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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION_
Map o��y. wr Parcel ' 4 �'t Q Y . Application �c3
Health Division Date Issued co, CEO
Cib
Conservation Division Q 407 Application Fee '
Planning Dept. t `
' My Permit Fee,
Date Definitive Plan Approved by Planning Board
Historic- OKH Preservation/Hyannis
'rProjectrStre Addre s S(o l—Pti�Lf.�l�£w OtL�y
Ownb—rlSic mcuEA d se s ..r:S Pr�►� Are i�$o�n
Telepho e
Permit-Request C
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
tProject Valuation--1o,aop Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family U6--' Two Family ❑ Multi-Family(# units)
Age of Existing Structure V1 yr. Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: &fu'll ❑ 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 Rik',
County
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑ Other '
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/ oal st o: es ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: 0,:. :xisting�] nPw 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
r " v Q)�1 C NT INFORMATION
(BUILDER O OMEOWNE
Name S �'Ec-> Qr• VHQ.Ik. Telephone Number '36�•�W
Address LA1,M%(kW t& License#
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
i �y van S�rf�
SIGNATURE DATES
1,
j FOR OFFICIAL USE ONLY
APPLIQATION#
v DATE ISSUED
MAP/PARCEL N0.
" .-ADDRESS _ VILLAGE `
OWNER .
. DATE OF INSPECTION: '
FOUNDATION 5o W5 oK- 7��T
FRAME ¢
INSULATION ,
FIREPLACE
.'ELECTRICAL: ROUGH -FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH - FINAL
FINAL BUILDING
t
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111 .
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le dbl
v
N37]78_(BustnesslOrganization/Individual): ,
Address_� L PrYAyt C%,4 b es i,re- C iIL
City/Sate/Zip,-,,GfkT-r-& Phone.#:
Ar e-you a employer? Check the appropriate bons Type of project(required):
4. I am a general contractor and I
1.❑ I am a employer with 6. ❑New construction
employees(full and/or part-time).
# have hired the sub-contractors
❑ listed on the attached sheet 7_. ❑Remodeling
2. I am a'sole proprietor or partner-
ship and have no employees These sub-contractors have g- Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers'comp.insurance comp.insurance.#
}-r i c 5. We are a corporation and its 10.�Electrical repairs or additions
_ uied
] officers have exercised their ILL]Plumbing repairs or additions
KEW,am a homeowner doing all work
�""" •• ~L right of exemption per MGL
yself [No worke?-_�'—Zol
m7.. 12.❑Roofrepans
any ere c. 152, §1(4),and we have no
quired13V9=Other s
'� employees. [No workers' �,��,�, - -
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-contractum 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,is 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 maybe forwarded to the Office of
vest ations of the DIA for insurance coverage verification.
7do,,Iere-by eerti ains-a d enalties of perjury that the information provided above is true and correct:
Si ;) s —
Phone# J v J So��
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 hue,
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 representative's 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`shill not because ofsucl employment be deemed to be an employer."
MGL chapter 152, §25C(6).also states that"every state or local'licensing agency shall vtithhold,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 with 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),addresses)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
s 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 Towu 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 trust 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 hike 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. #617-727-490.0 ext 4.06 or 1-977-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass..gov/dia
Town of Barnstable
�ppIKE Tp��
Regulatory Services
saxxszeat E, ; Thomas F. Geiler,Director
MASS.
9q,,, 16,9• p.�� Building Division
TfD � Tom Perry,)3uilding Commissioner
200 Main Street, Hyannis, MA 02601
www.tow n.b a r n s t a b l e.m a.u s
Office: 508-862-4038 Fax: 508-790-6230
HON1EOWNIER LICENSE EXEMPTION
Please Print
DATE. A�.
JO�TION;-� UL.L g
number street village
"HOMEOWNER": S�.�t J y�nft. S11 P 36Za 393 Syl; 361 000
name home phone# work phone#
CURRENT MAM NG-ADDRESS: S
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 .
re ents.
Signature of Homeowners -
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will'be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
t
aFIKE, Town of Barnstable
Regulatory Services
BAMSTABLE' Thomas F.Geiler,Director
9 � ,
t6 0
i9
AlF059. 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,Owne Must:* ,
Complete and Sign This Section
-if UsirigA''Builder�-._'" r,
f
I , as Owner of the,subject property
r~
hereby authorize r� to act on my behalf,
in all matters relative to work authorized bythis building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is ap---- g for permit please compete the Homeowners License
Exemption Florin n the reverse side.
rl-Pr1R AAQ•r)VJMPR PFR MIQSTON
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map V LA Parcel 0U:::� Application
Health Division Date Issued Z-•
Conservation Division Application Fee
Planning Dept. Permit Fee 30(0
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address ltlb 1.-'NV�-:-\1\eUJ
Village
Owner w,&,\-k pALA Address 56
Telephone
Permit Request
Square feet: 1 st floor: existing Z\o14proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Cam,4CY-'�o Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family iZ Two Family ❑ Multi-Family(# units)
Age of Existing Structure \CIM0 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: 'gull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Z\(21lA
Number of Baths: Full: existing 4S new Half: existing Z new
Number of Bedrooms: L\ "S existing _new
Total Room Count (not including baths): existing O_new First Floor Room Count
Heat Type aZes
I: ❑ Gas A iI ❑ Electric ❑ Other -
Central Air: ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑3xisting ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage:V existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: --�
I=e ,
o---a N
<1
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
r Commercial ❑Yes ❑ No If yes, site plan review#
70
_ _Current Use --__ -. Proposed-Use
�a
APPLICANT INFORMATION y
(BUILDER OR HOMEOWNER)
Name M \C\'rNy--1— zq Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE ),U—, Liz-
FOR OFFICIAL USE ONLY
A�PLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME S Z
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING D 3/)1
DATE CLOSED OUT
ASSOCIATION PLAN NO.
lite rruzmomve of Massachuset
• Deparfinenf ofIncstrialccidem
Office ofFicvesdgadarzs
= -600#rashhttt n Street=
Briton,MA 021-U
wtmnzass gavldia '
Workers' Compensation Fnsunnee Aff davit B Ijders(C
Appficaat Informifaon antractorslII ciecfr� lPjIImbers
Name Please PrmtLe-ly
'Address: •"�' �� � -'� •- .: •
Are you a
. Check the apprap -de bay Z. .
1•❑.I a -4. ❑ I am a general Mml racl-or and I Type of pi aject(requiz ed);
(fall and/or park timIel. have hued fm gub=cmtt.. fi �=Cdemg
onstracdcm2I am a'sole givpretor or padnar- listed CM�M_attached sheet' 7. .
ship and have no employees - These sub•-contractts have8. ❑Demolition
wmlmg for me in-any capacity, =#0Yee9-and have worllams'
[N°worker' comp.ms�ce cQmp...#MMMnce.$' 9• ❑ mgaddifion
�qr d j 5. ❑ We area cm-Pbiadon and ifE 10.❑Electrical repairs Cr ad ores
3.❑ Tama homeoW'=-doing in-work officer;have==deed their 11❑pig repairs.or adaffiM mysedf [No worker,' cep• right of exemption per MGL
ill�req[jjMjj t .-- -a- 152, §1(4), and we have no
employees. (No workers' 13. Other Si0\A�CT
comp.>nsarmce required]
Any aPPH-at that cheeks bes#1=mt also f Il out&e s=C=brbw wh g c,mpm,,fi,,Pricy iuftsmafion
Hmmowners who snharit fhis afndm it indices fhb am
*Coatraofnrs that check(his boxmai�aftached sa addiiiaaal sbd aII work and ihen hire outside c.to,c -mast submit anew affidavitmdic�g mcb
= l ff showing fhe name of the sub---M&Mlnm and state whether ornot these enfifirs have
sir coahactns have®PY-,f-9 ffirst.wmdb their workers cow poHcyn=3ber.
I am an employer that is proNirfmg(porkers'cotnpensatian insurance far my employees. BeIoH,is the pokey and fob site
• insurance C
ampany Name'
Policy#ar Self ins.Ian. -----------------
#k
Job Si•tt:A.ddress:
Attarh a copy of fhe Trarkere c ensation P oli •
CI
°� cy declai titian gage'(shawrag
Fa the P�9 n�ber and eapirafia'n date}.��e to•secnre co verage as regt>i�d ceder Seefion25A ofMCrI,c. 152 can lead to$be o ' '
foe tip to $1,500.00 and/or 6n =U=MI4eII mmP sttlan of crir�nal penaiies of"a
Of up to $250.00 a day aga>aor. Be advised that a Penalties in the fiarm of a STOP WORK ORDER and a foe
?nve of DIAcoveLacolyy of this statement may be forwarded to fhe Office of
Ida hereby certify under thpenah%PZ a,f'pm7uy that the irsfar=tzan provided above is(rue alid camecl;
_ JUJkjR_: ,Z
Phone
affzcial.use arrly. Donut write ire this areg fo be camplefed by crty ar.lawn o�"zct¢[
City or Town: Petmrtll�icense# .
l srfittg AAufharity�BD
I.Board of$ealtlipartment 3.CSig(TOwn Clerk 4.IlectricaI Inspecta2. 5•PlBmh'
6. Other . mg Inspector
Contact Person: Phone#: -
t
e •
Office of Consumer Affairs and usiness Regulation
10 Park Plaza- Suite 5170,
Boston, Massachusetts 02116
Home Improvement Co .tncctor Registration
i Registration: 165291
i M �• ; Type: Private Corporation
t j Expiration: 1/27/2014 Tr# 220620
,TRADEMARK PROFESSIONALS
MICHAEL BAKER ;j
78 BRIDLE PATH
MARSTONS MILLS,MA 02648 r° /
Update Address and return card.Mark reason for change.
Address [� Renewal F, Employment Lost Card
DPS•CA1 0 5OM•04/04•G701216
P r -
��e lOomnzoreu�ea�// a� ac6cugell2 License or registration valid for individul use only
Office o Consumer Affairs&B siness Regulation g Y
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: a�,.,165291 -Type: Office of Consumer Affairs and Business Regulation
Expiration: �1127/2014 Private Corporation
10 Park Plaza-Suite 5170
Boston,MA 02116
T EMARK PROE$SIp�tALS� y,
MICHAEL BAKER
78 BRIDLE PATH ( y ;;
r-
MARSTONS MILLS,M,�026 ` Undersecretary Not valid without signature
`lassarbusetts'- Department of Public SafetN
Board of Buildin- Regulations and Standards
I Construction Supervisor License.Irri
ice W'Cr"93325 .•. ,..
MICHAEL B BAKER P _
78 BRIDLE PATH
MARSTONS M►LLS, MA 02648 _
Expiration: &6/2013
<'u�runi.wiuner Tr#: 2595 ,
n 121211:29a •TradeNlark Professionals 508-681-8477 P.1
• TO"-.�f Ba�►stable
Regulatory Services
Geller Director
t Thomas�'.
• ,,.� Bailding Division .
Tom Perry,Suildmg Commissioner
2W Main Street,Hyannis,M.A 02601
www.towu.batnstable,MLUS
Office:. 508-862-4038 , Fax: 509-790-6230
Property Owner Must
Complete acid Sip This Section
If Usi=A.Builder
1, as Owner of the subjectptoperty .
hereby authorize 1C,��CCC �.-- � C ' to act on my bebz.
in aR n attm seladve tD work authorzed by this busing permit
(Address of job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not-to be filled before fence is iastiaed and pools are-not to be •
utilized until all fma inspections are perfotme and accepted.
Signature of Owner Si of Applicant-
- �,�b�r�� ._ ��\�a� • . .t � .Y-� . . - •
�' t 1�T3tne Pint m=.e_
pia
Date
Q•FORM5:0'01AiER_pIItMI5St02dPC?�LS � ,
h
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map < Para%I ®t Permit#
Health Division O " )a6cq OF S ARPISS / Date Issued
Conservation Division / , T � � � � Application Fee
yk
Tx Collector Permit
Tax C e t Fee
Treasurer ""------
i, 11t71'd SEPTIC SYSTEM MUST BE
Planning Dept. W-STALLED IN COMPLIANCE
Date Definitive Plan Approved by Planning Board VIIITh TITLE 5
21MYRZONMENTAL CODE ANIV
Historic-OKH Preservation/Hyannis TWUN REGUL T ION1
Project Street Address
Village CE-0-11-1Z VILL E-
Owner � �`' L AddressE.�
Telephone �� f ° .'"® R_3
Permit Request K l-t S 15- (5WWt)A F__0 �£L 1 b- W k-a-0 ,l m
Square feet: 1 st floor: existin `�� roposed 2nd floor: existing s_. proposed Total new
Zoning District �`� Flood Plain U 6 Groundwater Overlay k
Project Valuations Construction Type l`0I
Lot Size I , q C Grandfathered: ❑Yes Ono If yes, attach supporting documentation.
Dwelling Type: Single Family Or'- Two Family ❑ Multi-Family(#units)
Age of Existing Structure_ I�A Historic House: ❑Yes AtNo On Old King's Highway: ❑Yes KNo
Basement Type: 14 Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) lQ/A. 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 ~r First Floor Room Count 7
Heat Type and Fuel: .❑Gas E POS1 ❑ Electric '❑Other
Central Air: As ❑ No . Fireplaces: Existing `Z— New -- _ Existing wood/coal stove: ❑Yes 9T.No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size ' Barn:❑existing ❑new size �—
Attached garage:,kLexisting 0 new size �_ Shed: ❑existing ❑new size -- Other:
Zoning Board of Appeals Authorization ❑ Appeal# 01A Recorded❑
Commercial ❑Yes U No If yes, site plan review#
Current Use off _ (xl, Proposed Use �-
BUILDER INFORMATION
Name lr� �l L �`W � ,1 Telephone Number LL 4
Address Or License# =
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN
t�_SI_GNAT0RE- fb-ATE 3'2-"-k
t I FOR OFFICIAL USE ONLY
I r PERMIT NO. t. !
y DATE ISSUED
MAP/PARCEL NO.
ADDRESS" A .VILLAGE "
OWNER - 4 � t1 ., . • .. . ' •* _ . � -.
DATE OF INSPECTION:
FOUNDATION
a
FRAME
INSULATIONS
J f
i FIREPLACE
ELECTRICAL: -ROUGH FINAL '
PLUMBING: -,zROUGH FINAL '
GAS: ROUGH • ' FINAC''
FINAL BUILDING
,i DATE'CLOSED OUT
,y, ASSOCIATION PLAN_ NO. j
i
The Commonwealth of Massachusetts
- - Department of Industrial Accidents {
— _
Me Ol/flYBSUffsaolls
- -
=A , 600 Washington Street
Boston,Mass.,' 02111
Workers, compensation Insurance Affidavit
tG2„off
'L hone# G
I am a homeowner performing all work myself.
I am a sole proprietor and have no one works in ca acity
a sol/l e vrcvrieet or//%///////////////////%////%//////%/////%//%///%%/////%////////////////%////%//%%///%/%%/%/%/%%%//%%/%%//%/%/////%//%//%//////////%%/%D/%%//%%%%%%%%/�//i///%/r.'
1 am an employer providin :. :....:?..:: : .n:..:..Y...:e'm: .p..;l;°YEgworkers w..;.oig on this job>:.;>::.;>:::.>:::>;»»::::;::::<::;>:::::>:<::<::>:»::::>
v nam
:...:.::::.:..
......
address'
;:..
hone
I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who
has e
-
the following work compensation.............::..::.polices:::::::::..:;.:::::::.::.:�<:?.:::::::..:::.:.:::::::::::.;::::::::::::::.:;:.:::::::::.::::............. ::..::._::..:.......:...::::...:.::::::::::::.::::::.-::::..::.__.;;..:
tom a7' name: ".:.......:,:....?::.:
. ..... :.: .:. . ....
-+ti'-f*:4F...;Ar..::+�!!n�tit?M;+Y..•.1<./.Yv:::::�i.:...,.::..:.: ..,
city '
kti�nranceco:..: �:.
c anv.naru
a�
ftn cup to Jim
prmaldes
i r 110De� �
L7tP.:
a fine uP to
Fai]Dre to trctae coverate as regnlrrd�denaities in the f t7n of a Sr P ORK ORDER u�id a Hot f
ofa510 00 a day against me- midentmd t1-t 1.
one ymn tmprlsonment as nrIl as dull p
copy of thu statrrnent may be forwarded to the OfYlce of Investigation o[t}u DIA for coverage veriticstion
1 do herehy certify under the pains and nalties ojperjury that the information provided above is trw and carted
rDa e J 3-V-k7d
ShIE
,.�.J Phone#
omc ai use only do not write in this area to be completed by city or town official
perrdtlllcene# ❑Bu!7ding DepscTtn`°t
City or town: ❑Ilcensing Board
❑5dectmrn'i Office.
[i check if imrncaude rcporse is regnired ❑Heslth Depc-cola
phone ii; ❑Other f_
contact penon:
•1 1
Txhle 15.7.1fl(cantCaiccd] gated�ltb T<* fI F'urli
p ��p fxye pxcksga far dita$AdSUb'I rrwFuaity#�aideatiil gAiidialp
11 MrnXM 'X Wnslcooling
14'1AX M Wdl Roar ? pcw I:qu3Pmmt icimc}a
1 r dladng Glaxin8 de{ling �t A yXli1C� r
' Azti!(y�y lr.valu� Ft-vxlu� R•� 1;.�yalunr • R•�a0
• y�3o 5701 to 6500 Hacking n�17x� 6 Nann.at
13 19 10 6 N13
lxil� Or40 38 19 19 10 6 1S 1►1"UE
Q 121/8 0.i2 30 13 t4 10 Narrnal
A 1V/. 0r50 31 NIA 6 Normal
. I3 '
15rfi 0.36 33 19 19 10 15 AM
T 15*/. 0.46 38 S3 y NIA NIA 15 AFt1E
Y15'/4 o.44 � 19 19 10 tI(A Nocrnal
1114 0 1i N/A rlarmal
13
W ta`!. 0.32 31 19 3S NIA NIA on AFLM
Y19/-L 0,42 31 13 19
0.42
x j0 6 S !►FETE
18'!. 19 Ig 10
d
s0
VX
• s
1, ADDRE5S OF MOFERTY'. y
VARE FOOTAGE OF ALL EXTERM WALLS: a
sQ F i --•—
3. SQUARE FOOTAGE OF ALL GLAZING:
Q AREA(P DNIDED BY K)
rl
�. °�c GLAZIN
51 SELECT PACKAGE(4�` 'see chart abova}:
RMOREyOL'YED METHODS OF DETE
G MRGY REQUIREMENTS
O- ; OTHE
ARE AYA�ABLE. A5K t1S FOR THIS YNFO
. B�,DING IrISP�CTOR APPROVA.L.
N0 YES,
q•focros•�$0303a
Town of Barnstable
o�,•Ctrs io�y • .
o� Regulatory Servides
r
Thamas F.Geiler,Director
a S& Building Division.
'°lEa Mph TomJ?erry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax: 508-790-6230
Office. 508-862-4038 '
' p ermit no. •
Data
VF
CIDAYIT
�SUFFTB-kCT OR�,E�E IY RHT TO PERMI'.0 A CA''ONw
1�IA requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
MGL c. re-existing owner-occupied
•improvement,removal,demolition,or construction o£an addition to any p
GO at least one but not more than ontract zswith ertain ex ptions,along other nt to
bail g ba done by registered
such residence or building
requirements. 000
Estimated Cost
Type of -------------
q�ork:
Address of Work ,
Owner's Name;
Date of Application:
I hereby certify that:
aired for the following reason(s):
gegistration is not required ,
[]Work excluded by law '
[]lob Under$1,000 ,
C]Building not owner-occupied
9Owner pulling own permit
Notice is hereby given that: PE
OWN BM�T OR DEALING WITH UNREGISTERED
OWNERS p-r LLNG TEMIR
CTORS FOR AYPLTCABI�E HONK I11 PRO GRAM 0'IPR GUARANTY FM DER IVIGL
S 1�2A.
CONT TITRATION
ACCF, 5 TO THE ARB •_ • ,
SIGNED UNDER PENALTIES OF PERJURY
Thereby applyfor apermit as the agept of the owner:
Contractor Name
• Registradonhio. ,e
Date
OR
T
Owner's Name `j
�FTME Tp Town of Barnstable
Regulatory Services
sAMSTABLE, : Thomas F.Geiler,Director ,
y MASS.
039• Building Division
TFD MA't s
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: Z � °� r n
JOB LOCATION: g, A-a!11�� �R 0—u-)f fe V/L LL
number c street village
c^ ,
"HOMEOWNER": - -I �tzL of 34�,Z o N ?
name ^7 r home phone# work phone#
CURRENT MAILING ADDRESS: `J (U C1k&e,,V L E 0
city/town state b, 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
requirement - J�
Sr re o Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section.127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns..You may care t amend and adopt such a form/certification for use in your community.
Q:fomrs:homeexempt
11
_ r •
Daniel L Braman,PE
189 Harbor Point Road
Curnmaquid,MA 02637-0361
Phone(508)362-6016 r
. r
May 21, 2005
Project: 14505
Steven Mele Residence ��,sa�®�
56 Lakeview Drive �r ` OF
Centerville, MA 02632 DANIEL E.f4��
BRAMAN
4 a STRUCTURAL
NO 305
For: Kevin Werner a
CADZooks ``''lion&E '
10 Seaboard Lane D
Hyannis, MA 02601 —
•(508) 775-6631
EVALUATION OF STRUCTURAL INTEGRITY OF
VAULTED CEILINGS WITH COLLAR TIES
On this date I evaluated a drawing covering a new vaulted ceiling for the above
residence.
Roof slope is 8 in 12.This is greater than 3 in 12,therefore a minimum of 1x6 collar
ties are required, 48" o.c. (rafters are 24" o.c.) The proposed 3/4" plywood gusset is
satisfactory to be used.
This is in accordance with the MASS State Building Code 3608.2.3.2.
I find that the new roof structure (2x10 rafters @ 24" o.c., 3/4" gusset at the peak of
the original trusss, and 2x8 @ 24" o.c. ceiling joists, are sufficiently strong to
support all expected imposed loads.
In addition, place double 2x8 ceiling joists at the gable to strengthen the gable.
Steven Mele
� 3/41Uplywood
56 Lakevie.w Dr
gusset Centerville, Ma.
02632
2x10 Rafter
Double 2' 2x8 Collartie
thru bolts
8 . '1 Z
" ply /
4' laminated Nailing
plate
Existin Slider
22'
21'
1
existing House
25' -
•
y
e,
•
x } 5�
Steven Mele t
56 Lakeview Drive
Centerville, Ma: 02632
.,+..... ,c'nit_'^.r.r.» -• .,.R.' ,:.wg.r�wrr..,.yC '4 .:�'.e"m Y
Assessor's office(1 st Floor): r� 1/ he,
Assessor's map and lot number .7 ai YSE toy
Board of Health(3rd floor):
Sewage Permit number
� V Z DAHa9'f4DLL i
Engineering Department(3rd floor):
House number ✓ !C1��G °o 163o.
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
T ON N OF B A R N S T A-BL E-- �'--� .
BUILDING INSPrECfT0R -
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION "rf / �'
� Clrl� �r-��� ?off' t�.� C /��PJ F
19 C16
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby-applies for a permit according to the following information: _
Location
~ 0 A) /Aix
g /
Proposed Use �s n���� /�" r`�'���c r/c/c�>✓c C� _.
Zoning District lT Fire District ���%f t r�!!���— I/ e
-.Name of Owner Address /lti A),
--Name of Builder IT/'I�/hv/'" 1;)///1Aram1 Address 0 /c!
Name of Architect ,,e: /�/,`ii�/L. _ c ewe,? Address
Number of Rooms Foundation %/,ter,->'c
Exterior V/ `��1 ti\!�/i�fr Roofing `�� �> .� �� t
Floors //., � /� T/ 1L Interior �vr� � �,r G� � �� /7/'
Heating Plumbing
Fireplace Approximate Cost
Area
..Diagram of Lot and Building with Dimensions Fee
f
.t.
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
4'
1 r
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License '1
r
O I K, HOWARD & KAREN A-21 -0 4 8 k
1� !
#-
No. 3 3 8 8 9 Permit For Remodel & Ad.d To
Single Family Dwelling
Location 56 Lakeview Avenue
Centerville
Owner Howard & Karen Onik
w
Type of Construction Frame
Plot Lot
Permit Granted j my 31 , 19 9 C
Date of Inspection 19
Date Completed 19
a -
r
PERMIT CQMPLETEQ 1.
of
let .1
Assessor's office(1st Floor): /
E•:"11TIC'SYSTEM FRI I a
Assessor's map and lot number he",C � !tP�, pr ii ,, o*?ME ro
IiS���'�L�CL�®�4Ci�®T�a� I��1tiW l{,,aGm r
Board of Health 3rd floor): 2 Q
Sewage Permit number
MEr
Engineering Department(3rd floor): `�j.^ v � 1 0 7
House number t� �i c�., 1a o•
Definitive Plan Ap rovedd by Planning Board 19 �o��r s•
APPLICATIONS MCESM IP30-9:30 A.M.and 1:00-2:00 P.M.only
x® ° sg"$`$°n N OF -BARNSTABLE
Iced >Q$to ILDING_ INSPECTOR
APPLICATION FOR PERMIT TO !'�d-Ts a.�c/�v m e�i�/t� / yrro�Y�� `�` N�LOA)
TYPE OF CONSTRUCTION ���� �1`p�l� 7��p^ `Q 1t)e Q�
2ge 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned
hereby appli for a permit according to the following information:
Location t�� �cA _ V1 d_Lj 4 yw AFL) --
Proposed Use F c!F
Zoning District Fire District y_ i��,/j sde r�dl,�t
Name of Owner Address ✓e� ./A'S e �
Name of Builder r/hr�/ f�/a�rA /iVr Address_ zr� / l any/.-ri"
Name of Architect Address d fvr�C
Number of Rooms /V�aJ�+ Foundation�OP1alca/ afg2e_ Q �IV 1 t
Exterior �1 Roofing .6
Floors `e `/� ✓ ` Interior 4 4-4 /''
Heating D�l �� ��dlF/ Plumbing
Fireplace o Approximate Cost Ay"A m2r
Area
Diagram of Lot and Building with Dimensions Fee
7 2-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
wmz,
1
Construction Supervisor's License 0)
ONIK, HOWARD & KAREN- f
ry
No. 33889 Perm,,it For m Remodel & Add to
Single?4Flm'iILIdwelling
Location 56 Lakeview Avenue ;t
Centerville _ : r .._ .y �_ .•
Owner. /HowardQ& K ren Onik �, r
n � _
Type of Construction � Fr me r r `✓ '
Plot Lot _
Permit Granted July 3.1,, - 19 90
' r
'
Date of Inspection ll/Z 19
-
Date Completed 19 -
it
r
n 4
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(CENTERVILLE) '
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a+—jm[n[(
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CONDITIONS
PLAN
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-
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For: Steven Mele
556 Lakeview Drive
RcA.1► r. t -{VA a1. Centervillie, Ma. 02632
fw ,. .
Y
t
n;
12 3/4"" plywood
guSSet
Double 2 x 8 collar tie
thru-bolts @ < 2/3 rafter length
Skylights �Q�
t. b.d. Viable end framing to be
g 2xlo Rafter
. determined
Nailing
Plate
r,
www•
Z ,
Existing Slider
« r
We
w
• ' �' - �fit;}�N. �,;,,
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i
. . .. .�'
Steven
e Mele
56 Lakeview Drive
Centerville, Ma. 42632
F
-
J .
10 q `
WiAl
'�11 MIMI 9 .
4' STEP EXISTING DECK
3'
10 EXISTING DECK
16
Floor Plan for Steven Mele - 56 Lakeview Drive, Centerville . Ma. 02632
To: T.O.B. Conservation Commision
200 Main Street, Hyannis, Ma. 02601
Re; Building Permit for Steven Mele
�tNG OWELUNG
EX1S 1.7 51.7
EXIST• r - —_ `
45, DECK cr
EXIST V
DECK r i
t0 r *• OLD �' �r
0 STAIRS � 50.7.' l4� 4
45.2 f .
A �7 - .. D� A�0 Ark
• �' � _
4 43
42 ¢� 40
Original plan as shown on Order of Conditions
#SE3-3643 for� Steven Mele,56 Lakeview Drive, .
Centerville, Ma. 02632 dated 4/19/2000,
PROPOSED ; Repair portions of existingdeck and
eliminate a portion of= the existin deck. yr.
io� LET <a.
/ SIrP r
oCNVJ..-�
3
.....:... . .
L
.... a. - - • a • n .r a .
IRON q? `� � o:• ; —
1 PIPE
�h I / � �. �• F PARM FOIE
10.07" J OVERHEAD HOWARD ONIK
� lo I
� GARAGE ADDITION
DECK BELOW
l EL= �"•"
ROOF 91.14
OVWP
/ S
DRAINZfL ^
MAN l
OUTLETS
g CAPE N �9
f 1 UTILI /
I FLAGSTONE i S / POLE /
TIO
L 8.� � OF,y s
x.4.'PILES ) ( IPA
,0 SH ' .
1 ` �, •91.2' d Q WIDE z 9c
CONCRETE ` + 1 STOR 1 CD TOFWE y `
-XISTING RAISED• i r GSTON / A.M. 50� I P•�ouY ni 4
OODEN DECK I DECKS , I p DWELLING WALK f l N CIVIL
I C3 T.O.F.m / _ Associates � ,�No.a5&U o y
0D ^�
! \ � 91:08 �° Inc./ I
a��''
COVERED
ONCRETE
1 � �C Cb- PORCH �
(STAIRS / 911 Mdn Sleet S �z
oetelrAsAA 02655
<' 1 LL t MB-428-1450
STONE GRI GARAGE /
Q REM VED 3 WIDE
G
��• FLAGSTONE Drawing 11tie:
�
WALK 9� qs_ CB/DH� �
�) \
q 3
m \ SITE PLAN
0
6.02OPOSED
1
PROPOSED ADDITION
� � \ CB/DH B.M. EL.=86.68
v\ 40.8 64
SHED —
Scale: 1 20' :.
f
6 0 20 0 FEET
Date: 6-25-90 Dwg Na:
Oest C.P.J
Check: P.F1
CENTERVILLE ReWslona:
DATE DEICMrif0H
5/27/92 ADD WOODEN DECK
RD.
\�
`nEW A LOCUS
aoo�
PUBLIC
LANDING
PROPERTY LINES SHOWN HEREON WERE COMPILED
WEQUAQUET
FROM A PLAN RECORDED AT THE BARNSTABLE _
LAKE
COUNTY REGISTRY OF DEEDS IN PLAN BOOK 1
PAGE 53 AND DO NOT REPRESENT AN ACTUAL
SURVEY ON THE GROUND. .
SCALE: 1 2083'
LOCUS MAP References*
ELEVATIONS ARE BASED ON AN ASSUMED DATUM.
i _ _ _ _ _ _I ASSESSOR'S MAP 214 LOT 48
EXISTING ZONE RD-1
I LEACHING SETBACK REQUIREMENTS
I -
AREA Or FRONT 30'
SIDE 10'
REAR 10'
UTILITY MIN. LOT AREA - 43,560 S.F.
I POLE
Project Title:
MAP 214
LOT 49
IRON
-
czz , j �v PIPE LOT L
'4
DWELLING U E
DWELLING - � � I �,
I
a
ABB ,,NE \ \ \ �N. ( CENTERVILLE )
WELL RS PROPERN j \ \ \ \ � � o � !Z
� g48.07 I
BARNSTABLE
Q.Q°
%c MRHEAD WIRES _i. — -
UTILITY
IRON _ I POLE GRAVEL
j - , UTILITY / ROAD
PIPE _ - /.i i' - j TIUTY ., \ \
5 7,, II tJ %{ - - - - 1�__/__ ! .. ._ POLE _ � / - POLE =` r �,a Ar .
I ,� - j - , _ - �. �., .:.
J / �1 �. CATCH ; =- / ,� 73,616 SF
BASIN STONE �'
l I f I /
I 1 � � R
I10.07 r3 WALL EXISTING GAL
�J f / S T LEACHING PIT W/2' STONE -
O _ O �� PREPARED F01t
1 / GARAGE PROPOSED CONCRETE EXISTING � GAL.TANK WF�C /'
/ ADDITION 0 ETE / - ,1 / OVERHEAD
\ I / DECK BELOW WALLS _ _ �" - y \ WIRES HOWARD ONIK
EL= 1 r _ ,
ROOF � 91.14' _ � �� - - IVY
I 155 To W
DRAIN WALK 2
I OUTLETS M1NOv5 AREA. O' R
I I 1 J J l EXISTING D-BO \ - PROPOSED 60C; GAL. ' RIB
I ( 50
I LEACHING HIN G P T W/2 ONE
I�I,AIN \
( / \
\ I - / \
� 9 N CAPE 0" PINE � � r EXISTING 4�� PVC I ! �; � 11 -- .I j / B -- � / �•\ � ,
4'x 4'PILES > FLAGSTONE S
1 I PATIO T. S
EXISTING RAISEDI CONCRETE I EL, 91,2 _ / UTILITY /
S �- �" j
WOODEN DECK DECKS 1 STOR 4 WIDE D Q _ J '1 POLE
, f , ��}---- - .� / / j
f 4 ( DWELLING GSTONE "1'� ` 0PROPOSED 4
I I z T.O.F.- WALK �s
I91.08 RIB m o A.M. Wilson . , Ly
I CONCRETE J �r 81 I j / / j CO -_ Associates 0 Nu.J J�!
Q ISTAIRS p COVERED �/ , / l / _� j / i 9F � o
G •1 1 I ( ► >I PORCH CATCH / �O �x `� j i / 0_ ,�
( � t �- / i o_.� Inc. �, T�i' - �.
I I I BASIN I
STONE GRILL l ' i
Q \ /
/ � �
G REM VED 3' WIDE GARAGE ' / / / \ �.. �/ �t1 hdn stint
C� `�°P�" z�192
' FLAGSTONE � � I � / ,�' 5
TA
WALK L-�' ! rr Oelervre/Y4 Q'MSS
�I 0
/ SHED i � _ 50&-428-1450
m \ 1 POST be l ! / / / j i / a. CBi DH Drawing Title:
(f� o \ \ I\ RAIL FENCE
\ \ \ I PROPERTY LINE
,_ -6.02
-� I ` \ OPGSED 4 -_ _ - - "W ' 480.46 ' _
m \ 12-02 -30 /
\ S ,� _ SITE PLAN
ABBUTTER'S
ro \—_-- - -- - -- - - - - _ - - - --- - - - - - EXISTING WELL ADDITION
\_CB/DH B.M. EL.= 86. 68 _ '
E�TI INCG COTTAGE
0 -\\ _ --
SHE \ _ - — _ - SYS iEM SHED H of ',
7a �c r L —�_�? c ��
NOTE Z�
N, P6A
LOCATION OF EXISTING SEPTIC SYSTEMS .�
AND WELL ARE APPROXIMATE BASED ON ,
DISCUSSION WITH HOMEOWNER S4N1,
Scale: 1 20'
MAP 214 -
LOT 47 - - - - - - - - - - : 0 20 40 50 FEET
EXISTING
SEPTIC Data 6-25-90 Dwg No:
I SYSTEM _
, I
Deal : C.P.J -
Check: P.RF
EXISTING HORSE Drawn: J.V.B.
Job No: 2.0495.0 Sheet 1 of 2