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HomeMy WebLinkAbout0118 BAY LANE W1. �i,A gg� jg,' �xl AP Lp kgq if AIM, O'H i'Mir,I If U '11TE10th ,tmv Ne �'I"14111 111M.1"I'll A Al �ONfl, Ali, iuwft�f 1.4 Mp MT PUB F,14 MN IF" U INN, I 1�`vi 3! 1 Rp 1,101*P1,114 ii,q'i ,,1, '11% ;9111 - I W pq �"i j *1 NY t,1,�X f, il AFA j fi M2, �7,072 Tli, fit, 'MA gig le,14! f" wig 401, "t R� WO 14"gill, I 00"i i fm op THE 1pk ` r Town of Barnstable *Permit#� �� Expires no=date ]Kw latory Services Fee saxtvsrna , 9 MASS. Thomas F.Geiler,Director lfD MAC A pa��� 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 XPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address II S R,9 y U vi r-1.�"- AM . O 26�3 Z ❑Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S eecf,-J M A L0A) a; y Contractor's Name 60r^c"t/C7� 440"A G,-0v P ' Telephone Number 50 ff N ZeZg 2. Home Improvement Contractor License#(if applicable) Ll S� Construction Supervisor's License#(if applicable) GS - ��I H 3 o Z ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Iq I have Worker's Compensation Insurance Insurance Company Name MAC Nt IL S�j t-yi A :fr-( > L L L , Workman's Comp.Policy# g-0 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) S, Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\decollik\AppData\Loca icrosoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 hr Tite Coln mompenith of?M aisachusetrs W4 Departmeatt ofhtdustrial Accidents Office of Insestigations ry hilt toll.Street � ��� t1,5 gr Bostoltl?IIA 02111 �`� 44'ttF'ti.711t1S:S'.�Oy'�dlfi '4 arkers' Compensation Insurance Affidavit:Builders/Conk-actorslElectiicianslPlumbei s Applicaut Information Please Priut Lem Name(Busines,-,IO gauization"ladividual): M 1�" 1�� {-�M� ( roue Address: &") S NW i `S j .—,2N-[4n y 1 o 2(e)3 2 Ciwstatetzip: Phone : 5'Od' Zd' 2-9'2- Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with J?_ 4. ❑t gm a general contractor and r 6. M New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor orpartuer- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-coutractors have, 8. ❑Demolition workingfor me in an capacity. employees and have workers` y �F t3'• 9. ❑Building addition (No workers'comp.insurance comp-iusurauce.l required.] 5.❑ the are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers}rave exercised their 11.❑Plumbing repairs or additions. myself[No workers'comp. right:of exemption per h1GL 12.❑Roof repairs insurance required.]l c.152,y§1(4),and we have.no employmes.(No workers' 13.❑Other comp.insurance required.] 4Any applicarrt that checks-box#1 must also fill out the section below,showing heir workers'compensation policy information_ I Ho-meowners who submit this affidavir indicating they ate doing all wmi-and then hire outside contractors must submit a new a1fidava indicating such- =Contractors that check this box must attached au additional sheet showing the name of the sub contactors and state whether or not those entities bane employees. Irthe sub-contractors have empl9yees,they must provide their workers'comp.policy number_ Ialli all eanpinyelr that is pros?ding workers'compensatiDn instiraurw for uty'employees. Betotf,is tile policy atarf job site information. . Insurance:Company?Fame: fVW1,� �V pLVI F� �g. 49, u L� Policy#or Self-ins.Lice.#:. 7-04 1 W 6� S Expiration Date: 3 z-3 7i0 Z� Job Site Address: R b �1 Cityrstate/zip: � �*�"�` I l G M/r Attach a copy of tlre:workers'compensatiarr policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andxor one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of-up to$250.00 a day against the.violator. Be advised that a copy of dais statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby certify It er the pains and penalties of pegriq that the it forraurtion provided abot• ist�trne and correct DDPi ature:. Date: T Phone#: sb s q ze br&Z't Offleial use only. Tao not.write in this area,to be completed by city or tnavlr afficial r City or Ton-ri: PermitUcense# Issuing Authority(circle.one}: 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector g.Plumbing Inspector 6.Othei Contact Person: Phone# �F THE Tp� a r BARNSPABLE. • - `""S%& i639• Town of Barnstable �0 ArFD MAC� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, SeAri r,1 A L--o P� Ey ,as Owner of the subject property hereby authorize C OM\P1,G (C- G to act on my behalf, in all matters relative to work authorized by this building permit application for: = (Address of Job) Signa of Owner Date Print Name If Property-Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QP E6ZUBN\EXPF ESS.doc Revised 053012 5 A- /'-[�CORO® DATE(MM/DDn•YYY) CERTIFICATE OF LIABILITY INSURANCE -04/01/2019 THIS CERTIFICATE IS ISSUED AS A TTER 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,AN4 THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject t the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to ,he certificate holder in lieu of such endorsements. PRODUCER CONTACT Jeri Davis Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 FaC e• 508 957-2781 404 Main Street EMAIL . mark@marksylviainsurance.com INSURERS AFFORDING COVERAGE NAIC q Centerville MA INSURERA: Farm Family,Casualty Insurance INSURED INSURER B: Complete Home Group LLC dba Hostetter Homes INSURER C: 770 B1 Main Street INSURER D: Osterville,MA 02655 INSURER E: FINSURER . . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 9F INSURANCE LISTED BELOW HAVE'BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REgUIREMENT, 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 P LICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A DL SUBR _ -POLICY NUMBER POLICY EFF POLICY EXP - LIMITS X COMMERCIAL GENERAL LIABILITY ; EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FROCCUR DREtAISE GE To ERENTED a occurrence $ 100,000 r • .A> - MED EXP(Any oneperson) $.5,OOQ A 14 N 2001 L6914 12/4/2019 12/4/2020 PERSONAL&ADV INJURY $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY J CT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ A AUTOS ONLY X AUros 14 N 2001 G5913 2/11/2019 2111/2020 HIRED X NON-OWNED r PROPERTY DAMAGE $AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DIED RETENTION $ X PTA TE ERH WORKERS COMPENSATION - - - ' AND EMPLOYERS'LIABILITY J Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N A N 2001 W8025 3/23/2019 3/23/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If r describe under �, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 ' 9 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE (ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) General Contractor Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. : • CERTIFICATE HOLDER CANCELLATION t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department ' 200 Main Street AUTHORIZED.REPRESENTATIVE _ L Hyannis MA 02601 f Fax:5087906230 Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs&Business Regulation m - HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration -Office of Consumer Affairs and Business Regulation 178455 04/15/2020 One Ashburton Plac -Suite 1301 THE COMPLETE HOME GROUP,LLC , Boston,MA 0210 ' _ 24 7 ADAM HOSTETTER ' 770 MAIN ST OSTERVILLE,MA 02655• N t Valid Without signature - Undersecretary , r a � - ` — • ', a III q T ' Commonwealth of Massachusetts Division of professional Licensure Board of Building Regulations and Standards c Co�e rstc i©rt Sur ii�oi _ expires: 12/2212019 CS-094302 ARAM HOSTETTER r 770B1 MAIN ST u � ` OSTERVILLE MA 02655 � ~ Commissioner _ Y 09 ND 1 Z. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map w Parcel'y n y Application Health Division - Date Issued -- Conservation Division `, Application Fe Planning Dept. Permit Fee (O +_ Date Definitive Plan Approved by Planning Board 4 Historic;- OKH Preservation/Hyannis Project Street Address c6xt Village CeN It " Owner 5voi I o �"� Address 5 C Telephone iJ f1 I t a Permit Request Q y i ���� , y UT Q 06 4- S AV mft IZ CtAld r 0 A5tm Square feet: 1`st floor: existing proposed��2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ProjeVV ct Valuation l �s loo® 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 A No On Old King's Highway: ❑Yes ❑ No Basement Type: ull ❑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 inew Total Room Count (not including baths): existing new First Floor Room Count " Heat Type and Fuel: ❑ Gas XOil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove:,❑Yes❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes XNo If yes, site plan review# Bp � Current Use tdl Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 4 Name ' _ NIA4 Telephone Number .✓ `z L� Address 7 7 0 A N i - License # jL Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE t Z, 1 r FOR OFFICIAL USE'ONLY f APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 45difa 0 �1slj® 4 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ® yV Sfl0 v DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents -- Office of Investigations ' a .600 Washington Street Boston, MA 02111 www.tnass.gov/dia Workers' Compensation Insurance'Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organization/Individual): Address: 7-0 � City/State/Zip: O WO II f &j UM a Phone#: Are you an employer?Check the appropriate boa:, Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). * 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees 4 These sub-contractors have g, ❑ Demolition and have workers'.ees to working forme in any capacity. . employees Y 9. ❑ Building addition [No workers' comp.insurance comp. insurance.# required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions - 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their 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 mty employees. Belowls the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lici. #: f� Expiration Date: / I Job Site Address: I ` �/ 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 tip 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 fo_4 insurance coverage verification. I do hereby certify and s and penalties of perjury that the information provided above is true and correct Signature: Date: 2 /Q Phone#: SUP.-I1 6 r al use only. Do not write in this area,to be completed by city or town officiaG r Town: Permit/Licebse# g 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#: fYJassachttscttti-"Department Of Public SafetN - 'Board of Building Rc ulations and Standards ; Construction Supervisor License License: CS <943o2 Restricted to: 00,,- ADAM HOSTETTER 770 SUITE A MAIN ST OSTERVILLE, MA 02655 ` :x Jam— Expiration: 12/22/20T1- a. . Commissioner Tr#: 13857 is I. jCIL q k4y a 9EIJt L, 5"T,Z).i;l' x I i, ( Inc,l.`dut use .,we tote eap r Itlur, '� lr:l ofBull: stet + EXplt t I b ! ne , is nd Stan ' 't ds ,5 by rr,IVlduof t . f'':,Mon r, WAr,1 hIOSTETTi (. T `I b f, ADA F)n�TETTF� i 70,r1 A.I AII .ST , 7 „:- mow, t�lze2"- Al 4 : °FTHET°k� Town of Barnstable ' Regulatory Services • anxxsrABLE. � v MASS. $ Thomas F. Geiler,Director 039, Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 vvww.toi�,n.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this'build ng permit application for: (Addles of Job)Lx--- . "Signature of Owner D to Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.., Q:FORM&O"ERPERM[SS10N CERTIFICATE OF LIABILITY INSURANCE DATG(MMlDDIYYYY) 12/07/2009 . XSy103 Insurance Agency (508)428-0440 THIS CERTIFICATE; IS ISSUED AS.A MATTER OF INFORMATION / it Main ONLY AND CONFERS NO. RIGHTS UPON THE CERTIFICATE 1 Street HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR e� ALTER THE COVERAGE" AFFORDED BY THE POLICIES BELOW. �o�' 03tarville MA 02055 -- INSURERS AFFORDING COVERAGE— ---— - . .. . _...— NAIC / Est Bay,property Management Trust INeURr:RA Moncpelier US Ins Co -- Adam Hostetter,Trustee 770A Main Street INSURER D WeaCo Insurance Co — - ' ---'--"-"' Osterville;MA 02658 _-INSURER C -- INSURER D VERAGES INSURER E ,IE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE,FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING JY R2QUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER_DOCUMENT WITH RESPECT TO WHICH THIS CCRTIFICATE MAY BE ISSUCO OR AY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH )LICIES'AG(3REGATE LIMITS SHOWN MAY HAVE BEEN REOUCIZO BY PAID CLAIMS Ab _—.—..—.. _._....._._.—_ — ---- - POUCY NUMnrR r,Ol,l v t-r��c'nvc P Lltr Y'XPIRATION -- WL'NGRAL LIABILITY LIMITS - _ COMM9RCIAI,(30RERAL LIADILI'IY MP0006001002077 ,EACH OCCURRENCE 5 1,000,000 12/4/20ofl 12/4/2010 baEdAZ9l l4fRrarelr---" CLAIMS MADG OCCUR rHCMlf31.8.1nq.8Q°Id1911&91_.-. 6- 100,000 n MBp DxP•Art ane pares $ _ 5,000 - PPRGONALaAovINJURY _R 1,000,000 s/ OEN'LAOORE_6ATLLIMITAPPLII^SPPR. G�I`NPRAI"AGQRCGATE tg_ 2,000,000- - POLICY -� P.:O' PRODUCTS COMPIOP A(bQ 6 - Z,000,OOO ( �\ I.00 -- - ---•_ - o fi AUTOMODIL4 LIADIL Y G ANY AU'I'0 COMDINt r)SINGLE LIMIT c ti Il:o acoidont) yS Al 1.OWNED AUTOS _ .60HEOUL1�0 AUTOS I:Par parson)IODII.Y(N,IURY I . ' HIRED AUTOS � - � ---....._...... .:_-.-_- -�-.._-.---._......:. NON-OWNED ALITOS PODILY INJURY Q (Per gamdanl) -- .—..-.—....-------- I'Ii0PflN1Y DAMAGE. _GARAGE LIABILITY - (Per occldant) •�titi@ O ANY AUTO _ AUTO ONLY-(@A ACCIDfSNT Io C� OTHER THAN EA ACC 0 - .._---. ....;_._ •Qi 1!XCS6G/UMDRC AUTO ONLY IAA I-IADILI'tY A00 0 ISAC129c[RR-NC4 OCCUR LI CLAIMBMADE -- ........... AGO COATQ � RUI!NTION 6 ---- ------ Io VORKORS COMPGNGATION AND 1 01. iMPLOYERB'LIABILITY VVWC3004610 W 8IAIU- 3/23/2009 3/23/2010 ---_ TORY LIMIT _.NY PROPRICTORIPAR'rNCR14XPC1.IT'IVG ..-. _ LEACH ACr`IDI7NT _ �, __•BOO.. 'Q IPPICCI@/MCMDER GXCLUUED7 f_ yyae deacriho under E L DIBEAet -IlA I'•MPI.OYDC 3 b0O,000 Pf I;IAI.PROV1610NB below _ _ -- rHI¢R - I!L DISEASE:POLICY LIMIT 19 .500,000 PTION 06.OPCRATtON$/LOCATIONS!VEHICLES/oXCId161ON8 ADI)CD DY CNDORBGM4NT/SPECIAL PROVISIONS :rape gardening, painting,carpentry N p�IR�ti FICATE HOLDER .a CANCELLATION 773 (508)790.8230. SHOULD ANY OF THE ABOVE DC6GR100 POLICIP6 DG CANCaLLED OBFORE TH EXPIRATION TOWn Of Barnstable Building Department DATE THEREOF,THE ISSUING INSURER WILL t NDI'AVOR TO MAE < %,DAY9 WRITTEN 7 200 his Street NOTICE TO TI•IG CERTIFICATC HOLDER NAMED TO T E LIFT.OUT FF>IURE TO-00 60 SHALL. yyt�nie,MA 02801 - IMPOSG NO OBLIGATION OR LIADILITY OF ANY KIND!UPON THE:IN A.ft3 AGGNTG OR Rr4PRGFGNTATIVPt3 � _ AU'rHORIYCD RrPRucNTA'I'IVO. 26(2001/08) vr✓�S '"C�_.• i C ACORD CORPORATION 1988 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- p Parcel 633 :.i.,AppIicatidh # 1041)q Health Division "Date Issued Conservation Division pp.!. "A 1cation Fee tzr Planning;Dept: Fee Permit Date Definitive;Plan Approved by Planning Board ('0 Historic OKH Preservation Hyannis Project Street Address ooy Za4h a­14,10 T Village S� , a/a174 hv YOwner qev Address Caj & . PL 070W Telephone Permit Request ItNccdecl Ifle4l Z VL 0�0,014� IaC6 f,4'd AAot� 1ej t roposed �2nd floor: existing—proposed Square feet: 1 s floor: existing ----_Total hew' Zoning District, Flood Plain Groundwater.Overlay Project VaIuation Construction Type Lot-Size I Grandfathered: Ll Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family Q Two Family LJ Multi-Family(# units) Age of Existing Structure YIS Historic House: LJ Yes 4,Wo' On Old King's Highway: Ll Yes U No Basement Type: U.?6l, Ll C,ra,wl LJ Walkout Ll 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 Ro6 rn Coup -JT Heat Type and Fuel: Ll Gas LJElectric -.L] Other Central Air: U Yes WM6 Fireplaces: Existing—ZNew Existing woia coal stave: > "s Ll No CC Detached garage: LJ existing Q new size_Pool: LJ existing, J new size Barn: 0 existingo❑ new size7 J LJ Attached garage: Ll existing U new size Shed: Ll existing Q new size Other: cn Zoning Board of Appeals Authorization Q Appeal # Recorded J Commercial LJ Yes U-N-b- If yes, site plan review# Current Use er,-,,,I, Proposed Use 4AW A APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name fee,v Telephone Number ��Gy Address License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE , �% %� D K FOR OFFICIAL USE ONLY i A APPLICATION# t DATE ISSUED `r MAP/PARCEL NO. " s y ADDRESS VILLAGE OWNER . DATE OF INSPECTION: 3 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - - GAS: ROUGH FINAL FINAL BUILDING J -DATE CLOSED OUT, F: ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston;MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infoimation Please Print Legibly Larne (Business/Organization/Individual): —(%fib . Address: eolv 0;, City/State/Zip: ���(�(�UV/ Phone#: �' Are you an employer? Check the appropriate box: Type of project(required): 1.El am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 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 working for me in any-capacity. employees and have workers' No workers' mp.insurance comp. insurance.$ 9. ❑ Building addition ayself 5. We are a corporation and its 10.❑ Electrical repairs or additions 3. meowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions o workers'com right of exemption per MGL p• 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi rpains and penalties of perjury that the information provided above is tr a and correct Signature: Date: Phone#: 576 d _ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and,who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b'e,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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for 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 pen-nit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,161e'phone and fax number: The Commonwealth,of Massachusetts Department of lndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Town of Barnstable OFSME Tpr,_ , Regulatory Services sA.RvsrnBt a Thomas F.Geiler,Director 9q, 1` �.� 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 HOMEOWNER LICENSE EXEMPTION uPlease Print DATE: t O JOB LOCATION: cfn irw I number street village "HOMEOWNER �/y�_ ": 1 t Q — �"! name home phone# work phone# CURRENT MAILING ADDRESS: ®o 0 -70 (a1) 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 `%o e sm&'ill submit to the Building;0-fficial on a forth acceptable to the Building Official,that he/she shall be r��LYSi[3i�If'ir ail SiECi2�r�`fJrn��va`��d midge fie€�iYtida€i�134.r°`asa��. (ui:Cii�ia lf;�.l.€# � The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and.other applicable codes,bylaws,rules and regulations. T'he undersigned"homeowner`'certifies that he/she understands the Town of Barnstable Building Department . minimum insnection nrocedures and reauiremer,ts and that he/she will comely,with said. require Signature orneo Approval of Building Official r Note: Three-family dwellings containing 35.000 cubic feet or larger will be required to comply h the State Building Code Section 127.0 Construction Control. �t�t ;�avNl�°��Xi'107P1'ItJN ' "'he Code states tbai: "Any hembo��er.perforaaine work for which a building permit is required shall be e.-xmpt 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 s,wh Work.that such Homeowner shall act as supervisor.' Man;bwneosvneis wlio use this exeniption ale unav;;are that they are ass3wilin the frsponsibilities of a supervisor(see Appendix Q, l4;' e3 - ter Lne-oviv,p Constrwfi-on Sup?rd3sons.Serction 11;51) This lacy:of avmreness often Tesults in s$rious vroblerns.uanicul^a_riv € when the homeowner hires e:rilk:ensed peesons. .In this case,our Board cannot prozeW against the unlicensed persan as it would with a Ikessed E aper-; ulti€tmiety restX nObte. To t ure that l onus;her is full;'a;;rare ofiii lber.*i sponsibilitim+iianY conii:iiinities requim,as Bart of the permit application, +n...ofs': ru r. r' k'rri G'.yn,pt} 54 i, t;i�� f I.�.ii f fi�tl .:j f. .:F.- },..`£t Y. 1 (. •.:f '�•! - 4 Worms1omeexempt April 29,2009 Sean Moloney 118 Bay Lane Centerville,MA 02632 Attention: Jeffery Lauzon Town of Barnstable Barnstable Building Division Hyannis,MA 02601 (ph 508 862 4034) jeffery.lauzon@town.barnstable.ma.us Jeffery: Thank you in advance for your guidance and review. Attached are the following documents: A.Permit application B.Basic drawing of executed and proposed changes. C.Home owner exemption F ' Figure I.Back Door Anderson Door with storm resistance glass Installation overview: 1.Two 8"LVVL, 2.Maximum Span 5ft Double Jack Double High either end. Figure II.-Remodeling Plan(114"sca le) 1. Remove kitchen wall 2. Back door install 3. Remove side-door t 4. Remodel kitchen 5. Recessed lighting and electrical(requires review) " 6. Sinks&Toilets in(2)bathrooms 7. New front door Costs&Payment Submissions: Remove Work order fee:$50.00 Estimated Construction/Town Remodeling Fees(value at$9.10/1k):$300.00 Reg rds, Home Owner j o�o �Al Ir -10� 109� � - -2 8 3 - f° r 108 2,, 24" 9 46 4„ 28 41" 4" 54" 27' 25F „ 44,, 36" 3 1341 4 0 93 W3330 .� C1 M1 C.CV CO :, CO O CI) 24.DISHW BWBT18-2 CO C O N M m e- (V LJ �h N C O ° 0 Z rn M 24 FWT BUTT DB24 0 M 4 co p 1- c o - r, M O M N COp ? m x ' N CO CO N 48" . • p 00 A 0 cn �. p o N .J All dimensions_size designations This is an original design must given are subject to verification on g Designed:2/7/2009 job site and adjustment to fit job not be released or copied unless Printed:2/7/2009 conditions. applicable fee has been paid or job order placed. 202080c0.kit All Drawing#: 1 Triple 1-3_/4" x 9-1/2" VERSA-LAM® 2.0,3100 SP Floor Beam\FB01 BC CALL®2.0 Design Report-US 1 span No cantilevers 1 0/12 slope Thursday, April 30, 2009 19:34 Build 276 File Name: Moloney Bay Lane Job Name: Moloney Residence Description: girt replacing Bearing wall Address: 118 Bay Lane ,4. Specifier: City, State, Zip: Centerville, Ma Designer: Customer - Sean Moloney Company:, Code reports: ESR-1040 Misc: , H 15 10-00 BO,3-1/2" B1,3-1/2" ILL 2,058 Ibs ILL 2,058 Ibs DL 1,140lbs DL 1,140 Ibs Total Horizontal Product Length=15-10-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 1.00% 90% . 115% 133% 125% Trib. 1 - Standard Load Unf. Area(psf) Left 00-00-00 15-10-00 20 10 .13-00-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 11,939 ft-Ibs 57.0%. , 100% 1 1 - Internal Completeness and accuracy of input must, . End Shear 2,761 Ibs 29.1% 100% 1 •1 - Left be verified by anyone who would rely on Total Load Defl. U272(0.677") 88:1% 1 1 output as evidence of suitability for ' - Live Load Defl. U423(0.436") 85.0% 1 1 particular application.Output here based Max Defl. - 0.677" 67.7% 1 1 on building code-accepted design properties and analysis methods. Span/Depth 19.4 n/a. 1 Installation of BOISE engineered wood ' products must be in accordance with %Allow,. %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) j'- Value Support Member Material building codes.To obtain Installation Guide 0 or ask questions,please call BO Post 3-1/2 x3=1/2 3,199lbs -' n/a 34.8/ Unspecified B1 Post 3-1/2"x 3-1/2" 3,199 Ibs, n/a 34.8%, Unspecified (800)232 0788 before installation. BC CALC@,BC FRAMER@,AJSTM, Cautions ALLJOISTO,.BC RIM BOARD TM BCI®, Member is not fully supported at.post BO. A connector is required at this bearing.' BOISE GLULAMT"' SIMPLE FRAMING Member is not fully supported at post B1. A connector is required•at this bearing. SYSTEM@,VERSA-LAM@,VERSA-RIM PLUS@,VERSA-RIM@, VERSA-STRANDS,VERSA-STUD@ are Notes trademarks of Boise Wood Products, Design meets Code minimum (U240)Total load deflection criteria. L.L.C. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. " User Notes Attic load only Connection Diagram I l b i� Imo—d R a I I -IH0 • • , 1 SMCTLPA NO'. Do a minimum =2" c=4-1/2 b minimum =3" d= 12"" e minimum=3" fpNAi.. Nailing schedule applies to both sides of the member. Member has no side loads. Connectors are: 16d Common Nails i oFtM r Town of Barnstable Regulatory Services • r B MASSS. Thomas F.Geiler,Director 1 3;9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 April 16, 2009 Sean Moloney 800 Charlotte Road Plainfield, N.J. 07060 RE: 118 Bay Lane, Centerville, MA, Map: 186 Parcel: 033 Dear Mr. Moloney: In accordance with 780 CMR 5118.2 you are notified that you are in violation of 780 CMR 5110.1. Recently, this office observed renovations taking place at the above referenced address without the benefit of a building permit. You are hereby ordered to immediately discontinue the illegal action and abate the violation. Abatement may be achieved by obtaining all proper permits for said work and must be accomplished by April 30, 2009 or this office may pursue criminal prosecution as allowed for by 780 CMR 5118.3. Additionally, renovations to the dwelling must restore egress requirements per 780 CMR 5311.4.1. Thank you for your anticipated cooperation in this matter. You may contact me at (508)862-4034 with any questions. By Order, YrZL4L 4au z—on Local Inspector Q:zoning5 n s TOWN OF BARNS TABLE DEPARTMENT' OF HEAL:I'H SAFE'Ty AND NTAL SERVIC ENVIRONME AND ES BUILDING DIVISION STOP Woir3y,;, THIS STRUCTURE AND/OR PREMISES HAS BEEN INSPECTED AND THE FOLLOWING VIOLATIONS OF THE BUILDING. CODE AND/OR ZONING ORDINANCE HAVE BEEN FOUND; ' �-, ' . 3) , D t 4) , F YOU ARE HEREBY NOTIFIED THAT NO ADDITIONAL WORK SHALL BE UNDERTAKEN UPON THESE PREMISES, OR THE PREMISES OCCUPIED UNTIL THE ABOVE VIOLATIONS ARE CORRECTED. ANY PERSON REMOVING THIS NOTICE WITHOUT PROPER AUTHORIZATION SHALL BE LIABLE TO A FINE OF NOT LESS THAN FIFTY, NOR MORE THAN ONE HUNDRED DOLLARS. Address ) ti$ g ivy L Date ��)-3 0 41 n , J. ui ding Commissioner A-V ' Engineering Dept. (3rd floor) Map Parcel cs33 Permit# House# Date Issued ,_ Oard of Health(3rd floor)(8:15 -9:30/;1:00-4:30) Fee' it Gensernatimraffice(4th floor)(8:30- 9:30/1:00-2:00) PlanningHM.(1st floor/School Admin. Bldg.) Approved by Planning Board 19 ` MAS& TOWN OF BARNSTABLE 'F°""''�� Building Permit Application Project Street Address Village Ca-Ar— I/i L L-t-C- ' Owner s 7f G ZPX/ �,6'7J 1a76 Address e. 9 R,&pa r-,6- P-h Telephone / L7 22Z.- 7?/Z:3 e52,177 i •Permit RequestC �Lc�cs�c �ufr/Ji4Tr'�'fz/ I' First Floor square feet Second Floor square feet Construction TypeA�cld Estimated Project Cost $ 950 y--9'S4 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family � Two Family ❑ Multi-Family #units Y Y( ) Age of Existing Structure ? Historic House ❑Yes EI/No On Old King's Highway ❑Yes H<O Basement Type: Ua/Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Q Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing ?i New Half: Existing a New ,-No.of Bedrooms: Existing S ' New -Total Room Count(not including baths): Existing New First Floor Room Count Meat Type and Fuel: ❑Gas Udbil ❑Electric ❑Other Central Air ❑Yes p No Fireplaces:Existing New Existing wood/coal stove ❑Yes a 140 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ONF one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes QNo If yes, site plan review# Current Use Proposed Use Builder Information Name /5 &#c a, Telephone Number 7 75" D V8'S Address /?�, &7� License# C /ZI-5-53' Home Improvement Contractor# /0-c,2 7 7 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOir/�'r��Q�cr'- SIGNATURE��.�C.�� DATE - --.Z 7 Yd' BUILDING PERMIT DENIED FOR THE FO LOWING REASON(S) /� - FOR OFFICIAL USE ONLY _ _ •` _ _ _ 4 PERMIT NO: DATE ISSUED ' t ' MAP/PARCEL NO. _ a ADDRESS VILLAGE , OWNER DATE OF.INSPECTION. FOUNDATION FRAME' ' i • - _ - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ;-FINAL, + r GAS:. ROUGH FINAL FINAL BUILDING t - DATE CLOSED OUT ASSOCIATION PLAN NO. + The Town of Barnstable �$ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hymois MA M601 Raiph Crassca Office: 308-790-6227 Building Commissicn: Fax: 509-790-M0 For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT'CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION air, modernization. MGL c. 142A requires that the .reconstrucdon+ alterations, cenovatfon, rep conversion. improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than tbur dwelling Waits or to structures which are adjacent to such residence or building be done by registered contractors. with certain exceptions.along with other requirements. e Est.Cosh i � Type of work. A S"ZUG— Address of Work: Owner's Name Date of Permit AppllmUon: I hereby certify that: Registration is not required for the following renson(s): Work excluded by law r! Job tinder SI.000. Building not owner-occupied —Owner pulling own permit None PU�G O OWN PERMIT OR DEALJNG WrM UNREGZSTEREO CONTRACTORS FOR APPLICABLE HOb'IE IMPROVEMENT WORK DO NOT HAVE ACCESS TO THEARBITRATION PROGRAM OR GUARAN IY FUND UNDER MGL c- 142A SIGZ= UNDER PENALTIES OF PER.IURY I hereby apply for a.permit.as the agent of the owner. Dace Contractor Name Registration Na OR Date Owners Name r - The Commonwealth of Massachusetts Department of Industrial Accidents "1• �=�� - t 011co ol/nt;-estigadoas ' 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit ROtl ' ' ` Y�//////////��%%%%%%%%//%%////////�///�///�//''l///%%/,///,/i.. name location //8Y city /� ��gc y3 . /et//S; �i¢ ®Z�Cl/ —l��ie'� phone# „ 4� — Z 7S o y�S" ❑ I am a homernvner performing all work myself. [ I am a sole p rietor and have no one workin in amp ca acity //////O/'///%,/////////!%%/ %/ % %O////%/%////%%///////////%//0%/////////////G /%/ /////////%%% //////%%%%%%/////%//%O//l%///////%G�s ❑ I am an employer providing workers' compensation for my employees working on this job. com anv name• address: city phone 0- insurance cn. nitcv# ///////!!!!�"��//LME;; /(/////////////////%lG//////////%///////%///////////////////////%%///////////////////%//////c'!�/�//////////i. ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers compensation polices: com anv name, address: dtv phone insurance cn com anv name- «; .... address• dtv phone# :>,.... CV a insurance Co. Failure to secure coverage as required tinder Section ZSA of�IGL 152 can lead to the imposition of crinuna!penaltlea o[a One up to SI�00.00 and/or one years'imprisonment as well as civil panitiea in the form of a STOP WORK ORDER and a One of SI00.00 a day agawt me. I nnderstattd that• copy of this statement may be forwarded to the oMce of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature �Z �'\ �� 1 � Date Print name 2itJl PfC - Phone 7 Ccontact use do not write in this area to be completed by city or town otIlcial citytown: perndtJUcense N ❑Bttildinq DeQatsmettt ClUcensing Board ediate response is.;quired ❑Belt canen'a OtIIce❑health Depatsment phone p• ❑Other (tevata 9/93 P1Al Information and Instructions y Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their q. employees. As quoted from the "law", an employee is defined as every person in the service of another under any con=--: P , 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 . trustee of an individual, partnership, association or other legal entity, emploving 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 —6o w*,inyv to do maintenance , construction or repair work on such dwelling house or on the grounds o: 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 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 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. Mom 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 permit/license number which will be used as a reference number. The affidavits may be returned to 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,io not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 8Mce of Inyesagadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 i 1 lST/�L: STvh s 1 ell ps zX$r�77 �r � �,_�:&:„-- omvnoruue o�✓�,aaaacf u�tet�s DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number Expires: :., FRAW fi- THACHER II 220 ANNABLE PT RO/PO BOX 277 CENTERVILLE, NA 62632 �fi°P C✓i(e�oonanooeuieald o�✓�aaaadu�eQ2 a F HOME IMPROVEMENT CONTRACTOR Registration .100277 - a kTYPe xINDIVIDUAL t Expiration 4�ob/15/00 ,,#y FRANK 6 �,THACHER, II . Annable Point Rd P O. BOX enterville MA 02632 t Engineering Dept.(3rd floor) Map Parcel 5_-�,e,-66ermit# Q—ado House# Date Issued 16 - Board of Health'(3rd floor)(8:15 -9:30/1:00-4:30),e__ 3,5- Fee a - Co_ r)(830-9:30/1:00 2:00) dmin. Bldg.) ��� �tMf E De 19 RNSTALLED IN 9• TOWN OF BARNSTA- d a ALE ' AN® Building Permit Application T® 9�E�aULAMO f- Project Street Address Village (n PiiA,Gil/ck[, .4Z/9 6 A 3.2 Owner 'j�:t i �1i�� Address fji,� ,��� �r �,t �,_ �''•/l� Telephone &/7- �d__)ez o Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ v2 , (no y Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure �_f Historic House ❑Yes polo On Old King's Highway ❑Yes Lwo Basement Type: p611 ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing ;Z. New Half: Existing New No.of Bedrooms: Existing J New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas WNI ❑Electric ❑Other Central Air ❑Yes p-J4o Fireplaces: Existing _ New Existing wood/coal stove ❑Yes LkNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) @,&one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information //)"Name `pt,/ru, Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /o BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) /i FOR OFFICIAL USE ONLY PERMIT NO. = r DATE ISSUED, . MAP/PARCEL'NO. ADDRESS: — ' r • VILLAGE # OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: =Y ROUGH, FINAL i FINAL GAS: � �GH� , - - _ • FINAL BUILDIN M : r r `a DATE CLOSED OUT44, &t`3 ASSOCIATION PLAN:NO.&�+ , I i The Town of Barnstable MARL e� Department of Health Safety and Environmental Services Building Division 367 Main Sheet,Hyannis MA 02601 Office: 508-790-6227 Building Commissioner Ralph Crossen Fax: 508-790-6230 For office use only 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,al g-with other requirements. Type of Work• Est.Costs ' Address of Work: :�i� Owner's Name Date of Permit Application: A®— / 9� 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 MOROVEMENT 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. Contractor Name Registration No. ate OR. The Cuatmum+•calth q f Massachusells r;� 's -•--=1�r Department of Industrial Accidents ' office of/ByeW921lous 600 111avititti;tun Street ` !•- • _y; '4,; =• Bustotr.Mass. 02II1 �-' Workers' Compensation Insurance AlMdavit Avalicn—n—formation - Please�'RiNT leribl`v�_= cit%, 122i0 Dom/), nhoone# 2 - 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity f-_.Il�.I..V�rww.! w!!'lT•.:5.. `1... - .. �.;,,_ .-.•_ ' ' y ... .'nw. - ._..`- ��y���..�w I am an employer providing workers' compensation for my employees working on this job. i COMMInr city nhone#- I am a sole proprietor, general contra=, eowa one) and have hired the contractors listed below who hz the following workers' compensatiion somnnm nnmc idre city! 0o9/ nhone#s 412 Y insur-ince co, policy# cnm arf•name• iddre c• cif phone#• -� nee co policy# _ Attach addittionaCsheetiftiecessa}y'� "w - '•-'��:•f'f�� •` : :.c.l. •� ..t...y.+•�� -�� --- —•—� 4y� ��•y�� ruilure to secure coverage as required under Section 29A of 51GL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.UU andiu one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I understand that copy of this statement may be forwarded to the Olriee of Investigations of the DIA for coverage verification. ' 1 do herebt•certify under the pains and penalties of perju y that the information provided above is true and correct. Signature 1�al, �a ��A�'"o� Date /U -•- Print name rn Ie en -Phone# V—-) /U official use onh• do not write in this area to be completed by city or town otlicial city or town: permit/license# rnBuilding Department C3lrccnsing Board cheek if immediate response is required OSeiect Office �Ileatth D D eeepartment phone#; -Other contact person: ,�• Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the empioyccs�,.As quoted from the "law", an emplitme is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrplin-er is defined as an individual, partnership, association. corporation or other legal entity. or any two or mor the foregoing engaged in a joint enterprise, and including the le-al representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However th owner of a dwelling house haying not more than three apartments and who resides therein. or the occupant of the dwcllinY�; house of another who employs persons to do maintenance , construction or repair work on such dwelling: lie or on the arounds or building appurtenant thereto shall not because of such employment be deemed to bc.an employe 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 commoni•ealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. 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 ; been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the boa that applies to your situation and suppiying company names. address and phone numbers as all affidavits 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 ydtt have any questions regarding the "law"or if you are requirez- to obtain a workers' compensation policy, please call the Department at the number listed below. '77- City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie. be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned 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 question 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 rYL., Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (6I7) 727-7749 nhnne H: (6171).727-4900 eft. 406.. 409 or 375 �o • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street address Section of town "HOMEOWNER" Name 6,G . Home phone Work phone . PRESENT MAILING ADDRESS 10,3 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Officia: on a form acgaptable to the Building Official, that he/she shall be responsible for all such work performed under the building ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE �,6f/I�� APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "owner- actir. as i supervisor p s ultimately responsible. .• ,;. To ensure that the Home Owner is fully aware of his/her responsibilities,- mar communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. O ' fi'-ID' 5'-t0• 6'-10• � 6'-IO' - 6-IU' �'-i:f 6 IC.. 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V®, 5/4°TY.°os6='To `R 814°TYa oDa 1%kIFtLDR--� o`a i NAIL®0 4L4'eD TO JOIST PULLED 0 GUAD TO JOIST I YM F.G.INFIULJ 4C�' - / m KY!RAP/eurAxuD�r �d° C I AA WIOzfB OR K!'.IP3 n.en - (s)ZtIQ.s O w•OL. _ - a � e8 OR W I2a5 a Bn Q w Kc.eaaP�r9. 0 -10°FG coL . LQ Ild ex1�n1� C ' uDLe'no ON _ (� ILI — .F- -1'. FASTENZINIM-TO To - ITS"JOIST W R:T7 JCt°JT W. t i -ram i/I°fiALV. V'Y GALV, CA WUAGL°MMTa f MAf4 DMTa _f 10 PILL VAPOR R�TAiLD2-R / j I B i5'O.C. — - 61'O.C. *� ( 1iez . JC.BTIN6 GIRDER — -- al GALV 4UPtt8`ti GRLV 18.VM°ok s•y:'� a-Il.BN B V2°LALLY — -�'{ aTL BT9 64146 CghE`.32sYe WAl-,--- .Ilr" eAa EP[O. a V2'LALLY COi1it':d- - r°.. ' - -. RENTR us A ear �skl y e�-CY I s�- COTtTTMLMitA1 FOOT'Dkd " ezlliTiT7G p' - :I II 5/8 ANCI4OR BOL" . PT18�...DDED 7' GALV.PlLTAL PLAT AW..YGR 5PACE0 32 O.C. t2''8'CW TLOV PIHt W/ HEET I OF 3 12' FROM CORNIR.B 2a''On FOOT'FOOrD4 TYP. _ I • M.POST ANC 20'-O' 2{-O° �, l2'°8:7A'0 Tim'PiSt W �°°Bd6 FOOT°ROOTDA'TTP. i G--UQN ig SCALE. 1/4' 1'-O° SCALE. 1/4' 1'-0' .,JOB: 0904 DRAWN BY: KW DATE: 12/16/09 Ln ' 9 in, I-JoisT 1 { O M2ti8 OR MUSS M MM ABOVE W 1- k ► �n —c2)q tA•L.w E -s eraR aM Z O c)l rA W Z FLOO SCALE. 1/4' V-O° I — 1 �—bn` -- I 6A2 6n2--4 - --- — ) L D — --- - —•'e (L i 2) 9 LV� —� LU IL # <—4/12 'SA2- > — -- _ F --_ qq -- -- - - SHEET 2 OF 3 ,S 1;; taY_Ee0 HOr®Ofl. 6/12 SCALE: 1/4' 1'-D' s2na Rv1a—, JOB: aiO4 DRAWN BY: KW DATE: 12/Ib/Oq is � ;� ,� _ , . . ',. • .. .�, . GENERAL NOTES . 1.) THE INTENT OF THIS PUN IS TO SHOW PROPOSED WORT( AT LOCUS 2.) LOCUS AREA IS COMPRISED OF ASSESSOR'S MAP 1S5 . .PARCEL D33 C•T.F. 187j607 • '�+ APPLIGWT• SEAN T. MALONEY 8� CHARLOTTE ROAD N.J. 07060 PROr►Ea BENCHMARK : Na SET W UTILITY POLE #9' f ABOVE GRADE EL - 13.02 LOCUS MAP ... 4•) ZONING INFORMATION ZONING DSiW : RD-1 (ResidwgW) Scale: In = 2000' RPoo - AP WF CI-1a MWIWUM ZONING REQUIREMENTS 5.1 UK LOT AREA - 43.560 S.F. Alk LOT FRONTAGE - 20' WF C1 17, .0 AL 5.2 FRONT YARD SETBACK - 30 / WF SIDE d: REAR YARD - 10' 10' AL MAXIMUM BUILDING HEIGHT - 30' �• AL WF C1-16 418. \ 5.) A 1TiLE SEi1RCH HAS NOT BEEN PERFORMED FOR TFMS SITE IF DETET6NNm w g TO BE NIf.CEx W. A TITLE SEARCH SHALL BE PERFORMED BY OTHERS. \ 5.6 WF 81-6 A` AL AL AL L6• THE PROPERTY LIE WFORANTiON SHOWN iS BASED ON CURRENT AWABLE RECORD NEMIATION CONSISTING OF PLANS AND DEEDS. 5.4 \WF Ci-15 AL � OEM THE OE FEATURES SHOWN HEREON WERE OBTNNED FROM AN ON THE GROUND FIELD \ ,� \ SURVEY PERFORMED BY BAXTER NYE ENMNEEI G & SURVIYYWG ON JULY 15 & 16, 2009. No C1-1 \ � AL JL 7.) COMMUNITY PANEL NUMBER: 2500001 0016 D AL il4 AL THE FLOOD INSURANCE RATE MAP OEM TM AREA AS ZONE A10 (EL 11). 5.7 N WF 81-5 AL WF Cl-14 AL � ''� 5.9 WF C1-2 WF 81-4 8•) ENROMWAL -_ _ WF 81 3 AL ( SiTE IS NOT WITHIN AN A.C•EC: (AREA OF CRITICAL ENVIRONMENTAL CONCERN). � 4.2 I WF C1-13 x 6.0 �r x 5.7 6.1 _l -- `'- o SITE IS NOT W M AN AREA OF ES 010 HABITAT OF RARE WILDLIFE PER \ C1 3 1 i NHESP WP Off0BER 1. 2008 'ES 070 HAWATS OF RATE WILDUFE' �\ l 3.7 FOR USE WITH THEW ' AYE I WF 81-2 WETLANDS PROTECTION ACT REGIIUTTONS (310 CM 10j. • TAT •SITE DOES NOT CONTAIN A 4 x 6.6 � � _ CERTMIED VERNAL P001 PER NHESP MAP OCTCER 1. 2008 • .9 45.622 SQ. h1'. t ' BMM VERNAL POOLS.' 01-1 1.05 ACRES #- :f ...• ::. •S►TE S NOT WTtT N A PRIORITY HABITAT PER NHESP MAP OCTOBER 1. 2008 'PRIORITY � CAL WF C1-4 Wi IATS OF RARE SPECIES' FOR SFM UNDER THE i ASSADAZETIS ENDANGERED ,1„ :•• SPECIES ACT, REG MIS 321 CMR10 WF C1-10 AL WF At-14 4.g l Q� •SITE IS WITHIN A STATE APPROVED ZONE I GROUND WATER REDOM PROTECTION AREA. .•• 0 /6 4` PV x?:7 p ROOF DR�U C1-5 / .g- WF Al-16 •SITE IS WMN THE ZONE OF CONTRIBUTION TO SALTWATER ESTUARIES, INV.-6 17 15.5 WF Ai-15 C8 FNO ' 4.9 -MIF Ct-� '� / 9.) Ui ITY INFORMATION SHOWN HEREIN. l �I�p WF 1-� ./ .: WF Al-13 6.0 'W` ' • THE CONTRACTOR SHALL CONTACT DIG SAFE(AT 1-888-DIG-SAFE) AND UTILITY COMPANIES TO LOCATE ♦�. ,` -- , ALL DZ WG UTiIJTES,, AT LEAST 72 HOURS POW TO THE START OF CONST ION•RUCT THE LOCATION OF _ a.t 29 E 4 I EXISTING tNrOERGRiXMD MiFRASTRIICTURE: UTNJIIES, CONDUITS AND LINES ARE SHOWN N MI APPROJg1NTE C8 FND N,88 43 x 6.4 7.71 WF-C1 �' __- __..���.�WAYYONLY..MAY.NOT,:�EIE� 1D.�7}I06E.,SFiOWNi,tIEROd..ANI!]:�HAME--8E'EJ�L;�. ONi 11�, O , HELD _ ! � � � � � - _ %T�- --8 r --\ -., AVALABLE Mff RECORDS NOTED FEREON. THE`CONTRACTOR AGREES in'BE FULLY RESPONSDLE FOR 160.8� _ SL to C8 8--. \ ~ ' ' \ ANY AND ALL LIAMAGES WHNCH MOIT BE OCCASIONED BY THE`CONTRACTWS FAN IXRE TO LOCATE SAV \ -� \ MANHOLE \ *?ASTRUCTURE AND UTILRIES EXACTLY. IF FIELD CONDITIONS DIFFERS FROM PLAN 161.24 -cpyER ® 5 \ - 5.s MiFORWTION� THE 5 �- __ ^. WF 12 - CONTRACTOR SHALL NOW THE ENGINES ANEDNTELY FOR PO651EILE REDESIGN. i / / • WATER LIE AND APPURTENANT *MIATION iS BASED ON A PLAN /C_Ml-P PRO1wI 10 ` 4, c AL AL BY C-O-MIA WATER DEPART14ENT (DATED 816181). +$ 4.6 Al-11 AL ' 10.o INV•-9.11 5\ � •ASSESSOR'S REM OS INXATE THAT PROPERTY IS HEATED BY OIL 11 -tlpgp 2 ♦ F �`'4Y \ l ELECTRIC LINE INFORMATION PER NSTAR ELECTRIC AL �4�7 WF Al-10 IS CttRREMLY OVERHEAD FROM UTILITY POLE AS NOTED ON PLAN. T LOCUS ♦ _ O SEPTIC fA�, AL TANK i+ •� A,b t1. '�I •SEPTIC SYSTEM LOCATION IS APPROXIMATE. PER TITLE 5 INSPECTION FORM DATED - J 2 STATE DEFINED COASTAL BANK POLICY 92-1: FIGURE 4 11 QED BY SEAN M. JOIN TITLE Y r AL ( ) /2/2oors. Es. SEPTIC INSPECTOR. ♦ HELD \ ? ♦ ; 1 \ l l%.2 5� A1-9 11;6 d� \ f ♦ \ \ I PLANTER "`Y /11 7 << 1.2 I•, f / CB/^FND /` / �� / / / ' �'`D-BOX\ / f 1 IS Bay Lane ` 'Al- Centerville MA 02632 x 11.3 / / / 10 eRe s A10 /.✓�'►' i / ,,� PREPARED FOR FND - ��P --7 Q,>. / i Sean T. Maloney q,,_ ` 4AL l 4 4 Al-7 NAIL SET IN UTILITY POLE #9 IF EL - 3.a`�'°E 5.6 Al-6 Wetland Permit Plan / ♦ R� /� �t 10.6� �N soy$ BAXTER NYE ENGINEERING & SURVEYING ♦ wAL ,0.2 1 9.� \ ,�.\ AL WF A1-4 \ .4 Registered Professional Engineers and Land Surveyors 4 \ \ `� y w \ \ 6.7 _ 78 North Street-3rd Floor,Hyannis,Massachusetts 02601 d• WF 1 3 6.4 AL Al-1 1 Phone-(508) 771-7502 Fax - (508) 771-7622 ` \ \ 1-2 I 1 1 20 0 20 40 \ F SCALE IN FEET w � 9 1 SCALE: 1" = 20' .2 \ DATE: 07/21/09 %% ♦ ~ 9.5 / %% N0. BY DATE REMARKS ♦ "I*. / ` DRAWING NUMBER a ` , 0: 2009 2009-033 SU wrksht 2009-033WPP.dw 2009-033:01