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0040 BLUE WATER DRIVE
1Y. 11111",�;,"',,�"'l AGA i �fp A F M1,EmnP"'A giat TOWN.— pla g POP Now to too A fi Masm R; aj QI p_ WIT-B-0-01111 IRE V! N 3- Ma 04 Q jazqw lip S, ............ to MY& 04 d) 001w g, ,2, 01�31 1�11*_440 3?'�',`T"�',",, ,EMMMIN .................. NQW, WA NMI wMW ,WES A �RV 1MME Emma "I' Q-0 ,�v ............ &V1,144 7 "N.4 �MMHWS, qMgq gym 1111'r =1 1WINDOWN Moo man MEMN Mum q Wh .................... j VQW 0-0 MV M A01401 .......... iA NiQ�Pv§" gem BAN, �--NOlNa v S for I CF THE BUILDINGDEPT. Application Number.......!`- ®....�... 4�i ..�............... sn MASS. # AUG 2 2OZO .................Zoning District........................ MA83. 4 Permit Fee................ 1639. � CFO MA'1 A e TOWN OF BARNSTAB �otal Fee Paid.....20 j TOWN OF BARNSTABLE c— Permit Approval by.................................On....... �... .....0 BUILDING-PERMITSCANN' D e Map.......................................Parcel............................................. APPLICATION Section 1 - Owner's Information and Project Location Project Address �� � �-e.,f' " ,�, Village �`� ��0`n UP, a Owners Name Owners Legal Address cityo State A" Zip Gj Owners Cell # E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 — Type of Permit New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Foundation Only Other—Specify Section 4 - Work Description r e 5„ , , cv� <av v+ �. e Last updated: 1/31/2020 Application Number..`:..d.` i.. .`....'................................... Section 5—Detail = Cost of Proposed Construction 0 obo Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing _ Total# Of Bedrooms(proposed) 3 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6— Project Specifics [Aring ❑ Oil Tank Storage [•Smoke Detectors [Plumbing Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7— Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No 3 Section 8 —Zoning Information 1 1 Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed 4 I� Rear Yard Required Proposed Side Yard Required Proposed - Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No i Last updated: 1/31/2020 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfigadons 600 Washington Street Boston,MA 02111 www.mass gov1k a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Let34y Name(Business/Organizati on/Individual): j �g✓1 Address: q&o City/State/Zip: coto.�Gh r Phone#: � �— 4 i Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 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' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. 2 We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumb 3.❑ I am a homeowner doing all work ❑. '�repairs or additions myself[No workers'comp. right of exemption per MGL 12. Roof rep insurance required.)t c. 152,§1(4),and we have no employees.[No workers' 13.[a'bther ( comp.insurance required.) act w„ c *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy info on t Homeowners who submit this affidavit indicating they are doing all wont 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 worker;'comp.policy number. 1 am an employer that isproviding workers'.compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: o-C:. �® Policy#or Self-ins.Lie.#: wCC t9U 5-0( 09ao'l Expiration Date: Job Site Address: 7 y .u�(�a -(;� City/State/Zip: f 'Yl/4 6 3 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 der the ' • and penalties of perjury that the information provided above is true and correct: Si Date: Z6 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# 4k� 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 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 mmiber 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number:. The Commonwealth of Massachusetts Department of Industrial Ao idents Office of bVestigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 www:mass.gov/dia ACO® DATE(MMIDD/YYYY) TY INSURANCE CERTIFICATE OF LIABILITY 08/1 z/zo2o THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Caitlin Regan NAME: Dowling&O'Neil Insurance Agency PHONE (800)640-1620 plc,No A/C No Ext 973 Iyannough Road E-MAIL SS: cregan@doins.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA-02601 INSURER A: Associated Employers Ins Co 11104 INSURED INSURER B: Sunrise Restoration Company,Inc. INSURER C: PO Box 802 INSURER D: INSURER E: East Sandwich MA 02537 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2081248166 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBIR POLICY EFF POLICY EXP - LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIODIYYYY MMIODIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ - GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY ❑PRO ❑LOG JECT PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH _ AND EMPLOYERS'LIABILITY Y/N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ AOFFICER/MEMBER EXCLUDED? FN NIA WCC50050196992019A 11/29/2019 11/29/2020 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable-Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD axXtaeA Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 71.0 Boston, Massachusetts 02118 Horne Improvement.Contractor Registration Type: Corporation SUNRISE RESTORATION COMPANY INC. Registration: 190352 P.0• BOX 802 Expiration: 01/1$12022 EAST SANDWICH,MA 02537 Update Address and Return Card. SCA 1 Cj:,2aMOW17 r T�•�rf��rrirrrrr�rxrl/�r. ��r�drir�rr.ir//,r Office of Consumer Affairs r Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corooration before the expiration date. If found return to: 'Registration Ex0ration Office of Consumer Affairs and Business Regulation 190352 01/18/2022 1000 Washington Street -Suite 710 SUNRISE RESTORATION COMPANY INC. Boston,MA 02110 WILILLw FEDER . 480 ROUTE 6A EAST SANDW ICi1;MA'02537 trot Valid without signature Undersecretary. R Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstrQL4%AO6jSpprvisor CS-105323 - i xpires:03/14/2022 WILLIAM M FEDER 134 TANGLEWOOD OR"*' ,, OSTERVILLE MA 02854 ,`` "= i "$PSG 1 Commissioner Sunrise Restoration Company, Inc. P 480 Me 6A, I'U Box 802, Last Sandwich, .MA 02537 Horne Improvement Contactor#: 190352 AUTHORIZATION TO PERFORM SERVICES AN I) DIRECTION TO PAY kf^,r't �ti �� �%�' V`�r 'therein referred to as "Customer," authorizes Sunrise Restoration ebmlpaiy, Inc.qt4ein referred to as "Sunrise," to perform; Drying and mold treatment.permitting,demo,disposal and replacement of damaged items: drywall, flooring,trim,insulation,plumbing,electrical and cabinets. on Customer's propert at: r Tel: Customer authorizes 6 u� Cti��v,�, Insurance Company, herein "insurance Company," to directly and solely Ilay Sunrise: If for any reason the cheek(s) from the insurance company should come to or be made_payable to the Customer, Customer then agrees to pay Sunrise in full immediately upon receipt of said check(s). If the loss is not covered by insurance,Customer agrees to the pay the total amount to Sunrise upon receipt of the invoice for work performed. Customer agrees to pay Customer's insurance claim Deductible to Sunrise, the amount of which, is stated in Customer's insurance policy . Additional remarks: I have re tl ' document a co pletely accept the terms contain within. Date Customer Signature Print Cust a e Sunr P6s oration ompany , Inc. Signature Date a C y Nil I 7 77 r _ x a �t WOO 001, IOX � e a w _ iI vi /z So E Application Number........................................... Section 9— Construction Supervisor Name \11� 1 6L t A tj Telephone Number SZ> 2 q3 --7-7 u7 Address 13 (,41y&_Cl v L fl N p 4' City 4s-r-rg-Vt t,t,^� State M Zip 0 -a-Ce 5"' License Number G License Type Expiration Date =1 -� Contractors Email l( u ,� Cell # 5-16 Tr-';-4(,g =- `7-7 7 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code: I understand the construction inspection procedures,specific inspections and documentati ' d by 780 C R and the Town of Barnstable.Attach a copy of your license. �-� Signature Date Section 10 -Home Improvement Contractor Name 1Sj LAc.Telephone Number 90a-93`3 —"3 / �I Address You (6,6/4 City t. 5"L ,;�d, State Zip Registration Number Expiration Date - -- I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building de. I understand the construction inspection procedures,specific inspections and documentation req ' e 80 t le Town of Barnstable.Attach a copy of your H.I.C... Signature Date ,f . Section 11 - Home Owners.License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature % - ` ` Date '1L VVP Print Name �'� ►�ll � Telephone Number P E-mail permit to: ky, </2 /Ly.I yt2,l Last updated: 1/31/2020 Section 12 — Department Sign-Offs Health Department ❑' Zoning Board(if required) ❑ , Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak Section 13 — Owner's Authorization 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 vc ( �-1 j Last updated: 1/31/2020 Town of Barnstable Building Post;This Card So.,Thatat�s Visible Frornthe�Stceet•Approved;,Plans Must be Retained on,Job_and•this CardMust be Kept WPostdUntilFinal � Permit ... Permit No. B-18-211 Applicant Name: PAULJ. CAZEAULT&SONS, INC. Approvals Date Issued: 01/25/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/25/2018 Foundation: Location: 40 BLUE WATER DRIVE,CENTERVILLE Map/Lot 253 028 Zoning District: RD-1 Sheathing: Owner on Record: WRIGHT, DAVID L&MARJORIE R Contractor Name PAULJ. CAZEAULT&SONS, INC. Framing: 1 Address: SOUTHOVER REDOUBT HILL Contractor Lic6h' , 103714 2 UNITED KINGDOM, . � 4 Esc Project Cost: $8,450.00 Chimney: Description: re-roof stripping old A `Permit Fee: $43.10 Insulation: Project Review Req: Fee Paid $43.10 Date 1/25/2018 Final: 7 .. 2 Plumbing/Gas 3� "1 1V a Rough Plumbing: Buildin Official g Final Plumbing: s,,f This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months,�afteKi Rough Gas:% ssuance. g All work authorized by this permit shall conform to the approved appl cation and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures,shall be in compliance with the local zonin laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access st,reet or-road-,arid shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Build mg and Fire Officials are provided o�this permit. Service: Minimum of Five Call Inspections Required for All Construction Worki 1.Foundation or Footing Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I i \�qP Town of Barnstable *Permit of �\ Z tres 6 months rom issue date � " a � puilding Department ee j ,,,a,,, Brian Florence,CBO �C) MASS. i�0� 2 3 2NO Building Commissioner 200 Main Street,Hyannis,MA 02601 'J AHIu8IAC7 LE 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 Map/parcel Number 3 2 g 1 Property Address -f d �'�� D`2A J O ('Residential Value of Work$ g ��� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P \Il D W fP t.6-P T Contractor's Name fAill -`I ' � l'i �`¢y /�-f �r/�fl S Telephone Number.saJ` �`a"� �l7 Home Improvement Contractor License#(if applicable) 1a.3 71y Email: Construction Supervisor's License#(if applicable) /D*X.ri `7 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# w S c3 I� �� G (� Z 7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) C9 Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken toy42 A' ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A opy of the Home Improvement Contractors License&Construction Supervisors License is r6quired. SIGNATURE: ��� I C:\Users\decollik\AppData\Loca1\Microsoft\Windows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 ( ftice of Consumer.Affairs&Busme s Regula�i pi ME IMPROVEMENT CONTRACTOR Registration J 103714 pia s Expiratign,L d8/ 018 f_ auppl t C3 PAUL J.GTAZEAULV&SONS, INC .' MICHAEL ALDEN r 1031=•MAIN ST QSTFR,VILLE,MA 02658 ` Undersecretary '�„ k The Commonwealth of Massachusetts Department of Industrial Accidents .,��;,� Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): � -(;` L L�'2 . �V i. S tD Y� Address: ri S City/State/Zip: crLa✓ Phone #: 5- Z ` l t 3? Are you an employer? Check the appropriate box: i Type of project(required): 1,� a 4. ❑ I am a general contractor and I m a employer with 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. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its ' 101-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] + c. 152, §1(4), and we have no employees. [No workers' 13.�therjC comp. insurance required.] *Any applicant that checks box 41 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 ama an employer that is providing workers'compensation insurance for any employees. Below is the policy and job site information. Insurance Company Name: Ai -S Policy#or Self-ins. Lic.#:�/ / 3 % 5 3 6 6 6 -7 GU Z 7 Expiration Date: ( 16 J Job Site Address: �/v e,Wt�e Cer�a~�t�+(fie City/State/Zip: %Jt45 S • U a Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: 24�L,�� Date: `Z3 ~� Phone#: Ski — � cg l/ 7�' 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#: i,��. J ,� .v �' E�,•:. ) 11 .�±,_- -)?,- r%ifs:;.� �., -, � I;. �...7_ ' C ( vffice oC � arsBs �,e1'eg tlla.?teio;nl - ? - 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Horne InaproveMent Contractor Registration Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC, Expiration: 7/9/2018 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mal-lc reason for change, i z sc Address Renewal Employment E] Lost Card I a r�rr•!n Office of Consumer Affairs&Business Regulation License or registration valid for individual use only JAM ����kIOME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: l Fi - Office of Consumer Affairs and Business Regulation;{ ;( Registration: T037jq Type: 10 Par•k Plaza-Suite 5170 = = Expiration_ :7jgj2p.g,- Supplement Card Boston;MA 02116 PAUL J.CAZEAULT&S_ONS,INC. RUSSELL CAZEAULT 1031 MAIN S :=...:r :_•;_._; OSTERVILLE, MA 02658 Undersecretary Not valid witliout�R' nature 1 ( PJlassachusetts -Department of Public Safety board'of Building Regulations and Standards I ConstrurtiOn.0UI)019'i.l()l' T License: CS-108157 "- iI RUSSELL C 2071 MAIN STRRj�7 =... BrewsterlflA 02631 -- f,7 4,_ :` F. piraticn l commissioner 11I23/2018 ' 1 I Property Owner Must Complete & Sign This Form I If Using a Roofer l Builder. I 1 (prin1) D1 /4C,/(,4 W/),/ /-;,— as Owner Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job e � ��- t v e�v7�ez U i l eI,�, 6 3 . Signature of Owner Mailing Address of Owner S-,il� Telephone # a Date / l I I j Please return this form to Paul J. Cazeauit Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 f office@cazeault.com f q /'mac®& w C E R B R V W !I E OF UAB UT t( EI II V S V IfV(r` N C E r ATE(MM/DDYYYY) 08/10/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY acNN Ext: (508)775-1620 ac No: ADDRESS: Isullivan@doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURERA: LM INS CORP 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC INSURER C: INSURER D: 1031 MAIN ST INSURER E OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 181752 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES,DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MMIDD YYYY) (MM/DDfYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ PRO- POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMB INED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ �/ $ WORKERS COMPENSATION /� STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? N/A N/A N/A WC531S386670027 08/10/2017 08/10/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Paul Cazeault ACCORDANCE WITH THE POLICY PROVISIONS. 1031 Main Street AUTHORIZED REPRESENTATIVE Osterville MA 02655 Daniel M.CroGv ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f Town of Barnstable *Permit# G Expires 6 mont rom issue date Regulatory Services Fee JS',_ BAMS ABLE. 9� Mnss. Richard V.Scati,Interim Director 039. ♦0 RFD MA'I A C'dJ49 Building Division Tom Perry,CBO,Building Commissioner` - 200 Main Street,Hyannis,MA 02601 MAR 1 3 2015 www.town.barnstable.ma.us p1 A111 ,TABLE Office: 508-862-4038 _TOWNFax: 508 R790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY a 5 3 i c.)z g Not Valid without Red X-Press Imprint Map/parcel Number Property Address y 0 'F_>UUV 1N A'T� � tV G.l= �4-,e—V tLWE Residential Value of Work$ ��� ° Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address p.'V l 11�►`Q�i -i- '• E-p,�j t? LlV L� W/k'1?�4� p VZ4 V GNTS,t2y lc E M R O Z6 3 2-- Contractor's Name Pkl. C�zP�t-� t 5 oN Telephone Number Home Improvement Contractor License#(if applicable) �'Z Email: O .Cc-zo 451 u, Cc)vl_� Construction Supervisor's License#(if applicable) C S '_.6 2�0 .3 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ JaKthe Homeowner I have Worker's Compensation Insurance Insurance Company Name �,�A CO � C Workman's Comp.Policy# C� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request eck box) e-roof(hurricane nailed)(stripping old shingles).All construction debris will be taken to ❑Re-roof(hurricane nailed)(not'stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#.of windows Sy #of doors: r. ❑ 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 withother town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN_MBuilding Changes\EXPRESS PERMIT\EXPRE S.doc Revised 061313 r I l 1 i Property Owner Must Complete & Sign This Form If Using a Roofer I Builder. I (print) � � i , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job Signature of Owner Mailing Address of Owner_ Lf0 B L'� wig Mkt v L' m z G 3 2-- Telephone # _ _-- '1 o R( Date 3 I S i Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com r ..y Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ' Home ImproverrientContractor Registration Registration: 103714 Type:, Supplement Card ?'t t` Expiration: 7/9/2016 PAUL J. CAZEAULT & SONS, INC RUSSELL CAZEAULT 1031 MAIN STD OSTERVILLE, MA 02658 a.t Update Address and return card.Mark reason for change. scA 1 0 20M-05/11 [j Address ❑ Renewal E] Employment [j Lost Card �l e cvycc»za�tcc ectlC�al p%r rc'dac/1 cc:tCM- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �= OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Office of Consumer Affairs and Business Regulation Registration 103714, Type: 10 Park Plaza-Suite 5170 Expiration "7jg/2016 .'.' Supplement'ward Boston,MA 02116 PAULJ.CAZEAULT'- SONS INO; f RUSSELL CAZEAULT 1031 MAIN ST _ -- OSTERVILLE,MA 02658 Undersecretary Not valid withouk9criature � } Massachusetts -Department of Public Safety Board of Building Regulations and Standards . Construction Supervisor I License: CS-108157 Fia I RUSSELL CAZEAULT ' 2071 MAIN STREET Brewster MA 026-31 i 'r Expiration � Commissioner 11/23/2018 .{ I The Commonwealth of Massachusetts _ Department of tndustrialAccidents t.. Office of Investigations . _ 600 W.ashixgton Sti-eet Boston MA 02111 �• www.massgov/dia Workers' Compensation Insurance Affidavit:Baffders/Contractors/EIectricians/Plumbers APPIicant Information . Please Print LedblY Name(Business/Organization/Individual)' ��:I/L J_ C-°q 2 F_f1"a CST' f S'�y\►- Address: 103 City/State/Zip: ©S TClZ y'I L—L C ; M/q Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1. 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' 9. (]Building addition [No workers'comp.insurance comp.insurance.* required_] 5. [] We are a corporation and its 16.❑Electrical repairs or additions 3.❑ I aun a homeowner doing all work officers have exercised their •11.�Plumbing repairs or additions myself-[No workers'comp. right of exemption per.MGL 12.0 Roof repairs insurance uired re q c. 152, §1(4),and we have no /PrPL/Kt Ocj employees.[No workers' 13.E Other comp.irimira_rce required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policyinfot'mation ' Homeowners who submit this affidavit indicating they are doing all work and then him-outside contractors must submit anew affidavit indicaiing inch.•. �Contracxars 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 employers,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: L/ //V s . "-'CO P h . Policy#or Self-iris.Lie.r"r W G 5"— 31.s' �t�. ~Q�y. Expiration Date: Job Site Address: qO ,?LC,4X_;r- cIA� 2 r V City/State/Zip: L&TJ—r`i0-LIL i' ,)�I 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 fie up to$1.500.00 and/or one-year imprisonment,as well as civrq•penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. 13e advised that a copy of tfiis statement may be forwarded to the Office of Investigations of the Da for in�ce coverage verification I do hereby certify render the pours and penalties of perjury fiiat the it formation-provided above is true and correct Si�aatzue -Date: 1 L 11 Phone#` 2 - i f � Official use only. Do not write in this area to be cbmpleted by city or town ofJiciaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: A6o o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `� 1 8/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DOWLING &O'NEIL INSURANCE AGENCY INC NAME: - 973 IYANNOUGH RD PHONE FAX PO BOX 1990 A/C o Ext: A/C No HYANNIS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN STREET INSURER C: OSTERVILLE MA 02655 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 21146142 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIOD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DA PREMISES(Ea occurrence MAGE TO RENTED -- $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COM Ea accidBINEDentS INGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC5-31 S-386670-013 8/10/2013 8/10/2014 �/ STATUTE OERH AND EMPLOYERS'LIABILITY Y/N WC5-31 S-386670-024 8/10/2014 8/10/2015 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? ❑N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE LM Insurance Corporation CJ� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 21146142 CLIENT CODE: 1614182 Lucy Garfield 8/7/2014 2:44:49 PM (EDT) Page 1 of 1 �tKEE, Town of Barnstable *Permit# Expires 6 nwnths roni issue date yT Regulatory Services Fee — sARNSTABIX, t `�� Thomas F.Geiler,Director PE r jOrFn ° � Building Division Tom Perry,CBO, Building Commissioner OV 1.9 2013. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ®��®� R 8 6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number E ���� Not,Valid without Red X-Press Imprint 1 Property Address �� f�L(i� °T�tc ���I.V� � /✓ �Y���Pr esidential Value of Work$ ` Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address / oy K/6 Contractor's Name 11*41zj� �(,(G I �CJ/I�.S .L�1/l' Telephone Number C,ar� �o�9 1177 Home Improvement Contractor License#(if applicable) �r�✓ T� �' Email: UiC'e 2��iGC�7 ( i yyj p.�-. r Construction Supervisor's License#(if applicable) ./1'S /y !i 6 0 01�5- nWorkman's Compensation.Insurance Check one: ❑ I am a sole proprietor h❑ I m the Homeowner ave Worker's Compensation Insurance Insurance Company Name '! L.�✓�GfiQC[f7 e� L f/•�� Workman's Comp.Policy#' y,-5 - 945—,36071� Copy of Insurance Compliance Certificate must accompany each permit: Permit Reque (check box) a if12Gr✓t'`'� �+9 �'f �� Lid'Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Ykk ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum.35)#,of windows . #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor'plans iiarked 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. Y A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: ---- C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 w The Commonwealth of Massachusetts Department of Industrial Accidents 4 Office of Investigations 600 Washington Street Boston,111A 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r Please Print Legibly Hanle (Business/Organization/Individual): Address: City/State/Zip: �S7'Py/11e%'1V - D �— s^ Phone#: l7 7 Are you an employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with /0 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' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.# required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[50ther C e° comp.insurance required.] lz&aY *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Name: ) h Y-k1 Policy#or Self-ins.Lic.#:--` C S'- Expiration Date: Job Site Address: �� ya°I�(/�T"`''�- /ye City/State/Zip: a- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties o r'ury that the information provided above is true and correct Si ature: CoL Date: //_ 13 3 Phone#: S /l 7 7 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#: 3/16/2013 8:05:09 AM .PST (GMT-8) FROM: 100005-TO: 15084204555 Page: 2 of 2 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) A�0 L8/1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER DOWLING &O'NEIL INSURANCE AGENCY INC CONTACT NAME: 973 IYANNOUGH RD PHONE A/c No Exl• FAX A/C No): PO BOX 1990 HYANNIS, MA02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INS URER A INSURED INSURER B: PAUL J CAZEAULT &SONS ROOFING INC 1031 MAIN STREET INSURERC: OSTERVILLE MA 02655 INSURERD: PISURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 17327850 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS TYPE OF INSURANCE GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED occurrence) $ CLAIMS-MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED OW SCHEDULED BODILY INJURY(Per accident) $ AUTOS 8 AUTOS NON-OWNED PROPERTY D $AMAGE HIRED AUTOS AUTOS Per accident? S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION WC5-31 S-386670-013 8/10/2013 8/10/2014 W STATU- AND EMPLOYERS'LIABILITY Y/N ✓ TO CRY LIMrrS E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD WIT NO.: 1712050 CLIENT CQDE: 16YI82 Anne Chandle 8/16/2013 8:03:3,3 AM P ge 1 of.1 �rFhis CertJlCate Cancels and supersedes AL previously issue Certificates. Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. l(Print) ,' d i. as.Owner- ent of the subject property hereby authorizes Paul J. Cazeault.& Sons Roofin-a Inc to act®nbehalf, in all matters relative to work authorized by this building permit application for:' Address of,gob c; �t�� 'I k. OCWT !LL-E- Signature of Owner - Mailing Address of Owner ' r-*--L-%'V-'Ma-�,d 5- k � Telephone # 3�A ,�( !RIC ®ate Please return this form to Paul J. Cazeault Roofing along with your signed contract.' It is needed for us to obtain the building permit required b our town to q Y Y complete your roofing project fax#508-420-4555 office@cazeault.com 4- 1 - � 1 - C�1�e�a��cTizaruaerclf�c��G���i��ruJac%crJel7� i ' a ` "'office of Consumer Affairs&Business Regulation ' 1 ME IMPROVEMENT CONTRACTOR Registration: 10371:4 Type:; y Expiration: 7/9/2014 Supplement PAUL J.CAZEAULT&SONS.`LNC. JAMES CAZEAULT . 1031 MAIN ST gd OSTERVILLE,MA 02658 I • Undersecretary, Massachusetts -Department of Public Safety -r Board of Building Regulations and Standards C'un.structiun Supervisor License: CS-098595 ' .• `tiff f�j✓, t�� . .{ JAWS L CAZtAULT 63 CAPT AIANS LANE - ®STERVILU MA 02655 — r Expiration Commissioner 02/24/2014 Print Page Page 1 of 3 Print this page • Owner Information-Map/Block/Lot: 253J/028/- Use Code: 1010 Owner Map/Block/Lot GIS MAPS 253 /028/ WRIGHT,DAVID L & ` Owner Name as of MARJORIE R .Property Address 1/1/12 SOUTHOVER REDOUBT HILL 40 BLUE WATER DRIVE UNITED KINGDOM, .. . Co-Owner Name Village: Centerville Town Sewer At Address: No GIS Zoning .Value: RD-1 Assessed Values 2013 - Map/Block/Lot:`253/028/- Use Code: 1010 2013 Appraised Value, 2013 Assessed Value Past Comparisons Building $ 241,000 $ 241,000 Year Total Assessed Value: Value Extra $ 50,400 $ 50,400 2012 - $ 4751,300 Features: 2011 $ 473,700 Outbuildings: .$ 16,300.- , $ 16,300 20.10 $ 444,100 Land Value: $ 161,200 $ 161200 2009- $ 556,800 . 2008 - $ 504,000 2013 Totals $ 468,900 $ 46M00 2007 $562,700 Tax Information 2013 -Map' Block/Lot:253/028/`-Use Code: 1010 Taxes C.O.M.M. FD Tax $ 693.97 (Residential) Community Preservation Act Tax $ 123.23 Town Tax(Residential) $4,107.56 Fiscal Year 2013 TAX RATES HERE . 4,924.16 • Sales History -Map/Block/Lot: 253/028/- Use Code: 1010 http://www.town.barnstable.ma.us/assessing/print l 3.asp?ap=0&searchparcel=253 028 10/11/2013' A LOT 39 z3s,8' a LOT 37 LO T 36 o c 43, 570 SF s.a• h , g_ '3: n" 92.7' . ✓ ,. J.P e.a• ` O E L zz:58 p' n x ASSESSORS MAP -253 — PARCEL ,.2, 1 6/9/95 INITIAL ISSUE 5 N0. DATE DESCRIPTION E THIS PLAN IS NEITHER INTENDED AS—BUILT FOUNDATION: PLAN—LOT 36 ° FOR, NOR SHALL IT BE USED FOR BLUE WATER DRIVE MORTGAGE LOAN PURPOSES. BARNSTABLE, MASSACHUSETTS•• - ...FOR MORIN REALTY SCALE; 1' = 50' JOB. NO: 1700/1257PE I CERTIFY THAT THE FOUNDATION o so 10o I. SHOWN HIS PLAN IS LO AT D Al, raP,ttt-A• \u',`, , ON THE GR S IN A D « �4:vr t. 27 i 6/9/95 �,p r, 4 ,f y��;/,4 LEVY, ELDREDGE & WAGNER ASSOCIATES INC, r GATE G ERED LAN SURVEYOR ' 7 '� /d°� ENGINEERS LANDSCAPE ARCHITECTS PLANNERS LAND SURVEYORS t ,{ 586 STRAWBERRY HILL ROAD CENTERVILLE, 1n ' TOWN OF BARNSTABLE BUILDING P_E_RMIT APPLICATION Parcel Map (��� __ ; � Permit# MAY % a Health Division �� ,� �n�,A�.,r -- Date Issued Conservation Division�/S�d�B( � Fee 5 Tax Collector SEPTIC SYSTEM MUST BE Treasurer- 10' INSTALLED IN COMPLIANCE WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE'AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 40 8(13 je Village � 11 P I Owner .�2� �. � + ' L�c.cer Address u�-_ Telephone r f2)r 3 G Permit Request A sot /3 YC) Square feet: 1 st floor: existing /6 60 proposed 2nd floor: existing proposed Total new Valuation ,DDU Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes QNo If yes, attach supporting documentation. Dwelling Type: Single Family 1( Two Family ❑ Multi-Family(#units) Age of Existing Structure S 2 ,/rs Historic House: ❑Yes dNo On Old King's Highway: ❑Yes 31No Basement Type: CdFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /3�3 Number of Baths: Full: existing 3 new Half: existing l new Number of Bedrooms: existing__ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ECGas ❑Oil ❑Electric ❑Other Central Air: lJ Yes ❑No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes @'No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:Ldexisting ❑new size 2- Cao- Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes, site plan review# Current Use r�S� -� ?`3•� Proposed Use BUILDER INFORMATION Name VQ QSP�— Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 5—/ 40 S d! . Y FOR OFFICIAL USE ONLY PERMIT NO. s DATE ISSUED- 11 ' ` MAP/PARCEL NO. f d' t: ADDRESS VILLAGE ` OWNER } DATE OF INSPECTION: ,a FOUNDATION FRAME M ' INSULATION w.• z ` FIREPLACE ELECTRICAL: ROUGH'":; == FINAL ` PLUMBING: ROUGHS FINAL GAS: ROUGI-17 FINAL 4 FINAL BUILDING - r DATE CLOSED OUT - i` ASSOCIATION PLAN NO. 4 • t 77ie Commonwealth of.3lassactsusens LE �_: Department of Inrlirsrri&Acridenrs =« OBY=ofla�sstlgatlods �� —_ IL `�► _ �. 600 Washington Street Bostors,Mam 02111 Wor€cers' Comneasatioa iasursace davit w 117117 rntrtc L' lc. a L s A c e '7 a citv Csl6zp V'I to 6:� K 7S—t)`�Tt I am a downer peaormiag ail wozic myseii: I am a sole atQeriaor acid have as a=wand=is aar cmazitr ON I MI an eztmioverproviaiag waticas' ®m�io�form�ee�piayees wofldag as this job. a ......�.:.:M?A•O' ... ..... •. .. ......,•.`-.•a�. ..:�^'• •4v `;:fi?:vY: ....:k7-0 ..:nr•................. ... .. ......::w.•.}:: .. ; ::•.:•.w •.�:..v•......`S ,~?.} •� :•}}?O!w.=.?\ti+ti:+:.. ::.wN��':�i�.:�:.vi:}}:� ......,.•.;:M.... • hvn•.v}::•x:.n::., .:vy:....:....vi»x.,v,. ,�4..fi _ ,city•:•:a,'•"w'.;b .'•Y.'•h•.vx. ufin•.v i;.yw YY��r7� ... ...,::;.};:.4:.e;.;.}..vf�x.4.�•:: 'v�.�... ;.{r.}h rr...'-yi•:�,,:�.t�•..y; ..:.... .... .....aGY ,.�.,+fitjy:4:{::;i.!;S}v. .y r'v •J::r.:,:: ... -.v4?..•....\.n ��.,�'�;�r��+Y•. 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Geller,Director Building Division Elbert Ulshoeffer,Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date - AFFMAVIT 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. Type of Work: a"'4 W-W�a 4, Estimated Cost Address of Work: "qO 610-- E► a.��c- 27:tie C21v1122rV-��� Owner's Name: 70-a, cr44 �w� Date of Application: I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law []Job Under S 1,000 QB_uilo' not owner-occupied Qbwner 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. t :> OR Date 'Owner's Name q:forms:Affidav 04/04/2001 07:51 5087605244 HOOPHOUSE LLC PAGE 02 I4AY—I2-O0 FRI 2' 021 PM Meadowv1ew Woodwork Fi,:' Ncl' F. I 12ct own 41i* (Post) Typ. { 2" G"TyP ) ,looring YE ) (point to moult, 1 57 1/." ' .�,,,ea,1r dL C)p1v-n+- .a Q r , �5r /r / U0 1 V33 �aos C�/r /. b � ( e q'� Pof`t a v► � 1 � e,,4,,, Pc, 4—, 1 ke- axexsr�+st.r~ The Town of Barnstable 9. Regulatory Services Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA.02601 Office: 50 -8 862--1038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /� Please Print DATE: -`i'}' JOB LOCATION: number street village .HOMEOWNER•: &__11W c1er a o&) 37��- 097Z • name home hone# P work phone# CURRENT MAILING ADDRESS. �D 1(3(� C U.)y'� De!;Y cl;-.. rti'�)/4 C�2�7Z 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 Buildinc,Code and other applicable codes,bylaws,rules and regulations. b 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 re ireme . Signature of Homeo er 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 EXFIIITTON The Code states that "Any homeowner perforating work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems.particularly when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities.many communities require.as pan 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:EXEMFM fAP& ZS3 f�t&. Z8 As essor's office(1st Floor): r Assessor's map and lot numb '` sEpnc SYSTEM MU Conservation(ath F(oor): -�y S,s ' INSTALLED 1N COM �. Board of.Health(3rd Iloor. �� �T"�u t sea»r�nr,t Sewage Permit number [- ENVIRONMENTAL C Engineering DepartmenU(3rd floor): '- r TOWN REGU TT..I® House number Definitive Approved by Planning Boar AP' AT ROCESSED 8:30 9:30 A.M.and 1;00-2:00 P.M.only TOWN OF 8ARNSTABLE -6UILDIING (INSPECTOR LICATION FOR'PERMIT TO C.oyt-s4-ruc-+ q S1 LAA, - -VCA D TYPE OF CONSTRUCTION LJ O0d ►7�Q_ 730 19 15� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �+ 3�-(, Jgl uE Qaler. Dni.ne._. (•ernku'Vil12 ., IN1A-. Proposed Use Slv��t I�U JUI-P, ihQ Zoning District Fire District Ce.rn*le-ul[(e (��-lertll(,le Name of OwnerEhUAfu �S Q n k"vle+^ Address 35 kMh*-5+IA. Name of Builder.1GtcAM-%l).Mry-,A Address 3 00 &arse� (A1Q,u "(tfin/S, F'1A buai Name of Architect �}LL3 Er1Q1 a."-E-s i�� Address may-,4,s tic a[(ls MIL Sj&: Number of Rooms 9 ( _ Foundation kyu>� vL¢C6Y -k— Exterior C(� ._f S�boc� Roofing Floors W(JA l�,lq Pig jynZX3 Interior T�vuAal�, Heating�0.S Warm a i t^ Plumbinga- Fireplace sr"ck— Gas f,u Approximate Cost ' .000. Area a56 o Diagram of Lot and Building with Dimensions Fee t c OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name _7 • 7'l�c�wi� Construction Siipervisor's License _ 0 s'7 7 7 d No 47-&8�— Permit For Buildg.S/Family Location Lot #36 40 Blue Water Drive, Centerville MA Owner xEdward & Joan Lerner �- - Type of Construction Plot Lot Permit Granted 19 = Date of Inspection: E Frame ' 19 r Insulation Y - 19 - Fireplace �(� Li -� 19 n - Date Completed 19 f` Lqq ii�•:� E • ....✓ �. �J 1 ,��'^ � cam: i a 2- G i T A�_ ! UUlY1MUIN Wrj :iti Uk 1Y11 i0 c.� DErAII'MEN7 OF]ND US TFZIArf,XCCIDEN fS 4. 600 WASHINGTON STREET games. Car�poei BOSTON,,MASSACffUSETTS 02111 ,or: :ssione: WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, CMG vim' 0 Y-�A- - picensee/pernttae4, , with a principal place of business/residence at: (C Stuo4) do hereby certify, under the pains and penalties of perjury,than [) 1 am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number O 1 am a sole proprietor and have.no one working for me. 1 am a sole proprietor.general contractor or homeowner (circle onc)and have hired the contractors listed bclo\ who have the following workers' compensation insurance policier. Name of Conrraaor Ins cc Company/Policy Number , ' o <� s Name of Conc o Insurance Company/Policy.Number Name of Concnaor Insurance Company/Policy Numb. Q 1 am a homco ruing all ncc work myself. ��Jeue be owue that wbile bomcov'Mm who emalov persons to do raaiateaaaee.eonstructtoo,or repair work•oa a dwciiin hosAl orc that t.tcc units is whscb the hor•cowocr asso resiccs o.r oo the Frouaas appurtcaaat thereto are cent�eacrally considered to be cm lovers un(icr the Vorkcrs'Compensation Act(GL C 152.scot. 10)).application by a homeowner for a liccasc Of permit may cvicccee tie legal tutus of as employer under the Worlcrs'Compea:ation Act. .' 1 un-emend th:::cow c?t'"is scacr:scr.t will be forwuccd co rise I�cpa..nc:.t of lndus::id Accidents'Office of l9suranci for coves;c vcra:::ron:rd: ::i:iiu:c to ir.:::c eovc;.cc s rcouize� t:nce:See:ios_'.; 'oi:r;Gi 1;3 e::.lead to.t:�e impoiition of erimi.�aJ penalu ccnsiso'r:¢of:.ri.c of err tc S 1500.00:.:clor imprisonment or up to onc y=sne C%Z7 pcn::ucs.= the form of:Stop Work Ordc.and : fine:of S.100.00 a ca,Y maim.mc. Signed ' i5 � d2vor Lice Pc:r.: c z Livasor;Permi:.ar. r4' o 'Q N 1/,/IvI�)c1 00 tc 0 G d3� CLWDO xos r ro wumu rrP. III�II�I11 Hart 4LVA110N orar ® oo ® ono � 0 00 a � G[DAi sus ' RCNt 6CVAli0N5. FRONT ELEVATION •v� 1 RIGHT SIDE ELEVATION w Q . u O in �., 11 � +� a O 1B �w oG w n � FrT= zmz ® oc0Q oo�- REAR ELEVATION SHEET NunaEa LEFT SIDE ELEVATION ,,,.•.,-0• scat.v_1.-0. LF/IILLLEIU\NANE, 9211JAI .. ,. �.. .,� � '.,-s,�.a � ...w�yn,«..,•�eptm+ ..«...nrt.` � .:�• � tkdeR'rYzeot. ,�._� •:.x> l�a+ ,.r�x. .,, .. �w�--��'xa --,....,T�-�w���.?'�'.1 -a';"?<4r"!;�< ` .�'�•s1u2W7ta;'&. amuse,:_ ,.. ..� °!'��i r ,<; "' HYANNIS• MA 02GOI t T-2• Sr-11• la'-'A• !'4 I T-2 T-z' I• � � nc) m , ♦ - e10 �srn.vzmM D♦1 6 , DECK q c I tr a ze' - '0 - � C1rP Q x 2� /1 F I I n ` LIVING DINING QIlI J 0 MASTER 5EDROOM a O v, I DOOR SCHEDULE v� ----------------J 5 ` O .i IR7 (1T. D�SLR�11011 RW^J1'OP°J'DIG 6 12'-2 V2' G-t ve I g stall tr To I t t 3 a.w ?u" a'-2 va•a G-1.T sraeAL•f ni 1 II I`''11'"'111 111"'11'_•111 I p I srau¢o ez 2 t re•.ce sr= zc coo r-lo va•.c-o srativT a ji O. �- M aj '� 1 4b•a T-0.OYCRf!!lD 4s a T-0' aLL GarC Dnae nor rxovSx ve• y t wain 1 O U� " on I O tx caDc cn.ea - - s•sTn •� ♦t au cannon � c s � rc.cc•cr:+a rro ve•.c— ncer+n n-lnsl 4•osr i '1 o:w. LAV. r cw.s.•s m"'c=" t I • z'.'..:•a.rn r<ve•.c•.r ncecw n-zDaz p 6 b I f a0 Y carte T wHc srs:zs I ©. a z - 2- a c'c•Vu z'-z vs..V-a t"cat - O __ 9 S so•.cc•Bran r-z ve•a c-r nceun n-aro-lwn - O ie I T", 1, GARAGE a .'D'a ce•raD c-z ve•.c q noec.n n-.rD Soat a a nMA5TCR --------h O FOYER�i KITCHEN 4 I Y BATH . I 9 W corm ro 1 ° " tT a © off � � i rI-AL � _N �I b I � �S ro• r-o• Iz-s .-a• a'<•rl r<• I a'-` s_.a 3'10• ca 0 ' ., 0 c•a rc 1 tra u'c• sa r-e• � u'o• - I -. . FIRST FLOOR PLAN r-tar a yr u-o sn• co ve• enze Dune rsar 2x 1 saow! sc.::•vs'.ro• LA�T` ♦s ICO`J ~ - BEDROOM corn To>=m Q . A Sa•-1 air u--w va• I u•o• i C.) 0 AA�, � oM Inn 0 r r O BALCONY 1 3 0 , E a qrr tK � � Q1 ct c Ll ---- ----- w1 1 rQ corn ro access i I OC 0 Q eaowi Y�(L� /1►• 0 0= ®i COM To Dd csTo .0 j Y O L_J I L SHEET NUMBER. 1 U� s<• s•e• rr s•e• c{• r-c a'a• a'<• r-e• p Ip 5ECOND FLOOR PLAN D` u{• v,.rc[ - ME NAME. 92113AZ S - Cg mN - X2N 0 0 NOR•C.G.a FOUNAT1011 ^ Q GONTN0005 RDC1 Vdi Lg11RAGTOR TO vCRRT Q '_Y TIPGAI.U, - IX LOCAT M a OMA♦ pa tz IOGATlp14 Of SONATIKS L�F �5 TTPGAL Ts I GONSTIOGTCN - -------------- 4 ; p ATTIC TO YW000�2. @ ...9'rBm-55 NStL RAPRRS AT IG'OLIPROVIOF TROP[RVOR' i FOWL sTYRAPOAM N51AAllp1 {iCQy MINH TAN—MG AT FAVFS AM)S OMV (MOP WALL - TYPLK B'LONLRFtC WALL NSWT[O cttNGSmtOVxX GOnR000S Q C NG5 WALK-IN BEDROOM AT V FOOTMG FOR BlLO t' ON 1G'a e•.carteuous L '-0 >2 SOPIR VF+rtnGmtoV a e. G n5LLAT1011 u u 1 l a BIARiOIGRFTF 32 RFOlRCO ALLTFO , g gg a A.O NCR Q GT GOOF UOIFG3aT5 Ot00) ` a N FULL BASEMENT TTo m aA WALL cAT 4TTO ION u> 4 Q eM eM , it<• w u�wa�ir a° Aro MLYV q oc DINING RM. W„R MAR 5„NUFs AT,T°wv ma L_J L_J _J L J L_J L_J r,1 q BmFANOR .4 SV SATW rcr. i L p)2• O GRi OL I SNCATMNG 2•.ST D5 AT 1G'OFl F 1/2'rBOLGLA55 NSLtATGf1 sMe A S1 - GILFD Trr.�o•.x•.u'coec.Ca.rm �- J am nACID r o-Ts GARAGE ( 2,10'e IG'x 2.301 et 1G'of 2,G TRFATFO 5LL CA'conc.sae wi 4 z.to rmr - e W.wN{RGI To Q LI'rBOf GaN NSIL TYP. - CKRMC40°OCRs' I N e.smar GaNG FULL BASEMENT ,.GONGRFTF WALL J1 v r'� w J�LLT :Rlm sR¢ F- U L J. GONG SLI-1 9'GMT.cOHL.'rooTnG O 5TA 4 4 ORor wALL raR°I - `I—x•,eG•.to 4 c0NGRM ca.rm Q Q r Q - In MONOUING.'LOHLRCR '< YS' 9'6' .< - r•IaJ w „°R ;. 2D'4 GROSS SECTION J In a cow.LONG.rcomG SCALE.1/A'_1'-0' - Q .. WQ. . FOUNDATION PLAN Z�,z O0 O0 SHEET'NUMBER. FILE NAME, .... _ 9288A3 NOTE- G.G. t FOUNDATION coCq ' CONTRACTOR TO VERIFY ( = z ,n Dr ENSIONS Of DECK + LOCATIONS OF SONATUMS LSD C CCGT• i � b DROP WAU —— YMA 5- C NON EM W L -Oj FmtflalEAD C CONCRETE FOOTING - - - - 0 a - N to ^ FULL BAS MENT co _J L J L_J L_-E- J C3: 2 x 10 Gn2T CT i P_' I TTP. 30" x 30- x 10" GONG_ COL_ PAD L I J _ . GARAGE I a d j coC4" GONG. SLAB W/ i W.%iAN /PffCN TO z� OVERHEAD DOORS � O ?'ems 4_ LJ Btt BH O I PICT_ PKT. ' 4 d STAIR - o 1 Q ----- 0 DROP WAIT FORD PR 1 PAD , p �. 6. -0. 3.-C. L--_J ------ ----- -- -- 1 4.-0.. 3-O. 2-O" -8' C2' G APRON MONOIlnic 4- GpNGRETE SLAB.AND B' CONCRETE Lr/1D7;4- Ci0"/l 1tl'�F Z3•"-O MOST WALL ON 1G' x B" CANT_GONG. FOOTING _ - ..._Y .:.�.s e._..5'- .. uSwP+�%M...'.New`R'wT-i,'.4�'uFT.:. _-.,"'� il. ih.i .+ - .. i."+i.+rv"�.vta`".r - - .... _-a._ -.. . .�-. ., t-,._'.'n-i....KP•?3;6mv. :w�^..c�' +;:L .'+ih^'^^^ge'�,y ?�"2. 5 _ - DEPARTMENTOF PUBLIC SAFETY- - •'� - - - - - ONE ASHBURT , PLACE, RM 1301. O } BQSTON� N42108-1618 4, D.P.S. CONSTRUCTION SUPERVISOR LICENSE ` > i Number Expires: Res 1 t riCred To: 1G irk 5 JACOL'ES N. MORINach bottom, l old sign on 300 SEAR __ WAY a v_n,Gn, and lam'nate. licers2 cai d HY irii'!1J1 ii li 2 ed too fo r2cel Pt anv change dress no l i i ica"on. ✓lie ' P,es:.trict'ed To: lG I OERAR,TRENT OF PUBLIC SAFETY CONSTRUt TI9N SUPERVISOR.LICENSE 00 - None ' RNI& ' -jxpires: IG - 1 8 2 Family H el-ra lg M iG { �G�eb+n+►'r. �� Ct}iIES N MORIN r �?r300 BEARSES`NAY. s > - HYANNIS, tIA •02601' ' - `' .. • ._ •- -� ',✓yam .. - & ^ � T �� z i - COMMONWEALTH OF I DEPARTMENT OF PUBLIC SAFETY MASSACHUSETTS I ONE ASHBORTON PLAWTV CE 5 "Se`T io��- s..s s c c�1ro�fe BOSTON MA g r1 �uv,c<' 0210 i t c PG"�f:i';� om.cam;,,,-,�.�S a LICENSEEXPIRATION DATE I ar'rd,i�ft�c Ean,cr�erecz?tan CONSTR. SUPERVISOR CAUTION I�6/17/1 99� RESTRICTIONS (�t;�, EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST 014E s06/30/1993 T905 THEFT, PUT RIGHT THUMB o PRINT IN APPROPRIATE A A`it1RK A iti+� �NZ EL 8 BOX ON LICENSE. t333-44—�i��3 Q.� fNIAAli WAY . a Z CEi+6TERVI L>~ C2t53, � BLASTING OPERATORS PHOTO(BLASTING OPR ONLr) q p^y r m Z MUST INCLUDE PHOTO. I f NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ? HEIGHT. STAMPED-OR,SIGNATURE OF THE COMMISSIONER f� { DOB: !a I)E/17/1956 i THIS DOCUMENT MUST BE �Nl _ CARRIEDON THE PERSON OF; THE HOLDER WHEN EN- SIGNAT�4UR F LI SEE SIGN NAM ElN FULL ABOVESIG OTHERS _ -- OTHERS-RIGHT THUMB PRINT GAGEDINTHIS OCCUPATION.' r ���} O - .. - N_ i TOWN dF BARNSTABLE CERTIFICATE OF' OCCUPANCY PARCEL ID 253 028 GEOBASF ID 16572 ADDRESS 4.0 BLUE WATER DRIVE - PHONE Centerville ZIP - i LOT 36 BLOCK. `' LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 11644 DESCRIPTION SINGLE FAMILY DWELLING BLD P T #4485 PERMIT TYPE BCOO TITLE CERTIFICATE OF OC Uf3arltnient of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: TOTAL FEES.: Ox lbw, BOND $.00 CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY J A"ST'#'j3M MASS. E � �i6g9. OWNER RNE L R, EDWARD & JOAN ED MIS ADDRESS 35 AMHERST ROAD I� NEWTON' MA BUILaING DIVISI03 DATE ISSUED 11/14/1' . EXPIRATION DATE BY k`c4 i DIVISION APPROVALS FOR e CERTIFICATE OF OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION BUILDING:• f 4 >, DATE: I COMMENTS: PLUMBING: DATE: COMMENTS:' _ r ELECTRICAL: DATE: f COMMENTS: N GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIMEw TOWN OF BARNSTABLE, MASSACHUSETTS DATE 19 PERMIT NO. APPLICANT ADDRESS IN0.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO (_) STORY DWELLING UNITS lT'/PE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) �1��' t3/C. JJ7/(/� DISTRICT % (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) ' LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR - PERMIT VOLUME ESTIMATED COST _- FEE $ (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS LcPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ' MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A. CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHP.LL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH).3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS avolrG / .ems• Y z2- 9s� ov f sue- 9 29 -�S Aeowoor 2 Z?/ ' Z z/1�1J1 6�' �///li/_114 3 HEATING INSPECTION APPROV S ENGINEERING DEPARTMENT 1AVI -s z /1 s BOARD OF HEALTH OTHER SITE PLAN REVIEW APPROVAL /z WORK SHA N ROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS A OVED THE VARIODUS STAGES OF I WORK IS NOT STARTED w,%THIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NAKED ABOVE. NOTIFICATION. I i 4 I, 'E 1 as 1 S v L NTAO FlC nF L4trUG' 2Ld � a S-\j��S ��� �l C '4--6 \d oa,tLT RE'OJECTED Type of Inspection -�,R Svc Date of Inspection Inspector y V Nri�i' e " i Town .of Ah i"$table I3es�c �nts On May 4, 1985 Barnstiil eik'own Mi eeiing adopted Ler- missive legislation(Chspter.448Sectipn261 )which re- quires smoke detectors,in;all residential:buildings,with five or less units to..be installed within one:year.q.the date of acceptance.Below is:Chaptef i.8;"Sectj9&:26E.. In any city or'town which..accepts.;th ',,eot ion,_ buildings or structures occupied in whote.or in part for residential purposes,and not regulatedbysections . twenty-six A,twenty=stx$,or twenty-siX ilia wltbin one year of46 date of suchAc111 ceptat e,get pad with an approved.monitored*—a , a mo�Co t` detector or an<approved prinary::pgwersmoke;tlete ,P a. 7 for shall be installed:of each level oi'lwbtion,�,� , on the bisement;lei+el; providedj-" vecktltat`tpe head of the-fire:department shal`hallowahe: tion'-of-app i-mijred roved o battery p wer smoke' detectors Such approved monitof a bat ltow.er_;, smoke detector or"approved primary power smoke . detector shall be installed Idthc1blJ6vying manner `an. approved monitored battery powecamoke_detector:or, an approved prltnaiy'powersmokO^.detecoor hall"be installed on the ceiling of each stairway;teadingaCthe; floor above,and the base of,;but notwithin emclttalr waj andaii approved awaitored biatteq_PQWgx_smo - detector.or`an approved primary,power sntoke`detec for shall be,installed in to dwe of idii each separate'Sleeping area, provided,However, that.th . head of the fire department'"shall.iiUo.;the installs r tion of approved monitored batter powa� smoke'n detectors;and provided,fuither,;that in all common hallways of said residentiai.l}utldhn,q._atcuctures a series of interconnected approvedk.primary power ,smoke detectors shall be installed Th e tread oYthe:fire:' department..sh"enforce the provWonsn :f this section The provisions of section thirty shalt not l , o tU1 section�* The Town of Barnstable district eartinents are willing to assist.any:resident.with".inforinatton regarding placement of smokedetectors by simpty call= ing-or stopping by your district station at the follow; .l ing locations: Barnstable Fire .Dept.,.,Main SC.,._Barnstable= ` 362-3312;West Barnstable,Fire,Dept.,Rte.6A,Vest Barnstable-.362-3241;'Hyannis Fire;Dept;;93'Higli:'-. School Exi,Hyannis—775-1301;Centervtlie�&4 Marstons Mills Fire Dept:;999 Main Sf` OstervWe- 428-2467;and the Cotuit Fire Not" St Cotuit� 428-2210e r. Detectors must be installed:by'May_4, 198b. a ' residential units in the Tbwn of Barnstable. BIKE r° The Town of Barnstable BA MATq LE. • Department of Health Safety and Environmental Services MASS. '°" '0� Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection ��- evh�1p��� Location -O W �� Permit Number Owner < Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting; 17 L�--l—) To Please call: 508-790-6227 for r)eeinnspecc(tion. Inspected by � Date i - LOT 39 LOT 37 3 LOT 36 � 43 ) 570 S F . � 6 01 rne-�� V ✓Vii hCYD s.r e•a,.. 927 • 23 3 . DRY V _ E L -5 A, 8.0 E" vV �. \, U 20' MINIMUM OR AS INDICATED ON PLAN NOTES: '10' MIN. �C 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. S' . MASONRY EXTENSION TO 12• TITLE 5 ' THE TOWN OF RULES AND �y" 4 BELOW GRADE •0 -- ---- Q4 `�TOP OF FOUNDATION BACKFILL WITH l l3�U� TH REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE- "� >, r 6' MIN. 5(o•O -_�{'.Q CLEAN AN MASONRY EXTENSION TO 12• �IAy ,RL �1 AND THE REQUIREMENTS OF THIS PLAN. _ BELOW GRADE '� 41 LllA.r?" 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO .N fiv. __ WITHIN 12" OF FINISHED GRADE. MI . PI 40 PVC PIPE 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE MIN. PITCH 1/8• PER FT. N "p" T. FLOW UNE 2• LAYER SHALL BE MORTARED IN PLACE.10• TEE WASHED 1/2-STO 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE• MIN. ?n < OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 53.7 2VELa GALLDN WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING 2• MIN ,EVEL LEACH SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR—0• `S/.8 PIT LIQUID F < WASHED STONE PARKING. LEVEL DISTRIBUTION 48,S BOX > < 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED 42..5 RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL I = 1500 1000 GALLON SEPTIC TANK OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. LOCATION MAP I Z 1 60 I Z" i z_ 6. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE ASSESSORS MAP PARCEL z8 & WAGNER FIELD NOTEBOOK #z5�,+�5A-- LIQUID DEPTH IN SEPTIC TANK DEPTH of OUTLET TEE BELOW Flow LINE BOTTOM OF TEST HOLE 1 ♦ FEET 14 INCHES 5 FEET 19 INCHES OR USGS PROBABLE HIGH WATER LEVEL B FEET 24 INCHES I ART, 43 ALt.0wAl3LC- fz=uxj CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS SEWAGE DISPOSAL SYSTEM PROFILE 3306rV/Ac, 43S70/4.35- , � MIN. FRONT SETBACK 3a FEET NUMBER OF BEDROOMS 3 NOT TO SCALE 330 GPD MIN. SIDE SETBACK 10 FEET GARBAGE DISPOSAL UNIT N01.1� TOTAL ESTIMATED FLOW MIN. REAR SETBACK Ip FEET ( 110 GAL./BR./DAY X BR.) GAL. /DAY REQUIRED SEPTIC TANK CAPACITY 47t)S GAL. ACTUAL SIZE OF SEPTIC TANK ICOO GAL. PERCOLATION SOIL TEST (P-?761) LEACHING AREA REQUIREMENTS SIDEWALL AREA Z• s GPD./S.F. BOTTOM AREA _ ► 0 GPD./S.F DATE OF SOIL TEST 317�Y0 - SIDEWALL 2717( 10 /2)( � )SF x Z.5 GPD/SF = 471 GAL/DAY i TEST BY 1 c Li.4�_ Frc�c.p L. . \ BOTTOM TT (10 /2)2 SF x _ 1 GPD/SF = 71 GAL/DAY I S8 •� r WITNESSED BY --- ! PERCOLATION RATE _ z- MIN./INCH SF SSO GAL/DAY LnT _� `�. ` � ":� TEST PIT 1 TEST PIT 2 BREAKOUT CALCULATION: AJ A $ �`' \ `�•'' �•`�. \ \ r -- — "� ELE V.= 571,.5' ELE V.= �t•�n \ \ W STONE tom, �3 70 5,F LE(GEND : EXISTING SPOT ELEVATION OOXO NG 77L. `F a� . \ , S �o WATE(1 3.0 I _.� _ FINAL ALI SPOT 00.0 ELEVATION - ---- FINIAL CONTOUR TP SOIL TEST PIT LOCATION BOTTOM OF TEST HOLE BOTTOM OF TEST HOLE F'xtr-r 1 / \ ( f� 1 J OR WATER ELEV. _ 3� S OR WATER ELEV TOV'VN WATER -W W �'` \ () SEPTIC TANK DISTRIBUTION BOX ❑ WATER LEVEL ADJUSTMENT: 0/fA PRIIMARY LEACHING PIT O t RESERVE LEACHING PIT LR' TEST DATE — WATER LEVEL ,1.. INDEX WELL ( \�` �. ..- � 'L WATER LEVEL RANGE ZONE 2 3�/6 pit �cvcf,c 9, yf° r rPv,. t ✓`�W 1 3 q ya INITIAL ISSUE £(,KC .,. 54- DEPTH TO WATER LEVEL FOR INDEX WELL NO. DATE DESCRIPTION BY FOR MONTH OF: , ,T- v L. WATER LEVEL ADJUSTMENT 51 D =' Tip D MC r 1 ='T 3G DEPTH TO HIGH WATER WXTEX 15AR-M STABLr-- MA FOR APPROVED: BOARD OF HEALTH w STEP-IEhd '�i `' ' '�S '�`�C'T ` ALLYN W ILSON ,QNo.312lb' SCALE: �1'�,4 , JOB NO. SITE PLAN DATE AGENT llff ~' LEVY, ELDREDGE & 'WAGNER ASSOCIATES INC. PERMIT # MW I,1MM allIM P1JNl M LiND SU"ROYS 889 WEST MAIN STREET CENTERVn. E MA 02632 NEW ENGLAND REPROGRAPHICS&SUPPLY CO