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TWIN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application # 3 ,331
Health Division Date Issued /l-16
Conservation Division Application Fee
Planning Dept. Permit Fee S
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Str t Address � 6
Village
Owner J (� ��V'�,Lr-v�'� Address
Telephone �� 2" 71
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 6 ( Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes *No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) c
� I
Name � Telephone Number
AddressLAV14- ay _ License
vp �V Y" Home ImP rovement Contractor# �{✓ 101
Email Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESUL G FROM THIS P�RQJECT WILL BE TAKEN TO
/rW
SIGNATURE DATE
FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
MAP/ PARCEL NO.
t
ADDRESS VILLAGE
`s OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
} PLUMBING: ROUGH FINAL
' GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
` 1 ASSOCIATION PLAN NO.
i. Massachusetts Oepartment of Public Safety
Board of Building Regulations and Standards
License: 08•100908
Construction Supervisor d
HENRY 8 CAS-SIDY.
8 SHED ROW
WEST YARMOVfH 2' '
•r�sl''
n,+/hco�
Expiration:
Commissioner 11/11I2017
•
Office of Consumer Affairs and Business Regulation
10 Park Plaza • Suite S 170
Boston, Massachusetts 02116
Home Improvement C61�rhtor Registration
' Registration: 153567
Type: Private Corporation
Expiration: 12/15/2016 TM 259168
CAPE COD INSULATION, INC '
HENRY CASSIDY
18 REARDON CIRCLE
SO. YARMOUTH, MA 02664 —
Upda,te,Address and return card, Mark reason for change.
SCAT <'+ 20M•OSril CJ Address Renewal Employment U Lost Card
ItJO�I`J ................. .........
VIGB 0�l7Upt09LlU2C!•IGIO�Q/p�lldJCf•O/G
•0mcc o.f.Consumcr Arfnirs& Ruslncss Regulation Ucenss or registration Yalld for Indlvidul use only
OME IMPROVEMENVOONTRACTOR before the expiration date,'If found return to:
e91640kn: 10507 Type: Office of Consumer Affairs and Buslness Regulation
xplrallon: :1;f9:5./20:1.6 Private Corporatloo 10 Park PIRzR •Suite$170
j 0
�..., Roston,MA 02116
CAPE COD INSUTAT:I'ofJ:;:INC
HENRY CASSIDY
:8 REARDON CIRCL . '
50. YARMOUTH,MA 02009 Undersecreinry
9N- yallidwl ut sign .e
The Co»Imonwerchll ofMressachusetts
Deprcrlm.ent of lnrlrestrtral Acct dents
1 Con
gress Street, Suite 10
Boston, MA 02114.201�
• Iv�vw,m.�ss,go�/rllrc
VVQrkers' Compensation Insurance Affldavlt; Builders/ContraotorsfElectriclans/Plumb
TO BE FILED WITH THE PERMITTING AUTHORITY, ers,
ilcant Information
Name(Business/Organization/Individual)- Please Print I,c ibly
Address.
Clry/S—State/zip; ' 2� Phone #:Arc you nn employer? C eck t�eappropriate PP oprlate box:
I.�am a employer With Type I �--�""''"•--_ -
employees(full and/or part.time),� TYp� of protect (required) �—
2.[]l .
am a sole proprietor or partnership and have no employees working for me in
any capacity,fNo workers'comp, insuranco required.) 7' NewConstluetion
am a homeowner doing all work m self, 8 'D Remodeling
Y (No workers'comp, insurance required, i 9,a �I am a homoo�vner and will be hiringconductall ) Q Demolition
ensure(hat all contractors tither have
workers'compensal on insurance o►arc I will 10 C] Building addition
MOM(;with no employees. o
11•�] Electrical repairs or addition•.,
I am a general contractor and I have hired the sub,00ntraclors listed on the anaolted sheet,
These sub•connactors have employees and have workers,comp, insurance.i 12-Q Plumbing repairs or addition
6 We are a Corporation we
and its officers have exercised Ihelr right of exemption per MGL e. 14 13. Roof repairs
152,§I(4),and we I�avo no employees (No workers'comp,insurance required,)
[Other �.• /'
'Any applicant Ihai chock^box NI must also fill out the section below showing their workers'tom ensa
' Homeowners who submifihis affidavit indicating they are doing all work and Ihen hire outside Mponsc
P lion Polley Informalion.
IContraclors Vial check This box must attached an additional sheet showing the name of Iho subcontractors
such. _
M cmployees. If Uie sub•conlractors have employees,they must provide their workers'comp.policy numbcrrs must submit a now affidavit indicating
and slate whether or not Ihosa amities have
am rrn employer!llrr!!s pro s�lrllrlg workers'compensation lrrsrsrartce for rrry er [o e
• ir:forgtntlon,
� yes, Below!s l/Ie policy anr(/vb •—
.Insurance Company Name --
.
Policy b or Self ins• Lic. if:
Qp P-Wration Date: .'
Job Sile•Address: 7 �./ ,—• �� w
Altach a copy of the Wo kers' comps nsation policy declaration a. City/State/Zip:
Failure to secure coverage as required under MG c, I S2, §25A is a criminal v(showing
vile
and/or one-year imprisonment, as Wv lI as civil penalties in the form p Y aumber•and ezpiratio )�tci
day against the violator. A copy d'f,tl;fs statement ma Ion punishable by a fine up to$1,500 00
Of a STOP WORK ORDER and a fine of up to$7.Sfi Vii
coverage verification. Y be forwarded to the Office of investigations of the e Of for insurance
l r!o hereby certify urtr/er7lle palms anrf pennlltes ofperfury llaal lyre lr(/ornuctlon
provlrled above 111 is true and correct
hen a. G D l
b
offlctal use only, Do,.-liot wr!!e III e/Ils area, to be cornpleled by c!
�' town of,/lcla�
City or Town,
Issuing AuthorityPermit/Llcense
I. Board of Hea q( 2rBuilding Department 3, Ci /Z'
6, Olher ��,� ty owe Clerk 4, Electrical Inspector S, Plumbing Inspector 'I
Contact Person;
Phone p,
CAPECOD-27 CLEDDUKE
ACORO° CERTIFICATE OF LIABILITY INSURANCE DAT11/ DD/YYYY)
71112016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement, A statement on this Certificate does not confer rights to the
Certificate holder In Ileu of such endorsement(s),
PRODUCER NAMEACT
: Barbara DeLawrence
Rogers&Gray Insurance Agency,Inc. PHONE FAX
434 Rte 134 A/C No):
South Dennis;MA 02880 ADMAIL
DRESS:bdelawrence ro ers ra .corn
INSURERS AFFORDING COVERAGE NAIC N
INSURER A:Peerless Insurance Company
INSURED INSURER B:Safety Insurance Company 39464
Cape Cod Ins'61aiion,Inca : . INSURER C:Endurance American Specialty Insurance Company 41718
18 Reardoh,fa.hle wsuRERD:Atlantic Charter Insurance Company 44326
South�(errn'OUth,MA 02884'.. INSURER E:
INSURER F:
COVERAGES CE TIFIC. ;l~NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLIMS OF 3NSURANCE';LI.$TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY'RFsQUAtMENT,4-15Aill O.R.CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY:;PeAtAIN, TH9..(M5UxAN.CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUC.H;POLICIES.LIMITS'SHOWNWAY HAVE BEEN REDUCED BY PAID CLAIMS.
INStJK
POLICY EF
LTR TYPE OF INSURANCE AOUL ",!,'.POLICY,NU• BER MMIDDIYYYY MMIDD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE a OCCUR CBP8283;063 04/01/2016 04/01/2017 PREMISES 177
rence $ 100,000
orcu
MED EXP(Any one person) $ 61000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT A.PG GENERAL AGGREGATE $ 2,000,000
X POLICY :PR O
� LOC PRODUCTS•COMPIOPAGG $ 2,000,000
OTHER:
$
AUTOMOBILE LIABILITY COMBINED
deDl SINGLE MI $ 1,000,000
B ANY AUTO m 6232707 CO
01' :. 0.4i01(2016 ''04'/•01/2017 BODILY INJURY(Par person) $
ALL OWNED SCHEDULED
AUTOS X ..AU.TNNOS BODILY INJURY(Per accident) $
X HIRED AUTOS x.•'AUTOSWNED .
Per a Itlent $
$
X UMBRELLA LIAB X OCCUR•: BA04C.000RRENCE $ 2,000,000
(,`• EXCESS LIAR CIAIM,S.MADE EXC1:0008836001 04/01(2Q16 04101/2Q1.V"AGGaeF3'ATE $
DEC) X RETENTION$ 1.0.i0 0 "WORKERS COMPENSATION ;Aggreg e:• $ 2,000,000
AND EMPLOYERS'LIABILITY Y)•N; .•• TATUTl3` ER
D ANY PROPRIETOR/PARTNER/EXECUTIVE WCEO0431�902 06/30/2016: 16/30/2017 "g;':;�,CHACCIDEN•T::r•; $ 1,000,000
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory In NH)
If yes,describe under E.L DISEASE•E&EMpLOYE $ 1,0001000
DESCRIPTION OF OPERATIONS below E.L.DISEA,S;:P••GL'ICY LIMIT::;$: 1,000,000
..i is ••
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICI (ACORD 101,Additional Remarks 9chedul9,'mey,be;atfad.ltAd;IPmore space Is required)
Workers Compensation Includes Officers or Proprietors.
Additional Insured status is provided under the General Liability and Auto LI(; I ItY4ken required by written contract or aijAd 6Rtw+'16 the Certificate Holder.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
�hO *Hlg-) 0 e a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
94A Co erce Park SL u h ACCORDANCE WITH THE POLICY PROVISIONS.
Sou hatham,MA 02669'
AUTHORIZED REPRESENTATIVE
m 1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD
-r
Town of Barnstable
' Regulatory Services
UMVSTAMX
MASS.163A `0$
Richard V.Scali,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,tifA 02601
www.town barnstable ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
zf Using ABuilder
Alan J. Colarusso
f, ...�,as Chimer of the subject propeny
herebyauthoriM �-'(�SIic,1) to act on my behalf,
in all matters rclative Ttokuthorized by this building permit application for.
154 Katherine Road Centerville MA 02632
(Address of job)
Pool fences and alarms me the responsibifityof the applicant;. Pools
are not to be filled or utilized before fence is imtalled aud all final
inspections are performed and accepted
E-SIGNED,by Alan J. Colarusso
Signature of Owner Signature of Applicant
Print?Name � Print Naznc --
Date
Q:FORMS:OCIATFRPEZMiSSI.ONPUULS '
�2oZ(�%L-O J�
CAFE COD
INSULATION
11111101 AS$ SIAMl1S1 1F RAY FOAM SUSPINOIO
IATTS OU1T111 INSULATION CIILIN01
1-800-696-6611
Town of Barnstable
Regulatory Services
Building Division
200 Main St `
Hyannis, MA 02601
r
Date: i(� 1
Dear Building inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc, performed &
completed the insulation and weatherization work at the property listed below, Cape Cod
Insulation did this in accordance to the specifications listed on the building permit
application, All work has been inspected by a certified Building Performance .Institute
,(BPI) inspector, All work preformed meets or exceeds Federal & State Requirements,
Property Owner Property Address Village
At C 0 LAWS-0
Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted
Ceilings
Slopes
Floors ( ) ( ) ( ) ( ) ( )
Walls ILO ce VOr k Fer�or�r�d
6
�N erg 1 k
�
Sincerely
2Hi E ssration,
sident
Insc,
4� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Applicationd aa l5v
Health Division Date Issued t
Conservation Division Application Fek
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
C�Proiect-Street Address
Village 1 u y�
C O ne � �J C b Address `` '`� t f
Telephone• �� �� 77
Permit Request
eon
inuou ) A to n W,
v
3:�c
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
rV)4
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: LbYes==T❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished.Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # . Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Namam - -
e � Telephone"N umber -�-
CAddress� License #
0_Vt4e,dt- Home Improvement Contractor#
Worker's Compensation #
ALL,CO, STRUCTION DE I LESULTING'FROM-THIS PROJECT WILL,BE TAKEN TO_. .—_ ___
hi
SIGNATURE -:777DATE
+4
i FOR OFFICIAL USE ONLY
�PPLICAT,ION#
DATE ISSUED
MAP/PARCEL N0.
1•mil 1 � _- _ �... _
ADDRESS VILLAGE
} OWNER �R
DATE OF INSPECTION:
FOUNDATION
i FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL ^'
f Ln
GAS: ROUGH FINAL r----- ' -
F
FINAL BUILDING
DATE CLOSED OUT ,-
ASSOCIATION PLAN NO. ,�
r -
C,,,
Town of Barm-table
Regulatory Services
BARNSTABLE, " Thomas F. Geiler Director .
Y. MASS.
rFflA Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
Office: 508-862-4038 Fax: 508-790-6230
NOTICE TO THE BUILDING DIVISION OF
CHANGE OF LICENSED CONSTRUCTION SUPERVISOR
law T ctro'Y-vSS
, owner of property located at
4- J<:7J�ekl VLF' �- �e"l4ev hereby v) 2 , that.
Y certify
is no longer Construction
Supervisor listed on the application for the project under construction as authorized by
building permit # ,�® 1106 7-0, issued on Z Ld 201_�_.
I understand that the project under construction must cease until a successor licensed
Construction Supervisor, is submitted on the records of the Building Division.
PRCYRTY OWNER DATE
Q
/forms/newcont
reference R-5 780 CMR
revA 10410 ;
12
Townof
* * Regulatory Services
*
* BAMSPABLE,
MASS. Thomas F. Geiler, Directbr
v'°TF1639. A Building Division
Tom;Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601:
www.town.barnstable.ma.us`
Office: 508-862-4038 Fax: 508-790-6230
NOTICE TO THE BUILDING DIVISION:OF
LICENSED CONSTRUCTION SUPERVISOR
ASSUMPTION OF RESPONSIBILITY
141.4V,
�. � _ �-�$ ✓led r�.h -
# : ;hereby certify that.I have'assumed responsibility for the project under
construction, as authorized by building permit#�Lol/o (-2 S G , issued to
(property address) i ` � r�IC� Q�
on �1 `6 , 201L.
The following documents are attached:
copy of my Massachusetts State,Construction Supervisor's license
or Homeowner's License Exemption form (if applicable)
copy of my Home Improvement Contractor`registration (if applicable)
Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit.
Road Bond (if applicable)
-. 12
DATE
G 1MQ O JAtrUA—
q/forms/newcontrb
rev:1,10410
The Commonwealth ofMassachusefts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
°' �• '� www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le "bl
Name(Business/Organization/Individual):
Address: I`'tJ� Cep
City/State/Zip:. ��"�� V Phone.#: �d.� 9R.) ^ 7 7/f
Are you an employer? Check-the appropriate box. .Type of project(required)
C�4_[�a.general contractor-and I
1,❑ I am a employer with' --�-----► 6. ❑New construction .
employees(full and/or part-time).* have hiredYthe subcontractors
listed on`the�atfached`sheet. T ❑Remodeling
2:❑ I am a sole proprietor or partner- ,,,,, ,
These sub-contractor�ve -8. ❑Demolition
ship and have no employees -w-._._.-- .
e to es and have workers'
working forme.in any capacity - �$ 4 9. ❑Building addition
[No workers' comp. insurance r"comp insurance.
❑ We are a coiporation and its 10.❑Electrical repairs or additions
required-] 5. _-
3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp.; right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp:insurance required.] .
*Any applicant that checks box#l.must also fill out the section below showing their workers'compensation.policy information.
t t submit a new affidavit indicatin •such.
d then hire outside contractors muss b
Homeowners who submit this affidavit indicating the are doing all work an g,
g Y g
$Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors bave employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job,Site Address: City/State/Zip: -
Attach a.copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure.to secure coverage as required under Section 25A oflvlGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to$1'500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be.forwarded to the Office of
Investigations of the DIA for insurance coverage verification
I do hereby c n r e ains•and penalties of perjury that the inform_ation providedo ve.f/true and correct
Si ature: ( J Date: ��
Phone#
Official use-only. Do not write in this area, to be completed by.city.or town official
City or Town: r Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.'City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and InstructYons
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to.this statute,an employee is defined as"...every person in.the service of another under any contract of hire, '
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any.two or more
of the foregoing engaged in a joint entziprise,and including the lep'al representatives of a deceased emjIo er,or the
receiver or trustee-of an individual,partnership, association or other legal entity,employing employees. Howevertht
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
'dwelling house of another who employs persons to do maintenance,construction or repair;work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to'operate a business or to construct buildings in-the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the.insnrance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until-acceptable-evidence of compliance with the inset-ce
requirements of this chapter have been presented'to the contracting authority."
Applicants .
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to.contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations is (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a-home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit
The-Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, ,
please do not hesitate to give us a calla
The Department's address,telephone-and fax number.
The�omtno�w�alth o�Nl�ssacktusott$ � � .
Office of lave;wp% oas -
6QO Washingtoii S 1
Boston, MA 02 111
Tel.##617-727-4900 ext 406 of 1-977- IASSAFE
Revised 11-22-06 Fax#617-727-7749
www.mass gQVAdi
r Town'of Barnstable.
Regulatory Services
snxrrsTABIX : Thomas F.Geiler,Director
16 9. �,•� Building Division
FD MA't _
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION .
Please Print
f l 1121
DATE: \.
JOB.LOCATION: JAa `e
nu rer street, G village
"HOMEOWNER": -S V 0 '9�a 7 7 7�
name jj home phone# work phone#
CURRENT MAILING ADDRESS:
YS O'1VC
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
req %onnew-ne,
Signatur
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 5;
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:homeexempt
'ME Town of Barnstable
Regulatory Services
xinas g, Thomas F.Geiler,Director,
059. 1m
Fc " Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us.
Office: 508-862-4038 Fax: 508-790-6230
t
Property.Owner.Must ;
Complete and Sign This Section
If Using A Biii.lder,,. ;
as Owner of the subject property
hereby authorize to act on my behalf,.
in all matters relative to work authorized by this building permit:
(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 6/2012
r
t r f ia�
1
J �
VI)
� f
Town of Darnstabl�e -
o Regulatory ServicesTOWN U_
t IMMM Thomas F. Geiler,Director
Building Division 22 ' $ -' 6
�D Tom Perry,$Wilding Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-862�038 1�ilFa�t�;508-790-6230
REQUEST FOR ELECTRICAL INSPECTION
ELE CTRI CAL PERMIT NUI LSER: �I
(Permit required in order to process inspection)
Today'a Date l Requested Date of Inspection I
y
hereby request an inspection under Massachusetts
General -
(NeCtr'3Qa
Law.chapter 143, section.31, and 237 GMR L02(3).fi V�
The installation will be ready for inspection at / "E
(Property Lc�cation)
Type of insr)action requested:
❑ Temporary Service' , ❑ Service Re-inspection.
❑ Excavation ❑ Rough Re-inspection
❑ Service Inspection ❑ Fir:al Re-inspecton
❑ Rough Inspection for ($100.00 Rer=v�j'DIlFPspection Fee)
Final L*1sgection fo= Nil :'�:. 2 �' o t-'o— .1 t C�' �oti �.P-6
�� J L.
3 3
.I i y ,� r i�Y Aim. peg reL'ni�
L ) r f-(LrzJS f/vt1 r U r✓r�e
s
l� er nR r''�..=} .•-�'•
Owner or tenant;___
r
Licensea's nazne, address, and phone ` i j ''
numb z . �� 'i`'`��'� Licensee's.Signature
License e
This se tion be com Barnstable Inspector of FT'it-es
Inspection date ❑Not`_4Pproved
This work was not F-pproved"for violation of the following Articles and Sections of the MA
Electrical Code:
Q;WPReS-fDrms:Mro=t Mquest
ReYM O8
1 �-d �60M9809 };osojowq . d69:90ZL£L
r
f=---! Town of Barnstable
p Regulatory Services TGNI l O BARNSTA E
Thomas F..Geiler,Director
EALIOTEMAMM
"`"M 16 Building Division 2012 MAY 4 AN 7: 5 7.
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
Office: 508-962-403 8 DIVE Fax: 509-790-6230.
REQUEST FOR ELECTRICAL INSPECTION
ELECTRICAL PERMIT NUNSER d
(permit reqused in order to processinspection)
Today's Date �; - Regneatod Date of Inspection -/ �- / �Z
I }
act.� hereby req-sest an inspection under Massachusetts
General
(Fjectrician)
Law chapter 143, section 3L and 237 CMR 4.02M.
The in.etallation will be ready for inspection at •�-T
, -
_ (Property Location)
Type of inspection requested
❑ Temporary Service ❑ Service Re-inspection
❑ Excavation ❑ Rough Re-inspection
❑ Service Inspection ❑ Final Reimpection
Rough Inspection for sj ( 100.00 Re-inspection Fee)
/)AII 6 y� ,i • t f f & x+� -�
❑ Final Inspection for
❑ Other
Owner or tercet
Licensee's name, address, and phone
9
License number `r> Licensee's Signature
MiB section to be comp a Barnstable Laspector of WL-es
Inspection date MAY 0 72012 . pproveci ]Not Approved
This work was not approved for violation of the follcwing Articles and Sections of the Kk
Electrical Code
Q:WPFiles:fornts:electreoaest _ •
• Rev:4/8lOB
`, l'd MN99909 osaoiW dSZ:LO Z Co A
r
C'ommanweafth of MaMackuseffi Official Use Only
Aartment oDD
P l3 ire Services Permit No. C;
-
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071' (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(IvIEC),527 JMR 12. 0
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �— d Z /Z
City or Town of:, To-the-Inspector.o Wires:
By this application the undersigned gives noti e of is or her intention to perform the electrical work described below. -
�J Location(Street&Number)
Owner or Tenant Telephone No.
�,} Owner's Address
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
�-
Purpose of Building 7�1Alyr5 ze Utility Authorization No.
Existing Service /&,0 Amps Volts Overhead Undgrd 0 No.of Meters
New Service 'Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
h Location and Nature of Proposed Electrical Work:
`�nt Com letion o the ollowin table m be waived b the Ins ector of Wires.
No.of"Recessedaires No.of Ceil:Susp.(Paddle)Fans Tr s Total
Transformers KVA
No.of Luminaire Outlets No,of Hot Tubs: Generators KVA
Above In- o.o mergency Lighting
No.of Luminaires Swimming Pool rnd. ❑ rnd. Battery Units
:
No.of Receptacle Outlets 0 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices r
Total
No.of Ranges No.of Air Cond. N f Alerting o.o
g / Tons Devices
No.of Waste Disposers Heat PumpNumber Tons KW No.of Self.-Contained
Totals: .......... Detection/Ale. Devices_
Muni al --;
No.of Dishwashers Space/Area Heating KW Local❑ El
Coe ee_tion
No.of Dryers Heating Appliances K�r Security Syyste[as:* -
ry No of)Devices or E ui Pent
q No.of Water No.of No.of Data Wiring--
KW 5 Heaters .KW Si ns Ballasts No.of Devices or E uivaJent
W W = No.Hydromassage Bathtubs No.'of Motors Total HP,
Telecommunicaitions Wiring:
N No.of Devices or E uivalent
.gym
Z = Z OTHER:
N Attach additional detail if desirec4 or as requiP d by the Inspector iflivires.
—_¢ Estimated Value of EI ctrica Work: (When required by municipal policy.)
�LL d H
®Lu , o ¢ Work to Start: 0510 2- � Inspections to be requested in accordance with MEC Rule 10,and upon completion.
m
" INSURANCE CO ERA E: Unless waived by the owner,no permit for the performance of electrical work may issue unless
F-o LL 5
W TV a the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
Of
o undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office.
a Y W CHECK ONE: INSURANCE [BOND ❑ OTHER ❑;(Specify:)
i�MEo I certify,under the pain and penalti s ofperjuty,that the information on this application is true and completes
o a ii FIRM NAME: f LIC.'NO.:
Licensee: �p� Signature - LIC.NO.: �j
(If applicable,enter fxempt"in the lice we number line. Bus.Tel.No.:
Address: 4 (,4$ ['7 r� %VV C c�t� Alt.Tel.No.:
*Per M.G:L.c. 147,s.57-61,security work requires Department of Public Safety"S"'License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required bylaw. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent._
Owner/Agent
Signature Telephone No. PERMIT FEE:$�/(,;Q, Q
i
3
ti TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 0 S O Application #OPT 75
Health Division '.Date Issued
Conservation Division �1� 1�e� o✓�r-.;N�+"� �c�'v)'L � � Application Fee
1�
Planning Dept. `Permit Fee �� �` 6d
Date Definitive Plan Approved by Planning Board Zll Ll��
Historic - OKH — Preservation / Hyannis
Project Street Address 15!' V-AT-H FRJh)T Rp
Village OaETMW
Owner NUS V9'50 Address dW1
Telephone 505 !� 5 2 777770
Permit Request �►,/1A tA,,o (QI� . 1. N1 ft4m, 1Pd2W\006V15 , f�6'UJ
Square feet: 1 st floor: existing luprop6secl 2nd.floor: existing 432. proposed 04—t—Total new 532
Zoning District Flood Plain Groundwater Overlay
Project Valuation d, rV Construction Type
Lot Size d Grandfathered:, 0 Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure ° 'gam Historic House: ❑Yes R No On Old King's Highway: ❑Yes S No
Basement Type: IdFull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new Half: existing O new
Number of Bedrooms: existing b new
10
Total Room Count (not including baths): existing new First Floor Room Count,
Heat Type and Fuel: ❑ Gas M(Oil ❑ Electric ❑ Other . 4 r
Central Air: ❑Yes M No Fireplaces: Existing New Existing wood/coal stover❑Yks,5eNo
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑new size
Attached garage: existing ❑ new size _Shed: E/existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes RI No If yes, site plan review#
Current Use Val I L Proposed Use tJ I
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name k��V A6A4A�C� 74 W'�- $�� Telephone Number SQ ��� Sr!!)
Address 310A MAIN r T License #
�kv4N TMAA! Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO
P VW
SIGNATURE DATE O
{ l
FOR OFFICIAL USE ONLY
APPLICATION#
` pATEISSUED
MAP/PARCEL N0.
ADDRESS VILLAGE -�
:+
OWNER 5 +- .a a• ;, ,_ ,,' , �_ '.
DATE OF INSPECTION: - -
FOUNDATION K. 71 L '� `� '
FRAME �ISD Z 5 0 3 7 S
s INSULATION (bRJ
FIREPLACE
4 `t ....
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL_
GAS: ROUGH FINAL., ;
k FINAL BUILDING
DATE CLOSED OUT ,
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
f Department of industrial Accidents -
J
Office of Investigations
� 600 Washington Street
Boston,AL4 02111
www.mass gov/dia
Workers' Compensation durance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leibly
Name (Businessiorganization/lndividuaI):• �j� � �
Address: 3 Z��i A/V�'lP1 �'� �Al�-�T'$'� I/ AAA 412 3 47
City/State/Zip: ,
Phone#:* 541-16
Are you an employer?Check the appropriate boz: Type of:project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
mp]oyees(full and/or part-time).* have hired the sub-contractors 6' �O,�N!ew construction
2.K I am a sole proprietor or partner,- listed on the attacheds LIheet. 1 7• Kemodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working forme in any capacity.: workers' comp. insurance. 9. ❑ Building addition
[No workers' comp, insurance 5. ❑ We are a corporation and its
required] officers have exercised their I O.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL l LEI Plumbing repairs or additions
myself. [No workers'comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t- employees.[No workers'
comp. insurance required.]' 13.❑ Other ` ..
•Arry applicant that checks box#1 must also fill out the section below showing their workers',compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
ram an employer that is providing workers compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site
Address-City/State/Zip: a,
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that,a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct
02
Si mature: Date:
Phone#: �
F
only. Do not write in this area,'to be completed by city or town offtcialn: Permit/License#
hority(circle one):
Health 2. Building Department 3. City/Town CIerk' 4. Electrical Inspector 5.Plumbing Inspector
son: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract.of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
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 anotlaef w,ho,egiplo s>persb4s.ta do.,ma at�enanc, corns ction or repair work on such dwelling house
or on the grounds or buildmg'appturten;Lt thereto shall not because of such employment be deemed to be an employer."
MG L chapter 15p2,�§25C0 alsio'sfaIes at"e`very` s to or local licensing gencytshall�withhold the issuance or
4 N C i 4.Z tiknt V.
renewal of ja lkewpogApewmit to,ppei�tpa business or to construct buildings in the commonwealth for any
applicant who)ias.not produced`acceptable`evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C()states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority." o
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners;are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that-the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
PIease be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on fi1e for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hke to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's adds'ss te
r Tend fax number:
lephone
The-Commonwealth of Massahu�sefts•
Department of Industrial Acct&'ihs a e'' " ` "•
QMce of Investigations
600 Washington Sheet
Boston,MA Q2111
Tel. # 617-727-4300 ext 406 Qr 1-9.77,MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass..gov/dia
Of TfiE rp�
P� y
f h
He181'/n'1 Ate➢ -
Town of Barnstable
Regulatory Services
Thomas F. Geller,Director ,
Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannisi MA 02601
www.town.barnstable.ma.as
Office: 508-862-4038 Fax: 508-790-6230.
Property Owner Must 4
Complete and Sign This Section
If Using A Builder
014VIT. U350C4 (Gv
as Owner of the subject property
hereby authorize C�047�e sSo.etc,+-e
to act on my behalf,
in all matters relative to work authorized by this build g:pemvt application for:
(Address of Job) f
Signature f wrier Date,
�&AA J V she
Pont Name
If Property Owner is applyingfor permit,please complete the Homeowners License Exemption Form on the
reverse side.
CrlUsersldccolliklAIPDa18U:OcallMicrosofilWindowslT.cmporuy Intern Fibs\Cnntcnt-OuQooklDDv87AAZ\EXpRESS.doc
Revised 072110
Town of Barnstab-le
( THE
Regulatory Services
Thomas F. Geiler, Director
a,uzxszAac.E, • _
Building Division
t6 p. ♦�
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.t6wri.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town ' state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less
and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be,a one or two-family dwelling, attached or detached structures.accessory to such use and/or farm structures. A
person who constructs more than.one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall fit!
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 Barastable•Building Department
minimum inspection procedures and requirements and that he/she will comply with-said procedures and
requirements.
rt
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or Iarger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMED WNER'5 EXEMPTTON
The Code slates that; "Any hbmcowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Liccnsing•of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
worlcti that such Homeowner shall act as supervisor."
Many homeowners who use this exemption-=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-probrcrns,particularly
when the homeowner hires unlicensed persons. In this case,mtr 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 rare t amend and adopt such a fomJecrtifreation for use in your community.
Q:fornrs:homccxcmpt
r
c a1
Office of Consumer Affairs and usiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 167464
Type:. individual
Expiration: 9/23/2012 Tr# 203706
KEITH MACKENZIE - BETTY
KEITH MACKENZIE BETTY
3286 MAIN ST L
BARNSTABLE, MA 02630
;\ J� Update Address and return card.Mark reason for change
4
�' `�;✓✓ � Address Renewal (] Employment E].Lost Card-
3ps_cAI Co 50M4W04-G11/01216pQ
Office`6ff"cod�iitressRe� License or registration valid for individul use only
before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR
Registration: 167464 Type: Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Expiration: 9L23i.2012 Individual Boston,MA 02116
TMACKENZ4E -_
in
KEITH MACKENZf�$3 7 : G'✓✓
3286 MAIN ST
BARNSTABLE,MA 02, Undersecretary Not valid without sig tune
31�• Massachusetts- Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 103766
Restricted.t6.: 00
KEITH MACKENZIE i
3266 MAIN ST-
BARNSTABLE, MA 02630 -'
Expiration: 6/19/2013
('ommksioner .. Tr#: 103766
Office of Consumer Affairs and usiness Regulation
10 Park Plaza - Suite 5170
M Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 161464
' Type: Individual
,js Expiration: 9/23/2012 Tr# 203706
_
KEITH MACKENZIE - BETTY
--�;
KEITH MACKENZIE BETTY P, —
3286 MAIN ST
dg H y
BARNSTABLE, MA 02630 � f`- r
Update Address and return card.Mark reason for change.
:` Address Renewal n Employment. E] Lost Card .
S-CA1 0 5OM-04/04-G101216
Offce iWil iWO License or registration valid for individul use only
!)HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 167464 Type: Office of Consumer Affairs and Business Regulation
Expiration: 9/23%2012 Individual 10 Park Plaza-Suite 5170Boston,MA 02116
MACKENZI�E
KEITH MACKENZIE BEST` � i �Gwv 3286 MAIN ST
BARNSTABLE, MA 0263W : Undersecretary Not valid without sig tune
i
I
REScheck Software Version 4.4.1
Compliance Certificate
Project Title: Marla and alan Colarusso
Energy Code: 2009 IECC
Location: Centerville(Barnstable),Massachusetts
Construction Type: Single Family
Project Type: Addition/Alteration
Heating Degree Days: 6137
Climate Zone: 5
Construction Site: Owner/Agent: Designer/Contractor:
154 Katherine Rd Keith Mackenzie-Betty
Centerville,MA Mackenzie Betty Associates
3286 Main St
Barnstable,MA 02630
508 367 5900
kmb@mbetty.net
Compliance:0.0%Better Than Code Maximum UA:0 Your UA:0.
The%Better or Worse Than Code index reflects how dose to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Ceiling 1:Flat Ceiling or Scissor Truss — — -
Exemption:Framing cavity filled with insulation.
Wall 1:Wood Frame,16"o.c. — — — — —
Exemption:Framing cavity filled with insulation.
Window 1:Wood Frame:Double Pane with Low-E — — — —
Exemption:Glazing replacement in existing sash or frame:
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space - — --
Exemption:Framing cavity filled with insulation.
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2009 IECC requirements in
REScheck Version 4.4.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name-Title Signature Date
Project Title: Marla and alan Colarusso Report date: 11/30/11
Data filename: Untided.rck Page 1 of 4
REScheck Software,Version 4.4.1
Inspection Checklist
Ceilings:
❑ Ceiling 1:Flat Ceiling or Scissor Truss
Exemption:Framing cavity filled with insulation.
Comments:
Above-Grade Walls:
❑ Wall 1:Wood Frame, 16"o.c.
Exemption:Framing cavity filled with insulation.
Comments:
Windows:
❑ Window 1:Wood Frame:Double Pane with Low-E
Exemption:Glazing replacement in existing sash or frame.
Comments:
Floors:
❑ Floor 1:All-Wood Joist(1 niss:Over Unconditioned Space
Exemption:Framing cavity filled with insulation. .
Comments:
Air Leakage:
❑ Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are
sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or'
solid material.
❑ Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,and in openings between
window/door jambs and framing.
❑ Recessed lights in the building thermal envelope are 1)type iC rated and ASTM E283 labeled and 2)sealed with a gasket or caulk
between the housing and the interior wall or ceiling covering.
❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or
damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed
to maintain insulation application.
❑ Wood-buming fireplaces have gasketed doors and outdoor combustion air.
Air Sealing and Insulation:
❑ Building envelope air tightness and insulation installation complies by either 1)a post rough-in blower door test result of less than 7
ACH at 33.5 psf OR 2)the following items have been satisfied:
(a)Air barriers and thermal barrier:Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or
repaired.
(b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed.
(c)Above-grade walls:Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier.
(d)Floors:Air barrier is installed at any exposed edge of insulation.
(e)Plumbing and wiring:Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring.and plumbing,or
sprayed/blown insulation extends behind piping and wiring.
M Comers,headers,narrow framing cavities,and rim joists are insulated:.
(9)Shower/tub on exterior wall:Insulation exists between showers/tubs and exterior wall.
Sunrooms:
❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum
skylight U-factor of 0.75.New windows and doors separating.the sunroom from conditioned space meet the building thermal envelope
requirements.
Project Tale:Marla and alan Colarusso Report date: 11/30/11
Data filename: Untided.rck Page 2 of 4
i
Materials Identification and Installation:
Li Materials and'equipment are installed in accordance with the manufacturer's installation instructions.
0 Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value.
Ll Materials and equipment are identified so that compliance can be determined.
Ll Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
Ll Insulation R-values,glazing U-factors,and heating equipment efficiency are clearly marked on the building plans or specifications.
Duct Insulation:
Ll Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are
insulated to at least R-6.
Duct Construction and Testing:
Ll Building framing cavities are not used as supply ducts.
0 All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means
of tapes,mastics,liquid sealants,gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or
UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings are mechanically
fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three
equally spaced sheet-metal screws.
Exceptions:
Joint and seams covered with spray polyurethane foam.
Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the
joint so as to prevent a hinge effect.
Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa).
All ducts and air handlers are located within conditioned space.
Temperature Controls:
At least one programmable thermostat is installed to control the primary heating system and has set-points initialized at 70 degree F for
the heating cycle and 78 degree F for the cooling cycle.
Heating and Cooling Equipment Sizing:
0 Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code.
0 For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial
Building Mechanical and/or Service Water Heating(Sections 503 and 504).
Circulating Service Hot Water Systems:
LI Circulating service hot water pipes are insulated to R-2.
Ll Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the
system is not in use.
Heating and Cooling Piping.Insulation:
HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3.
Swimming Pools:
Heated swimming pools have an on/off heater switch.
Lj Pool heaters operating on natural gas or LPG have an electronic pilot light.
Timer switches on pool heaters and pumps are present.
Exceptions:
Where public health standards require continuous pump operation.
Where pumps operate within solar-and/or waste-heat-recovery systems.
Ll Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a
minimum insulation value of R-12.
Exceptions:
Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source.
Lighting Requirements:
0 A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following:
(a)Compact fluorescent
(b)T-8 or smaller diameter linear fluorescent
(c)40 lumens per watt for lamp wattage—15
(d)50 lumens per watt for lamp wattage>15 and 40
Project Title: Marla and alan Colarusso Report date:,11/30/11
Data filename: Untided.rck Page 3 of 4
0
�. (e)60 lumens per watt for lamp wattage>40
Other Requirements:
Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting
off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is
above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement's').
Certificate:
A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window
U-factors;type and efficiency of space-conditioning and water heating equipment.The certificate does not cover or obstruct the visibility
of the circuit directory label,service disconnect label or other required labels.
NOTES TO FIELD:(Building Department Use Only)
Project Title: Marla and alan Colarusso _ Report date: 11/30/11
Data filename: Untitled;rdc Page 4 of 4
2009 IEcc Energy
[efficiency Certificate
Ceiling I Roof 0.00
Wall 0.00
Floor/Foundation 0.00
Ductwork(unconditioned spaces):
Window
Door
Heating System:_ — —
Cooling System:
Water Heater:---
Name: Date•
Comments:
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TTALSCHEDULE
Will Not Be Issued Before*
------r- - ----- ---=------------January 12, 2011
----=---------------- ------January 26, 2011
---------------------------------February 9, 2011
----- ------ ----- -----=-=February 23,tl201 l
---------------------------------March 9, 2011.
---------------------------------March 23, 2011
---------------------------------April 6, 2011
---------------------------------April,20, 2011
---------------------------------May 4, 2011
---------------------------------May 18, 2011
---------------------------------June 1, 2011
------------------------------ ina 1 S ?01 1
cn
PROPOSED BASEMENT PLAN q(( � 1 FT.
I Fe
✓ J {1 NEW 2 B RIM JOIST LINE OF FLOOR
3'-3R` 3'-4 ,y�' CANTIL '7 EVERING "
16 O ABOVE
l %IBTI III OR
/-6 12-2 EXISTING 1'.
FOUNDATION
WALL
NEW 4'X 2 X S SISTER JOISTS ADDED TO
EXISTING FLOOR—18TB WITH PT WALL
PL4TE ON E%IBTINB FOUN OATION WALL AT
CRAWL SPACE 34'-4"
r FAST T �>rsn�w�i ~J s t-s
NEW 4°WASTE TB TO /� �` I
DONEO E%IB'1'I G 1 M1 r ( .(� � 1,.'�/f,(/f��f� Wj°.
'NEW 4'X 1 B"ACC7E�a
QurINTO Ex BT BASEMENT I�
FOUNDATION Wdl/LL
-
r-4 T-4'
24 GARAGE SLAB --//— --_�
ABOVE ex..VA rioN
NEW CRAWC/dPACE:.'B' // 26'-4. P f 2 '
ff
/ WIDE B%�/
d/ /
WITH 2X4 WALLS
6 J°B E TRDCK
/ EXCAVATION TO OUTSIDE TO.
/ u SURROUND CTAIR
AND SUPPORT NEW
WALLS ABOVE
AOJAOENTN
TO BE GONE
WITH CARE HXIBTIN
ABpVEE
EXISTING
A W
HEATER AND BFIBTO -
FURNACE
E" A]][[��
14' A DITION FO HD 1TiON;4.rUr tiD /C
WALLS WIT.24 10'STRI OOIIN3 PRDI OE
Cae'2OD3TD'ON'T ORILI:'OARS';'FOOT ND WITH NOTE:GAS METER -
KEYWAY:LAP TOP BARB TO MAIN WALLS BARS ABOVE HERE - -
PROVIDE TRANSITION BARS AT 12°CTS: - -
PROVIDE ANCHOR BOLTS AT 410"O.Q.MAX. -
36'
1 F <'} ° )
[T-54'KATHCRIN'-BT., ENS V , M J� PRO POKED BASEMENT PLAN, OWG.ND.1 54KAT'1 1 D MAOKENZIE BETTY ASSOCIATES
` / 90ALE °= 1 FT.(1:48) DATE 1 9TH MAR.... ARCHITECTURE AND CUSTOM BUILDING
ea M ..B a
'•I n KL2U•S�� N''f�-lr� 7
O� `•t-._f `••i- cr-
PROPOSED ROOF PLAN 4u 1 FT.. 0firA I-
. DES ? f
®AO LC AND PITOHeD - '�°r`i-"-{�ry4 NCI DORIII
ROOI ON NEW OGRMCR ��n ^•n f�JU'/SIN 6%IBTIN®ROOI
I
i
. • - - - IINe F B�.{N RocM I Bec
. _ F�9oR waLL eaLOW- it
NEW DON.OR: - I -
IN '%IBTIN®ROOF' I.
II
EXISTINO DOUBLE
HIJND WINDOW
Na Rvoa \���, �1.. •'�dy ... � 'r���lKrl�l.�r.:J {�f�,� I
Rf
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IC----- ------ ------ -- ------�
CHIMNEY ////T
LINE OF.KNCfi.— LINC OF KNe¢ —/
WALL MLOW WALL DELOW
. N1W DDRMER
IN exI.".a RODP
Al 0
NOW PORCH
154 Ku r1I Rt A� C R ,LE, PROPOSED ROOF PLAN, DWG.r.154KAT-16B MACKENZIE BETTY ABBOOIATEB
SCALE °0 1 FT.(1:4B) DATE: 2DTH MAR 201 2 ARCHITECTURE AND CUSTOM BUILDING
3282 MMN BT,BMNXTABL¢.MA¢ewcNUC¢TI¢03B3C L.SOB 3S2 68CC
TOWN OF
BARNSTABLE
PROPOSED ROOF PLAN q)) - 1 FT.
ON AND PITDMCD NEW DORMER
ROOFOF ON NQW DORMER IN EXIDTINO ROOF
vL
'NEW DORM ER
IN IBTINp ODF
\Y:
- � EXIBTINp DOUBLE
HUNG WINDOW
NEWROOF \ J �-
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New
Ego
NEW DORMER
IN CXIBTIND ROOF
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o S T RUCTURi'l cn
No.41,34 1
NEW POgOH
1 54ZK.ATFIERIN'E.B,T,„-CENT.ER.V.ILIE,�,M'A` PROPOSED ROOF PLANT OWO.NO.1 54KAT-1 6 MACKENZIE BETTY ASBOCIATES
SCALE °= 1 FT.(1:4B) DATE 1 5TM NOV 201 1 ARCHITECTURE AND CUSTOM BUILDING
_ paea M.w en Bw°X°T�p�[,M.°°A°qu°cTTa paaaD �,ape asa asap
`pFTNE Tp Town- of Barnstable
`
LE. Regulatory Services
MASS
BA Aq.q '
9 .
1639. Building Division
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
Inspection Correction Notice
Type of Inspection L 9A m,r-1
Location I_57— /(-A� 4 E RTZA)C_ kii Permit Number
w
Owner Builder
One notice to remain on job site, one notice on file in Building Department.
The following items need correcting:
U,,1 brJT f)0P�_ +CrC M_'"5S A1�F?Y 7-t) pI E: CvAjr:cbra�'is
tiU i C 1) C .TL-z�� ITS? L�FQ A>t}ri�6IJA-L- S1APPo/�If--'
- � l oN J41U E 1 0 5 1 T)U W tJ 7-7)
y�3�r
Please call: 508-862-4038-for re-inspection.
rl �
Inspected by A !?
!/1_7 �[4��JL/
.JJ
Date
RTAN
X EN!i
GINEERING,LLC
Sm,ctuml
A fnvesligoflons
May 29,2012
Mr.Keith Mackenzie-Betty
Mackenzie Betty Associates
3282 Main Street ,
PO Box 645
Barnstable,MA 02630
Subject: 154.Katherine Street;Centerville,MA.
Regarding. FramingeModification Review
Dear Mr.,Mackenzie=Betty:
At your request+visited the subject.project`in order to visually review the framing modifications
which were made to the°subject single family residence. Based upon.the visual observations the
newly installed modifications made to the gravity framingsystem.appear to be complete and are
considered to be structurally acceptable.
Thank you for the opportunity to provide.you.with structural engineering services. If you have
further questions regarding this matter,please call the undersigned at(508) 532-0876'.
Sincerely,
Fora""f \f.,
..,. StHI . ;,cuiY, Y
Frank Lagodimos,PE �10 , :, g
< i
�0 Spruce Street,FraminghamMA 61701
(508)532-0876
y
THe.T TOWN OF BARNSTABLE
BARNSTABLE. i
9� ,639.
Ar- BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ....x:?.4.�./ ... ..... ,1�?..�..........0 � ...............................
TYPE OF CONSTRUCTION cJZ:?:,f."�........ %` � ........ ... '............. ......... . ....................................................
.....<... ......:..,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .....7. .:. // ..... .......................................................................................................6
Proposed Use ...A-�9"
.....................................................................................................................................
ZoningDistrict . .............�.................:............Fire District .......;.....................................................................
Name of Owner .......................... ...:........Address
/ l r
Nameof Builder ....................................................................Address ..................................................................................
Name of Architect ..........f.e....................:.....`..........................Address ...........&...................................
....................................
Numberof Rooms ........ ..............t..........................................Foundation ... .. .. ... ...........:...........................................
0,0
Exterior ..... ...................... .....................................Roofing ........ ... ........... ....
Floors .........................................................Interior .
Heating '.. . . ... ...... .. ... ....... ...::.......................................Plumbing ......... .......................................................................
Fireplace ..... ................................................................Approximate Cost .........j. ` ..................................
Difinitive Plan Approved by Planning Board ________________________________19________--
Diagram of Lot and Building with Dimensions /cueAr Ll
y9
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding the above
construction. /���
Name .. .... . ..... . .....................
Capewide Construction Co.
No ..10911 Permit for ...,.,,one story,
s�i�ne family dwelling......................
Location .........Katherine..Road........................ ' b
Centerville
...............................................................................
Owner .........Capewide. Construction Co.
Type of Construction .............frame,.............,,,
Plot ............................ Lot ........#45.................
k
Permit Granted .,,.„November 18 66
...........................19
Date of Inspection .../... .y° 19 }
......`.,. ......... 7
Date Completed ......................................19
PERMIT REFUSED
v
................................................................ 19 ,
................................................................................ .
...............................................................................
...............................................................................
Approved ................................................ 19
...............................................................................
A
S'-1116" ( 1 _116'.�1 n
✓ PROPOSE:D BASEMENT PLAN 4 - 1' FT.
1 � -
6'-41615.
„
4 -616 f8 — 2 1
I
// \ / \
1 l:• .. .,. 1 l - .., EXISTING - 1 "24'—S"
1✓ ✓1 BASEMENT ..
.... :.::.:. .t .ACCESS STAIRS ..... .. -
REMO
VED AN
" `�,-,,1 11 n :. AREA BACKFILDLED - .. ..
T-3 6„ 16
EXISTING DO
q OPENING INFILLED
8
WITH 1 0° BLOCKWORK
_.. 6'-4„
,. EXISTI N.G DOORS
RELOCATED:WITH NEW
- 3 K STAIR AN 4;_4,, D OPENING
.. .. - .. IN EXISTING
CRAWL-SPACE _. - .:.BASEMENTO 2 .: NEW 4°WASTE Y
.. CONECTS TO EXISTI G
—
.. .NEW 4� X 1 8" ACCt55/ 2
.. ,
51
...... CUT INTO EXISTI <t PA.
- -
5�.
.. .. ... FOUNDATION W t .. w .. ..
ASEMENT.
GARAGE SLAB - -/- - - - -- J
ABO�/E NO // , // ( A L
EXCAVA rioN
.. .� .. - NEW CRAWZ PACE. 6. 26.'—.4„ .. P -
... _ .. .. .... ....
WIDE BY yVDEEP - .. :. �,_l.O ry. 4,�4a /�,.._p
/ ... .. r ..... NEW 2X4 WALLS ..
6/
- / NO � .. ,. :.. :: � WITH.J�� SHEETROCK
EXCAVATION - :TOE OUTSIDE TO .. .. .. ..
SURROUND STAIR
NE
D S PORT '
NOTE: .. .. .. .. -
WALLS ABOVE
"" ::/ " EXCAVATION ... -
f ,
ADJACENT El
~
�c�P / TO CHIMNEY/D` TO BE DONE :. .: .. ...-
WITH CARE EXISTIN ^ ^
CIF
/ .. .ABOVE j? / eFF���ppp"`
EXISTING,. _ N W f�1' .w•�-*.e,,
WATER :. �f � ' i` G... , STi41R TO .. ttg99 <y / ^..., 4K CNt
HEATER AND. ...;. ... X'U •4a�J C.i. .:
R
...FURNACE .. �.. U S1 r',!..,)�HlaL �.
- � �0.41534
(T 14' _ /= j
ADDITION FOUNDATION, 5' DEEP,10° R/C : .. .,
WALLS WITH 24" X 1 0° STRIP FOOTING PROVIDE - : -
2003 CONT. HORIZ. BARS, FOOTING WITH NOTE: GAS METER
KEYWAY. LAP TOP BARS T❑ MAIN WALLS BARS ABOVE HERE - -
❑V DBARS AT 1 2" C S.
PROVIDE ANCHOR BOLTS AT 4'0° D.C. MAX. 11 - MACKENZIE BETTY ASSOCIATES -
PROPOSED BASEMENT PLAN, DWG.NO."1 54KAT —1 1 B
1 54 KATHERINE ST., .CENTERVILLE, MA ARCHITECTURE AND CUSTOM BUILDING
S ?ALE qll = 1 FT.(.!.:48) DATE 1 OT.H. N OV 20 1 1 3282 MAIN ST, BARNSTABLE,MASSACHUSE'TTS 02630 TEL. 508 362:9500
.. W DECK, RAIL .. .. ..
D STEPS FROM
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.. 1 ° SONOTUSES •, , :., "�,. ^
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AND STEPS FROM EXISTING 32X5 .J —�8 �,f�•'�{: �. BA ... EXISTING 32X52
PT LUMBER,.2# : — — — WI DOW PIPE PROM DOUBLEHUNG
Lat <
Y r.?1
DOUBLE HUNG _
1 O SDNOTUBES WINDOW REMOVED EXISTING DOOR NEW DOUBLE �" REMOVED 2ND TO WINDOW rr -
REMOVED : -HUNG WINDOWS : : •• < IVf,
W PATIO ODORS .BASEMENT
..: , DISH I : _ W IXIST:IN GII C- 1
.. - ... ..
- w -'VPASHER — m WALL -
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z IIj 5-_1— SHOWER
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r � _ EXISTING 32X5
— 1... 1 I. 1 ... 1'`'. J.(,�s�.Q (//�i � �wM. DOUBLE HUNG. 2
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. _ FREEZE 1 k „A f
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• .I', II IS - EXISTING WN.ALL.�R,E,M,p.V O ..
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yn�• Z 7 T .,
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C
12 S4 I
I .
-N.EW 20 MIN. ., ��'I f✓ ,
32 X 70 D ❑R I 1 F/c;7,3
.. . - NEW.OAK FLOOR TO
i 1
... ., .._
. . - - • ... - P�ATC H:,EXISTING OVER .;..::_ 1 2i"'1 �.: _ .
NEW CRAWL SPACE .� - —__ - STAIR TOE-----_ - ..
O_LD STAIRS REMOVED., BASEENT
I NEW BEAiM GADDED,. I - � f
.. : AND ... .. ..
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xx
i-
i
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I
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r HUNGIf WINDOW NEW _ HWINDOW_
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PORCH HUNG
FPROPOSEDFIRST PLAN, KAT -1A2C :MACKENZIE BETTY ASSOCIATES
S 1r4 R DWG.NO. 5
FI1 54 KATHERINE ST., CENTERVILLE, MA : II ARCHITECTURE AN;D CUSTOM BUILDING
SCALE � = 1 FT.�1 :4'B) DATE : 1 OTH NOV 201 1 : TEL. sDe 3ez ssoD
4 3282 MAIN ST, BARNSTABLE, MASSACHl15 ETT9 Oz53❑
PROPOSED ROOF PLAN qu _ 1 FT.
'
U
a
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NEW GABLE AND PITCHED NEW DORMER
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,
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1 54 KATHERINE ST., CENTERVILLE, MA ARCHITECTURE AND CUSTOM :BUILDING
SCALE 1° — 1 FT.(1 :48) DATE 1 5TH Nov 20 328 AI
1 1 BARNSTABLE, MASSACHUSETTS 0263❑ TEL. SOB 36 MAIN ST 2 9500
4
2
W DECK, RAIL
A N D STEPS FROMwo
.. PT LUMBER. 2# — _
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R,E
U 9
PT LUMBER,
DOUBLE HUNG ..
1 0 SONOTUBES WINDOW REMOV EXISTING DOOR NEW DOUBLE / �- REMOVED 2ND TO WINDOW
REMOVED -HUNG WINDOWS - • N W PATIO DOORS I - BASEMENT
s
: •
F-
DISH -
I I. .. ..
.. ... . W XISTING-JAS,HER L — — m WALL RY
NEW 20 MIN. r : 3. EMOV DI I
_ WASHE
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: SHOWER.W ...
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-
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NE WW—BB- - - - - -
w.
1
. :EXISTING WALL REMOVED. 2.'—_. �, _ .. .. .. .. _ ...
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.NEW 20 MIN.
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F C.'7'
;,. NEW OAK FLOOR TO -
:. : :. '. N{ATCH EXISTING OVER - W
I �
.. ... ..NEW CRAWL SPACE. ,. .-STAIR TO -
1
: OLD STAIRS REMOVED". BAS MENT
� � yr✓ '�' `�`.:
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BEAM,ADDED
.. .. .. I I. - LO FILLED .. ... ... (�ey� .. .. ... .. ._.
AND NEW , � v
IN
D
. . �
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R CLOSETWOE EN RC�, -1
_ute Z z BEDROOMRo
..
om
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ZS AIRTo
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GAB; I
:. .... ..
1.4' METER
EXISTING 8'4 EXISTING 6'.4
X52 DOUBLE
X52 DOUBLE .,
HUNG'WIN DOW NEW PORCH:: HUNG WINDOW
El
PROPOSED FIRST::PLO OR PLAN, jDwG.NO. 1'.54KAT -1 2C` MACKENZIE BETTY ASSOCIATES
154 KATHERINE ST., CENTERVILLE, MA ARCHITECTURE AND CUSTOM BUILDING
SCALE .111 _ 1 FT.(1 .48) DATE 1 OTH� NOV 201 1 3ze2 MAIN ST, BARNSTABLE, MAS SACHUSETTS 02630
TEE_ SOB 362 950C
EXISTING BASEMENT PLAN 4 — 1 rT.
32'-7" 4'-5
UP
—3°
6'-4°
1 4'-4°
CRAWL SPACE 3
�6'_4a E1_4d
,_101 7.-4A
2
24 GARAGE SLAB - - -
ABOVE
26'-4° P I 2 '
3'-10'-L--L-4'-4" I &'-8
BASEMENT
1 '
1 1
EXISTING
C) WATER
- HEATER AND -
FURNACE -
14'
36'
1 54 KATHERINE BT., CENTERVILLE, MA EXISTING BASEMENT PLAN, DWG.N0. 1 54KAT -1 A' MACKENZIE BETTY ASSOCIATES
SCALE q" - 1 FT.(1 :48) DATE : 27TH OCT 20 1 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN ST, BARNSTABLE, MASSACHUSETTB 02630 TEL. 5138 362 9500
EXISTING FIRST FLOOR PLAN q�l - 1 FT.
3T-4 223'
EXISTING 32X52
EXISTING 32X52
DOUBLE HUNG
DOUBLE HUNG
WINDOW WINDOW
a o
KITCHEN CLOSET
DINING AREA BEDROOM 2
EXISTING 32X52
DOUBLE HUNG
WINDOW
IAJ
-6" GARAGE
2# EXISTING.,, 44V N T
32X52 DOUBLE
HUNG WINDOW UP E E 2 3 '
EXISTING 32X52
CLOSET DOUBLE HUNG
WINDOW
LIVING ROOM
' BEDROOM 1
CLOSET
14'
EXISTING 8'4 °- EXISTING B'4 °
_ X52 DOUBLE X52 DOUBLE
HUNG WINDOW HUNG WINDOW
1 54 KATHERINE ST., CENTERVILLE, MA EXISTING FIRST FLOOR PLAN, DWG.NO. 1 54KAT - 2A MACKENZIE BETTY ASSOCIATES
SCALE = 1 FT.(1 :48) DATE : 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
2282 MAIN ST, BARNSTABLE, MASSACHUSE TS 0263❑ TEL. 508 362 9500
1 u,
P LA - -
EXISTING SECOND R N 1 FT.
Ex D FLOOR
4
35'-3°
- - - -- - - _ - - - - -.- - -- - - - p� Oa �'- EXISTING 32X52
�E DOUBLE HUNG
-± - WINDOW
GARAGE S LAB EXISTING DOUBLE 13'-4 zff
ABOVE HUNG WINDOW
EXISTING 32X52
_DOUBLE HUNG
_ _ WINDOW -
W
S
TC
1 54 KATHERINE ST., L'ENTERVILLE, MA EXISTING SECOND FLOOR PLAN,. DWG.NO. 1 54KAT -3A MACKENZIE BETTY ASSOCIATES
SCALE11 = 1FT.(1 :45) DATE 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN ST. BARNSTABLE, MABBACHUSETTB 02630 TEL. 508 362,9500
Fml
- - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- - -
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- - - - - - - - - - - - --- - -- - - -- - - - - - - - - - - - - - - -
- - - - - - -- - - - - - - --
� , II
II I �
- - - - - - - - - - - - - - -� I I f
� � II
I � II
EXISTING FRONT ELEVATION 4�� - 1 FT. LL - - - - - - _ _ _ - - _ - - - -- - - - - - - - - - - - _ - - - - _ - - - J
- J
EXISTING FRONT ELEVATION PLAN, DWG.N0. 1 54KAT -4A MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA
SCALE 11 = 1 FT.(1 :48) DATE : 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN ST. BARNSTABLE. MASSACHUBETTS 02630 TEL. 508 362 9500
i
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L - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - J EXISTING EAR ELEVATION R E
- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -� 4 - 1 FT.
1 54 KATHERINE BT., L'iENTERVILLE, MA EXISTING REAR ELEVATION, DWG.NO. 1 54KAT -5A MACKENZIE BETTY ASSOCIATES
SCALE qll = 1FT.(1 :48) DATE : 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
. 3292 MAIN ST, BARNSTA91-E. MASSACHUSETTS 02630 TEL. 509 362 9506
�� ( —11-6 (�1
PROPOSED BASEMENT PLAN 4�s — I FT.
6'-416"
/_615" 1"'2'— 2 -I
1 .� " ( 1 ( ) I EXISTING I 1 /
32 —7 - .BASEMENT 4 —S
ACCESS STAIRS
REMOVED AND
33160 3'-4 " AREA BACKFILLED
I
.EXISTING DOOR 3/_0�"
OPENING INFILLED 8
WITH 1 0° SLOCKWORK
6'-4a ;•
EXISTINGDOORS
RELOCATED WITH NEW
STAIR AND OPENING r�
' IN EXISTING C
1 CRAWL SPACE BASEMENT ,
NEW 4° WASTE is
CONECTS TO EXIST[ G ,`•�6,_4d I _4"
NEW 4' X 1 8" AOC�88 - '—�1"�
CUT INTO EXISTIyG/ BASEMENT 2
FOUNDATION Wall.
' 102" T 4"
GARAGE SLAB - -�—� - - - �
ABOVE No
EXCAVA ION//
.. NEW CRAW PACE: 6' 26'—!}" P I - 2 '
/ WIDE BY
810
Fe 2
NEW 2X4 WALLS,
/ NO WITH Ziu SHEETROCK
EXCAVATION TO OUTSIDE TO
SURROUND STAIR
AND SUPPORT NEW
WALLS ABOVE
/NOTE: _
EXCAVATION ADJACENT
TO CHIMNEY
TO BE DONE
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CHIMNE
2 / ABOVE
/ EXISTING N W
WATER STA TO
IR
HEATER AND
FURNACE FIST
14 12'-4�° � •
ADDITION FOUNDATION, 5' DEEP,1 0" R/C -
WALLS WITH 24" X 1 0° STRIP FOOTING PROVIDE -
2003 CONT. HORIZ. BARS, FOOTING WITH
KEYWAY. LAP TOP BARS TO MAIN WALLS BARS NOTE:ABOVE HERE
METER
u RE
PROVIDE ANCHOR BOLTS AT 410 O.C. MAX.
1 54 KATHERINE ST., L'ENTERVILLE• MA PROPOSED BASEMENT PLAN, DWG.NO. 1 54KAT -1 1 B MACKENZtE BETTY ASSOCIATES
ARCHITECTURE AND CUSTOM BUILDING
SCALE f
= 1 P .(1 :48) DATE 1 OTH NOV ZO 1 1
32B2 MAIN ST, BARNBTABLE, MABBACHLIBETTB 02630 TEL. 508 362 9500
1 °
W DECK, RAIL
D STEPS FROM
LUMBER, 2#HONOTUBES
PROPOSED FIRST FLOOR PLAN 41I - 1���.,FT
�
-1116
NEW DECK, RAIL _
AND STEPS FROM EXISTING 32X5 3'-58°
EXISTING BAY NEW DOWN EXISTING 32X52
PT LUMBER, 2# DOUBLE HUNG WINDOW PIPE FROM DOUBLE HUNG
1 0° SONOTUBE5 EXISTING DOOR - NEW DOUBLE REMOVED ZND TO WINDOW
WINDOW REMOVED /
REMOVED HUNG WINDOWS N W PATIO DOORS ' ( BASEMENT
-11,.�W— c
Q TA KI
SHE
I�— JA HI BE m XI WALL, I
WABHE
NEW 20 MIN. W EMOVEDI I / DRYE EXISTING
32 x 70 DOOR —
Z I I 5 w SHOWER
KITCHEN I I NEW 2 BAT ROO ExISTIN
LAUNDRY CLOSET NEW SASEMEIl
RAISED CEILING I DIWING AREA Rik At CESS, WITH
BETWEEN - N W BULKHEA
OCIORS
DORMERS I I EXISTING 32X52
EXIS NG DOUBLE HUNG
CLO T WINDOW
'OVEN / I I 14'-111°
MICR 2 - - BEDROOM �2
II
O - I
D OOR
\\RE.MIOVED? .
FRIDG
FREEZE
GARAGE EXISTING WALL REMOVED - -
i NEW BEAM
EXISTING WALL REMOVED 1^�i_C`dt
1 d I I
NEW 20 MIN. I ( 11 I 1G J I 2 '
3 2 x 70 D OR I ( F/C 7'3
NEW OAK FLOOR TO / -
MATCH EXISTING OVER I I IrNi W - ,
NEW CRAWL SPACE STAIRS
— STAI TO
_ OLD TAIRS REMOVED BASEENT
FAND NEW BEAM ADDED,
FLOOR FILLED IN -
5 - F - 7T- - - - -
1
m —
D
2" I I Z I EXISTING 32X52
T-3 I I]� CHIM rl EY LIVING ROOM I DOUBLE HUNG
P W D E I t CLOSET
EN RANG WINDOW'
— M�� Z
O Room p New BEDROOM 1
Z I STAIRTo
61
91 m I n I SECOND
F/c 7 3
O
VOID OVE
� C �, ENTRANC EXISTIN
/_2d1 J L1/J2d i I CLOSET
GAS
14' METER —
EXISTING 814 4u EXISTING 8'4 °
X52 DOUBLE X52 DOUBLE
HUNG WINDOW NEW PORCH HUNG WINDOW
1 54 KATHERINE 8T., CENTERVILLE, MA PROPOSED FIRST FLOOR PLAN, DWG.NO. 1 54KAT -1 2C MACKENZIE BETTY ASSOCIATES
SCALE �[� — 1 FT• 1 :46) ARCHITECTURE AND CUSTOM BUILDING
DATE : 1 OTH NOV 201 1
32H2 MAIN 9T, BARN STABLE, MA55ACHU9ETTfi 02620 TEL. 508 362 9500
PROPOSED SECOND FLOOR PLAN 41I - 1 FT.
RAIL, AND SHELF
ri
0
WALK THROUGH
- - - - -- - - - - - = - - - B2IJ-i OJO-bL - - - - -
KNEE WALL REMOVED
NEW DORMER I - EXISTING
IN XISTING ROOF I RAIL, AND SHELF Z Z KNEE
(�\J a J _ WALL
O - TUB SHAYVER S AT O.W j
LI
H NGI G W _
N
_ — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ExiSTINd 32x52
DOUBLE HUNG
BEDROOM 3 - WINDOW
EXISTING DOUBLE
- HUNG WINDOW
OLD ST A RS REMOVED EXISTING 32x52
\ AND NEW EAM ADDED, DOUBLE HUNG
- - I- - �L TtFTCi.€6TIT - - - - — - - - - - -- - - - - - - - - WINDOW
\ = OFFICE
\ I CL SET \ -
NEW ROOF N E \
EXISTING SLOPING ST IRS \ EXISTING SLOPING
CEILING ABOVE
CEILING ABOVE / \
NEW D13RMER /
j
EXISTING KNEE WALL- EXISTING KNEE.WALL
CHIMNEY ATTIC ATTIC
' VOID OVER STAIRS SHELF
PROPOSED SECOND FLOOR PLAN, DWG.NO. 1 54KAT -1 30 MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA SCALE to = 1 FT.I 1 :4S) DATE : 1 5TH NOV 201 1 ARCHITECTURE AND CUSTOM BUILDING 3292 MAIN ST. BARNSTABLE, MA55ACHUSETTB 02630 TEL. Soe 362 9500
J
NEW DORMER WITH 3
_ WINDOWS AND
BEADBOARD SKIRT ®..
- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - - -
. _ ..®
® dH I
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NEW SHUTTERS NEW SHUTTERS
NEW PORCH AND DOOR
WITH GOTHIC ARCHES '
1 54 KATHERINE ST.. CENTERVILLE MA PROPOSED FRONT ELEVATION, DWG.N13. 1 54KAT -1 4B MACKENZIE BETTY ASSOCIATES
SCALEn = 1 FT.(1 :4B) DATE : 27TH OCT 201 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN ST, BARNSTABLE, MASSACHLISET S 02630 -TEL. 508 362 9500
J
LN M.MWWWO
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en LURE
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PROPOSED ROOF PLAN 4�� - I FT. » � .
' - NEW GABLE AND PITCHED • NEW DORMER
` ROOF ON NEW DORMER IN. EXISTING ROOF
NEW DORMER _
IN XISTI NG ROOF
EXISTING DOUBLE -
.Y,. HUNG WINDOW
,
NEW.ROOF ..;
NEW D RMER
.. NEW DORMER
IN EXISTING ROOF
.CHIMNEY
NEW PORCH
l 54 KATHERINE 5T., CENTERVILLE, MA PROPOSED ROOF PLAN, DWG.NO. 1 54KAT -1 6, MACKENZIE BETTY ASSOCIATES
ARCHITECTURE AND CUSTOM BUILDING
SCALE11 = 1 FT.(1 :48) DATE 1 5TH NOV 201 1
3282 MAIN ST, BARNSTABLE, MASSACHUSETTS 02630 TEL. 50B 362 9500
8L0 G —i'F`�'�
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W DECK, RAIL
D STEPS FROM 1
PT LUMBER, 2# —, A wl_ II 1 FT.
SONOTUBES 4
NEW DECK, RAIL
AND STEPS FROM 3'-53„ \ EXISTING BAY NEW DOWN EXISTING 32X52
PT LUMBER, 2# EXISTING 32X5 / �� /'/'/ _ _ _
DOUBLE HUNG 8 ` Q�vc 1 WINDOW PIPE FROM DOUBLE HUNG
1❑11 SONOTUBES WINDOW REMOV EXISTING DOOR NEW DOUBLE 1�J05? � �j"� �J� � REM DYED 2ND TO WINDOW
REMOVED HUNG WINDOWS 9 SJ�"'" N SN PATIO DOORS I I BASEMENT
Q TAC KIN
DISH I m XISTIN L I WASHE
�VSASHE. ` W'�`I-�- / DRYER COT
NEW 20 MIN. 3 EMOVEDI I
EXISTING
32 X 70 DOOR I — Z I I 5 _15
8 SHOWER
I I I 1CUP
NEW72" BAT ROO ExisTIN
KITCHEN I CLOSET NEW BASEMEN
LAUNDRY . AC
E WEBUL HI
RAISED CEILING DINING AREA N EA.
MICRO BETWEEN I I D ORS
DORMERS EXISTING 32X52
EXIS G DOUBLE HUNG
C:Oa CLO T WINDOW
FRIDGE 4' Ili" I I -�LA`�!f] BEDROOM 2
FREEZE I yLY 1R-71C G
OCIR
0 !" r'f1�L7G � I Y-Y �L�C I 0P ( D���7� �\RENY\11F OVED? III
I I I \\ �
- I EXISTING WALL REMOVED
GARAGE —I- 1— — � — — - - - - - - - - -
�_ —� NEW BEAM
EXISTING WALL REMOVED I � \ 11 2'-5�
/ �1
2
NEW 20 MI I I F/C 7�3'!i� ('
32 x 70 D OR I NE OAK FLOOR TO
iidATC1WEXISTING OVER I I H��Yy��1s,(�8n � �p.e.�z fv
I
NEW CRAWL SPACE STAIR TO �4'�` .�
_ OLD STAIRS REMOVED BASEMENT v� C
AND NEW BEAM ADDED, FF,M,kC G, !GN
_ FLOOR FILLED IN LfvC Ji�: S
LD `fR 1?LIRA1- �
— — — — — — — \Io.41534
1
rrY� Q
T T
1 r
a
3'-12"
_ ,,.zr°EXISTING 32x52
T-3 I 0 - CHIM EY LIVING ROOM EXISTIN /j/���rL DOUBLE HUNG
(p I CLOSET r v�^ WINDOW
P W D E EN RANC =
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PROPOSED
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GAS
14 METER ExISTING B'4 EXISTING S'4x.32 DOUBLE X52 DOUBLE
HUNG WINDOW HUNG WINDOW
FIRST FLOOR PLAN, DWG.NO. 1 54KAT -1 2C MACKENZIE BETTY ASSOCIATES
1 54 KATHERINE ST., CENTERVILLE, MA SCALE 111 = 1 FT.I1 :48) DATE 1 0TH NOV 201 1 ARCHITECTURE AND CUSTOM BUILDING
4 32B2 MAIN ST, BARNSTABLE, MASBACHUSETTS 02630 TEL. 50B 362 95130
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PROPOSED ROOF PLAN 4 — 1 FT.
e NEW DORMER Y
NEW GABLE AND PITCHED
ROOF:'ON NEW DORMER IN EXISTING ROOF -
CAW
NEW DORMER - r
IN XISTING ROOF -
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EXISTING DOUBLE -
k HUNG WINDOW
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NEW DE RMER .._._ _.
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- IN EXISTING ROOF or Fsui
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PROPOSED ROOF PLAN, DWG.NO.1 54KAT —1 6 MACKENZIE BETTY ASSOCIATES
1154 KATHERINE ST., CENTERVILLE, MA SCALE qIi = 1FT.(1 :48) DATE 1 5TH NOV 201 1 ARCHITECTURE AND CUSTOM BUILDING
3282 MAIN STD BARNSTABLE, MASSACHUSETTS 02630 TEL. 508 362 9500
� ASSESSORS MAP : -
TEST HOLE LOGS
PARCEL:
`a I NOTES:
FLOOD ZONE: Mod �G �1(f-1e SO I L EVALUATOR : I pVl , �NI " G�6
3 WITNESS : W
REFERENCE: Ct a-r J�I 7�j /� OF �-4 DATE : q�� p 1) The installation shall comply with Title V and Town of Barnstable Board of
PERCOLATION RATE : 2,Mlt4, Health Regulations.
2) The installer shall verify the location of utilities, sewer inverts and septic
�j ' ' Ib' ! ��Z components prior to installation and setting base elevations.
TH- I TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
/ 14q two feet out of the d-box to the leaching shall be level.
0 _ L 11 4) This plan is not to be utilized for property line determination nor any other
f �1 purpose other than the proposed system installation.
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5) All septic components must meet Title V specifications.
LOCATION MAP Z 32a `D 6) Parking shall not be constructed over H10 septic components.
7) The property is bounded by property corners and property lines.
t� ✓ 8) The property owner shall review design considerations to approve of total
design flow and number of bedrooms to be considered for design. Receipt
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l of payment for the plan and installation based on the plan shall be deemed c�r,�r �D I ' 3 approval of the design flow by the owner.
� a 9) The existing leaching or cesspools shall be pumped and filled with material
L 10i\ �� I U per Title V abandonment procedures. Those within the proposed SAS shall
Q�o lr� i k � ) 4 be removed along with contaminated soil and replaced with clean sand per
O� D_ Q-Wa .GJK Title V specs.
.�G# I Z7Z S 10)System components to be 10 feet from water line. Sewer lines crossing the
4, J E P T I C SYSTEM DESIGN water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
/ applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
FLOW ESTIMATE 11) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
BEDROOMS AT GAL/DAY/BEDROOM - ZZE) GAL/DAY 12)The installer is to take caution in excavation around the gas line if such
/ �7f F_Q_ A t 2 �� exists.
SEPT I C TANK 13)The installer shall verify the location, quantity and elevation of the sewer
/ ZZO GAL/DAY x 2 DAYS GAL
lines exiting the dwelling prior to the installation.- U
USE (% GALLON SEPTIC SANK
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\ SOIL ABSORPTION SYSTEM
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(� SIDE AREA: DAVID
\ � BOTTOM AREA: 2 I X � ,1 - ��„ P.
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I _ — C SEPTIC TANK 6�l-�EY�w0( J a "- 4 'DO��$1 1�� R- 3TV4
SITE AND SEWAGE PLAN
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PREPARED FOR : S,s✓P_77C
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SCALE:a.
DAV I D B . MASON R.S DATE:IC) 2
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Z DATE HEALTH AGENT ( SOS ) 833— 2 177