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0069 CARLETON LANE
_... ._. .. .. - �. ,� ? n � / n Town of Barnstabley a�sxtrrw 200 Main Street Hyannis MA 02601 508-862-4038 Application for Building Permit ' .r _10 Application No: TB-17-728 Date Recieved: 3/17/2017 C ID PP 7MI, - �n Job Location: 69 CARLETON LANE,CENTERVILLE ZZ Permit For: Building-Insulation-Residential 10 51. Contractor's Name: Elwell H Perry State Lic. No: CS-104088J r Address: Acushnet, MA 02743 Applicant Phone: (508)992-5770 (Home)Owner's Name: HANSEN,MARY ANNE P&WADLEY, Phone: (339)793-1854 JAMES A (Home)Owner's Address: 69 CARLETON LANE, CENTERVILLE,MA 02632 Work Description: Air Sealing 10 hrs. Install weatherstripping 2 doors. Install 9"Cellulose to 1100' open attic. Install 1 roof mounted bathroom vent. Install(9)4"x16"soffit vents. Install R-19 fiberglass to 150' at house sill. Total Value Of Work To Be Performed: $3,246.00 " t Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Elwell Perry' 3/17/2017 (508)992-5770 Applicant Date. Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost $3,246.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 i 3/17/2017 $85.00-\ XXXX-XXXX-X)M-. Credit Card 4419 ..........................................................................................................................................................................................................................................:...................................... ........................... Total Permit Fee Paid: $85.00 • - 5�23 j� - Town of Barnstable *F9rM1t#Z �+ O Regulatory Se�°�nces F.�6awnths,jmm imedate Fete n� Richard V.5ea%Weaaffi Director 40 , Building Division � /C 9 i ,c Tda Perry,CBO,Biding Commissioner A0 Main Street,Hyannis;MA 02601 wmw town.barnstable ma us Office: 508-862-4038 Fax:508 790-6230 > RESS PE-"n APPLIcA'HQN m RESIi?E ONLY - 1Yotvalid"thoutRedX-Pressimprint 1Viaprgarcel Number g� Z ��// Property Address �D� C6d/'��7"0/7 �iG/Ie 7,�-d-✓l Ile Residential Value of Work$ Mmnmum gee of M35.00 for work under S6000.00 — Owner's Name 8t Address Jw Contractor's Name �� /Ni )''►-An$e0W Telephone Number- �f Home improvement Contractor License#(if applicable) ��(� �'�'•3 Email: Construction Supervisor's License#Cif applicable) Q q<:F (� Workman's Compensation Insurance .Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance insurance CompanyName &eV klig Sl '/ . � . Worhran's Comp.Polio;-W G Copy of Insurance Compliance Certilleate.zamt accompany each pRaftermiU Permit Request(checkbox) Q Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to � ❑Re-mof(hurricane nailed)(not stnl)pmg. Going over existing layers of mot) (�Jle-side ,.. a RePtacement Wmdows/doorsJsfiders..IT Value - 3 (maximum 35)#of win ws #of doors: '0 Smoke/Carbon Monoxide detectors 4 door plans marked with red S and inspections required. Separate Electrical&Ike Permits required. = Wheterequire� LWOMMofftPemk&mum exemptconqffim=Yn&e =towndepartmeor ons,L,—� .Consavadon, Note: Property er ga Property Owner Letter of Permission. r copy of H Improvement Contras License&Constroctioa S�apervisorsl acense is required. SIGNATURE: T:IKEVIN D1Bm'Iding Ct�1ExP RSM&C Revised 061313 , Massachusetts-Department of Public Safety Board of Building Regulations and Standards cofl5iiuttStii7 SuP/Ei viitii SYiZCt3iid � License: CSSL-MI62 TIMOTEKYPHAN 4 CIRCLE DIt"-' Wareham MA 0271 •y �l Expiration Commissioner OSAW=17 FROM_ :jam9ad FAX NO. :5083622271 Nov. 9 2012 9:12AM P1 HOME 1aVIPROVEMENT CONTRACT PLEASE.READ THIS Branch Name:New Date'•-1-/_4 _ Sold,Furaidd and Installed by: THD At-Home Services,.inc. Branch Number:31 6Wa The Hord Depot At-Horne Services 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID#75.2ri98460;ME Lit#C 02439;RI Cost:Lie#16427 q / !GT 1.ic#HIC.056�.55�2,,2;M�A Homc I�mp/rovament Contractor dreg.#126893 ilstallation Address:.. 6 / [ Q(�C'"•��• I��[1CP Vfr�e �l cY d of - City State Zip 1'mrLaser(s): Work Phone: Home Pboue: CeJ!Phone: Rome Address: (if different from installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): []1 DO NOT wish to receive ahy marketing emaus from The Home Depot ro t'A t I ormati m Undersigned("Customer'),the owners of the p located at the above installation address,agrees to buy, anct D AM=,;Services,inc.("'the Home Depot)agrees to furt>��and arrange for the installation("Installation")of all malrxials described on the.below and on the referenced Spec Shcxt(s),all of which arc incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): job#: (rnt, i Rd—) ucts: Sheet(s)#; Pro'ect Amount / __ ❑koufina ❑Siding indows L]Insulation `J Gutters/Crnen ❑Entryihiurs ❑ 03045. $ ❑Roofing ElSiding❑Windows ❑Insulation $ " ❑Gutters/Covers[]Entry Doorti ❑ Roofing siding❑Windows ❑lrrsulation $ ❑Gutters/coven ❑Entry Doorsrl ❑Ronfing Sidinng El Windows El Insulation []Cutters/Covers ❑T.nrry Dtxms n $ Mmiutrm 255%Deposit of Contract Ammut due upon eremmOn of thus onatrack Mann Purdm a not Total Contract Amount $ rrcry depasikmwetbao�bh+daftbeConmractAnw�t Customer agrLcs that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Products)included herein,at its discretion,if The Home Depot or its authrxized service provider determines that it cannot perform its obligations due to a structural problem with,the home,environmental hazards such as mold,asbestos or lead paint,odor safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment•Sutnmarv: The Payment Summary# a 0'9 ',1 rincluded as part of this Contract,sets forth the total . Contract amount and payments required for the deposits and final payments by Product(as applicable): NOTTCF TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sW Do not sign a Completion Certificate(tote: there is one Completion Certificate for each listed Product as defined by iaalividual Spec Sheets)before work on that Product is complete. in the event of termination of,this Contract,Customer agrees to pay The Home Depot the costs of materialss,labor,expenses and services provided by The Home Depot or Authorized Service Provider tbmgb the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE ROME DEPOT MAY WTT}YII OLV AMOUNTS OWED TO THE HOME. DEPOT FROM THE. DF.POSTT PAYMENT OR OTHER PAVMENTS MADE, WITHOUT LIMiTiNC.THE.HOMF.DF.POT'S OTHER RF,.MFDTES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Aothoriration: Customer agrees and undcrstands that this Agreement is the entire agreement between Customer aud.The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This A-reement cannot be assigned or amended except by a writing signal by Cuslu! r and The Home Depot.Customer acknowledge anTa Tees that Customer has read,understands;voluntarily accepts the rs ul'and has received a copy of this Agreement. *CNPCELLAITON, b . Sabmi by: nIcLzr��__ rd+nau a '`� Snits Co ultant's ignature DxtcTelephone No.'s Signature DaSales Consultant License No. CXJSTOMI,1 MAY CANCEL THIS applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTiCE TO THE HOME DEPOT BY MIDNIGHT ON THE, THIRD BUSINESS DAY AFTER SiGNiNG THIS AGREEMENT. THE STATE. SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE. IS SPECIFICALLY PRESCRIBED BY LAW iN CUSTOMER'S STATE- NOTICE:ADDITIONAL TERMS AND CONDfrIONS ARE STATED ON THE REVF.RSF,SIDE AND ARE PART OF TMS CONTRACT tlWg15 WhPoB-lRMnohF% Yellow—Customer I - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - �www vws-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectridans]Plumbers AvOcant Information please print Legibly Name(Business/0rgauizationll[ndividual)- _I 1� 6"7 Address: Q C/f`Je b rt ue- City/S afe-h QM Oa 5 7/ Phone#: urd K— ?&;2-- Are you an employer?Check the appropriate box: Type of project(r 4. I am a YP P J (required): I.❑ j am a employer with ❑ general contractor and I * have hired the sub-contractors . 5. ❑New construction Panmploayseee {full and/or part time).2. proprietor or partner-' listed on the attached sheet 7. ❑Remodeling ship and have no employees Thy sub-contractors have.. g. [3 Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insures ce comp.inm ranceJ !J g required:] 5. 0 We area corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their . l I.[]Plumbing repairs or additions myself(No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required,]t c. 152, §1(4),and we have no 3a.0 I am a homeowner acting as a employees.[No workers' 13.0-Other general contractor(refer to#4) comp.insurance required.]. Any applicant that chests boa"al must also fill out the section below showing their wodk=s'compensate ,Mlicy m� t Homeowners who submit this affidavit indicating they am doing all work and then him outside contractors mast submit a new affidavit indicating such. •tConnactors that check this boa must attached an additional sheet showing the n me of the sub-eontcsctom and state whether or not those entities have employees. If the Bove employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation Msurance for my employee& Below is the policy and job site _— information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy oft the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as reT*ed under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP-'WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I dip hereby certi under th pains and enaldO rtf perjury that the infor madon provided above is true and correct Si tore: _ Date: Phone#: O,U al use only. Do not write in this area, to be completed by city or town o&&L City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone* The Commonwealth of Massachusetts f Department o De art Industrial Accidents P Office of Investigations -> I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Leaibly Name (Business/Organization/Individual): The Home Depot At-Home Services Address:908 Boston Tpk City/State/Zip:Shrewsbury,MA 01545 Phone#:508-962-6942 Are you an employer? Check the appropriate bog: Type of project(required): L K I am a employer with 200, 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp.insurance.$ required.] 5: We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp: right of exemption per MGL 12.0 Roof repairs insurance required.]f c. 152,§1(4),and we have no WINDOW REPLACEMENT employees. [No workers' 13.01 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:New Hampshire Insurance Company Policy#or Self-ins. Lic.#:WC 015519215 Expiration Date:3/1/20177 M n Job Site Address: �� a lz e A,-) 1-'g0 e City/State/Zip: 6P i/P✓yi f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the VIA f surance coverage verification. I do hereby certify der a pains and penalties of perjury that the information provided above is true and correct Sip-nature: Date: �� b Phone#: 401- -6 9 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License It 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#: Office of Consumer Affairs and Business Regulation 10 Parr Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvern eat Contractor Registration Registration: 126893 - Type: Supplement Card THD AT HOME SERVICES, INC Expiration: 8r3rza16 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE=3OQ_ -- ATLANTA, GA 30339 -- -.- -. — - -- Updnte Address and return card.dark reason for change. J Address III Renewal Employtnent Les!Card d-7Xe L'Q�yyby/7,C92wec,,LflZ,61!Q1(��Cwar.l26ZeffS Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 9 OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation /,rRegistratiar�- t gg3 Type: 10 Park Plaza-Suite 5170 9W Expirafi, s / l2f6_" Supplement Card Boston,MA 02116 THD AT HOME SESEI RVICE THE HOME DEPOTrXT—'I SERVICES ANDREW SWEETS;:,' `'" 2690 CUMBERLAND`PRRt1lVAY AN�`A,GA 30339 Undersecretary Nov i with ut signature DATE(NMMDD/YYYY) AC40 CERTIFICATE OF LIABILITY INSURANCE 0211612016 F �TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE 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). CONTACT PRODUCER NAME. FAX MARSH USA,INC. PH(AIONE A/C No TWO ALLIANCE CENTERE-MAIL 3560 LENOX ROAD,SUITE 2400 ADDRESS: ATLANTA,GA 30326 INSURE S AFFORDING COVERAGE NAIL# 100492-HomeD-GAW-16-17 INSURER A Steadfast Insurance Company j367 INSURED INSURER B Zurich American Insurance Co 535 THD AT-HOME SERVICES,INC. INSURER C:New amp N Hampshire Ins Co 23841 DBA THE HOME DEPOT AT-HOME SERVICES Illinois National Insurance Company 23817 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER:8 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 URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUER POLICY EFF POLICY EXP LIMITS r6— TYPE OF INSURANCE POLICY NUMBER MM/D MMrOD/YYYYGL04887714-06 03101/2016 0310112017 EACH OCCURRENCE $ 9,000,000 Ell X COMMERCIAL GENERAL CIABIUTY DAMAGE TOR NTED 1,000,000 PREMISES a occurrence) $ CLAIMS-MADE OCCUR EXCLUDED LIMITS OF POLICY XS MED EXP(Arty one person) $ OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 GEHL AGGREGATE LIMIT APPLIES PER: 9,000,000 PRODUCTS-COMPIOP AGG $ X POLICY ECT LOC $ OTHER: 03/01/2016 03/01/2017 COMBINED SINGLE LIMIT $ 1,000,000 B AUTOMOBILE LIABILITY BAP 2938863.13 a accident BODILY INJURY(Per person) $ X ANY AUTO BODILY INJURY(Peraccident) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS PROPERTY DAMAGE $ NON-OWNED er accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE $ EXCESS UAB CLAIMS-MADE $ DED RETENTION$ :TWC055`19215(AOS) 03/01/2016 0310112017 X STATUTE ERC WORKERS COMPENSATION1,000,000 CAND EMPLOYERS'LIABILITY Y/N 015519217(AK,KY,NH,NJ,VT) 03/01/2016 0310112017 E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE a N/A O3IO1/ZO16 0310112017 1,000,000 D OFFICERIMEMBER EXCLUDED? WC015519216(FL) E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) 1,000,000 li yes,describe under Conitnued on Additional Page E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD (29�� 17 h r Town of Barnstable *Permit /_ (o ll Expires 6 mont rom issue Regulatory Services Fee BARNSfABLE, MAC' Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY (,© Not Valid without Red X-Press Imprint Map/parcel Number " Property Address 9 c,O ILL E`rPN f> ❑Residential Value of Work$ D� , . Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M E C A, (,L//7 pLE� Contractor's Name Telephone Number�a]Y S,a�,�.t op Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: PRESS #& ❑ I am a sole proprietor XoI am the Homeowner SEp 3 2n1 I have Worker's Compensation Insurance ®w ry Insurance Company Name IV OF B4 8/nU ,J V S rAB LE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(st'ripping old shingles) All construction debris willbe taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows V e d 1 �i #of doors: n� Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors Licenseis required. SIGNATUREZI - Q:\WPFILES\FO \building permit forms\EXPRESS.doc Revised 040215 d} ?lie Commomvealth of MlMasmacdjusetts . . Department c�,f litdostiialA.cciderds - Offl-ce o,f".£rrwestigad ens 600 Washington Street ti Boston,MA 02111 f Vrvrf nrassgovfdia Markers' Cumpensation Insurance Affidavit:B_mldersiCuntractors/Electricians/Plumbers Applicant Informafiani. Please Print Lg,ojbIy �T _ 3 1`Ie USImL 3�Q33ffIIEQa1 Address: h2 qGL L1 0 ./ D�city/statep_ ,3nej�7 \r7q= �� B Are you an employer?Check the appropriatk box: T of project r 4. I am a general contractor and I Y� p ] (required): 1.❑ I am a employer with ❑ 6. ❑New construction employees(full andl`oc part-time)-* have hiredthe sub-cone actors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 't- ❑Remodeling ship and have no employees. These sub-contractors have g_ ❑Demolition woddrig for me in any capacity. employees and have workers' 9. ❑Building addition [No nrorkem,comp.insurance comp.mstrance,t required-] 5_ ❑ We are a corporation and its 10_❑Electrical repay or additions 3. I am.a homeoumer doing all work officers have exercised their I L❑Plumbing repairs or'additiom myself[No workers'camp- fight of exemption per MGL 12.❑Roofrepairs insurance required-]F c.152, §1(4) and wre have ns employees.[No workers' 13.❑Other camp.insurance required.) *Any WKczrathat checks box PlmostakefMoitthe section baLowshavdngtheirwalerecompensaticnpolicginf ntsdon- Hnmeawners who submit this aftidnit=&rzft g they axe doitg sll wank sad then hie outside contractors most sohmu anew affidavit kdicaiin,-such, fC ontlactors Yfixt check This boat mist attached an additional sheet showing the name of the sub-contrwAmm and state whether or not those entities have empimfees.If the sub-coatnutflhshave employees,they mustprov-ide their workers'comp.poli-Ynumher. I ant an eariplgyer tliat is pratzding it orkers'congwisadora insairance for arty*enrplp},ees ,Below is the pollry and jab site infbrnxrrtian. Insurance Company Nance: Policy#or Self-ins.Lic_# F-kpiration Date: _ Job Site Address: CitylState/25p: Attach a copy of the workers'compensation policy declaration page(shoving the policy number and respiration date). Failure to secure coverage as required.under Section 25A of MGL c- 152 can lead in the imposition of criminal penalties of a fine up to$1,500.00 andFor one-year imprisonmentas will as ci-i+il penalties.in.the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verifrcation. I rd'o hereby f3'under tha pains andpenaWes f wry that fife infonuadmi pm*&d abm a is berg mid correct Si�atur - Date: p- Phone r— Official use only. duo not write in this area,to be campleted by c4 or tonrn o f 4ciat City or Tomu: PermitiLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector S.Plumbing inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts G&neral Laws chaptea 152 requires all enrplayers'to provide workers'compensation for their employees. Pm suantto ibis statute,an.mployne is defined as."_.every person m the service of another under any contact of hire, express or implied,oral or wry" An errpFayer is defined as"an individmaI,pa tambip,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 iadividnal,partnership,association or other Iegal 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 mainteamm,construction or repair work on such dwelling house or on the grounds or budding appurtenant therm shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also stairs that"every state or local ficensiug agency shall withhold the issuance or renewal of a license or permit to,operate a VuSiness or to constrnctbwTdings in the commonwealth for airy applicant who has not produced acceptable evidence of compliance with th-e i„cm-ar�ce.covearage regained." Additionally,MGL chapter I52, §25CQ states"Neithmthe comnidaw-ealth nor znyofits political subdivisions shall enter into any contact forthe performance ofpublic work unifi'acceptable.evidence of compliancevrith the insu-a„ce: regIjar- Tents of this chapter have been presented fin the contracting Lft Di it " Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their cerEificafe(s)of k c zEmee. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,ale not regtmed to cauy workers'compensation insu:r-ance. If an LLC or LLP does have employees, a policy is regnued. Be advised that this affidaYit may be submit--d to the Department of Industrial Accidents for confirmation ofinsurance coverage. Also be sure to sign and date-he affidavit_ The affidavit should ., be reta=ed to the city or town that the application for the permit or license is being requested,not the Department of Ljauah-iai Accidents. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number lisiad below. Self-insured companies should enter their self-fisur ce license nrmber on the appropriate lime. City or Town Officials . Please be sure that the affidavit is complete and pried 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 penit/license number which will be used as a reference number. In addition, an applicant that must:submit multiple permit/Hcense applications in any given year,need only submit one affidavit iadicaimg current policy imfo=atiorr(if necessary)and under"Job Site Address"the applicant should•.write"aII locations in (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the ' applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves eto.)said person is NOT required to complete this affidavit The Of of InvegagEdions 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: 1 e C.G.MMMWeRjtjj of M szachusetts ' i Degarbnent of 1ndustcial Aouiderits Gface-of j ve.sfZ tio= Goo,WaSUEOau St-A ostGns MA G2111 TfI 4 617 727-4900 Qxt 4-06 or 1-9 I &AFF, Fax 9 617-727 7M Revised 4-24-07 Town of Barnstable Regulatory Services • �oFtHWE rOiyr Richard V.Scali;Director ' Building Division t. EIMMSTAB Tom Perry;Building Commissioner MASS v� 1639. �e� 200 Main Street, Hyannis,MA 02601 '°rEv www.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION —, Please Print DATE: q''�`� ��r n t ,�^ �,/� � �n � .r Q JOB LOCATION:Aq C/�1'C`-+G I D!G 1 Z• C, Fjj i(* V i L L� ri�"/l number '*� street village"HOMEOWNER": C i ►'V� l _7! ` �rS�" f� _��4` / ;J fl 9 /-7► name home phone# ° work phone# . CURRENT MAILING ADDRESS: Lt ` . city/town N state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess'a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends-to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. e undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection cedures and requirements and he/she will comply with said procedures and requirements. Inature of Hom er k Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the ' permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ' 41 anxxsrnsi.E. II ''. Town of Barnstable 1639. �ArED MA'S A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 r t J i ` �t 4,1 ram. �t i www.town.bacnstable.ma.us Office 508=862-403$ 4� 1 ( ; C.( - }� �� \`Fax: 50$`7;90-6230 Property'G* r Must Complete and Si This Section. If Using Builder I ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorize y this building permit application for: t (A ess of Job) Signature of Owner Date Print Name If Property Owner is pplying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHILESTORMS\building permit formMeRESS.doc Revised 040215 E " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel OF SARINS TAPA41ication # �r IJ 6 �-- Health Division o.Date Issued Conservation DivisionAA" Application Fee Planning Dept. . . . Permit Fee Coo.00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4 A h E g?fit` 4 , Village M/1 OwnerTROI E� lam(.JAOL E1/ Address Zaq L APb e Fyu 1.HJ Telephone 7`7 q - IQIQ Permit Request otgA n A A k or /yy-y E lit Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,0400 0®Construction Type EC 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 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)_ A // Name 4 Telephone Number I- 7'7q°-JTa I DIO Address � 4ff2LO4�bc License # ce MA D Home Improvement Contractor# Email' A I Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `�/ice_ �f L SIGNATURE DATE / ELVt d- FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ` OWNER : I DATE OF INSPECTION: FOUNDATION 5C-,; - Va ts" FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING e ZJ l;r DATE CLOSED OUT ASSOCIATION PLAN NO. r 17re Commomvealth of-Massachusetts Deparbrrerit of rmha rial Accidents - - Off r-e of fnvtestigations. . 600 Washington Street y Bastonl MA 02111 ivYs nn'ma_,mgon°1dia i Mrarkers' Campensaf ffn Insurauce .davit BiiildersiCuntracinrs/FIectr cianslPlumhers Applicant InfGnnation Please Print 1&,cgbly Name(B=wJ07ga imfi'madivi W1Y , kMol�y city/ &i�/ :_ ceap y, (le © Phone- •- 7 7 Y S'S _J 100 Are you an employer?Check the appropriate 0= Type of project(required)c 1.❑ I am a employer with 4. I am a general contractor and f 6. ❑New construction employees(full anVor part-time).* have hired.the sub-contractors 2.❑ I am a sale proprietor or partner- listed on the attached sheet. I. ❑REmodeliug ship and have no employees. These m 3b-contractors have g Demolition wor#ting for nee in any capacity. employees and have worlcers- 9. ❑Building addition [No Workers' Gi7mp.inSUT nre comp.msuranci—# required.] 5. ❑ We are a corporation and its M_❑Electrical repairs or additions 3.❑ I am a homeo Amer doing au work - ofFcm have exercised their 11.❑Plumbingrepairs or additions =)s f [No workers' _ right of exemption per MGL 12.❑Roofrepairs insurance required-]i c.152, §1(4),and we have no employees.[No workers' 13_❑Other• . camp-insurance required.] Tiny appFiamt that checks box 91 most also fill cutthe sectionbeIaw showing their workeie compensation policy in5rMatian- Homeowners who submit this affidzm indicating fhey are doing all wcA and then hire outside contractors— submit anew affidxvxt indicate sash_ Z03ntractors tfiat check Thk box mast attached as addi6nna2 sheet shoo mg the name of the sub-camU ctors and stare whether,or not those entities here employees. If the sub-conttactorsltave employee%theynnist provide.their norkers'comp.policy number. lam an eiiiplger tliat is pronzdirrg iiForkers'contpensadaif insurance for uzy enrplayees. Seloev is the policy arnd job rite information. Insurance Company Name: Policy 41'or Self-ins.Lic.4 Expiration Date: Job Site Address: CitylState 2 p: Attach a copy of the corkers'compensation policy declaration page(showing the policy number and expiration date.). Failure to secure coverage as required udder Section 25A.of MGL c 152 can lead to the imposition of criminal pemlties of a fine up to$1,50D 00 andror one-year imprisonment as well as civil pen.alties. m in the for of a STOP WORK ORDER and s Rue 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 afthe DL4 for insu=ce coverage verificatiom I do hereby T under the paints and pt;nr ' s of-perjury d!atthe informations primided abm a is tnw and carrect 0,,7ciaL use only. Do na7t write in this area,try be completed by city ortown official 'City or Tonu: PernutUcense 4 ` Issuing Antheri€ty(circle one): ' 1.Board of Health 3.Buildmg Department 3.C`i yTo*n Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other u Contact Person: Phone#: Information and Instructions T Massachusetts Geneaal Laws chapter 152 requires all employers to provide woike&compensation for their employees. Pmsuant-to this side,an mrPlo3' ee is defined as."_.every person in the,sm-vice of another under airy contrast of ham, express or implied,oral or written." An.employer is defined as'an individual,partnership,association,corporation or,other legal entity,or any two or mote of the foregoing engaged in a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individnal,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 - ciwelling 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 shaI 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 ficf- e.or permit to operate a business or to construct buflditrgs in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the hisurance.coveirage required." Additionally,MGL chaptrr 152, §25C(7)states-Neither the commonwealth nor any ofits political subdivisions shall enter iat:) any contract for the performance ofpublio work until acceptable evidence of compliance with the insurance.. regrriremenfs of tip is chapter have been presented to the contracting'aLdhozity." Applicants Please fill otut the workers' compensation affidavit completely,by rhecldng the boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers) along with their certificate(s) of in -ance. Limited.Liability Companies(LLC)or Limited Liabffity Partnerships(LLP)with no employees other than tine members or partners,are not required to carry workers' compensation insurance. If an LLC or LIT does have employees, a policy is required. Be advised that this afa-da7yit maybe submitted to the Department of Industrial Accidents for confiatiou of insurance coverage. Also be sure to sign and date-he affidavit The affidavit should be reused to the city or town that the application for the permit or license is being requested,not the Department of IndustialAczidents. Should you have any questions regarding the law or if you are requ d to obtain a workers' compensation policy;please caIl the Department at the n=Lber listed below Self-insured companies should enter their self-insurance ce license number on the appropriate line. City or Town Officials f _ Please be sure that the affidavit is complete and prmtEd.legibly. The Department has provided a space at the bottom of the affidavit for you to f5Il out in.the event the Office of Investigation has to contact you regarding the applicant Please be sure to fill in the pemritAicrose number which will be used as a reference number. In addition, an applicant that must submit multiple pennit/Iicense applications in any given year,need only submit one affidavit indicating current policy iulf6rnation�rf necessary)and under"Job Sim Address"the applicant should write"all locations n (city or town)_"A copy of the-affidavit that has been officially stamped or mariced bythe city or town may be provided to the applicant as proof that a valid affidavit is on file for fume 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 (Le. a dog license or permit to bum leaves etc.)said person is NOT zeqaired to complete this affidavit The Of 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 Dei art n fs address,telephone and fax mmmber. -Tht C�G.nMjanWattbL of Massachustt�-. Dep eMMt of 1 mtdal Accidents . G.fuce of bveydkatlo= 1504 WasbiVGIL . Basto-n,MA G1 l I I TcL 4 617 727-4900 ext 4-06 or I-977-MASSAFE Fax# 617-727-7M Revised 4-24-07 p ,mass-govldia A FVC Guide to Woad eorestrucdorr irr'firV� mad Areas:1l Q 1 plr fKad Zane Massachusetts ChccklLst for Compliance(7so cmR s3v' r.l), Pl ch=k _ cDMprianrs 1_t SCOPE- VOW Spe!d-pser<gust)- 110 mph Wind Exposure Category-- ____-------__B Wind Exposure Categary._:.............Engineering Required For Entire Prn)ed_-_-----:•-- -.__-------- ._C 12 APPLICABILITY -Number of_fr-'Wes(a rpof which exm eds B in 12 slope shall be considered a story) - stories 5 2 sinries Roof Ptth .__._ _-._- -- ------ -(r9 2) __ <_12:12 Mean Roof Height - -- ----_. _.---:---(Fg 2)--=-- -- — - - -- ft`s ' Building Width,W Fig 3) Butldin_g Leng$i,L _._._ ----_--__-_-- (Fig 3)_ Building Aspect Ratio(11W) ______._._-------(Fg 4)-_--- _--- ____ �3:1 Nominal Height of Tallest Opening2 (Fig 4)__-_- -----__-_ :_�� <SIB, 1-3 FRAMING CONNECTIONS General compliance wFdh ft nfrig r'nnec6ons_-._____-7:-.(Table 2)------:---------.__._-----------._-_. 2.1 FOUNDATION " Foundation Walls meeting r'eq gmments of 780 CMR 5404 Cones----•••-•....... . .....--•-----•-•--- --._..:...__... -._.:.1.- - ..................................... Conte Masonry....... 2.2 ANCHDRA§E TO FOUNDATION"3 5/3'Anchor Bofts•imbedded or 5/8`Proprietary Mechanical Anchors as an alit=rhative in concrete onfy BDIt Spacing-general..........._........--------------�.(Table4}_ _.--- �__.___ in. RDItSpacin"g from endrIDInt of plate _,__-(Fig Bolt Embedment-concretL- _ _---.(Fig 5)..-- in.>7 Bolt Embedment-masonry-:-._-:-------:__(Fig 5)_-_--_-- - _-_-- _ in_>151 Plate Washer_._ F -?3`x 3`x tl. --_____- [ g 5)_- _-----:- 3.1 FLOORS M Floor-framing member spans.checked _ _----(per 7BD CMR Chapter 55)-------_--�- Maximum Floor O lng Dimension-- -____-_-- i 6 ------:-__-_-• Full Height Wail Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)_________________________ _-------- Mh-dmLim Floor Joist Setbacks SuppDMng Loadbearuig Watrs or ShearwaR_-___-(Fig 7).__-.,.._-_--_--__-�- -_-_ft: s`d Maximum Canflevered FloorJofsfs_ Suppo-rfng Lbadbearing Walls or Shearwall-.-.-__._(Fig 8) It :5 d •FloorBracing at Endwalls-_----•-_-....��__------.__(Fg 9)_ -__---___.�_.---------• Floor Sheathing Type Floor Sheathing Thicfiness (per TBD CMR Chapter 55).---...T:._........Floor Sheathing Sheathing Fastening...........:____.______- ___:_.(Tahie 2)__d rzaifs at ' in edge I'in field 4_i WALLS Wall Height Loadbearing __:- -(Fig 10 and Table 5)' :ft s 10' Nan-Loadbearing walls —_(Fig 10 and Table 5)_ Waft Stud Spacing ..--------�.- ----_:_ (Fig 10 and Table 5)__� rrn_<24'o_c. Wall Story Offsets •' ___�___ -.�-___- -�____'[Figs 7&8}-- -._.__.:__.-_-_ ft s d . 42 ECTE UDR WALLS Wood Studs g -R to ----__...- Laadbeatirr �aILs____�- - _ -._. .._._. ale •---_.2ac - fit in. _ Non-Laadbearing waifs.-_---- .(Table 5)_-_.------..-____2x - ft in Gable End WaA Bracing' — — — FuIl HeightEndwall8tuds ' - (Fig ID) WSP-Affic Floor Length r ft�:W/3- Calling Len Cif WSP not used r 1 I Uyp�irn 9 C ) - (Fg ) and 2 x4 Continuous La ial Brace Q B ft o.c _(Fg 11�--________________•----..-----____-- or 1 x 3 cr ding finning strips 1 T spacing-mm_with 2 x 4 blocIdng @ 4 ft spacing in end Joist or truss bays Double Tap Plai>e Splice Length (Fi9 SpIIcs Canneafion (no_of 16d common nails)- -_-__(Table fi)_�- ATYC guide to TYood Catrstrucd6l' in Nigh Wtad Areas: 110 ftrph fflaid Zane ' Massa cliusetts Checklist for Compliance Mo awlzs3o1.z.1-1)i Loadbearing Wall Connections - Lateral (no_of 16d common naffs)__----__ (Tables 7) NDn-L•aardbearing Wall Connections Lateral eral(no.of 16d common naffs)-_.-__ -._(fable Load Bearing Wall Openings(record largest opening but check all openings for mi pttance fn Table 9) Header Spans -_--__- _(Table 9)--_.-_-___ _ft_in.511, SM Plate Spans _. --_(Table 9)____--_____-_.--_ FLA Height Studs (no_ of'sffjds)___— -__._-(Table 9) --- Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) fY in. <1z SIR Plate Spans.--- -- ---(fable 9)____ —ft_in._<12" Full Height Studs(no.of studs)__--_ _ (fable 9)-_---___-- __-- Exierior Walt Sheathing to Resist Upfdt and Shear.SimuttaneDusv Minim=Bolding Dimension,W Nominal Height of Ta lest Dp riingz - 5 Sheathing Type_._ _--____--(note 4) Edge Nail Spacing _- (Table 10 or note 4 if less)---_._-___-_. in- Field Nail Spacing-__-- ------.�.(Table 10)__-_-_-____-- in. Shear Connectiori(no_of 16d common nails)(Table 10).;-_,-____-__.-_ Percent Ful(-Height 5heathing_____---_.: (Table 10)-_ _--------- ------_% 5%Additional Sheathing fDr Wall with Opening>-S'W(Design Concepts)-.__--____.__. Maximum Su!(dng Dimension,L Nominal Height of Ta lest DpeningZ—--------------------------------------------------------_—<6'8' ` Sheaffiing Type. ----.---(note 4)_--+ - ---- ------- Edge Nail Spacing--__. -_-- _--(Table 11 or note 4 Feld Nail Sparing (Table 11) - ,--- in_ ShearConnection(no. of 15d common nails)(Table 11).... . __-•-- Percent Full-Height Sheathing--- __(Table 1I).- 5%AddrbDnai Sheathing for Wall with-Opening>6'8'(Design Concepts)------__-_._ Watt Cladding Rated for Wind Speed?--__---- _-�___�_-._..___ .___-_ __ _- ---•- 5.1 ROOFS Dof framing member spans checked?_ _.�.(For Rafters use AWC Span Tool,see BBRS Websr�) R RDDf Verhang ______.__________.._-•_--•:-•---- ---(Figure 19) ___.:- --- ft s smaller of 2'Dr v3 Truss or Ratter Connections at Loadbearing Walls Proprietary Connectors -------------.(Table 12)_-_------ --- U= Plf 'Lateral_:_-----.�-_-----.-_--(Table 12)__ _--- ---.-L= plf ---(fable Ridge Strap Connections,if collar ties not used per page 21-._ (Table plf Gable Rake OuttDOkar------------------__--__--;_____-_(Figure 20) .____.. __ft_<smaller of 2'or 1_12 ' Truss or Rafter Connections at Non-LDadbearing Walls Proprietary Connectors (Table lb. Lateral(no_of 16d commDn nails)_..(Table 14)----------------------------------- ! _ . ib. Roof Sheathing Type (per7RD CMR Chapters 58 and 59)------------ RDDrSheafhing Thicdmess------.-- _ --__;----__-- --__— in ?7116'WSP Roof Sheathing Fastening---__-- -----_- (Table 2)___�:-__-y_-_- -----•_ NDtBS: 1. This checklist shall be met in its entirety;excluding the specific exception noted in 2,to comply with the requirements of T30 CMR53DI2-1.1 Item 1. If the checkfst is met in As entirety then the MM&ving metal straps and hold downs are not req uired per the WFCM 110 mph Guide: a_ Sfeei Straps per Figure 5 b. 2b Gage Straps per Figure 11 c. Upfdt Straps per Figure 14 4 cL All Straps per Figure 17 e: Comer Stud Hold Downs per Figure ISa and Figure 18b 2. E=epfion:Opening heights ofup to 8 fL shall be permrli!A when 5%is added to the percent full-height sheathing requirernerifs shaven in Tables 10 and 11. 3- The bottom silt plate in eAf4ior walls shall be a minimum 2 in_nominal Hckness pressure treated##-•grade. ATVC Gz de fa Wood Corr.T&ur..tiory i:n I�i,�tc frindAreas_ 110 raph H,?xrdZc>ae y Massachusetts Checkhst for Compliance(790 CKR53.0t3:.1:I)r 4 a_ From Tables 10 and 1 i and location of wall sheathing and Building Aspect Ratio,determine Percent Fufl•-•Height SheWhing and hlarl Spaang raipirements I I - b. Wood Strudival Panels shall be ma►fmum thickness of 7116'and be•installed as follows; L Panels shall be installed Mth strength;M' parallel to studs. H. All horimntaf joints shall occur over and be nailed to framing_ tn_ Dn single sfniy cnnsfrucfion,panels shall be atfached to bottom plates and top member of the double top Plate Iv. Dn tvm story mnstucGon,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel_Upper atfachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first boor framing. v. Horimntal nail spacing at double top plates, band joists,and girders shall-be a double row of Bd staggered at 3 inches on center per figures betDw:Vertical and Horizontal Nailing for Panel Attachment 5_ Glazing protecfion:a)'new house or horizontal addffion—requined if project'is 1 mile or closer to shore(generally,south of Rte.2B or north of Ria.6) b)vertical addfh'on—not required tmless there is extensive renovation to the first floor . c)replacernentwaidows—needs energy conservation mmpGaflCe only(chap 93) S.Wood Frame Construcdon Manual(WFCM)for 110 MPH,'Exposure B may be obtained from the American Wood Council (AWb)vlrelbsltf_ � YIriH•rTNs IDGET�rSrs ou _ ' > rsasd war.$ ATts tt ,1 t • .t tl ' 1 �' " i ll 11 _ I r' ❑c - l 'l' I7tr � I• I < t .. f I o is • F ii lI m_ _ 1 i ¢ i 1, G t .i itr t t r. ' hi t I{� � •1 ... I�GEBQtL tl LE w ;: II Ir - L' t - 3tat 'tt u • p ii fi� I I •c � I i II n 1 I u rc 1 r II Ir r� i. t r n fit tI STh[GERED 3`hdld i E 5?.4CkJG WAX PATTEF" z p • 1: EDCwr-- 'D0LMLEWAJLSJGES?ACM DEFXL See Detail on Ned Page _ Vertical and HDr'aorrW HaIng Defaifl for Panel Attarhmenf ' V=rfiGai arxt}ioficDnfal Naitii�g _ M1 for Panel Ati ad ment Town of Barnstable Regulatory Services °Fare r°iyy Richard V.ScaIi,Director ° Building Division j�$r�y-tAART.1t Tom Perry,Building Commissioner ' MASS 200 Main Street, Hyannis,MA 02601 pTEO www.town.barnstable.ma-us Office: 50 8-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ` ^ p D Is,- Please Print - DATE:~ ` ` /] . JOB LocATI02 —6 C AkVIDN L(f. C E rkkk1LLE t 1.A_ 0�.,(p3 number street village -HOMEOWNER":_TACnrz-_ 9, M)ftLC�! I N F,50,J !o v _? ?_7 yY 144 name h ^ ome phone# work phone# --CUPJ b' MAMING ADDRFSS: � G A/L t� rorP C N {2�/�l Q. ��'( V 4jj city/town state zip code. The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow 'homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor... DEFINITION OF HOMEOWNER l 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, aifached 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 Build ag Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned``homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection rocedures and requirementsand that he/she will comply with said procedures and requirements. Si aiure of Homeowner Approval of Building Official a •_Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTTON The Code states that- "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1,7.Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case;our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the Iast page of this-issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFMESWOKM.S\budding permit fomss\EMESS.doc Revised 061313 �zHE r° ti Town of Barnstable Regulatory Services + RARN x ELV. f 9 MASS. Richard V.ScaI4 Director s6;q. 'OrEnMa�I Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 P� P ro 'e'rY OwnerMuhst �,-� .�� :�� �1r .,s �� •, S- �i'�,�-- ,�Womplete and Sign`%This;Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorize bythis wilding permit application for. ( ss of Job) Pool fences and alarms e the responsibility of the a licant �Tools� are not to be filled or u d before fence is install1-rdl d all final inspections are performe and accepted.: Signature of Owner Signature of Applicant Print Name Print Name Date QFORMS:O WNERPERMISSIOhTOOLS r ACORU® CERTIFICATE OF LIABILITY INSURANCE - °"�`"�41=015 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 WANED,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 NAMThe John M.Sullivan Insurance Agen PHO E 78 -44 330 FAx No: 781-449-3511 P.O.Box 92 AADDDDRLESS: sullivan.insadv@verizon.net Needham,MAA 02492 INSURE S AFFORDING COVERAGE NAIL 0 INSURERA:Essex Insurance Company INSURED INSURER8:Associated Employers Mutual Metro West Residential Const INSURERC: Archadeck of Metro West INSURER0: 48 Mechanic Street INSURERE: Newton,MA 02464 n+suRERF: COVERAGES CERTIFICATE NUMBER: Z.507 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE D SUS WVD POLICY NUMBER MMM EFF POLICY ExP VMS GENERAL LIABILITY 3DX9435 1/02/2015 1/022016 EACH OCCURRENCE E 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) E 50,000 CLAIMS-MADE �OCCUR MED EXP are $ Excluded PERSONAL&ADV INJURY E 1,000,000 GENERAL AGGREGATE E 2,000,000 GIEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG E 1,000, POLICY PRO-JEcT LOC E AUTOMOBILE LIABILITY COMBI SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) E ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per ec�erd) E HIREOAUTOS NON-OWNED PROPERTY DAMAGE E AUTOS er trc�erq E UMBRELLA LIAR OCCUR EACH OCCURRENCE E EXCESS LIAR CLAIMS 6MDE AGGREGATE E DIED RETENTION E E WOR107tS COMPENSATION WC STATU- OTH AND EMPLOYERS LIABILITY Y/N 323/2015 3/23/2016 1 TORY LIMITS EEL ANY PROPRIETOR/PARTNERIEX:CU IVE EL EACH ACCIDENT E 500,000 B OFFCERR*EmgER ExcLuDEoz ❑ N/A WCC-500-5004380-2015-A (MamWM In NH) EL DISEASE-EA EMPLOYEE S 500-000 If yyeess describe under DESCRIPTION OF OPERATIONS below - EL DISEASE-POLICY LIMIT E i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks Schedule,N more space Is required) CERTIFICATE HOLDER CANCELLATION JOSeo' Florentin0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE `THE-EXPIRATION DATE—TREREOF,—I�OTLCE WILL BE—DELIVERED IN 7 BariBQf Road ACCORDANCE WITH THE POLICY PROVISIONS. West Roxbury,MA AUTHORIZED REP ©19884010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD s U.S. Structures, Inc. Construction Division y The intent of the mention of a material or method of construction in this outline of specifications is that the material. be installed in a, workman like manner, and the method be within the highest standards of the applicable construction trade. All work shall meet or exceed provisions of all governing codes and ordinances. The drawings 11 attached hereto act in concert with this set of specifications and the AGREEMENT. The drawings are general it nature. It is intended that the contractor adjust dimensions, materials,.and methods of construction to properly adapt the work to site conditions. Work in excess of that shown or described in the contract documents may be the subject of an extra charge to the Purchaser by ARCHADECK(the contractor). EXCAVATOR. ! Excavate for all foundation work to depth below grade required by Local code. Footings shall rest an undisturbed„earth CONCRETE: concrete of a Solid concrete masonary units or 3000 psi strength , Size sufficient to spread the imposed foundation load on the bearing soil in accordance with code requirements. CARpENTRY: . All wood shall be#2 or better Southern Yellow Pine,pressure treated with otherwise indicated on waterborne ACQ preservation to .25 pcf(unless the'drra&gs), of norminal sizes and detailing indicated on the drawing or by the code. WTAI.S: All hardware shall be galvanized or zinc plated of a size and spacing sufficient to carry pr transmit the intended structural load in. , accordance with governing codes and applicable structural standards. -N SPECIFICATIONS CONSI — �- . , Rm iie 1/30/08. w. T�pfcal Girder oditock and :Ratl IDstail 2XIa jo IT ate 16 C)AW 4d x �.T' Col umn loft 5/4x4:,v ast-ofto'k, frig, an .4- 4 :IP sple Exterfor mks a, L `1 Ptlo-kou spadrn I ,Joist$ CRY 0.01 Have* aarla:- �r<r ►Ilq �m� ►I to footrr s CoMm . u e 0K.TGAGE . tNSPECTION PLA. I el- iic tAA Parch f 4 7 T 05' Niewtm 3 iC r c r r1 bra Pr 60,n r r W. .. ct�f�foh" td the Icx ,z err �i ter f �t tie t� � o f any u wit'o r s c ie t ru al rxa t trsry 1 tf ire € e iat t r orrs exempt kor vi©(ati&e �i c� ra rr� t a tiler r GL" it NO:� . 4W tv � to 4 61 nkeW� S&Ww andtwos.�� . 4 "giant for Won c a�ftrnttf� u�i�rac��r �` COLONIAL �� �t� t►s�t�ere�r: t`�:.76�f515 `A. J.t �f�+I��.��1'A1�'�?15 f:�.f "t'E3„��Pt1�iE��*l. w _ ` ' INS¢ �TME Town of Barnstable *Permit 0i Expires 6 m , hs rap7issuedW Regulatory Services Fee � BARNSTABLE. • , Mnss. Thomas F.Geiler,'Director prFOMP't�'`� ' lls-itZ Building Division Tom Perry,CBO, Building Commissioner 2.00 Main Street,Hyannis,MA U2601 www.town.barnstable.ma.us Office:.508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not.Valid without Red X-Press Imprint Map/parcel Number b 2 3 L, 1 Property.Address CD f L'aV`t.?-fd LA C&J U'i(p esidential Value of Work© ,C Minimum fee of$357001or work under$6000.00 Owner's Name&Address ri�!1CWLLO ��2�t1"C.l� Contractor's Name VSG(� ��[�rP -- Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance- Check one: .071 am a sole proprietor NOV ❑ I am the Homeowner ?0'� ❑ I have Worker's Compensation Insurance 'rOw . Insurance Company Name K.Y& Nl T L0 N pp Rq RNSTAe Policy# /A4/° (>S// -9 T 4 It z 1 zo--i 3 - LF Copy of Insurance Compliance Certificate must accompany each'permit. Permit Request(check box).. ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping: Going over existing layers of roof) 0 Re-side #'of doors Replacement Windows/doors/sliders.U-Value >• 30 (maximum.35)#of windows 3 ❑.Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical.&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,:i.e.Historic,Conservation,etc. ***Note: PropertyQwner must sign Property Owner Letter of Permission.. . A copy of the Home Improvement Contractors License.&Construction Supervisors License is required. . . SIGNATURE: QAWPFILESTORNIMbuilding permit formsT— S.doc The Caaxr!nanvvea th tia f Massachusetts Deparhnent of Industrial Accident Office o,f'Investigations 600 Washington Street Boston,.MA 02111 . wnnv.mas&gov/dia Workers' Compensation.Insurance Affidavit: Builders/C-ontractors/Electricians/Ph mbers Applicant Information Please Print Legibly Name(&isiness/or�timdn&vidaal)��: 0 Address: ��t rLrt�i r�r mac, CityfStats/Zp: �6 ` �tvJtS 1� OW Phone Are you an employer?Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a genera contractor and 1 6 ❑New construction loyees{full arldfar part-time}.* have the sub-contractors � listed on the attached sheet, 7. ❑Remodeling 2.''�"am a sole proprietor or partner- ship.and have no employees -eontractors have $. ❑Demolition employees and have woorrkeers' working for me in any capacity. 4. ❑Building.addition _ [No worloers'comp.insurance comp.meivantce.l required.:] 5. ❑ We are a corporation and.its 10.❑Electrical repairs or additions I❑ I am a homeowner doing all work officers have exercised their 11..❑Plumbing repairs or additions myself. [No workers'comp right,of exemption per 1wfGL 12.❑Roof repairs insurance required.]T c. 152, §1(4),and we have no employees. o workers' 1 Other comp-insurance required-) �oGzG�1l�S *Any applicant that cbecks box#1 must also fill out ibe section below showing their workers'compensation policy rnformatian: T Homeowners who submit this affidavit i idicating they are doing all work sad than hire outside contractors mnst submit a new affidavit indicating such tContractors that check this boat must attached an additinnA sheet showing the asane of the sub-cma=tors aid state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer dratis prviiding workers'compertsad on insurarimforazy eWpLgjee& Belau is the po icy,seed job site informatioar. Insurance Company Name: L (s&AS Policy#or Self-ins.Lic.it: F'( F� (1 i (� Expiration Date: 2-— Z 00 �� Ci /'State! bMA V U(14 t'`Cst o zo y3 , Job Site Address:&� ��. P 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 al penalties of a fine up to S 1,500.00 andlor one-gear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify Un.der the ns undpenalbFies of pedu7 that the infortr>2atian protdded above it trite and correct Date: / / — .o r 2 Phone# . Official Use only. Do not write in this area,to be cvippteted by city or tower of ci>at City or:Town: Permit/License# Issuing Authority(cinte one): 1.Board.of Health 2.Building Department 3.City(Fown Clerk L Electrical Inspector 5.Plr3mbitig,Easpector 6.Other -, r Contact Terson: Phone#» x 6 . TME� Town of Barnstable Regulatory Services snxivssnsce, . . g Thomas F.Geiler,Director s63q. ♦� i°rFnMa�� Building Division Tom Perry,Building Commissioner . 200 Main Street,Hyannis,MA 02601 www.townibarnstable.ma.us. Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub'ect'property J P p riY hereby authorize .—= �� 1`p� to act on my behalf, in all matters reladve'to work authorized by this building permit: 4 (Address of Job) **Pool fences and alarms are the responsibility of the applicant.: Pools are not to be filled or utilized before fence is installed and all final inspections are-performed and accepted: . Signature of Owner Signature of Applicant i C yc. �y� N✓� Print Name= Print Name _ Dafe Q;FORMS:OWNERPERI M$SIONPOOLS 612012 �t"E r Town of Barnstable Regulatory Services 1ARKnA1112, : Thomas F.Geiler,Director Mnss �bp 1639. Building Division rED MA't A - Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street. village "HOMEOWNER": name home phone.# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 10,,9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly h when the homeowner hires unlicensed persons. In this case,our.Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities.require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used`by several towns. You may care t amend and adopt such a fom-Jcertification for use in your community. Q:forms:homeexempt ` t Massachusetts -Dgpartment of Public Safety Constructionod Supervisor 1 & 2 Fm ! Building Regulations 1Sd Standard Office of Consumer Affairs&Busi�ess Regulation License: CSFA-069660 m ! Wepgi ME IMPROVEMENT CONTRACTOR ',.'i s' stration: Jn24.793 TYPe'VA SCO ENUNEZiration 8/2 /2013 Individual 79 MAYFAIR)tDG y \ South.Dennis 1VYA%02660 r� F Vasco E.Nunez, III Vasco Nunez, III I i Expiration 79 Mayfair Rd. 6P� Commissioner 10/03/2014 S.Dennis,MA 02660 "+.- Undersecretary. Assessor's map and lot number ....M-1.90„ L-2 .6 "w SewQ9ea Permit number .............................. . ........:...... c; �0 c ♦ is Qo�.TMETo� TOWN% OF 6BAR.•NST.A.BLE toy" y0, all .14 Z BA`HBSTIIDLE. i Qi ' `.•� } +-'3.< � w• , 1639• -{a BUILDING INSPECTOR . �-: �-, .. • E, r� ! , c ad APPLICATION FOR PERMIT TO ...Cosistrzac ••sx�gl e... am113�..hca�e. . .. • ........ :y TYPE OF CONSTRUCTION . .......?.............. ..... ........... ... ................. I ..................... 19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....Crel?,teX'.Y.ille.,...Ma................................................................................. Proposed Use .....S121g1.0...f.=1 .y..year...r.RUC),d...home.......................................................... ............................... Zoning District ........................................................................Fire District C.entex'villemOster3rille................... Name of Owner J Albart Bur etti........................Address Lerman...Lane.,...South...YarmAuth.,...Ma. Nameof Builder ....Same...............................................:.....Address ..................................................:...........................:..... Name of Architect ..Same...................... ...Address ................. ...................................................... Number of Rooms" f1Ve ............Foundation ......Poured...cancrete...............:................ ' Exterior .......whit<?...Ceder...rWainglez..................... g p...Roofin asphalt ...................................... Floors r13Y'C ••WOOfl�. . ? a,d..a,Y�:.}S7.t..... ... a.tk..Interior dry .................. Heating fQrced..hot...water...by....gas.....................Plumbing ..one•.bath...(plastic..pipe.).................... Fireplace in...liwing..raom...(red...brick)..............Approximate Cost....2.5,000............................... .................. Definitive Plan Approved by Planning Board ________________________________19__,_____ . Area. ..1.0.7.6.-living. area Diagram of-Lot and Building with Dimensions see attached plans Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. No ................................................................................... Bassett, J. Albert --19426 one story No ................. Rermit for .................................... single family, dwelling ............................................................................... k Location ... ..Carleton Lane...................................................... Centerville ............................................................................... Owner J. Albert Bassett ................................................................ Type of Construction ..............frame ........... ....................... ................................... Plot ............................ Lot .............. #14 ................... July 25 77 .Permit Granted ................................... . 19 Date of Inspection ...... I ........19 Date Completed ....... ............. .......19 PERMIT REFUSED .................................................................. 19 -4 . .......................................................... .................... ............................................................ .................. ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... sessnj's map and lot number M.— ......... � � + - ` SEPTIC SYSTEM MUST BE 7 7 . 11 Sewa INSTALLED IN ge Permit number .......................................................... "COMPLIANCE WITH ARTICLE r II STATE TOWN OF BARNSN� THE Tp�yow AND T�Q�IVIy Z BAHBSTSDL$ • "6 9 BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..Ct.QJ S. ux'Sr ...S.i. . ,1.4'...fFa.XQ7,17..home............................:................... TYPE OF CONSTRUCTION .........WoOd frame - ........................:........................................................................................ ......Ar3 a...28x...1f�77.....19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location lot 14. Carleton Lane,.. Centerville . ...... ............................................................................................................ Proposed use ..single family year„round home....................................................................................... Zoning District ........................................................................Fire District Or.Qnt.ex'V. lle.,?nO.sterville.................... Name of Owner J. Albert Bassett ..Address Lyman Lane, SOUth Yarmouth,„Ma, . Name of Builder ....Same. ...................Address .. .......................................... .................................................................................... Name of Architect ..Se ..............Address ........................................ .................................................................................... Number of Rooms five Foundation Concrete ............. . ..... ................................................................. Exterior ...white ceder Sh�.,ngaeO...................... ....Roofing ...asphalt.. seal tabs .... .................................................... Floors hard„wooa� ??.�a:L.d...�.z7;... , .,�... C..b .tr1...Interior ........?7..A411...................................................... Heating fQr.Q.Q.d...hOt...Vate.r..by..geS......................Plumbing .one...bath....(PIfK,t.I.Q...R.I ?10.)..................... Fireplace A4..7 tying room (red bra ek,), pp ; ,, .... ..... ...........A Approximate Cost ...........J�. Q.QQ............. 4--ri........... Definitive Plan Approved by Planning Board -----------_------__.---------19________. Area ...fir ..liv1ng...area Diagram of Lot and Building with Dimensions see attached plans Fee ............. ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ...... ..... ............................................................ 1 No ................. .Permit for .................................... ........................................................................ Location ................................................................. ............................................................................... Owner .................................................................. Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ............ ...........................19 Date of Inspection .....................................19 Date Completed. ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ........................................................... ................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot number .... .. IDS SewTge Permit number .......................................................... yoFTHETo�° TOWN OF BARNSTABLE Q 2 f i EASBSTAME, i M6 9 - BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ ........................................... TYPE OF CONSTRUCTION .....t1 !? frama ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lq*I 1!4 Carl cai-nn, T,rane. CPn+ArYtsi l l c?, Ma ................................................................................. ............................................... ....... Proposed Use ......9IRxl e, fermi l,v Zoning District .......Fire District 'Antr�rzri l a._[)a+creri i l n Name of Owner J , Albert Rasset ... ..... i;.... .. Address f vman„ Sr»,t ► V�nrrnn„+1, �to .. ... .. ....f Nameof Builder ......c,ame.....................................................Address .................................................................................... Nameof Architect ..Same.....................................................Address .................................................................................... Number of Rooms ..:: xf%.....................................................Foundation ......Un,arcari Exterior .......whitF+ c+E+dPx' �thi Jtacrl a Roofing acr�lnfal t Spfl1 +a'ha Floors hFlrci t9QOd1iri1 R3.d i n ki. t'. ...R!...r'A:t?...Interior rir, .ra�. .............................................................. .......................................:.... Heating ..r�rr.:>� 'hn+ �•rcttcar ..... oa a Plumbing n,�n F,o+h 1 Fireplace i 1 i vi nrr r+nr%m (Y'A },r; r•kA............ pp �F, O(1r1 .......................,.. , Approximate Cost .... ._ ...................................:.. ................ Definitive Plan Approved by Planning Board _______________________________19________ , Area Diagram of Lot and Building with Dimensions see attached plans Fee ... v.............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. Bassettv J. Albvrt A=190-236 9426 one story No ... ....... Pe rmit for .................................... j'single family dwelling ...................................................................... Carleton Lane Location ................................................................. Centerville .................................................... ........................ Owner J. Albe t Bassett .................................................................. Type of Construction .. .........frame .............................. ................................I........................................... #14 I"t Plot Lot............................ ................................ July 25 77 Permit Granted .......................................19 Date of Inspection ...... .......................19 Date Completed .................... ................19 PERMIT RE USED RE .......................................... .,.s.................. 19 ...................... .................... .............. ......................................... ................................... ......................................... ............................................................................... 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APX rAPPROXIMATE P.L. , POIE'NT IiIJC WL9PX TO MEET LAP STAT5 AND,IkPPOC ISLE:RULE-5 001. �IE3C ARD P.U,.:F, POUNDS PER:LINEAR FOOT AND,Ri C3tJd A#T I Sit , Il h. -IC!E f 1( I,IINI� F,S.Oi. p E INE I E . U41�#I IF bGD i' FWL FROST' « SGASM ON APA : �b14EC, t•.IC�7IIlNU,.f�,Ex�"I� , psj, POUNDS PER SQ1ARR UIhC IN-GRAM U tSNl AJLIII~ N3 IST F ]s.clN1 HANG r ALL FLUSH AIA COUDUYIDV6: F�N»�'��ISTTd (FIE i PARTING . , A Q� �p 0 � N 130ARLD LO( tENTIER« PRkSQ110PTIVEWWE SOIL " A EiJAr � CO 4:RE 1E MA3OWW WNIT R001 im,4 « FROST LINE 4 ', �AT Ia3lIN t'�"r. '•p�E.IiI�Trr�'T�� E�Iwl�? Li�m E�i�;�'T « PONKC't'O NS;TO EXIS [ING 1fmI .c1rugE FL.ASOdE PER LOCAL CCOE CONT. IC011ra°i«iN(K)U S �I P ,c.-, POLY VINYL IHLt,�(FIE E � 5�i �L.p�A"1 q+�;rN l E 'L. -IC1��4ims Me, •RItI)GE I�'IIsAItA � � �I[ kl'e 9 ALL FRAMING LUMBER TO BE 401 S.Pa.,(SOLIT'HERN PINE)OR Milli%. »1011, 11015TeR Rj,(),QSL 0(MR01 BFSB 11 i.,TREATED FOR lEt'S 1 BR,It I USE,PIER LOICA#L C3ODE LI;,N.C7. C9EOd. -ICIEIN11�1�dSIt�DIW [�E�4L�, R b!�Ell :m Fail.. «DEAD LOAD' � R.O. • RA'LIGH'E)F'ENING « ALL FSLfOL.0 i Ei+$( E ,20 TYP0b), ,S.1/I1I IR T't9'E3�.Tt� flrFq FOR:E)tY E:I�ICaO�ltl�zq �I -DOWN R:SWW RI•I01*E��DIJPI4'�pIkf NMA•'IL.IL. POR A91Y OIJE$TIO NS OR 4�'*N I"16�MS �'OC-ASE 1 trlP,Ei(; CT�f O'S.I:. 1`RBt S I�f 5( ,Il i!xt>I 6j,h"..S.I M. --ID ETAIL 0RUC.T. STRUCTURAL. , « .ALL LVIMIC OU.I>~AM I�.NOINE IRFI)'TYPE L.AMBER TO ME IJV"i( Rii ;LI E ONLY, � On1E'IE�C714rnY MST t z�lE .FJ�E�IdL'�l�d�I`�R1DIaT�1�9d LEEC,. ilwL; d>I�U aAL �a.F. iAslFt Fla 't<1lFIE; •T 4p IMichank Street 84 to 203, Newilon, Upper FaIm,MA 102404 L.y�,U l TE SiSS;'t 1A4. ;I"V; I IOOFb�I .SwI,. ( t, Af. -ILL. 1a!A�11I IIVI�E3 E. 1,G1�.E `��I�, . wa:VAIE� IWiC?EMVE� �i#17j1 a►-1 "15 . L EO!: F I a I,JA4l I Lr °E`001GUI�.�t�E�;tJ`�'tiw1 I!AIINIIt�IIJ!#9 C)A(1t l IWI1�1?t 5511iIU•B"fINI IV�3 UI't 3000 Fell. OxT. .I �;IO' d l�iF IE.. .,'EICmT'A4L LOAD M PINT. wIFEIVI�PH �'.C?.E.)•. ..."rICJU 0PIDE C :. .y. R—Eeff• iIP�II i b FLIP. Ii=L4 o IFO. vt ; ,TYPICAL. :I�GMNEER OF �CI�00KID, NOM THIAt NOT Aj.II ,1{DII3S REOUTAE.ALL�St�EI 1',� � FND. M FOUNDATION UNFiIN, ,•.UNFII'NIP"E D (A A�PLJ ALE) " � I' p it F1' -IBC> 1I O '1" U-M.O. : UNLESS INCJ-11 f'Hek1 ,1Sa I�il. IT �ll .„ PA91 -IFOVI DA,"T"ION V1ENT V11 ..IYWllnH 01LU. .1011JALA N V1110 WI111HOUT EV41, -ELEVATION lad' -FLOOR � �QI'�1 •� '� 1 `'i�� �,� iEavnnll>a .r�RlSpEr�I�',r.1A��H�;t ;��1lwirl��>IWUI��r .. `u 4d aiN V FtU C3'E"Ia N&E3 I IFTI4idf it 1111-PARRMRAIT I�P wl�ll OOR P hi Ni3OvE CH/•#dioc 14'FR.EXT C'F -CEILING I�'RANHiN 31%ViSNt'g30 �i �. raRCAI�s,�nnA,�Ir�a�� t�1UiA,iRL;H pfCK Pi1OE'ROW IMM IRF4 -IRO * FRAMING IIatNAU 11h'C$3ZF, DKbW'II•ICA*16,N 1113 A VI L,A.'R1014 t)F ALL rXID4 -SECTi NICI -TAIII. AR'VICAJILIF LAW awltwaar }u fwtNwiiwwlarMl�wwwwr !rRewa �awlaa�na�IwIwrtarwl t�I �eIII° a. W-0 rr } Q v . 'tal• tw 4 ,. CZ I € lYfits��� f . in-1 1. I. .S, (%a —4fIE �� I IT # � m& ' } . � Hill &S Carifift-Or. L&W _'-1 z of IRS Metro West. fff e ; All d t i 40_ a S - 1 f IT • SSS { { 3 I Y I. , t a 71� '. zft fitlu - g • jy' ij�}..f}1^ eft^•ET }QQi - R .. + • ' _ E -u - 3G 4 , 3 � fri -1 1 j. {. g � (arc CO] m I Mlle MA 02632 t� g of ' � Metro West. ' ` gggg � � PING 1,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW RIOR , SEPTIC TANK PROFILE DISTRIBUTION BOX DE'� NOT TO SCALE NOT TO SCALE-:' r ca r A ., P JAM jN�: • OF0 love P/ a 52- xi o a� 0 -54 ytp 54 1D azt ZO 91 #69 MAP 190 w LL - --- __r 1 EXISTING PARCEL - \ °�i►r j 3-BEDROOM .20,816±S.F.' DWELLING N _ O o _ l TOF = 55.0' co± C0 , t iS0 �� TO EXIST-ING 1,000 C. 1 f N BE UTILIZED C e iead , •y �1 v !-` -• EXISTING LEAC.HI L: t /, 3 5� __ LOCATION ONLY)_ \ CLEAN COARSE ! 12" 53x8' PR. D-BOX LP P 2.' - y o� -I 53x5'n 53x5' o 13TP 1 653x9' 53x5' g — tk - z „ 53x6 - ' S0 ° 3 PROP. 2-500 GAL.`H-20 r. J I / � 56913a9�` LEACHING CHAMBERS , WITH AGGREGATE / PROPOSED INSPECTION PORT 0 3 55,E � • ' - � _ _ s 3a$$ _ ; • • MAP 190 • - _� '. _ - . . ,. PARCEL 83 PROPOSED 4 PVC VENT PIPE; EXACT LOCATION PER OWNER i .. �.' ,� •tea > !D ALONG THE TOP EDGE OF EACH SEPTIC _ y sb ti INS ------------- PECTOR: David W.!Stanton, R.S. 12. ALL SEPTIC SYSTEM CC �8 i 1 1F kY *' r 4 EVALUATOR: Bradley M.Bertolo, EIT, CSE LOCATED UNDER PAVE( C.S.E.APPROVAL DATE: July 2003 THEY SHALL WITHSTAN DATE: May 20,2015 ° � 13. DOUBLE WASHED CRU $ h F rtrf 3x �e-�f TEST PIT#: 14• WHERE REQUIRED, COP IN AREA BENEATH AND r . �►' a r ` „ > x ��tt� ELEV TOP 53.50 ; � ,,, ��, Fx� � • S UNSUITABLE MATERIAL {o t 4 t ELEV WATER= <42-.50' UNSUITABLE MATERIAL a �F PERC RATE_ 15. CONTRACTOR SHALL N1 < 2 min./inch SITE CONDITIONS FROM .aFc"'F-Jr ?.•,. 7 +. . Z y � ; i'U�rr � �'L i + �, ,xr + �! • �� DEPTH OF PERC= 36"-54" 16. PROPOSED PROJECT IS F� TEXTURAL CLASS: 1 ASSESSOR'S MAP OWNER OF RECOF 11 + w� A Loamy Sand ADDRESS: _} 10Yr 3/2 ' •%-t c fat is c`"t7t'8'dfz Y i t 2 e V 6.„ ' H_ • 5u". f '{ Loam I t., + '• �.. .ei,t ,is,,,:.... y Sand F EMA FLOOD ZONE 10Yr 5/6 COMMUNITY PANEL t` •" N # , � sf` 50.50' 17. DEED REFERENCE: DE[ ` ► o' 3 Loamy Sand E "4 � � `+ Ir' Fir"• • • Perc 10Yr5/4 U 18. PLAN REFERENCE: PU z r , a ' 3 , •+ + F.. Loose I� " 49 19. ALL DISTURBED AREAS S any k aN q +5 b.. 1. LL*ry yah.L sf 5.�s PI°' is r k i 17,Y 54" .. Fir + tz/.aft } aFp ' n r1;1� 49.00' PRO PER' , +• + fin_ ;�� .'r )e C-2 Medium-Coarse Sand 20 FOR SEPTIC INFORM +cehw ; 2.5Y 5/6 - - SYSTEM UP( o FOR USES OF THIS PLAN o E¢�,,J . 80" 15/o gravel 46.83' A J _ i 21. A 4"PERFORATED SCH.4 DEPTH OF THE BOTTOM C THREADED Medium Sand REMOVABLE C LOCUS PLAN C-3 2.5Y 6/3 22. IN ACCORDANCE WITH 31 APPROVAL IS REQUESTEI SCALE: 1"= 1000, (1.) A 0.40'WAIVER(3.0 132" 42.50' fi No Standing, Weeping, or Mottling Observed DESIGN DATA I TEST PIT DATA PERC NO. 14687 50x0' (ROOMS (DESIGN) 3 INSPECTOR: David W.Stanton, R.S. — 50 110 GAUDAY/BEDROOM EVALUATOR: Bradley M. Bertolo, EIT, CSE ' C.S.E.APPROVAL DATE: July 2003 LOW 330 GAUDAY DATE: Mav 20,2015 50 200 % = 660 GAUDAY ` TEST PIT#` ' 2 1,000 GALLON SEPTIC TANK T GAS — ELEV TOP= 53.50' li ELEV WATER= <42.50' TELE — PERC RATE= 0%H/W -------------- 500 GALLON H-20 CHAMBERS DEPTH OF PERC= W w IPACITY TEXTURAL CLASS: 1 ITH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.) = GAUDAY (2') (0.74 GPD/S.F.) = 112.0 GAUDAY O O i 0" C� A Loamy Sand 53.50' ACITY 6„ 10Yr 3/2 53.00' iTH) (0.74 GPD/S.F,) = GAUDAY 74 GPD/S.F.) = 237.4 GAUDAY B Loamy Sand ❑ 10Yr 5/6 36 -Loamy Sand 50.50 ' 0 C-1 10Yr 5/4 DF CHAMBERS 2 48 Loose 49.50 REV. DATE 'AREA 472.2 SQ.FT. PI CAPACITY 349.4 GAL./DAY C-2 Medium-Coarse Sand 2.5Y 5/6 80" 15% gravel 46.83' C-3 Medium Sand 2.5Y 6/3. 132„ 42.50' Sc No Standing, Weeping, or Mottling Observed �SH OF A148Syc� ERVED FOR B OARD OF HEALTH USE �� JOHN L. 0 • o CHURCh11Ll JR. iVJL/ • f� ✓'r . Dramn SOIL LOG • i \X>t fli.�ll 7(IO\Uii!uY-�Kt►t//svcr[!�(,�aVn/W/.V�x - II�S / 2".PEASTONE/S .—LOAM a FILL——- 12"MAX. W ca 0 j) 40A., 7.O I 5 o e o 0 0 c l 0C BOX �•t ° °° a o °� Cv.g S` /*MIN. 1000. _ �; 0 e'"'e 1000— GAL. d o00� • � � S•� b GAL. I 0:° PRECAST OR SEPTIC 6'� BLOCK °o TANK I� ° e ° SEEPAGE PIT ° •° �Lc N 20' MINIMUM °• 10 0. 01 FOUNDATION /o :" WASHED STONES_ I T�. ELEVATION SKETCH` +lot �`i''� PERc. RATE III -u. pFee SCALE: 1"=.4' TEST BY: G F.aNT�°G /t/ F? Al•cle6el�etJ TOWN INSPECTOR: r2o /"e-I,v7L.2K BACKHOE OPERATOR: M. ,a• f1ASsn"T? as a•p# pi..�a�PIvf Y TEST MADE ON-: _L=f 7y Illy KEN, SOP �,s� ".;,,�' �•�. � .� ZI .!` / o � RENWICK cy GFIAPMAN CAI �p � E�� �c+C 7,csr� T `T" 7`e �t No• 27 a 654 0 �`p , ' ^' S7'�C�GTt.+-cW-1S�Guc/ /.4gelbv,q,�,/ GJ.6-s. eaC•p'7_ 7 }y, c5tf� IST&���� "8Iv Ar+r R�.r'�..��s:4. : if�rSSvreaes�/©mot ..IuG�/ /8r��7?'f .�iVtS .; `y SSrONAI �G 0c~s r 7".+ f eve* NE Q JAMES ELEVATION SCHEDULE WISWELL ROP,OSED•'SITE PLAN I. INV. AT FOUNDATION = 1110?O ,A,N it 9 o SEWAGE. SYSTEM DESIGN 2. INV. INTO SEPTIC TANK = tliO' U . SIN 116•da., Lbw �4 3. INV. OUT OF SEPTIC TANK - C�TE•eV%t!'r.,., lW°45S• 4. INV. INTO DLSTRIBUTION „BOX = E1�3`�'?. SCALE: I '•a•'` u "y 19 rT 11�i•7!r" �- 2 4 5. INV. OUT OF DISTRIBUTION BOX 6. INV INTO SEEPAGE PIT = 11 , CAPE COD SURVEY CONSULTANTS ROUTE 132 7. '6OTTOM OF PIT HYANNIS,MASS. IA DIVISION EOSTON SURVEY CONSULTANTS, INC. 8. BOTTOM OF STONE LAYER = it 6 g*`p •.