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0116 BRALEY JENKINS ROAD
' F a , , �vrs 4r �" ss<•'+e, ,"E..,Xjf' 'In,"+,,� J vi KSi. 1? > �z - �,' 'r-." -+1 y:"E'y''ix s� "» -�"+ it c" a' .° rrE '{:..... ..x '.rni• i",', �� �- ° 4w rir sPi " r M1°*i' _.S 4 +*� _.. .....,....x..a s. -,r.:. @.,n„ x•...1. p.., ! ..� ;. �., ."_,- .". '���4 ar. } ti;. ...id .:' ir�.�P� 7 ^a" 1 ,: ti :� r rl ;p Y Eg' a .e �t?t, ,4:1.�:�.. '%.'� _' 3 •.i, u. 9, ,,...,_. .... s.,...,.. r:. ...,,i �. �•�} �er '�Aad �� ',�ii� `a�'i e. �k�.. -�n $.. ,.. ,i�I..' r � vkLz:,' ^� °_ ° r.. � a �h11P 6 �skt 1 4. A �rti r'. �.. nk,, � r� -`t - m• � - 9 m a 4 It 0 0 u , v e' w e ^ ° e . o = e • a n w ° L ° ^ v 0 +� a e m ,q c . ° o ° e ° ^ , ° a v _ s w p ° y F e fe :•gp. a o u °., ^. .k ,', a w, ° .. "P TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -76 f --1 H O Map \ Parcel c plication # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Feel Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner,5<gle e lr-lew Address Telephone Permit Request /C , /®e/Z ®�ee Olary Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - ®l�D, /� Construction Type��6� "'` -� 2: ca Lot Size Grandfathered: ❑Yes ❑ No If yes, attacf',uI pporting`ocu ntation. Dwelling Type: Single Family f& Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Vo On Old King's Highwaj7==0 Y No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other a Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4Qaexf /,G!���/��� Q6� Telephone Number -- , . l Address �/�� .�d®�io ��d� License # /U ® 9,5�7 er Home Improvement Contractor# /,5r�.f I i Worker's Compensation # 40a&?s Zzfa ALL CONSTRUCTION DEBRIS RESULTING FROM:THIS PROJECTWILL BE TAKEN TO SIGNATURE DATE z�`/) fG FOR OFFICIAL USE ONLY APPLICATION# yt. DATE ISSUED 6 !Mr MAP/PARCEL NO. r- ADDRESS VILLAGE OWNER z DATE OF INSPECTION: 't FRAME INSULATION i s ' FIREPLACE ELECTRICAL: ROUGH FINAL E. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING. DATE CLOSED OUT ASSOCIATION PLAN NO F w Uttar ± Y� :PANCIPARNG mass save COMMOR pinty,:Arou�h o:+ei$Y TfftC10MV _ - - PERMIT AUTHORIZATION FORM . I I, ,owner of the property located at; (Owners Name, printed) _ Z (Property treat Address) (City/Town) I hereby authorize the Mass Save.Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building,permit to perform insulation, and/or weatherization work on my property. 3 . . -79 Owner's Signature JV Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: U0 TA G U(-A T I IM/N to lip i1 ry b Participating Contractor Date e . Rev..12132011 I I he 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/Organizadon/Individual): Address: City/state/Zip: 2 T� /9a o JPhone#: �- Are you an employer? Check the appropriate box: 1. I am a employer with -� 4. Q I am a general contractor and I Type of project(required): 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. Q Remodeling »' ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity; ' employees and have workers' [No workers' comp. insurance comp. insurance.: 9. Q Building addition required:] _ S. Q We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1`1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof re airs insurance required.] t . c. 152, §1(4), and we have no p 3a.❑ I am a homeowner acting as a employees. [No workers' 13.2 Otlier1ZZXZ4 ZZ2%G.�l general contractor(refer to#4) comp,insurance required.]' ------------- *Any applicant that checks box#1 must also fill out the section below showing their workers'compmsatioz4olicy information.t Homeowners who submit this affidavit indicating they are doing all worst 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 co number. y d 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.#: /�G.9�ai>J 5 'i�G Expiration Date: / ' I Job Site Address: G ✓ r/✓l/� i Attach a copy of the workers' Cnty/State/Zip: 'Z ®Z G 3 L compensation policy declaration page(showing the policy number and expiration date). j 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. v I do hereby certify un the pains and penalties of perjury that the information provided above is true and correct Date: G !o !y Phone#: .�'7J 7:'7-b 12 j O,Q9cial use only. Do not write in this area,to be completed by city or town officiaL City or Town: PermitlLicense# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I v AP EC. _ D 0" - 27 KLI DATE(MMIDDIYy�y'�TT CERTIFICATE OF LIABILITY INSURANCE - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H 6113 OLD ,THIS /2 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 INSURE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, R(S),AUTHORIZED IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollay(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 endorsements), RODUCER CONTACT Wers&Gray Insurance Agency, Inc,• NAME: Barbara DeL.awrence Rte 134 PHONE )uth Dennis,MA 02660. (AIc.No Ex I: Fa c N°; 877)816.2156 A-MAIL A ES ; bclelawrence ro ers ra ,com - INSURER S AFFORDING COVERAGE NAIC H s RSA ,_ INSURERA,Peerless Insurance Company " II INSURERB;COMMERCE INSURANCE COMPANY__ Cap@ Cod Insulation Inc INSURERC;Evanston Insurance COmpany 16 Reardon Circle INsuRERD;ATDANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURER E; - INSURER F: D ERAGES CERTIFICATE NUMBER: N NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NIA 0 D ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE 'AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E Cl-USIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS, R TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXp MMIDD MMI DIY X COMMERCIAL GENERAL LIABILITY - •. -- LIMITS - r 1 -— CLAIMS-MADE I X OCCUR CBP8263063 EACH OCCURRENCE L--� 0410112014 04101l2015 E-T07ERTEb— $ 1,000,000 PREMISES(Ea occurrence) $ 100,000 A. ___...__._ MED EXP Any one person) $ _ 5,000 PERSONAL&ADV INJURY $ 1,000,000 G N'L AGGREGATE LIMIT APPLIES PER: --� _ _ POLICY l PRO- ('J GENERAL AGGREGATE -- $ , 2,000,000 L__:.I JECT l J LOC y, A OTHER a �e P ' ' ` PRODUCTS_COMPIOPAGG $ 2,000,000 AUTOMOBILE LIABILITY _ $ COMBINED SINGLE LIMIT I ANY AUTO 14MMBCKVMK Ee accident) $ 1,000,000 ALL OWNED x SCHEDULED 04/01/2014 04/01/2016 BODILY INJURY(Per parson). '$ AUTOS AUTOS — X NON-OWNED. BODILY INJURY(Per accident) $ - HIRED AUTOS AUTOS PROPERTY pAMAGE — Per accident) $ X UMBRELLA LIAR X OCCUR $ j EXCESS LIAR _ _ CLAIMS•MADE XONJ453514 ' 4URRENCE $ 1,000,000 04/01/2014 El/2Z01E DED X RETENTION 10,000 WRKERSCOMPENSATION @ $ 1�00,000AND EMPLOYERS'LIABILITY TE HRH• 4NY PROPRIEI'ORIPARTNERIEXECUTIVE YIN WCA00525904 06l30l2014 06/30/2015 OFFICERIMEMBER EXCLUDED? NIA E.L.EEACH ACCIDENT '(Mandatory In NH) �— $ _ 1,000,000 If Yea,describe under E.L..DISEASE•.EA EMPLOYEE $ — 1,000,000. DtSCRIPT10N OF OPERATIONS below I E.L.DISEASE•POLICY LIMIT $ 1,000,000 9RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Ad ker Compensation Includes Officers or Proprietors, ditional Remarks Schedule,maybe attached If more apace Is required) I : 1 ID al Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. 7TIFICATE_HOL.DER ' Massachusetts -Qepaftmta'nt of.,fubl-lc Safety of Buildlilg Regula$funs end Standards Constnretiun Supen'isor •� vl ,�, `;, t,icense:,CS•100988 - . HENRY.F CASS130 8 Sl•IED.R0W WEST YARMO'L�.'1.1 - �I Expiration Commissioner 0,1111112015e.a, /X/K : %'liGGJ F<�l�• Ri QfliCtl of Consumer Affairs and Business Reglalatlon 10 Park Plaza - Suite 5170 Boston, Wssach�jsetts 02116` I Zome Improvement CQ a for P��g stratic�n e v�G:•n .SIM - i Registration: 153507 '.'.•nif' '`r ::';: ::::::.::� Type: Private Corporcition CAPE COD INSULATION, IN ,Y{ �•• �.: :.::..,.•: ratio) zala i1n z:iaas'l HENRYCASSIDY :I• ;:,.:.:1::: �.:..:. ...; _....___.._._.,....... . ..:...:. ................ 18 REARDON CIRCLE �`'V� "#"� � --- � ° SO. YARM U , ,'! t' ;;� Q TH, MA 02664 U dat•o Address na(I return card, Marts reason rur amigo, Address �.12tnuwnl �� 1!rnpluymunt ( � 1.ustCnrd '��ia �(,r.�rrr.•rrr•crrr•ccrarcr•l!� r.`�C?'/%t<cdJcac'Oc6dcdl�3 .. • � " l.)I'fice ul'l'onxumlrrlffnirs rk llnsi toss Rebulnliurr 1.l('e11Se or r'ogistrntion YOlid'for ht(livi(ttll tlso oltly 'F�1 C)ME IMPROVEMENT CONTRACTOR ;bcfaro thri expirntlon dafe.wIffound return to;.' ' E�eglstratlon; 163 G7 ` Type; "Office of Consumer Affnlrs aitd Business Ttobutation' Jkxpirat(on: 1�/1"5/201A Private Corporallon a 10 ParkPinu•Suite 5170•. if)IN5ULA'I'L(�N SI'I Boston,MA 0211G r G` .. ., WWDY t 'C )ON CIRC:L. 1101J1'hl, MA 02613Qe d I,ludurat,c,rcrri ry of Val' twithu• t rillt r u _ a sr _ r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map zy+4 Parcel okz Application #c0 J Health Division Date Issued 0 �L y Conservation Division Application Fee v Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner Address \Ly c....F,o�+ `g►a6 Telephone so%- s 3%.k— ct %A g Permit Request ._ � � t o c_ . Square feet:'l st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation z.ono . 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 %c%6 S Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing z new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing c. new First Floor Room Count Heat Type and Fuel: O'Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No "Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 3 . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L;L'.3 0& Telephone Number sme'k- �'33 • 'Q�'�`1 Address %,A License# b... �,.�.�►. .�...a o i.�� c.'� Home Improvement Contractor# a i s.' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -T-e..s ., d V N%!Z,o%I Z.v 4L �.. +ram h• . .,. %-- SIGNATURE rAV84 DATE /O"/,S— a E FOR OFFICIAL USE ONLY APPLICATION# _^DATE ISSUED _ MAP/PARCEL N0. 4 la ADDRESS Y VILLAGE , OWNER r, E DATE OF INSPECTION: uf } - FRAME A INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING E a DATE CLOSED OUT 4 ASSOCIATION PLAN NO. The Conttnonrvealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02.11.1 wHnv.niass.govhlia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name (Business/Ot-ganization/individual): ConserVision Energy Address: 376 Route 130 Suite C City/State/Zip: Sandwich, MA 02563 Phone# 508-833-8384 Are you an employer? Check the appropriate box.: Type.of project(required):I. 1 am a employer with 8 i. ❑ 1 am general contractor and'l 6 ❑New construction employees(full and/or part-time).* have hind the sub-contractors 2.❑ I am a sole proprietor or partner- Iisted on the attached sheet. ? ❑ Remodeling= ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity• workers' comp. insurance. g• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have. exercised their 10.0 Electrical repairs or additions required.] 3.❑ l;am a homeowner doing all work right of exemption per MGL 11.❑ Plwnbing repairs or additions myself. [No workers' comp. c. 152 §1.(4),and we have.no 12,❑ R.00f repairs insurance required.) employees. [No workers' Other Weatherization crimp. insurance required.] `Any applicant that checks hox'91 must also tilt out the section below showing their workers`compensation pulicy 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 mu;t attached an additional sheet showing the name of the sub-contractors and their Nvorkers'comp.police information. lane an employer that is providing workers'compensation insurance for my employees. Below is the polio,and job site infnrnration. Insurance Company Name: CS&S/WORKCOMPONE Policy## or Self-ins. Lic.#: 6011316349 Expiration Date: 03/11/2015 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 forth of a STOP WORK:ORDER and a fine of up to$250.00 a clay 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. f do hereb tifjr t tder tit p 'ns nd penalties of perjury that the information provided above is trite and correct. Si matures ',�-- Date: V Phone#: Official use onlj,. Do not writern this area, to be completed ahv 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 Aco CERTIFICATE OF LIABILITY INSURANCE °AT3/'17/0`14 0311712014 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 ondorsement(s). PRODUCER CONTACT NAME: CSSSIWORKCOMPONE PHONE FAX PO BOX 946580 (A)C.No,Est): LAIC,No): AIL MAITLAND,FL 32794-6580 ED ADDRDREE SS Phone-877-724-2669 INSURER(S)AFFORDING COVERAGE NAIC N Fax-877-763-5122 Continental Casualty Company 20443 INSURER A INSURED .INSURER B: CONSERVISION ENERGY INSURER C i 376 ROUTE 130 Continental as EC pany 20443 SUITE C .INSURER D SANDWICH,MA 02563 INsuaeRe;Continental Casualtpany 20443 .INSURER F i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 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. - - - POLICY NUMBER MWDD/YYYY MMIDDAM' W1101 LIMITS LTN TYPE Of INSURANCE INSR WYD $1,000,000. GENERAL LIABILITY NCE _COMMERCIALGENERAL LIABILITY NTEDncel $300,000 1 INIU11CLAIMS-MADE EOCCUR. ne person) $10,0A Y N 601131633 003/11/2014 03 /1112015DV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY JEC LOC COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE.LIABILITY (Ea accidem) BODILY INJURY(Per person) ANY AUTO A AALL UTOS AUTOS AUTosuLED N N 60113/6335� 0311.1/2014 03111/2015 BODILY INJURY(Par accident) HIRED AUTOS NON-OwNED PROPERTY DAMAGE AUTOS (Pei accidenq UMBRELLA UAB OCCUR EACH OCCURRENCE 1,000,000,- _ D ExcEss uAe CLAIMS-MADE N N 6011316352 03/11/2014 :031:1111/2015 AGGREGATE 1,000,000 DED RETENTIONS 10,000 _ - -- WC STATU- OTH- WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOPJPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100,000 E OFFICERRAEMBER EXCLUDED? ❑ N N 6011316349 0311112014 03/11/2015 - - - $100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE -it yes,describe under $500,000. DESCRIPTION OF OPERATIONS bebv> E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I-LOCATIONS/VEHICLES tAllach ACORD 101.Additional Remarks Schedule,d more space Is required) Certificate Holder is added as an additional insured as provided in the blanket additional insured endorsement. CERTIFICATE HOLDER CANCELLATION ise ng neering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1341 Elmwood Ave THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 1341 Elm RI d Ave ACCORDANCE WITH THE POLICY PROVISIONS. Cra910 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD wcnaes. f 1 gj Massachusetts -Department of Public Safety Board of Building Regulations and Standards Con,truction Super%isor Speriulo License: CSSL-102778 - l 3 CONOR D MCINEAnY' r#Y t 39 SIASCONSETARWE, 1 SAGAMORE BEACHMA,,02562 f S ii IN: ;4 Expiration Commissioner 06119/2018 • r"%/rn`l�i"r t�ii�tr.nurp/l/r r�"C'•.�lu;rrr�iiie//1 .—.-..,.:�.. .Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 94 ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �egistration: 171251 Type: Office of Consumer Affairs and Business Regulation zpiration: 3/1/2016 Partnership 10 Park Plaza-Suite 5170 . Boston,MA 02116 CON-SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE SANDWICH,MA 02563 Undersecretary Not valid without signature OWNER AUTHORIZATION FORM owner of property located at hereby authorize ConserNision Energy,to act on my behalf to obtain a building permit to perform work on my property. Owner Signature _ �'— Date �4yoF11co e TOWN OF BARNSTABLE Permit No. �7.0 . BUILDING DEPARTMENT Cash TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond ......x...... CERTIFICATE.OF USE AND OCCUPANCY Issued to Lebel Sollows Trust Address Lot #146, 116 Braley Jenkins Read Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. February 18, 19 $$ ........ ...... ............ Y Building Inspector a . , Assessor's office (1st floor) ` � _ � r ,.•rf-fin �f'1 F.f".�i ��e�.'. Q�' 4. Assessors map an of num er. ............ ............................... Board of Health Ord floor): ® Sewage Permit number ! saaasTsncs . MA06 • Engineering .Department Ord floor): l r-J-51 rlc °a oo 039, \e0� House number .. ,m��, p�pYa• �iS� �ta_ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only SEPTIC SYSTEM MIDST BE TOWN O F B A R N S T A fllFWED IN COMPLIANCE H TITLE 5 BUILDING I N S P E C T O I �� ®"M �',TAL�O®EANP APPLICATION FOR PERMIT TO ..... l. .................... TYPE OF CONSTRUCTION .......wl�Q..�.........l.:.K...!:'xl'�C ................................ ....... ..� :.::::................ L/ .........../2.. ..... ......... 19-w TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to t1he following information: Location .. ...r. ...... ....... :may �.��-1! .5...... ................ 11 .'4� �. ............ GProposed Use ..... ~ .`/./.........:......................................................................................................................... ZoningDistrict ..............! ...............................................Fire District ....... ...................................................... 4 ' •t3 2.. �[n s......heJJ.0 ... 1. ... I © l3 Z Name of Owner ...-. ... Address .. ..... ......................................... .... 4� Nameof Builder ...................................................�r-.X.............Address .................................................................................... Name of Architect ..... C�,.r'�C=N......Address ....�'?.�...................................... Number of Rooms ..........................................Foundation ....`otjCan-............................................. ........................ Exlerior ...� Alo.l �' f!.�... L r ........................Roofing ....4.... ���....................................................... Floors © Interior ......... ................... . .........n.......................................... Heating .........Plumbing ... ll ..n Fireplace Y.�.�..............................................................Approximat Cost ``'a� ©........ Definitive Plan Approved by Planning Board ___ ' L ______19________. Area I..�J � ................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of th T n rns ble re` iktheabove construction. L Name ... .. ... ... .......... .... . .. ....... ......... Construction Supervisor's License . .:....... .... ... ..4...... K ' 'EBEL SOLLOWS TRUST old12.7 0 11 StorN7 ... ..... Permit for .......................4............ Single***F I ami.1y...Dwelling........ Location ...dot. U46, 116 Braley jenkins Rd. ............................................. . ...................Centerville................................ Owner .....Lebel Sollows Ttti§t ....................................................... Type of Construction ..Frame ........................................ Plot ............................. Lot ................................. Permit Granted ....... ...........19 87 Date of Inspection .....19 Date #Co7mle:;e�d�.,.... 19 . ..... ...... L Assessor's office (1st floor): J�, THE Assessor's map"and lot number ...................................J .. To ......... Board of Health (3rd floor): c of k Sewage Permit number t BARISTADLE . AM Engineering Department (3rd floor): �' FS S. 9°0 t6 9• Housenumber ........................................................................ aMIR ' APPLICATIONS PROCESSED 8:30-9:30 A.M..and 1:00-2:00 P.M. only TOWN OF BARNSTABLE j BUILDING INSPECTOR APPLICATION IOR PERMIT TO ..... C.:d..!..' ...... ........'..t" :.: '.`......Y' 2w5� .................... TYPE OF CONSTRUCTION .........Fe O ........... '�................... 1 ........... 2., .,..........................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .:.i4- ...... 0r-:7, ................................ �✓�:'.t/�GLC ,-'Proposed Use ...... (,.o(....1.-1.f 44 u-� ........................ Zoning District ►"` :Fire District �. Name of Owner .� �: a���.. J` �� Address ..I. � ...<az .I ...................................... c Name of Builder .................................................... ..............Address .......................................................! ............................. Name of Architect ..... 3 "7/U.....Address ...... .... ........................... Number of Rooms S........................................................Foundation ......... ? ................... Exterior ....i. (�ll�s... ... .�lJ�(.�,I Roofing ...................... ,..(................................................... Interior . "" ''�!''J � -- P�Heating A-5� ...................................Plumbing ........ Fireplace et.��......................................... ..................Approximate Cost ....... ......J..................................................... _.. G - Definitive Plan Approved by Planning Board ____' _ ------19-------. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town 0061680nst6ble regarding the above construction. Name ...... ....•................... :...:'..::'.''. ...... Construction, Supervisor's License ....n.........�......"!...... LEBEL SOLLOWS TRUST A=171-230 Ndl' .31270.. Permit for ..1 z...Story............ Single Family Dwelling............. f Location .... ...,,,116 Braley„Jenkins Road Centerville ............................................................................... Owner .. L eke l......Sollows. . ....Trust. . ............. . .......... .. . .... .. .... Type of Construction Frame ............................. ................................................................................ Plot ............................ Lot ................................ Permit Granted October 7, 87 .......................................19 Date of Inspection ....................................19 Date Completed ......................................19 z THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M A� DATA i f�=i 11- 30 ?Tt DATE 0Ctti)1)C`r I 19 87 PERMIT r _ APPLICANT LD'k>( 1 :iC)11ows D(:-v. ADDRESS 131 oid ktu 132 . i IN0.) 2 (STREET) (CONTR'S LICENSE) PERMIT TO Build JWylliiic,� ( i' ) STORY J1.Ii(y1� �'`ciiilll llY7i3 NUMBER OF .1.11ra(�TDWELLING UNITS_. (TYPE OF IMPROVEMENT) NO. - (PROPOSED USE) ZONING AT (LOCATION) _ 1,%L146, 116 �.i.ci�.t�`y' vt,tl�tlf'ta ��:.ic:1L�, l:El:i.c:'.rVll.�.._ _, _DISTRICT— INR . �' 0.) (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 CONSTRUCNON TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) ..._ Siv yc: 4816 4 9 REMARKS: VOLUME AREA OR IU 6 b,q. `t O }� lJJli . t;(J PERMIT ESTIMATED COST FEE (CUBIC/SQUARE FEET) Ll OWNER ;a(�1Ul.S.+JW::i 1ji oid ,Zt , �11°e`ti:t;!;.3 BUILD,.,AG DE PT. ADDRESS BY _ THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY FART THEREOF, EITHER T.E'Me�ORARILY OR.�A PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY NOT SPECIFICALLY PERMITTED UN?OER THE BUILDING CODE, MUST BE A'P PROVED BY THE JURISDICTION. STREET OR -ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED'.. FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. _ MINIMUM OF THREE CALL APPROVED.PLA.NS 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 SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI 70 LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. - - POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS fo �V/V I Q � , 2 2 --- 2 3 + HEATING INS TION APPR VALS ENGINEERING DEPARTMENT I )K S uo(jJ i1 1-d W A I J6,e OTHER 2 .. BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT lY!LL BECOME NULL AND VOID IF CONSTRUCTION. INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION' PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. • :) ;i'is �"'f----�— `�:----- CO,NT I NUAT I Oil OF ROAD DOIND --- BUILDING PER1.IIT he undersigned owner/contractor hereby agree to maintain their road and in force until the following work items are completed to the atisfaction of the Engineering Section of the Department of Public orks. loam and seedshoulders as soon as weather permits. other (explain) ION : 61( 41 L IGN D ne C ntrac or NGIN N AU ORIZATION ol 1 1. 'Q -401.� Ll . lv CERTIFIED PLOT PLAN L O C AT 10 N FOR SCALE.Z"=3a" DATE: T- /9fi> REFERENCE: ,O cE /,4,/G GOT /< . -7 •off c�r E: I CERTIFY TO THE BEW MY KNOWLEDGE AND BELIEF FROM INFORMATION A T1IRED HATT� Efoy�o�gT/ate SHOWN ON THIS PLAN IS LOCATED N ATE GROUND AS SHOWN -IEREON. of Mgm P, /ATE P �SSIONAL LAN SURVEYOR o M. v MONAHAN,JR. J. M. MONA N, JR. & ASSOCIATES N0• ' 0 PROFESSIONAL LAND SURVEYORS 8 ENGINEERS !q'�ECtSTE���p� TOWNE PLAZA - 900 ROUTE 134 SOUTH DENN.IS, MA. 02660 ® S��v� J.N N. 87-/08 . vj s 2 [ w�31�,�yr' oEt►�rq�, 'Town of Barnstable *Permit 0 � 1 ti Expires 6 neonths from issue date E BARNSTABLXE . Fee Regulatory Services 2�0� Thomas F. Geiler, Director = c r4 A f0 MAC y1 Building Division TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 Fax: 508-790-6230, r EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ( Not Valid without Red X-Press Imprint Map/parcel Number i' C / Property Address , Giro;��— [Z/6esidential Value of Work O Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address AIM A p Contractor's Namez jZ A(I Telephone Number t! 0Y Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's "ompensation Insurance Ch k one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's CompenFion In�urance Insurance Company Name Workman's Comp. Policy 9 C) ` tD Copy of Insurance Compliance Certificate must be on file. Permit Request eck box) Re-roof(stripping old shingles) All construction debris will be taken to l (,�/�1 YJ( J�O (gy�pp ❑ Re-roof(not stripping. Going over existing layers of roof) ❑. Re-side ❑ Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: rroperty Owner m�o'gn Property Owner Letter of Permission. m �+ ntractors License&Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\Express\EXPRESSPERMIT.DOC Revise06O4O9 04/14/2009 12:29 506-790-0249 GOLDMAN & ASSOC. PAGE 02/02 ACORD CERTIFICATE OF LIABILITY INSURANCE CS R DATEIMWOOTYYYY) SUCH5o 04 14 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GOL DM2'iN a ASSOCIATES INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FINANCIAL SEAV10ES INC. HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 933 VALMOUTH RD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, HYANNIS Mh 02601 Phone: $08-7'75-6010 Fax:508-790-0249 INSURERS AFFORDING COVERAGE NAIC 0 INSURED �+ INSURER A; AIM MUTUAL INSURANCE CO. HECTOR SAP7CHEZ INSURER B: SOX ML CONSTRUCTION INSURER C; . INSURER D; CE14TERVYLLLE MA 02632 INSURER E: COVERAGES 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 18 SUBJECT TO ALL THE TERMS,EXOLU81ONS AND CONDITION8 OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTRINSRE TYPE OF INSURANCE POLICY NUMBER DATE MMroD DATE MM D/YY uMlrs 4�... GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES jEA o=Mco $ CLAIMS MADE n OCCUR _ - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO S POLICY=JEO PRQf LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Es accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ t PROPERTY DAMAGE $ (Pnr pcbldont) GARAGE UABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ • OTHER THAN AUTO ONLY: AGG $ EXCESM14BRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE T AGGREGATE' $ DEDUCTIBLE �� $ RETENTION $ g WORKERS COMPENSATION AND TORY UMTT- ER ANY PROPRIEI'ORlPARTNERIEXECUTIVE EMPLOYERS'LABILITY A 0329000900 04/04/09 0 /04/1 E.L.EACH ACCIDENT $100000 OFFICBRNEMBER EXCLUDED? El,DISEASE•EA EMPLOYE $160000 ityy��aa d�+�crfbnundnr 8PECIALPROVISIONSbslaw E.L.DISEABE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES F PXCLUSIONS ADDED BY ENDORSEMENT/SPECWL PROMS NS CERTIFICATE HOLDER CANCELLATION ii OREV ID SHOULD ANY OF THE ABOVE DESCRIBED POLI01£S BE CANCELLED BEFORE THE EXPIRATION OATIE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN FOR EVID9M IARY PURPOSES.ONLT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 80 SMALL IMPOSE NO OBLIGATION OR LABILTTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, ) ► JAUTHDRIZE NT A� LO ACORD 25(2001108) Q ACORD CORPORATION 198E r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Tnsurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Le bl Naive(Business/Qrganization/Individual):- If) r Address: t C) City/State/Zip: t Phone.#: Are y an employer? Check the appropriate box: Type of project(required): 1. 4• ❑ 1 am a general contractor and I I am a employer with 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors •.2:❑ Tama sole proprietor or parttler-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'-comp.-insurance comp. insurance.$ required.] - 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.)t c. 152, §1(4), and we have no employees.[No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 mptoyccs,they must providt their workers'comrp.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.#: ODD Expiration Date: Job Site Address: - r,� City/State/zip: L\t Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fins;iip 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 eri.fication. I do hereby certify under s-andpe ies ofperjury that the information provided above is true and orrect. Si e: Date. •��� � — Phone# Official use only. Do not write in this area,to be completed by city or lawn offUaL 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#: Informat on 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 7. of the foregoing engag in alomEen rpm inclu3mg the leg represen�atiYe3r6f- tlec�ase�i-empiuye -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()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 Rzth the insuraauce 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-contiactor(s)name(s),address(es)andphone 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 permitllicense number which will:be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or 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 fo any business or commercial venturem (Le.a dog license or permit to bu 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 Massaohusetts }department of Industrial Aocidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext-406 Gr 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass_gov/dia r4 zHE Town of Barnstable Regulatory Services y $ Thomas F. Geiler,Director A.- Building Division' Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town_barnstable.,ma.us Office: 508-862-403 9 Fax: 509-790-623C Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. .(Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable Regulatory Services r r A�Rt,rcrAAT� Thomas F. Geiler,Director � iti Building Division �rFO Tom Perry,Building Commissioner . .2001 ai -Street Hyannis MA-026-01 www.town.barristable-ma.us Office: 509-862-4038 Fax: 508-790-6230 HOAEEOWNER LICENSE EXEMPTION Please Print DATE JOB LOCATION: number strcct village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: eityhowo state zip code The current exen=ption for"homeowners"was extended to include owner-occupied dwellinm 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 suvervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,riles and regulations. The undersigned."homeowner'certifies that.he/she understwds the Tpwn of Biirpstable,$vildizig Departnienf minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatixrc of Homcowmcr Approval of Budding Official Note:.Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constrnction Control. HOMEOWNER'S EXEMPTION The Code statcs that: "Any borneowner performing work for which a building permit is rcqubrd shall be rxemptfrom the provisions of this section(Section 1 o9.1.1 -Licensing of const mr-tion Supervisors);provided that if the homeowner engages a pasan(s)for hire to do such work,that such Homcowna shall ad as supervisor." Many homeowners who use this exemption are unavra=that they are assuming the responsibilities of a supavism(see Appendix Q, Rides&Kcgulations'for Licensing Construction Supervisors,Section 2.I5) This lack of awareness often resides in serious problems,particularly when the homcoven er hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed parson as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsnble. To ensure that the homeowner is fuIly rware ofhis/herrespmm-bilitits,many communities require,as part of the permit application, that the homeowner c tify that 1reJshe understands the responsrbilitirs of a Supervisor. On the last page of this issue is a form currently used by several towns. You may cars t amend and adopt such a fmrn/catification.for use in your community. Q:fwTm:homccxcmpt rt# '�'" � as � .�i-� a� _ •II. � � ., gg y , €.. ex- ���" .a,k sue: ,:: '�' _ - f 6 -,¢ ry r '♦ i�+ id-<r>$W..*s �. � '�` "` *2-` ti'.�t' '..-��. 1 A ,,'.. �- K,�s .,�s tJa+•-� �•'- r ¢'" 6. T-,,, F.� ay a ,+ �y yy- 3 ..�' � tC,..a. .J` 1.r� L °IG""+¢�, � �_l '� '�'��.�; +-� '."'Y ,may 4a�Y..s- ' � cy *�,',M�� �-� �/"S.a�-*�"v y.•':' . . Z. x�",� z � ls"sr�'S"`a' � Sta dar -^a "rw•� ds anv and n ; tions � ' Board of Building ENT TRACTOR R 11 _ r `;. ' OVEM CON t •�� HOME INIPR t -. .x�, �a^ is Reg _ Trtt 283768 t ,A istratiori 145356 1 ExpaEion 1i 121201 :. ter iT pe DBP�' ;. MMANUEL CONSTRUCTION zJ " E 1. CHEZ {aJ i HECT SAN OR r e ss i L86 STRA�NBERRY HILL R Administrator C_NTERVILLE,MA'02632 ^,� t • , . . ut Pulilic S►fct} Dc1)ttt►nent and St�nd.irt►s . ,:•. a��.;ihnsctt�- Rc��ulatinn Licen$e ervisor e�i alty 9 Bo:ud of Btsildin� Construction Sup License-. CS SL. 99382 Restricted to: RF,WS HECTOR SANCHEZ ROAD WBERRY HILL 286 STRA MA 02632 CENTERVILLE, _ Expiration: 3114/2011 i car 4'� Tr#; 99382 �. ('ununi..iuncr 94y .47 - ��'"'�'s"�+�ewd - €e ! : + ,\ `v`aJ`vs�p. a{°<`Oaa<et4 as as WIN vxo � stta<`°°date•�o"Ns a�a • " ,; �,eense tie egQ a`��jiee¢�1 Owl$pa<a „ One tea. i' Nlatis zhusetts- Dcltai•tmcnt of Puhiic Safct} Board of Buildimt, Re-ulations and Sr.►nd:u ds ecialty License Construction Supervisor y.: License: CS SL 99382 Restricted to:`RF,WS w HECTOR SANCHEZ s . - -286 STRAWBERRY HILL ROAD CENTERVILLE, MA 02632 Expiration: 9/14/2011 Tr#: 99382 ('unuiu.ci„ncr r s # a P.O. Box 311 ' � 508-367-1679 Centerville, MA 02632 CONS [7CT'I®N� Fax: 508-790-1856 PROPOSAL SUBMITTED TO: PHONE: {� DATE: G STREET: _ �{ / /,� JOB NAME: JOB#: (a 2 �! l� lC�f1� l�6e CITY,S TE and ZIPII CODE: JOB LOCATION , ARG FTECT{{ 7• DATE OF PLANS: ! JOB PHONE: At a Lu rq 4<- 1-t/OD ?G lc V,4��v, ? We hereby submit specifi atio $and estimates for: q60 - VC Vrop05C hereby to furnish material and labor-complete in accordance with the above specifications, for the sum of: . � f�"r dollars($ (� 0- oo Payment to be made as follows: j All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above specifi- Signature cations involving extra costs will be executed only upon written orders,and will become g an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn b us if not acCe ted within insurance. Our workers are fully covered by Workman's Compensation Insurance. y P days. �CCQpt�TTCe Of �r0�1DgAr-The above prices, specifications =--_�-� " --_r_��� and conditions are satisfactory and are hereby accepted.'You are authorized Signature: -' ....__.._....:- _: to do the work as specified. Pa nt will be made as outlined above. �. Date of Acceptance: Signature: . .t Lj Engin6ering Dept. Ord floor) Map 7 Parcel '. Permit# -2 House# Date Issued l 3 �6ard of Health'(3rd floor)(8:15 -9:30/,1:00-4:30) 0 0 d�onservation Office(4th floor)(8:30-9:30/1:00-2:00) -A QV 25j, %f f�Q ! (/ aFl nnin-g'Hept. (1st floor/School Admin. Bldg.) n+E < SEPTIC SYSTE aBe€In Ian Approved by Planning Board 19-11 STALLED IN N E WITH TI T TOWN OF-BARNSTABLE)NMENTA;L ND Building Permit Application °l OINYg y REGUL11MCIMS / . Project Street Ad ress /r�� _✓�� le-r Alt Village -,P/j/l -� Owner .Z Address ki, Telephone - 'Permit Request e/ - 1d1 /1-1 S'd a -V First Floor �/t/C'u/ )quare feet Second Floor, square feet Construction Type Estimated Project Cost $ %, 1 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Car Two Family ❑ Multi-Family(#units) Age of Existing Structure '0 V&i Historic House ❑Yes 31qo- On Old King's Highway ❑Yes Basement Type: p Full E<rawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ZO r P I r Basement Unfinished Area(sq.ft) Irv/0 Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New _�First Floor Room Count —Y Heat Type and Fuel: b Gas ❑Oil ❑Electric `❑`Other Central Air ❑Yes 5 -Pd` Fireplaces: Existing New _� Existing wood/coal stove ❑Yes fro Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) MAttached(size) Z� ❑Barn(size) ❑None &Shed(size) X ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �To If yes, site plan review# Current Use Proposed Use Builder Information Name w ti 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 BUILDING P MI IED FOR THE FOLLOWING REASON(S) LOA �.3 FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED MAP/PARCEL NO. Is - j ADDRESS VILLAGE OWNER ti + DATE OF.INSPECTION:: !. a FOUNDATION � FRAMEZA ' ti. � • ,. - , r {_. - -`� _ 1 ► a ,FF 1171 1 INSULATION ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH '- FINAL I ri c GAS:- FINAL ; FINAL BUILDING •Y7 0 r_ , "" t DATE CLOSED OUT. ASSOCIATION PLAN 1V0. , iL The Commonwealth of Massachusetts ~` =•� :— %VWWDepartment of Industrial Ai ents . =. VNCV of/m�esd atieos 600 Washington Street • _ - s Boston,Mass. 02111 _ _ Workers' Com ensation Insurance davit i e---- 9, . name: \ lz,6 a/Z . -/ / y� / /'c location //(D //ri,/e, r°i1'I!L/bl:S' ��' , . 11Zci 2.,eyi4e,-�,/le b�G '3� hone# 7 �9 7.5—' I am a homeowner performing all"work myself. . ////////////////////////////////////// . ❑ I am a sole rietor and have no one workiz in ca achy ❑ I am an employer providing workers' compensation for my employees.working,on this job. :::: : :::.:::.::.::::::::::::::::::: :::.:::..:.. ...:..:.::.:::::•:.:::::..::.::::.::::: ... a 'mare':.::: :.. .. :;.:::::.:.-...... .. .. >:;::{;;:::i::;::{:i::>::i:;:::?i't' ::::......::Ci::::::i:;:;::;:;y;i:; soma nv _ ............ :::::::::.: a eldress:::: :.:.;,.;;;:::. ;: ..:::.::.::..::..::::..:..::.:..:::::.::........... . .:..::. . .:: ................................... cttv:::. .... phone#:.:::;' <:'':>::>: .. :..:...... insurance co>:..:..: . .:...............:.... .:.. ..:»;..::.: ali _..... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hire the contractors:listed below who have . . .. . the following workers'compensation polices: . :'..:.:::::::.::.::::>: comvanv:name .. :;;. :::...:............................ ... ...:::.:::. <<::: > .... ���l:`:::;.j:::,::':;is;:is:i::::::�i:i:i::4{:!;:;:;:; :;i:;i:::t?:::;:;:i.....v::::: ::::::::::::::::::i::::`'C?:::::: :::' ::::;'f-.::..::.:::::::!: i::'{<;i::::::i::�::;:;:!;::'r:;':!::in::"'`ii.�i'}:'::.....::.....:;:y:. �i:;:is:;isj?{:}::C$:'>:'�:'iS}::::::::{.::':::: ::;';i::::'i::::':: % ad 53.;...... ..: .....:. :::... : i::i:>:�}:::.. .J�:v...... ::::.:.::::::::::::::::::::::::::::::::::.:::.:::::...:::.�:::..:...........::..........I............:::::::::i:::::::::::::::::::.�::•:::::::::::::.i'::::::::::::::::::.�v.�::::::::::.�::::::::•::::::::::::::::::::::::::::::::: ...................:::............:.:::..........y....:.................:...:.:..................- ... •:iiii:}iii:::-i::{•.�::}i•i•:ii}/•::•:i•.i:•iiY•ii}i:ii.::.ii}iii}iiii%::<i:::�'r:ii:i}iiiiiiiiv::::u:i'?+4ii}iii:-iiYiii:::is iii'r'<::i:4.i'::::::.:::L'••:'•::••:':::::n::::..••••:•...•••••:.•:iii:is�.i-i'.:.:..{-i........iiiii:v:::: ....i•n nµv.. .:.�v.•::: :::::::i:'.:vv:::'::::: e: ; :�:+<:;!:!;:;+!:: Y:y:':�>:{::?>:::�'{......J:::Y::::j;r:�i:G}:':;i:ji'i::•::: }.::::. ::?::j:i::i::::%:v:::::::::{:::v::::::::::+ii::i::::.,::::i:;::i:ivv{:::i::}::±:<:::<:i:'::::.ii:i.:.ii:•i':.::.i:::.ii:iiii}ii:::i::-.i::•: ::::::::::.:::::.v::::.�:::::::::::::ni:-,.. ::...:v::::::i:::.::.}::-:::::...:.::::::-:.�::::::.:.�.:•:.�:::::.�.}-:.�::: :;:j}::j!::::j:(.• ::i4}:::h:ii;{iv::Lii?::•iiY}iiii}i::ii:iiii}:iii:^;;{Ci}iYi:::•h.....•::-:::{-i}i::{v{::!{4::{-:^}::.�.:::::..:::... 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F— to secure coverage m regdred mtder section I of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties of perjury that the information provided above is tnw and correctQ � Sigoati— r D �,'`y / � — II Print name Jv%l/4/A-, ��JL� Phone# //—/ � oineial use only do not write to this area to be completed by city or town official • city or town: CIBuilding Department perndt/llcense# ❑Ig�� ❑chechif immediate response is required ❑selectmen's Ofi1a ❑Health Department _ contact person: phone#; ❑Other *rAted 9,95 PJIa The Town of Barnstable Department of Health Safety and EnvtroniaenW Services : BuDding Division 367 Main SftM HY=mis MA=0I Crosses Office 308-7907 Building dxMiuio-: F= SOS790-mc For aIItce use only Permit no. Date AFFIDAVIT SOME WROVEMENT•CONTRAGTOR LAW suPPLEMENI'TO PERMIT APPLICATION MGI. c. I42A req wires that the "reconstruction' allcrasiom renovation. repair, modernization. conversion. improvement, removal+ demolition, or coastracdon of an addition to any pre-esisting containing at least one but not more than tbur dwelling units or to Omer occupied building ntractors. withstruaarrs which are ad,ncent to such residence or building be done by registered co certain c=cptiom slang with other requirements. Type of warn: ESL Cart Address of Worst: Owner's Name Date of Permit App IIcation: I hereby certify that: . Registration is not required for the following rensonisj: Work ezcluded by law Job under SI.000. �Buildlag not owner-occupied Owner palling own permit Notice is hereby gig that: O�VN PERMIT OR DEALING WITIi ONREG� OWNERS pULLING THEM _ CON'ITtACrORs FOR APPLIGBR GZAh OR GZTARANTY Ft1NDOVEMENT WUNDER MGZ I4ZA ACCESS TO THE, ITRAZ'IO SIGNED UNDER pENALMES OF PERMY I hereby gplY for a.permit as the agent of the owner: Dam Contractor Name Reganztbm NO- OR . �/ Owners Name 7MCURAgp ufti ' ' Ta6bJS21b( - ptesaiptire FaelraW for Oaa and Two-Fatuity ResideatW Baiidlap Acted with Food FaeL MAXIMUM MINIMUM at ceiling Wail Boor Basement Slab E �) Uwaluez R-valUe' R vacua, Rrvalu2 wan P �P= �t� ivat 1' 4o Rrva &valua� $701 to 000 IleadaR Deem Days' Q 12% 0.40 3E' 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal 3 12% 0.50 3E 13 19 10 6 u' E T 1S9i 0.36 38L 23 WA NBA Normal U 15% OA6 3 19 19 10 6 Normal V 136A OA4 3E 13 2S NBA NBA ES AM W 13% 032 30 19 19 10 6 2S AFUE X IVA 032 3E 13 2S NBA NBA Normal Y IVA 0.42 3E 19 2S NBA WA Normal Z IVA 0.42 3E 13 19 10 6 90AFUE AA Ir/. 0.30 30 19 19 !0 6 90AFUE 1. ADDRESS OF PROPERTY: `P�I/�K��S<,I ✓C ` 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: D 3. SQUARE FOOTAGE OF ALL GLAZING: et 4. %GLAZING AREA(#3 DIVIDED BY!#2): r �i iT 5. SELECT PACKAGE(Q—AA-see chart above):, V , `� e/6 NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR AP VAL: .YES: NO: q-forms-f980303a F I LE # MIP 4614 CENSUS TRACT 128 CLIENT-'-punning, Forman Kirrane, & Terry DEED BOOK 8505 PAGE 155 OWNER:Judith A. Notz PLAN BOOK PAGE LOT APPLICANT: same ASSESSORS PLAN PLOT MORTGAGE INSPECTION PLAN of LAND LOCATED AT 116 BRALEY JENKINS ROAD CENTERVILLE, MASSACHUSETTS . SCALE : 1 = 40' SEPTEMBER 27, 1996 1 C>0-00' oT ►NL 15, 00o 5-r do PATI D ARCA oT" J47 l r� k" X3�-r- DRivC, U D•ocy, P�oc� KI N6 I CERTIFY TO DUNNING, FORMAN, K I RRANE, & TERRY, CITIZENS MORTGAGE CORP. , AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE. NO VISIBLE ENCROACHMENTS OR- EASE- MENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION, THE LOCATION OF DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPLICABLE ,.► ZONING BY-LAWS WITH RESPECT TO HORIZONTAL ;.- ..kOL_4.; DIMENSIONAL REQUIREMENTS THE DWELLING SHOWN HERE DOES .NOT FALL WITH— FEWHI A vi IN 'A- SPECIAL FLOOD HAZARD ZONE . AS No.207,0 DELINEATED ON A MAP OF COMMUNITY #250001- 15C DATED 8/19/85 BY THE F, I A , t L,;,•; ,. y J �,. Kenneth R. Ferreira :N Engineering, Inc. CY ---- ' �4Y P.O. Box 1903 New Beclford,.MA 027,11-1903 508 992-0020 A Fax:508 992-3374 GENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, information, and belief as the result of a mortgage plot plan tape survey inspection made to the normal standard. of care of registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date. (3) This plan was not made for recording purposes, for use in preparing deed descriptions or for con— structions. (4) Verifications of property line dimensions, building offsets, fences, or lot configuration may be accomplished only by an accurate instrument survey. TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . DATE JOB. LOCATION . Number Stre t address Section of town "HOMEOWNER" �/• � -,�. �-���.�_ 7�.�=/� 3�0 ame Home phone Work phone - - PRESENT MAILING ADDRESS S Y- =''• City town State Zip code The current exemption for "homeowners" was extended to include owner-occuDiec 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 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 Offic_ on a form acceptable to the Building Official, that he/she shall be resnonsi� for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes . responsibility for compliance with the St. 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 minimm inspection procedures and requirements and that he/she will comp]v wit . id proc:edurb.-a and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC AL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State. Building Code Section 127.0, Construction Control. HONE 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 Own. shall act as supervisor. " Many Home Owners who use this exemption are unaware .U* iat they are ass ming the responsibilities V4 a supervisor (see appendix Q, Rnles and Regulations for .licensing Construction Supervisors, Section 2.15) . . This lack of awarenE often results in serious problems, particularly when the Horne Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Rome"Owner act: as supervisor is -ultimately responsible. .. To ensure that the Home Owner is fully aware of his/fier responsibilities, ma communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of. a .supervisor. On th 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. �1�t'ClZ St �E ilk 1 i C I• I � WALL_. . rC cL LPN v Au) A nI w�Lj!r FAP7, 6 J •� ., . . �[�I Ll�ll��r Th a oven of Barnstable IRAmING SECTION - - - - - _ ALL DIMEN51ON LUMBER SHALL i BE KID SPF NO.2 OR BETE-R. x COLLAR TIE @ 48"" O.C. i 2 x/b RAFTER @/o" O.C. 1 6x AEILING JOIST @ SHINGLE W/IS LB. FELT 1 I I Ix PINE FACIA R-30 KRAFT FACED FG Mrs 4 R- UNFACED FG BATTS —f SOFFIT VENT W/(o•MIL POLY VAPOR BARRIER — (1 sT E 2No FLOOR) PINE SOFFIT i L o- Ally- 1 - I i , 1 1 1 2x FLOOR JOIST @ O.C. (isr 2m FLOOR) - i I 1 1 I SILL I SILL SEAL '�J '� I�INCFIOR BOLT @ 6,-0" O.G. "CONCRETE °' FOUNDATION WALL i► \ ' - I\ \ �� '51olu iLF- S OVER �.�/� FEL I ogPER . PAL y i -I G FOISTS -1 �/)RAC-�`1�► '-- '1 ,Exi5-r/A/G C1.6 , .TOtST 14ia'50 rti po u, .��fFL �'oiST' /fi9NC—�E.QS NEAf-;>C-RS T YP ,CXI ST1N G lj)/)LL 7o BE RFmuuED- F 7l vtcl oo / l-qoo _FL00Lit, — 7— Sic.L CA. IMF .�6iii���S 'sue I I I 1 I C etlF S i ,F S i O / SM.6- t' _ � � S%�c I- ��� ' a r - I ICA M." ty,, _ y . I . I I III -J`K• If "emu.ov. �' '�f,,:� •J' " hy 1 , •i.. j�.;;t "�. s',Crit^i;li•�nt� 1��i:.r.,• • %Y.r t s ;•.} ICI:. ��`j'1S •'('•J�'4r •.Yf _ i�,,�r ,, 1 j (+111i � r r''� / I j., . ;. 7� is �� 1� SFr .ai 3• •It'+'y. ?:•, rp�"'Td/) r �, +, �`-,• •7 r"-'�?�'y ''i�w'IS'� ;�.. •'Ij `� t,t��y _ � .' '�'I►yY '�,��G.= ••. V �"/ y'ck ., i �y�♦�'♦,�t���ly;/'i r* ' - '� 1n�/twT N'I i }� ��o! - 11� �^`•.�+.�_ ��f '/ -✓ +c J �S � :,''•���F+iNt'',�%•y`�•: it I •=—�L �-��F!��'C ti��';� -�'�'1!'r"�3�,'�.',,, - - --- _ -- + '� � '�yy°.iM °,��Ji.`+� �(,.•'+ ! 4 msN�r,','•^ �!///�� )Y�^a i:%G 'a) �.•., 1� it ,� - '' � � �i• �1 r ,_�;:. Ts�,,:� JIM 1 •4� i in m 1 III n �.{•�.•�.... -- .2� rr. — I• 1 1 1 1 . � 1 1 Io, r i ■ran�,,� 1• sUU � I:J` o � � �i � 3m m �o �� jl SOI L LOG P 48 - � Q A DATE / J / o � q ,�' nrt Con/ 1, o Z.✓ 3 . . J x O WITNESSED BY : I-'ETcIt. S ��L/ �/ "-� ✓ - [3AXT�=,2 f'/Vy� CLL ALE X K /R OA�D EAN ,+?bP',L) �40 �v A Y' 13gs/wS � VEK1 it l � 1 � Q ` N ©� wATt'ic - . C <D '..j n/TEJe 1 ,Z, r .. 7. N S ��� ;1• � � �7. O ► �E_LEV�TOP OF MANHOLES AND COVER TO BE BUILT WITHIN / 7 � o FOUNDATION _- -�' i2 OF FIN ! SHED GRADE . --- o r . 0 qnN 1 S H E 0 6 R AD E -- AA I N. 2 Z SLOPE /7 ' L� �'r- �' N1 o % / ` 6- ` - v 4�`CAST I RO - �� a Gz Lim✓� p OR 4" PVC SC 40 IST ' PVC 5CH 40 ` PITCH I�4~ FT � 2' LEVEL, RAIN. 2" LAYER 1\ S 1 / T 1/8" _ 112�� pEASTONE P ITCH io„ , ,, p .. '!� c, I I SE1riC Dox I NV RT -�J INVERT DI5T A E GALLON INVERT' ,-. LoT / 4-7 TANK INVERT. ,�2 � % BDx ap N �' 3 4 - 1 1 2" DIA 5EPTICTANK -- . D DSO �Lcr�� /�, e'.": •.• INVERT S / = ,_. � � uD WASHED STONE PiT' .`•" /,✓rJ tNVERT .e to aOO..' ALL AROUND . ems--_ -----ice---f"' fi-_ �,•� i 8 , ...�: ; 0` _ � � • GARBAGE ELEv BOTTOAA Oa �70 t/ ~ MIN . -- G R I N D E R --- - - -.--- _- -._ Q-- - -- --� - 8 U fc'ta'S FR YE 6'-0"D I A--4 O F P T = 4 LEs?Gif. 4 OT 1� •:.:;' 2 0� A.� I N `L 1 7FT _ - _ PROFILE OF GROUND WATER TABLE ELOv✓ � � ©• �� - SANITARY DISPOSAL SYSTEM NOT TO SCALE DESIGN DATA 1 / 032d=-- 15 7— • CONSTR UCTI0N OF SAN ITAR Y DI POSAL BEDROOMS SYSTEM SHALL CONFORM TO MASS . DESIGN F LOW __ v�GAL ./DAY ENVIRONMENTAL CODE TITLE V (REVISED 7- I - 77) LEACH RATE � _ MIN./INCH AND THE TOWN OF— !;\> 1*,V -S � �- PROPOSED LEACH CAPACITY HEALTH REGULATIONS . • SEPTIC TANK, DISTRIBUTION BOX AND LEACHING PITTO BE OF REINFORCED CONCRETE : 443 GAL/IDAY MIN CONCRETE STRENGTH 3000 PSI MIN STEEL STRENGTH 2000OPSI H 10 DESIGN LOADING • DRIVEWAYS NOTTO BE LOCATED OVER SYSTEM UNLESS H - 20 DESIGN LOADING IS USED. • ALL PIPES AND FITTINGSTO BE WATERTIGHT AND TO BE OF CAST IRON OR SCHED 40 PV. C. SITE PLAN SHOWING PROPOSED CONSTRUCTION SH. _ 0F SHs LEGEND L 0 C A T I O N s ;---� 1 / „;7' -:T . _ &-� ^-; -4 s FOR : GE �f - � '=a 'r ,,• mot_ _ t� � APPROVED ----- 19 SCALE : , '3 DATE : % BOARD OF HEALTH BUILDING SETBACK REGULATIONS PER EXISTING CONTOUR - --16- -- R E F E R E N C E : Z- 7- 3 BUILDING INSPECTOR OR BUILDING COMMISSIONER . PROPOSED CONTOUR DATE AGENT [,,/ IN FRONT SETBACK - EXISTING 5 POT ELEVATI0N IT6 MIN . SIDE SETBACK PROPOSED WATER SERVICE WcRl ('H�9 Jf n '` `-1 " TEST HOLE LOCATION clvl` MIN . REAR SETBACK ' No. 27483 C . R . SHORT, I N C . G,,STER�v PROFESSIONAL LAND SURVEYORS L ENGINEERS ss�flr�AL_EN% 1586 MAIN STREET (RTE. 6A) EAST DENNIS, MASS . 02641 '