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0126 BRALEY JENKINS ROAD
a - t I o o c e i n 1 v as TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I-7 Parcel I5 1 Application # > - Health Division Date Issued _Shah 6 Conservation Division R � Application Fee _�� lily. Planning Dept. Y (�Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis M Aa�L_ Proje tustreetAddress 1U Brr e4Z ler [(c ns _ Ville �y�L� e \ner Ri'&w.rA n, 4 Mic�Jv-, A W h` KatL4 Address _!�_a V*e y o t -�jy`f-ZS Sq Telephone,_4�+�o I?e'rmit.Request Pam % ✓i �a e�,,c a� r®o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation„ 2 DO 00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No d Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: 0 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) Nameai v1�yl License # Home Improvement Contractor# Email aw 51 e _1 (90 4 eye.'d m Cnm Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH y FINAL FINAL BUILDIN DATE CLOSED OUT ASSOCIATION PLAN NO. Ord ?lie Commonwealth off Mass€chusett° Departirrent of1t'rr&Yftia1Accidents Offire oflmvstt'gatians { 600 Washington,S'freet y.. Bcwton,41A anii f n 1Pf1!X1:lltf7s£�fl9�[�I[! '- 1 .• . 'Wurkers' Cumpensaf ffnInsuranceAffidavitBmldei�Cuntract rs/EIe�ctri;cians/Pjurabers Applicant Infw-oration M Please Print I.e tI �Namu AddFes Cit�r1' tatefip t5 P110no 3, Are you an employer?Check the appr priate b - Type of project(required)c L O I am a employer uith 4.1 gI am a general cofactor and I employees(full and/or part-time).*' have lured.tha sub-contmctom 6. New construction 2�.❑ I am a sole proprietor orpartnee- listed on the attached sheet. 7. ❑Remodeling , s and have no em 1 :gees. These sub-contractors have �P P� $. 01?eualitioix worldag forme in any capaciilr� employees andhatre workers' [No-w-odams'comp_insurance comp.insuranml 9. ❑Building addition, re ed_ ❑ .Nile are a corporation and its ' ❑ epair%or additions 1� �. 1�0� Electricalr ofcers]rave exercised their 3:7❑ I am a hameoumer doing all work • 11_Q Plumbingrepairs or additions - " "�se1f o workers' rim of exemption per MGL' - - MEI Roafrepairs , msurance required-]i c.1,52,§1(4k and we have no - employees_[No workers' 13.0 Other . comp-msuran-re required-1 + *ANY RnBczaitdsstchecksbox9ltnns'also IMoutthesectioaberawshmaingtheirnroAaeco®pm&&dDapoliryiufoemsuva , T Homeowners who submit ffm af5d2ru indi-ling they are daiag&U wat smA Ikea hize outside contactors amst submit a new SMdavit indlcat m..sacb_ rG3utnctors than check iWs box must attadhed as sdditianal dip-at sharC o iag the none of the sub-ca�sraa tat and se whether.or not thosa enldtinhare + employem h the sutrtentractorshave employees,tfieynn stpravide thek workers'romp.policy ninnber. . I am an emploj-wr that is pravOng workers'congwisa ore innirmwe for ury enipinyees,,Selvav is the pa/icy rued jabs&e r irrfarmrriiort: • Insurance Company.Na=- , Policy i,&'or Self-inst.Lic. E�piratiouDate:" Job Site Addres „City/State/Zip: Attach a copy of the workers'campensatiQnpoIic decIaratian page(showing the policy number and eipiration date). Failure to secure cover a>,,.a as requuedunder Section 25A of MGL c�Lam'can lead to tfie imposition of crimirai penaltaes of a fine up to$1,500:00 andfar one-yeari q='sonzneuf;as well as cizal penalties is the fora of a STOP WORK ORDERand-a EM of up to$250.00 a day against the violator. Be adiised that a copy of this statement maybe forwarded to the Off;iCe of Investrgatiom of the DIA for insurance coverage verification Ida IierRby certi j I D=s oat parr pet ury!fJtattlte infbrmrrtioi�pratrTedabat i trTIE andctrrrect Simature: ' a,f jfcird irse anfy. Da Fiat avrke in this merr,to be camp&t6d by cite artopm affreiaL City or Tom a: PertaitJLicense# Issuing_Authority(c r-de erne). } 1.Board of Irealth 2.Building Deppirtment 3.City1rown aerk- 4 Electrical Fnspector rr:.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Ins ctions ' Mecca r_huse s General Laws chapter 152 req=s all empIoyers Y o provide worker'comp msaiion for Bien eroPIoyeds. pmmmTa„ this statute,an azzplvyee is deed as.`-.every person in the service of another under any contract of hire, =-press or implied,oral or wrap" er is defined as"an individual,partnership,associab on,corporation or other Iegal entity,or any two or more An �PL°J' - of the foregoing engaged is a joint enterprise,and including the legal=presentatives of a deceased employer,or the receiver or trastee of an individual,partnership,association or otherlegal entity,employing employees_ However the owner of a dvmMog house having not more than tbree apartments and who resides therein,or the occupant of ne- dweIIiD.g house of ano ther who o emons to do maintenance,consftuction or repair work on snch dweII house; hous employs P or on the grounds or bmldmg app thrmto shall not because of such employment be daemed to be an employer.„ Mate or local licensing agency shall the issuance or GL chapter 152,§25g6)also states that"every st renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any aPP licantwho has notprodnced acceptable evidence of compliance with themrn.lnsace coverage required.. c subdivisions shall political nor � AddiiionaIl ,MCA chapter 152,§�����"I�Teithes the comm�wealih auy of its P y enter into any contract for the performance ofpublio work tmiul acceptable evidence o f coin pliana with the insUrnc6. r(--(ements of iris chapter have Been presented.to the contracting a of ozziy-" Applican-ts Please fill onf the worker'compensation affidavit completely,by checking&c;boxes i`iiat apply to your situation and,if necessary,simply sob-conixactor(s)name(s), address(es)and phone nuimber(s)along with their cerfficatP(s)of ircr„-ance. Limited Liability Companies(LLC)or Limited Liabi-ity-Parinersbips(LLP)withno employees otherthanthe members or partaers,are not required to carry workers' compensation m s=an ce- li an LLC or LLP does have employees,a policy is required. Be advised that this affidayitmaybe submitti--d to the Deparbnent of Industrial Accidents for conErmatioa of insr¢-anc,coverage- Also be sure to sign and date the affidavit. The affidavit Should be retnmed to the.city or town that the application for the penait or license is b eing requested,not the D epartmeat of „ , ' 'Accidents. Should you have any questions regarding the Iaw or ifyou are req�ed to obtain a workers' ompensation policy,please c-Z the Department at the number]isted below. Self-ins2zred co�anies shonId enter their c self-i ice license number on the appropriate line. City or Town Officials t - Please be sore that the affidavit is complete and printedlegi-bly. The Department has provided a space at the bottom of the,affidavit for you to h[1 out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pen it celse number which wM be used as a reference number. In.addition,an applicant that must submit nzultiple penDWHcense applications in any given year,neej only submit one affidavit indicating current r Address" he licant should wIIte"aU locations n (may or policy information.(1f necessary)and under fob Site_ app town)."A copy of-the.affidavit that has been officiaUy 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 peM#!s-or licenses A new affidavit must be Eled out each year.Where a home owner or ci-i7.en is obtaining a license or pemitnot related,to an ybusiness or commercial v6nft e (ie_ a dog license or permit to b>m leaves etc.)said persou is NOT rC;C r to complete this affidavit The Of of Invesbgaiinns 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 Depar(zo enfS address,telephone and fax mmnber. Thu CG.MM :w=IffiE of Massachnsalts ' Department c&Iz dial Aacidets� Once 4f I-Ve.sastio-= 600-Waahoaa St:t#--t Bagtou,MA 0�111 Tt,-L 4 617' 7-4900 Qxt 4-06 or 1477-MASgAFE Fax 617-727 7749 Kevised¢24-07 maz.gagidia AFYC GL de to Waad Consti-acd6 .L7 FlV4 Wrzd Areas:IYO t zplr frmd.Zorze Massachuscffs CheckEk far Comoa`ace Ugo cMRs3v.2 I_i)' CAI chi . 1.1 SCOPE. . mph Wind Speed{3-se�gulf)__-__�__ -_-• --: - - - ,11D - Wind Exposure Cafagory_ - W-md Expasure Ca&gary--:...........-Engineering Required ForEtrfire Project:.. ........ ...:-_-- :.._...._C 12 APPLICABILITY ' .Number 6f Sfnries(a roof which.exceeds 3 in 12 slope steal be considered a story) '' stories 52 sbrie-s Roof Pcfch (Fig 2)'" ----___-- 512-12 Mean RaofHeight _ __-- _-_----(Flg2)- ff 5'33' Building Midth,W ---(Fig 3) s_-- -- _it !9 81Y Building Length,L (Fig 3)= - - ------- -- `80, . Building Aspect Rafio(UWh) (Fig 4) - ---- --. S 3:1 Nominal Height ofTaIlest Dpenin92 - - (Fig 4)-'°' -- _ "— r' 56'B 1-3 FRAMINC CONNECTIONS General com-pliance,with framing cdnner#ions -:_:(Table 2) 2-1 FOUNDATIDN Foundatlan Walls meeting requirements of 780 CMR'-594.1 Cone-- .....................•----- _ •--•--•- - - - -- - ---- - - . --- -- Goncmb_-Masonry------ ---------_�_-�__-_�-- ---= --- _ ---- 2-2 ANCHORAGE TO FDUNDATION'- 5/B'Anchor Botfs*imbedded or 51B'Proprietary Mechanical Anchors as an alfamafive in concrete only Batt Spacing- eneral -•___ -(Table 4) - g trt. Bolt Spactig fmm end(omt of plate ---- _ :_._(Fig 5).__ __-�_--_ Bolt Embedment-concrete-_. -(Fi9.5)•_._: -- _ _in.>T Bolt Embedment-mason Plate Washer___- ____..(Fig 5) 3'x 3-x% 3-1 FLOORS r' Floorfiaming member spans checked _-_-_--[per 730 CMR Chapter SS)_-__�------._-� Maximum Floor Opening Vimension Full Height Wall Studs at Floor Openings Less than 2'from Exterior Wall(Fig 6)------------------------ ---------- Wixi Lun Floor Joist Setbacks 5. Suppoilfng Loadbearing Waifs or Shean a -_-_(!'i9 ft s d Maximum Canfrlevered Floor Joists Suppgr&)4 Lbadbearing Walls br 5hearwall ' (Fig B)_---=-__-_.:--- :-- ..�._ ft s a FloorBt�cing atlsdwalls-._-Y.:.--•-_ :__-_ _.�(Fiig 9)_.' Floor Sheathing Type ._(per7B)CMR Chapter 55) Floor Sheaffiing TbIrJmess _ - -=(per730 CMR Chapter 55)------ in' Floor Sheering Fasteiiing--- --•-- .. --=---=(Table 2)__d nails at - in edge 1_in field , 4.1 WALLS Wall Height Loadbearbg walls_.��__-_ [Fig and Table 5)-- _ iT 51 D'10 Nan-Laadbearing walls--. (Fig 10 and Table 5) ft'S 2(r ; WaII Stud Spacing (Fig 10 and Table 5) Wan Story Offse -- - --(Figs 7&B)- 42 L LC am-L MzJ OR WALL53 Wood Studs Loadbearia walls __ ..:- (falale )_.._�.+.._,:__..�. c ft in. hlon-Laadbearing walls.- :(Table S)__- ----2x_-_ft ut Gable End Wall Bracing t -- Full Heigo Endwall Studs •(Fig 10)_ WSP Aff=Floor Length ft LW3 - Gyps ttn Cetfng Lengfh[if WSP not used)_. _ (Fig 11) ft�0.9W and 2 x4 Cbntircuous Lateral Brain Q B ft o_o_-(Fig or 1 x 3 ceBing furring strips @ 16'spacmg.min:WMi 2 x 4 biockmg @ 4 ft.spacing in end joist of inks bays - Dar�ble 7-rp Ptaf� - — t 13andTable 6 5p[ice Length ) SpftM ConneC5Dn(no:of 16d cntnmon nart)'— • f fable A FVC'wide fo tYood Carlstrucaan in pligfr, Ffrad fLreQs: II D rrzpk iyrrd Zone Arrassachusetts Checklist for Compliauce go afR_ r.i)l Loadbearing Wall Connections - L aferal (no.of 16d common naffs)_-�__._- - (Tables 7) --- Non-Lnadbearing Wag Connections Lzieral(no-of 16d common nails)-.- —(Table B) -_ Load Bearing Wall Openings(record largest opening but check all openings fbr mTftprrance tD Table 9) Header spares .-_-_ -_ ___-_ 9)--- (Table .---- _ c _.(Table _. ft tn. 11 Sig)late Spans 9).__ —___-._ _$—tit<11 Full Height Studs (no. of studs) ---(Table Non-Load.Bearing Wall Dpenings(record largest opening bill check all openings for compliance to Table 9) Headef Spans----.----- :-___._________ ..__ --(Table 9)__-__ —_-. _ ft_in_512, sin Plate Spans.---- -;-- ---(Table 9)-. --- _ft—in_s I Z' Full Height Studs(no.of studs)__ -_-_-- FderiorVVal1 Sheathing in Resist Uprd and Sheaf Sfrnutiane0usfy4 Minimum Build-rng Dimension,W Nominal Height of Tallest Oaeningz ------------------ -_---__._._ __-___.__._ 5 SW Sheathing Type- -- Edge Nag Spacing --—- --(Table 10 or note 4 if less}___-.__--_ fn_ Field Nail Spacing—._-_ .__-- --.(Table 10)_—_--- - in_ Shear Connection (no_of 16d common nails)(Table 10)---------------•----_---------_ Percent Fulf-Height•Sheathing____-_ ____- (Tabfe 10)---------_-------,_------_`� 5%Additional Sheathing for Wall with Opening>VW(Design Concepts) Maximum Building Dimension,L Nominal Height of Tallest OpeningZ_---_--------------------------------------------------,. ____s5S _ Sheathing Type____- -------------- Edge Nail Spacing__. —(Table 11 or note 4 if less) Feld Nail Spacing_-__-- _.____-._:-(Table 11)____.--- --_------------- m- Shear GDnneciiDn(no. of 16d common nails)(Table 11) Percent Full-Height Sheathing- .(Table 11) 5%Additional Sheathing for Wall with'Dpening>6'S'(Design Concepts)-__-__—_-- Wall Cladding _ Rated for Wind Speed?---_- -- ------ - ---- ---- 5-1 ROOFS Roof framing member-spans checked?_-__ -(For Ratters use AWC Span Tool,see BBRS Website) RDDf Overhang ._-_----------- ---------_-----(Figure 19)__ :_-_-- fI s smaller of Z'or CI3 Truss or Rafter Connectiond at Loadbearing Walls Proprietary Connectors Up1ifE-------_----- (Table 12)___ __ ._ __ —U= pff Lateral__----- _-- - _(Table 12)-- _ -__-__L= plf Shear___ (Tahle12]_-.__-__-___ _ S-- plf Ridge Strap Connections,if collar ties not;fised per page 21__- (Table 13)_--_,_-._-_.T= pif Gable Rake (Figure 20 ft_<smaller of 2`or UZ ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Upriit__-_____ - _._ (Table 14) t1= [b- L-ateral(no_of 15d common nails)__(Table 14)------_.__.-.--------:__-_--- -L= - lb- Roof Sheathing Type-__-- -_- _(per 7B0 CMR Chapters 53 and 59)............. RDof Sheaifung Thickness____----_- - -_ -_---.- —in-2:T116'WSP Roof Sheathing Fastening—___ (Table 2) — NDtes '1. - This Fist shall be met in.its entirety,exciudmg the specific exception noted in 2, to comply with the requirements of TRD CMR53012.1.1 item 1. ff the cheddst is met in Its entirety then the following metal straps and hold downs are not required per the WFCM i 10 mph Guide: _ a. Steel Straps per Figure 5 - - - b. 2b Gage Straps per Figure 11 r- Uplift Straps per Figure 14 d_ All Straps per Figure 17 e_ Comer Strld Hold Downs per Figure 13a and Figure 1Bb 2 'E cepti=Dpening heights ofup.tn a ft_shag be permitted when Sol.is added fn the percent fuit-height sheathing ' -requin rents shown in Tables 1 D and 11. 3_ Tha bDtfam sill plate in exterior walls shag be a minimum 2 in_nominal thickness pressure triatad#2-grade. { . ' ATFVC wade to Wood Corimf-Yctiorr arrlii lz l ladAreas_ 110 mphlyrNazone Massachusetts Ghee for CompRaxiee(790 CKRS_ol?:.i i)I' 4, _ a. From Tables ID and 11 and location of wall sheathing and'SuNng Aspect Ratio,determine Percent Full-Height Sheathing and flail Spacing requirements - b. Wood Structural Panels shall be minimum thickness of 7116"and be installed as follows: L Panels shall be installed`t+b st�ngth axis parallel in studs. I All horizontal joints shall occur over and be nailed to framing. ut On single siniy CDnstruGtion,panels shall be attached tD bottom plates and top inenber of the double - . top plate _ nr, On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at botinm of panel Upper attachment of lower paned shall be made to band joist: and lower attachment made to lowest plate at first floor flaming. _ Y., Horizontal nail spacing at doublee top plains, band joists,and girders shall-be a double row of ad staggered at 3 inches on center per figures below:Vertical,and Horizontal Nal7ing for Panel Attachment 5. Glazing protection:a)'new house orhorizontal addition—required if project'is i We or closerto shore(generally,south of - ? Rte.28 or north of Rte.6) b)vertical adcMDn—not requtied unless there is e„rtensive renmraf cin to ffie first floor c)raplacenentiyMdows—needs eneW r_onser fat?on oomprtahCe only(chap 93) 6_Wood Frame Cortsfru ction Manual (WFCM)for 11D MPH,Exposure B may be obtained from rn m the Aeric:n Wood Gouncif (AWb)websRe. a rI> rtNs1�X_FRffSMDR R�resAlGrisEsdJ><Ii'C� ATStLc r tr t 1 ." tt [1 e t L , 1 o ti ! a 1 a � it i 1 - _ � f 1• IL 14 [ram - lu � tii o �! IDEEkmF4.EEDl/CrL 1 l f W a , Z 3fSt •XL: li is - ..t it It G�SJAL1= f Sf STRCx ? - 3`FdYd # fSAE��kGk -� f ttifCPA7�t� p.A Fill H]LCE DOUKEBIfi1LMQESPACM bC'TAL See Betel[on Next Page Vertical and Horizo rlal Na3Ting Detail _ V=r for Panel Rttachment � iiFai ArilHariziknial Nailing • foe imel Attachment Town-of.Barmtable Reg daiory Serviees mass, Richaz-d V.ScaTi,Dirmb Building Division • TamYerry,Emldiag Coner 200 Maim Street Hymmi s,MA 02601 ' www tnwnlarnstable emus ofiace: 509-862-4038 Tax: 508-790-6230 Pragei6� Omer Must Complete and Sign Th s Section- if Using A Builder as Owner of the subject property• hen-V int-hoNTP to act on nV bebaFf; ' in all Matteis=If=to work 2:46AZed bytbis bm7ding pema,it applEalka for -Pool fences and alarms are the responslflL7of the applicant.Pools are not to be fr7led or used before fence is installed and all final ' inspections are peifo=d and accepted. r - - Sipvre of Owner Signature of Applicant 1 { PrintName Pxi=Name . Q:Fax�rs:ow2��srorz'eoors • Town of Barnstable Reguktorg Services 1. 1, , r � Richard V.Scald,Direr fur , b )3TIIZ(FMg Diy7 xt �=„�•asxrx F - Tom 1-My,Bwlffmg commmsron_r $ S- .ate 200 Main.Stream Hyancis,MA 02601 pl4b M� W4PW fD44II_�32M91:fah T&ma us ' Office_ 508-862-4038 - Fa= 508-790-6230 - - HOMEOWI�S r rr- F�TIQN • .��sePrint JaBLoc�Ttort �Z�o gra�e� �e�iKiv►5 , en- 'Clle. /??rt D2632 '�oN1E0W2gR: I�LG�Ia�� In. W i ont _J O g��128-�41�7 J�B14=LfZ�S'�� � CURRENT kfAILRTC7ADDRESS: 12 b u/e14 �•1 °t _ �` np code The current exemption for`-homeowners was wlmndedta mclpde owner-Deeded dweIIm s of six-imifis or Iess�and to aIIow homeowners to mga-ge an individual for hh ewho does notpossess a license,gtoyided iiztthe owner acts as slaperwsor_ DEMUMON OR HOMBOW Ba pesan(s)who owns a.parcel of land on which heJsheresides or intends to reside,onwhich them is,or is intended to be,a one or two- faunZy dwelling,. welling,atfiaebtd or detarhed sixvct3res accessory,to such use and/or farm sftnc > s A person who cons mots more than one home is a twc-year .period shaIl nat be=Ldd -cd,ahomcowner. gucl,`homcownee,.;ball sabmitto ffie Buflding Official on a farm arceplabI,to the BirrrlrTT Official,tliathrJshr shaU be resyonsible for D such warkpesfnzmcd undsrthcbmZdm�ycrmrt (Section 109.L1) The undersigned`homeowne='a� �n=sponsibr7ity for compliance whh.the Siaiu Bm7dmg Code and ot�cr applicable codes, bylaws,roles and regvlatinns- - 'Ibe tzndcraigned`5homcowner"cmt fies thatbelshe m,dczsta_ ads the Town ofBamstablc Biul ft Departm=tm>nfi=msPnc:6M pro and nfs that hrlslm wt-I comply with said pmcedmrs and z�emeCs- • 5itaatnr�ofSnmcaSencr - .". .,_ - Approval efBnBlrm9Of5d2t • Nofa_ lllree-5m3Zy ciweMap mnfaining 35,000 cubic fret or larger wMbe rDqaiedto comply with the Sin -Bmldiag Code Seddon W.0 Consten 031 CantmL HDMEO'WIEB'S E EMZMN The Code dates that: allay homeowner perforating workfor which a btuT Tin permit is required shall be exempt from the gravisions of this secfina(Section I09.1.1-Lim of eonstratdion Sxpervisors);provided that if the homeowner engages a person(;)for hire to do such work,that such Hameawner sha n act as sap erPisor." bl=y homeowners who use ffiis exemption are unaware that ffiey are arc-m ing the responsibilrtlea of a Sup i;or (see Appendnc Q,RnIes&R.eguIafians for Licensing Constmcfror<Si[perdsors,5er6nn 215) This lark of awareness ofL-a results is serious problems,parded2rlp when ffie homeowner hires 1mTcensed persons. In this case,our Board ca=ot prope6d against the=licensed person as if would wn a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible- To ease exit the homeownrr is My swam of h.imlher responsr"brTitles,many communities re�ttae,as part of the is pew applirafran, that the homeowner crrfify thatheAh.e nndersfaads the responsrfsTtZ-es of a Supervisor. On ffie Lest page of ffiis issue is a form-carreatlp ii a bg.several towim Yon may caret amend aid adopt sack a formlm_*f*fi�n for use is your mmmsauity. p��.,....a=s•avFCC dnp • wised 06D 13 21 a eoIImmompeakh of Masmadjus.ffB rA Department ofludust3'ial Acddenft. 4 . Offwe o,f' tigadvas 600 Washington S&eet Boston,MA 02111 kv1P1v mwmgf)11dia Workers' Compensafrtfn Insurance Affidavit Buflder-JCantractaisMectriciansd3lumbers Applicant Informiation Please FI1nt Nam(� U s rCity/Statet�-�!!�AV- phow i�- (�34� 90A- �S .ore you an employer?Check the appropriate btu`: • Type of project(required). 1.❑ am a employer with 4. El am a general contractor and I 6. [:]New oomsizucfias: loyees(full andfor part-time).* ;rave hired the sub-contractm 2. lam a sole proprietor or partner- listed on the attached sheet 7. g ship and bgme no employees These sob-conzracyors have 8 ❑DemolidDa wadnng forme is any employees andltave worms' I 9- ❑Building addition [No worimm.COa1p.mi smanre comp. su ance re,qaire&] 5. ❑ We are a corporatitan and its 14❑Electrical repairs or aeons 3.❑ I am a homeowsier doing all w6& officers have exercised duqr 11-❑Plumbing repairs or addi#ions o vvarloets' �bt of e'1;mption per MGL €irmmtrtcerequ d Tom- c-152,§1(4),and we have ao 12.❑Roofrepairs [ 13.❑Other employees. 1�To camp-.insurance requireAl ;Any appfi=dent chedes•boa ff1 must also ffi cutft section below shotsiag the¢v dme compensafiottparmy infotmaHM Raz evw men who submit this affidavit i they are dom.-all wank sad then}tire oaai&rmtltra wmwm sacb. / � h _ =Caausctats z5st check.this box Est attached as additiamal sheet sboterag the nee of the �d ctafe�betLer ar n/�ottba_sey em>ties bare _ emplayem Iftbe sa&ca trams have eoplayee%etegmastpmvide their wmke&c mp.parity nmabex I am an employer tlrct#isprQtaeikg workers'campmmoian insurance for sty enwroi EdaW'4*11ffP?H ry artd jab sffe irrformrafisim Insurance Company Name !_i) Policy,'*'or Self-inn 1 ic.it F�pirsEioaIJate: . ``\ Job Site Addre= Citg/StafeTp. Attach a copy of the work-ere compensation policy deciaration page(shams the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can}dead 10 the impositioa of criminal pe 16 of a fine up to S 1,500 00 and for one-gear impasonment,as well as civil penalties.in the form of a STOP WORK ORDER and a fate of up to M' G-00 a dap against the violator. Be advised i`haf a copy of this statement may be forwarded to the Office of Isrvestigations of fire DIA for insurance coverage vetifica#ion- I do hereby c .u the pains and pe"al�s e�P�larf iJtatfhs mforrsrauonprr�vt� bm�e` true mud tarred Siustature- Date_ `v Phone Ofsiai ass only. Da not wrrhe in tins area,irr be comple ad by adp ortewn afrtdrrt City or Ta wra Permitf aicense ff Issuing Authority(eacleone):. 1.Board of Health 2.Building Department 3.CitpTovm Clerk'd.Electrical b pector 5.Plumbing Inspector 6.Other Contact Persia: Phone#: . formation and.lnstructions Macc�eft C=b aal Laws chVbw 152 req[i rm all eurplvy=In prov2de workers'Compensation for their employees. Purs-� this site,an MnPIny,=is&Tined as."_.every pmsonm.the service of another under any contact ofhire, espr=or implied,oral or Wes." An employer is defined as ran individual,partnmmh�p,associ:at�corporaflon or other legal entity,or ary two or more of the R=goiag engaged is aJQi33t =and inchidmg the legal reFsese helves of a deceased employer,or the receayer ar trustee of an individual,part amsbip,associ-Om or other legal mttty,employing employees. However the owner of a dweI Eng horse having not more than three apartments and who resides therein,or the occopant of the - air wodc on such dweIlD2 house dwelling house of another who employs pmsons to do mace,c^•^��on or rep g or on the grounds or bmldmg appm-�$herds shall not becanse of such employment be deemed to be an employer." MGL chapter 152,§25C(�also states that¢every state or local licensing agency shall withhold the issuance or - renewal of a Iicen a 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 re uh-ed." Additionally,MGT,chapter 152,§25C(7)stairs"Neither the conm=wealfh nor my ofits political subdivisions shall enter unto any contract for the performance afpabIla wow until acceptable evidence of compliance with the;r,mr�. rcq m-emeuts of this chapter have&--en presented to the contracting auiioirity.7 : APptic Please fill oi2t the worms'compensation affidavit completely,by cher�the boxes apply to your sitnkian and,if necessary,supply sub-conftactor(s)name(s), address(es)End pbonemr— m(s)along With their CMtECate(s)of fiance. Limited Liability Companies(LLC)or Limited Liabr7ity,Partnerships(LLP)with no employe=other than the members or partners,are not reqaired to cry workers'ctaapensafion insm'mce If an LLC or LLP does have employees,apolicy is rapiccd., Be advised that this affdaQitmaybe sum to the Department of Indnstcial Accideuis for conffimaiion of woe covmmp. Also be sure to sign and date-he affidavit The affidavit should be ruet2nned to the city or town that the application for the permit or license is being requested,not the Department of bdastrial AccidmtL Shm0yon have any gnes'tions regarding the law or ifyou are rcq ed to obtam a workers' compensation policy,please call the Department at the number listed below. Self-trisect companies should eatcr.1hair self-iasarance licemse n=ber on tho appropriate Ire. City or Town Officials t Please be sate that the affidavit is complete and printed Ieg>bly_ The Departmenfhas provided a space at the bottom of the affidavit for you to fill out in the evert Office o - lion has to comtu t you regarding the applicant Please be sure to fill in the pen�it(licrose number Which wiill be used as a reference number. In addition,an applicant that must submit multiple pemnitllimnsse applitaiims in any given year,need only submit one affidavit indicating cun-ent policy fnformation(if necessary)and under"Job Sib-Adfress"the applicant should write"all locations in (city or town):'A copy of the affidavit that has been officially stamped or mmk-d by the city or tnwa may be provided to the applicant as proof that a valid affidavit is on file for fftm a p=mits or licenses A new affidavit must be filed out each year.Where a home owner or citizen is obtahing a license or pmmitnot related to any btt cinr_cc or commercial ventne (Le. a dog license or permit to bum leaves said person is NOT rup hr to complete this affidavit The Of of Juvestiga daps Would lrke to than you in advance for your cooperation,and should you have any quesdcros, please do not hesitate.to give us a call The DgpFt aenfs address,telephone and fax=zalber- The CGMMMN?mdft of Masschusefts . Dupaxfment of IndutdBl Accidents Off!=of Itve&tk40= 6w-waW Bosom lA Oil 11 ToL 4 617-' -4 cid 4-06 or 1-a M CAM Fax#617 727 7M Revised 4-24-07 I� _ n r _ I7'y 6 x7 ��6 /3�2H-ctti J'cyN ICin�S 2� . Ceti- no � h _ w Ti N '7n l' eN I � b 1 LrVior, rwv - f Ja 6 6 2A LCq LX 54, no cliaK,,r e 1 � t t -t Z ; 1 • � �y i E€ t 1✓4 C 6 �4 ) i C- t ki y .- �t x 5 j S 4 _ 4 II l @ 1 S � t f .r O i<<tiS Ce toy--ex-v I tie /o0 VI o clna� ,e 41-1 DeN X ISM � L r VrNy r2,t�vW, _ /a 6 13/L A LeC7 k f � �5't'%A^ - no Ghavl� '2 i . E t 1 4 � - a f y _ b it g � P JJ 7 f P r 4 �L 4, vi � r s f j f s Y E e1 f. i. 1 P C - � l � t s r t ' �I E k` . . •'� � ,.tom � .. � . i - # W f f t M i 0_ 17' y" X 6`X V t I - 7 7/ ' De-N _ EE - Cl ' LrVlNS twvr, /a 13/LA Le(i i24 t x S- -�F.✓h�t �nrw, i 4 3 7 I. + r h t 1 3 �1l ti 5` r v 1,7 t El zt- F�1i �atx.F � Yr 4 _4 L 1 5 F x t F l a- f i f ' y 4 SIP r f R - { c s f � Y - r: { _ I F 4 _ i . �dO. 00 /sad 710 - /00 0 /bo.00 -CERTIFIED PLOT PLAN L O C A r I oN: de. Aflo F O R•��B•�G-.,S��Go�l.LS / �GO�� M''CC/L!O 3CALE= -3v DATE: /.987 R E F E R E N C .s�lp 6 �- 1 CERTIFY TO THE BEST OF MY KNOWL D � EG. LAND SU EYOR AND BELIEF FROL4 INFORMATION ACQUI EDP T �'�U �O! T/d HAT THE1 ' QAISHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. OF A` JOSEPH M. v MONAliAN,JR. H No. tm J. M . MONAHAN, JR . & ASSOCIATES ® 0 PROFESSIONAL LAND SURVEYORS & ENGINEERS Si�l �'�44• T.OWNE PLAZA - 900 ROUTE ( 34- SOU_TH DENN(..S., MASS. (� �0 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,t f Map ! Parcel Application `� U Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address /;-(a RA4 P cf .7;fN K//J 1 Village CZ�Jre-( .\,j i LI e, Owner t f lO t K A:I N eti Address SAnl e- Telephone SPg Y 31,S 3 b�J Permit Request Ren owe K c.Y-Lhe,j "11-,61 �,e7�; S 4ee_-r1"K D L(e To IvA-r&L DM" A:je /U o S T-/1.4cTu.¢e_ Af oll 0 V 4L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 'X y$b0.m* Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' ghway:Z1 Yes-#❑ No. Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (scft Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Rol Counter F;, 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 R t C."l -xJ Telephone Number 7�I c�_6 Y—51-77 Address L L-�5-A YV License# (° S (— A SSf 7 ©a,3:70 Home Improvement Contractor# l o�'a Email )--#bQ_1.4- &(7 6) h S 4° ala*" Worker's Compensation # a W C ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C0AS7-2tcr!o,-.) (� ced�t/0 S7—e4_ D A) S 7-G SIGNATURE DATE `�� FOR-OFFICIAL USE ONLY PPLICATION# F , DATE ISSUED € MAP PARCEL NO. , ADDRESS r VILLAGE OWNER - DATE OF INSPECTION: `! - FOUNDATION 5 FRAME INSULATION C 1 S `+ FIREPLACE ELECTRICAL: ROUGH t FINAL - PLUMBING: ROUGH = FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT ASSOCIATION PLAN NO. ' } The Commonwealth of Massachusetts Department oflndustrialAccideni<s Office of Drvestigations 600 Washington Street Boston,MA 02111 www.mass govldia Workers' Compensation Insurance Affidavit;Builders/Contractors/Electrician /Plumbers Applicant Information Please Print Legibly• Name(Business/oro mzafion/Individual): /� �(� S I/�7`'e K e ST 5 Address: e Q U 0 .. City/State/Zip: ttq-s� Pee l�(� Phone �s-- Are you an employer? Check the appropriate box: Type of project(required): 1.[LI am a employer with 4- ❑I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6 El New consfruction 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. gDemolition working for me in any capacity. employees and have workers' [No workers'comp,innn-ante comp.iiisurancc- # 9. El Building addition required-] 5. 0 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 insurance required.]t r c. 152, §1(4),and we have no 12_�Roof repairs 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 hue outside contractors must submit a new affidavit indicating such_ 1Contractnrs that chock this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employers. If the sub-contractors have employers,they mast provide their workers'comp,policy number, I am an ernployer that is providing workers'compensation insurance for my employees• Below is the policy and job site information, //�� Insurance Company Name: A m e, d I AQ S • Cc, , Policy#or Self-ins.Lic•,4: A D-W C.S— /(5 Q- 2 8 Expiration Date: 7!6 Job Site Address: I e)ZALeej ,7-e,o K i o S R-1 City/State/Zip: le 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$1,50-0.00 and/or one-year imprisonment,as well as civil penalties in the fora 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 ofperjury that the information provided above is true and coiTect. Signatore Date Phone#: 1 7 Official use only. Do not write in this area, to be completed by city or town ojJiciaL City or Town: Permit/License# 9 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3,City/Town Clerk 4..Electrical Inspector S.TPlumAbin g Iuspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"_..every person in the service of another under any contract of hue, 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 tntil acceptable evidence of compliance with the insuranc6.. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retuned 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 Iaw 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 lime. 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 sho,-,ld 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 fixture 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 bun leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to than 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 Commmiwealth-of Massachusetts Deparhncnt of Industrial Accidents office of Westigatio.As E4Q�ashu�gton Strcct Boston,MA Ell 111 Tel, 9 617-727-4900 o):t 4-06 or 1-97 -MASSAFE Fay#617-727-7749 Revised 4-24-07 w .mas3_govjdia f Client#:34309 MULTISTA �ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 10/07/2014 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 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: Maria Barnowski Starkweather&Shepley PHONE FAX PO Box 549 A C.No, xt E :401 435-3600 (A/C,No): 401 431-9326 ADDRESS: mbarnowski@starshep.com Providence,RI 02901-0549 401 435-3600 INSURER(5)AFFORDING COVERAGE NAIL# INSURER A:American Safety Insurance INSURED INSURER B:AmGUARD Insurance Company 42390 Multi-State Restoration Cape Cod INSURER C:Hartford Ins Group 19682 Division,Inc. 68 Nicholetta's Way,Unit G INSURERD: Mashpee,MA 02649 INSURER E: INSURER F: 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 CONTRACTOR 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. LT R ADDTYPE OF INSURANCE NSRLSUBR WVD POLICY NUMBER MM/DDNYYY MM/DDY� LIMITS LTR A GENERAL LIABILITY EPK102728 1/01/2014 01/01/2015 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence s50,000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $5,000 X BI1PD Ded:5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY 0 PRO LOC $ JECT C AUTOMOBILE LIABILITY 02UENQT4762 1/01/2014 01/01/201 COMBINED SINGLE LIMIT Ea accident $1,000,UOU X ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - BODILY INJURY Per accident $ ' AUTOS AUTOS - ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB H OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY R2WC510288 7/16/2014 07/16/201 X WC STATU M,j OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? NIA _ (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: 126 Braley Jenkins Road,Centerville,MA 02604 CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 0.. S ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S627394/M627393 MBB — -- — o/ JJa�i�er�t7 � Mee of Consumer Affairs&Business Re ula ion I� B � License or registration valid for individul use only _ ,... - • ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Office of Consumer Affairs and Business Regulation - - egistration 140427._:. - Type* 10 Park Plaza-Suite 5170 • - Expiration 10/15/2015'_: Supplement;9rd - - - Boston,MA 02116 .. `' MULTI-STATE RESTORATION C.CAPE COD - - - :. RICHARD LAURIA':` P. O.Box 2210 - MASPHEE,MA 02649 Undersecretary ,� Not valid without signature. Massachusetts-,Department.of Publie,Safety :Board of Building Regulations and Standards Construction Supervisor I Bc 2 Family - License:CSFA-051784 RICHARD D LAUJtIA y Rockland MA 02370 , 1 LEAH DR J G �l1�6igc.n n Expiration -. Commissioner - 04/01/2015 t - F r A MULTI-STATE RESTORATION, INC. FIRE* FLOOD*WIND* SMOKE*HURRICANE*VANDALISM Fed ID#050515889 CONTRACTORS REGISTRATION#140427 AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT i� Y; ,herein referred to as "Customer",authorizes MULTI-STATE RESTORATION,INC.,herein referred to as "MULTI-STATE",to perform any and all necessary cleaning and construction services on Customers'property at: /24 Ar6/e.s ova, 0263-Z Telephone: and with respect to items that need to be cleaned at a remote location,to remove and clean such items as necessary. [ 77q-1gq-25-5-q Customer authorizes /�Av✓a r e Insurance Company,herein referred to as "Insurance Company",to directly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers'name,and to deposit Insurance Company checks or drafts for MULTI-STATE services. Customer agrees to pay Customers'deductible in the amount of$ that applies to this claim. If the loss is not covered by insurance,Customer reeMy tptal Lto ,.MULTI-STATE upon.receipt of the invoice. i signature of Owner It is my understanding that the services to be performed by MULTI-STATE will be limited to those,which are authorized by my Insurance Company. Insurance Compaffy Name Policy Number Customer agrees that MULTI-STATE is working for the Customer and not the Insurance Company or agent/adjuster. Additional remarks: I have d t and om etely un rstand and agree to same. V- 7 Signat Da Printed Name P.O. BOX 2210•MASHPEE, MA 02649.866-921-9111 •FAX 774-238-4422 _ _ I A .y MM DD YYYY ❑Delete 924i NFIRs -1101 I �f 09 � 2014 ange❑ h Basic FDID State Incident Date i Incident Number - * * * � Station * Exposure * No Activity- ❑Check this box to Indicate that the address for this incident is provided on the Wildland Fire Census Tract $ Location* Module In Section a"Alternative Location Specification". Use only for Wildland fires. ®Street address 126 U IBRALEY JENKINS RD ❑Intersection Number/Mile ost Prefix P Street-orHighway -❑In front of .Street Type Suffix l� ❑Rear of I CENTERVILLE I IMA 1 102 632' r I-1 ❑Adjacent to Apt./Suite/Room City - State Zip Code ❑ _ I Directions I Cross street or directions as applicable C Incident Type * El Date. &'Times Midnight is 0000 E2 Shift. & Alarms 111 o Local'Option Buildin ' g fire Check b xes if I dates are the Month. Day Year Hr Min Sec Incident Type same as Alarm, ALARM always required - - 17 1 I. - I CQ�3 Date:, Alarm'* 0 16 2014 21:12:24 Shift or Alarms District' D Aid Given or Received* �� �� ��� I Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received 2 ❑Automatic aid recv. Their r enID Their '❑' Arrival'* �9� 16 I 2014�' 21:17:59 1 E3 State CONTROLLED Optional, Except for wildland fires Special Studies . 3 ❑Mutual aid given P 4 ❑Automatic aid given I I El Controlled �J � I 1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED,. required except for wildland fires IuI g Incident Number Last Unit , ' ` Special Special N nX None - i pq1 'Ll� I 20141:22� 08 s 55J Study ID# Study Value ❑ Cleared ', - 1 --1 F Actions Taken* Gl . Resources:* G2 Estimated Dollar-Losses & Values }.❑ Check this box and skip this - - LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires 10 (Fire control or I Personnel form is used: . None Primary Action Taken (1) Apparatus Personnel Property $l ,I , 1 002 , 000 ❑ - - Suppression 1 0007 51 -1yentilate I Contents 1, 002 ,1 000 '` ❑ Additional Action Taken (2) • s EMS I .PRE-INCIDENT VALUE: Optional 86 (Investigate' I Other,L 0008J 1 0004� y Property $1 258 0�5 r00� ❑ Additional Action Taken (3) El, Check box if resource counts - - - -' include-aid received resources. Contents $I`. I , 002 —02 ❑ Completed-Modules Hl*Casualties❑None H3 Hazardous Materials' Release _ I Mixed Use•Property > Fire-2 Deaths Injuries N []None NN Not Mixed +.. 10 Assembly use ©Str Fire ucture-3 I ` 1 ❑Natural Gas: aloe.leak, no evaaatioa or HazMat actions' 20 Education use ❑Civil Fire Cas.-4 service 2 [-]Propane gas: a3: <21 lb. teak (as in home HHg grill) 33 Medical Use ' ❑Fire Serv. Cas.-5 Civi liana l� ❑ 40 Residential use 3 Gasoline: vebiole foal tank or portable container ❑EMS-6 1 ❑Kerosene: feel basin t e:` 51 Row of stores g equipmen portable storage Detector 53 Enclosed mall ❑HazMat-7 Required for Confined Fires., 5 []Diesel:fuel/fuel>Oil:vebicle fuel tank or portable 58 Bus. & Residential Wildland Fire-8 6 Household solvents: home/office spill, aleahap cnip 59• Office use ❑ ❑ 1❑Detector alerted occupants 1. 60 Industrial use,. Q Apparatus-9 7•[]motor oil:; from engine or portable•croataines ary OPersonnel-10 2❑Detector did not alert them 8 ❑paint: from paiat cane totaling<55 gallon f 65 Farmtus use ❑Arson-11 ❑' 00 ❑Other: special Harmet actions z.q iied or spill>55ga1.,:k .00 Other mixed use (J Unknown .Please lets the HarMat form J Property Use* Structures 341❑Clinic,clinic type infirmary, 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 [:]motor vehicle/boat sales/repair 131 Church, place of worship Prison or ail not.•uvenile ❑ 361❑ j 7 571 ❑Gas.or service station • 161 ❑Restaurant or cafeteria 419®'1-or 2-family dwelling J99 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 [:]Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel'' 700 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential," board and care 819 ❑Livestock/poultry storage(barn) 311 nCare facility for the aged 464❑.Dormitory/barracks •882'❑Non-residentialparking garage • 331 ❑Hospital 519❑Food and beverage sales .891 ❑warehouse Outside 936,[:Ivacant lot 981 ❑Construction,site 124 ❑Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream 669 Forest (timberland) 951 Railroad right of way Lookup and enter a Property Use code only if ❑ ❑ g y you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street. Property Use 1419 . 919 ❑Dump or sanitary landfill 961 ❑Highway/divided.highway 931 ❑Open land or field 962 []Residential street/driveway .I1 Or 2 family dwelling NFIRS-1 Revision 03 11 99 COMM Fire District 01920 -09/16/2014 .14-0002797 K1 Perjon/Entity Involved Local Option Business name (if applicable)PP Area Code Phone Number - QCheck This Box if �, I �,. I same address as Mr„Ms., Mrs. First Name MI Last Name Suffix incident location. - Then skip the three duplicate address Number - ' lines. Prefix Street,or Highway Street Type YP Suffix (Post Office Box Apt_/Suite/Room City State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 owner Same as person involved? Then check this box and skip I I 774 — 994 — 2559 � . The rest of this section. - Local Option Business name (if Applicable) Area Code `Phone Number (Rick I Wiinikainen I �J ® Check this box if Mr.,Ms., Mrs. First Name MI • Last Name Suffix same address as _ I incident lt tha. I126 I �J IBRALEY JENKINS he I 'RD Then skip the three duplicate address Number Prefix Street or Highway . - Street Type .Suffix. lines. WIINIKAINEN,` RICHARD M I ICENTERVILLE Post Office Box. Apt./Suite/Room City ` - U 102632 1-I�_I _ State Zip Code 1. L Remarks Local Option- - - - - - - - - Caller Name" UNK Caller Phone c 774-368-2654 t Caller Address t OIC : SARGENT x Pats. : .0 AGR : NINone lmotte ; 2014/09/16 21:17:59 `- 321 AT EVENT ',MANNING IS 1+ • lmotte ; 2014/09/16 21:18:44 - 323 AT EVENT MANNING IS 1 lmotte ; 2014/09/16 21:19:45 - 307 AT EVENT MANNING IS 3 lmotte ; 2014/09/16 21:20:38 - 303 AT EVENT MANNING IS -3'' . lmotte ; 2014/09/16 21:23:01 = 304 AT EVENT MANNING IS 3 $. lmotte ; 2014/09/16 21:24:59 - 320 AT= EVENT MANNING IS 1 lmotte ; 2014/09/16 21:25:01 -. 301 AT EVENT MANNING IS 1 •, lmotte ; 2014/09/16 21:36:19 - 324 AT EVENT MANNING IS 3 lmotte 2014/09/16 21:14:42 ' KITCHEN FIRE _ lmotte 2014/09/16 21:18:25 321-1.5 STRY NOTHING SHOWING, -HAVE CMD ` lmotte ; 2014/09/16 21:19:57 321-FIRE APPEARS OUT,. HEAVY SMOKE COND, KEEP THE ASSIGNMENTeCOMING L Authorization ' 8410 ISARGENT, RICHARD P. CAPT 09 16 2014' - I I I � U Officer in charge ID Signature Position orrank' Assignment. Month Day Year Check f®• I8410 ISARPENT, RICHARD P. I iCAPT . L I_ -09 16'1 .2014 same Member making report ID Signature Position or rank °Assignment •Month-. Day .. Year - as Officer 4 P g - - - in charge. a . COMM Fire District 019M. 09/16/2014 14-0002797 MM DD YYYY 01'9$►0 U �9J 16 2014 U 14-0002797 000 complete, FDID State Incident Date - - Station'^ .Incident Number Narrative _ * Exposure..*•,: - Narrative: Caller Name UNK Caller Phone 774-368-2654 Caller Address OIC : SARGENT Pats. : 0 AGR : NINone lmotte ; 2014/09/16 21:17:59 - 321 AT. EVENT MANNING. IS 1 lmotte 2014/09/16 21:18:44 = 323 AT EVENT MANNING IS 1 lmotte 2014/09/16 .21:'19:45 - 307 AT,EVENT MANNING IS 3 lmotte 2014/09/16 21:20:38 - 303 AT EVENT_ MANNING IS 3 lmotte 2014/09/16 21:23:01 - 304 AT EVENT, MANNING IS 3 lmotte 2014/09/16 21:24:59 - 320•AT EVENT-MANNING IS '1 lmotte ;_ 2014/09/16 21:25:01 301 AT EVENT MANNING IS 1 lmotte 2014/09/16 21:36:19 - 324 AT EVENT MMANNING IS 3 lmotte 2014/09/16 21:14:42 Y * KITCHEN FIRE lmotte 2014/09/16 21:18:25 321-1.5 STRY NOTHING SHOWING, HAVE CMD lmotte 2014/09/16 21:19:57 321-FIRE APPEARS OUT, HEAVY SMOKE COND, KEEP THE ASSIGNMENT COMING • Y f lmotte 2014/09/16 21:27:47 CMD-MICROWAVE FIRE AND CABINETS, VENTILATING, ALL .UNITS,ARE COMMITTED-I ADV HAD A CREW HERE, REQ 324 TO THE SCENE lmotte 2014/09/16 21:31:35 `- t .CMD-HAVE'324 STAGE ON PRINCE HINCKLEY AND THEY'RE AVAILABLE lmotte 2014/09/16 21:33:02 CMD-INTERIOR' REPORTS NO EXT, CONT TO VENTILATE lmotte 2014/09/16 21:42:09 TO CMD-HAVE ALS CREW AT STA- 3 AND 1 DO AT STA 1-CMD SAYS .THEY. WILL. BE"CLR IN 20-30 MINS ' lmotte 2014/09/16 21:58:08 CMD-CMD TERMINATED, RELEASE OPS CHANNEL, 324 CAN RET', •REMAINING ON SCENE FOR A FEW MINS - Received call for kitchen fire. During response dispatch reported all- occupants out of the - home and I heard the BPD sign off on -location. Upon arrival of Side A, I noted nothing showing from the road of a 1 1/2 story wood residence and took command. I was met by• BPD officer Travis Brown on-'location who reported he had entered the building and discharged his extinguisher on a- fire in the kitchen and that the fire was out. I found the residents at the front of.the,•house reporting no one else inside ' and a heavy smoke condition in the home. 307 arrived and was given orders to enter the building._with SCBA.to check for fire and. extension. Upon completing 360 of the building I noted no fire but smoke coming from the COMM Fire District 01920, '09/16/2014.• '»14-0002797 MM DD YYYY 019-20 U L 91 16 1 2014 u 1 14-0002797 1 000 complete FDID State Incident Date Station Incident Number Narrative - * Exposure * _ Narrative: upstairs open windows. 307 reported fire -out checking for extension and to begin PPV. 304 was given orders to check the 2nd floor for extension and FF' Davern .setup PPV at the,side A door. 303 had arrived at the hydrant and was requested-to leave pump operator and send crew to meet command. They assisted 307 with overhaul, of the kitchen .area. 324 was requested to'the scene but left available due to FF operating in SCBA: No other,manpower", was, needed. 304 reported no extension to the 2nd floor- and 3.07 reported no extension beyond--area of origin behind the stove after they opened the wall. Upon clearing of the smoke investiagtion found a fire starting on the stovetop due to pan left unattended with oil cooking. The fire extended to either-a towel hanging on the front of the stove or directly to the microwave . above. There was significant heat and fire damage to _the microwave and charring to the cabinets adjacent to the microwave. the stove had moderate damage to the front and top. The. microwave was removed from -the home and the stove was «pulled away from the wall and unplugged. No electrical circuts were. tripped upon- checking and the kitchen circuts were isolated and turned off.. f The building was ventilated and units picked up and'were '"returned. I' took the owners inside- and went over the damage and our findings: They were advised ,t"o`cont act their insurances company, given the names of local disaster contractors and I suggested"they find arangements to stay the night at another location due to the residual odor in-the home. ' . >. Pictures were taken and are located on the,COMM server. The owners had no additional" ,'- - questions and 321 cleared. A ' ; e COMM Fire District 01920 09/16/2014 1 ' 14-0002797 « TOWN OF BARNSTABLE DAIIISTABL KUL MASSACHUSETTS Solid Fuel Stove Permit DATE OF APPLICATION ................. S..................... F UFi.- 'P' 7 ISSUING PERMIT ............................................................ L NAME (owner) ........... NAME (Installer) ...........AAJ_....... ................................................ ADDRESSZ�p?�49 /U< ADDRESS ........................... ................................................................ STOVE TYPE .......... .qi o0d............................................(5�n4-v u L(tr--CHIMNEY: NEW ........................ EXISTING .................0......00000000, f . Manufacturer ................... .[SA ........................................................ CHIMNEY: Masonry ....................... .......................................................... r Mass. Approval ..4. ,9 7- .................................. ........................................................................... CHIMNEY: Metal ................................................................................................... This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed address in accordance with an application on file with the ................................................................................................... , and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. Issued73y: .................................................................................................................................Title .................................................................................... Date .......................................... Permit to install expires 60 days after issue date Stove .........................................'0...... ................................................................................................................................................................................................................................ ..... W7- Stove Clearance .......................................................................................................... .................................................................I............................................................ Floor ..................................... .............................................................................................................................................................................................................................. Smoke Pipe .......................... .............................................................. ................. ............................................................................................................................................. ,/_od.............Smoke Pipe Clearance .............. ............... .. .................................. Chimney ................................................................. ........................ Smoke Detector ................. e-5 ..............................................................................I.................................................. ........................................................................................................ The undersigned hereby certifies �hat the installation of solid fuel burning stove and equipment made under au- thority of permit dated //IPZZIW.................... has been made in accordance with provisions of the Commonwealth of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................ Installer INSTALLATION APPROVED ............ By: .................... Title: ........................................ date WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT Town of Barnstable ermit: 2144 O �pF-THE rqy� Regulatory Services ate: j12 jas Thomas F.Geiler,Director BAMSTA13M ' Building Division ee:,&.' bU yQ, Mass. vpr i639• A1�� Tom Perry, Building Commissioner, Foy 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 d Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT i l n r, vL e v, Phone: Owner: kar Install at: b �e —'�,, �p r �!el ��l. Village: Map/Parcel: 17 t L Date: l 7 p Stove A. New Used l�✓1�-i 4v e B. Type. adiant/ Circulating C. Manufacturer: i✓l u, noa �- �. �n C�0 Lab.No; D. Model No.: ' Chimney A. New/Existing 07fexisting,please note date of last cleaning B. Flue Size C. Are other appliances attached to Flue? 0 O D. - e and Manufacturer E Masonry: Lined/Unlined Hearth A. Materials: ��t LC- B. Sub Floor Construction: hoc)& Installer Name: c� c.`�' Ck S Address: DS 7's�d-�/'��/ (t-' • Phone: 0 � :tF -G i � Location of Installation: i24 �Y:/�fe J �,as , C V." l�� APPROVED BY: y� Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 �,. b �. ___ ._, _� .y „' .��. _- �: = - _ _ <�� a;. ad._ i "n�;� _ _ _, ,. �iU'i�' `.�rri. �� � �., �" 1 � �Y �• j '. �1 ., '�, �w 5+. { � � ` i �� } � E 9 3 e � 1 Bray ' Jenkins nkins Rd, 14/05 ��.,� °•.w TOWN OF BARNSTABLE BUILDING DEPARTMENT = ssaier TOWN OFFICE BUILDING rua S �°1' i639 HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $�....... /2 _Z .................................................................................................................. ....................................... / G .� issued to �fb.� ....�.o/L.v...uJ�.........Y�;,,... ... 1..i�� -..... . .......6 CJ/� l�.r� Please release the performance bond. h'.�:;�4.,'.u`5"�r. ,rlv4`F"fM�i,.v:.;y,�. tt�,;•,�jFk?•i's,�,�.`+'.�,`s,� !£L"v�,.+�"4.�! ' I•.o"Y`"' ..�.,.-�,,.. ,-.. t,,.�,.l, ;u,;d�•',;'t ,�ya1-�'.x; ,r�:.-:. '���,;!�raf.�;.w ..�,.i�'=f`' '"�,..�+fi� yof ? TOWN OF BARNSTABLE Permit No. .�.1272......' 4 BUILDING DEPARTMENT Cash TOWN OFFICE BUILDING t67q. p' "heur� HYANNIS,MASS.02601 Bond ....X..Y4.0 e CERTIFICATE OF USE AND OCCUPANCY Issued to Lebel Sollows Trust Address Lot #145, 126 Braley Jenkins Road 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. March 10, 19...8 82= .............. ,►�,� ............ f $uildmg Inspector as Assessor's office (1st floor): "` Assessor's On' and lot number �-Y...1. �. ... '4�� y�� S @���T �E y FTHETO� g,`' c-� �oO6��PLIANCE. Board of Health (3rd floor): _ STALL� Sewage Permit 'number ...................................................�E r".' il��y ., ; V�� _ Z B9BB9T11BLE. � Engineering Department Ord floor): . I ''1 � S "� [; , VsRONMEN LY. ,�.;�i 900 ,"639 0� House number S�l4.......... y �, �E('�- M_ a Mnr a� ..................................... t , APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only 1. SEPTIC E® IN C I1APL ANCE TOWN OF BARNS-TAD SYSTEM MUST BE WITHTITLE5 BUILDING ANSPECT 0 RENVIRO MENTAL CODE A AND APPLICATION FOR PERMIT TO5 .................... ..` ......:..................................................... TYPE OF CONSTRUCTION .........Wood...Fr. ....ame ..............: .................................. . .............. ..................._....... . .. .......... 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Braley Jenkins Road Centerviller MA 02632 .......................... ...... .............................................. ProposedUse .......Dwelling................................................................................................................................................ ZoningDistrict ........RC...........................................................Fire District ........C..and...0..................................................... Name of Owner L.ebel Sollows Trust .....Address .1,31 Old ROute 132 Hyannis,MA 02601 Name of Builder Lebel Sollows Deve.lopment...Address .1.31 Old Route Hyannis, MA„02601 Name of Architect Northside Design Address .Rt,,,6A...YarmouthPort,.,.MA ................. .„ Number of Rooms FIve ..............Foundation Concrete ............................................................ Exterior .......Clak?s...and..Shingles..............................Roofing ......Asphalt............................................................ Floors ........... P1...X Wood. . ......................................'................... r.y.Interior ......Dwa,ll............................................................ .. .. .... Gas .. ..................Plumbing ....IDW&IA...2...ba.t.h.5......................................... Fireplace .....Yes,....................................................................Approximate Cost ....$6.Q.1.Q 0 0. 0 Q - ............ Definitive Plan Approved by Planning Board __Julyr__l6_----------19-_B-4_ . Area �Y��.................... ..................... Diagram of Lot and Building with Dimensions Fee �DR, ................. SUBJE T PPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS .REQUIRED FOR NEW DWELLINGS I herebyagree to conform to all the Rules and Regulations ofy0wof �ble re afgth�XoVe 9 99construction. Name ..........� ^. ......;.. 4OT3434 Construction Supervisor's License .................................... -UEB ;L SOLLOWS TRUST , • 3i272: permit for ...1 z Stork o ............ ............ Sin.10 FamilyDwellina :-- ..... .... .............................................?............... z. rLocation .Lot #14 � 326 Era1.. Jenkins Road • Centerville ............T............................................................ Owner ...Lebel Sollows Trust ......................... ` Type .......Frame '= T e of Construction .................................... -j - .... ..................................................................... Plot ............................ Lot ....:........................... Permit Granted .....October...................................19 87 Y Date•of Inspection ........... ......................19 p/ ,d Date Completed c :: ....................1 9:2 g y; f r� -7 If t Assessor's office (1st floor): THE Assessor's-map and lot number : .... . Board of Health (3rd floor): P, fO Sewage Permit number ........................................... ......C?. Z BARNSTABLE.. i IL Engineering Department (3rd floor): t j5 90o rb 9.a\0m� Housenumber ...................................J. :....: ................... 9M APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .1.1. .1 .�.d. . . ..h., , .c=......... ............................................................................ TYPE OF CONSTRUCTION .........TA10.0d...rr-.<:nne....................................................................:........................... �. ....-------------------19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot 4 A-6,..ArAlmv j7anXi.n.s...R.Oad...Cent-.exvi. le... t X......0. 6.3.2.................................... ProposedUse .......Dwelli.n.c(......................:...............................................................................................I......................... ZoningDistrict ........RC...........................................................Fire District ........C..a.nd...0.................................................... Name of Owner Lebel,,,Soar.lot,�s...Try.G.t...................Address .1.. J....n1..d...R-0?,1-tn...l. ?...t�? ► r,�. �nrtz�.. .n�.601 Name of Builder ...De_,,�f'. iop??Q.d?t...Address ..1..37.....,f.?1A...Rn?.t.t..p...1.32... ..0.2601 N®x s Name of Architect .......��...�.,�P..T�PA�a.�t�..:...":..................Address .Rt-....6A... Mz�...:...................,.. r Number of Rooms ......... FI,Ve...................................................Foundation Conx,.retn.......................................................... Exterior .......C1a.ps..And...Sk�lnal.(.................................Roofing ......Asrph .�.t......................:...................................... P1 Aod ................Interior ......n*_:In.1.a.,:>.-1............................. Floors ..............�................................................... ................................. Heating ....GA ................................Plumbing ...PVCC/ 1...?... ---hs......................................... Fireplace ....X.S......................................................................Approximate Cost ...s-6-o-r 4!-0, 0.?....................................... Definitive Plan Approved by Planning Board _ii1[ i 19--A . 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�thetn'of Barnstable regarding:tkd above construction. �� f ue:` s . Name...... ..: fi R. ................. e 43434 Construction Supervisor's License . LEBEL SOLLOWS TRUST A=171-230 /7/ ? 17rr No 3127.�.... Permit for ...1 z Story ,._.,,.:....Single Fami1 we Dlling .............. Location ..Lot #,145,..._..126 BraleX Jen+,ins Road Centerville Owner ...,Lebel Sollows Trust ................................................... Type of Construction ..Frame Plot ............................ Lot ................................. Permit Granted October 7, 87 .......................................19 Date of Inspection ..........I..........................19 Date Completed ......................................19 1 TOWN OF BARNSTABLE, MASSACHUSETTS BUILDWO FERMI A=171-230 4, {� DATE, Oc tolpe'.r I o 'i 19 87 PERMIT'W1 �:���272 - j APPLICANT 8ebel SU.ltows ll>rVj,,, ADDRESS 131 Ultl lkg�4 .0 1.32, by nnis 4009121 IN0.) (STREET) (CONTR'S UCENSEI - . NUMBER OF - PERMIT TO BU:1�.C� Dwtl-+-111LT ( 1 i+HISTORY S iLCI,10 r cl_fil:.�y D1ge .11:-1(qWELLING UNITS (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) Lot #145 1_26 iiralL ' J k} ' its a ZONING AT (LOCATION) / �' rl ` � ItC)dCl� L(:.Tilri'�Y,`/_11(.. DISTRICT RC IN0.) (STREET) j 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) Sewage, #86-456 REMARKS: 'BondAREA OR , VOLUME 1356 sq. it.. ESTIMATED COST $ 601 000• OU FPER EEMIT (CUBIC/SQU $ 108• 50 7 ARE FEET) - OWNER LebC-1 SoliuW5 Trust ` ADDRESS saute 3l/ !.� c11117 i S BUILDING DEPT. BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART'THER EOF. EIT HER,TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, N-)T SPECIFICALLY PERMITTED UNDER® THE UILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADE AS WELL AS DEPTH AND LOCATION OF PUBIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE C.:.' 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 SHALL NOT BE OCCUPIED UNTILMEMB - FINAL INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE.3. FINAL INSPECTION BEFORE ' OCCUPANCY. - POST THIS CAR® SO IT IS VISIBLE FROM M STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS A 2 2fJ J 3 CA N91HEATING INSPECTION PPROVALS ENGINEERI G DEPARTMENT OTHER BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INS NS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE `� ARRANGEjp,k B.BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATIOW.-,,—s _ - SOI L LOG DATE: L-1, WITNESSED BY : /Vl C 0 /-V 4 (0 Z"\/ O P J L. 7-4ff CD V) T 7— C Z eFoq A/ /V .-IS 7- 7-0 t _ Lc� OsE 4 v) 14 7' E-)e QL 7-Er�t �F D LAANH OLES AND COVER TO BE BUILT WITHIN -- 12' OF FINISHED GRADE . -j- ELEV. TOP OF o FOUNDATION . - kAIN2 SLOPE ' NfSHED 6 RA D E CAST I RON v ST pfcbp j)f(106 0 R 4�' P V C S C 4 0 rA- A PVC SCH. 40 PITCH (/4 T LEVEL V E L, r -V 4�— '7F UIN ?-" LAYER \p4jF z to I/8 (/2" P E PITCH _j 4. 4,Z rq) cl 1::4-154. 1/4.� FT., (L D 4- 4 GALLON NV R T ., 7- 1 Z- I N V E R T 0j 6 1 E T DIST. I NVE E3 C) C. INVERT -r4 - V Box < 3/4"-' 1 (12"D i A SEPTIC TANK z: C3 se --) Z.Tf- WASHED STONE '31 T3 INVERT I N V E R T C)',' ALL AROUND 5r- 13 E '7� --me - GA R 8 A 43 E LEV. BOTTOU 0--a -1 - 0 F P I T Z.-- R -34 MIN G R I N D E R 6-0 'D "Z -r 14S E L E V. a PROFILE OF GROUND WATER TABLE 13zFz-c)\," SAN ITARY DI S P 0 SAL S Y S T E M NOT TO SCALE DESIGN DATA BE DROOMS, \3 f o CONSTRUCTION OF SANITARY DISP05AL DESIGN FLOW ` 33C) GAL ./DAY SYSTEM SHALL CONFORM TO MASS . LEACH RATE Z MIN./INCH ENVIRONMENTAL CODE TITLE V (REVISED 7- 1 - 77) AND THE TOWN OF PROPOSED LEACH CAPACITY - 2, HEALTH REGULATIONS . 9 SEPTIC TANK., DISTRIBUTION BOX AND LEACHING PITTO BE OF REINFORCED CONCRETE - -44 ,3 MIN CONCRETE STRENGTH 3000 PSI GAL/DAY MIN. STEEL STRENGTH 2 0,0 OOP S I H 10 DESIGN LOADING 0 DRIVEWAYS NOT- TO BE LOCATED OVER SYSTEM UNLESSH - 20 DESIGN LOADING IS USED. • ALL PIPES AND FITTINGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR SCH E D 40 P V. C. SITE PLAN SHOWING PROPOSED CONSTRUCTION 5 H -=='4- OF -1- SH5. LEGEND L 0 C A T 1 0 N . 3 (..'r- F'/v 7-e P- V.1'L / E-j /,-r 11c) Z'-s - C O)R APPROVED F 0 R lf-,C3 If 4 2 "v—1 19 SCALE: DATE : BOARD OF HEALTH BUILDING SETBACK REGULATIONS PER EXISTING CONTOUR - -16- REFE RENCE en 7- 4Z- P,4 w-sl 43K- 3 <0<o 3 BUILDING INSPECTOR OR BUILDING PROPOSED CONTOUR DATE AGENT C Clk/l M 1 5 5 1 0 N E R . - ION N —E— - I N FRONT SETBAC K EX I STING SPOT ELEVA-T 17 6 PROPOSED WATER SERVICE —W OF 4f MIN . SIDE SETBACK - EST HOLE LOCATION CRA MIN REAR SETBACK T -4 VIL CA CR . SHORT b. 27483 . , I N C . -STft PROFESSIONAL LAND SURVEYORS L ENGINEERS S/ONAL 1586 MAIN STREET (RTE 6A) EAST DENNIS, MASS . 02641 I-J,-7 )Q L.