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HomeMy WebLinkAbout0205 LONG BEACH ROAD ate= �y���.-v ���� `�� ., ., �. .. � � . . y 7 . � :� � ��� �, z o ., _ v .. r � � ...� ._ c . _ ., . o � � � � - a _ . � .� x _ :. - .. . �.. - ,�` t _ FLr ., » .. , .. _ ,- t, F � - - ' .. ..'� F. ': ..: M1 .. :- r C•�, x }; �,. '. .�...� � ,.,�wr_s,..:,,�,,.k....c-.. .:...��anr�� ..�;re. -..r,�:<wk:m..,�e...w,....._,�........_.v.,:.,,-.�_w.....v,a,.,,�...v,<.,.��- .,aw,.,.,�:i .. ��...,.r ,.� .���»..m. ,�.z-�,..� ���. - C ifJ-' ICJ i OFTHE T� Town of Barnstable *Permit# Etpires 6 months fro issue date Regulatory Services Fee — • BARN611Asr e v 6 Thomas F. Geiler,Director pTED MP'1 A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601' : www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ZNot Valid without Red X-Press Imprint Map/parcel �Numberfib ��� —✓ Property Address &n 4ef'z/,^( ' ,,Residential Value of Work UUV 1 Minimum fee of S35.0.0 for work under S6000.00 Owner's Name&Address S S l Contractor's Name tj A f� Y {/' �(A/1��� Telephone Number Home Improvement Contractor License#.(if applicable) Construction Supervisor's License#(if applicable) 00 3oZZ-P "ESS PERMIT Workman's Compensation Insurance Check one. OCT 18 2013 ❑ I am a sole proprietor ❑ I am the Homeowner ( I have Worker's Compensation Insurance TOWN OF BARNS+TABLE Insurance Company Name` / ►/"U r �Q I N : Workman's Comp.Policy# QVS3 90 l 3 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) XRe-roof(stripping old shingles) All construction debris will be taken to fia 0 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Wind ows/doors/sIiders..U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance.with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property.Owner Letter of Permission. " A copy of the Home Improvement Contractors License & Construction Supervisors License is required. ro ► r SIGNATURE: "I 3 QAWPFILES\FORMS\building permit!formslEXPRESS.doc Revised 0701 I0 A�CORO® DATE IMMIDDIYYYY) \6r�� CERTIFICATE OF LIABILITY INSURANCE DA09/19/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TACT Erica H O'Connor E, HART INSURANCE AGENCY,INC. PHONE 243 MAIN STREET 508-759-7326 x205 Fac Ne:508-759-7366 PO BOX 700 ADDRESS: BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE NAIC q R INSURER,: ARBELLA PROTECTION INS CO 41360 48 Rosary L INSURED EJ Rosary e Lane Builder,Inc INSURER 1: ARBELLA INDEMNITY INSURANCE COMPANY 10017 Hyannis,MA 02601 INSURER C: INSURER 0: INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILA TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY E%P POLICY NUMBER MMIDOM F MMIDOM(YY LIMITS A GENERAL LIABILITY 8500042039 01/01/2013 01/01/2014 EACH OCCURRENCE $ 1,000,00 COMMERCIAL GENERAL LIABILITY DREMI ESrou enc $ 300,00 —AVA—arTO—RENTED ClA1MS-MADE OCCUR - MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,004 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER:- PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY PRO LOC B AUTOMOBILE LIABILITY 1020011547 COMBINED SIN LE LIMIT $01/01/2013 01/01/2014 eacade 1,000,00 ANY AUTO BODILY INJURY(Per person) $ AUTOS AUTOSALL OWNED ULED B001LY INJURY(Per accident) '$ HIRED AUTOS NON-OWNED, AUTOS Par accident $ A UMBRELLALIAB OCCUR. 4600042040 $ 01/01/2013 01/01/2014 EACHOCCURRENCE $ 2,000,0 EXCESS LIAR --HCLAIMS-MADE OED RETENTION$10,000 AGGREGATE $ 2,000,00 B WORKERS COMPENSATION 0053890113 .01/01/2013 01/01/2014 WCSTATU-AND EMPLOYERS'LIABILITY YIN - ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? - NIA E.L.EACH ACCIDENT $ 500,0 (Mandatory In NH) ' If yes,descAbe under E.L.DISEASE-EA EMPLOYEE S 500.0 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,0 O DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 1e1,Addhlonal Remarks Schedule,If more space is mqulred) CERTIFICATE HOLDER CANCELLATION Fax#:(508)852-4717 TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 230 SOUTH STREET ACCORDANCE WITH THE POLICY PROVISIONS. . HYANNIS,MA 02601 ' AUTHORIZED REPRESENTq/��///' . a l' ID 1988-2010 ACORD CORPORATION. All rights reserve . ACORD 26(2010105) The ACORD name and 1990 are registered marks of ACORD J s s • fARN3fABLE, • '"" S. 1e39. Town of Barnstable .� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 90be/0 1'' 1 �,Q,S ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: A0 6 �� C�n�crv�rl (Addr ss of Job) /0 / LI 3 Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 wk ;�°�� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): c l h Ci Address: 11�sa1 �.rrG(�Q.' City/State/Zip: & I / Phone.#: C��) rI r72 4g Are you an employer?Check the appropriate box: Type of project(required): 1. employer w I am a em to with /�� 4. ❑ I am a general contractor and I p y 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors .2:❑ I am a sole proprietor or partner listed on the attached sheet. 7...❑Remodeling 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.$ required.] 5. ❑ We are a corporation and its -10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself [N o workers'comp. right of exemption per MGL y p 12�oof repairs req uired.]uired.] t c. 152,§1(4),and we have no q 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: A4 G Policy#or Self-ins. Lic.M Q S 3 0_1 13 Expiration Date: 1 l Job Site Address: a City/State/Zip: e !// I1-e d 26-za— 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the n enalties of perjury that the information provided above is true and correct. Signature: Date: 10 K 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#: 91te &mmoww�,aN Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contract or Registration Registration: 110609 Type: Private Corporation Expiration: 11/3/2014 Tr# 233027 . E J JAXTIMER, BUILDER, INC. -- ERNEST JAXTIMER - > 48 ROSARY LN w HYANNIS, MA 02601 f Update Address and return card.Mark reason for change. Address 0 Renewal Employment ❑ Lost Card JPS-CA1 0 5OM-04/04-G101216 ✓fie Sumer Affairs& °P✓�s Regulation a License or registration valid for individul use only Office of Consumer Affairs&Business Regulahou g Y (�HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: lit Registration: Type: Office of Consumer Affairs and Business Regulation I,1`I 9• .�1,10609 YP Expiration un/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 E,JJ TIMER,BUILDER NC 4 T) ' ERNEST JAXTIMER r I y 48 ROSARY LN M g HYANNIS,MA 02601:*;`-p Undersecretary Not valid without signature 1 9 Massachusetts Department of Public Safety �-- Board of Building Regulations and Standards Construction superlisur J License: CS-003251 ERNEST J JAXTIMER !p 48 ROSARY Z1ANE '„ f HYANNIS MA 02601 i a- ^•`•.`,�` Expiration ' Commissioner 01/14/2014 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ..i f I Flap c � Parcel [Z _ Permit# I ` O Health Division '/6�0)- )d0 9—0 3? Date Issued �'/6 e� s3.�9a1 RQV P1- 4409/02 - Conservation Division a . Application Fee Tax Collector Permit Fee Treasurer SEPTIC SYSTEM M T EE Planning Dept. INST��TH TITLE D IN �pNCE NVIRO NENTAL CODE AND Date Definitive Plan Approved by Planning Board ETOVVN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 4� G Village i Owner Address Telephone . Al2o— 9 o Permit Request gcC , f= °7a? — — $' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain /Groundwater Overlay Project Valuation v Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 0-' Two Family ❑ Multi-Family(#units) Age of Existing Structure ,� Historic House: El Yes Qd o On Old King's Highway: O Yes �t 11110 .t Basement Type: 2 Full 4 rawl ❑Walkout ❑Other s Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 'I Number of Baths: Full: existing / new Half: existing ew �p Number of Bedrooms: existing 3 new c, Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: OGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes V'No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Cl existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes NQ If yes, site plan review# Current Use &51 p w1w Proposed Use BUILDER INFORMATION / Name e =� f Telephone Number �5�LJ� 9 Address 1 U�n /= 'T� License# !f 0 _' �!��'�.��, / oL/r/ Home Improvement Contractor'# Worker's Compensation# (� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO .�14 r i SIGNATURE DATE :51T2 Al "L FOR OFFICIAL USE ONLY PERMIT NO. 1 t' DATE ISSUED M4P/PARCEL NO. 7lDDRESS f VILLAGE E� OWN1ER DATE OF INSPECTION: 021 FOUNDATION `r FRAME w a • INSULATION 1 i ,• FIREPLACE v J ELECTRICAL:� ROUGH- p FINAL ` PLUMBING: ROUGH; f, FINAL 4i i GAS: ROUGH " FINAL FINAL BUILDING + i �-'► i i ' 0. 0 DATE..CLOSED'OUT , ASSOCIATION PLAN NO. I1 t - .i °FTHE Tp Town of Barnstable Regulatory Services * B^aNSTnsrE, * Thomas F.Geiler,Director ; 9 MAS3. � �... , 1 39. .�A`` Building Division Tom Perry,Building Commissioner ' 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW I 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: Estimated Cost 4 0 C) Address of Work: ,� /o C/�� /�01� r 'z' Owner's Name: In C,let P Date of Application: 0 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Dad Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav The Commonwealth of Massachusetts - Department of Industrial Accidents Office ofinyestigations . 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit i name: 1 / ) location citv phone �_ D ❑ I am a ho eowner performing all work myself.I am a sole proprietor an have no one capacity '///❑//%%/%%%/%%% %%//%%%%% n%%%/%%%%%%%%%/%/%//%%%/%%/O/%%%%%%%%/%%%/%%%%%%�%%%%%%�/%%�%%%%%%/�%////%%%% I am an employer providing workers'c mpensation for my employees working on this job. ..,; :.: Coln any: : iddi t ss . ...:.._............ . : . .::. ;. .. _. . ........ .................:::::::::::::::::::::........... ci ":... .. .:. . :. . .. . ......:... ..... . hone#. ....::: .. .:.:::.. :.;;:.: .;.:;:.... I am a sole proprietor eneral contras or r homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: < ya %yiii2i E''��'i i %'asii >`?i > iiii>iti5 '><ii2ititi?2%+iii2iiE<iiiii' ' y a r y_ � iirance c :::::::....::.:::.1//%G/%%%/i. ? . ` .2G� ': ';< '> 2; ;`;; 2 ' t< $;.............. ; 2 is ; Y t2<' ?;` '.'• ? �'': address. .............. X. nsnrance:co:::<:::><::<:::;: <<;>.;X. <:::.::;:: .::•::::.:.•.::::. Failure to secure coverage as required ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi the pains and enalties of perjury that the information provided above is true and correct c � Signature Date z Print name I t/�/ �T l-5`I✓9� �'S Phone# official use only do not write in this area to be completed by city or town officlal city or town: permit/license# ❑Building Department ❑Licensing Board 04 ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) Information and Instructions Massachusetts General.Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a . dwelling house having not more than three apartments and who resides 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill-out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pmit/license number which will be used as a reference number. The affidavits may be ret<uimed tr the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me 01 Investigatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 RESIDENTIAL: SHEDS - POOLS -DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $ >750 if- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ � (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ Q:forms:dkcost eff:082301 I �� ✓lie �airvrraoruueaCC� c�/l/la:�aac�uae�d - ' Board of Building j Regulations and Standards License or registration valid for individul use only _ • — HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 125460 Board of Building Regulations and Standards Expiration: 12/22/03 One Ashburton Place Rm 1301 Type: DBA Boston,Ma.02108 STEPEHN J. GIATRELIS,.BUILDE JTEPHEN GIATRELIS 106 CAPE DR _ MASHPEE, MA 02649 � � v Administrator --------- Not valid without signature ✓/. eoarrvrrcoouvea` /(p�aacfual 6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number..CS O49915 T Birthdate::i07/21/1962 E Exp►res:,07/21/2002 Tr,no: 378 Restricted To 1[G STEPHEN J GIATRELIS 106 CAPE DR MASHPEE, MA 02649 Administrator , N O N O 9L t N N S ti 5 1/2" MAI40G. TOP 4 BOTTOM ~ RAILINGS o w/1x2 R.C. BALUSTERS RAILING AT MAIN DECK • 5" O.C. -- BEYOND C j m P.T. 4x4 POSTS w/NANTUCKET STYLE R.C. CAP _ i TYPICAL IL - N O • a _ p o — , N " w O C - d 5 1/2" MANOG. TOPE 50TTOM RAILINGS - w/2x2 R.G. BALUSTERS ® 5" O.G. in P.T. 4x4 P05TS WRAP uw/1x CEDAR w/NANTUCKET STYLE R.C. CAP TYPICAL N O PY G D IS S o G TREADS D T A E D . T E REDto DN. LL MAIN DECK b - o 72 LL TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �� Application #C� Health Division Date Issued Ul ce l l Conservation Division Application Fee Planning Dept, Permit Fee l0 Z ZCI Date Definitive Plan Approved by Planning Board - o►� Yfb�1� ftAy— Historic- OKH Preservation / Hyannis Project Street Address P Village Owner Kfi im Address 6gos- 1.67 &L . Telephone ` Permit Request / Ime ( ` Alro odo,l t Square feet: 1 st floor: existing ro osed 2nd floor: existing ro osed Total new q 9—proposed —p roposed P Zoning District Flood Plain Groundwater Overlay Project Valuation 126t OlJ()f Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No (` Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Lm Number of Bedrooms: existing —new ql Total Room Count (not including baths): existing new First Floor Room Count V Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing:wood/coaGtove"�0 Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ .Appeal # Recorded ❑ ` Commercial ❑Yes ❑ No If yes, site plan review # Cni Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) l Name �J v tG t Telephone Number d Address IT4OSClA�l,1 1.2� License# M30)1S1 1 l Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s SIGNATURE DATE 7) 2 FOR OFFICIAL USE ONLY w - APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME GZ l l K 2 t It d itlR)40_1Zj INSULATION 16)m bt FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ILA. I 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 Legibly Name (Business/Organization/Individual): r•� �/�L K/ (j�ff�� �l�/ l(�,Q� /{'�� . Address: City/State/Zip: S m/1 02&0 Phone #: (6-00 '71 P • Jf 9( / Are you an employer? eck the appropriate box: Type of project(required): 1.2 I am a employer with 20 4..❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑ 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.$ required.] 5• ❑ We area corporation and its 10.❑ Electrical repairs or additions exercised their 3.❑ I am a homeowner doing all work officers have 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.) 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: �BSA P47WROK( /& 5' C Q . Policy#or Self-ins.Lie.#: y53 11- Expiration Date: Job Site Address: ga City%State/Zip:_ 4�- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the pains and penalties of perjury that the information provided abov is true and correct, Signature: Date: 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#: I ACCPR®® CERTIFICATE OF LIABILITY INSURANCE °A03/o/2o1`11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER,THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsome s). PRODUCER NAME Erica H.O'Connor HART INSURANCE AGENCY,INC. PHONE (508)759-7326 _Ne:(508)759-7366 243 MAIN STREET PO BOX 700 ADDAIL SS: BUZZARDS BAY,MA 02532070.0 INSURE S AFFORDING COVERAGE NAIL C INSURER A: ARBELLA PROTECTION INS CO 41360 INSURED EJ Jaxtimer Builder,Inc INSURER 8: ARBELLA PROTECTION INS CO 41360 48 Rosary Lane ARBELLA PROTECTION INS CO, 41360 Hyannis,MA 02601 INSURER c INSURERD: ARBELLA INDEMNITY INSURANCE COMPANY 10017 INSURER E: . INSURER F: .COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED.NAMED.ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUER POLICY NUMBER .MOLICY EFF POLICY EXP LIMITS . LTR A GENERAL LIABILITY 850004203E 01/01/2011 01/01/2012 EACH OCCURRENCE S 1000000. DAM_A510 COMMERCIAL GENERAL LIABILITY PREM, .fEa ogw RENTED E 300000 CLAIMS-MADE OCCUR _ MED EXP(Any one person) E 5006 -PERSONAL B ADV INJURY S 1000000 GENERAL AGGREGATE S 2000NO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 20000W IrCT POLICY PRO- LOC- - _ • S g AUTORIOBILE LIABILITY2166240DO04 01/01/2011 01/01/2012 Mm ED SIN LE LIMIT 1000000 lEy ed I ANY AUTO - - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - AUTOS AUTOS BODILY INJURY(Per acciderd) E NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS - - r E FD UMBRELLALUIB OCCUR 46DO042040 01/01/2011 01/01/2D12 EACH OCCURRENCE E 2,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE S 2,000,000 DIED RETENTIONSWORKER$COMPENSAna+ 0053890111 01/01/2011 01/01/2012 WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN - ANY PROPRIETORIPARTNEWEXECUTNE _ E.L EACH ACCIDENT E 500,000 OFFICERIMEMBER EXCLUDED? .NIA (Mandatory In NN) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes desuWe r unde - - DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT E 500,060 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AftcIr.ACORD 101,AddWonal Rema*s Schedule,R more space Is requbed) - - CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE 200 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT'n . ©1988-2010 ACORD CORPORATION. All rights reserved.. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and usiness Regulation Y 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 'Home Improvement Contractor Registration Reqistration: 110609• Type: Private-Corporation - - mw Expiration: 11/3/2012 Tr# 205399 E J JAXTIMER, BUILDER, INC: ERNEST JAXTIMER iI ry 48 ROSARY LN HYANNIS, MA 02601 m y `Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CAI' s0 50M-04/04-G101216 Office o& me° ,iciness a License or registration valid for individul u_se only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 4410609 Type::. Office of Consumer Affairs and Business Regulation Expiration 1113i2012 Private Corporation' 10 Park Plaza-Suite 51,70 Boston,MA 02116 . E,.. TIMER, BUIEQERzII a i ERNEST JAXTIME'R ; s 48 ROSARY LNtF _ - a! .: HYANNIS; MA 62601`N ry U 11 ndersecretary Not valid without signature g �' Nlassac.husetts- Department of Public SatetN , i a -- Board of Building Regulations >� und.Stundards Construction,Supervisor License License: CS 3251 Restricted to: 00 • ;ERNEST J.JAXTIMER � ` _4.8 ROSARY-LANE I. HYANNIS .MA'-02601 Expiration: 1/14/2012 K Conunissiotio Tr#: 13122 I,,. r tiTown of Barnstable Regulatory Services Hs $� Thomas F. Geiler,Director t639. �w Building Division Tom Perry, Building Commissioner ..200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 t Property Owner Must; Complete and Sign-This Section If Using ABuilder I, 1 as Owner of the sub'ect property l P P rty hereby authorize t:%i Q-1 melLL to act on my behalf, m all nutters relative to work authorized by this bul7,ding permit application for. ( dress of Job) ILtore of Owner Da Print Nla mP . if Property Owner is applying for permit lease corn lete the P P _ Homeowners License Exemption Form on the reverse side. i Q`.FO Rt,4 s":OR'N ERPERh4ISSION IS _- ._ __.q__._........ fir' t .__ .. ... � .... ..� ��'...�.....__. .{ `y���. .�y,•(�'g4.j.._.._.._,_.�. r- i � , ., -rt.� r m.�w .awam�m.�wnnvpup�u�,�w+wowgn�•�.,�.. .,� � � - ..f...,..._..�_«��i= _ « .. _r1- ice.«-._._..,.I i oi ._ Y`p\.,: tip �.�...................�..:.._ ----- ...- - __�.•. ..�. - E I ' Ule r f � _ } � I t: i wt&f �s �u E F k 1 f` U —. I do TI U/J Prisi 1 `ir his-18/2011 18 � �� -4686 PAGE elm Y {, JOB 'll'.GR ?ESIGN,A sHEErNO. l�Q Box'131 r7 ,� foresfdaie,:MA 0 6 � cnLaUufnay_Gr'r" DATE AL--It 686. ca+tc nev DATE 1 ` i WILL MA �+voFr r • a- --r— -- T_ -- ",G..__ _ . `fie_e ��w��.�b•�.-- ---i - _ ,` :., i _ � � t 1 • r-;rw._I_. els _ - f _�_:.-�_ �.+.t •.'L'�+'�►����1.��"' ' "- `'SSG�',�► ' t a i FS/2011 18:42 508 i90=4686 PAGE 02/03 WAI TAYLOR DESIGN ASSOCINC I NO. � OF P p. Box 13I3 Fores#dale, MA 02 CALCULATEDaY DATE Te{.lFow. (508):790 86 I \ CHECKED BY DAM pas dlknm 1 1 i ' Ma.-_ :... .�:.._ .. ,� y:.._.� /�{0.'!•4F. � •ice..:•— _..L _- 4 � !r IC A . . Y.3.. �__.. - 0;1 lb J. - - ;- ' „ err., .._•1 ... ^..—;��—_�,.—__ - 4 • e� 1 i 8/2011 18.42 rt=ies� r 508-790-4686 e a,`'` TAYLOR DESIGN ASS 1N�� s�€rHo t OF � r'f P.O. Box 1313 MCUlATM� " ^T w+ Forestdale, MA- 02 Tel./FaX- (508) 7904 6 CHECKED i ..MID- �" 77 rf.WE lq�06.pit 14 . __.-'_.;.. _ �- � -. nod�••�lbli�r ���__.. ��� �� ,..__.... tt Ow iS 4— he irq i.� I ; _� '-_ ---Lam.-�-_..:-._.-,1-_....:••-._...:_......•. • 7 'Assessor's Office`(1st floor) Map Lot Q Permit# Date Issued Fee gineering Dept.(3rd flo oIuse#1 ._.._._._._ _ _ _ r � BARNSTARLE. ` MA8& ED IA1d� TOWN OF BARNSTABLE Building Permit Application 4* Addiess „r) -p F .,, /X Village Owner Address .Telephone r Permit Request 9 Total 1 Story Area(include 1 story,garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ &oo6 r Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use, lbllele'' AZ rf Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information NameS�/fi).ci I7 T ie%� Telephone Number Address �7/ ;tf f��,�,,,r l�,- �L/e.� 's License# n, e) Home Improvement Contractor# 112 3 F Z Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ����ia DATE S` BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PER N . c _ — - .• — DATE Sill.'- MAP) r PAIRRCEL NO ADDRESS 4 4 VILLAGE « OWNER 1 DATE OF I SPECTION: FOUNDATION ' 1 FRAME' INSULATION FIREPLACE' ELECTRICAL: ROUGH FINAL PLUMBING- ROUGH - 1 FINAL GAS: ROUGH FINAL i s _ FINAL BUILDING i } DATE CLOSED OUT ASSOCIATION PLAN NO. ; i • e Town of Barnstable K ,g Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 mph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,.removal, demolition, or construction of an addition to any pre-edsdng owner occupied building containing at least one but not more than four dwelling units or to structures which am adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: xe /'leas) Est Cost 6LLO � Address of Work: AaeJ�s.a✓�� ��or� /�'���1 ���v�=�vi��v Owner.Name- Date of Permit Application: Al la I herebv certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-ooarpied Owner pulling own permit Notice is hereby green that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH t7NIiEGIS'TEIZED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 27k.� Date Contractor name Registration No. OR ' Date Owner's name The Commonwealth of Massachusetts Department of Industrial Accidents � t � �N office ollnrestiyations 600 Washington Street Boston,Alas. 02111 Workers' Compensation Insurance Affidavit �jijil'icanf-information � "� "' �"Please PRINT lebtbl�"`>" "��'•` ' "'"�` nameq location: A, 1_felr e,'� �1 cl /* city ce.1 //t`" Phone4 2ZS__— 4a7W /I am a homeowner performing all work myself. 5 ' am a sole proprietor and have no one working in any capacity E ..:� I am an employer providing workers' compensation for myemployees working on this job. company name: c�/,t; c/Cze /c'�% address: ELy ��� L tl city `t' z/ phone#• —2?,�" 74,9 =� insurance co. el(df'•t `C' 1 — M W policy# , . .,: >'i "n+c:,gp .,:ggr+v' ?�kF's'4'�, 'K���+ a.,� .+aAy�3,•r,'Fyn >ti+M.> *+`+ rsw �+vw+..... :, m -:<,fFrra� sSaz»fir..,. .. . ..,.. ,,;.s;,. ,. ... _ .: ,� ^.•. .4,�.:rw•• .ik��-.'_.. I am a sole proprietor;)!eneral contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address city: phone#• insurance co. policy# tit�A. t Jp.T r rrrt . ..s.. eps3<ay a.::. 'wee ?,t*ns:xT u.i^ ,1 'i a�axs.is uiu ..s.w...,s.._...�s..[.a.wai!—......«...aB�.II �a:AN.C�v ��i4.niSt��!✓iurystilA��'J company name: address city: phone#: insurance co. policy# :Atiach tidditional sheet tf necessa rr: "_ �,, �t '" ` z�� ., r �.'1¢'�"� } '+ '> '". � ch'i-._iti til' .._.... «.�z.Z... .e 3 as _.. 11 s. Failure to secure coverage as required under Section 25A of NIGL 1.2 can lead to the imposition of criminal penalties of a lineup to$1,500.00 and/or one Fears'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herebt'certi under the pains at penalties of erj ty th t the 'n1prmation provided above is true and correct. Signature Date moo ' Print name Phone# arofficial use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department Licensing hoard O check if immediate response is required oSelectmen's Office C lealtli Department contact person: phone#; nOlhcr Y . .x..::.S, ��'�•.::.. x'BT5!_ Y .....',,;ta., .p. .. -.. .t ...� i�Ez..:iA".>jF^{:.�fp.�y aJi:W. (rmsed 3/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compcnsation.for their employees. As quoted from the"law", an emplopee is defined as every person in the service ofanother under..any contract of hire, express or implied, oral or written. An e►nplt!ver is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwellin�o house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until.acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. ..::.-..x,,.^"r'"'?' n--�....�,.. Y"""'�g, '"""LyR'"e"�"""r-.4� s _ z`'w3.C '�a'^y;��„ `yr*5 i ''6v -f' ..R >xy .,� t:� T,.,9-. K p s,r>;l z�s- qe>..i r7g j. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. *' ATM:q,9tz 4n.` ":!"L z:s'4T91` ,."4f"';'m-rye.r• ,',.i�-'- ...... �. -�• ...: .: ...r;. k at .,,k � ; 3�� 5 ,,„ :t '"yw ,tr yrvr#:, City or Towns Please be sure that the affidavit is complete and printed legibly. Tile Department has provided a space at tite 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. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. aue�+-a.• _ _ ...... ^uxsrcv. s r��.-s-z.,r= sa>:x..-zoa.rsr �..*r+snR+�"f'"7[�p�:��msew+e».�' o'�,��ro "gw�Ya^raa'�Rg.a� rr w �•r�+ln:ah+mn+q:, The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston,Ma. 02111 _. fax #: (617) 727-7749 _ phone #: (617) 727-4900 ext. 406, 409 or 375 I -- ,off / ��----�. :�•• �m � e - Vent BaffleorTee FG.9.6 0-944- justInstall Risers toToo EL8.8Finished Grade . Bot.EI.7.8 8.7 8.5 5Mtn.toAded t:� •' "t )` ' Ground-Water 1500 Gal lon Nov. 2001 El. 2.8 . • (''p��' y 001. 0 Connect Septic Tank to Septic Tank Pump `�r•.L• ,�!S •"i,; ,` Chamber , • . ••: Exist.House Sewer •j(• � • ,o l ........ LoGAT10N OF VttlT CAN C36 a ' (,• °••��.. •�` o .9 . raI vllle .:�.,,....,.,-,c:..,. ,.:...•-•.:::v....... ...... AtJSU 6TED TU N1P� 13ENIN0 - � e;L_ I/2 HP Pump by Myers Bedding as CAI-ANT\N G S v \Public1�1 e or tpproved Equal Per Title 5 �� Landing Beach,-� n DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 5 Not to Scale 3 / NOTE:Waterproof/Seal Concrete Septic GROUND-WATER ADJUSTMENT e° in e Tank Ek Pump Chamber nt. �' thTwo(2) Coats of Approved Sealaan Ground-Water a 4.3': Elev. 1.2 CEGR ILLE \ Index Well : MIW 29, Zone A / ---�- Adjustment: 1.6', Nov.,2001 Adjusted Ground-Water Elev. 2.8 LOCUS PLAN Scale: I"= 2000' TBM E1=5. 13'NGVD '29 0-TEST HOLE ELEV. 5.5 Assessors Map 205 To Of MO Nall Set 5j 0 Sand With Loam IOYR 5/3 Parcel 030 521. C Coarse Sand IOYR 7/2 Ground Water Overlay AP Class I Material, Ground Water at 52" Date 11/29/01 by SElnc. au d fFIN � r " R=4.4' j 30� 7 12 05 E N 8 � 0 I- ' j ---� - Edge of P,Vement ) [' _ Min. 0_ Finish Grade Elev. 9.6 C..._-�` HW -OH I, 3"Min. Compacted Fill-f Filter 4.0 Perforated 15'Min, ,� Fabric PVC Pipe 8 1/8"-1/2• / -•�. 1 I - H 1 L l Pea Stone 9 t 1 1 aW I 3 -3/4`•-1 1/2" 1 LA 1 Double Washed Stone I Sol.Elev yE & "z I e� .' 1 �` 7 Spaces at 3'-C"-6 Dist. Lines 7.8 Existing 21'-0' 4 D I 1 1 at / 1 i Grade - 1 Lawn / / U(=U//= co i � / 1 ° CROSS SECTION OF LEACHING BED 5'Minto Adjusted Ground 1 Xt / Q / a1 / Water Elevation I aW +1 �` I Not to Scale HOC /� O�, Elev. 2.8 II/28/01 LV D�� r x• ! ct J� ... .__x -- DESIGN DATA NOTES C�� ! S �� I j ' rr 1 5 To\e G RKmc^/Ep 9 Y- I. Water Supply For This Lot is Municipal Water. it Single Family-5 5 Bedroom ` ` With no Garbage Grinder G D Ul ! j Daily Flow= 110 x 5 = 550 gpd 2.Location of Utilities Shown on This Plan Are Approx. O Septic Tank 550 ° 9P At Least 72 Hours Prior to Any Excavation For This gpd x 200 /o=1100 d Project The Contractor Shall Make The Required t;l Use a 1500 Gallon Septic Tank. Notification to DIG SAFE-1-888-344-7233. m \�� �� . ''"'•. t► /bI LEACHING AREA 3.The Contractor is Required to Secure Appropriate I Q Permits From Town Agencies For Construction r- 6� _o p ` t, �1Q I ° • 550 gpd/0.74=744 s.f. Required Defined by This Plan. G seBo,tomArea Qnly. e� U 1 At' C.G.Rllvt � ' •. 6. / Q � w� Bottom Area =21 x 36' = 756 s.f. 4.Instal l Risers as Required to Within 12"of Finished I a Grade. ��y > � Y� �.-- o V y_`- "/ NNec t Ncw SEPTIC Subject to Vehicular to e - Loading. re or _ LEACHING BED DESIGN 5.AlI Structures Buried Four Feet (4') or More All Pipes to be Schedule 40 PVC Perforated S bje t I b H 20 C`�, I - - `-- + p`t- " �_ TANK -rc> gx\9 1 With Capped Ends.Use 6-4"0 Distribution TAIIJsE s�w�1-t f 6.Septic System to be Installed in Accordance With Lines in a 21'x 36'Washed Stone Bed as Shown. • � - 1 R�Zr'*�N �-� '. ;�1 � !i� - 7 310 CMR 15.00 Latest Revision And The Town of Barnstable Board of Health Regulations. T\1.\6 7'P Nam' _ '1 �.►wrr! i 7 All Piping tobe Sch.40 PVC. CD D -1 Lan p t X \`\ O (`; Q 1/2 b Galv Pipe For Frame 6 Cover. 24"0 Opening Above For M.H _1 . j• Float Support 49 01 ,>. O v \ y` �TRBN GIB �X\ST 1�5T / 1!`+'-f1 _I L_ i --Pump Power a Float Control To D Bo> _ �_ N a 4{{ _ t1�• RAIN gP\PE NE�sY - I] J 0 OJ O) Q Cables Installed inAccordanca I O 9 � �`�' P 1 b�wsR'�,-.,.•,- .. .•..' ...e' `L\NG i •(� With Local Bldg.B Elec Codes. 1 N� O m q ti0'4a EX\STo Z�2 6T0 s�2`1 M•pl 1 \L v a 4.0 From Septic zi I }10"""" �� F •�, ^ Tank.Sch.40 PVC Precast Pump rn Chamber porch � � •.. nN 1 N PLAN \ \ - 1 1 CU 40 Sch 40 PVC Finished GXIST, l EACI-I P TO IT O From Septic Tank Grade 7 13ti PLlMPED 4 _ T' >^ O a r e..\ Yy/CLt-aAN MAT��Z►AL � � ooe 'o Lawn o Conduit Thru Chamber For Power 8 Float GaN •° To 0-Box N / O EmerggengStorage Cables Chain o: Vol.550 Gal op Min 2'Cover v \ Inv.4.6 ° Alarm on El 2.47 O 2 0 Sch 40 PVC \ - - - - - Pump cnE11.97 Mercury Float ' Switchs-3Req'd Threaded Pipe Edge O_-f Lawn _� Pumpoff El.1.40 Secure PipeatTop8 Check Valve Bottom of Chamber Bottom El.0.10 , a f eMe Ston ®a � t�, _ �' \ \ �- -- - SECTION T- Q- cOO Gal.Septic Tank PUMP CHAMBERDETAIL \ Not to Scale REVTSF.D PLAN SUBMITTAL SI'-EET r \ \ __ 1q 0 _I ;; AVA\-PB11_TY�OF PLANT \ / \ I1nATE�\e.La�11NOScAPE CI SE3• 5qZ - - � - _ 17gb1GNEQ3 PREF'>=RANGE y •� - - - - - - APPLICANT'S NA2rfE tE- .- -.. .- t ZOS /-o/%y F3Gl�tta RA \ _ _ - 4 •»�.h<vac.« ;t „ .. PROIECr LOCATION: - - ._ _ - -- - - - '- - - This protect has already -n i.ti„ d an Order of Conditions 0 / zr OR C3xt One / C 0 / ? Order of Conditions not Net i<a,et1 ED -- This plan will be eoasidered on Dan _ 1 _ _ -- - - -6- - - ............ ......................................... Beach Lang Directions to Site: From Hyannis, take SITE PLAN take a Main Street to the West End Rotary and PROPOSED SEPTIC UPGRADE PLAN ,V Scale : 1 20' right onto Scudder Avenue- At the stop 205 LONG BEACH ROAD sign, take a right onto Smith Street which CENTERV ILLE, MASS. merges into Craigville Beach Road and FOR follow just to the end of Craigville Beach and LAU R I CE M UT R I E then bear left onto Long Beach Road and SCALE! AS SHOWN DATE:JAN.23,2002 house is on the left#205 SULLIVAN ENGINEERING INC. RU_V151011,1 oN/IB/oz REvl5C0 bRlvwvVAy 1_A1yoUT OSTERVILLE, MASS. 7 ATTACHMENT A