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HomeMy WebLinkAbout0032 GREAT HILL DRIVE a �� � �� � 3 Gr�4��� N �,!/� ��r. ., .a �, .. � � � _ . e 4 ,:. .. �. _ � .A .. .u ._ .. - .. �.,. ,. 9 ,. ,� n ... ` � - � .. .. - ... �^ ,: c ` - n _ .. n - :: -_ - ; � ,. - .. ,. _ � ,. - w '. � ,. :. C � ,. ., .. �. _ :. � �. e � -_ 4 - .. ,.' �. ,. Town of Barnstable BuIllldIln B Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MAS& Posted Until Final Inspection Has Been Made. rru•+' Where a Certificate of Occupancy is Required,such~Building shall Not be Occupied until a Final Inspection has been made. �ermit Permit NO. B-20-1508 Applicant Name: Roland Langevin Approvals Date Issued: 06/17/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/17/2020 Foundation: Location: 32 GREAT HILL DRIVE,CENTERVILLE Map/Lot: 173-083 Zoning District: RF Sheathing: Owner on Record: Brian Taylor Contractor Name: INSULATE 2 SAVE INC. Framing: 1 Address: 32 GREAT HILL DRIVE Contractor License: 180747 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $2,450.00 Chimne Y: Description: seal and insulate attic hatch,ventilation chutes,6"fibergiasl S R-19 Permit Fee: $85.00 and rigid to knee wall slope, 10 dense cellulose to garage ceiling. Insulation: Fee Paid) $85.00 Project Review Req: Date: 6/17/2020 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this—permit-is commenced within six months after issuan icia Final Plumbing: All work authorized by this permit shall conform to the approved application and the approvedconstruction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building.and-Fire-Officials-are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed_ Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector.has approved the various stages of construction. Health "Person ontr ing with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department d{ All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: CommonweaM of Massachuseft Title 5 Official Inspection ®r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments tri 32 Great Hill Dr. '4 Property Address Estate of Ray Luning Owner Owners Name , information is WesSbieI �/��� MA 02668 8/24/2016 required for every page_ Cityfrown State Zip Code Date of Inspection m Inspection results must be submitted on this form.inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information ic 2 on the computer, , use only the tab 1 Inspector key to move your cursor-do not Paul Martin use the return Name of Inspector key. Cape Cod Septic Services Company Name 350 Main St n v; Company Address W.Yannouth MA 02673 Cityrown State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems_ I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/29/2016 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Hoard of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of,10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyeri if applicable, and the approving authority. ****This report only describes conditions at the time®t ihspectissn and under the conditions of use at that time.This inspection does not address hour the system will perform in the future under the same or different conditions of use. t5ins•X13 Tdle 5 Official Inspection Form:Sub udace Sewage Disposal System.Page 1 of 17 c Commonwealth of Massachusetts W Title 5 official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA. 02668 8/24/2016 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete'all of Section D A) System-Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System in working condition. B) System Conditionally Passes: ,❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the-box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration'or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. - *A metal septic tank will pass,inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA 02668 8/24/2016 page. City/Town State Zip Code . Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):- El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑.ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further.Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation'by the Board of Health in order to determine if the system is failing to protect public health,safety or the.environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool-or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering_vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA 02668 8/24/2016 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health,- safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA 02668 8/24/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface.water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 'Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility design flow of 2000gpd- 10,000gpd. t ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped.Zone 11 of a public water supply well If you have answered""yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Great Hill Dr. M Property Address Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA 02668 8/24/2016 page. City/Town State Zip Code Date of Inspection C. Checklist T Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ,❑ Has the system^received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Ej ❑ Was the facility or dwelling,inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Z ❑, Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,.depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been•determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310. CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):, N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,w 32 Great Hill Dr. Property Address Estate of Ray Lunin Owner Owners Name information isequired or every West Barnstable MA - 02668 8/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? El Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2014=36Gpd Detail 2015=27Gpd Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: w . Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) -Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5'system? ❑ -Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 'w 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owners Name information is required for every West Barnstable .MA 02668 8/24/2016 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection?.', ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system' ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval., ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection F®rrn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Great Hill Dr. Property Address C Estate of Ray Lunin Owner Owner's Name information is required for every West Barnstable MA. 02668 8/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1984 Per BOH records. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet , Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank (locate on site plan). Depth below grade: 20" feet Material of construction: ® concrete Elmetal ❑fiberglass ❑ pol ethylene y y ❑ other(explain; If tank is metal, list age: • years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Tx5' Sludge depth: 6-8" 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Great Hill Dr. Property Address " Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA 02668 8/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2-3 Distance from top of scum to top of outlet tee,or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank could be 750Gal tank. 5xT. Tank in good structural condition. PVC tees in place. Tank at normal operating level. Covers 20" below grade. Grease Trap (locate on site plan): r Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions.- Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c,M 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is required for every West Barnstable MA 02668 8/24/2016 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping.recommendations, inlet and outlet tee or baffle condition; structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tight or Holding.Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions.- Capacity: • gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached?, ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection F®rm _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 32 Great Hill Dr. H Property Address P Estate of Ray Luning Owner Owners Name information is West Barnstable MA 02668 8/.24/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0.1 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-3 with 1 line in and 1 line out. Box is showing signs of wear but walls are intact. No sign of overloading or hydrauiic failure. Cover Ki' below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection 'Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owners Name information is required for every West Barnstable MA 02668 8/24/2016 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.j Type: ® leaching pits number. 1-6x4 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1-6x4 Pit with stone. 2'of effluent in pit at time of inspection. No sign of.overloading or hydraulic failure. Cover 3' below grade. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool r Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is West Barnstable MA 02668 8/24/2016 required for every page. C4rrown State` Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,•condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions h Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of.Massachusefts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luninq Owner Owner's Name information is west Barnstable required for every MA 02668 8/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) J Sketch Of Sewage.Disposal System: Provide a view of the sewage disposal system; including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owners Name information is required for every West Barnstable MA 02668 8/24/2016 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: +12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: 1- You must describe how you established the high ground water elevation: Hand auger to 12'with no water encountered Bottom of pit at 8' Before filing this Inspection.Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for`Voluntary Assessments 32 Great Hill Dr. Property Address Estate of Ray Luning Owner Owner's Name information is required for every west Barnstable MA 02668 8/24/2016 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 13 �J I LOCATION SEWAG-E PERMIT NO. VILLAGE INSTA`.LLEVS !NAME i ADDRESS I U I L D E R ON OWNER DATE h E9MIT- ISSIJ E D DATE C 0 M P L I A N C E ISSUED �iG �, Town of Barnstabl�e�ARE& *r it of rti Regulatory Services ems• ths�from issue Mate : . AfAY • sAMSrABLE, , //�� y MA Richard V.Scali,Director romlAj 0,, , �8 ®Fr 5 D �pT i6 9. Building Division Paul Roma;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 . 173_n(J/ Not Valid without Red X-Press Imprint Map/parcel Number_ 1 Property Address r► . V5e11 c _ •--�, E Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address * pD 12 t�h� ( yb8 46 9 --oiz Contractor's Name C �-(o�- o— - Y®VeTelephone Number\ � Z Home Improvement Contractor License#(if applicable) f 6&0� S Email: ��1'�►� A Qj Co truction Supervisor's License#(if applicable) 10604.0 Workman 's Compensation Insurance Check one: ❑ I a sole proprietor ❑Yam the Homeowner I have Worker's Compensation Insurance- Insurance Company NameN^ Workman's Comp.Policy# Y631b 2— Copy of Insurance Compliance Certificate must accompany each permit.' Permit Reest(check box) nn— Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to S C'1�c9 4/e�u Nis ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ; ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.' ***Note Property Owner must sign Property Owner Letter of Permission. A copy of the UeiAge Im rovement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMSUilding permit forms\EXPRESS.doC 01/25/17 4 TIFE fJ12Z1 4017f�ea l!,lf M[LFSfft:Irme `S y Deparhamt afradusbzalAccrdents - d Of-C8 of lnP aflGFflS s _ 600 Waskutgto t}STtreet 1VFV113H1asmg"/dzR Wurlfe& CunTeniafi nMmn-tnceAffidayit13mldeiSitt.=b=Wi,JMectd mns/Plmnbers AppHrant Inforll7,atim n r Please Print� C.Nam e o� rnIA 'oveAX ,P � (Addess � - c' fsta 404 , C)2G-*3 Phone ak- —0102 Ar a an employer?:Checkthe appropriate box: T of project r 4 ❑I am a general contractor and I YP rn7 (e F �e�'= employees(fall a I.. I ant a employas with 6. ❑New oons{ratcEcotx ' . ndlor part-ft * 1tave hiredthe sub-conbactars 2.❑ I am a sole pmpFdetas ofptartues- Hgfed onthe attached sheet: 7- ❑Remodeling shrp and have no employees These sub-contractors have- 8. ❑Demolition -Worming forme in any capacity. employees and hne wooers' ' 9..ElEnildiag addition [No wodoers'Comp.imsante camp.ins ranee# m- required] 5. ❑ We are a coapomtifln.and its 1 Q❑Electrical repairs or addslroas 3.❑ I a=a homeowner doing all work officers have m=--sed fliek 1L❑Phzrabing repairs or adc€tioris [No workere comp- � of exemption per MoL v ffipset€ - inc n�trar er d. Y C.M§1(4h andwe have no, L.❑liflafrepairs employees.[Nowoti=. 13_❑other co=p-+nsreran ce 1equired.] '�.esyspptiesv�t$�stched-sbas�lmasielsnfllo�theseehi�oabeToa*�rasaiu��iea•wodces`compensariaupaTicyiafa�saaa ' #Flaaxecwaerstrbosabxmit dris sEldnii inxrcath�gtheyaxedninggnvrc&andtben him outside coutmcimsumstsalrmitaxiemaffid t:md ngsuch. ICax�cmxsYhatcbect sbmcmasta3tach =additional sheet showingt3mnaxaeofthesal�-ccmftxct=zadstatewhetherarnmlhmeeatiieshsw emplayns.Ifthesab-co�txactflesbave employers,t&T=Lrtpxaszdi=tluea wadams'vmmp.policy nuxnbm I am an stliploysr that is prauiri%rrg tvarkers'compertsrdian irtszirartcs f Wy employees $etoty is filepoucy drul joh site P Insurance Company I'lTame: Policy or Self-ins I io_ �l G 3 g 2- 1Mpiratios Date: 04 o.? C-;?L� Job%teAddress: 32 (.rcct, m Citglstat zE p: Attach zropf of the warkers'compensation policy declaration page(showing the policy,number and�ezpiration date). Failwe to secum coverage as requited nudes Section 25A of MGL m 15 7 can lead tD the i mposxtioa of criminal penalties of a . �mupto$LSODODimdforoti-e:y&irimpdsonment as well as ciud penalties in the form of a STOP WORK ORDEIRand a fine of up la 0_00 a day ag-ainst the violator. Be adhnsed'thaf a copy ofthis.zbdementxnaybe forwarded fn the Office of I4rvesfrgatians oft he DIA for" cn coverage tit fi n.. Ida 1wre-by certify fouler&e off furl th .4he irt,farma�rvrrpraa abm�s ig true and correct Silasature: . •Ilat+r �S.J.S. (�- . Phane Sad 46�J�—o�Q�i a;ftfiaL use wily. Do neat orate in this area,€a be cmnp' Teted by city srtown o,oreral Clt1'or Taww Permitll icense 9 Lssaing-Authvritl'(drele floe): L Board of HMItlt r.Buffiring Deemd 3.eityffown,Clerk 4 Electrical Easpector S.Plumbing Emspecfmr 6.Other C'omtact Person: Phone#- f armmation and Ta.strnctions ` carhrrce General Laws chapter ISZ r egoaes an employers m provide wvorl me= easE±=far fbzm employees. P�tD this ,an Mvkyae is defined as-:.ever yp easimin fb.e scavicc of�atbrr Doles�y co�ract ofhv esprew or h pled,oral or written." ���J'�is did as aaam P associs iom;corporation or other Iegal e�y,or any two or more of the faregoing=gagedcLajont QE�.andinchuimg the Iega1 jv2m ntatrves of a deceased employer,or$ie reeeiyer or trustee of an kffTi 12 Pam=association or officrIegal entity,Cn3p1°Yh29 en=ployees However the owner of a,dwelling horse having not mote t31M tbree apartmefs and who resides therein,or the occupant of the - dwelling hoase of ano$er vrho employs pcssans to do maims cc,cams�T act on or repair work.on such.dwelling house or on.the grounds or bnl7dmg apputienait ffie�sbzH not becanse of such employma t be deemed to be an employer." also states that"every stain or local seams agency Shan withhold fhe issuance or MCsL chapter I52,§25C(� renewal of a Ucer:se or permit to operate a business or to construct bull ings iu the comet onwealfii for any aPP&canfw•ho has notproduced acceptable evidence of cdmpyance witI>,the ftLmrance.coverage required f Add>tionany,MCEL chapter 152,§25C(7)slates-Neither the nor a'ay ofitspoEtical subdivisions shall ffn h3:h3anycontractfortheperfm==cCafpublicwm3cm3tllacceptableevidenceofcompliancevlitht-Le;ne1nancr-- req==euts of•this chapterhave been preseitt-dto the cordractnzg atdioi dYf Applicants , Please fiII oil flit w033='compensation a]'Edavit completely,by chwJdag Le bodes that apply to your situation and,if' necessary,gapPIY s)name(s), addresses)endphonennmber(s) aIongwiththeir cfreate(s)of i asuiance. Limited Lhbz"Iity Compa ies(ILC)or Limited Liability Parfa aLTs(LU)WI&no employees otfi=than the mertibers or parrs, are not rbquirtd to cmry wmke&compeassafron hienranpe_ If an LLC or LLP does have empIoyees,apolicyisregaired. Be advisedthatthisaffidayitmaybesnhmif�dtotheDepmfineatofIvdusfriaI Accidents for conEmnatim of fiomm=cove Also be sore to sign and date the affida-it. The RfUk it should be stunned to the city or town that the application for the permit or license is being reqaestA not the D eparEmenf of LAast ag As cid�is. Shonldyon have any►questions reg g the law or lfyou are regizaedta obtain a woriors' c en ompsation pli ocy,please call the Department at the number listed belovr. Self-msued companies should y enter the self-insm-mce license vmnber as the agpropriain line. City or Town OfFicials Please be sore that the aTadavit is complete andprkftaIegibIy. The Depar fmcuthas provided a space at tha bottom of the affida-v t for you to frIl Dirt in the event the Office oflnvesEigaiiQns has to cozriar t Young th a applicant Please be sureo t fDl in the pen licm=number which vM be used as a reference number. 7n addition,an applicant that must submit multiplepe:Mitlliceose applitaiioms in;my givenyear,need only submit one affidavit eomnt policy is o lion.(if n=s--a y)Emd under`Job Sitr Address"the ipplicautt should write'all locations in (c'tY or- town):'A copy of the-affidavit that has bcca officially stm3ped or mmiced by the city or town may be provided to the - - appHcant as-tmo-f ha a valid affidavit is on file for b:dm pcmlits or Lice uses Anew affidav>tmvsf.be fiIled°T each year.Where a home owner or citizen is nbtaiamn a license or pernot related in any bnsinrss or commacial � (ie_a dog license orpmmit to bum leaves etc-)saidpmsm is NOTreqikzdto co3ilete f25s affidavit The Office oflnvc:Sd9zd=wouldlrketo thankyoumadvance for your cocpeaafimand shovldyouhave anygaestions, please do not hesitate to give ns a caI-. The 1?eparfineufs address,telephone and fax number: r - 'FIB ttt�of 1 Ch Depsifinent GHC A -Uents (ice of 6Q4 woman� t r Ta 4 61'�-727-4900 QExt 4€6 M 1-977 MA SAS Fax 9 61-1-727-7749 ' Feviscd424-07 ma at�g f ToWn of Barnstable Regulatory Services use. � Richard V.Scali,Director - 6s63¢ � Building Division. Paul Roma,Building Commissioner , 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mans Office: 508-862-4038 •, Fax: 508-790-6230 Property Owner.Must Complete and Sign This Section' z If Using A Builder ' h as Owner of the subject property hereby authorize to act on my behalf in all matters krelative to work authorized by,this building permit application for. (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 Print Name = Print Name Date QYORM&OWNERPERMISSIONPOOLS R Town of Barnstable Regulatory Services ! plFtHE Richard V.Scali,Director Building Division BARN esr a. = Paul Roma,Building Commissioner M039.AM 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: f 1 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 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 unlicensedperson erson as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. that the homeowner is full aware of his/her responsibilities,many communities require,as part of the To ensure t Y understands the responsibilities of a Supervisor. On the last page she unders P certify that he/ p permit application,that the homeownerrhfy this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomvs\EXPRESS.doc 06/20/16 . CAPE COD Homelniprovement CAPE COD 'HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001', (508) 469.0102 CAPECODINC@GMAIL.COM, WWW..ROOFCAPECC)D.COM, WWW.FACEBOOK.COM/CAPECODHOME • ALL GROUNDS TO BE CLEANED UP ON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED. HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. CERTAINTEED(30 YEARS WARRANTY+ APPROX. 2 SQ OF WHITE CEDAR SIDING FOR CHEEKS) LABOR AND MATERIALS: $6,460.00 DUMPSTER: $520.00 (S&J EXCO) M 4 • GRAND TOTAL: 6 980.00 *WE WILL MATCH OR OUTBID ANY LEGITIMATE COMPETITOR CAPE COD HOME IMPROVEMENT TM IS PROUD TO PRESENT YOU WITH SUPERIOR 10 YEAR WORKMANSHIP AND SERVICE WARRANTY.THIS.WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTIES.IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION vd PAYMENT TERMS: 50%AT DEPOSIT; 50%UPON COMPLETION. ! ` ( �.� 0 vvs JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO B WEEKS AFTER DEPOSIT RECEIVED C6 A&�) WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY 1 TO 2 WEEKS. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY !� PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGEl- 'ram Office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation , Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number Search You must click the "Search Registrant" button to search by name or location. Search by Registrant Company name Search by Registrant Last name Isivitski City/Town I i Search Registrant State Zip code Click on the registration number to.view complaint history.You can also view arbitration and Guaranty Fund history. The list is current as of Thursday, May 4, 2017. Search Results RESPONSIBLE . REGISTRATION EXPIRATION RegistrantName INDIVIDUAL NUMBER ADDRESS DATE STATUS CAPE COD HOME SIVITSKI, ANATOLI 168043 27 MILL POND RD 12/06/2018 Current IMPROVEMENT, INC. WEST , YARMOUTH, MA 02673 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. httos:Hservices.oca.state.ma.us/hic/licenseelist.aspx 5/5/2017 , 1 _ ._. a P' w s w.3' .t �, L-... ^R.P "gg^M � .. m a d r y � r - ;., �,< � f Fir. s . : }, ti Co list ruc tit ) 11, Supervisor Speclaltv N4, e ns,­ CSSL-106040. ' i�. MIrK., .�LfT T _ 1Q, AT O•!�I S Jam. i I T � L S R TT Z ttt•"•", r 4i.. ;11_}, 222 , x k� ..i ISLANDOD��012 z 'Vest a �r outs 026t�;"17�f�73 �sr�z ACC>RD CERTIFICATE OF LIABILITY INSURANCE UAIt:(N1NVUD1PYTY) 06/08/2016 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemetit. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Christine Davies _ DOWLING&O'NEIL INSURANCE AGENCY PHGNE (508)775-1620 _ FAX No(; ADDRESS: cdavies@doins.com 973 IYANNOUGH RD. - INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 _ INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B:_ CAPE COD HOME IMPROVEMENT INC - wsuRERC: INSURER 0: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 59476 REVISION NUMBER: . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1ADDL SUBR POLICY EFF POLICYEXP ILTR TYPE OF INSURANCE I POLICY NUMBER D MM D LIMITS _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ! CLAIMS-MADE OCCUR DAMAGE TO RENTED i ME ISES(Ea occurrence) S MED EXP(Any oneper�on) $ __ _J N/A i PERSONAL&ADV INJURY _ $ GEML AGGREGATE LIMIT APPLIES PER: PRO- nj GENERAL AGGREGATE $ POLICY C JECT L�LOC PRODUCTS-COMPIOP AGG S OTHER: I $ AUTOMOBILELIAMi. CEOM�BcINIEeDtSINGLE LIMIT_Cg $ J ANY AUTO BODILY INJURY(Per person) S IALLOWNED SCHEDULED .f AUTOS AUTOS N/A - BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE _ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB ! - I-- OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE j N/A AGGREGATE I$ i DED 'RETENTION$ -$ WORKERS COMPENSATION v AND EMPLOYERS'LIABILITY Y/N I I X ST LUZE B ANYPROPRIETORIPARTNERIEXECUTIVE 1 1 ! A OFFICERIMEMBEREXCLUDED? WA WA N/A R2WC746392 06/03/2016 06/03/2017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below IE.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date ofthis certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel M.Crowfey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. Ar`n Cr1 9G/9MA/n11 TI n AIIAOn n�mn onA Innn oro ronic�nrnrl mor4a of Ar`n01'1 i� .. 4 ale& CAPE COD Homclmpnwement GAPE COD HOME IMPROVID MEET TM 27 MILL POND ROAD,WEST YARMOUTH MA 02673 (6.17) 710-1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PROPOSAL 05.05.2017 TO BRITTANY FORTIN LOCATION: 32 GREAT HILL DR, WEST BARNSTABLE WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: - MAIN COMPOSITION SHINGLE ROOF: • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE.: • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST OF$40- c PER FOUR FOOT BY EIGHT FOOT SHEET OF PLYWOOD NEEDED.DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION(APA).NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE.DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF,FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE JACKS,PERIMETER DRIP EDGE MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL,ALL MATERIALS TO MEET OR EXCEED MANUFACTURERS REQUIREMENTS AND TO BE INSTALLED`HIDDEN NAIL"FASHION SO THAT NO"SHINERS"ARE PRESENT. • A NEW APRON FLASHINGS,SADDLE FLASHING,AND NEW STEP FLASHINGS SHALL BE INSTALLED ON THE SKYLIGHTS. • ICEN•WATER"HENRY"PROTECTION MEMBRANE SHALL BE INSTALLED ON ENTIRE DECK SURFACE. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERTAINTEED SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SIX NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREA IS CONTINUOUS AND WILL PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST OF$7.00 PER LINEAL FOOT THEREAFTER. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE.FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE 5 CAPE COD Iiwncimpro cnuut APE COD HOME IMPROVEMENT TM , 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001, (506) 469-0102 CAPECODINC@G MAIL.COM, WWW.RoOFCAPECOD.COM. W'WW.FACEBOOK.COM/CAPECODHOME • ALL GROUNDS TO BE CLEANED UPON A DAILY BASIS.ALL!BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED.HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. CERTAINTEED(30 YEARS WARRANTY+APPROX.2 SQ OF WHITE CEDAR SIDING FOR CHEEKS) r LABOR AND MATERIALS: $6,460.00 DUMPSTER: $520.00 (S&J ExcO) GRAND TOTAL: $6,980.00 *WE WILL MATCH OR OUTBID ANY LEGITIMATE COMPETITOR CAPE COD HOME IMPROVEMENT TM IS PROUD TO PRESENT YOU WITH SUPERIOR 10 YEAR WORKMANSHIP AND SERVICE WARRANTY.THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTIES.IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION PAYMENT TERMS:' 50%AT DEPOSIT; 50%UPON COMPLETION. JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO 8 WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY 1 TO 2 WEEKS. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE f 40, dw CAPE COD g� mm q. Home Improvement CAPE HOME IMPROVEMENT `�EME T "��� 6 27 MILLPOND ROAD,WEST YARMOUTH MA 02673' (617) 710-1001, (508)469-0102 CAPECODINC@GMAIL.COM, WWW.RoOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECbDHOME ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00jPER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND LUMBERYARD RUNS,MOVING ALL PERSONAL OBJECTS,FURNITURE,ETC,FROM WORK AREA,WILL BE SUBJECT TO EXTRA CHARGE. IN THE EVENT OF ROT REPAIRS,ROOF REPAIRS OR ANY RELATED WORK REQUIRING IMMEDIATE ATTENTION,WE WILL PROCEED WITHOUT CUSTOMER APPROVAL. CAPE COD HOME IMPROVEMENT-.WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE(PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT Tm WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PERFORMED BY INSURED PROFESSIONALS. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER. OWNER TO MOVE ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD BE CONSIDERED FOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDITIONS,ETC.TO GUARD AGAINST DAMAGE.IN THE CASE OF ANY ROOFING AND RIDGE VENTING,DUST AND DEBRIS SHOULD BE EXPECTED AND ANY ITEMS IN THE ATTIC SHOULD BE REMOVED.CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY, ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION-RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND.COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON-PAYMENT.- WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENT TM THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI "TONY"-.SIVI7SKI lk D� CAPE COD HOME IMPROVEMENT Tm GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME_IMPROVEMENT TT't WITH ANY QUESTIONS OR CONCERNS ,4+6 PLEASE INITIAL THIS PAGE_ I . i e4tu 4 A 61 CAPE COD 7-lomclmprovement CAPEICOD HOME IMPROVEMENT TM 27 MILL POND ROAD,WEST YARMOUTH MA 02673 (617) 710-1001, (508) 469-0102 CAPECODIIVC@GMAIL.COM, www.ROOFCAPECOD.COM, ' www.FACEBOOK.COM/CAPECODHOME ACCEPTED BY 1 G �A �i tat' SIG DATE ACCEPTED BY SI DATE ACCEPTED BY y SIGN DATE CAPE COD HOME IMPROVEMENT Tm GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT Tm WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE7-:�;Z� gmeering Dept.(3rd floor) Map Parcel Permit# .11(©Q House# � _ Date IssUqd Beard of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) THE rq, Definitive Plan Approved by Planning Board 19 ' BARNSTABLE. MM TOWN OF BARNSTABLE Building Permit Application Project Street Address Village Owner VCUA, ry1(Y^a (lA)I YU<Z� 4 '"Kddreess� Telephone Permit Request t r First Floor square/feet Second Floor square feet Construction Type Estimated Project Cost $ 31&—n Zoning,District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 - 6arage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Narne Telephone Number Address 9 1 jn 26Sev%- C/dZ License# Home Improvement Contractor# l/�5 Worker's Compensation# p/l/ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 1 FOR OFFICIAL USE ONLY PERMIT NO. CMG DATE ISSUED i MAP/PARCEL NO. ADDRESS VILLAGE OWNER I i DATE OF INSPECTION: l F FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL . t GAS: ROUGH FINAL FINAL BUILDING J-/ v i DATE CLOSED OUT ASSOCIATION PLAN NO. The Town of Barnstable • EuvsreBM • 9� MAM ,0� Department of Health Safety and Environmental Services 'OrE1 9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only > Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. c Type of Work: Est.Cost /d Q " V Address of Work: — Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the ra th Vner�- '. D to Contractor Name Registration No. OR Date Owner's Name w The Contntott irealth of Massac h usctn -.i• a ,� i , .:: ,_.. Department njlndustria!Accidents Office ofittvestiga11ons 600 !f a-0inrtoit Street • ':' Boston.Alms. 02111 Workers' Compensation Insurance Affidavit Appitc•tnt information•' Please PRINT IebNE name: De�� �✓1 Ci�-� locntion• �� 7—i92c��o�'� 0/9 City lS_4,(� phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �'!'^. r,P- ....)r.w.�:yf�rsr�.f 7[f![T.�.�Mrt�.11l��--.7Tw .. .�.•w�.��Y.'�w...h.•mow.•.•nw..�.y...�.•.._...-_....... [j 1 am an emplover providing workers' compensation for-my employees working on this job. enninnov name: /�/d.0�/1 (m 6 address: cih: L �/� n Phnne#• insuranceen. a/ IitJ CRX lies # 6 0/Z" [I I am a sole proprietor. general contractor, or homeowner(circle arc) and have hired the contractors listed below who have the followiniz workers' compensation polices: company nnmc, address• nhnne#: insurance rn, policy# 1 yw.._- �.:Z..._ �:'-- __ fir'-..��::�^tom iT"S!7rrw:s,.� .�7r.: ...a•ti...�....-... commas• name: address- city: Phone#: insurance co policy# -Attach additional sheet ifneccs_saty� ^- + --+�' �:;L" :� i•'.. _!^_C•%>•.'' ;_'-'`'":'•` •=►:,"' ~~'__.r,_ _ Failure to secu_re coverage:ts required under Je+ c� ttion:SA of 111GL 152 can lead to the imposition of criminal penalties 01•2 line up t SIS00.00 andiur une�cars' imprisonment as well as civil penalties in the form of a STOP'WORI:ORDER and a fine of S100.00 a day against me. 1 understand that n copy of this statement may be forwarded to the OMcc of Investigations of the DIA for coverage verification. 1 do hereby cc ', under t c s and pe of perjure•that the information prodded above is true and correct. Si_nature Date Print name 1 �9'vt/ L z/Lli��2.� Phone# TIolTicial use unit' do not write in this area to be completed.by cin•or town official .+ city or town: permit/license# riguilding Department C3Liccnsing Huard check if immediate response is required Selectmen's Office F ' C311eaith Department contact person: phone#: nOther Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "la%%•", an empint•ee is defined as every person in the service of another under anv contract W ire. express or implied, oral or written. An employer is defined as an individual. partnership, association. corporation or other legal entity. or an,., two or more . the forcuoin�_ cnLaucd 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 hous or on tine `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that e,%•en• 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. Additionaliv. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha been presented to the contracting authority. 77 Applicants Please fill in tine workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for tine permit or license is being requested. not tine Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required to obtain a -workers* compensation policy. please call the Department at tine number listed below. . Cite• or Towns Please be sure that tine affidavit is complete and printed legibly. The Department has provided a space at the bottom of tine affidavit for you to fill out in tine event the Office of Investigations has to contact you regarding the applicant. Pleas be sure to fill in the permit/license number which will be.used as a reference number. The affidavits may be returned to tine Department by mail or FAX unless other arrangements have been made. Tine Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to uiye us a call. r••a►•v.-.+• .._-.—•'..r•.. ..�.�.wr•r..•.. � --s-:�.....i _•_..•.r r�.w..w• .... _ _ err.w•�n•vrr.+...+a Tine Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents F rr Office of Investigations ` 600 Washington Street t Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 opc- J�50z- Assessor's map a6dlot number ... 1;79—.2 .. C—,, ...................... I E Sewage Permit number ...... 33AR35TABLE. House number ....................... .......dui 1........................ V MAM 1639- 0 MAI TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..................... ..................................... TYPE OF CONSTRUCTION ......................................... ........................................... OL, .................19-e ........... T..../........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............................................. ....................... ................................................ ...... ProposedUse ........................................................ ......04 ............................................................................ Zoning District ................................&r.............................Fire District ............... ....I0......................................... Name of Owner ..........61 .1.........Address ............. Nameof Builder ....................... ........................Address ..................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................6............................................Foundation ............... I.K.01,,1V r.7 .......Z73.. ............ Exterior ..................... . ......Roofing ..................... * ;1(!�`�r(........... ................. ..........Floors ..............jV..... . ............................ . .....Interior .................. Heating .................F."-1 ......../ ..............................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ................... ........ ....................... Definitive Plan Approved by Planning Board -----19--- Area .............................. ......... Diagram of Lot and Building with Dimensions IA41F I Fee ......... ........L-71 SUBJECT TO APPROVAL OF BOARD OF HEALTH 7 0 a4-vq-.5 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin the above construction. Name .............. ................ Construction Sb p ervisor's License GREENBRIER CORP. A7--174-2 0 27011 1-31 story No ................. Permit for .................................... 0 G 2 7N Single Family Dwelling.................... ..................................................... Location Lot 36, 32 Great HillRaad ocation ................................................................ Centerville ............................................................................... Owner ....... ..CQXP......................... Frame Type of Construction .......................................... ............:.................................................................... Plot ............................ Lot ................................ Permit Granted .....September 25.........19 84 ........................ . Date of Inspection ....................................19 Date Completed ......................................19 -Z-7 o� "r► TOWN OF BARNSTABLE Permit No. -------------------------- Building Inspector Cash ------------------------ �'`°""'` OCCUPANCY PERMIT Bond ------------------------- ' Issued to Address iz', !`r-� r�; 1 1 ?2c n.,•,�-rvi11e Wiring Inspector - Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. ....................................................... 19............ .........................................................................................._...................... Building Inspector r FROM - ` OWN OF BARNSRABi. BUILDING DEPARTMENT Mr. Francis Lahteine «.. Tbwn Clerk s-. b,. � ,�..,r a» � MAIN STREET ' HYANNIS, IRA. 0�1. Phone: 775-1t2I SUBJECT: T r -FOLDHERE -DATE - - - �AESSAGE InTork has beeal c �,�s al,.[...x++r* mder Pp�nit rae x�#27011 r�r a+wiprb «..�....s:a.�aa��.-.E"ra.a� +a.,�,w.+u•a.wx�w.r,o..+t�e»�:.F' x�•. I, Please•release Bond. I ^G6gI:Lr R^�S fi"$',sy:�,as,.,ill av NI IN+Y vNe"�L dF+Y`%'�,*.,t�'^RIX��'�'7Y'4�t5•Mq:CWw!">M a"3Pe9 wt iM'f' SIGNED, DATE REPLY / SIGNED N87.RMf _ _ RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY • - ' ' t PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH,CARBON INTACT. o T /Y// ti V > �l 0.7 / 36' J id �I . L g0o.l4 . LOT 37 C77- 8 p�/�� T CERTIFIED PLOT PLAN cy LaT.3 b GRc A7 iZ L. 7�.v.g T� NEW CONSTRUCTION ONLY = orb ' ROBERT °,�� CL-/C/T�--- L�/L-. l._ - BRUCE TOE' OF FOUNDATION IS— FEET FEET EL°RE H IN ABOVE LOW POINT OF ADJACENT �►� -,�, �� ROAD. tqG'� �y°� Nn sum SCALE �f0 / DATE= 7 9/8 GE E 9 fL• INI I CERTIFY THAT THE 7rO/y iGiSTERED REOISTERE® CLIENT .,_;. SHOWN ON THIS PLAN 13 LOCATED �3 2v CIVIL LAND fjos,uo.m ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR ®R,®Y� F-,f _/�, CONFORMS TO THE ZONING LAMS OF BARNETASL , MASS. 712 MAIN STRE.ET "' CH.Bye � •�•� HYANtdIS, MASS. $MEET_L,OF ATE REG. LAND SURVEYOR Assessor's map,and lot number, ..... ..... %,THE Permit n Sewage umber ............. ......... . . ......... SEPTIC S'6'i i i" " . House number ........................Jaz......a?.%t..................... INSTALLED MARISTAXIj ,L VOT, A 39- I, I , a V�011,1 AZ AL.1f* 411'0W I Ell' 1% W TOWN , OF BARNSTAR BUILDING. INSPECTOR APPLICATION FOR PERMIT TO ... ................. TYPE OF CONSTRUCTION ........................................ A.%.�........................................ .........................19......1P ..f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the:following information- Location ..............................................(....0 ....... ... .. ......... ......... ........ ... .............. ProposedUse ..................................................... ..... ......................... ..........................................I......................... ZoningDistrict ....................................r ............................Fire District ......................._.. ................................... Name of Owner ..........CtM55 ...CLV,41:� .Aciclress .............�. ......S_Z�.J(2...C... ..... Nameof Builder ....................... ........................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ................ ............. . ......... ....... ...... .....Exterior ............ /// ....f ....i. ......Roofing ............ .......... .....5 ..........Z.3.. ........ o' . ........ ...Interior ................. Z_.............. .................. ......... ....Interior .................... .. . ....Floors ..............J/...... Heating .................F ..............................Plumbing ................... ...... .......................................... Fireplace ..................................................................................Approximate Cost .................... ............I.......................... ..... Definitive Plan Approved by Planning Board 19--- ...................Area ......... ............... Diagram of Lot and Building with Dimensions 14-41F Fee ......... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 60 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin the above construction. .... ...... . .......... Name .................i.. ........X............ Construction Supervisor's License ....... 6. —GREKINTBRIER CORP. No Permit for Story................ ............ Lot 36, 32 Great Hill Mgtd Location .................................................................. . ............1_...Centervi1jQ................. .. .................... ..................... Owner .....Greenbrier .......................... . c. Type of Construction Xrma................. ............ ...................................... ............................. Plot ............................ Lot ................................. Permit Granted ......SePte�...2.5 ......19 84 .................... Date of Inspection ....................................19 Date CoI to 01 JV/O /J. . ......19,4 .........