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TOWN OF BARNSTABLE.,BUILIDING PERMIT APPLICATION.,-
Map Parcel! 'Application #
Health-'Division Date Issued
Fee
Conservation (,Division �'.Apolication F 4-4- V
-77
V,
Planning:Dept'. Pe m it Feed' 0
Date Definitive Plan Ap
proved by Manning Board
Historic = OKH Preservation Hyannis
Project Street Address k'&-eL�se,
Village
>28,0a-
Owner Address ! 1570 1/ TX
Telephone 97 -7 7(;L 3
Permit Request eP0,,,9tF\_ A&4,_o-. C Q.
Square feet: 1 st floor: existing.1 roposed 00 1 2nd floor: existing 12&2,00proposed 0 Total new 16>01
Z6ning District Flood Plain Groundwater Overlay
Project ValuatiJ e
(PI _30�00.0 M Construction Type
Lot Size `3 '70 -5-.2 � Grandfathered: LJ Yes LJ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family Ll Multi-Family (# units)
Age of Existing Structure Historic House: E(Yes LJ No On Old King's Highway: Ll Yes Ll No
Basement Type: Wfull Ll Crawl Ll Walkout LJ Other 5-0--e- cir--v/ r
Basement Finished Area(sq.ft.), Basement Unfinished Area (sq.ft)_;)-
Number of Baths: Full: existing! 1 new Half: existing new
Number of Bedrooms: existing l new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: LJ Gas WrOil Ll Electric Ll Other
Central Air: Ll Yes - Lkl(No Fireplaces: Existing I New 0 Existing wood/coa stove: Yes---,Z(N o
Detached garage: L3 existing LJ new size_Pool: U existing LJ new size Barn: LJ existing ❑Llc'i:pgw ---size
ZZ
Attached garage: Ll existing LJ new size —Shed: LJ existing LJ new size Other:
Z
Zoning Board of Appeals Authorization Ll Appeal # Recorded LJ
Commercial Ll Yes Ur"No If yes, site plan review# Cn f M
C1.)
Current Use e- 11
I Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name % Telephone Number -5-07 S-90 6 / To
Address E&Y- License
'7_eq+�, c k-e f /Vla OJ-5-3 6 Home Improvement Contractor# // T Y_76
Worker's Compensation # WC 6q7_-35_
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
(f-
SIGNATURE DATE A
FOR OFFICIAL USE ONLY
.,APPLICATION#
r
s DATE ISSUED
MAP/PARCEL NO.
f
`. AbDRESS VILLAGE
OWNER
DATE OF INSPECTION:
K FOUNDATION -7 Ito 1tici W.
_ FRAMES
t`4 h.ham
INSULATION ( 1 12.()Io, P�
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING 3'lt
DATE CLOSED OUT
r'
ASSOCIATION PLAN NO.
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r _-_ _ --- q T""' FOUNDATION PLAN
' .. �———_ — — (819;�'P h�B;a r lt•uN4 YyRc,_
...,ECT. WOO RESIDENCE ADDITION
- r 80KEARSARGE.AVE.,HYANNISPORT, MAl`
. .. r� LIWAN WOO
1504 EAST 31 STREET, BYRAN,T% 77802
MICHELE CUDILO, P.E.
.�.• Consulting Structural Engineer
pec-rrtl�!.u.x.Es,aew NBz,5µ,atE uwaucs,emr xs,aT�. ,v t COTTDMD VNc CDffVN wsskDjATts osvz(�)nl-Tsol
NB HUMBER� 2007-116 VN BY, MC BRRVIND NUMBER.
*OUID-ATION-'PLAN 5Ho%JR4'i'T rL00p;F.p.;,IPjq';'E:.'8,�-LfZ'U�1� S—Cl.S NDTED —E. SEPT. ,2008 S 1
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ROOF FRAMING PLAN
A ' PRG�ECT. WOO RESIDENCE ADDITION
80 KEARSARGE AVE., HYANNISPORT,MA
. .R� .�15 LILLI
% 77802
STRE N W00
... '... ....,. . ......-- ___..._ _ 04 EAST 31 STREET;BYRAN;T
Ae"''"` MICHELE CUDILO, P.E.
------- B_y (,,..RR.1 -- -zc a++TMs... roB.(nn Consulting Structural Engineer
in COf1UNRooB WL CulrtxUL KkSSAO ISM M02(soelmasGl
AB NUMBER. 2001-IIG BRNVN BT. MC BRBVING NUMBER.
ROOF FRAMING PLAN sn�E Bs NnT. BRTE. SEPT.,zoos S'2
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The Commonwealth of Massachusetts
Department of Industrial Accidents -
Office of Investigations
' d 600 Washington Street
Boston, MA 02111
sqV www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers `
Applicant Information n Please Print Legibly
Name(Business/Organization/Individual): 1`O kp+ U y I ki
Address: ,
City/State/Zip: Phone.#: 0G (o l
Are you an employer?Check the appropriate box: Type of pzoject(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors6. ❑New construction
.2.❑ I am a sole proprietor or partner-" listed on the attached sheet. 7.- ❑Remodeling.
ship and have no employees These sub-contractors have 8. ❑Demolition . _.
working for me in any capacity. employees and have workers'
$ 9. ❑Building addition
[No workers'_comp. insurance comp. insurance.t .
Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑ P
3.❑ 1 am a homeowner doing all work offices have exercised,their 11.0 Plumbing repairs or additions
myself. [No workers'comp_ right of exemption per MGL . 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp:insurance required.]
*Any applicant.that checks box#1 must also fill out the section below showing their workers'.compensation policy information.
t Homeowners who<submit.this affidavit indicating they.are doing all work and then hire outside contractors must submit a new affidavit indicating such.
!Contractors thahcheck this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for,my employees. Below is the policy and job site
information
Insurance Company Name: V
Policy,#or Self-ins.Lic.M W C G 77 S.� Expiration Date:
Job Site Address: ��✓ �I -e G[/'..5,�t'� y City/State/Zip: , h oY
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 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
Invea9zations of the DIA for insurance coverage verification.
[do hereby ce i under the pains d penalties of perjury that the information provided above is true and correct
Sigii Date:afore: t . l .. Is— -.1-6C5
4
Phone#:
Official use only. Do not.write in this area, to be completed by city or town offtciaG
City or Town: 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 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 another who employs persons to do maintenance, construction or repair work on such dwelling house
of on the grounds or building appurtenant thereto shall not because.of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any.of its political subdivisions shall .
enter into any contract for.the performance of public work until acceptable evidence of compliance vzth the insurance
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-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.Ae-
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 mush submit multiple permittlicense 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 afl-rdavit•.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 call.
The Department's address,;telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigationts
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
Expanded Bag Cover�lge:Chartfor Nationalfibar'6r Cellulose
Walls or Enclosed�avltles' At�lc Floors or Open Cavities(Aireas)
Dt9rlse.Pack't�:3.6 Lbs7CuFt, . . Loose Fill 61A LbSICUR
Covers a for 26:6'Pound 09 Covers a for 26.5 Potmd Bev) .
Cavity "Coverage ; 'Installed 'Settled. •Gout:rage
',Depth .` per.Bag. Depth Depth "psi Bag
FtNalue nche9 et F R-V lue ' Inches Inches MUM
Ft
7 2.0 • • 45.4 13. 4.3 3.8 9(1.8
2x3 9 2.5 36.3 15 4.8 4.3� 7A.0 "
11 3.0 30.3 19 5,9 6.3 53.5"
2 x 4" 13 •3.5' 28.0' 22 8.8- 6.1 44.1
14 4.0 22.7 ' 25 7-7 8.8' 3i':7
18 :. 4.6 20.2 30 e.•1 8.1 3(1.0
18' 5.0E14.
35. 10.5 9.4' 21i.0
2x6. 20 6.5. 38. 1I'A 10.2 ZL 722 8.040' 12.0 10.7 2'1.3
8.545 ' 13.4 ' 12.025 7.0 . 50 14:8• 13.4 113.5.
2x14.7
;8.;. 275 �1.2.1
27 8.0- : 11.4. 80 171 16.*0 .. .... 115.
31 8.5' 10.7 ..65., 19.1 17.3 1,t.3
32' B.0 10.1 70 20.5 18.6 11.4
2x 10 • 34 •9.5 9.8 .76. 21.9 19.9 11).8
36 10.0 . 9.1 80 23.3 .22.5 '
38 10.5 717 85 24.7 22.5 - ..:g.2..
40 .11.0• 8.3" 90 28.1.. 23.9 E.8 .•
2x 12 41 11.5 • :7.9
2 43 12,0, 7:8 'Depth and coverage values were ,
45 12:5 7.3 'extrapolated from progres�sNe coverage .
47 13.0 7.0 chart found on bag.
2 X 14 49 13.5.. 6.7
50 14.0 8.5 "Coverage per bag does notdaMi In .
'62. 14,6 8,3 accounf/laming.•Actual coveraga
64 ` 16.0 8.1 due to framing will typiceliy beat out . .
2.x 18 66 15.6 .. 6.W 10%mo►e.
68• 1e.o. 5.7
69 18.5 6:5 Note:R-Value decreases slightly vs.
61, .. 170 , fi.3" Insulation tlenslty increases Y
2x 18 .. 83 : A7.6• 5.2
85' 18.0 6.0 0.#fulatrunk-National Fiber 2007 ---
ThermaGlas®.Fiber Glass Loosefill•Insulation
Tee
hmenl
Wood Frame Construction.
49.0 33.3 30 1.173 191/2
44.0 , 30.3 33 1.053 171/2
38.0 - 26.3 38 0910 151/1
30.0 20.4 49 0.718 12
26.0 17.9 66 0A522. 101/4
22.0` 16.2 68 01527 .82/4
19.0 13.0 77 0.455 V/2 '
11.0 7.6 133 OJT 41h
insulation . Me hlIOW-the W alue,the'gmeter the blmu>ft pomr.Ask your seller for the fad:sheet on R-Values.
ThermaGlas®fiber glass looaefill
is an alternative to roll or batt insulation in
attics,new construction and retrofit
applications. 8tutece Burning Characteristic"uliding Cods Consructlon Classiflcttition
6 5 , All ftm M Typar Aa 7ypra Aa 7Ypes
M mnolue aw pa Iowan iae kft cmtfm m to the pmdud mq d mnesae al'AUM CM Type 1(p--tic
Voadw.c4tpm2 outer d a >y u rota teatfor An chaos WO).
R-vatuea im dtstamsoed in aecatdmtoe with AM C587 and AMfM 0610.(See des t above).
Cmdmma to Depathttettt of onzw mdedd dandsr&.
m....w......d...n:nti of Xg7U HM and Is corddered nmmmnbusWs by the mu del building code&
cool NOI TIISNI AN01I00 LUN,99905 XV3 V.S:RO OTOZ/ZZ/TO
Telephone:508/563-6049 COLONY INSULATION INC. 28 Jonathan Bourne Mve, Pocasset, MA 02559
BLOWN-IN'INSULATION SPEC: SHEET
CONTRACTOR: 3 row N 3u\\ANV% Co. _
JOB SITE ADDRESS: FIBERGLASS
DATE: 1 l.2 010 CEI
XULOSE
MAREA THICKNESS R-VALUE # OF- 19,, . FAGS USE
g dral Ceiling
Garage Ceiling
Basement Ceiling
I
Slopes '
Exterior Wall
Garage Hse. Wall
Walkout Wall
Cathedral W All
i I
Blockers
Overhang'
Stair/Risers
All R-values and thickness measurements are deemed to be accurate by the follow'-ilig Inst Ifers:
1je4 4 -
fL p
TECHNICAL DATA FOR MATERIALS IS PRINTED ON THE ]BACK OF THIS FORM
Z00 E M011vinsmI AN0100 LTTSItMO5 Xvd E5:80 OTOZ/ZZ/TO
P���
Is
��aTM CERTIFICATE OF LIABI
LITY INSURANCE DATE,MMIDD,TYYY,
� ooUceR (781) 595-4410 03/27/2008
TH{S CERTIFICATE 15 188UEb AS A MATTER OF INFORMATION
The gills IaguranCe Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
38 Colchester Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
F.O. Box 157
P1 m ton MA 02367-0157
N5uR=u INSURERS AFFORDING COVERAGE NAIC#
DOC)GT•AA C GROWN INSLIRERA:11►MRICAN INT IL
1 D5A BROWN BUILDING CO INsuR;;I&J SAFETY INSURANCE
1 L' O BOX 2766 INSURERC:
I E .Falmouth MA 02536— INSURERD:
COV "(3ES (NSURER5:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 4fX)'L
L 7R INSR TYPE OF INSURANCE �•IC M P cnA POLE EXPIRATION
POLICY NUMBER
GENERAL UABIUTY LIMITS
17 `—I / / / / EACH OCCURRp ICE S
COMMERCIAL GENERAL UAHIUTY DAMAGE TO DENTED
CLAIMS MADE 0 OCCUR PREMISES n oa irmnca $
/ MED EXP -e B=n 3
PERSONAL r ADV INJURY I
GEN'LAGGREGATELIMIITAPPLIESPER; / / / / GENERAL AGGREGATE $
POUCY dECT LOC PRODUCTS-COM,°/OP AGG $
II AUTOMOBILE UABIUTY / / / /
1025060 12/31/2008 12/31/2009
ANY AUTO - COMBINED SINGLE LIMIT
(Ea se dea,q $.
ALL OWNED AUTOS / / / /
jI X SCHEDULED AUTOS BO toDILY INJURY
HIRED AUTOS Ip-pq 9 100000
iNO"ANIED AUTOS / / / / SODILYINJURY 300000
PROFlERTY DAM4GE
(Peraoddontl 6
GARAGE UAEgLTTY 100000
I
4ArN4Y AUTO / / / / AUTO ONLY,F�ACCIDENT S
OTHERTHAN EAACC i
AJMBRE AUTO ONLY;
LLA UABIUTY AGG $
CUR D O-Alms MADE / / FACH 0=11RRFNCF $
AGGREGATE I
j DEDUCTIBLE / / $
iRETENTION
A vriR �COMPENSATION AND $
FanpI.AYERV UADILITY 9{C6483524 01/12/2009. 01/12/2010
aN� ctOPR1ETOPJPARTNEWp(ECUTIVE R UNIT$ t
OEFI%-WMEMBEREXCLUDED? EL,EACHACC(DENT
/ . / $ 100600
If Y❑::,d�aiho un+fer / / E.L.DISEASE-EA EMPLOYEE
Sr':CLgL PROVISIONS Cetow
OTIeER EL.DISEASE-POLICY LIMIT S 500000
' >T,raN of OPERATIONSrLOX A710NSnmHICLEw1=AuLUSIONS ADDED 9V ENOO{ pMENT/SPeCIAI PROYIryONS
t-RTIta ATE HOLDER
} _ CANCELLATION
(508) 548-4290 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED_BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL
TOWN OF FALMOUTR 10 DAYS WMrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,EUY
Jr 9 Town Ha Square Hall S FAILURE.To DO 80 SHALL IMPOSE NO OBLIGATION OR LI4BlLITy OF ANY IOND UPON THE
RE I A E o REf'REStNTATIVES,
_ FF LMOUTH A E t
o�L���{2ooTioa) MA02540-
ti2, t)ACORD CORPORATION 1488
ENERGY CONSERVATION APPLICATION'' FORM FOR ENERGY EF FICICIENCY FOR
ONE- AND TWO-FAMILY DETACHED RESIDENTIA.L'CONSTRUCTION (780 CMR�61.00)
Applicant Nairie: `iC�� � Site Address: V
P
prig— 'X`own: t�rS•j�' h s
Applicant Phone: �� ® / �` —�
Applicant Signature: Date of Application:
NEW CONSTRUCTION: choose ONE of the*following two—options)
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA, FOR
NEW ONE-AND TWO-FAMILY BUILDINGS
MAXI1vrM MINIMUM
Ceiling or Slab
Q Option l: t 13ascme�it
Fenestration exposed Wall door Perimeter
U-factor floors R-'Value R-Value /all R Value AFUS HSl?F SEAR
R-Value R-Value and De th
National Appliance•Enmw
35 R-3 9. R-19 R=19 R-10 R-I Q, Conservatian Act(NAECA)of
4 ft.- 14S7 as amended,mimmuuns or.
ester as a cable
Noto: This form is not required if you choose either of the two versions of RBScheck as listed below.
Option 2: REScheck'Version 4.1.2 or later'variant sofhAra ,, analysis must be completed
780 CMR 6107.3.2
R.l✓Seheck--Web which can be accessed at http://www.energycodes.gov/r-.scheak/
ADbI-xION•S OR1 A4-TERATTON�70 EXISTING BUILD NGS,OAR 5 YEARS OLD*
}Buildings under 5 years old must use option 91 or 0-in New Construction section above.
Complete the following formula to determine,the % of glazing_
(a) Gross �ValI & Ceiling Area equals Formula: (100 x b-=a)
Z5 2, ,SF
100 x S(o '=-152fo = % of glazing
(b) Glaring area equals S G(.P S1Y b a
If glazing xs< 0%.use the char) below. Tf lazy is>40 %' r4ceed to"SUNROOM" section
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXJSTING
LOW-RISE RESIDENTIAL BUILDINGS
MAXIMUM MINIMUM
Benestration Ceiliz)g and .'l7J'all Floor Basement Wall Slab Perimcier
Exposed floors R-Value
U factor R-Value A Value ] value R�Value and Depth
.3� R-37 a R-13', R-19 R-10_ R-10, 4 feet
a R-30 ceiling insulation maybe used in place of R-37 if the insulation achieves the full R-value lover.the entire ceiling
area(i.e.not compressed over exterior walls,and including any access openings).
SUNROOM—An addition or alteration to an existing building/dwelling unit where the total
glazing area of said addition exceeds 40% of the comb�ned gross wall and ceiling area of the
addition.
Note: Owner to fill out Consumer rn ormation.dorm found in Appendix 120T
. . lee 'C�ar�movzurea�i ✓�aaaacfzuoelta '
Hoard of Building Regulations and Standards -License or registration valid for individul use only
— HOME IMPv`JEMENT CONTRACTOR before the expiration date. If found,return to:
tic Board of Building Regulations and Standards
RegistraUn 115476 'One Ashburton Place Rm 1301
Expirat on 3/6/2010 Tr#. 263300 {
3= Boston,Ma.02108 f
BROWN BUILDING CO ,4-i '3 f
DOUGLAS BROWNS , u
89 SHOREWOOD DZ,
E.FALMOUTH,MA 02536 Administrator Not valid without signature
1 ,
7
� l J &�. ✓lie �omirruYx�ue�L o�,./�a;a�zc, f i
• '"r'+ Board of Building Regulations and Standards j
Cuction Supervisor License
�. Lid'6ns N CS 50151
Tr# 23731
Expiration_ 5t26/p2010
r Rei traction 00 pM
DOUGLAS C BROW -
'}. l PO BOX 2276'. Co rriiss�oner i
l
TEATICKET MA 02536
f+
Town of Barnstable
:
Regulatory Services.
s�xivsresr.E. •
HAM Thomas F.Geiler,Director
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
Property Owner Must
Complete and Sign This Section
If Using A Builder
®O , as Owner of the subject property
hereby authorize )a S � � ro� -,— to act on my behalf,
in all matters relative to work authorized by this building permit a lication for:
70 Go-
(Addres of Job)
Signature of Owner Date
+ Wk o,h �. v�l�p
Print Name
If Property Owner is applying for permit please complete.the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISSION
r,
P�oF zHE to �
Town of Barnstable
y� Regulatory Services
t swtuvsUBIP- : Thomas F.Geiler,Director
MA
p t639. ��� Building Division
rED �A Tom Perry,Building Commissioner
200MairiStreet,_Hyannis MA02601-- -----__.___.___^---.----.__---.---
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINPTION 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•underahe buildirigf 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
m;n;rr,um inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
.The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section_(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q.
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the 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 fomr/certification for use in your community.
Q:forrns:homcexempt
0$ Woo l4mt-ndr4
Q I .,780 CMR: .STATE BOARD OF BUILDING REGULATIONS AND STANDARDS ��i6
' "°F r'r's MASSACHUSE 7S STATE BUILDING CODE
p M I y s.
CHELE c {� A WC Guide to Wood Construction In High Wind Areas:110 mph Wind Zone
0 CUDILO
No.34774 -+•It- Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)'
STRUCTURAL Js
craE° �``� C�J Check
sr 1 Compliance
SCOPE
Wind Speed(3-sec.gust) ....................... ........................ 110 mph
Wind Exposure Category ........................................................ B _
1.2 APPLICABILITY
Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story)
1 stories s 2 stories V
Roof Pitch .............................. (Fig 2) .................'dam V..II s 12:12 I1
Mean Roof Height ........................ (Fig 2) ft s 33'
Building Width,W .. _ .... (Fig 3) ................... 2
aft s 80'
Building Length,L .:..................... (Fig 3) ft S 80'
Building Aspect Ratio(L/W) .:..... _ .... (Fig 4) .. Z r s 3:1 tK
Nominal Height of Tallest Opening' ........., (Fig 4) ., 1 _A
1.3 FRAMING CONNECTIONS
General compliance with framing connections ... (Table 2) ......................... _
2.1 FOUNDATION
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete .......... ....:....... ............................................ �N
Concrete Masonry ...........................................................
2.2 ANCHORAGE TO FOUNDATION'-)
Anchor Bolts imbedded or W'Proprietary Mechanical Anchors as an alternative in concrete only
Bolt Spacing-general........... ..... (Table 4) ............ in.
Bolt Spacing from end/joint of plate .,..... (Fig 5) ................ in.S 6"-_in.
Bolt Embedment-concrete..... (Fig 5)....., ...... ..- .-I in.x 7"
Bolt Embedment-masonry.............. (Fig 5) .................. — in.? 15"
Plate Washer ..... .................... (Fig 5) 2 3" _✓x 3"x'/."
3.1 FLOORS
Floor frarning member spans checked ........ (per 780 CMR 55.00) ....... v
Maximum Floor Opening Dimension......... (Fig 6) //�_ft s 12' r�
Full Height Wall Studs at Floor Openings less than 2'from Exterior-Wall(Fig 6)
Maximum Floor Joist Setbacks
Supporting Loadbearing Walls or Shearwall . (Fig 7) ......... ... ......... ft s d
Maximum Cantilevcred Floor Joists
Supporting Loadbearing Walls or Shearwall , (Fig 8) .... ...............N�A_ft s d
Floor Bracing at Endwalls .................. (Fig 9)
Floor Sheathing Type (per780GMR-55.00) ........
Floor Sheathing Thickness .........:........(per 780 CMR 55.00) ....
Floor Sheathing Fastening :................. (Table 2)_Ld nails at min edge! L to field
4.1 WALLS
Wall Height
Loadbearing walls ..................... tag 10 and Table 5) ........... �.ft s 10'
Non-Loadbearing walls ................. (Fig 10 and Table 5) ....... ft S 20, e/
Wall Stud Spacing ...... .................. (Fig 10 and Table 5)....... -in.s 24"o.c. _
Wall Story Offsets . ...... . ............... (Figs 7&8) ......... ........*ft s d
4.2 EXTERIOR WALLS'
Wood Surds
Loadbearing walls .. ....... ........ (Table --� Q ft in.
Non-Loadbearing walls'.. .. ...... (Table 5) .... �� ..2x�-.1=ft.L in. _
Gable End Wall Bracing'
Full Height Endwall Studs ............... (Fig 10)
W SP Attic Floor Length ................ (Fig I l) .............. f,.�'A—fta W/3 q
Gypsum Ceiling Length(if WSP not used)(Fig 1 1) .................... _ft it 0.9W el-
and 2 x 4 Continuous Lateral Brace®6 ft.o.c...(Fig 1 1).....................
or ► x 3 ceiling-furring strips® 16"spacing rein.with 2 x 4 blocking 0 4 ft.spacing in end
joist or truss bays ..........................................
Double Top Plate v
Splice Length......................... (Fig 13 and Table 6) ................ .�_ft
Splice Connection(no.of 16d common nails)(Table 6)............................
! I
A WC Guide to 6Yood Comviruc%iou iu High Ward Areas: 110 mph P* d Zofte to J� r
Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)
I �hly115Po tiA
Loadbearing Wall Connections 4/
Lateral (no.of 16d common nails)...............................(Tables 7)...................................................... 7-
Non-Loadbearing Wall Connections
Lateral (no.of 16d common nails)...............................(Table 8). ....:.. ............................................ 2
Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9)
HeaderSpans .........................................................(Table 9).. ..............................�! .ft O in.511'
SillPlate Spans ........................................................(Table 9)................ ............-ft Q in.5 11'
Full Height Studs (no.of studs)...................................(Table 9)........................................................
Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
HeaderSpans...... ......................................................(Table 9).................................. ft_D_in.512'
SillPlate Spans............................................................(Table 9).................................. ft_in.5 12' �G
Full Height Studs (no.of studs)................................... Table 9 V140.5.... 2-
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously°
Minimum Building Dimension,W t
Nominal Height of Tallest Opening2 ..................................... lg1AlY..1 1 ...•.•.•••_1 6'8"
SheathingType........................ . .................(note 4)............................ ............... .W 5 7P
Edge Nail Spacing........................................(Table 10 or note 4 if less)V.&41..A0Kn In.
Field Nail Spacing........................................(Table 10).........:....................................
A1Pr7
Shear Connection(no.of 16d common nails)(Table 10)........................................................ o
Percent Full-Height Sheathing......................(Table 10)......................... 11r�... �o
5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... _ tom
Maximum Building Dimension,L ,
Nominal Height of Tallest Opening2......................................¢�1Cf 1 t.I'�L— .rc:Ia......�s 6'8'
Sheathing Type.............................................(note 4)...................................................... WS r li
Edge Nail Spacing.........................................(Table 11 or note 4 if less 'BAkctDA(�,Y�in. _!G
Field Nail Spacing.....................:::................. able 11 JL in.
Shear Connection(no.of 16d common nails)(Table 11)' ...... F( v
Percent Full-Height Sheathing......................(Table 11).......................... lct emg.t2_V.
5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)..................... _11
Wall Cladding - I .
Ratedfor Wind Speed?..............................................................................................................................
5.1 ROOFS
Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website)
Roof Overhang .............................................:......(Figure 19) 115 ft:5 smaller of..2'or U3- _�Az
Truss or Rafter Connections at Loadbearing Walls
Proprietary Connectors
Uplifp ..............(Table 12')................................... ..U=�plf
t.................................. .......
Lateral...............:.............................(Table 12).............................................L=��plf
Shear.........................................:....(Table 12).............................................S= 77 plf
Ridge Strap Connections,if collar ties not used per page 21... (Table 13)....1 /kc PLAa...T= pif
Gable Rake Outlooker......... ....(Fjgtire 20)............. ft 5 smaller of 2'or U2
Truss or Rafter.Connections at Non-Loadbearrhg'Walls
Proprietary Connectors AA
Uplift..................................:.............(Table 14t.../1...........-1!e...r'L U-417 lb.
Lateral (no.of 16d common nails)..(Table 14).......................................L=L(Llb.
Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59)............
Roof Sheathing Thickness.................... ............ ...IJIU in.?7/16"WSP
Roof Sheathing Fastening... .........:..................... (Table 2). .....�"i!tJtX.�1W. .G1�.-.tom......... _
Notes:
1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of
780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not
required per the WFCM 110 mph Guide:
a. Steel Straps per Figure 5
b. 20 Gage Straps per Figure 11
c. Uplift Straps per Figure 14
d. All Straps per Figure 17
e. Corner Stud Hold Downs per Figure 18a and Figure 18b OF A4A
SS9C
2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sh y
HELE,
requirements shown in Tables 10 and 11. o� MIC 4.ti
3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-gra
CUDILO
O No.34774.
u STRUCTURAL
Si LF
ONA
wa
t90 di/11691� EXPOSURE R WItV® zOhfE
Table 2. General Nailing Schedule
Joint1 of
Number1
Common -Nails Box Nails Nail Spacing
! Roof Framing
1 .
Blocking to Rafter(Toe-nailed)
Rim Board to Rafter(End-nailed) 2-8d 2-10d each end m2-16d
3-16d_.-.... . .,... each end 2
Wall Framing
Top Plates at Intersections (Face-nailed) 4-16d - -
Stud to Stud (Face-nailed) 5-16d at joints
Header to Header(Face-nailed) 2-16d 2-16d 24"
o.c.16d 16"oc along edgesMalang
oil
�
Joist to Sill, Top Plate or Girder Toe-nailed (Fig.
( ) ( 9 14) 4-8d 4-10d
Blocking to Joist (Toe=nailed) per joist
2-8d 2-1od each end
Blocking to Sill or Top Plate (Toe-nailed) 3-16d
Ledger Strip to Beam or Girder(Face-nailed) 3-16d 4-16d each block Z
4-16d each joist
Joist on Ledger to Beam (Toe-nailed) 3-
Band Joist to Joist (End-nailed) (Fig. 14) 3-10d per joist
3-16d 416d per joist
d
BanJoist to Sill or Top Plate (Toe-nailed) (Fig. 14) 2-16d
3-16d
Roof�Sheathing
' per foot
Wood Structural Panels
rafters or trusses spaced up to 16" o.c.
8d 10d 6"edge/6"field
rafters or trusses spaced over 16°o.c. •
8d 10d 4" edge/4"field
gable endwall rake or rake truss w/o gable overhang 8d : f
10d
gable endwall rake or rake truss w/structural 6"edge/6"field
outlookers 8d 10d 6"edge/6"field
gable endwall rake or rake truss w/lookout blocks 10d 4"
-
/4"field Ceilin S in ._ 9e e '9 .heal`h g
Gypsum Wallboard —- - --- —_---..�: �----
5d coolers - ' 7"edge/10" --y field
Wood Structural Panels -�, . ... ftm
: .,
studs spaced up to 24"o.c.
10d 6"edge/ 12"field
1/2"and 25132" Fiberboard Panels 1
— 3"edge/6"field
1/2"Gypsum Wallboard
5d coolers — 7"edge/10"field
Floor Sheathing
--- ,
Wood Structural Panels .
1"or less
greater than 1" 8d 10d 6" edge/12"field
10d 16d 6" edge 16" field
T Corrosion resistant 11 gage roofing nails and 16
gage staples are
permitted,check IBC for additional requirements.
Nails. Unless otherwls9 stated,slurs given for nails are common wire sizes.Box and
diameter and equal or greater length to the specified common nails may be subs pneumatic nails of
Y tltuted unless Otherwise prohibited. �
1
+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 0 ` �_ Application# v " v `J'
Health Division
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fe
Planning Dept. Permit Fee tt 01 S•
Date Definitive Plan d by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address ® E AR 5AR&O A'V 0-
Village rY�A
Owner ( I L L 1,l Address &Q K HA 5ARC, E A vQ_
Telephone dog -7 75 — / 7/
Permit Request 1Z 1ILACF_ K/ TC41 N CA Bin- A Tic .T?S
F_?`L AC E RdrrE6 -L--Pi"0d4LL_
I V�'%ZTA-L 0, .-!5"A1v a K ITCI-/ff N rL00 P, , .3 N79IZ)ok No"7r N-Icn
Square feet: 1st floor:existing proposed 16 2nd floor:existing CCO proposed 1906 Total newer
Zoning District R E5 Flood Plain f-'d Groundwater Overlay
Project Valuation L1 00 Construction Type
Lot Size _ra 8Q1Ea5 Grandfathered: ❑Yes ❑ No If yes, attach supporting documen5tion.c-:
� welling Type: Single Family K_ Two Family ❑ Multi-Family(#units) '
tige of Existing Structure /Gb A Historic House: ❑Yes, &LNo On Old King's hway: akYes �_JNo
Basement Type: KFull ❑Crawl ❑Walkout ❑Other c, c
a)
Basement Finished Area(sq.ft.) �JQ Basement Unfinished Area(sq.ft) ® M
Number of Baths: Full:existing a new O Half:existing new 0
Number of Bedrooms: existing ils q new 0
Total Room Count(not including baths):existing 9 new_� First Floor Room Count L4
Heat Type and Fuel: ❑Gas kOil ❑Electric ❑Other
Central Air: ❑Yes klo Fireplaces: Existing l New 0 Existing wood/coal stove: ❑Yes ALNo
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn: o existing ❑new size
Attached garage:*xisting ❑new size Shed:&existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal#_ ,._R_ecorded_❑.-,-
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name 0,31 ATA A L0 `YLE 7Z Telephone Number S 0 8-36 y- -71'S
Address o L L yAJX 46 L M 0— License# -7 a S "7q
(-/YA,U A-)6 W► .4. 0 a (0 O 1 Home Improvement Contractor# LOG 6 a 7
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &,w t3A PN5'TA,81_Z'
SIGNATUREJT;7� DATE 04
FOR OFFICIAL USE ONLY
i
Y
PERMIT NO..
DATE ISSUED
MAP/PARCEL NO.
i
I -
ADDRESS VILLAGE jl
OWNER
f
DATE OF INSPECTION:
> FOUNDATION '
FRAME
z '
y
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
t PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
F FINAL BUILDING
t
k �
DATE CLOSED OUT
ASSOCIATION PLAN NO.
i
r
i
°FTME��y Town-of Barnstable
yP °� Regulatory Services .
* snarrs�►B , t Thomas F.Geller,Director
y Mass. g
i 19- Buildincr Division
�
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 509-862-4039 Fax; 508-790-6230
Permit no.
Date
AFFIDAVIT 1
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: ��CH 1W C R 1>C N 4,VE5 Estimated Cost�' ®o 0
Address of Work:
Owner's Name: I (,L I A W 0 O
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
QBuilding not owner-occupied'
❑Owner pulling own permit
Notice is hereby given that:
OWNERS FULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT RAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND MINDER MGL c.142A.
SIGNED UNDER PENALTIES.OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
Date Owner's Name
Q:fb ns:hcmeaMdav
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
M 5 www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): . 1 1.
Address: ; (IXA.1 X, ff 0 L,01 CT
City/State/Zip: VAPM3 , pl fi 02fij�l PhoneA SOS` Sa l
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. I am a general contractor and I
. employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction _
2JMI am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. '❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P t5'• 9. ❑Building addition
[No workers'comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1 LEJ 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#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
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 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 co ra e verification.
I do hereby c rti un i lties of perjury that the information provided above is true and correct
Signature: A Date: O�
Phone#:
Official use only. Do not write in this area,to be completed by city or town official'
City or Town: 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 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 another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until.acceptable evidence of compliance vdth the insurance
requirements of this chapter have been presented to the contracting authority."- - w
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit"should
be 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 in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn 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 call.
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
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 11-22-06
www.mass.gov/dia
.JUN 06-47 WE 12 : 1 7 PM LILLIAN. WOO �y 205 234 0328 P.01
� Regulatory &ir-Vi ..- .. .:� ....-_...
'� 1,�, �'�aau1�►s�'��eil�r,]?ire�•toP
'fog Ver,rp, Bpi!=liL�CQm;iaassic�Mr
2QQ Mail,S160t V"s7A�A 3vff�Qif+1
C1�fice: SD�•862�G3r ' ,
Property o%mer must
Complete. and Sign This 5c c do;n
If Vsing A BuAder
hereby authcv .Ze
My t.eh Llf
ia a!1 l3t4tCc [S ieiati`!e to-wQ:k duthDri,.ca bytbz tor;
A�czess Fab) , ,
r 8T?
00
w
?ant aVu-re
.4i
671
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registrations,,,-106627
Ex� anon 7/24/2008
t...
! Type Individual
JONATHAN M TYLER IF'. I_, r! 4` s
Jonathan Tyler
67 Cranberry Lane Box 80
W Hyannisport, MA 02672
� Deputy Administrator
i
I Boa d of Bu jd g Re
Construction S gulatiorf
upervisor Li and standards
Lice&te- CS cease
11 Yrthdate`� 72579
—_ 1/4/1965
Exptratton _
Restrrct►o� 1/4/?008 T�
7 _ 00 5740
a` PONATHAN M TYLER +
O BOX 80167 C
W HY
ANN/SPORTNBERRY LA
i �'iA`02672'
Commissioner �.
SCHEDULE OF ELEVATIONS 1. T RISERS AND COVERS TO FINISH GRADE. SEWAGE SYSTEM PROFILE 8c DETAILS
, •wM GENERAL NOTES
• • �+ = 2• H-10 COMPONENTS AND SCHEDULE 40 PVC PIPE THROUGHOUT. NOT TO SCALE
o 1 FIRST FLOOR 1 34.8
1 ALL CONSTRUCTION AND MATERIALS SHALL CONFORM TO MASS ENVIRONMENTAL
�•s . 2* TOP OF FOUNDATION = 2* 33.8t 1 34 8 3. EXISTING SEPTIC TANK, D-BOX AND CHAMBERS ARE TO BE PUMPED DRY PRIOR TO .
•�` ••' 3 PIPE INV. AT FOUNDATION = 3 28.6 EXCAVATION. OBSERVATION PORTS
CODE (310 CMR 15.00,TITLE 5), AND THE LOCAL BOARD OF HEALTH.
••M. SET TO WITHIN 3" 2. THERE SHALL BE NO CHANGES MADE IN THIS PLAN WITHOUT THE WRITTEN
• 4 INV. OF PIPE AT SEPTIC TANK INLET = 4 28.32 4. EXISTING SYSTEM COMPONENTS MAY BE RELOCATED AND RE-USED IF COMPONENTS OF FINISH GRADE S=2% MINIMUM PERMISSION OF THE LOCAL BOARD OF HEALTH.
• • 5 INV. OF PIPE AT SEPTIC TANK OUTLET = 5 28.07 2* 33.8t ARE UNDAMAGED DURING EXCAVATION AND FOUND TO BE IN GOOD CONDITION. 3. ALL ERRORS, OMISSIONS, AND CHANGE OF CONDITIONS AT THE SITE SHALL
•, �; N • 6 INV. OF PIPE AT D-BOX INLET = 6 27.93 ANY DAMAGED COMPONENTS MUST BE REPLACED. BE BROUGHT TO THE ATTENTION OF THE ENGINEER PRIOR TO PERFORMING THE
•� 7 INV. OF PIPE AT D-BOX OUTLET = 7 27.76 NEW CLEAN STONE MUST BE USED IN RELOCATED SOIL ABSORPTION SYSTEM. 11 30.5t RELATED WORK.
14 3 1.7
M M galN • 8 INV. OF PIPE AT START OF LEACHING FIELD = 8 27.39 4 128.32 13 30.8 5 28 07 12 30.7 4. THIS PLAN HAS BEEN PREPARED SPECIFICALLY AS A SEPTIC SYSTEM DESIGN AND
LOCUS N•Na j u • • 9 BOTTOM OF LEACHING FIELD = 9 25.39 ;;':, IS NOT TO BE USED TO ESTABLISH PROPERTY LINES OR BUILDING SETBACKS.
10 28.22 MIN. BREAKOUT PROPERTY LINES AND BUILDING LOCATIONS ARE GRAPHIC ONLY, PROPERTY LINES
0 1 r 10 TOP OF STONE = 10 28.22
FINISHED GRADE OVER LEACHING FACILITY = 11 30.5f ?' 15' NOT HAVING BEEN VERIFIED. NO REPRESENTATION OR CERTIFICATION AS TO THE
. •: ouTLE .
••'• 12 FINISHED GRADE OVER D-BOX = 12 30.7 •D' BOX
1 ACCURACY OF THOSE SHOWN IS IMPLIED OR INTENDED
' _ BACK FILL wITH 5. ALL DISTURBED AREAS ARE TO BE LOAMED, SEEDED AND MAINTAINED
13 FINISH GRADE OVER SEPTIC TANK 13 30.8 � / sPE i'
o MIN. S=0.02 LEVELERS CLEAN FILL TO PREVENT EROSION.
14 FINISH GRADE AT FOUNDATION = 14 31.7 ! +'
--- MIN. S=0.01 MIN. S=0.01
LOCUS MAP NOT TO SCALE 15 BOTTOM OF SEPTIC TANK = 15 23.74 L=10.5' `-, 1. 6. FOR PROPER PERFORMANCE, SEPTIC TANK SHOULD BE INSPECTED AT LEAST
16 TOP OF CELLAR FLOOR = VARIABLE 16 26.0 `' f� i O SCHD. 40 PVC TEES L=9.0' L=VARIES : C3 C3 0 cm .•: ONCE A YEAR AND WHEN THE TOTAL DEPTH OF SCUM AND SOLIDS EXCEEDS
1/3 THE LIQUID DEPTH OF THE TANK, THE TANK SHOULD BE PUMPED.
* ACTUAL TOP OF FOUNDATION ELEVATION AS REQUIRED BY ARCHITECTURAL DESIGN ! 7 ACKNOWLEDGED
i. . THIS SYSTEM HAS BEEN DESIGNED FROM DATA REVIEWED AND
TO MATCH FLOOR LEVEL OF ADDITION TO THAT OF EXISTING DWELLING. : �" I
:. ' ! "[ 0000 ' GAS BAFFLE 4 1`0 6 27.93 7 27.76 f, BY THE MASS. D.E.P. AND THE LOCAL BOARD OF HEALTH; AND
i5 I<<([ 4' OF NATURALLY OCCURRING •� CONFORMS WITH THE REQUIREMENTS OF TITLE 5 OF THE MASS. SANITARY CODE.
. III� litr[i $ 27.39 PERVIOUS MATERIAL N NO GUARANTEE OF PERFORMANCE IS EXPRESSED OR IMPLIED.
�� <' 1 liL <
16 26.0 , Ln
8. TEST HOLE INFORMATION SHOWN HEREON IS LIMITED TO SOIL CONDITIONS FOUND
1500 GALLON SEPTIC TANK 9 25.39
AT THAT PARTICULAR TEST HOLE LOCATIONS AND IS NOT CONSIDERED AN
..•:: ;';' . H-10 PRODUCT N ACME NO GROUNDWATER ENCOUNTERED ® ELEV. '0.3
PRECAST MODEL OR EQUAL IMPLIED OR EXPRESSED WARRANTY OF SOIL CONDITIONS BEYOND LIMITS OF
INSTALL ON STABLE COMPACTED USE (5) 500 GALLON GALLEYS WITH: SUCH TEST HOLES.
6 MIN. CRUSHED STONE BASE
3/4" TO 1-1/2" DOUBLE WASHED STONE 9. ALL ORGANIC AND UNSUITABLE MATERIAL MUST BE REMOVED FROM THE AREA
�._. ..._ ._..._ _.. ... .�. : _.._.. __.w.. w..._ _.__.._..
15 23.74 SEE NOTE 3 ABOVE PROFILE. 48" ALONG SIDES; 48" EACH END. DIRECTLY UNDER AND 5 FEET BEYOND THE PROPOSED LEACHING FACILITY. THIS
TOTAL LENGTH = 50.5' TOTAL WIDTH = 13' AREA MUST BE BACK FILLED TO THE ELEVATIONS INDICATED ON THESE PLANS
WITH SELECT ON-SITE OR IMPORTED SOIL MATERIAL, CONSISTING OF CLEAN
GRANULAR SAND OR OTHER GRANULAR MATERIAL, FREE
. OVERLAY NOTE:
DESIGN DATA MATTER AND OTHER DELETERIOUS SUBSTANCES. MIXTURES OAND ORGANIC
1. BUILDING TYPE: EXISTING 4 BEDROOM; UPGRADE TO 6 BEDROOM HOUSE SHALL NOT BE USED. THE FILL MATERIAL SHALL CONFORM TO MA STATE
\ THIS LOT DOES NOT LIE WITHIN ANY STATE DESIGNATED ZONE II 2. DESIGN FLOW: 110 GPD PER BEDROOM = 110 x 6 = 660 GPD HEALTH CODE TITLE 5 - 310 CMR SECTION 15.225(3) AND SHALL HAVE
THIS LOT DOES NOT LIE WITHIN ANY GROUNDWATER PROTECTION OVERLAY PERCOLATION RATE OF BETWEEN TWO AND FIVE MIN. PER INCH, BEFORE AND
4 WIZ) �- Pf�/!/.4 TE �A THIS LOT DOES NOT LIE WITHIN ANY WELLHEAD PROTECTION OVERLAY 3. DESIGN PERCOLATION RATE. 5 min/inch AFTER PLACEMENT.
THIS LOT DOES NOT LIE WITHIN ANY ZONE OF CONTRIBUTION TO SALTWATER ESTUARIES. 4. GARBAGE DISPOSAL: NO
10. ALL STONE MUST BE DOUBLE WASHED AND FREE FROM FINES AND ANY
5. SEPTIC TANK DESIGN REQUIREMENT: 200% DESIGN FLOW ORGANIC MATERIAL AND MUST HAVE LESS THAN 0.2 PERCENT MATERIAL
660 X 2 = 1,320 GAL. (USE 1,500 GAL. MIN. PER TITLE 5) FINER THAN A NUMBER 200 SIEVE.
N17'12'30"E EXISTING PAVED WAY g�5 _ 9 _ - _ _ - 6. TOTAL LEACH AREA REQUIRED: 11. THE DESIGNER HAS NOT BEEN RETAINED BY THE CLIENT TO CONSTRUCT OR
e)Ing ? TITLE 5: 660 GPD / (0.74 GPD/SQ.FT.) = 892 SQ.FT. (CLASS I SOIL) SUPERVISE THE CONSTRUCTION OF THE SYSTEM. THE CONTRACTOR IS
155.00' 'I` \ 7. TOTAL AREA PROVIDED: RESPONSIBLE FOR MAKING ARRANGEMENTS FOR INSPECTION OF INSTALLATION
_ 1 OF THE SYSTEM WITH THE LOCAL BOARD OF HEALTH.
w26 // // // N I 13' X 50.5' LEACHING TRENCH (SEE DETAIL) - 12• THE GENERAL CONTRACTOR IS RESPONSIBLE FOR ALL HORIZONTAL AND
\ � o / // // o a \ ` EFFECTIVE DEPTH = 2.0 , LENGTH - 50.5 , WIDTH - 13.0 VERTICAL CONTROL OF ALL SYSTEM COMPONENTS.
-►OD �' n'- o 1 13. TIGHT JOINT PIPING TO CONSIST OF POLYVINYL CHLORIDE (P.V.C.)
cn SIDE WALL AREA = (2x50.5)(2) = 202 SQ.FT.
/ r \ 1 SCHEDULE 40, UNLESS OTHERWISE NOTED.
� BOTTOM AREA = 13x50.5 = 656.5 SQ.FT.
w �O / m \\ 1 END WALL AREA = (2x13)(2) = 52 SQ.FT. 14. THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER FOR CONSTRUCTION
INSPECTION AFTER EXCAVATION FOR THE LEACHING BED (PRIOR TO THE
/ \ / r
TOTAL AREA PROVIDED = 202 + 656.5 + 52 = 910.5 SQ.FT. PLACEMENT OF STONE) AND ALSO AFTER PLACEMENT OF PIPE & STONE
, - 910.5 SQ.FT. x 0.74 SQ.FT./GPD = 673.8 GPD PRIOR TO BACKFILLING.
LOT A , PARCEL ID 225 022 - 15. DESIGN ENGINEER SHALL CERTIFY CONSTRUCTION C;F SYSTEM AND '•MATERIALS
' TOTAL FLOW PROVIDED = 673 GPD INSTALLED. THE CONTRACTOR SHALL PROVIDE A SIEVE ANALYSIS OF THE FILL
37) 470 S• F• STING 1 MATERIAL REQUIRED. AN AS-BUILT PLAN SHALL BE SUBMITTED TO THE LOCAL
o / ELLING 1 NOTE: SYSTEM IS NOT DESIGNED FOR A GARBAGE GRINDER. BOARD OF HEALTH UPON COMPLETION.
'Il I /, CU o,� oA ��30, ` - - _ - #64 THIS LOT SERVICED SOIL EVALUATOR S LOG
16 SEPTICBBER TIRE BED EXCAVAOTIONRUCTION MACHINERY DUR DURING CONSTRUCTION.
DRIVE OVER THE PROPOSED
, , - - - 31 1 BY OWN WATER
THIS LOT SERVICED rn I i III / �, I 1 17. DIG-SAFE AND ALL OTHER NECESSARY AUTHORITIES SHALL BE NOTIFIED FOR
r+� .� / . .
BY TOWN WATER 1 III / �I " • " • 3p-61 F-I'/ 1 Elevation Depth from Soil Soil Soil Soil Other THE PROPER LOCATION OF EXISTING UTILITIES PRIOR TO ANY EXCAVATION.
• ` ' " Surface Hor. Texture Color Mott. Relative
,ticcq T�tic 1 (inches) (USDA) (Munsel) Factors
r
PARCEL ID 225-020 j I j I I .*' ` :` 32�' �e SAFe Otis FAr,� �09� 1 DEEP OBSERVATION HOLE 1 elev.30.3
,7�0 73 29�9 Oti Rp �o?� o 1 27.3 0"-36" FILL 1 OYR 8/2
6 c 4 1 PERC
I I I I I 5 REMOVE AND REPLACE. ,. " • ` / SOS, �011 'Qp Oq - - - -�, 1 1 / N22 32'15"E
SEE GENERrL NOTE 9-_..� " _ 24�1 - 3s"=6s" a LOAMY SAND 2.5Y 6/6 ELEV. 25.3
"" y /J 1'L 30 II \N -4 89.50' �"$$� 20.3 66" 120" C SCLEAN AND FINE 2.5Y 7/4 NO
/ / I I 1 1 1 I J "• �;. o 'BP�4 \C411 ICE 0 I
EXISTING / / I I I I J 21.6' ` " ° ' ' x \ ¢6' - I can DEEP OBSERVATION HOLE #2 (elev.30.8) 1 4/16/09 SIX BEDROOM DESIGN DF NDS
DWELLING I 0.5 , . . • ^a \ A ! �gi »
• " . "• ' 'QOp�� g N22'32'15" I 1 f 2Z.1�_ o -36 FILL 1 oYR 8/2 REVISION DATE
I , , • �� ^� qp' p �, E �\ �6 " " DESCRIPTION BY APPR
I o S�' \ �� S �' l 2.5Y 7/4 NO
#90 / N III r / / r\ .��O T ,F� ;� / 60.00' _ tig 20.8 36 -120 C CLEAN FINE
% I I ► ' �� � �� 20 `1�� }o�� \ Oti ,' /- - \\ 1 SAND APPLICANT. LILLIAN C. W00
/ III c,Qo o 1 ao DEEP OBSERVATION HOLE #3 (elev.32.0)
/ // // I I I J �4/� a// / �, Q� 6• �g? `��' // 'LI I �, 29.0 0"-36" FILL 10YR 8/2 1504 EAST 31 st STREET
o�0 /� ON / ��^� �^ ` ` // Fk/S H \ I 8 J 36"-120" C CLEAN FINE PERC
BRYAN, TX. 77802
_b I / , /\ 2 / \Gj IV / SyFO17 G ( p� �`� SAND 2.5Y 7/4 NO ELEV. 27.0
40 / 5 �� �<y/ �Fri \` �1 �� v ��,� ti �, PROJECT:
��`� o ;Sr�N�S�tic �� _ J y� _ \ DEEP OBSERVATION HOLE #4 (elev.31 .3)
%8 1 28.8 0"-30" FILL ,oYR 8/2 SEWAGE DISPOSAL SYSTEM UPGRADE DESIGN i
0 0� \ 21.3 30"-120" C CLEAN FINE
2.5Y 7/4 NO
EXISTING
DRIVE I SAND 80 KEARSARGE AVENUE
STONE 1
200.83' �1 6° PERCOLATION RATE _ <2 MIN./INCH IN
i 1 I �► \ \\ `�s oo \ FOB �I I �0� / 59 e S 17*12'30" W �,� DEPTH TO GROUNDWATER = NONE ENCOUNTERED BARNSTABLE MASSACHUSETTS
i 1 RBI ��\ \ _y, � `- ? _ \ \ �\ �\ 1 1ti (n Nrn Zed°` II /// /�// , OBSERVATIONS BY: DONNA Z. MIORANDI, R.S. / CHRIS COSTA, P.L.S. '
a$\\ 4�1:5�\ v \ \ \\ \ \ I ti \ ge cJi"i (�/I S(��(/ jo /DE �/�/�,� TE STf�E�T DATE TESTED: MARCH 26, 2009
\ \ \ \ o, 4l �_ IS / /
17'1 '30" �0 00, \ \\ \ \\� \ \ \ 1. �?wo Ze SHEET NO.: 1 OF 1 DATE: 03 27 2009
NOTES SCALE: As Noted
PRG FILE: KEARSARCE_80_TY00
- - - - - - - - - - - - - - �- - - - - - - - - -� � `�9yc4. \ems �\ �,\ �� \ ,� m �'� `'�� era
EXISTING STONE DRIVE Z
g ° m`(11M1 �.� �,� \� 550 �8� 66� 1. THIS LOT IS NOT IN A FLOOD HAZARD ZONE DESIGN BY. DAVID FRENCH CHECKED BY. CHRISTOPHER COSTA, PLS
LEGEND - - -1 -1J 1-1 1l- - J AS SHOWN ON FIRM FLOOD INSURANCE RATE MAP.
7� ODE { AZA-01A/V EAS1 i_A1E/VT 56 2. THIS LOT IS SERVICED BY TOWN WATER. PREPARED BY.
KP9 38,3 PG /9) \ 59p 3. WATER SERVICE LINE SHALL BE LOCATED AND MARKED
EXISTING PROPOSED APPROXIMATE LOCATION ATM PARCEL ID 225-027-002
OF EXISTING WATER SERVICE METER PRIOR TO ANY EXCAVATING AND 10' MIN. SETBACK
CONTOUR ELEVATION THIS LOT SERVICED DISTANCE FROM SAID SERVICE TO THE SEPTIC SYSTEM Christopher Costa & Associates,, Inc.
BY TOWN WATER SHALL BE MAINTAINED.
50.5 50x5 SPOT GRADE 4. ALL WATER LINES SHALL BE SLEEVED WITHIN 4" PVC CIVIL ENGINEERING • LAND SURVEYING • ENVIRONMENTAL CONSULTING
PARCEL ID 225-027-001 SCH 40 PIPE FOR 10' ON EACH SIDE OF SOIL ABSORPTION SYSTEM.
TEST PIT (TP) LAYOUT PLAN 5. EXISTING SEPTIC SYSTEM IS TO BE PUMPED DRY AND DISCONNECTED. P.O. Box 128 / 465 East Falmouth Hwy. 508.548.0350 FAX
�H OF M ss „ , 508.548.6424 PHONE
❑ � CONCRETE BOUND (CB) � y'
6. GROUND ELEVATIONS ARE BASED ON AN ON THE GROUND East Falmouth MA 02536
GRAPHIC SCALE �'} ` c TOP SCHNEDER y INSTRUMENT SURVEY AND ELEVATIONS BASED ON N.G.V.D.29. DRAWING TITLE:
SPIKE (SPK) o
UTILITY POLE (UP) zo o �o so 4o eon: eo $ .3 CIVIL 7. LOT COVERAGE CALCULATION:
C STOP
No. 38540 LOT AREA = 37,470 S.F. SEPTIC UPGRADE DESIGN PLAN
OSTa yo ' RFc� EXISTING DWELLING, PORCHES, DECKS & SHED = 2,320 S.F. ( 6.2% )
LIGHT 31305 ROE PROPOSED ADDITION = 1,001 S.F. ( 2.7% )
►� WATER GATE (WG) ( IN FEET ) " y�Zd TOTAL LOT COVERAGE = 3,321 S.F. ( 8.9% )
4S 1 inch = 20 rt. ^r .�r - jh ASSESSORS INFORMATION: PARCEL ID. 225 / 021
SiO IP MATCD CC[�\/I(`� �WCl