UMBRBlA LIAR OCCUR EACH OCCURRENCE I Excess lrela CLaBYI&MADE AO EGATE t pEDUCTHILE RETENTION s I A ANDe ERS' s 2001 W8390 , MX °� �LITY L _ ANY PROPRIETORIPARTNERMECunVE Y/N E.LEACHAccrGENT a GO0,000 OFFICER/11RMeERVOLLIMD7 NIA (Myyaeenss dalwy In NH) E.L.DISEASE•EA EMPLOYE I 500 000 idw DESCIRIPTION OF OPERATIONS MAW E.L.DISEASE-POLICY LIMIT S 600,000 "NOR IP M-1 OP OPERATIONS I LOCATIONS 1 VEHICLES(A1hoRACORD 101,Addilaml ROM10.9*"ft.N men.PW*If 16q*9d) Carpentry CERTIFICATE HOLDER CJINCELLATION (5D6)420-leas Doyle&Thomas Construction Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 168 THE EXPIRATION DATE THEREOF, NOTICE WILL Be ID ELPANED IN Centerville,MA 02632_ ACCORDANCE WTH THE POLICY PROMIONS. AUTmt] RERERNTATNE t LLL ,ti. 0 IM-200 ACORD CORPORATION. All rights reserved. ACORD 25(2009M) The ACORD name and logo are reglstered marks of ACORD P 60Z/£L/b0 u011Caldx3 Jauotsslwwo-) Z£9Z0 'h!i T'I�IIA2IiLLI�I�a t' AI2LQ„ 'H NLL,LOM 66t, S' R.L V AO ILL \WO' 2LL £16660-1SSO :asuadt� . tjta adS.rnsl.�,tadnS unitin.rt`ut'.:) spiepue3S pue suogeln6a6 15ulpling jo pjeog /`fa;eS otIcInd jo;uawytedard sftasnyoesseVv Z h,, �fe iJanz�naozusea i °/11/&J.ac�uaelG2 - =` Office of Consumer Affairs&Business Regulation License or registration valid.for individul use only n before the expiration date. If found return.to: HOME IMPROVEMENT CONTRACTOR i' Registration: 14,5954 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170. y Expiration -.3/151M3 Private Corporation Boston,MA 02116 DOYLE+THOMAS CONST INC< TROY THOMAS 499.NOTTINGHAM DR'- - CENTERVILLE, MA 02632 Undersecretary Not vydid wi out signature s The Commonwealth of Massachusetts Department of InduMrW Accidents Ofjgce of Investigations 600 Washington Street Boston,lllA 02111 www massgov/dia Workers' Compensation Insurance Affldavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business organizadongndividuai): r Address: 0, Rav- 1600 _ b Ci /State/Zi : MA OA 12 Phone#: 1S Are ye as employer?Check the appropriate boo: 1.12 1 am a employer with 4. ❑ I am a general contractor and[ T of project(required): employees(Rill 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. . etnodeling ship and have no employees These sub-contractors have g, ❑Demolition for me in any capacity. employees and have workers' [No workers'comp. insurance comp.Wsurance.t 9. ❑Building addition required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their. 11.0 Phunbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. Roof re insurance required.)t c. 152,§1(4),and we have no Pam 3a.❑ I am a homeowner acting as a employees.[No workers' 13.❑Other general contractor(refer to#4) comp,insurance required.] - •Any applicant that checks box#1 ante also fill out the metion below showing their workers'compmsatkW ooliey ration.t Homeowners who subndt this affidavit indicating they ale doing all wont and then hire outside contractors must submit a new affidavit indicating such. tContrsctors that check this box must attached an additional sheet showing the name of the sub-vort�a and state whether or trot&M entities have employees. If the sttb.contraatoss have employees,they rental provide their workers'comp.policy number I am an employer that is pmiding tvorhers compensation b's rw "for my emp/oyera. information, Below is the policy and fob site Insurance Company Name: �•,,C ' Policy#or Self-ins.Lic.#: _2rto/ .4 3 f 4 Expiration Date- Job Site Address: d City/State/Zip. Attach a copy of the workers'compen ation Policy declaration page(showing the policy number and eaptration date),Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition fins up to$1,500.00 and/or one-yew. of criminal penalties of a y 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 cad# paten and penaltlea of perjury'that the brformatlorr prnvfded above is leer and convett Phone O,�clal use onl}e; Do not writs in thb artra to be Completed by city or town oA?Ciat City or Town: Permit(Licen�# Issuing Authority(circle on 1.Board of Health L Bundlrig Department 3.Cltyll'owd Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone Al. a 508-328-1535 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com _ P.O. BOX 168 BBEk CENTERVILLE, MA 02632 Fully Licensed & Insured Construction Supervisor Lic# 99913 Doyle and Thomas Inc.Proposes to perform the following work: Location of proposed work: Annellen McNamara 294 To bey Way Centerville, MA 02632 Date on which construction should begin: June 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: $14,679.00 Above proposal includes the strip&install of Maibec Double dipped Seacoast shingles Install of Azek pvc trim around windows and two doors as discussed In the event that while stripping the siding 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 -Siding to be stripped and cleaned of all old shingles&debris -Home to be papered with Typar house wrap Maibec Grade A double dipped white cedar siding to be installed -Azek pvc trim to be installed with Cortex Hidden fastening system (screws) -Install of two pvc gable vents -Install of primed red cedar clapboard on both front upper dog houses -5 yard dump trailer will be needed on site; and will be removed 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 G Town of Barnstable �able *Permit# Fxpirra 6 months from issue d Regulatory Services F RIAMTIRT ' i Thomas F. Geiler,Director 1 Building Division AU G Tom Perry,CBO, Building Commissioner F B�vR���'�'-. 200 Main Street,Hyannis,MA 02601 TOWN 0 Office; 508-862-4038 www.town.barnstable.ma us EXPRESS PERMIT APPLICATION - RESIDENTIAL Fax: 508-790-6230 Not Valid without Red X-Press Imprint •Map/parcel Number ��p��0 � I . yanhis Property Address g� 94esidential Value of Work Q , 9 Minimum fee of$35.00 for work under$6000.0 0 1'Owner's Name&Address ti" 04AJ �c NnMAf c, • ° �Aj contractor's Name a+�.ang Telephone Number_ 09 *{1DO . 4 Tome Improvement Contractor License#(if applicable) ;on�struction Supervisor's License#(if applicable)�13 ?workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ 1 have Worker's Compensation Insurance ` 3urance Company Name (:;Z VVI,`` :)rkman's Comp. Policy# J py of Insurance Compliance Certificate must accompany each permit, mit Request(check box) Ld�Re-roof(stripping old shingles) All construction debris will // /��" ��,, be taken U- ���t 1F2� y�-�'s 1 ❑Re-roof(not stripping. Going over existing layers of r000 ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum.44)#of windows *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 Rome Improvement Contractors License& Co required. nstruction Supervisors License is (ATURE: . I ?ILESTORMSIbuilding permit formslEXPRESS.doc The Commonwealth of Massachusetts Department of Industrial Accidents ;1 Office of Invesfigations 600 Washington Street sl i:�a: . Boston,MA 021.7I t 3' www.mass gov/rii d Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (Business/Crganization/IndividtW): � Address: q64, 1po City/State/Zip: ca.t�tce, Q. ,2 Phone #: 3� E01 n employer?Check the appropriate box: FOther project(required) a employer with_ 4. I am'a general contractor and I loyees (full and/or part-time).* have hired the sub-eontraciorsew construction a sole proprietor or partner- listed on the attached sheet. tmodeling and have no employees These sub-contractors have molition ing for me in any capacity. workers' comp. insurance. ilding addition workers' comp, insurance 5. ❑ We are a corporation and its red.] officers have exercised their ctrical rep or additions a homeowner doing all work right of exemption per MGL mbi g repairs or additions lf.[No workers' comp. c. 152, §1(4), and we have no f repairs .nce required] t employees.[No workers' comp..msuiance required.] er *Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policy informadon. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. �Contractnrs that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an anployer that is providing workers'compensation insurance for trry em*ployees Below is the policy and job site information. Insurance Company Name le. Jam/ V Policy#or Self-ins.Lic.#: �Gs Expiration Date: . 2 Job Site Address: �/ O City/State/Zip: Attach a copy of the workers'compensa 'on policy eclaration page (showing the policy number and expiraltion 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 S250.00 a day against the violator. Be advised that a,copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herehy certify and the pains and enaMes of perjury that the information provided above is true and correct 3i afore: 'hone#: �t MY Official use only. Do not write i11 this area;to he completed by city or town"offu ial 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 1 • J 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 io do maintenance, construction`or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency,shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is-required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are.required to'obtain a workers'. compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line: City or Town Officials Is 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 i;i-the'pennit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitAicense 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 Iicenses. A new affidavit must be flied 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 406 or 1-877-MA.SSAFE 1;�- 4 41'7 '7) 7 '7^7A n ry Town of Barnstable ; 0 Regulatory SerYices WARS. $ Thomas F. Genet Director ` Building Division Tom Perry,Building Commissioner 200 Main 5trcct,Hyanais,MA 02501 wwMtown.barnstab ie.ma.us Office; 508-862-403 S Fax: 508-790-623 0 Property Owner'must Complete and Sign This Section _Ifs A Builder as Owner of tjie nj ect I property hereby authorize to act on my behalf, in all matters relative to work authorized by ibis binding permit application for. (Address of Jab) $ignatum of Owner Date print Name If PrOpea Owner is applyi�g for permit pleas e,corn Ie te.the Homeowners Licewe Exemption Form on the reverpe side. Town of Barnstable HE y Regula.td y Services Tbamas F. Geiler,Director �, >« Buildin. `b s439 }mob g Division .oj. ED t�i Tom Peery, ,. _ Buildin g Commissioner . 200 Maui-Sircct; Ayaffiu, MA 02601 • R�r.to�b ai-nsfable_ma..vs ' Ofae: 508-862-4-03 8 Fax: 508-790-6230 HOMEOWNER I.ICFA'SE EXEMPTION Plesse Frint DATE JOB LOCATION: number street village "iOMFAWNER": name borne phone# work phone# CURRENT MAILING:LMDRESS; ertyltown state IIp code The c=cnt 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 stmeryisor. • DEFWI1l ON OF H01+2EOWAl;R Person(s)who owns a parcel of land on which helsbc resides or intends to reside, on which =c is, or is intruded_to- be, a one or two-family dwell attalchcd or detached struetnres accessory to such use and/or fans s5ructcurs. A person who cc nstrgets more than tine home in a two-year period ShzZ not be considered a homeowner, Such "homeowner"shaIl sab=t to the Bmlding Ofcial on a form acceptable to the Building Official, that hdshc shall be resoori.sible for aD such work=1brmcd'undertbe building PenniL (Section 109.1.1) The undersigned`bOmcowner'a c=rnr_c responsnbllity for compIia.nce with the State Building Code and other. applicable codes, bylaws,rules and regulations. The undcrsigncd"bonicownct"ccrtiiZcs that,c/she,understands the Town ofBamstable Building Depa tmr—nt nrinirim inspection proccdvrn-.s and rests and that hehhe will comply with said procedures and requirements. Signatitru:of Hamcawna • tpproval afEurldnrng,O�cisl - ' Not,: Threc-family dwellings conbinmg 35,000 cubic feet or larger wsll be required to comply with the ' State Building Code Section 127.0 Cznsft cg^^Control- SOIldxovviER'S ExEA mbx The Code states that Any homeowner p=t=ni rg worn for which a building permt is required sball be crept fr=the provisions f this section(Section 109.1.1-Inc nsmg of consturtion Supayisors);provided that if the homragva engages a pcs®(s)for hire to do such 'ark,that ruc•k Hamcowncr shall ad as supervisor. )4any homcownas who use this cumptica are maw=that they arc aauming the responsibDities of a sups-visor(set Appendix Q, ulcs&R.cgula tions for;j=sinx Construction Supavisaa,Scctioa 2.1.5) This Jack of awauaress Men s=sults in scaious problcras,pardcaho}y ice the homeowner hires unliccascd priori. In this case,our Board crnnot proceed against the unlicensed person as it would with i licensed pervisor. The:homeowner aetiag st Supervisor is uhh7utely responmbJa To arm=that the bomoowncr is f dly awes of hislhaiic:spm rbrlidas.many communities rcqum'e,ru part of the permit apptinl;on, t the homcowncr ca-tify that hchhe undo stands the rrrpoanbrlitia of a Supervisor. On the 1=st page of this issue is a•form can mtly used by E 506-326®163 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.corn S P.O. BOX 168 sss. CENTERVILLE, MA 02632 Fully Licensed & Insured Construction Supervisor Lic# 99913 Doyle and Thomas Inc. Proposes to perform the following work: Location of proposed work: Annellen McNamara 294 Tobey Way Centerville, MA 02632 Date on which construction should begin: Late Spring 2011 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: 30 yr.Certainteed Woodscape Architectural shingle $8,694.97 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 Ynu Fnr Givinn Us The Onnortunity To Help You Improve i -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier, Synthetic underlayment, and installed with asphalt shingle 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 -Certainteed shadow ridge cap to be installed -Gutters will be cleaned of all debris and leaves at completion of the job -10 yard dump trailer will be needed on site; and will be removed 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 ten 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:D te• gmeown r �/ Contractor / 07/06/2011 15: 40 5084209227 MARK U,I SYLVIA PAGE CERTIFICATE OF LIABILITY INSURANCE DATE IN �.- 071t THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AU1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If 9Ut3ROtiATION 13 WANED, the terms.and conditions of the policy,certain policies may require an endorsement A statement an this cortifiCat2 does not confer NI cartiflcato holder in lieu of such endoosem s. PRODUCER TACr Mark Sylvia Insurance Agency LLC PHONE PAN 771 Main Street ems.NJLP *(508)42B-0440 AD Ostlerville,MA 02655 F M R NA111.1O.i INSURERISIAFFORDINGOOVERAGE _..... INSURED INSURER A: Farm Fa"C89uaity Inaumr= Doyle& Thomas Construction,Inc. — __.._... PO BOX Ise INSURER 9; ,- Centerville,MA02632-0168 INSURERC; INSURER D: - tNSURER E: _ INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTE13 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIO INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED by PAID apims.ADDL BOOR INBR TYPEOP INSURANCE ALe&wwn POLICY NUMBER �t rJl u �P LIMITS A acNERALunwrrY 20OIX0485 7/21/2011 7/21/2012 EACH OIIRRI"O%IIRREN�CF_ I X COMMERCIAL GENERAL LIABILITY P A T RE TIED Iy1111"51f:ey�anence� I} CLAIMS-MADE OCCUR NED EXP my person} $ PERSONAL A ADV INJURY 5 GENERALAGGREGATIE i GEN'L AGGREGATE LIMIT APPLIES PER PRODUOTS-COMPIOP AUG X POLICY JE PR LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 3 (Ed eetlderd) ANY AUTO 90DILY INJURY(Per person) i ALLO EDAUT09 GODLY INJURY(Per deeiderd) 5 SCHEDULED AUTOS HIRED AUTOS P�tr P GE S NON-0MIM AUTOS UMBRELLA L1AB OCCVR EACN OCCURRENCE S Excess uae CLAB�IS MADE AGGREGATE s DEOUCTISLE RETEMON III3 A AANNDaMn©�9LyINLITY 2001Wf33Q0 71112011 7H/,2Q17 ST X M A PROPRIETORIPARTNERIEXECUTIVE YIN NY OFFICERIME E.L.EACH ACCIDENT MINREXCLUDED? ED MIA . S. (Mandatory In NH) E.L.DISEASE•EA OMPkOYEE S II defy' under -- DESCRIPTION OF OPERATIONS bpbw E.L.DISEASE-POLICY LIMIT S DFJ OPTION OP OPGRA`n=I LOCATIONS r VBIIICLES(ARaaeACORP 101,AddMonal Rdarm a,9e w".a man apn9 to roq:trad) Carpentry CERTIFICATE HOLDER CANCELLATION (509)420-7989 Doyle A Thomas Construction Inc SHOULD ANY OF THR ABOVE DESCRIBED POLICIES BE CANCELLEC PO Box 188 THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELOP Centerville,MA 02632 ACCORDANCE WITH THE POLICY PROVISIONS. AUTNbR®RIW1=NTATIVE ®1988-2009 ACORD CORPORATION. All rights ACORD 25(2009M) The ACORD name and logo am malatered 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.-,'_145954 Type: Office of Consumer Affairs.and Business Regulation Expiration 3/15/2013 Private Corporation 10 Park Plaza-Suite 5170 "M Boston,MA 02116 DOYLE+THOMAS CONST INC TROY THOMAS 499 NOTTINGHAM DR CENTERVILLE,MA 02632' Undersecretary ! J Not v id w' out signature - tilassachusetts- Department of Public Safetl Board of Buildin-,Regulations and $taridartls Construction,Supervisor Spec.ialYy'license License' CS-SL 99913 Restricted to: RF,WS TROY THOMAS 499 NOTTINGHAM DRIVE CENTERVILLE, MA 02632 �- - - Expiration: 4/13/2012 ( nnmissi dice Tr#: 99913 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # w 530 Health Division Date Issued Z Conservation Division Application Fee Planning Dept. Permit Fee IDD� Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/Hyannis 'To Project Street Address 21 % W eAn Village A- Owner i�rV%^ R24­,. Address Telephone Permit Request ,7r� �� `ON • V UP, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0� Construction Type' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No . Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other r Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stove: ❑--,bs ❑ No Detached garage: ❑ existing ❑new size_Pool ❑ existing ❑ new size _ Barn: 0 existing ne 71 size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 4F Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r- w '-� Commercial L3 Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ( (% 3�`.` Telephone Number Address (� 1 " " License �✓�• ^'�` 'M'� Home Improvement Contractor# Worker's Compensation # J C MOW q 4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � O SIGNATURE DATE to FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION a FRAME s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 0 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): L', ��1... �` •n `+ Sa- Address: 46k �? City/State/Zip: tAP' Phone #: Are on an employer? Check tthe�ppropriate box: Type of project(required): 1.W am a employer with (/tt// 4. ❑ I am a general contractor and I .employees(full and/or part-time). * have hired the sub-contractors 6 El New construction 2.❑ I am a sole P or ro rietor artner- listed on the attached sheet. 7. ❑ Remodeling P P ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp, insurance. required,] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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. 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 andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.#: C. 6442 9 V tP —1 �O Expiration Date: (01 1 I l a Job Site Address:_�r '�' �1 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 cer n er It pains nd pen ies of perjury that the information provided above is true and correct Si nature: Date: os 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#: y 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 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 hone number(s) along with their certificate(s) of rY PP Y P insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP) with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit 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 pennit/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 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia IOct 29 2009 3: 40PM Helical Drilling 781 -849-2065 p. 2 10/28/2009 18:13 FAX 6179377261 IBT MFA R&C R1001/002 <g:�opler r:��r1�"a�.. �t�����:�f. Lhlic;;r.:u,tla•lica�i.:; 1=u:n..aki.n 3�•srcri 'We set it stroignt! Helicol piles •Und;:rpinning •Grouting • innovative solutions October?3. 2001)(revised) Annellen MciValnara 294 Tobey Way West Hyannispc�rt Re: Foundatior Settlement Investigation 294 Tobey 'Nay West Hyan:-usport Dear Annell en, We have corripl::ted our investigation of the addition at the above referenced site per our aFcepted propo-.al dated May 29, 2009. Two soil borin ,3 were performed at the rear of the house and adjacent to the addition, The locations are sk-tched on the included soil borings. The borings indicate that there is about I 1 feet of fill that consists of organic material, bricks, and mise materials_ Below this fill. material is a medium dense to soinetinies loose native fine sand indicative of what is found on the Cape. T its till material is the reason that the addition has settled. 'phis type of settlement if the addition is not underpinned. We were material is likely to cause additioni only able to complete two borings due to the fact that they weren't very shallow and access to the area around the addition was very limited. We recommenc: that the 12 x 13 foot addition be underpinned using helical piles. These piles will be about 2:> feet lent,. The reason for this length is that the native soils found 1 i feet below grade,allhough probably adequate for spread footin-support, due not have the density to allow us to.&,velop the required capacity at such a shallow depth. The scope of work would be for Others to remove the deck from around the room. We would ask that Others also try and remove as much of the spray foam and cosmetic repairs that would hair per any lift of the toursKoA119 ti, wall, We will rnobili e a mini-excavator us to excavate to the bottom of the wall :it these locations. We Twill then chip the footing to nearly flush with the foundation wall and install the piles. Once the piles have been installed and the foundation brackets installed, the foundation can be jacked to as level a position as possible. The final levelness is difficult to predict but my superintendent prides himself on getting things.as close as possible�� (sometimes to :t fault as it takes time!) _' '�V , ' ., � L... kC Q uGt7Ta 4'C(.E,I,!' CU //• 4�.D ,.. ,�nt..�/L'�.+f ry(/ale-.��-C rn 'r ✓ , % r/i /y L'L Helical Drilling hic. •639 carorire Street, Braintree, ,MA 02184 • is i 81-848-21 10 • F: 791.849.2065 • Fcliculdrilling.cu f �' . Oct 29 2009 3: 40PM Helical Drilling 781 -849-2065 p. 3 .10/26/2009 18:14 FAX 5179377261 IBT MFA R&C Q 002/002 w Annellen WA�a-nar•a 101,1312009 Page 2 02 We will then ba,:1fill and compact the excavation and rough grade.Others will need to do any final gradin:e and landscaping and replace the deck. Sheet rock crack repair due to cracking during the lifting process, if it should occur, is the responsibility of oLlicrs. This work above can-he performed for a lump sum of$1 1,900. We will warrant that the underpinned foundations will not settle more than, inches over the next 7 years. If you desire to aursue this work this tall please sign and return a copy of this proposal and we can order thr materials and schedule the work. Sincerely, Helical Drilling, Inc. . `.G. - c' Authorizedsignature / Date Chad Graybit 1 Idle. McNamara Props•gal I0'3o9 el;c 1 D(-Akri Inc. • 639 Ciieorise Street, Braintree, MA o71 84 • T: 731 94(3 21 10 • F: 761.849•?.t)65 • Feticaldri"iGr+g.cum y v �7 I DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/2009 PRODUCER Aon Risk Services, Inc. of Massachusetts THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY One Federal Street AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS Boston MA 02110 USA CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE- 866 283-7122 FAX- 847 953-5390 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Admiral Insurance Company 24856 •• Helical Drilling, Inc. INSURERB: The Employers' Fire Insurance Company 20648 w 639 Granite Street Suite 101 INSURERC: Everest National Insurance Co 10120 d Braintree MA 02184 USA INSURERD: Insurance Company of the State of PA 19429 INSURERE: Steadfast Insurance Company 26387 0 COVERAGES SIR applies per terms and conditions of the policy x 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED INSR ADDT LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ATE MM/DD DATE MM/DD A NERAL LIABILITY cA00000458907 06/01/2009 06/01/2010 EACH OCCURRENCE' $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $50,000 PREMISES(Ea occurrence) CLAIMS MADE X❑ OCCUR - MED EXP(Any one person) PERSONAL&ADV INJURY $1,000,000 ran rb GENERAL AGGREGATE $2,000,000 W GEN'L AGGREGATE LIMIT APPLIES PER: � PRODUCTS-COMP/OP AGG $2,000,000 p ❑ POLICY El PRO- ❑ LOC _ IECT to B AUTOMOBILE LIABILITY - 390-00-04-21-0000 06/01/2009 06/01/2010 COMBINED SINGLE LIMIT O Auto Liability - MA X ANY AUTO (Ea accident) $1,000,000 z B 7530196690002 06/01/2009 06/01/2010 2 ALL OWNED AUTOS AUto Liability - NH - BODILY INJURY 0 SCHEDULED AUTOS (Per person) - w L HIRED AUTOS BODILY INJURY V NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO - OTHER THAN � EA ACC AUTO ONLY: AGG c EXCESS/UMBRELLA LIABILITY 71CB000039091 06/01/2009 06 O1 72010 EACH OCCURRENCE ElOCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 ®DEDUCTIBLE - - RETENTION D wc6966196 06/01/2009 X WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TOR LIMIT5 E.L.EACH ACCIDENT $1,000,000 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If es,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 E OTHER PEC654092000 06/01/2009 06/01/2010 Professional Limit $1,000,000 ■ � _ 1 i Contractor Poll Pollution Limit $2,000,000 ~ Deductible $10,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Insurance. - CERTIFICATE HOLDER CANCELLATION Evidence Of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION _ • DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL MA USA - 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _Q6 ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION.All rights reserved= The ACORD name and logo are registered marks of ACORD i De Massachusetts- rau-tment of Public $afctj Botnef�61P� ifio n an a Board of Building.Rc,n�.lations .uxl Standards Construction Supervisor License HOME IMPROVEMENT_CONTRACTOR License: CS 75834 Registration 111851 f Restricted to 00# Y Expiratton 1 /5/2010 Tr# 278519 f � Type Pnvate Corporation 1 CHAD A GRAYBILL 171 RIVER RD HELICAL DRILLIN 1NC„ HANOVER, MA 02333 ' CHAD GRAYBILL f'I 639 GRANITE ST I � i BRAINTREE,'MA 62184= s''s Administrator Expiration: 7/26/2011 �1 C'onmiissimier Tr#: 19088 i p r r i ' P License or re v,. before the a registration valid for xpiration date. ndividul use onl Board ofBuilding Re If found r Y One Ashbu gulations a return for Boston won Place and Standards Ma.02108 Rin 1301 , a i Not valid withoutr signature t - a f VE ITnSi,VE ITAS engin rs , Client Job No. Sheet of q� Subject M�/�(�./y�(j yL+ tiV" By- . Date Ckd Rev 4k i sue" D,WM 6-walk tom°:I;C"D smv iv4 A, 4S g V`i LJ o. 34u 8 N sw o cp a 0 0o J LOT 12 TOBEY 30889 S. F. WA Y UN 71 clo hb oG�2C'��� • o, 0 0 In 5 op _ 0 129.0/ ' N 88°55'24'W y TOWN OF BARNSTABLE ZONING BY-LAW DATED SEPT. 14. 1989 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 RB DISTRICT. REAR - IO u� `L . PROPERTY LINES SHOWN HEREONu WERE COMP I LED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. THE DWELLING DEPICTED ON THIS PLOT C° • ; tea ' �� PLAN PLAN WAS LOCATED ON THE GROUND BY SURVEY ON SEPT. 23. 1996 AND 11 IN EXISTS AS SHOWN AS OF THE DATE BARNSTABLE, MASS. GF LOCATION. SCALE: 1 '-40' SEPT. 24. 1996 'THIS PLAN IS FOR PLOT PLAN EAGLE .SURVEYING A ENGINEEfBING.INC. PURPOSES ONLY AND NOT FOR 323 Route 6A RECORDING. DEED DESCRIPTIONS. Yarmouthport, afA. 02675 OR ESTABLISHING PROPERTY LINES. (508) 862-8132 (508) 432-53d3 THIS PLAN IS VOID IF NOT 19 STAMPED AND SIGNED IN RED. 0 20 40 " 80 PROJECT NO. 95-240-12 N - N we o h Al J L LOT 12 TOBEY 30889 + S.F. WAY w 0 �6 00 0Gy��� O� W a ehb ti o � In 5 e � o - 129.0/ ' N 88.55'24'W TOWN OF BARNSTABLE ZONING ' BY-LAW DATED SEPT. 14. 1989 ` ZONE RB / CERTIFY THAT TO THE BEST OF MY PROFESSIONAL ' SETBACKS KNOWLEDGE. I NFORMA T/ON AND BEL/EF THE DWELLING SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS FRONT - 20' OF THE ZONING BY-LAW FOR THE RB DISTRICT. SIDE - l0' ' REAR - l 0' `` "ySP PROPERTY L/NES SHOWN HEREON ����� Of WERE COMPILED FROM AVAILABLE C. yes PLANS OF RECORD AND DO NOT FRANK a' WHITING REPRESENT AN ACTUAL SURVEY , No.29869 ,. ON THE GROUND. 9Q r O Sao k s . GlSTER� a I hA LA' THE DWELLING DEP/CTED ON THIS C . "� PLOT PLAN PLAN WAS LOCATED ON THE GROUND ` 1 IN : ¢ BY SURVEY ON SEPT. 23. 1996 AND EXISTS AS SHOWN AS OF THE DATE BARNSTABLE. MASS. OF LOCATION. SCALE: 1 '-40' SEPT. 24. 19969s`: THIS PLAN /S FOR PLOT PLAN EAGLE .SURVEYING A ENGINEERING.INC. PURPOSES ONLY AND NOT FOR $29 Route 6A ' '4 RECORDING. DEED DESCRIPTIONS. Yajxouthpoi t. MA. 02675 OR ESTABLISHING PROPERTY LINES. (508) 562-8I32 (508) 452-5838 lot THIS PLAN IS VOID /F NOT STAMPED AND SIGNED /N RED. 0 20 40 80 PROJECT N0. 95-240-12 i I ' �. 1 a 1 ; R ! � ` 4 :k TOWN OF BARNSTABLE ` CERTIFICATE OF OCCUPANCY � PARCEL ID 247 250 GEOBASE ID 35609 ADDRESS 294 TOBEY WAY PHONE (508)778•--0734 W. H�rannisport ZIP - LOT 12 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 20Q93 DESCRIPTION SINGLE FAMILY DWELLING (PMT.#17481) PERMIT TYPE Bcob TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECT'S and Environmental Services TOTAL FEES: BOND $.00 ' OxI NE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY * HARN3TABLE MASS. OWNER MARKWOOD CORP. , 1639• Al ADDRESS UNIT 10 ED Mtn 110 BREED'S HILL RD HYANN I S, MA BUIL ' I G IVISIO BY DATE ISSUED 12/20/1996 EXPIRATION DATE �' TOWN OF BARNSTABLE BUILDING PERMIT ' PARCEL ID 247 250 GEOBASE ID 35609 ADDRESS 294 TOBEY WAY PHONE (508)778-07:' W. Hyannisport ZIP - LOT i BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY. PERMIT 17481 DESCRIPTION SINGLE FAMILY DWELLING (SEW.PMT.096-420) PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT CONTRACTORS: MARKWOOD CORPORATION Department of Health, Safeti ARCHITECTS: and Environmental Servicesv TOTAL FEES: $290.53 THE -' BOND $.00 CONSTRUCTION COSTS $93,720.00= Q� 101 SINGLE FAM HOME DETACHED 1 `' PRIVATE P ; c 059. OWNER MARKWOOD CORP. , ADDRESS UNIT 10 c 110 BREED'S HILL RD BUII.D IVIS �. HYANNIS, MA BY DATE ISSUED 08/26/1996 EXPIRATION DATE 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 WELLAS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE t.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. BUILDING INSPECTION APPROVALS 2PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS -111 G fw 2 JU nos 2121 2 /A00-4, �'�v,••G,•r� 3 ! 1 NG INSPECTION APPROVALS ENGINEERING DEPARTMENT a �IAo CsJr R z 9G 'L Y S 2 606 DHEALTH OTHER: SITE P REVIEW APPROVAL � 9 WORK bHALL NOT PROCEED jJNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. .2co V3 `oFtHe'°�ti The Town of Barnstable o� BARNSTABLE.o! Department of Health Safety and Environmental Services MASS. 0 Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location 12'q'1 Permit Number Owner (� �;� ((X' r Builder2 (A) One notice to remain on jobsite, one notice-on file in Building Department. The following items need correcting: .a 0 y P r I Please call: 508-790-6227 for reeinspection. Inspected by Y Date ` ` , .oF�HE, The Town of Barnstable O� BARNSTABLE. • Department of Health Safety and Environmental Services MASS. 16yq. �0 �f0 Mn+s Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection V\3 Location . T6nd Permit Number Owner .� l (s Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: v A0 en to r v Please call: 508-790-6227 for re-inspection. Inspected by V :'ie Date l 2. 9ENE 23542 7, 1SIARPARTMENT OF PUBLIC SAFETY ASHBURTON PLACE, RM 1301 3 Z BOSTON, MA.02108-1618T 3 U.1775 `. CONSTRUCTION SUPERVISOR LICENSE P Number: Expires: �hJ Restricted To: 00 TIMOTHY PEARSON beach bottom', fold , sign on i POBX 519 - back, and` laminate license card. CENTERVILLE, MA 02632 tKeep..top for receipt and change ,of address notification. - -- --. -- -- _----- - 23542 . Restricted To: 00 DEPA.RT.01 OF PUBIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 00 - None ' amber: Expires: 1G - 1 & 2 Family Homes Pes tricted °o: 00 Failure to possess a current edition of the Massachusetts State Buiilding Code is cause for revocation of this license. PC'H j19 CENTERVILLE, HA 02632 COMMONWEALTH OF "SACHUSETTS e G L C LQ DEPAR MENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET ames Camooec BOSTON, MASSACHUSFM 02111 Orr:'�:SS�One' WORKERS' COMPLNSATION INSURANCE AFFIDAVIT An f&x� YK�11-14 0 iccnsccJperm i ncc) with a principal place of business/residence at: ff 6 (Gry/SurcfLip) do hereby certify, under the pains and penalties of perjury,that: , 1 am an employer providing the following workers' compensation coverage for my employees working on this job, �. UM 760 Insurance Company Policy Number O I am a sole proprietor and have no one working for me. [� I am a sole proprietor,general contractor or homeowner(circle one)and have hired the contractors listed b:?ox who have the following workers'compensation insurance polidt= Name of Contractor Insurance Company/Policy Number Nam e of Contr actor Insuruioc Company/Policy Number Dame of Contractor Insurance Company/Policy Number 1 am a homeowner performing all the work myself. NOTE_ Plcase be aware that while homeowners who employ persons to do maintenance,construction or repair work on dwc'hng of not more than three units in which the homeowner also resides or on the grounds appurunant thereto arc not genet::], considered to be employers Lander the Worken'Compensation Ae:(GL C. 152,wxL 1(5)),application by a homeowner for a lice'sc or permit may evidence the legal tutus of an employer under the Workcrs'Compensation Act 1 undcrstznd that a copy of this statement will be forwarded to the Depa=.,c7:of indusuial Aeddeats'Ofnee of lnsurandt foi eoverast vc .-canon and that failure to secure coverage as required undo Scetion 25A of MGL 152 can lead to the imposition of criminal per-::s consisting of a fine of up to S1500.00 and/or imprisonment of up to one ye<:ad civt]penakues in the form of a Stop Work Ordc- r- a fine of S100.00 a day against me. 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OR EOUAL ° s .4 °ajUD6\�/R 11 IKSUL 2+4 STUos. vllm--.11 WGU1 A �' bTA FL bVA1L(i'��'o..� s 4• N ;; j. 1314,1Ca PLY\Vaoo / i 2.10 :J01 SjS YY I' n C 19111SUL J rL 1 J i WATE�Pra0F1+,w J A"L-Mr—COMC.SLAW j _�"Ee-T 10 tit A•A (I/9';I'-o") Engineering Dept. (3rd floor) Map _ " Parcel p(��7C/ Z26 mit# i9.0 House# el_�y Date Issued --�asd- Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee o2\, Conservation Office(4th floor)(8:30-9:30/1:00 2:00) - Z 1 D4 ` �C Planning Dept.(1st floor/School Admin. Bldg.) 111E►p;. Defi ' ee n Approved by Planning Board 19 RFD P TOWN OF BARNSTABLE Build_ ink t pplication Project Street Adrrd ss e Village , l Owner �� Address ! /0 1/ Telephone Permit Reques ,Y� kc.,77 C.2 /r e �� First Floor square feet Second Floor °"' square feet Construction Type l` ,/lJ7L Estimated Project Cost $ Zoning District (, --f Flood Plain Water Protection Lot Size 17410 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure lax.) Historic House ❑Yes o On Old King's Highway ❑Yes 2<0 Basement Type: ❑Full ❑Crawl ❑Walkout Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing _ New Half: Existing — New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Ls— Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ll? 0 Fireplaces: Existing New Existing wood/coal stove ❑Yes &go-*-- Garage: ❑Detached(size) /Other Detached Structures: ❑Pool(size) Attached(size) /'7.1'd t-o, ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board ofipealirzation ❑ Appeal# Recorded❑ Commercial ❑ /� If s, site plan review# Current Use 1 c Proposed Use L. _ Builder Information Name // L 111-1"LIL Telephone Number 7/X--o Address License# 2 Home Improvement Contracrtor,# Worker's Compensation# L)COM7� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL WNSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO LJ SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAI/PARCEL NO. 1 ADDRESS VILLAGE F OWNER DATE OF INSPECTION: " FOUNDATION FRAME INSULATION r FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' d GAS: ROUGH FINAL W FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. 9 z• b u � , n � bw [J-7 - • —Z------ S16`Fc..VO SH E.E.i M.xr I! U Liv JL.b-] C,AF-AGE m 4.1HK. COWC SLAG\v/ O H ICP--O LAH er—Ar1 OP_rOUAL OV6P z.c - m rr2 otL G"'V' •10 Gn�vH - — cu o I T I PITCH N 1.1 y I I-14 V ootG 1. m pi 0 1�-4 � WDCAPOIJ 1aWALL -- -- I I I in 1.4 POST r CA 9 f•_D in ij ! I , Leo 1q.J. I �I�� P�r�u r �4 1 0•. 1 /-/yWT I I h { / I - i Al El q6LT,........... � -- ---- li OF7 --IO O-ZD-EC.K. ol Tl- 1 --- C,TEP- N Ii t l k Q r ccMnUT FILL -- - - O i ! . i p lV ; PON PLAN - I _ . 1 �TMer� The Town of Barnstable • , RMAJ= • 9 � ,m�' Department of Health Safety and Environmental Services Eo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione: For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW N. SUPPLEMENT TO PERMIT APPLICATION MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:1,,I >C / �4 � �— t Est. Cos erzr-v, r' . Address of Work: 9 Owner's Name r� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as a gent o t e owner. Date V Contractor Na a Registration No. OR Date Owner's Name 23542 Q Q D . EPARTMENT OF PUBLIC SAFETY � a 2354 ISIAR •� y' 9ONE ASHBURTON PLACE, RM 1301 BOSTON, MA 02108-1618 3 U 1QQ5 3 CONSTRUCTION SUPERVISOR LICENSE P. //�II Number: Expires: -: Restricted To: 00 i TIMOTHY PEARSON Aetach bottom, fold sign on IIII � POBX 519 � r= back and laminate license card. CENTERVILLE, MA 02632 yr FKeep,top for receipt and change address notification. ��� � �y �r� d�✓G � i - - --- -- - 23542 Restricted To: 00 ') DEPARTHEM OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: Expires: 1G - 1 & 2 Family Homes Res trcted To: 00 Failure to possess a current edition of the Massachusetts State Buiilding Code ►•.r,r �� TIHOTH! PEA."-,SON is cause for revocation of this license. POB% 'S19 CENTERVI',LE, MA 02632 3 - L f2� � O��i l�Ga6aGLC'`ECI,�6 j I HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards ! One Ashburton Place - Room 1301 j Boston, Massachusetts 02108 i HOME IMPROVEMENT CONTRACTOR Registration 100871 Expiration 06/24/98 Type - PRIVATE CORPORATION O�.��' `�" � HOME IMPROVEMENT CONTRACTOR Registration 100871 MARKWOOD CORP Type - PRIVATE CORPORATION TIMOTHY M . PEARSON Expiration 06/24/98 . 110 BREED 'S HILL_ ROAD UNIT 10 HYANNIS MA 02601 MARKNOOD CORP TIMOTHY M. PEARSON G� �o --�10 BREED'S HILL ROAD UNIT -10 ADMINISTRATOR HYANNIS VA 02601 + I CUMMUN WLA 1 H Of- MASSACHUSETTS «LQ DEPA YMEN7 OF LNDUSTRIAL ACCIDENTS 600 WASHINGTON STREET -ames Cam=ei: BOSTON, MASSACHUSFM 02111 :,-0m.n:ssione• WORKERS' COMPENSATION INSURANCE AFFIDAVIT I 0iccnsccJpermincc) with a pnnci a fo l place of business/residence at: A* (Gry/Statc/Zip) do hereby certify, under the pains and penalties of perjury, that: (i l am an employer providing the following workers' eompensarion coverage for my employees working on this job. Insurance Company Policy Number [) 1 am a sole proprietor and have no one working for me. [j I am a sole proprietor,general contractor or homeowner(eirck one)and have hired the con tmaors listed bc?ox who have the iollowing workers'compensation insurance pohdc • Name of Conmaor Insurance Company/Policy Number Name of Contractor Insurace Company/Policy Numbe_- Name of Contractor Insurance Company/Policy Numbs: 1 am a homeowner performing all the work myself. TOTS.: Plcuc be aware that while homeowners who employ persons to do maintenance,construction or repair work oo dwc?ling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not gcnerJ%- considered to be employers under the Workers'Compensation Ae:(GL C 152,sect_ 1(5)),application by a homeowner for a lice=se or permit may evidence the legal status of an employer tinder the Workers'Compensation Act. I undcnt:nd that a copy of this statement will be forwarded to the Departne:of lndustrial Aeadencs'Of cc of Insurance for oove-a;: vc:-i:tcation and that failure to secure coverage as required undo Section 25A of.LSGL 152 an lead to the imposition of criminal per::::s eorsisong of a finc of up to S1500.00 and/or imprisonment of up to one ye<sad eiQ penalties in the form of a Stop Dvork Order rr,:: finc of S 100.00 a day&gains:me. Sipncd this dzy of . 19 �1 Licc:isc011 MIME Liccssor/Pcrmirtor •' S . a 4p N w, �, oa a 0 m J Lor +i ? TOBEY 30889 - S. F. �ry ti�� IVA Y evil Ch w 0 GB� I hb �a oG��q�FT6` c9n W o'� q O in 0 O 2 129.0/ N 88.55"24'W i TOWN OF BARNSTABLE ZONING BY-LAW DATED SEPT. 14. 1989 ZONE R B I CER T I FY THAT TO THE BEST OF MY PROFESS/ONAL SETBACKS KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING FRONT - 20 ' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS SIDE - l 0 ' OF THE ZONING BY-LAW FOR THE RB DISTRICT, REAR - l 0 ' J SS PROPERTY LINES SHOWN HEREON WERE COMP/LED FROM AVAILABLE PLANS OF RECORD AND DO NOT If}{{TING =s REPRESENT AN ACTUAL SURVEY ' �'�'�•G9869 ON THE GROUND. u1ST�a- �a - �aM e 'IVA! l 'v P/ THE DWELLING DEPICTED ON THIS �� `' `_.. I PLOT PLAN PLAN WAS LOCATED ON THE GROUND q IN BY SURVEY ON SEPT. 23, 1996 AND iEXISTS AS SHOWN AS OF THE DATE BARNSTABLE, MASS. OF LOCATION. SCALE: I '-40" SEPT. 24. 1996 THIS PLAN /S FOR PLOT PLAN EAGLE SURVEYING a ENGINEERING.INC. PURPOSES ONLY AND NOT FOR M Route 6A RECORDING. DEED DESCRIPTIONS. Yapxouthport, JIA. 02675 OR ESTABLISHING PROPERTY LINES. (508) 362-81d2 (508) 482-5385 THIS PLAN /S VOID /F NOT STAMPED AND SIGNED IN RED. 0 20 40 80 PROJECT N0. 95-240-12 Alp Assessor's Office(1st floor) Map '�Z` _ Parcel ermit Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Al � Date Issue �'� Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Engineering Dept. (3rd floor) House# �� L � Planning Dept. (1st floor/School Admin. Bldg.) Defi a nApproved by Planning Board " , 19 -7 7 7.�f (//Vl 11,) TOWN OF 16, i" TABLE-- Building Permit Application 4 Pro treet Addr s Village Owner Address fiti"W //0 Telephone Permit Request / a _ Cz d k t First Floor f� square feet Second Floor 2Z square feet Estimated Project Cost $ cj 7,2-Z Zoning District Flood Plain Water Protection Lot Size PYc5x 11 ezo_r"e Grandfathered ? Zoning Board of A is tho . ation _Recorded Current UseL y Pro osed Use P Construction Type Commercial Residential !% Dwelling Type: Single Family PC4 Two Family Multi-Family Age of Existing Structure y Basement Type: Finished Historic House Unfinished G9 Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor 7 Heat Type and Fuel6 Ar Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached C� �C�% Barn None Sheds Other Builder Information Name //_/_M Telephone Number �2 Address Ab, License# /7 /0 1V1130V Home Improvement Contractor# /� 4,:�e74,04 k1,111 a&?z Worker's Compensation# I XL�C uj �(�./ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTIOTEBRI RESULTJNG FROM THIS PROJECT WILL BE TAKEN TO lr SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY ;r PERMIT NO. LAB DATE ISSUED MAP/PARCEL NO. ADDRESS- ' VILLAGE OWNER «.. DATE OF INSPECTION: T y FOUNDATION 6 /�' 'r✓ 1 _ FRAME INSULATION FIREPLACE+ '' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH - FINAL GAS: t ,,,ROUGH FINAL FINAL BUILDING . 4 DATE CLOSED OUT ASSOCIATION PLAN NO. Ir-� GENERAL NOTES : ACCESS COVERS MUST BE WITHIN INVERT ELEVATIONS : DESIGN, CRITERIA : 28_0 __ 12' OF FINISH GRADE / FIRST 2' TO INVERT AT BUILDING: -_ 24, OT_ DESIGN FLOW: 1. THIS PLAN I$ FOR THE DESIGN AND � i _-_ _ BE LEVEL-, INVERT IN SEPTIC TANK: 23. 6 J 3 BEDROOMS AT. I I q-G. P. D. PER CONSTRUCTION OF THE SEWAGE DISPOSAL � 2* of / INVERT OUT SEPTIC TANK: 23. 35 BEDROOM EQUALS 330 G. P. D. SYSTEM ONLY. 4' PVC -- _ _-- PErSTONE SCHEDULE 40 - _ - o a1 • 22 Q i INVERT IN DIST. BOX: 23. 17 2. ALL CONSTRUCTION METHODS AND MATERIALS 23• I7/ INVERT OUT Dl ST. BOX:3/4' - 1 I/2• DIA, 23. 0 - �GARBAGE GRINDER AND MAINTENANCE OF THE SEPTIC SYSTEM I ¢ _ i � ' 5 INFILTRATORS W/4' STONE WASHED STONE SHALL CONFORM TO MASS. D.E.P. TITLE 5 i ------� 3 OUTLET AROUND. 39'X 11 ' OVERALL INVERT IN LEACH CHAMBER. 22. 92 _ Io' MIN. I000 �.' SEPTIC TANK REQUIRED: AND LOCAL BOARD OF HEALTH REGULATIONS. _ - GAL D-BOX ls.l `pr'20 BOTTOM OF LEACH CHAMBER:_22• � SEPTIC TANK / / �' ^_ ----- ___�G. P. D. h' 150x - _ 495 GAL . J. ALL SEPTIC SYSTEM COMPONENTS LOCATED � ADJUSTED GROUND WATER: �4. 9 SEPTIC TANK PROVIDED:___I000 GAL . UNDER AREAS SUBJECT TO VEHICULAR TRAFFIC PROF I L E : NOT TO SCALE / / / __ OBSERVED GROUND WATER: /O. 5 - OR GREATER THAN 3' IN DEPTH SHALL BE �`O ti° /'lam_ BOTTOM OF TEST HOLE *l :_ 9. 5__-- SIZE OF LEACHING FACILI TY REQUIRED (AA ) CAPABLE OF WITHSTANDING H-20 WHEEL LOADS. INDEX WELL M l W 29. ZONE C DES/GN PERC RATE ---( 6 M/N/I NCH 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 Is ? / // 4/95 READING-9, 0. 4. 4 ' ADJUSTMENT 330 GPD / 0. 75 - 440 S. F. OR APPROVED EQUAL. PROVIDED: 5 /NF I L TRA TORS W/4 STONE _ '� "/ / /' r 5. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. / ,, / / 39 'X l l ' OVERALLI I-800-322-4844 AND THE LOCAL WATER DEPT. / / I FOR LOCATION OF UNDERGROUND UTILITIES. 14•ay ��' / / I AA- (39+ 1 )X( l1 + I1 -480 S. F. Ew 6. VERTICAL DATUM IS: ASSUMED �� \ I , 2 \� �-t-?4,S 7. FOR BENCH MARKS SET. SEE SITE PLAN. \I \\\ \\ r II 1 R-57•5013 0 -`'� I \ \ 1 I I - ------------ \ � 8. NO DETERMINATION HAS BEEN MADE AS TO 7,;f SDIL TEST PIT DA TA F / \ \ 25.1 = ?s.J9COMPLIANCE WITH DEED RESTRICTIONS OR / \ \ \ 1 @ v4 INDICATES ZONING REGULATIONS. IT SHALL REMAIN / / / \ �; \� +,2€ PERCOLATION.0 •� \ �- INDICATES OBSERVED ' TEST GROUNDWATER THE CLIENTS RESPONSIBILITY TO OBTAIN ' // \ \ �\ ��� \� '` P-8492 ALL PERMITS. SPECIAL PERMITS. VARIANCES / / + ETC. FOR THIS PROJECT. /' / f \\ � �\ 26,13 TP*-�---- TP+ ----.-- // 2s.2 1 GRND EL . 19.5 GRND EL. 24. 1 9. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY / ,/ /// \e Ie,7rt �\ \ �+ jDgpCAT "-- - \ G. W.EL , 10•5 G.W.EL. N/A TO HAVE THE PROPOSED BUILDING FOUNDATION / / / \ � � / \ 0 19.5 0' - --- 24. 1 DESIGNED TO ACCOUNT FOR THE EXISTING GRADE , TOPSOIL / 19.4 1 \\24.2 424.40 �� SUBSOIL AND SOlL CONDlT!ONS AT THE LOCAT/ON OF THE /3,4 � T+ 1 - N ` �r 24.;dr2s.ao / 23 1 PROPOSED BUILDING. �Er E � �' 17.2+ u FILL O ' I r l0. THIS SEPTIC SYSTEM DESIGNED IN ACCORDANCE / yti _----� i� �- --'�j ~ � �L�WITH 310 CMR: I5. 005: (5) . THE SUBDIVISION W4S 13.e_,� o / o �TErCATCH BASIN I5.5'ENDORSED BY THE PLANNING BOARD ON AUGUST 8. 1994. 23.e+ -- ------- 14.0 24,42MEDIUM I1. UNSUITABLE MATERIAL (TOPSOIL. SUBSOIL / i \0 i � i� \ �FILL ETC. ) ENCOUNTERED BELOW THE INVERT ; I / / -_----,� / K �� � 24.4e MEDIUMFINE SAND -•-` F/NE SAND j OF THE LEACH CHAMBER TO BE REMOVED FOR A I / , DISTANCE OF 10' AROUND THE CHAMBER DOWN TO 1J 2 1� /�/I I LOT 12 • ESL ��� - I THE CLEAN SAND LAYER AND REPLACED WITH 1 ' �oo� \ 30. 889f S. F. 9' CLEAN MEDIUM SAND. 17. i �� / ` _ _SL_ 10,5 ' I �� �' ??.2� �� / , �� �� , 10_ _ _� 9.5 I3' NO WATER / �\k' \ �/ �� °- - --___, DATE: _ APRIL _18 - 1995 --- //r / ..\\�' i r 02 / /'� / �i� �` / TEST BY:_SEPHEN HAAS_- - /' I1a.3 �' �'� � / \ � 1��`' �' _- --�"�-� - W1 TNESSEO BY: ED BARRY 24.1 A i sus +219,5 _-- PERC RATE:-._(_ _ MIN/INCH Ew B $ I \e •a / / m PSo 1 l ` ye o / w s P . i c s )- S T FD�4/ L O T / 2 TO B E / I 17.1+ /OOO $A / `��� / \� �' & A R /V S 7 ,4 W . H Y.4 /V/V / SPORT MA . If ���/ SEPTIC,TANK -�EWA PREP,4 REO F-OR : /� /�� 4✓i /, /: / D-BOX i/rw �\\ A,11A R K WOOD C O R S C7A L E : / - 20 A U G U S T 2 .3 . `� ' ' s�'s i i E'�4 GL. E• 5'UR LIE•YI NG Bt E'NG Jr"VIE IE I NG . I NC . s /1e /crT In r O r14• STONE &UND I !" I29.01 /' 4 5� C 0 & -) 4 5, 5333 0 /0 20 40 +29.4 ��� JOB NO: 95-240 F/EL D:R VB/PDR CAL C: SAH/CFW CHECK: CFW DRN: SAH w _ SYSTEM PROFILE ALL SYSTEM COMPONENTS T SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR (NOT TO SCALES COMPARABLE MEANS FOR FUTURE LOCATION. ASSUMED � 0 (� 2" PEASTONE OR GEOTEXTILE DATUM IS ACCESS COPROVIDE IVERS TO WITHIN 6�OF FlN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE GHT 1. DA, TOP FOUND. EL. 26.91' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING d t MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 25.0 3. MINIMUM E PITCH TO BE 1/8" PER T. PIP FOOT. 7. 4. DESIGN LOA IN FRECABr H 10 BLOCKS OR' D G,FOR ALL PROPOSED PRECAST RISERS (TYP.) PRECAST RISERS I UNITS TO BE AASHO H-1Q 2•0 4"mSCH40 PVC MORTAR ALL 0 PIPES LEVEL 1 ST 2' 4' COMPONENTS � � 5. PIPE JOINTS TO BE MADE WATERTIGHT. n � ENDSWS EL 23.3' SIDES a ey w••�•- :::-�• 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE EXISTING 14" ,.•,-w- - ,- .. 310 CMR 15.000 (TITLE 5.) L cu 10" 1000 GAL H-10 • .°o°o°o°o o`b�2io: •. �' �o°o°o°o° WITH ... TEE TEE *23.2' ° ° ° ° oo °g° ®®®® ®®®® ° ®®®® -®®®® > o ° o ° SEPTIC TANK 6" MIN. SUMP '0°0°0°0° ®®®®®I�e®®®® ° ° ®®®®®®�®®®® o 0 0 o a h (RE-USE)** o°o°o°o°o°o° 'O°OOO°O0 ®® °p°O°° >°°OOOOOo CPO/ Vllle Be ,° °C°°° ° 0 12" MIN. INT. DIM. . �o°°° °o° ®®®®®®®�® 00°0°° ®®®®®®®®®®® ° ° ° ° 7. THIS PLAN IS FOR PROPOSED° °_ ° ° ° ° 0 OSED W GAS BAFFLE::; ° ° WORK ONLY AND °„n. , 0 0 0 0 00000000 000 0 °°°°°°°° ®®®®®®®8®®® °°°o ®®®®®®®®®®® :°o°a°o°o � NOT TO BE USED FOR LOT LINE STAKING OR ANY 22.8' 22.63' °°oR�� °°°°°oa° OTHER PURPOSE. 20.5 • � ':,.. ..... ..; �,:•; -. :: •. ...:- �.:...,...: .:�. V 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC: � LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL, rl 3/4"-1-1/2" DOUBLE WASHED STONE (3) UNITS REQUIRED _ 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 40' X 10' 9. COMPONENTS NOT TO BE BACKFlLLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) 5• HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. (_1_X SLOPS ( 1 X SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR ' LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP FOUNDATION EXIST. SEPTIC TANK 24 D' BOX 15' 15.5' BOTTOM TH-1 & 2 VERIFYING THE LOCATION OF ALL UNDERGROUND do / 1 FACILITY NO GROUNDWATER FOUND OVERHEAD UTIU71ES PRIOR TO COMMENCEMENT OF *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT WORK• NOT TO SCALE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE REPLACE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEP11C TANK IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 247 PARCEL 250 PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. 99- EXISTING CONTOUR / l X 99.1 EXIST. SPOT ELEV. 1 99 PROPOSED CONTOUR to I SYSTEM DESIGN. [98.4) PROPOSED SPOT EL 1 TH1 i TOBEY WAY GARBAGE DISPOSER IS NOT ALLOWED TEST HOLE \ DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD 2� SLOPE of GROUND / �� \ USE A 440 GPD DESIGN FLOW UTILITY POLE .. r .. / _SEPTIC TANK: 440 GPD (2) = 880 •-RE UZ-E-*ST!#G--SEPTIC TANK** - NOTE: NOr ALL SYMBOLS MAY APPEAR IN DRAMANG . / LEACHING: / �� SIDES: 2 (40 + 10) 2 (.74) = 148 GPD TEST HOLE LOGS - - - - ' P�� T( _'.K' 0bUTH 40 x 10 (.74) = 296 GPD LOT ENGINEER: ARNE H. OJALA, PE, SE / so,88st SF + °P°� ,F TO'I-A,!11 r 600 S.F. 444 GPD WITNESS: DAVID STANTON, RS 0'ex X /� �, °� USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DATE: JANUARY 29, 2010 ��� ,e�o�� PQ� a ,WITH 2, , 5'., STONE AT ENDS 5' BETWEEN UNITS AND 2.6' ti 4 , gT; SIDES - < 2 MIN/ INCHPERC RATE ti �. o� ti � • �p EXIST. CLASS I SOILS P# 12827 / DWELL , TOP FNDN v2P ELEV. ELEV.. . M ELEV. 2s s' o" Q1 �l ,y. ^� ����rt� \�;[(/ d ; , R APPROVED DATE ., , BOARD OF HEALTH A 2s.o 0- `��' 26.0 i TITLE 5 SITE PLAN FILL FILL i' OF w / 0 \/ % 24" 24.0' 28" 23.7' o 294 TOBEY WAY " ry / 2 ( WEST HYANNISPORT / - 26 Ile - TH 1 PREPARED FOR BENCH MARK - CORNER OF BULKHEAD (ON (MOOD) I ago / / / ELEVATION 26.6 c c / 5 = BORTOLOTTI CONSTRUCTION/ PEA 2` 2 - 2' �rn McNAMARA MCS MCS JANUARY 29, 2010 10YR 7/4 10YR 7/4 129.01' OFMq � , q� off 508-362-4541 s I fax 508-362-9880 Fs _;� downca e.com '3w s i P O " " LOCATION ONLYLEACHIN/E)GST. (AS-BUILT TIES NOT FACILITY. NOTE. PROX. �'(:� 02 .r. ' I• 126 15.5 126 15.5 � � yr Fc, down copy eag ineer�ng nc- Scale: 1"= 20' CLEAR) `r ° S10 �`EENG� c C%V%% engineers NO GROUNDWATER ENCOUNTERED I (-2°1-Yo RVE / land Surveyors (, 939 Main Street ( Rte 6A) l 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 026 0-003 7510-003.DWG(SBO)