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0290 AMES WAY
F ^ (/ /�N,{� ✓JW V • p , y jY a w . .� -,: � per, �..:• ,.'� .. .� n •' .> .a I.u,,, k. ��. a' .t'uE�s:, ' :Y�.y. ,i .�>ix - z� � ,�, l;�,o �'� :. ,�� �. �.,3 r,,:,>� g „,� �, o n k.°�;, � x .a, '..� :rah °'� •_F w 4 0 ` o S e a t To'6"6rn of Barnstable Permit# 0007 O 1 '�,9 0 Expires 6 monihs from issue date ♦) C?� Regulatory Services Pee - .p � IT Thomas F.Geiler,Director SS PERM Building Division s/2gld� MAR 2 7 2007 Tom Perry,CBO, Building Commissioner TOWN OF FSARNSTASLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION .- RESIDENTIAL ONLY Not Valid without Red X Press Imprint [ap/parcel Number 0.S f roperty Address a �' �///� . 0 Residential Value of Workr ZOO Minimum fee of$25.00 for work under$6000.00 iwner's Name&Address �` [5 kutkii-p- /-iy S kcl 0ek-krtlille v .ontractor's Name Telephone Number - 100bl/ oft 9 [one Improvement Contractor License#(if applicable) �n 1✓icerrse-#-(-;zf-appliccable-) ]Workman's Compensation Insurance Check one: ❑ am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance ssurance Company Name Vorkman's Comp.Policy# - :opy of Insurance Compliance Certificate must be on file. -ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) rO Re-side Replacement Windows/doors/sliders. U-Value ® (maximum,44) *Where required:4op vt does not exempt compliance with other town departmentregulations,i.e.Historic,Conservation,etc, ***Note: er must sign Property.Owner Letter of Per- issro :"' Home Improvement Contractors License is required. ;IGNATURE: 1:Fomis:expmtrg .evise061306 The Commonwealth of Massachusetts •�: 1 Department of Industrial Accidents Office of Investigations g d 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): . [e 5 Address• O AM,2,�_ City/State/Zip: re N�of � � Aez Phone t �i 0 C7 Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. E] I am a general contractor and I * a have hired the sub-contractors 6 ❑New construction . employees(full and/or part-time). Remodelin 2.❑ I am a"sole proprietor or partner- listed on the attached sheet.These sub-contractors have 7• ❑ g E ' ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers 9 Building addition t comp.insurance. [No workers comp.insurance 10.❑Electrical repairs or additions required.] 5. � We are a corporation and its . 3.0 I am a homeowner doing all work officers have exercised their I LF 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site i information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure_to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the IA for insurance coverage verification. I do hereby er the pains and penalties of perjury that the information provided above is true and correct. Signature: Date ? Phone#• �ye y 0 Z`2 r0fJf1cialonly. Do not write in this area, to be completed by city or town official,n: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiveL.oLtrustee 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 phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit,or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you.are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom �\ of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding.the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense 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 A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e,a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions' please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwoalth of Massarhusotts Dopartmont of Industrial A.ceidonts Office of Investigations 600 Washington Street Boston,MA 02111 TO. # 617-727-4900 ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 11-22-06 www.mass.gov/dia _ :� S��g � F. � � z � �� �p O �a� �`� �� �" C Town of Barnstable *Permit# /-Ao Expires 6 mo the r sue to Regulatory Services Fee BARNST,B z Thomas F.Geiler,DirectorMASS ' .� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax- 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint X-PRESS PERMIT Map/parcel Number / Property Address 90 Alm-e 5 wit c CP -�vl���-� R. C�ZC� �' DEC 2 7 2007 ❑Residential Value of Work TOO Minimum fee of$25.00 for work under$W1tlfl.'(►tl° OF BARNSTABLE. Owner's Name&Address CG1�S k� �V)2 2 90 V-1((z Contractor's Name Telephone Number bu Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance4 Check one: i ❑ I am a sole proprietor ' Z3 ® I am the Homeowner s r , ❑ I have Worker's Compensation Insurance ' `="t u; `► `^ Insurance Company Name z"T' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. o 0 M Permit Request(check box) ❑ Re-roof(stripping old shingles) All-construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side 5D Replacement Windows/doors/sliders. U-Value �'Y (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: ` . Prope Owner must sign Property Owner Letter of Permission. o y the a ImprBvem t ntractors License is required. SIGNATURE: Q:Fonms:buildingpermits/express Revise091307 y The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.gov/dia ' Workers'-Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers j ,A,pplicant Information Please Print Legibly Name(Business/Organization/Individual):z/U go Address: City/State/Zip.� ���/l�. Are you an employer? Check the appropriate bog: :Type of project(required)-.. 4.' I am a general contrabtor and I 1,El am a employer with 6. Q New construction . employees (full and/or part:time).*• have hired the sub-contractors 2.❑ I am.a'sole proprietor or partner- listed on the-attached sheet.. 7. ❑Remodeling . ship and have no employees These sub-contractors have, ' g, []Demolition �vorkin for me in an capacity. employees and have workers' g Y P ty t. 9. ❑Building addition [No workers' comp,insurance comp,insurance. required.] We are a corporation and its 10.❑Electrical repairs or additions . -3 in a homeowner doing t 11-work . officers have exercised their 11.0 Plumbing repairs or additions ' myself,[No workers' comp. right of exemption per MGL 12.0Roof repairs insurance.requized.]tI.C. 152, §1(4),and,we have no 13.[] Other employees. [No workers' comp•insurance required.] *Any applicant that checks box A must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating•such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors gad state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site,' information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date.: .lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,.as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Office of' Investigations of the IIA for insurance coverage verification ' 'do hereby ce under the pains undpenalties-of perjury that the information provided above is true and correct. onJ( , Si afore: Date 99 Phone#: Official use only. Do not write in.this area, to be completed by.city or town official City or Town: ' Termit/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#:' I tHE Town of Barnstable �pF Tp�� Regulatory Services w BARNSPABLE, Thomas F.Geiler,Director 9 MASS. i639• .0 Building Division 'fv ,t a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: n ter,�J9 "street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that,the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and recuilrements. ku ignature of H meowner 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 109.11 -Licensing of construction Supervisors);provided that.if.the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Nv �F1HElph, Town of Barnstable Regulatory Services SARNSrABLE, MAS.4. Thomas F.Geiler,Director �p .i639 �0�F1639 4 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION r Town of Barnstable *Permit# ge�7o61-72 &7d5, Expires 6 montlis from issue date > uvAE Regulatory Services Fee t 10$ Thomas F.Geiler,Director Dot` Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us -' 'S PERMIT Office: 508-862-4038 Fax j 0 790 2 30 EXPRESS PERMIT APPLICATION - RESIDENTIAL Not Valid without Red x-PresshWrint OF BARNSTABLE Mapiparcei dumber y Property Address A- �t l P S J///,�'](esidential Value of Work Minimum fee of$25.00 for work under$6000.00 / I r- Owner's Name&Address [,1 A�VCv d( Igo a4ge 4 � P¢-(-i/ AR� � ("j C— Contractor's Name Telephone Number 3bf-'YZO Oz jt j 9 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor •;_ I am the Homeowner ❑ I have Worker's Compensation Insurance r" Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(heck box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ( ' Re-side Replacement Windows. U-Value Uj (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prop e ust sign Property Owner Letter of Permission. e r mcnt Contractors License is required. SIGNATURE: Q:Formas:expmtrg Revise071405 i ne t.ommonwearrn of lnumaunusetla� Department of Industrial Accidents 93 Office of Investigations . 600 Washington Street Boston, MA 02111 - .•'y www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiicians/Pluixibers Applicant Information Please Print Legibly Name (Business/organization/Individual).-.(,? l Lu JA V410_ Address: 190 City/State/Zip: .(?Q i1 lew 1)���` /� Phone#: �5_0$ 1120 0 t fI f9 Are you an employer? Check the-appropriate bog: Type of project(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6, ❑ New construction employees(full'and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Budding addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10,0 Electrical repairs or additions required.] officers have exercised their 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or.additions myself. [No workers' comp. c. 152,§1(4),and we have no, '12.❑ Roof repairs insurance required.] t employees. [No workers 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp,policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy an` job site information. Insurance Comp any Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$256,00 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 in ance coverage verification. I do hereby cert' un er the �' d penalties of perpury that the information provided above is true and correct Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official f icial City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector S.Plumbinalaspecter �I 6. Other Contact Person: Phone r: Information and Instructions } rt- 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 phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in . (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 (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 hike 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. T 617-727-4900 ext 406 or 1-877-MASSAFE ram 61-7-727-7749 Revised 5-26-05 vwww.mass.gov/dia Town of Barnstable °FtKE> Regulatory Services Thomas F.Geller,Director sex�sr�ste• � _ . MASS.- Building 1Division . a639• Mp,�p�. -:Tnm Fer yj3uilding Comimssioner 200 Mam,:S,tre�t;.`I y;=,MA 02601 ' )ffice: 508-862-403.8 _.. _ Fax: 548-790`6234 . CONRLA, -NT1IhTQUIRY RESORT Date: - .. Complaint Name: , to Map/Pareel . t _ o Location P m Address: (J Originator Name: o�� . ' . - Street: Villag44Lr-, State: Zip: Telephone: Complaint Description: FOR OFFICE USE ONLY tj 1 Inspector's Action/Comments Date.. Inspector: i r RCS Additional Info.Attached TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ;Map Parcel Permit# ,� 9 S 0> Health toFU STABLE Date Issued Conservation Division f". �, q/� 2NrA; APR _9 A 9; 36 Application Fee.. \5 0 Tax Collector SE tS� aT�...li�� Treasurer T -- INSTALLED IN COMPLIANCE V ISION WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board A TOWN REGULATIONS Historic-OKH Preservation/Hyannis nf- Project Street Address 9,qD Village Owner On),1 4;,-�prer We- Address �11� T Ct 1 y_,-� V� Telephone 'DOFS _ LA 70- (ALA L vl Permit Request Y) Square feet: 1st floor: existing proposed 1 E)2 2nd floor: existing proposed 3 2 Total new 1 S 8 q Zoning District Flood Plain Groundwater Overlay Project Valuation 2,6000 Construction Type WooS2 Lot Size V51 O 00 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 2r Two Family ❑ Multi-Family(#units) Age of Existing Structure 7 Historic House: ❑Yes N No On Old King's Highway: ❑Yes U No Basement Type: VFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) -1&V 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: W"Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes TIN Fireplaces: Existing New Existing wood/coal stove: &1es ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes O No If yes,site plan review# Current Use - d Proposed Use BUILDER INFORMATION. ccf,h) 36a-smS Name l` ;I 1�(�51 t ),O ' ✓ �iJI�Q �'lY Telephone Number AddressR q D S ILhW License# ,enhA �1 I le- , jn Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT IN DATE ISSUED MAP/PARCEL NO. _ ADDRESS VILLAGE OWNER ,y DATE OF INSPECTION: FOUNDATION L611�®4JJ. FRAME dI �Ul� n 1 INSULATION (= � e /�c+.w�c pa� e try- • �a� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: R{t FINAL cr GAS: RPyUGI-�� O 9 FINAL FINAL BUILDING , — c m fn C Zim0 ►_' •U =t DATE CLOSED OUT r z a ASSOCIATION PLAN NO. p 's BC CALC®2003 DESIGN REPORT - US Tuesday,October 12,2004 11632 Dotble 1 3/4" x 11 7/8" VERSA-LAM®3100 SP File Name: BC CALC Project:17801 Job Name. Kuehne Description:Girt carring room over garage Address: 290 Ames Way Specter. City,State,Zip:Centerville,Ma. Designer: Bill Campbell Customer: Company: Shepley Wood Products Code reports: ICBO 5512,NER 629 Misc: Standard Load-40 psf i 10 psf Tributary 18-00-00 { e t 12-00-00 Ak 12-00-00 Ak 80 131 B2 3780 Ibs LL 10800 Ibs LL 3780 Ibs LL 863 Ibs DL 2875 Ibs DL 863 Ibs DL r Total Horizontal Length-24-00-00 General Data Load Summary ' Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 24-00-00 Live 40 psf 18-00-00 100% Member Type: Floor Beam Dead 10 psf 18-00-00 90% Number of Spans: 2 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 16410 ft-Ibs 77.1% 100% 2 2-Left Slope: 0/12 Neg.Moment -16410 ft-Ibs 77.1% 100% 2 1 -Right Tributary: 18-00-00 End Shear 3740 Ibs 46.5% 100% 4 1 -Left Cont.Shear 5935 Ibs 73.9% 100% 2 1 -Right Total Load Defl. U516(0.279") 46.5% 5 2 Live Load Defl. U597(0.241") 60.3% 4 1 Live Load: 40 psf Total Neg.Defl. -0.077" 15.3% 5 1 Dead Load: 10 psf Max Defl. 0.279" 27.9% 5 2 Partition Load: 0 psf Duration: 100 Notes Disclosure Design meets Code minimum(U240)Total load deflection criteria. f Design meets Code minimum(U360)Live load deflection criteria. i The completeness and accuracy of Design meets arbitrary(1")Maximum load deflection criteria. the input must be verified by anyone Minimum bearing length for BO is 1-1/2". who would rely on the output as Minimum bearing length for B1 is 4-5/8". evidence of suitability for a Minimum bearing length for B2 is 1-1/2". particular application. The output Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing.+1/2 intermediate bearing above is based upon building code-accepted design properties Connection Diagram and analysis methods. Installation of BOISE engineered wood Consult project design professional of record or BOISE technical representative for connection design - products must be in accordance Member has no side loads. with the current Installation Guide Connectors are:16d Sinker Nails r and the applicable building codes. To obtain an Installation Guide or if a=2" — you have any questions,please call b= b —d 3„ (800)232-0788 before beginning �— product installation. d_1" a BC CALC®,BC FRAMER®, BCI®, BC RIM BOARD'*', BC OSB RIM C BOARD-,BOISE GLULAM-, VERSA-LAM®,VERSA-RIM®, VERSA=RIM.PLUS®, o e VERSA-STRAN D'rm ji VERSA-STUD®,ALLJOISTO and AJSTM'are trademarks of Boise Cascade Corporation. Page 1 of 1. ®I$E^ BC CALCO 2003 DESIGN REPORT - US Friday,November 05,2004 09:00 Single 11 7/8" BCIO 600s SP File Name: BC CALC Project:J01 Job Name: Kuehne Description: Address: 290 Ames Way Specifier: City,State,Zip:Centerville,Ma Designer: Bill Campbell Customer: Company: Shepley Wood Products Code reports: NER 594,ICBO 5208 Misc: 1 t Standard toad-'40 psf 110 psf OC Spacing l&' 22-00-00 Ak 14-00-00 BO, 1-3/4" B1,3-1/2" B2, 1-3/4" 497 Ibs LL 1250 Ibs LL 337 Ibs LL 118 Ibs OL 312 Ibs DL 49 Ibs DL f Total Horizontal Length-36-00-00 General Data Load Summary Version. US Imperial ID Description Load Type Ref. Start End Type Value OCS Dur. S Standard Load Unf.Area Left 00-00-00 36-00-00 Live 40 psf 16". 100% Member Type: Joist Dead 10 psf 16" 90% Number of Spans: 2 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location 16'. Moment 3100 ft-Ibs 56.2% 100% 2 2-Left Slope: Neg.Moment -3100 ft-Ibs 56.2% 100% 2 1 -Right OC Spacing: " End Reaction 616 Ibs 50.2% 100% 4 1 -Left Repetitive: Yes Int.Reaction 1562 lbs 53.9% 100% 2 1 -Right Construction Type:Glued Cont.Shear 874 Ibs 47.9% 100% 2 1 -Right Uplift 92lbs n/a 4 2-Right j Live Load: 40 psf Total Load Deft. U546'(0,484") 44.0% 4 1 Dead Load: 10 psf Live Load Defl. U663(0.398") 72.4% 4 1 1 Partition Load: 0 psf Total Neg.Defl -0.111" 22.2% 4 2 Duration: 100 Max Defl. 0.484" 48.4% 4 1 Span/Depth 22.2 n/a 1 Disclosure The completeness and accuracy of Cautions the input must be verified by anyone Uplift of 92 lbs found at span 2-Right. who would rely on the output as . evidence of suitability for a Notes particular application. The output Design meets Code minimum(U240)Total load deflection criteria. above is based upon building Design meets User specified(U480)Live load deflection criteria. and analysis methods. Installation code-accepted design properties Design meets arbitrary(V)Maximum load deflection criteria. an Minimum bearing length for BO is 1-3/4". of engineered wood Minimum bearing length for B1 is 3-1/2". with the current Installation prodductsucts must be in accordance Minimum bearing length for B2 is 1-3/4". allation Guide Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+112 intermediate bearing and the applicable building codes. To obtain an Installation Guide or if you have any questions,please call (800)232-0788 before beginning product installation. BC CALCO,BC FRAMERS,BCIO, BC RIM BOARDTm,BC OSB RIM BOARD-,BOISE GLULAM-, VERSA-LAMS,VERSA-RIMS, VERSA-RIM PLUS@, VERSA-STRAND-, VERSA-STUDS,ALLJOISTS and AJSTm are trademarks of Boise Cascade Corporation. 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Inv .. 1 All j 1 SUR VIVO 20 T TO NAN jTj All it Of I :. ff _ .. .. t t '1 f w i .�. r --�.�,.,. ..,..�.•.rr�<.. �: .�+r• .....m.•..„n+- :y.. b.:u+�.,r -�.r.w:w.;..w.+' :»:�.h,�.�. �.. m� ti.�,-�,�.�..wK-.,�.�•,,,�.�•r^'�^r I ►,�.y f F1��a,.�ox,����� bsJv. �Y"��+v4�`" 1-�jr•e��-�r:.x. ;;�,�jc,�c�ro. �-�. .,.,yC�.�-; Y _ r e L . . fv Ay Or mA V� AA qq p , n" y 71 f F.PWAC00-6 t _ - � ; Town of Barnstable of Otte ropy • • , o� epl.atory Services Thomas F.Geiler,Director • s sTS& 1,s!On yqj sb39, k,� Bllll(�ln.g Div prFD Mpg Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 • Fax: 508-790-6230 Office: 508-862-4038 ' permit pate AFFMAVIT_ YCOME�ERO TO PE SUP RMIT APP CA'TZONw . o£an addition to any pre-existing ow�.er-occupied GL c.142A regwres that the"reconstruction,alterations,renovation,repair,modernization,conversion,, M -improvement,removal,demolition,or construction at Least one but not more than foul dwelling units or to structures which are adj scent to tu,�g containing with other s uch residence or building be done by registered contractors,with certain exceptions,along wi — requirements. Estim4ted Cost C 'Type of Work• _ Address of Work Owner+shame: �� •' ' . lioation: pate of kyP I hereby certify that: gegistration is not required for the following reason(s): , DWork excluded bylaw ' []lob Under$1,000 , OBuild ng not owner-occupied J Owner pulling own permit Notice is hereby given that: OR DEALING'WITPS UNREGISTERED OARS PULLING'I'HEDR O'WN�ERM[T CTORS FOR APPUC�LE HOME Il O GUARANTXOVZMMNT wkTUND UNDER MGL 142A. CONTRA ITgATION PRO GRAM OR ACCESS TO TSE ARB . SIGNED UNDER PENALTIES OF PER7URY Iliereby apply for aperMit as the agent of the owner: • gegistzationl�Io: Contractor Name Date OR 1 Owner's Name OF1HE rpm Town bf Barnstable Regulatory Services M B"liftABLE. : Thomas F.Geiler,Director 9 MASS, g i639. A.m Building Division lFD MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �,,�` Please Print DATE:�/'t�L�d �q, �1— Y JOB LOCATION: aq V 111 1 1PS IIVQ"I �� i lliV VI 1 k �,`number street village HOMEOWNER'�M 1Y ( � �Ql name home phone# work phone# CURRENT MAILING ADDRESS:Q��. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as su ep ryisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply.with said procedures and r uirements. Signature of Homeowner Approval of Building Official PP g , 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 n i of this section(Section 109.1.1-Licensing of.construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by m several towns. You may care t amend and adopt such a form/certification for use in your community.,:'. Q:forms:homeexempt W LOT 1 15,000± SQ. FT. 1S ti� OOO'. DECK EXISTING DWELLING CONCRETEp FOUNDATION iA 0 4y L 100•� 4 R - G� JOB# 04-255 FOUNDATION PLOT PLAN FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT ONLY PREPARED FOR: LOCATION : 290 AMES WAY CHRISTOPHER & JENNIFER CENTERVILLE, MASS. SCALE : 1" = 30' DATE : OCTOBER 28, 2004 KUEHNE REFERENCE : PB 306 PC 17 ASSESS. MAP 170 PCL 221 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE �k OF r� GROUND AS SHOWN HEREON. y�Fp� ASs9c ARNE off. 508-362-4541 U H. a I fax 508-362=9880 OJALA w down cape engineering, inc. o.26 48, Q. CIVIL, ENGINEERS LAND" SURVEYORS EYORS _ S 939 main st. yarmouth, ma 02675 DATE REG. LAND URVE rg� :t 1 F � t t x' , 06 0 77 a . 4 a: 79 Z'xkte.TS.Z.Zb( gd,tsd trtremarinax txYe Yxrkxgcs far dun$Ad'Tly*Vostt�'Rcstdeatlst Huitdla1p . ' preserlp ' 81ah 'Fi'�sttts6lG"c�aling� Vial13".mpat Fc� pv4pmcni mclw C3isxin�M Ctlazttsg �etling "��� hoar � � R yxluci R�� . A rtI►�r p sgc 5101 to 6500 EweagDMT"—Da}� 6 Namvcl 13 19 to 6 Narmxt I2,lT 0.¢0 38 19 19 10 b iS AFLTE R tz'h 0-52 30 13 19 10 Nartnal tz I�'l. a.30 33 13 25 , NIA WA Namsal I5Th 0.3b 33 19 10 iS AFUE ISTh 0.44 7d 13 5 NIA Z�A ' 1S AF1lE U ISIT 0. # 3 19 10 Komsal Y 1311. 13 0132 30 13 2 NIA K A �tcmtxI 11% 032 3a 19 25 NIA IA 4o AFU9 X I S K 0.42 33 13 15 to 6 g0•tsFUT~ Y Ig*1� 0.42 31 19 tg 10 x 18.1� 0.30 30 .kA , L� AppRE55 OPppo?FFTY: VARE FOOTAGE OF ALL {Z'EgCORAL�S: ' SQ .;_ 3. 5Q,JAgE FOOTAGE Oy ALL GLAZING, GLAZING AREA(93 DNMED BY 5, SELECT pAGKAGE�4�`�•sae chart ataaYc): . MORE (OL'YZD ZYiETMODS OF DETFER�rn a�gGY REQCTIREMENTS 0 ; OTHER . ARE AVA�,p,IlLE, ASKVS FORTHIS XNFO B�,DIrtG I1�tSPgCTOR APFROVAL� . q•ea�m;•flao3o36 , .` ` - :• " The.Commonwealth of Massachusetts , -- department of Xndustrirtt•Accidents' ' ' 6Q0'Washington Street _ Boston;Mass•.b211 ' !•' workers'.C m ensation. nsurnee Affidavit-General Businesses address: ,, }. h e •�0� l J'I�l • � state.' 21 • _ -. . • .. __.. ork site locatioli full address s e: [] eR []Restaurant(Bai/Ratingestablishment �' rietor and havd no onta �Rs>nes Autos etc, �] I sin•a sole prop []Office[�SaTes CM 1c din Rt;aY e, in an capacity. yvorlonS �' 'lo ees full&' art time: 4 � �]Z an em to er with / � % 'ob. , %//y� %/%%%/�/// gerst cbmaensation for myemployees worlang onthisr .. I ;em to providing W 15 t :1 a j :'<.. ':y�•,?',..r.;i �' . .. am an• .�,•{" .}•••ii• •1 • .th: ;. `..+{; .t1•• 1 yrt; r. •,l(5�:-��I'7•,t'•4:l;itji.�•' :fl..'.-':•JL. 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GIIC, a• '•1��'+Yi''1�1' "' '. 4••;r ',`•`cdr�'1 i '•l�,a fl1•'iL..Y ":'S%:.•2't• '.tM'�,:r' `.!•=�r.�tr:5 tti..r:.i. �'•'. . ��� -- fnsuran y osition of crimlizal p enaYties of a fine up to$1,500,00 suI or EWAe coverage as required under Section 25A of MGL 152 can lead to the imp secure OP WORK ORDFiR and a finto f$1011.D4 a'day against ma I understand that}! Failure to a enalties in the form of a ST one years,imprisonment well as ciXffp copy Of this statement maybe forwarded to the Office of Investigations of the DTAfor coverage verification. under the pains and penalties bf perjury that the . `ormation provided above is frue and rI� � I do here6 rtlfy , . pq 1 ' mot• 5 Print name - officLl]use Duty do not write in this area to be completed by city or town oMcW permitllicense# ❑Building Department []Licensing Board city or town: ❑SeIeetmen,s Office [3.checkif itamediatr response is required []HeakhDepartment , C]Other phone#; contact person: (!el SepL 2003) • Information and Instructions.` ~ _ efts General Laws' pter 152 section 25 regiiizes all employers to provl�'c workers' eompens�tion for their. Zvtassaclius. ernsloyees; .As Quoted'fromthe `law",, an employee i5.defined as every person m the service o another under any contract of hire;express oz inli�ed; oral or written, ,An emplo}►er is defined as ati individual,parhaersI4, association,corporation or other legal entity, 6r any two or more of the erapforegoinggaged'in a•joint enferprise,and including the legal*representatives of a deceased,employer, or the•receiver or artnershi association or other legal entity, employing tmployees. 'HOwevei•.the owner of a trustee of an individ�,p . p� dwell ag house hawb g.not'inore than three apartments and'who resides therein, or the,occupant;o the;dwelling douse bf b spersbns to do.maioke�aance,construction or repair work on such dwelling house csr on the grounds or another wlio empl Y uch.employment.be deemedtobe ati oy. hu�ding appurt t thereto shall not Vei caul a of s 1 t. IYIGL chapter 152 section 25 also"states that'every state or lacal licensing•ageney shall withhold the lssuaneb or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has cee table evidence of coinplianee with the insurance coverage rdgl ira Additionally;neither the' ' not produced a •p coinmonv�'eny•of its political subdivisions shall enter into any contract for the performanc alth nor.a e of public work unto of compliance with the insurance requirements of this chapter have been presented to the contracting acceptable evidence authority: FNIIII Applicants Please fill dTe wr e s'•eo�ensat a€ddavit completely,by checking the box that applies to your situation.,Please supply company tiazne, address and phone numbers along with a certificate of insurance as all'affidavits may be submitted to the Department'Of industrial A.ccidents•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 pepartment o#`Tndustrial Accidents. Should you have any questions regar&9 the"Iaw"or if you are obtain a vvorker6.'.compensgimppli0y,please call the tt =t at,the nVgb liste�d;lielow. required toy , . • . City or Towns pleas e b e sure that the affidavit is complete andprinted Iegi'bly. The Department has provided a space at the bottom of the affidavit for you to fin out tithe event the Offic6 of Investigations hfis to contact you regarding the applicant Please be sure to fill in the penuut/li.cens e number which will be used as a reference number. The.affidavits may.biyeturued tQ. FAX unless otheai angements ha.Ye been made, the Departmentb}�. i' r , The Office of Investigations world like to thank you in advance for you cooperation and should you have airy questions, esitate to give us a zaIl. ' please do noth / it's address,telephone and fax number: . The Dep . The Commonwealth Of Massachusetts- Department.of Industrial Accidents Ufa"DI(Hlfefllpftns 600 Washington Street Boston,MR. 02111 fax M. (617)727-7749 F ' " f " F " I f E •. _ _--- t_ v .p - - �-'"d"�w'.'� �k � '.- � •...r. tom""` `• � F � 1 i.~ ,n �' - I F i 290 Ames Way U ?r. e. /V- Ak J`YY E t � -3 { f , . < i "'•- _ �-.�, lam" .�,�,� 2-1 soaovo t ifs" MOW t t� f 3-a-X(O- YID Pr Ce4�=�ii Dec .... ... . ...... ......... . . .. .... . . ............ ........... . . .. ..... ... . . ............ ... ..... ... ....... . .. ... _.. . ..... . �V 71, 13gl j4�11 vo,N�q A\ To zoo f S t, A-1.(, r-oo r(Nth -To 6 Cv' p-rE vcws / .g any r-,IWAy Mt N, TOWWOF BARNSTABLE LOCATION. °? ! f S G,- SEWAGE # p VILLAGE e £ A-17— ASSESSOR'S MAP & LOT Qa _ i,C o -sd�"•!��S- J''az NAME&PHONE NO. / SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER C/ /� IVA., 1£L w _ ..,._,.PERMIT DATE: COMPLIANCE DATE: ,fieparation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private)Water Supply Well and Leaching.Facility (If any wells exist on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Fumished by LJ r ` // aS f y O r - "F4j f Ali`' A tier,i ,6. Town of Barnstable P�of�MET�,tio Regulatory Services h * Thomas F.Geiler,Director � 'l1i, Building Division: MASS. q 9 1639. �0 �'�TFD MAGIp Tom PerjTBuilding Commissioner _ - = 20. et,.Hyannis, 6 - _ 0 Mam:.Stre MA_02 01 . )ffice: 508 862-4038. Fax, 508 79 t .CO�VIPLAINT�OMY REPORT' = x w Rec'd-by: D-at e: Complaint Name: Map/Parcel� Do��l _ Location � Address: &�c Originator :.. . _ Name: _Street: 260 All 70 w G Village• State: Zip: Telephone: _1 � Z 4e� ? �' :- n Y/ Complaint Description: - M'11-:J) a eT-p e _ Q)j 6 A) 4D,�S_ S� ta� �S G r x (o r AbaLS_6_1 FOR FFICE ilSE ONLY• Ae i ! hGe(-U e ('Idgl7 e S u � deMor�s'Acti�n/Comments._Date: Inspector: M Additional Info.Attached- gp,pos;�-e 2�CtS �y i 6,,se { j tTOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ap f Parcel 22iJINBL Permit# 10 3 Health Division ��' 32 -? 2-9 03 64 . 3� Date Issued R'ZL—'U3 Conservation Division a � g `'' ,f s Application F .e `- Tax Collector '— o �- ��4 � _._ _---Permit Feed Treasurer L �� — P?t 1 !C; SEPTIC SYSTEM MUST 6� INSTALLED IN COMPLIAC��` Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANL TLlifllN REWLA'TIONS Historic-OKH Preservation/Hyannis Project Street Address ��� : �Is,�K)QUJ1 Village e— Owner S,k )iKy-e_l)ne_ Address Q O � Telephone �%-gQh-wyq Permit Request(0 Ix�k, tQ WN rl V3P=Xb Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size I�; !�4N Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 83 No On Old King's Highway: ❑Yes 8PNo Basement Type: �Q 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: dGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes 14 No Fireplaces: Existing New Existing wood/coal stove:/&Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:,Oexisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ZNo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number . T Address j,,� OS IA License# Cf'I A Q\\1i (D -3a Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE O Z�3 i FOR OFFICIAL USE ONLY 4 " y PERMIT NO. f DATE ISSUED MAP/PARCEL NO. F ADDRESS VILLAGE OWNER r �y DATE OF INSPECTION: FOUNDATION J/ FRAME C(! INSULATION FIREPLACE wj ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH: FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r M The Commonwealth of Massachusetts ... Department of Industrial Accidents office of/oyesafffi oos - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit %%%% r,%o/o lomfian qt� s " o �--i l i city phone# r �1 �]=I am a homeowner performing all work myself. ❑ I am a sole netor and have no one woridn m' capacity 1 ravidin workers'compensation for my employees working.on this job. El I am an employer ``;^: ; .';; :< :% :;:}:'`•'? :?:'::::;;;::;.:;>r::::: :::::<;:::::':::::�::::?:::: :'i':;:::i:2;::::;::Si:%:ii ii:J::J::i{ :::::::: Y:.:;<;:::.:}::.................::...:: .............. ........... : w 1[an ••'.• �#:^.'•.;.'�,:;.;.y,:;:;,..;:{?,;,j;';`...i:;i>;j$ :`><:{:;iy:;,;:4;:!ti;:n�li:�i: jf:$::}�i:;:i{:?:i���:�:�'2%t:': �tistan ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have n workers' co ensation olices; P .......................::.::.:::::::::.::::.}:::.}}:.;}:.:;.}:-}}:4::Y:-:Y:.Y}:;;.: Y:;::i.Y:;.;:.}:.J:;•;:•:.>J;:>:<::<:<:::<::»i::>i::>;:Y:::::�:' the follows .........................:........................................:...... g :............................................::................................::.....:::. ..::::::......................:...n.:..:,.:::..:,::.;.....: i'4v. nv:•::..•.:....:....::: •• % :y:•Y}i:•::4:::Y::•J:::;:h.:i:L:?:H:4;:..;:.;?.:.:::: n .. .. ....... :..:.....: ...........:...... ;:•:xis:.:n:•iY::•}:•+:- Nk•: $:;i'::%{isi':%%>.%v:%:;:!?;i$Jiiiliii :::;.:ii•:i;:;:;:j;xi:::::i'i��i:�i`:%viii::':iii iY':%ri;:;iii:�:�'xi:i�:•:i;}Y:iiij; s.:F?:•:iY:'sr:'f.;:i:;:t ii}::::;::J}:�iij<yx;ii i:<:}4:+.•Y:i;:j;:>�?i'+iiiY:,Ai: ":::}ii:::ti%J::j:;iiix:sir}::si:<::(:::':::'::':%!:ii:%!::ii:4:L::{si:% sis5%:'::i:;:;{::v%!%:%:::::::::;::i%C:::•,:i:%:J"::: :i:::: %'.::i::!% ;:�i::i::::i:>.f:!y::::isii::?`vi+:$:i::iii' :ji:::-:;i}ii:v:ti:i:?{'>.iYYYY;.}:;ry}}; .....v... .......... ..v....... .......... .......................... ......................:w:::•::::;.::...:..:. ..::•:v:v::••:::v:r.v:.vv...:..:-:•:::w::.v:::::::::..........:w:.:4;:.;.v+n4}:J.i•%vi}:::::• ............ ............. ................. ................ ....................n.... 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(1 :;:;i .:;i;:;':': ":::':::::::.':::::::::.`:::::::.'v:.vri.v.:.v..:.:r.�i.:i.:n:•:4i:4:•iY:•Ji::i•Y:{{iiiiiiiiii:^i:v:v....:::.:....:':::.:•:::v...::::::::........:v.::::::::•\i�::k:i•}:titi4:'}:+.. ............ ............. ................... .................. ...............................::v:::....,..........-v.�:::.............:�::::•.............................::v:n•::.v:::::::w::v:::m:r:i4}}:ii•�4......,.:,.,,% :�#.::::;:ii:;:;'i{:;:;:�$:`.�:;i:iir:x:j;:;%:;%::;(:::'i::v%:i'ri':'�::!<%xtx>??;:;{'{.::•:r:i::i.}^•i%%:x:%%:.:%YYJ:: •..•'.....>i`:SWAM :?airy!, ::+:::S:j�ij i:,::�;�:y:iii?}F•isC::i'ry':';`.:%?i;:;:>.v�i:::'iiii:;�•i�:?i:;S:;:>;:�:{:{:ii:;?:;i:}::;:; :•.�II]nrance Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition o[erlminal penalties of a fine up to$1,500.00 an our yam,imprisonment as well as civfi penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me: I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereb certify under the pains and penalties of perjury that the information provided above is trap. and correct �n Date \ Signa \ ^/'� ,l aq /� Print name lQ��� •� W kabp?_ Phone#Q�1 U U`�� 55555111,51,15 onic al use only do not write in this area to be completed by city or town offldal city or town: permitNcense# ❑Building Department. J CJLicensing Board ❑ ❑Selectmen's Office checkif immediate response is required ❑Health Departnent contact person: phone#; Other 4 (revised 9195 PUJ Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,neitherthe 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 a'. Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of inanr�nCe 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`9aw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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 permi license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 lnvesugations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 FIRE p� Town of Barnstable Regulatory Services �BAMWSSABL&g Thomas F.Geiler,Director 0.9. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more 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. Q IIn^ au Type of Work:'A' r VJ Estimated Cost Address of Work:C>M 'CCJI V 1M� Owner's Name: a 1n.111'/1 k e t nc, Date of Application: i �� I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Nam Q:forrmhomeaffidav , ».,.o�.,-;.4r,;,;iy- .: ' _2. -}'! t5�}q :z t .fie;.`rwY r.�sy :3 s s-tp ,�a.."#;G; l F��S.� /YT P� f1'Yxf -Yt 5������� ��t'tvi_ #�G ,,, PLAN NUMBER r LOT (5)t FLOOD;HAZARD 1NFORMA`TION. FLOOD MAP COMMUNITY.NO.: 25000t. ZONE: X �._. ... ASSESSORS MAP' MP70 LCK-PANEL 00.15C DATED 19 :PARCE :=221: - p . 150,00� 1 N/F .CRGSBY BECK w N t 1/2-STORYal Y LOT 1' o 15,000 S.F. V 9420' AM'ES WAYIRTGAQE LENDER :, E!S,E ONLY THIS IS THE RESULT OF TAPE*,MEASUREMENT, NOT THE RESULT �. : OF .AN INSTRUMENT SURVEY AND:: IS CERTIFIED TO THE TITLE INSURANCE—:COMPANY :AND ABOVE LISTED ATTORNEY AND LENDER.: .J� 40:KENWOOD' CIRCLE; SUITE 8, FR'NKLIN,. MA 02038 THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED~ TELr(800)287-8800' FAX.:(508)528=4011. DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT 'AS SHOWN:. OF, _:= THE .LOCATION OF THE.`DWELLING' SHOWN DOES NOT'-FALL WITHIN A SPECIAL FLOOD .HAZARD ZONE, RO.BERT , o EDWARD . c?: BiMNNETT .N Town of Barnstable Regulatory Services " Thomas F.Geiler,Director BAMSTABLE, • ' MAss. 9q, 039. ,�� Building Division prEO l'�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE 70B LOCATION: number street - village "HOMEOWNER": Y� Ike 420- Dggci e_ name home phone# work phone# CURRENT MAILING ADDRESS: I VAwe S c P,_j-pA�j I P • M f Oa(n as city/town state zip code The current exemption for"homeowners',was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual.for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm.structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and 4quiremenis' Signature of&omver Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This ladk 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:fomLs-.homeexempt I The Town of Barnstable IL Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis,MA 02601 862-4038 790.6230 PLAN REVIEW ner: Map/Parcel: 2 ect Address: iaNyqzs Builder: EW A e 16 e following items were noted on reviewing: � t D.S T S -+U ko a— `T X l 0 _Cy -� a'' a iewed bv- . ....,RUE■ .L■a.■■■.. ......■■.■■.N ME N..ER..C.O■...M.B.E.■.E■■■L...■ME....■■....E...■.M.■...E■..N■....i■.... ME .a ,E ■ .■ as/. i. ■ ■E ,,.■■■i.�■NYH■■./LL.LLLLLLLLL■LLLLLLLL:.LLLLL"i•••a ■N , LLNUNN 0 a on NMENNN.■■N■n■■M■■■■./■.■a.SEEMS ■ H ... ■ ai E■L LLLL iNLLLLL L . ■ ■ ■ ON a L iwmn■ Io ■ L... . . ago . . ■ ■ .a ■■ L L ■ ■■..■.B■NN ■ ■MEN D , .. ■ L ..■...■.MONSOON,a.■■■..■.■.a..ERR■..■LMENNL �. .■ RUN ESE . .,.,,N..,...■■....,■,■■■..■...■N,LMENNENE.■. ■ ! . ■.. ..■■..i. E.M..■..■■■...,■. ■.■a NON ■ LLLLLnommoLLLLL.'LLLLLL'LLMmommom'EE'E L..LLLL:'N= .L ,NE ■ ■■.■,■..■■.■■■■■.■.... MEN S■■.mom a ■■ ■.. ■ ■■ .■m ■..■..�.. 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H a■s� s ■ �Nwn■n m■osomsnsm■mmomom.i�fi■ ■ [w�in, � a o o■n. an ■■■■■■ti■i■.wow■w.i.ii ■NsnNs ®®�� MINN so.sa■s.ons a 0111IN 1 a ONE am mmummo NONE sommom�omm�msm Oman some== 9 r lag Monsoon mn� sin ®■■ mmom mwmmms■■■■ as■n�n...s•ss�H■■s.s■� oN■ wm■w No ■wmswss■■■Room onilNs■omm■ mm�somomsn�mogn m■.■ OSEEMS N ■■■■■ sonH11�i■■.i■s®■E monmino ■N■s�■.ems ■■■- ■■■■■ a �ii NONE a m ss swoon ii o■ ��■ ■■sin ■ ■ s ■nnm. ■fm ma' 'I ■sin n■mwiww■■ mOMEN ■o■mwm■n®mw■■s m..!sons ■..■sins■■®ir ■■nms■� ■. msmmm.N®■ mmommwmm■wNwmo■o■ no ME■.ss■■■ ■■ ■. o■nii■■s■®n ■■m■■■■woto■■i■■■wmono. oo.n �■mssos■n�som ®■osn■sn■■�. ®o■■ s .so moms o m®s■snoo �lsnos ®n■o■■i■ss�■ m■s. �■ ■ s■■m■■sssl■nss■.s■s ■■■■m ®nnom®mom®■ monm. m ■ sssNo■ ■snnsanii i■■.ss !■■■■nss.s■.■i■ w■■..■ �■ w®■■■.i■ n Ilona INORs ■■■i■ ■. .■■■!.® EMMEN mmommomm��m =son ON MINN so SERENENESS ■ ■■nnm wn■■mnan ■i■■ m/ ■ Hm■■mns ns■■■■i■■ss ■■ ■ w■■■=Son ■■■■■Hsi■ ■■■■ ■ ■ omwonm■ss■■aso■■sin■m ■mmw w■■.■■w n■1- w�■■■■.m■smmm■m■■msnnsmmwm .■ a snimmsmmonom o■i.■s mmommwmm■m■mm■moon ■■ s■i mnm■n■■.s. w■■■wwmmom■wmnommmmw■ ■■ i ■■sb■i■i■■■ii mo■■m■wm ■■.swmommssommonm Man!®mm■mm■wwm■■mmw■■■.■swmwo■■. ■ ■■ s. mm■nnoii�anom■ ■.■w■■■wow!■■mow■■■■■■■■H■■M■ ■----- -■■.s■■H.■ s■N■s■i ■■.w■■ww.■■m■■w■■s■nw■iwm�imt m■w■m ■■ ■ism.■s a —■mom■■mwwN■wI m■■■■■.w■�� . ■ s ssumm■■mm �rommmmom ommm ■=sonn niii�===ME Assessor's map and lot number1.:.7. ... :. � t: � J� THE Sewage Permit number :4... ..... ' Z�0•R35TAX L MbaH � . ......., L " . qQ 1639. i 9� TOWN_ ' 'OF . BARNSTABLE BUIINSPECTOR�LDIN 'G i �-� �a� APPLICATION FOR PERMIT TO ..:..... ✓ �i ...... � .... .. ................................................. TYPE OF CONSTRUCTION ........�:C e��.. "f ..................................................................... i. . .. .......................• ..19... •/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin to the follow•ng,information: Location ... ' Y� �S .... V ............... ProposedUse ........Z....... .................. ......... ........ ........ .. ............ .... .......:........ .c.......... Zoning District l .� .. R .. .Fire District .... ...... C11 Gl........ Name of Owner C?CXP......... ... Address z..a.....; ?K!:?C' IL S. . `. t•?. ! Name of Builder /.+ t ......44o(... ..... .... .Address l..�Scs �✓� ... 1........: ................................ c �/ Z71 - r Name of Architect ................................. ......... ......... .........Address ....,....... ....... Number of Rooms .........Foundation ...:.......... ..... ,,mi�ll ..yyam� Exterior :....................... !7� .. ......... ,...................Roofing ....... .....,! l....: - .................................... Floors .::.......Interior ............. . .................................. .... Heating Plumbing .......:... ......... Fireplace ...........Approximate. Cost ........... Definitive Plan Approved by Planning Board -- ----------- -_-----19 Area -of - -- Dia ram of Lot and Building with Dimensions g g Fee ,/'p t...........���........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH' � . - .•♦r ,. -• Y,� { _ - •, . e +fit •_ ' i•`- '. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS F +. I hereby agree to conform to all the Rules and.Regulatioris'of the Town of Barnstable regarding the above construction. Name .srf ..... t .�.^-41..................................... Construction Su ervisor's License ...0 ..� ��.7:....... SCUDDER, RIMARD M. & JOAN M. No 26626 Permit for ...COMPLETE 2nd Floor ................................. .............Single FamilX Dwelling............................ (4 Location ... .................................. 'Cibnterville ................. .............................................:%............ Owner (Scudder, Richard M. & Joan M. ................ ................................. Frame Type of Construction ........................ ................. (7 .............................................. .......... .................... Plot Lot .... ........................... s. Jge - • Permit' Granted ..............2..6.4., 1,9 84.............t........ Date of Inspection..........................!;i?::�q Date Completed ...... '� 11 9 -15 Ik 13 1 4-411, 1P, 011 AJ Cl TOWN OF BARNSTABLE 2182 _ . � _ Permit No. _--____-- � _ t Building Inspector, Cash9. OCCUPANCY PERMIT Bond -- No building nor structure shall .be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged- use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to James K._ Smith Address Lot 1-S 290 Ames Way Centerville Wiring Inspector Inspection date > s _ r ' �. � Plumbing Easpector Inspection date Gas Inspector, Inspection date Engineering Department---,l'//?ty,{1:4°,f'V,/r—/IV 67� Inspection date F THIS PERMIT WILL NOT BE VALID,.AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. f .....................s.. .....................�, 19_........,. ............ ..................Burl'"ding...Inspector ._..._......._.. ` is ma and lot number _ SS�E�S (� �/ �............ � .1. THE Sewage Permit number ........................................................ . ,err LE, • House number ........... ...:....:......:.............:... �o TOWN OF NST- A1, Mr0",j1W -- ----- BUDUILDIHG - 1SRECTOD APPLICATION FOR PERMIT TO Construct Dwe. . 11 in.g l ...... .... ... ........................................................................... TYPE OF CONSTRUCTION ...................Yo.0..Frame.:........................................................................................... Nov.e. ...mber 9. ............ . , �79 ...... . ........ .. . 19........ TO THE INSPECTOR OF BUILDINGS: '` `4' The undersigned hereby applies for a permit according to the following information: Location Lot 1-S Ames Wa,Y.f...Centerv,ille.i,..Maas. ................................:..............:........................................................................................ ProposedUse .......... e s i dent f a 1.......... .............................................................................. ......................................... Residential ,..,,.......Fire District ..,,,Centerville-Osterville Zoning District ............................................................ ........................................................... Name of Owner James K. Smith ,,,,,,.,,,,_Address pArl s s�bl�.............: .......................................................... ............ ..................................... Name of Builder ...James.K., Smith ..Address ..........:Barnstable .Name of Architect ..................................................................Address .................................................................................... Number of Rooms Four ....................Foundation Poured Concrete ........................................................................ Exterior Clapboard & T111 Roofing ...........As�t%alt Shinglps............... ...................................................... Floors Wall to wall ..............Interior .......::..Drywall....................:..................................... Heating ........... ......... FHW by 0i1 ............Plumbing .........Ch?A bath....................................................... ................... ...................... Fireplace One ........................................... Approximate Cost ........ 34 OD ............................................ Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area .........U6..S9.s...ft4p......... Diagram of Lot and .Building with Dimensions. Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ,GW1�Q/5....1`:.....��> 1`. ....................... r� r Smi'th, James K. ... Permit for .11-story••dwe11irrg r + .....................:......................................................... Location ....lot-4-S..2gp.-Ames..iry................ .........................Gentet yi-.1&...............:............. -_ Owner ........ ........................... Type of Construction ........frame....................... - ......................................................................... 7 Plot ............................ Lot- ............................... i M � � .1 S: '1 Nov. 13 79 _. Permit Granted ................./......y...................19 Date of Inspection . . ........:............ Date Completed ......4W. �........t.. 19 i . f PERMIT REFUSED ................... ....................................... 19 V } r. .... ................................................ `C. ... ............................................... Ap . .................................. 19 .......... .................................................... r. �a " SOIL LOG / r :•PE_^9TONE •LOAN FI LL•�' /12 MAX a S f f v • I 4 C.I. I°,.,;°•, p , p l S 8..ca 1000 GAL. 3,S 1000 BOX I°.••. . I IOpMIN. GAL. %,o PRECAST OR o i` 24 SEPTIC I •• • '. BLOCK ° • MIN c.L TANK I;;;'•'. . , o �I T�'s'T 6, I, °pee.D SEEPAGE ° �. . I o Sl : oe•o .° . . e °;8•, PIT 20' MIN. r�-FOUNDAT,ON i ' •. 1 %2" WASHED STONE -'.** TONE I I ELEVATION SKETCH I 10, 1 PERC. RATE: uNv> R2 Ztu,p��h�io SCALE I"= 4' TEST BY G, TOWN INSPECTOR: YNU +kriY BACKHOE OPERATOR- .a TEST MADE ON :, z.-rye: ZE3, •L G i.,"•or*� ,,.J''�,r�«,..J n.� .a-.�C:.e�E';c-f. �� " 1�► .5 S. N 0 F M4S. _. :TAMES T P. 2t -7/ LAPSLEY, ,A No.22697 O s �HQ SUR �( o►h - /s c�. © 5 5 4.-- 3 4 - 2 IS,- 3 0 M Lf qc ki�l� •p tiv x' G t1_ v _ 0-800 IDES- 1 d !o 0!1% �3 Q % it H 2;,t • N �a'r N s, o 00 .s E .�°° P f Top G�vv�.4�•- � -1 � .- ,��c, 1 r __ 3 SEa yam (Ko R eras Rl"c Q) x ►ro 441- S,ps w9c.Gs: �8s s, r. . 4, p L r 8a7T 0/1 ?o7-�9t,. 3) 7acvs✓ CJ�4T arHlc.I?i3G�' -7729 7-H15 LoT • .Ma, tN OF RENWICK yG\ CHAPMAN n No. 27654 O o PF. �, w4 FSS�ONAL a� ELEVATION SCHEDULE PROPOSED SITE PLAN I. INV. AT FOUNDATION ' = If4,5Z a SEWAGE SYSTEM DESIGN 2. INV. INTO SEPTIC TANK s IN 3. INV. OUT OF SEPTIC TANK V _ —'$I IB� �A�'VST�B(„E C4t�lT' J��Id-G�� ✓� SS, 4. INV. INTO DISTRIBUTION BOX - J1 SCALE: I"= OGT"j 197 g 5. INV. OUT OF DISTRIBUTION BOX _ _ � ' C ') 49'3 6. INV. INTO -SEEPAGE PIT = g 150 CAPE .COD SURVEY CONSULTANTS ROUTE 132 7. BOTTOM OF PIT =8?' S� HYANNIS ,MASS.