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0039 HEADWATERS ROAD
g hirm>w7r& , I i ti � �� ___._. �� 'w e ❑ i tj Engineering Dept. (3rd floor) Map Q Parcel -/, it# 0 o� House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) _ ' Fee A `7 ff' a G Conservation Office (4th floor)(8:30-9:30/1:00-2:00) Z zr- Planning Dept. (1st floor/School Admin. Bldg.)`41Uk 1HE De ' rve la Approved by Planning Board 19 �'7 ,It/ '�' • '` MASS: 19. TOWN OF BARNSTABLE Building Permit Application ' Pr 'ect Stre� Address r � Village L, Owner GCo 0, o Q, Address &N,1 r 7-)'/7c k C, Af? Telephone q2no Permit Request 5tt An 3 V✓1 .f ' o1we -3 First Floor ��y s /fit tZeoor � square feet Construction Estimated Project Cost $ U®, d D Zoning District Flood Plain Water Protection Lot Size !y 1/ 3 CJ 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: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /U Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New 1-2 No. of Bedrooms: Existing New Total Room Count(not inclu ' g baths): Existing New _ First Floor Room Count Heat Type and Fuel: as ❑Oil ❑Electric ❑Other Central Air ❑Yes L0<0 Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Gara Detached(size) Other Detached Structures: ❑Pool(size) Wone ttached(size) ;� X a �/ ❑Barn(size) ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use (( ii Builder Information Name Sv l I t��. yl �y► ,d�Or` Telephone Number Yam. Address \\ 'De X r 2,(S V`1+ I fQ License# 00 1`7'r 1 I OUT-1, w1 q O2 50 Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I SIGNATURE _ DATE _ Cf// BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY ry � ,-7 PERMIT NO. :—DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION f r ' 1 FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s t DATE CLOSED OUT { ASSOCIATION PLAN NO. TOWN OF BARNSTABLE,- , CERTIFICATE OF OCCUPANCY ' PARCEL ID 228 046 002 GEOBASE I•D 39048 ADDRESS 39 HEADWATERS ROAD PHONE Centerville ZIP LOT 2 & 3 s. BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 21072 DESCRIPTION SINGLE FAMILY DWELLING (BLD PMT 018323) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: ` ��" BOND Im CONSTRUCTION COSTS $.00 � 1 78$ MISC. NOT CODED ELSEWHERE * 1ARNSTABLE. MASS:.{ OWNER COGGESHALL, ROBERT 1639. ADDRESSF�MA'S 39 HEADWATERS ROAD BUILDI G D V S 0 CENTERVILLE MA BYa'�-� . . . " DATE ISSUED 02/11/1997 EXPIRATION DATE TOWN OF BARNSTABLE ;� - ;: BUILDING. PERMIT ' : ' PARCEL ID 228 .046 002 GEOBASE ID 39048 ADDRESS 39 HEADWATERS ROAD PHONE 't Centerville .. -zip - LOT 2; & 3 BLOCK LOT' SIZB DBA DEVELOPMENT .DISTRICT CO ; PERMIT 18323 DESCRIPTION SINGLE FAMILY DWELLING (SEW.PMT.#96-468). PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BIM PMT i CONTRACTORS: - SULLIVAN, DAVID Department of Health, Safet ARCHITECTS: and Environmental Services TOTAL FEES: $278,126 BOND $.00 : CONSTRUCTION COSTS $89.,760.00 101 SINGLE FAM HOME DETACHED 1 PRIVATE P `* M • i OWNER COGGESHALL, DWIGHT i63� A1� ADDRESS COGGESHALL MARION I P 0 BOX 63 BUII.D CENTERVILLE MA . BY DATE ISSUED 10/02/1996 EXPIRATION PATE -- - --------- -.--- ----------- -- ---------------- THIS --- ---- PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE t.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT �` 1 J2�ZO-S4z, 2 3 - C) Z-,// BOARD OF HEALTH I. � OTHER: SITE PLAN REVIEW APPROVAL G 21( �7 WORK SHALL NOT PR CEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map es A Parcel �f to�D�— _ Permit# � 0 5 Health Division 9t Date Issued �- 2,���� Conservation Division �5e �q O ® � , Fee. Tax Collector qol 1 '� icy/ d� ; SEPTIC SYSTEM MUST BE Treasurer INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 ENVIRONMENTAL CODE AND Date Defihitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village r Li t' /} Owner0 J 1e_r4F (f0QC?2S JL.eL Address Telephone - �' 77 t- 2 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 10?A .my Zoning District Flood Plain Groundwater Overlay Construction ype Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 'I V j Historic House: ❑Yes to On Old King's Highway: ❑Yes XNo Basement Type: Wull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing a new Half: existing new Number of Bedrooms: existing_ new 1 " Total Room Count(not including baths): existing new First Floor Room Count J, Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric XOther 6'r'oD cc h -e- Central Air: ❑Yes J9 No Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes XNo 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 Cl Yes ❑ No If yes, site plan review# Current Use Proposed Use B ILDER INFORMATION Name rJ Gr//L/ nn tt r�- rr Telephone Number Address License# MA Home Improvement Contractor# U (e 31— Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /'-)c Q ii e.d-r USA s C ec cr 4,4Mler v2 SIGNATUREDATE FOR OFFICIAL USE ONLY PERMIT NO. b ..�- - .•- - r�x' _ _ _ DATE ISSUED MAP/PARCEL NO., ADDRESS . ram. VILLAGE OWNER^ . DATE OF'INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE " ^� • r_E t' � x o .y ELECTRICAL: ROUGH' FINAL .' PLUMBING: ROUGH, FINAL .4 GAS: ROUGH? � i� � FINAL , • �.` FINAL BUILDING .�• ° r, in DATE CLOSED 4OUT ASSOCIATION PLAN NO. t ' 4 e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION SEPTIC SYSTEM MUS Map ��� Parcel INSTALLED IN COMPLI1 SS_# Health Division WITH TITLE 5 Date Issued ENVIRONMENTAL COD%AND Conservation Division TO'V'N RECULA6,EC?pJ ee Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address l' oa d � 9 Village Owner e'�-)\©k'Oa �- ��'� Address Telephone UQ Permit Re iest k A- e �� P > �^ Square feet: 1 st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cos*, O® Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout 0 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 '4\Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Cl No Detached garage:❑existing ❑new size Pool:0 existing O new size Barn:O existing ❑new size Attached garage: 0 existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Ns Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION /L Name dJ®,�J <��-' Telephone Number S 2-2- Address i VN c O\yd1 n �,� License# �K)uLx Home Improvement Contractor# Worker's Compensation# 000n b 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO JJ �L'� , 12 Ti SIGNATURE DATE !r i s FOR OFFICIAL USE ONLY j, PERI MIT NO. - C DATE ISSUED AL, MAP/PARCEL NO. _ '• • ' �� ADDRESS } VILLAGE 3 OWNER �� _ �'� � ' .• •� — \Si DATE OF INSPECTION: FOUNDATION., FRAME.: i .ei „z: f INSULVION , { FIREPLACE— ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:+ ROUGH FINAL t f� FINAL BVILDING DATE CLOSED OUT y ASSOCIATION PLAN NO. ' I k i., N 18'28'30"E 160.08 LOT 2 i ( 44, 439 SF. OG !U 01 g ExrssrW g i er a PV Nannaw $ 2!0¢ • Q is.00 ss.00 Z f� O ' l9 175.DO S 12-27'!5"w WAY f,N OWN AS BETH ANN LANE PL_ O T PLAN OF L A NL7 "TO THE BEST OF MY KNOWLEDGE, THE FOUNDATION L OCA TED IN SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS AND CENTERVILLE — BARNSTABLE THAT IT CONFORMS TO THE TOWN OF BARNSTABLE ZON.DO — REGUL A TIONS. REGARDING YARD SETBACKS" jH 01 M PREPARED FOR DA TE.' OCT.25. 1996 ``!!,'D s ti ROBER T COGGESHA L L r S. ` -bi;! `5 ` DATE. OCT. 1996 SCALE. 1'=40 FT. FLOOD ZONE NON—HAZARD ` Tf�E� CAPS 6 ISLANDS ENGINEERING , 0-61 2c \ �Nr.Nos/ MASHPEE — MASS. 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ONE RISE�� I�/111�I'i�A111111 � IlAlr � �� i1�i I i•� i�iA�i �■ ■■■E ■■■■■■■i ■■■■■!■■! 1 ■■■■ f ■■■ ■■■ z MEN NNE ■■■ ■■■ ■■■■■■■■■■■■■■■■■■■■■ @■I`1■■■MEN ■■N■■■■■■■■■■■■■■■■■■ R■I 1■■■■■■ ■�■■■■■■■■■■■■■■■■■■■?■■U N■■■ ■■■ man ■■�!�I ■■■■■■■■` �■■■■ ■■l I1■ i ■■■ s r„t` F`l..x:":,-, , c ', .. .Yt Y,x.-. xY , r :7.3• q -. ) .. r'C "cx:yv°r L' "'+ "iir'=' .e-Ku`X"'sarF .. .fi++ ' 3 •.S' R�4y�" . •'E }� Jr' K r` 9F ua -> ( 2 ...5 w oo'kF`N '> C': 9,.r Y '. $.`' . ..' k , rrt F 2 �'pi w . r d` N ''. s,.•w,' `n a t.4++" '.A �i`"°' '7 ,r,A _r\v,C•I..irR '``.s:� ki-� .", d' 'L• ,,.1 ;yr d'"" ,. .ire 7r ' wca+isa'., y+ca+� .'." .j..;..,,x-9 ...g.'F, " 5 - ,�•p �'$-s+af.ZE-" [?.®'`a..d+." `4> :r;;h r4c+wiLa. ..g- rrt :.t i...._i+ 7> ayarar.-..�mfi `•xsr,a..,z-vxn�a.."> Ss.+ - %. y °PYRE T The Town of Barnstable . . . B,�uvsrnerc. Department of Health Safety and Environmental Services E159.r A Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 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. Type of Work: 61 C— Estimated Cost C-� Ad dress of Work: b - s , Owner's Name: u .Date of Application: I hereby certify that. Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 F]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 ereb apply f r a pe it as the agent of 7 owner. Date Contra r Name Registration No. OR Date Owner's Name q:forms:Affidav ale � BpgRp 0F� j Llcelme CAN BUILDING ` STR RE Num UCTIQN SUPAT:IpN� bor CS ERVISpR 073387 �; 1�9/Z002 CCNALD q CCX. R Rest�ic d o T�no: 73387 s, , 3221 INCOLN RD H.YANNIS, k MA 02601 Adml nisb`atOr HOME IMPROV EMENT CONTRACTOR Reg istratio 127829OR Type - INDIVIDUAL Expiration 01/12/01 ti. r - DONALD q• CO ��' 322 LINCOLNRD JR 'DMINIS1RgTpq NIS MA 02601 The Commonwealth of Massachusetts _ Department of Industrial Accidents ol/asestigations _ � �`• 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit name: location: hone# city ❑ I am a homeowner performing all work myself ❑ I am a sole rietor and have no one woridn in any P„ acrtv �i��,�� am✓�� ,w,�a�.�.�iai������i�iiii�iiiiiiiiiiii�iiiiiii ' ensation for my employees working on this job. ; .:. .,.,::..... workers .;::.;:.:::::::::.::. :::::,. .;:::::::.::::: ...:::..: am an a loverproviding c°mp.....::.:..::.:...:.:.::.,:.::::::::....:.:::.::::.....:::.:.::. ..,..::.:::..::.:: :.::...::::::.:::::::::.:::. :::::::.:.::,.::: anv name:... . ii.:::...:':i::.:::..:-.r:-.;;y.•?:?•::;i{':::is::}:::}::•Y:•.;.:: :':j:':::::is r..:<:::4}'::::• ............. ii:ii::{:i::rij::Sisj;F;:;i ii:'vi:ii::i::i•:i.......... :.. .............�: :;}: .}::{•}:Y}iv:::v:•{:::ti;};;ice;;{i'•':ti J`' .. .........::.........:......... . .... ..:.::..............::::::w:ii}i:::::::::4?:^:�•}:fi}}}:::.+.fill:{'{{v..•:v:r::::}:{{•}}}:fi:::::::::: •�e'.�:.ii}:':;i:•i••�;h�:ii':::':::.;n:.::.._ :iiii;:::_�' i:} ';sii::::isisi:.::i:!::{+::,..•:':�::::::.. ............... cvtvx.. : ia; i ;:;i� i;>?� rt:.?<:?<ia'•? S?>�� :>i�: ... cv#... :::.::::..: ::::::::.;:{{.};:;.::...::...:.::.:«.,:,,:-::...:........ .......... of Insurance cas:::;;:;:.:::-}'::::::.;;,;:,:,::?{:::•::.. :,,:::.,. :.. I am a.sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have olives: :•:::{.:<.;::;::.;.;.;: orkers ensationP :.::.,::.:::.:::::: ...::::::::::;'<::.:::::..:.;:.:.:;>:<.::.::.::::::::::;:.:: ..::._:<.;:.;:«.:::::::.;:.>:.;;:.;;:.::; the following w comp..... .....:.::::.:: }:. :::::::::::....:.::.:::::..::.. _ . . - comp :•.:,:.::::::::... ... .. ......r... .....:::.{v... ........:?rv:•. .............w:•:4v;.•,-v,.w:.';{•:n:::n................v•:;_-::_:;.�:::.i:•:i}i}iii:•.:.};:'::.::::::::.�::•:: C C :: :•i:^i:4i :v';:i:::i4:i4:$:':j':::ii?!;{?v:i: <iii>.:}:C}:}ij:t{{%}ii: �y t 3 L <'••�� } ad es S J { { i J}4tY.hLd6 4:•i4}iC::::, {.;}, {r. :::�:•....::::::w:... ...:•,;., ..:•: ... : I.: ,if - .. :Y .vxn:•.WT•....rY.-r.•}:.:.A::.t.�.^. .. Y'•' ..i:}.....:: �V•�Pr.� ....:::.. .. ..'•)}::{'::h:?}::::'v:-i?iii}:•}ii:_iii}}:•::^Yii}i:•:ii}}i _ .. : .::;.r•;;':} ;:,,..�r,....,•4 .Yw,>.; ...:..: :•:.:.;..:..::}:.:}Y..... ...:... ..4.�• ..... 01 q win+::Y:•:i:` 2 F. Xww c n •am QQ N I� a ddr ess :::::............. .. <.:.,................. .............. .. ... .....:.v:::::a................••.::.. ................:::., ......... ......... ... ...._... .. .:.......... .......:.::........::.AW i}isi�:{?:{ :.............. order geetlan 25A of Mt R,152 can lead to the of eefminai peaaities of a 8ne>�to SI.S00.00 andior Failure to seem a coverage m required ��im die form of a STOP WORK ORDER and a fine of 5100.00 a dsy against me. I mtders�d Ehat a one years'imprisomnent as well as dull p copy of this statement may be forwarded to the Omce of 1av of'the DIA for coverage verification. 1 do hereby a the ants the information provided above is trw d coned IY fP�Y an�� Date t 3—(D _ Signature � Phone# 'T Print name am of racial use only do not write in this area to be completed by city or town official permit/iicrose# ❑BWlftg Department City or town: ❑Licensing Board !s required ❑Selectmen's Office ❑check if immediate responseQ ❑Health Department phone#; contact person: ❑Other Or-ad 9/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individuaL partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, canstructum or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavk completely,by checking the box that applies to your situation and names,address and hone numbers along with a certificate of insurance as all affidavits may be supplying company P submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. %%/%/ SEEM City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided"a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the.permit/liceose number which will be used as a.reference number. The affidavits may be returned fo the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents 0MC6.01 investlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 �v Town of Barnstable Assessing Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6215 Robert D.Whitty FAX: 508-775-3344 Director of Assessing TO: Frank Schlegel FROM: Robert D. Whitty, Director of Assessing Janice P. Semprini, Office Manager DATE: .7anuary 10,1997 RE: Change Requests to Assessors Maps • Please combine the following parcels on map number into one. Retain# / Void all other numbers. • Please correct the acreage on Map # Parcel# The current acreage of is incorrect The correct acreage should be Plan attached: Yes No Will follow • Please plot the attached survey plan Cin advance) for FY 19 • Please plot the attached survey plan for FY 19 • Please change the following parcel number from: to: • Please do the following: P1 Pa�P snl;t T nt S 2 F, 3 for FY 7 as shown on attached plan. R228-046 002 Pls correct the acreage to: Lot 2 1.02 Ac, and Lot 3 - .31 Ac. 'Thanks. j/fomns/map-chg I . n ..�--r, 72 3 C�In4ry ' l p- 0263,- y , 3 I+� L u�M LA-, 1x 4'i lip O U% �N a� B - = .10304- 124 (2 01 =24 . DEED Y j We , Dwight E.- Coggeshall. & Marion I . Coggeshall , of 301 Pine Street ,Dwight. (Centerville) , Massachusetts in consideration of : nominal consideration grant to Robert Coggeshall and Lu Ann E. 'Coggeshall , husband and wife, as tenants by the entirety , of 283 Nottingham Drive, Centerville , Ma. WITH QUITCLAIM COVENANTS the. land . In Barnstable (Centerville) ,. Barnstable .County , Massachusetts, more particularly described as follows: 1 Being Lot _. on a "Subdivision Plan of Land In CentervLlle . <Barnstable) , MA. prepared for Robert & Robin Coggeshal'1 , Scale-'1"=60' , Jan . 29, 1987, Down Cape Engineering, Clvil ': ' F Engineers, Land Surveyors, Rte. 6A, Yarmouth , MA. " and recorded with the Barnstable Registry of Deeds in Plan Book 429, Page 62: together with the right to g go, over , pass and repass, and, use for easements as necessary that parcel of land shown as Lot 3 and "Existing Driveway" shown on said plan , which strip of land leads to Headwaters Road. Subject to and with the benefit of all rights, restrictions -and easements of record. For, title reference , see deed of Marion Irene Coggeshall to us recorded with Barnstable Registry of Deeds In Book 980 , Page 146. �7♦♦ice�>��",'�`ii�'' . ;err Executed as a sealed instrument this /6 ) day of �v� 1996. ' Dwigh E. Coggesh9fIl ffin lirm Pnry nIVII. 0 Marion I . Cogg all COMMONWEALTH OF MASSACHUSETTS Barnstable , ss J U f. 1 U 1996 Then personally appeared the above-named Dwight 13 Coggeshall and Marion I . Coggeshall and acknowledged the foregnqi to be . their.. free act`• and deed befo re re me . l V i I� i Notary Pu 1 i.c ' My commission expires: �1�1� QUERY- PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 02/11/97 PERMIT NUMBER 18931 PARCEL ID 228 046 002 PERMIT TYPE BPLUM PLUMBING PERMIT DESCRIPTION 13 FIX MASTER PERMIT INSPECTION REQUIRED REQUESTED SCHEDULED INSPECTED RESULT INSPECTOR ,BPFIN- - - _ _-- - - ---� . 01/31/1997-- A- _ _ -RBUR BPROU 10/31/1996 EJEN BPROUl 10/31/1996 A EJEN BPROU2 12/17/1996 A EJEN BPROU3 PRESS ESCAPE ,TO END DISPLAY QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 02/11/97 PERMIT NUMBER 20013 PARCEL ID 228 046 002 PERMIT TYPE BELEC WIRING PERMIT DESCRIPTION COMPLETE WIRING OF NEW SINGLE FAMILY DWELLIN MASTER PERMIT INSPECTION REQUIRED REQUESTED SCHEDULED INSPECTED RESULT INSPECTOR BEFIN -_- _- -- - -- - - -- BEREIN BEROU 12/17/1996 A RWES BESER 12/30/1996 A RWES PRESS ESCAPE TO END DISPLAY QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 02/11/97 PERMIT NUMBER 18323 PARCEL ID 228 046 002 PERMIT TYPE BUILD NEW RESIDENTIAL BLDG PMT DESCRIPTION SINGLE FAMILY DWELLING (SEW.PMT.#96-468) MASTER PERMIT INSPECTION REQUIRED REQUESTED SCHEDULED INSPECTED RESULT INSPECTOR BCHM BCHM2 --- -- /3 1-7/19 9 7 ._'p, - AMAR BF IN 01- - ---_ - BFOD 10/25/1996 10/25/1996 10/25/1996 A RSTE BFOD2 11/18/1996 11/18/1996 11/18/1996 A RSTE BFRM 12/18/1996 12/18/1996 12/18/1996 R RSTE BINSU 12/23/1996 12/23/1996 12/23/1996 R RSTE PRESS ESCAPE TO END DISPLAY N 18'28'30"E 160. 08 —� LOT 2 44, 439 SF. O 9+.00 � Q � OUWA TSON �i Q 1P.00 pp.00 Z f� r 175.00 S 12.27'15w `,yAY f,,NOWN ,AS. BETH ANN LANE PL_ O T PLAN OF LAND "TO THE BEST OF MY KNOWLEDGE, THE FOUNDA TION L OCA TED IN SHOWN ON THIS PLAN IS AS IT ACTUALL Y EXISTS AND CEN T ER VIL L E - BARNS TABL E THA T I T CONFORMS TO THE TOWN OF BARNS TABLE ZONI PREPARED FOR REGULATIONS, REGARDING YARD SETBACKS" DA T ROBER T COGGESHA L L E.' OCT.25, 1996 ^ i!D �, . , n ' M "' DA TE.• OCT.25. 1996 SCALE: 1" 40 FT. a CAPS 6 ISLANDS ENGINEERING FL OOD ZONE NON-HAZARD \WSTQ� v MASS. D-61 2C ��+� [AND MA SHPEE - ,� _�„e . _ yn „^ � 'f`�/(/vy(/ 1 �� f �� ���� �� �� f 1 � � i i -. '� _ _ r of IKE ram, snartsrnsLE, Mass. 9� 1639. ArFD MA'S A Town of Barnstable Department of Public Works 367 Main Street, Hyannis MA 02601 Office: 508-790-6300 Thomas J. Mullen Fax: 508-790-6400 Superintendent To: Janice P. Semprini, Office Manager, Assessing Dept. From: Frank J. Schlegel, Engineering Records Manager- Subject: Subdivision of Map 228 Pcl 046.002 Date: January 10,1996 Dear Janice, This office is in receipt of a request to subdivide the above mentioned property. The property in question is currently mapped as developer lots 2&3 as shown on the plan referenced on the supplied deed(Book 10304 Page 124). Review of this lot reveals possible problems with the description you are requesting. Lot 2 is the bulk of the property and has no road frontage unless used in conjunction with lot 3. The plan states that"lot 3 is not to be considered a separate building lot but is to become and remain part of lot 2". A building permit was issued to this property in October 1996 according to the building dept. and removal of lot 3 may render lot 2 as unbuildable. Please contact the property owner requesting this change to be sure that they are aware of this possible conflict. A copy of this information has been forwarded to the building department for their review. - l CONFIRMATORY DEED, WE , Dwight E : Coggesha11 & Marim . Coggeshal I . of 30i P i ne Street , AmStable ; !its Rt rvi ; • p ; , i'1 assachusa : tq in C.onsiderWon of • nbUna , consideration gr.'nnt to Po6eIrt Cogg';`kink ono Lu .-:.nn E . Coggeshal l . Absband Drive Gentery I m ova, Wi TH .QU;TCL.r IM l OV.ENANT 7 s u 6 nt �., i rf drSd�t'1�5Ptt�, <t�1 C.�� 173C ' I 1 �i i 1 t P crlbed as fol lOWS Being LaC i gnq 2 on a L�4 f Land i ci.rt o 3 n C i Ceateru ? w( Barmabie) , MA . Pykred. for Robert 2"e 1987. ,riOwri Cape Engineering, C `v i 1. ungi heees , Lanq ur 4 r �r � s s Q e GA , 7:armomth . M `a d _reroEoed tai to .the Barnstable Registry of Deeds in: rt i°an ,o% Ila. Page 62 . QuAct Q WON the And e�iC'E'iY'i�'nti of. � � d benefit U� . �11 rights , µt' friction; 0r tit c sey .deed 01 Manion yys,sc,eecOrOe t with Bar�istab}1 e Registry of Leeds in Book' 980 , THIS 146 J A CONFIRMATORY DEED OF A DEED hATED ^ 1 7, RECORDED. ai BOOK .osv, PHvC lc:, 1 WHEREIN ' n iL 1 uL/1 Z 4 1 .t CONVEYED, 'Executel as a Sealed st rifi tj� t, 1 1e1• i. , � I tea:' of '.ianua ry , i�i�r i r Y • b r y r - a~Ci�ii'�11P:�°f ALTA vfP Ma.SS:6CHUSETTS _ j' 9` ; , �`� Y1 +' r C ••J�1.wl ti.�6 tY Then person .i ly ppe ,red We anave - amen Dwfght E. C:cggesra . l and MOon i , Coggef a , 1 and .:.tck:'thy i Doges '1' p ArP08% insLi'L;mpm zo be thelc Kee act di'G d'eea, before me . (-N . - • .. by s y'����7"'f�`�.fa�� !�� �� �� _ ........ Notary pub I C 1 � , oF,HE T The Town of Barnstable BARNSTABLE.� Department of Health Safety and Environmental Services MASS. t63P �0 �f039, Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice 1 '�c Type of Inspection RFO 1,0 IY�S J Location 13q Permit Number Owner Builder t `-1 LLi it:,g. One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: C� #-' 1 P 1�tn p o, ,mil Pd .cs ►r1 2 U v,3 dF ftvaAo%_- <:�T- i IWO Please call: 508-790-6227 for re-inspection. Inspected by - � " 1-11-11 Date 1, Z�-' t The Town of Barnstable O� sA �e.MASS. g Department of Health Safety and Environmental Services MASS. i63q.1639. Building Division 367 Main Street,Hyannis,MA 02601 rt Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection P /� -7 Location 39 4caAw ASS 90 Permit Number Owner OOC,Z•. C 9 �.��- Builder S� �� k2 `2�r,,} One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: L3t A,k 63, •l Z v rL, Th k S 7 -,z, 4S f l o o M 'Ra a-F 14 � p � Lu i W Y �f-TV✓-Q f Please call: 508-790-6227 for re-inspection. Inspected by t, ,.�4,,1X ,,4 Date �.�� �, � (,, ncA _ -- The Comnronivealth of ifassachusetts Deparnnent of Industrial Accidents ��; Of ice of/nvestlgaUons 600 li'ashinrttin Street �\ Boston,Mass. 02111 Workers' Compensation Insurance Affidavit licant information• name: location: city I�—�/ f we, phone I a homeowner performing all work myself am as sole proprietor'and have no.one working in any capacity _ ,. ,-,--,s-•�� -a.*C9•-"Jc�ae'"'--.�w4fEr�a�^•;R�+a� ,P.�..-H-....—�r'_!rt+l'��-�---"a-` I am an employer providing workers compensation for my employees working on this job. company name: — C/ t VQ PIS address: city: phone#• insurnnce co. policy# - `- --- - "--�•- -..,..... ,y,..-..�,t',:vq.r....«....-.• vsr +,::.> - - .a...,.r.....�...,.r,..�....>-..�-.-.. byl am a sole proprietor.general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: R company name: address: city: phone#: insurnnce co. policy# _ _... .a:,m« r�wn__ - -T!::e•,^h =. - ;-cc-�s-'�-.Stiz.^^�;t'Fo`:r,r�? r ..,+:! g�a:''i'.Tn,'.s:*? .'„�"- - company name: address: city: phone#• insurance co. policy# _ .Atiach additional sheet if iieeessa Fg.:zW_"t- �t'• r:F1 r;•i:� `!f»"� " hy: yay Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as%vcll as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herehr cNrtifj wrrler the ins and enaltieypV perjure that the information provided above is true and corre t. Si:nature ��G w Date Print name ��1/Div f/i�.�,�f Phone# yam otricial use only do not write in this area to be completed by city or town official city or town: permittlicense# I.1Building Department [3Licensina,Board U check if immediate response is required ❑Selectmen's Office C)Health Department contact person: phone#; Other (mised I");PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An crmplmrer is defined as an individual, partnership, association, corporation or other legal entity. or any two or more of the foregoing engaged in a.joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwellin`, house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to bean employer. MGL chapter 152 section 25 also states that even,state or local licensing agency shall withhold the issuance or rene-tval of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. / Applicants Please fill in the 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 the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Citv or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of lnvestiaatioils would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. �YiAR M!R•.••^:..,,.../.:.•r.-s.+..^h?!.l.^'•._ .,..,�n!R'AW/'!q �^"R�.[�/�""LR►n ;,•!'."!xra.•rs+ r: ,�...r•.,•sr?!:,qv.m.r+'Rn+,r+ ,n..,.--•+.•:.,.�•.w..�+nr-a-exw�..nc7" 77+*=7 71" / The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Yt ✓lie �ano�noozu��l/, a��'la.araclivaeCls I � _ .. •. .. Restricted To: 00 C '•I D�:ri1',T�iiiiT OF PUBLT.0 SAFETY "O`�S""'j"°,Ta4 Si'PERVISOR 'TCENc.' 00 `acne �..:' iLL.l.: 1 ul L- u1 VY ?umber: Expires: 1G - - -§ 2 Family 'Hones Restricted To: 00 Failure to possess a current edition of the Massachusetts State Buii?ding Code �1:-r x4ii DAVID R SULLIVAN is cause for revocation of this license. 11 DEXTER'. HILLS RD HIROUTB, RA 02536 °F THE lqr,_ R '10 The Town of Barnstable . srnsLZ 9 MASS& g Regulatory Services 1659• Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION air,modernization,conversion, MGL c. 142A requires that the reconstruction,alterations,renovation,repair, 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. I It Type of Work: L IS � 'e d Estimated Cost Address of Work: ! Owner's Name: Date of Application: I hereby certify that. Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Bui ding not owner-occupied caner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Ow r Name q:forms:Affidav r , 9� MASS. ���' Regulatory Services '°rEo 59. A Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMMON 1 Please Print DATE: JOB LOCATION: cJ / 7` �w 11�r'g d CIA 4p,r number street village "HOMEOWNER": n bC'r� �094eC 44 77�-7(e.� l -- name //��� nn home phone# work phone# • CURRENT MAILING ADDRESS: 3 f f Q cX Gy eC rS P(k Ce"rui )le_ MA_ " city/town state rip 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. DEFINMON 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 proc res and r quirements. 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 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:FORMS:EXEMPTN _�'"�`'�`— The Commonwealth of Massachusetts ' Department of Industrial Accidents oxce otlnsesmoodeAs 600 Washington Street Boston,Mass. 02111 Workers' Com �e�rnnsation Insurance Affidavit rmrsrnr name: -e1-4- location fPm /.V ct r S ci C� ! hone# .>'� ❑ I am a homeowner performing Al work myself. ❑ I am a sole ro rietor and have no one workin in a�ca acity rovidin workers' co ensation for my employees working on this job. :.::::::::,:.::.::::::::::: ❑ I am an employer p g mP. ,. cons an nanfe: _ seldress _ cv insurance co. i►h # rl//a m a sole proprietor, general contractor,o homeowner e followingircle one and have hired the contractors listed below who ' com ensation Polices:worke p P_oli,..:s: Vom an name: :.:...::. .... j :.. ....................... .. ..............:. ......... ........ . .............. . ir d ... .. .. ".:,.. address: .... .. :::... .. hone# soli Fsilm-e to secure coverage ss required ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one yeam�imprisonment a,well a,civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oiflce of Investigations of the DIA for coverage verification. / 1 do hereby c under the p ' and'penallies of perjury that the information provided above is true and coned Signature -4-3 Z44;::: -- Print name �4�l Phone# Sdgs�' 77 official use only do not write in this area to be completed by city or town official perudt/license# ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity;or any,two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,'or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides theiein, or the occupant of the.dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the ' commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting; authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,�not the Department of Industrial Accidents. Should you have any questions regarding the`9aw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peiinit/ cnse number which will be used as a reference number. The affidavits may be re uriR io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. %%%/%%///O%%%%///////%%%%%%%//////%/O/%%%%%///////%/%%%O%%%/%%%////%////%%%%%%O%%%%/////////%%%//////%%%%%%%%%////// %%%'�' ' The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Otflce of Imlesugadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 N 18'28'30."E 160.08 LOT 2 44, 439 SF. .00IL U o g . 'i"` �1Y`3 " 175.00 2.27015"w p WN AS ®ETH ANN LANE WAY fCN� P_ OT PLAN OF LAND "TO THE BEST OF MY KNOWLEDGE, THE FOUNDA TION L OCA TED IN SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS AND CEN TER VILLE - BARNS TABLE THA T I T CONFORMS TO THE TOWN OF BARNSTABLE ZONI bCl REGULATIONS. REGARDING YARD SETBACKS" PREPARED FOR +�w�o� ALL � DA TE.' OCT.25. 1996 UsROGER T COGGESH DATE.• OCT.1. 25. 1996 SCALE.• 1'-40 FT. d O . R.L.S. 2rS�d5 000 ZONE NON-HAZARD CAPE 6 ISLANDS ENGINEERING , / �A< <r, D MASHPEE - MASS. i 61 2C C ' f Parcel Lookup Page 1 of 1 e_X Logged In As:ar ed Parcel Lookup Friday, February 9 2018 Nancy Larned Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options Search By Street LZ �'1 Street# Scree headwaterName I Village All Villagesv. SearchY I <Prev Next> Page 1 of 1 79 Rows/Page: 100 Parcel Location Owner Village Index Map 228-046-002 39 HEADWATERS ROAD DESROSIERS, BARRY JR&TERI CENVIL 0683 228046002 228-148 41 HEADWATERS ROAD COX, MICHAEL& BONADIO, JOANNE MARIE CENVIL 0683 228148 228-043-001 44 HEADWATERS ROAD HERLIHY, MARK CENVIL 0683 228043001 228-179 47 HEADWATERS ROAD FALLON, MARK P&JENNIFER-LYN CENVIL 0683 228179 228-043-002 54 HEADWATERS ROAD PUCILOSKI, PETER L TR CENVIL 0683 228043002 228-180 61 HEADWATERS ROAD PETERS, GEORGE A CENVIL 0683 228180 228-043-003 64 HEADWATERS ROAD OBRIEN, CHRISTOPHER C&ERIN E CENVIL 0683 228043003 228-042 76 HEADWATERS ROAD CROSS, ROBERT F III ESTATE OF CENVIL 0683 228042 228-181 77 HEADWATERS ROAD HART, MARGARET J CENVIL 0683 228181 228-185 92 HEADWATERS ROAD LYNCH, STEPHEN A®INA A CENVIL 0683 228185 228-182 97 HEADWATERS ROAD CASEY, CONSTANCE T CENVIL 0683 228182 228-184 106 HEADWATERS ROAD GOYETTE,J PAUL&BARBARA J CENVIL 0683 228184 228-183 113 HEADWATERS ROAD COX, DONALD A&GRACE A CENVIL 0683 228183 http://issgl2/intranet/propdata/lookup.aspx 2/9/2018 oFt r Town of Barnstable �`Q� �rm►t#o Cv Dom'? Expires 6 months from issue date / Regulatory1!11#10 Fee * * swxtvsTna[.E, � 4 639: Richard V.Scali,Director ATFD MAC A .7 ('�V Building Divisio QF Tom Perry,CBO,Build ing`C® issioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 �FaxsSQ8_79_0�623.0� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ��yy Not Valid without Red X-Press Imprint Map/parcel Number �D Q'Y40 0 2— Property Address 3 1 *APWft:rfk5 RO C6 7GP V C_ /0 ❑ Residential Value of Work$J �j t!1 a0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address MA Contractor's NameA1 E'w(FAJ G f fW.8 M El 4 ( AAkS/M S` Telephone Number (j,r — 8 7 7- ? 3� Home Improvement Contractor License#(if applicable) (716 /®� Email: A16YJ Construction Supervisor's License#(if applicable) ��L— q C�✓l�I ❑Workman's Compensation Insurance Che one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. - Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ?Re-roof(hurricane nailed)(not stripping. •Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE:, Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revised 061313 M the Caywaamo-Feakh of-Massachuseffs - Office!OOM�Lsi afians b 600 Waykington Street Aastr>rn,,1 A 02.111 WF4}1�artcrss gar7ia Workers' Compensation assurance Affidavit BidIders/Contra:ctnrslFI,ethiciansMumbers AppEE:aut-Ecdrrnsation Please Print Lef�ibly T"am {$ognes3/Or nizafiou ndiv�dnan:N �V k A164"0 M 6"TAt M 115%Eo�J 1 A(C Citv/SL,a��Zi�p---=w ftt�ll 6 V TH MA� 479 — 07 eBa tire;ou an employer:r Check t1mappropriatebo� � of.1 o ect s 1 am a ezer-al contractor and'I Y� l { - l-❑ ?am a coup?aver wig { $. 6- ❑New cDns � n have hi.*r�the sub-contractors. °n-cr%ogees{full and/or gam-#ima�* Rdeliu � 2 ❑ I am a sole proprietor or partner Listed o�x e attached cfi i 7_ ❑ P� si13al and have no employees These sub-coutractors have -S_ F-]Demolifioa workiag vr-me in an ci r emplra3�and have workers' Y capa. 4_ $uildg addition No:wo+rnS' comp_rr,wrrance comp_msnrance 5_.❑ We ar?a corpor-ationaud ifs 10.❑Flecirical repairs or additions ffi oaas have exercised their I l_. Plumn rep airs or additions 3_El ?na a homt rn—m�doing all word ❑Plumbing ihtf Wyse f [No tvorla-'Comp- rg .o e supfiaager Iv£GL 12-.❑RLof repairs at» jcQ required-]I c_ 152,§1(4�and we hss au employ _[No wmioers' 13_❑ e Othes comp_msuran r�gnirer3. "3rr;Eppld amt dru t rhrck--box rl t=�t f�lsn fM o'Ut tha SeC-- below s razing[nrs�o keis�cormrrc og poii�iu� ire t EDMcVnus Ws M 5U'DMH this affaTma indi cstsg tney am riling zn vvrn and dim hire oatdde enotra Tors nmst Snrh C�asctnrs psi ch_�ck this bcx Est stlxchr�sa so3irionsi sheet�ffcciiit;�ns�of the�x- s�md stsi�uhethec oExwt i3�se�Sies b�-v= �!.,fE�_ Zfrh's¢b-{oai��acsh.-Ce eu�mTo�-r�s,the3musi giu:ide t�i-4.arks'comp.poLcF nmabex_ am art�:arpio}k"r`€hr�isgr3t�ic�ut�tE�or�erg'ccrr�arurliizn�rrsrtF�utcetot rsr� prrr�rl�-�c�. Ffe�t>'is ifc�jra�ic}rznd job z-r1� inforrrzali`orz � . Inr�uance Ccmpat�--�i�ia�e: Pali,.-y r cr Self-ias-- Expiration Date: Job Sim d&e�: CifyI S tate/Zig= Autzclt a ropy of that wGrkers'compensatiou polir-F de-cl-xrstiou page(showing the policy nrtniber and Rion date). Failure to sire coverage as regmued.under Section 25 A of MGL cc 152 can lead to the imposition ofcriminal penalties of a tine up to$1,500.00 and/or one=year i pr so nt,as well as civic g eaaHies in the fora of a STOP WORK ORDER-and a fine of up.to�250_M a-day agaivst the violator' Be advised that a cry of this 5btemeat maybe be forwarded tn:the Office of Iuve*gations of fie DIA frrr mi sgn-anct coverage vetcation_ I dii{tc�r e crrtt}` ruler tks peons ariapsngbyss a.p,darp that-the irrforazatian prcnided aba cue rs.Into and corrsct- r , , �Siaat"�� � QJ7,cia r--8 wiT . Du rro.t wjitg irr Aiis Area,to ba campleted by cifj or town affic&L City-or T owu: I'`cruritTucense ig IS& Tr�,w Antharmy(c1.rdc one): r I.Saard. Hedlth 2.Buff ing Departaeeat &GilyfFawu Clerk 4_Electrical Inspector S.Plra biug Inspector [.Other Cc+�L ct 1'ez on: Phone 9: - 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuautto this statute, an employee is defined as--every person in the service of another under any contract of hire, express or implied, oral or written-" An employer is defined as"an individual,partnership,association,corpora�ion or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,-or the receiver or trustee of an individual,partiership,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 maintenance,construction or repair work on such dwelling house DU on the grounds or building appu�:errant thereto shall not because o1. f such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to consfsuct buildings in the conamonweaith fo,-auy applicantwho has not produced acceptable evidence of compliance v-ith the insurance.coverage required t a MGL chapter 152 25C ^ sta_te e the c ll r, - =s ns shall Adaz�on IIy, p , § (/) s `N zther ?u omnonwea_?u-._or any of its political s�.ibdiv��_o_._ .._Ia-I enter into any contract for the performance of public work until acceptable evidence of compliance V iU''1 the iPSU17,-ace requirements of this chapter have been presented to the contracting authority_" Applicants - — - Please Ell out the workers' compensation a��davit completely,by chec l-n.g the boxes that,apply to your situation and i.f necessary,supply sub-coutractor(s)nane(s), addresses)and phone n:nnbe,-(s) along with'their ccer�:ncate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)vvitla no employees other han the members or partners,are not requ?re-d to carry workers' compensation ins z ante_ if an LLC or LLP does have employees, a policy is required- Pe advised that this affidavit may be s,.br-ziited to the Department of indus�aia_I Accidents for confirmation of inszrance aver age. Also be sure to sign and date the affidaN t I1?e aides*rit sho??d be returned to 'sue City or town that he application for the permit or 1icerse is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the Iaw or if You are required to obt=in a workers' compensation policy,please cal-1 he Department at he number lister below. Self:insured companies sb.o.tld enter tiatir sell-insurance license number on tre appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Deparsmtat has provided a space at the bottom of the affidavit for you to J11 out M-1 i h,event the Office of Investigations has to contact you regal-ding the applicant Please be sure to fill in the permitl cease number which will be used as a reference number. In ad.diticn,an.applicant that must submit multiple permit/Lcense applications is any given year,need only submit one alffidavit indicating cues en,t policy information (i.-necessary) and under"Job Site Address"the applicant should write"all Iocatiois in____(city or town)."A copy of the affidavit thai has been of icially stamped or marked by the city or town may be provided to the applicant as proof that a valid uzn__vit I on file for futuze permit or??cen;es. Anew affidavit m-1st be nll..d out eaci-i year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i_e.a dog license or permit to burn leaves etc.)said person is NOT reuuired to complete this afddavit The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a tail_ The Department's address,telephone and fax number Th Coatmaawc altlx of Massadaasetis D_eparb[aeDt of 1ndustaa1 Acci:dpas Q of IaVI�Sfigatian!i 6-GG Wasbingto--a St t Bostozi_ 02111 Ttl,9 61 7-727-9-00 W 406 or 197 -2-MiL4SSfi E Revised 4-24-07 Fax' 6 1 7-727- ,E•'-.`91 ��.�ass,gavlca - ?GYjjj �22� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 178908 i Type: Corporation -re F 7, + :sp Expiration: 6/2/2016 Tr# 252524 NEW ENGLAND METAL MASTERS.�INC µ LESLIE NOLAN .- - 6 HOMESTEAD RD �� ,� ? _ SAGAMORE BEACH, MA 02562 � y-" ;a a` - M1 • '�,,� µ-r;f, Update Address and return card.Mark reason for change. rd g , SCA 1 C 20M-05/11 Address Renewal Employment Lost Card � r ' . C��e�oowaaooacoeccCG�o��cuJoac�ccaeGlr� '- - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 178908 Type: Office of Consumer Affairs and Business Regulation xpiration 6/2/2016 , Corporation 10 Park Plaza-Suite 5170 ® N � Boston MA 02116 NEW ENGLAND METAL MASTERS:INC. LESLIE NOLAN 6 HOMESTEAD RD SAGAMORE BEACH MA'02562' Undersecretary Not valid without signature ,r, f i 1 i IVew Er�g�ar�d 1®/l�tal 1Vlast��-s Make your roof metal strong 31 Home Depot Drive, Unit 172 Plymouth, MA 02360 (844) 495-7663 f September 3, 2014 To Whom It May Concern: This letter acknowledges NR Construction, owner Nicholas Rivarola(CSL 97885) is an approved sub-contractor hired to supervise roof installations for New England Metal Masters, Inc. Sincerely, Leslie Nolan President r 08/19/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00996-001 CONTACT JACK WOODS, PRESIDEN Thomas J Woods Insurance AI/CNN.Et: (608)766.8992 AAIC.No.: (608)791-9841 P O BOX 2940 EMAIL Worcester,MA 01613-2940 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A.I.M.Mutual Insurance Company 26158 INSURED INSURER B Nicolas Rivarola Morales NR Construction INSURER C• 96 Glendale Street INSURER D Worcester, MA 01602 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDD MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Fa occurrence CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ . GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ __]POLICY EO CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED a PROPERTY DAMAGE HIRED AUTOS AUTOS a, Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DIED RAW M R�ETpETN�TIIONN $ $ ' �'I� M5� gCYERS€LIABILITY X TORY LIMITS �ER A P T&IffPARINER/EXECUTIVE Y/N r E.L.EACH ACCIDENT $ 100,000.00 A o� Ic�CPM EE EEXXCC UUDDEE�D77 NIA AWC400-7027311-2014A 6/9/2014 619/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 If Yes describe under SC describe OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DE DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i The workers compensation policy does not provide coverage for Nicolas R Morales CERTIFICATE HOLDER CANCELLATION O'Lyn Roofing Contractors Inc 915 Pleasant St Unit 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Norwood, MA 02062 THE .EXPIRATION DATE THEREOF, .NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. r AUTHORIZED REPRESENTATIVE f/•/}(�jf/J/�f�/J�/y;' ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) .The ACORD name and logo are registered marks'of ACORD • ti Board of Building Regulations and Standards v/ze Lpa��z��wouoea o�C�/�aaoa�-icoeCLe. Construction Supervisor Office of Consumer Affairs&Business Regulation License: CS-097885 i.� ME IMPROVEMENT CONTRACTOR eglstration 948827 TYPe NICHOLASRWAkOLA4, xpiration 10/27/2015 DBA 96 GLENDALE S3 r- Worcester MA 0 602 NR CONSTRUCTION ` ' � "`� J in � v Expiration NICOLAS RIVAROLA 03/18/2015 47 PRINCETON ST 2 Commissioner LEOMINSTER, MA 01453 Undersecretary i I ...... .:....... r ... License or registration valid for individul use only before the expiration date. If found return to: Office of,Consumer Affairs and Business Regulation 10 park Plaza-Suite 5170 Boston,MA 02116 Not lid without s nature f y � : 'a a,Weva L_ a Due V.NNW V am a67a 6v am I a7r%L_ %J P`.8476,%,L_ 1Va 4a 5.-4 a HOME IMPROVEMENT CONTRACTOR REG#178908 31 Home Dept Drive m� Unit 172 FEDERAL ID#46-5710609 New' [England Plymouth, NU 02360 MLEftaLl MR steirs 1-844= 95-7663 Make your roof metal strong. °°.M AKE YOU ROOF . ETA" L ST®ON GN THIS CONTRACT made th day of 20 If between: -' - (Homeown() ° r r 8: 2_ C (Ho R —A me Phone) (Cell Phone) r (Email) � �o .. (Address): (City) (State) (Zip) hereinafterthe"HOMEOWNER`.or"B.UYER".and NEW'ENGLAND METAL MASTER'S,hereinafterth6."CONT,RACTOR!'or"NEMM'; with all ofthe foregoing parties being collectively referred to herein Vs the"PARTIES". WITNES,SETH:Contractor hereby agrees that itWil -forthe co�nsi�d}erafion herein fter entio ed,furo(igsh a)l.l or and material necessary to install the following described.work at,premises'located at c _„\ ✓�1 `1�l . the"WORK". The word'I","me"., and"my".refer to each person who signs as Homeowner. If more than one person signs below as Homeowner,ea.ch person.shall be,jointly and severely.liable for the promises made in this Agreement.The words"you"and."Your" 01 refer to the Seller or holder ofthis agreement. AGREEMENT: I agree that it is my decision to purchase the goods and./or services described below at the Total Cash Price of$ f } 1(J I promise and agree as follows: is .29. GUAGE,THREE FOOT VIDE METAL ROOFING }J /� SPECIFICATIONS IFICATIONS OF CONTRACT NOTE:No surfaces will be covered unless specified: 1. Roofing Color: U' 1/�V c �/�� 6 6_E` y OTHER-:DESCRIBE, 11 Total . a�-- 2. es❑No; Ridge Cap Cash O **�' d. .5 Price i 1 3.1LYes❑No Drip Edge 14 . 4.❑Yes 1XINO Add Ridge Venting Deposit n Ik With 5. Yes ❑No Z Exposed Hurricane Hardware Order, (� Yes ❑No Clean up all job related debris and'ha away" Additional' 7Yes❑No' Chimney-Number of Deposit, 8. Yes❑No Flash.Pipes-Number of. EXCLUDED:. Due Date: e � jC1 /,o 9:❑Yes N0 Skylights-Number of: Balance Due. 10.❑Ye No Valley.. On �,!� Substantial D 11.�/JYes❑No Rake Tri Endwa) Sidewall Completion FF fff����� t.. .� 1.2.11YeNo " Remove Vents- e4. Closures �'�/ *� p /qJOBM'16 ':'1 �I 1.1 I SIGN OK Remove&Dispose Gutters r J IIIJJ �0 � t Propos _Start and Completion,Schedule f_ ( A Af date_when Contractor begin contracted Work: lLf ` / date when contracted work will be substantalfy.completed New England Metal Masterg Inc does not do any painting,or staining and is,not responsible for conditions or circumstances beyond its control Includin,g condensation resulting from or due to pre-existing conditions New England Metal Master$Inc.is not responsible for stripping any roof material priorto installation.Note: Fascia trim or strapping is not included unless specified _0 Cash_ , NEW .ENGLAND METAL MASTER'S INC. Assisted-Financing Ci Debit/or Credit Cacd` _ PROMISE TO PAY: I promise to pay NEMM theVIOal Cash Price.priorto or on the date of substantial completion as agreed to herein. If payment is made by credit card, I understand that I may only cancel, reverse,or dispute the credit transactions within 3 days,and thereafter all credit card transactions are valid and enforceable: BINDING NATURE: I understand thatthis document does not constitute a valid.and.binding contract for any purpose until and unless it is signed and accepted by NEMM. You May cancel this agreement if it has been signed at a place other than the Contractor's normal place of business,: provided you notify the Contractor in writing at its main office or branch office by ordinary mail posted,telegram sent.by delivery no later than midnight of the third business day following the signing of,this agreement.See attached notice of cancellation form for an explanation,of this right. DO NOT SIGN THIS CONTRACTIFTHEREAR,E,ANY BLANK SPACES!!! Two identical.copiesofthecontractmustbecompletedand signed:Onecopyshouldgoto the homeowner.Theother copy should be kept by the contractor. IN WITNESS-HE E�F the rtes hereto have signed their names this day of 20 a 9.. Signed: M <ETINF�REPRESENTAT HOME WNER / Acce ed Sig OFFICER OF NEW.ENGLAND METAL MASTER'S,INC. . - HOMEOWNER • _ Notice.The terms of this agreement are,contained on bot sides ofthis page. NEW ENGLAND METAL MASTER'S,INC CopyrigTit©2014 i y El a 004-26 aaa ------------ 1 i- l �1 --- 7 81 CD -C- \/ \ 001 C w 145- r ,. 1 S + ) ,. C X �a' IV �� � S • " a � c°oaM r j W u 5 a i ' y. a 0�ih N\c,.5 r eC' �J lot co Alt 77 g" Do r e�� o l2' - f eCG10c -t- I Cjo _ j V L6 Va rl S CG t E —�(O - �_.__.._...._..__�._-- 3 y lxo?. F . 1.1 i (CXJJ J{ to L _ f . wx r ! 'U 7 V �Q� N u i 1. fl rv1 s �XIO IG"O.G• N :` f � ' 77, N �: Ra�Ter15 160 G: t , y Al: f Collor ' of xc* l� GC. a �x�a•� R;olge r"�►e t � � � � awn_ �,v;� S1) �i_✓�'r� Coo FrcAw�:r,� • .. � �K o /L�cc ?abs i •w�,ire Ce cA,r I i - 1 I # I ( x 3 , ten"�. , a . n Asa x x; , . 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FINISH GRADE OVER FINISH GRADE EL . 7;-� OVER TRENCHES FINISH GRADE 7G. © FINISH GRADE OVER DI S T. BOX i sp° SEPTIC TANK 7 ,o,o. 12 MAX. a.0 �3 -fetf . c ..ob , d o'4 G• �....w: •d.• 'Q.•Ap.A�;ip .off dA.1O;V•o��d'ab!••da•'• .a•ti . i b / -- - ��o P: i OUTLET PIPE LEVEL TOTAL` LENGTH OF TRENCH 3 °: a FOR 2 FT. MIN. — e s . e :• :D a :d• b' • e w• b 4)log? i +. :a• a? :v : ' o°o ' s'� 1 �c�,_�Q p. ;f10 .r^• :.,�f lC7 . ..�• p' • _ 0 ,q `• �7yC C. I. OR P VC TEES e, G 3 v o ® ® I['� C.=1 o G� C! edH: '"� .... v•Q _ , ,. AO 1500 GALLON D. S TRI UTION BOX 06 BSMT FL . .o°:o o a EL . INSTALL ON LEVEL BASE "50 0 GALLON OR Yh/EL L S " ' PRECA S T CONCRETE H- /0 REINFO/"7C..ED `. �a .°�.i►•.o v`i''ri••oaaio'o'd' P;b'•a.a:.a4Ys.L\ar»r®,'V,b'P,C,':,�•�..4�7aQ. TRENCH SECTION SEPTIC TANK oe,� INS TA L ON L EVEL BASE `� NOTE' EXCA VA TE TO EL EV V. ^'/- OR a o L OWER TO REMO VE AL L IMPERVIOUS =� MA TERIA L BENEA TH THE L EA CHING AREA 4" DIAM. 12" MIN. - _ REPLACE EXCA VA TED MATERIAL WITH OF 1/8"-1/2" CLEAN, CLAY FREE SAND e77.0 : �a WASHED PEA STONE h 314"" 1-1/2" WASHED � pp • ioCy .Q •1\• O N 5 ..� G7 CRUSHED STONE © C� �y _ TRENCH WIDTHY �, 1. ALL ELEVATION' t SHORN ARE BASED ON ASSUMED '--Nl 1M'-DER-OF_TRENCHES_1 . _ � 2, s , 2• AL L PIPES IN �LHE SYSTEM MUST BE CAST IRON NUMBER OF DRYWEL L S '3 OR SCHEDUL E 40'' PVC• ��w°1�� 1 / 3. THE BOARD OF t rFAL TH MUST BE NOTIFIED + % 1 - w., �. �.. .�..v.er,o a---ra-- rz �- — r: BEN L ON i RUB :,��e�J �,r �.+tlA, c r� rr7.r CR - a W. PERCOLA TION RATE.' /two �.- _ _4/, c4' • e2 MIN./IN. s2 4. ANY CHr�NC�a_,v:� .��` T�'-9I,a PLAN MUST BE APPROVED WITNESSED B Y' BY THE BOnRL) OF HEAL TH AND CAPE eg ISLANDS SURVEYING CO., INC. EDWARD BARRY ®�� 5. . MA TERIALS AND ,.INSTALLA TION SHALL BE IN -- BARNS. BRO. OF HEAL TH DESIGN DA TA COAIPL IANCE- ,�I;;H THE S TA TE SA NI TARP � DA TE• ,�UG. 27, 299E CODE - TITLE � - AND LOCAL APPLICABLE �' t� r -61 RULES AND RECUL A T IONS 4 72.7 a y8 NUMBER OF BEDROOMS 6. NORTH ARROW I * FROM RECORD PLANS AND e s 6 ©rqn , 1' G !�YR NO P 7 N w _ . GPI RBA GE DISPOSAL IS NOT TO B�. �...�ED FOR SOLAR PURPOSES � � coa». s���i I�Y2 vie 440 GAL . 7. FLOOD HAZARD ONE C INON-HAZARD) Lcn",,,j .s,v„� DAILY FLOW / %r TOWN WA TER 28" _ o rr 2� j r - B. WA TER SUPPL Y SEPTIC TANK REQ D. 1500 GAL . SEPTIC TANK PROVIDED 1500 GAL a GPD. I r< 14) y `5/6 L EA CHING REQUIRED 440 l f• � •ram `N (. ,y—� ��-on� o SIDEWALL AREA 186 S.F. 1 B6 0. 74 137 S.F.X G/S.F. _ GPD. � ��,F s ,C, BOTTOM AREA =441 S.F. "1 s + LEGEND S a,-, �I s� , �� 441 S.F.XD. 74 G/S.F. = 326 GPD 0 �� LEACHING PROVIDED 463 GPD 1 � d P -OPOSED ELEVATION 2, s P -- ��-- E.'ISTING CONTOUR N \ ® sEVA TION PIT SINGL E FA MIL Y RESIDENCE C U \r q ® D.i S TRIBUTION BOX PROPOSED SENA GE DISPOSAL S YS TEM w Q o C Crr. b l it U 4 b 4 PREPARED FOR Rd. �,/ 41 ,S :P lIC TAN/ ... _ a� ROBER T COGGESHA L L HOUSE NO 39 (L 0 T 2) HEA DWA TERS ROA D ay = ast Ln 's° asi ab�`wb .'•8 T _. �"''� �^c /'^� Ma i n e��wo TO ea n d i a' �-- —_� d"��a7E11 VE AREA .,:-------. N ` o P a. a, CE'N TER /IL L E •— BA RNS TA BL E -- MASS. . LOG .r bnr a P,'PE INVERT ELEVA TIONq Ca�aarsCi y - ., andPPar _r.'>� „ sz' ,""� ,. .*'a :- Ie a a. vmiC�9�CKI DA TE:• �, !�; / . CAPE 6 ISLANDS ENGINEERING W4 Ci Yr 4o nOdSr Y ph icy;eYd Rd sT. uQ a �)235 PLOT PLAN U nne,a m . AF a,`° �, �� T �•o ,- SCALE AS NOTED 133 FAL MOUTH ROAD SUITE 2E Aa SCALE.• 1 ca �`' 2 4- - z ` ,, .52 i c ,: PLAN NO s� MASHPrEE, MASS. +r . i� (:' E am �/„ � ,A•r-o v._ . � ¢moo�'� � /I�/il//mil?l/�L1 �i�GWT�� TO, Z171 . � It It rn ` I I r /l/OT TU f3� OiYS/OL=%7� c� 7/�qT T�//S f� git� N�IS ir0� �N P GOT 1 �.f AL LIS g�T Q a \` �r � -<f 7(f? 7%Z-= 21 v' 9, /987 1 Y � I