HomeMy WebLinkAbout0264 LONG BEACH ROAD -0 ,w.•, 3f py
q
Xlz
q /}
c 1✓
n (
d
�/ a 2 t►� � ,/
..
... s �. „ a.. r�t: d ,y,�sYt��tt'.s. ✓ �'��}� / �P ��'. n w�a '� 4.��j,� !(������d F.,.,.
t.a,.,....,........ r .,. r, 4� ,.,.. ..,. a,-, '.�!,G :Y:.,1 ns f{kl. s. �`•w (:,. A�1!If :i s 3'
,'r. r .l. 1.' ai �r ' r7 �3„ J{ x, Y.:s' .. � .. .k'�• tl{�1,' � i;r;c xN q±r;'`<y�A 1;r<+ ;+ § i;;L n A C:, a a.x' :;ii .r r';.its
" ,.. + pp -. ,• ,� •',`t! r .: ,EC 7 ,: .rA ^rf s `... :♦. a'Hx. �a .,,x t'rrot.l, ;(#,.a4a a. ,1,,.., zw�aY a":rt,P ~�'q.,e �t�''. ,r}}r.,a+,�.,.;�4J ,t,}�t.t:.S!! ., .,. t 5L�`{
_ :� ,ff�. LP y - Iry r .;A N( i.t. 34 y.. y : §r 1�.. a• �.,(�dptA .n�, ".,1A: ,,, '.s�:,F,r. 4 6�' ..L::: �.4s;'!t��t. 43 , iF"Ai'.,,
, r `. 'r -�,,g' .,. •4' M•: 11I/.,:.. S�' ': C �P.. .' ,.:. ,. WN'4J 4 .e.�l r :4d A. ,}:. -1:L ..(diva` ',..^F,..3V� „3, Lt. Y% '�..,,� `�. .#�.}:3t YJ F,.
tRwtY
t 9 "'Ego
b 4i.. ., ..t..,:.
2,r 7� :a 1 '.�.+�i�u+ 4� a.✓.�-,s;A d t,r -:,.�P ,,75�"1 jH;trt x ,•L F tf *;y
t .r �, r. n �.+ ,r. . `re r• v4t r .?P,a y b.ru �{t,. � ;:�3tN b ,a tai191#
{ .�. ,tw r,:•�i , p Y { ar{ ar?y.,,rl7 3 3-:.,.a m, �1�5.'..{>!, �a'S�.; ,, �� � ,`i�tq. r?=yfh .:.ir,a i ,t d �+�tl �:,s ,r �3 V41,
f }1'r••F. :r, r;st .s f,..�,'># fe'�'s;.�r ",.. ,�ra4"3, ! «' p f 4`�,.
r
- .. �. r ` !P^'.. ;.,".f.Ti�scl4."�..ti, 7:�•.+..�,..:_:. '., .,, ,N •x:Sl!a� .rr
::,.;,.{n� ,.. t:✓r�.. +7. #-r ,�4.a kl.i..:.� ,xiY'jr'!� a Y1'' I� tl f'„' -�„> :
i., , .. [ 4,.-* .! F ,... .,...2. ,F-„ .,.,�'. .... R, 33 .1 ..,.t-�• .. 4 '!..,. ,. , , ..4• .. , ,......�` k :#f. A ': x
?T. t .. �. .., M lu ,} ....5„ ,.. �• .y-,,,,... r .,s ,. i A.�fl'c.."7 ... ,Y.ro r .sw .,, d 3 °, } •�.
.,�,P'tr.. .,,.F� x ,...., .$�k..,.; r ,:"�, ..y.N.r .,k� £. ,:,: n ir. •,3�:. ,, r�.,:+.:. �, .J :'• �.., ,.�,Y. .a � d5:.
' '.. :. , if,!�r, , ... ,. .... „u �i., e $... . a .. u. !, .`1 ,, ,�t. ..'iF. ,. -.:. �,Akl.. •�G
r .#' i,`£ - � r.,.tiry 1 4 s ,iv'�,:. .✓;x .€., .n.. e'�t�,, a�.. � 1;,. l r :.a-• ., ..-. .,: ,' -1 : %,.}. P . csk,$,.pp. S ..tN ,¢. r ^ re t.,... .. v.3 ,f:� 3; ..k -�,PP t,,q.. , {
.�' : � }�, �,.e_1. "}• roE' ,l, r.' ...., `t.� ,. :-,:}i, �. .r 1 ;'.{...,Y, fl.,r.,.x 9,. Y„ - r., L #.,. ,.. !,`, ::.,
.. , r. ,hk � :T Ar�. u cr A. ,' 3:;,.S, ,s. '•; ,..,r .:'n ...� „n ..�- ,,,r:tx+ , R_„1,�1. A.,.F'• 1 a 'f.. t. '� A.5„ .}i
,IL•-� �P !1 :�l,✓f�rL� --.. it �„"3. � ,�r 55 .:.H.r,.,. .,,xr � .'-.{.. : . R - .,i I S �. t :v� .k:.{.', 5':i,.
' -..e - �. rt C. w. s,. :..v'k4 ,Y., .t,a.n••. �, ,�. t: 1r,arri Lt,�. r".., t
- .>n .; ��s �- :_. i, " �,�. s ., i.�} � st, •« �.,.. ±:�. .,..:., +(:.>< }, .dk:^•„^`,�.f y � �t„a. {.. .-e +r,,..t.r_ � s .4,..,
�� .. -�., .a..�/... .... �`tt ,..�€., m=. -.a. �. ,..Er.1 ,.... cd'�,.. .(:w„5.�:2n..., } t�., ^�4• ..�.
. , l +t . . Q .,. ;, ,: rk L,: g, ,,R. ,• ' •,r rh � .,°-:.,-;,,, { t.$i,, t „+, �`r f,., .�t-.,..,.,Y`,n h ,,,.A s, L, aF..
i.�- p�r3 :3, ru'.�' 1 1 .�,s 3r.,t.: -r.. .F Jr n.n,. �r c,v .,•tx�G-S ,h 1 r't: '�a'�„ •F� o ,
�':fF 'ui{: �. � �'e: >+1 .:+,t- k .�. ,< 5;1,r .'w� -�. j •,�tst• ...7. a,.. d q n g t
, ^ .' ,. •A. 4,.. :: .� :.n ,�n.,i.. ., v ..r: a , qpy, , u 55 4`�'Y'.r"' h 4 �Y $v.. Y�X�:�.
a . F •; € , € 1 :.t .., ,r >� . :� tr c�r z� ,.x au'3' { „ds d .',;t ,{ A! ,: y';! .. t�„y
s`., ��, �� `�':, .+•l.s �'.,. :£ ,J�a-l�l, -.� f the 4. it .;"%�- .i-,•
. . .:., ,.�s ,. P. p)4s.e.�. � .. .. r l .�.,. �. .k: # �� ,FL..,N, %,�r{'1�.,.:.M Pt° Ri. .5... 1. ,>_ •.at!„.;
,�`•-
r
}s: .1'��� t., 'S sr.; '�}a •:a.x't,,� €s :K:: . •t i:'"��., � ,�? +: �'t�,,7.1 'cfi`",:i 1 � 1;+,.�Y 4.� y
� � t ,q, �t ,'�., �i• d• €S'a Y, u.:t. ,n, a ,.:}� >€3 ya,,t � :a+/� .: c �., ,}.k,.t y" r� :f '� •,'r�r
ppp
,�' t ;d. t� ,,"t ._g.:s•? ;,� 6 ��""kk :..ti••,' +� ,...pp,,52,y.$.ppa T[•...4s t.ts,;�: r ) t'#,...�:: t ..��r.t"�' t , ,rr�;�ii��,.>`•t [:,�-<,.:,,>�•,.
, i Q � �. A!¢t r�, �-1 S,a,. dyer 4M}F'� `:P,..,.J�•ti`r, .t{rr`Y"i„�,tD1-. 5')1.')...., ri 4„?.. t�.,.......y.� 3..e� A ,; d, ,4-.�kt 7�. J. .
.5 1. � - '3L( 'RK'..4. ,H�j..J IG.r l4..r, VA R' ,. .�� H.I [4,,,.f.f[ ,..'F,n. ..G f A j.,o.- 3-. •L,1.L, ✓„�," ?,.:.'
r -M. „ t ! ., n•,.. .. t „. ,,. �oiy.. .! ., 2 N,9{....,. :o, .. �. ,i, :�.z,: .4 l.:,ry r.h � ;P ,1 ,�. ,.�,.
... .,. s ��i�� ,:. s,• _,.:ra.r.,:,:_�.:. ,�r:4t�, , .,,, x d'.P f� axx,•�.n.. .�,a�. a} :rt^?.4.. n ,it�r��!'. ,� v(,x'K.,IP, ra .�.,'. ..,:f"�"
, ', ..- X' ,. L a dr, f ,. ..4 ......, _ .r�. .., ,.�cd ,...r .:�'.:k r�.6. ,&'� S�K..,.s�l�:f s,.Sf,:.,.�•«<. _..�lr <.,.+.P..r� fk.,,t.a i,,,< :`rti'$ }„ „i..g,fR�
,'. �+u3 3 - - .''§"k.' `➢�. ��. e;A t. F ,st`y,.1 ,Yh S °':3. .G F� F 7 If ..t ..r' .t^,. -n�S t M
,'r t. .Y: h 9: .,t a ssL�A.1G,� ,, r 7A�., PY?P' '�i #.} , $t,✓ ,'k-;�'a S t J � k, ,y.
r � � � : r' .. � 1 r9�'R i.t { a -. Ci'., .',.! ....'L..�$ .. 41 A.,*t•{-, ,e-n �Z ,,Yn._ w*!e 4�,-J'eR ��:J- :.FJ .Xftc!•xr,.l
i, 2._ .,,.�..: � >r xaf,<FI w.r �,t,�,,, .., �4.q. .,,..fi, 1�1,<• �` �r ad��`". � r +.e S� n'�`:tsr �./P'P `-� �z�., -St7�.,�
- . :. a' .., '• ,� ,(�. •A: ,,��� .r--:}}r ^r�y�5-'6 t, +t�r�: a fi. us £fi, Y�Aios' ,y` >ti`:�'Ur f,� ' .d5 drat.,u�`�:�.C,,. �„s..; n5 ..�;i 6a,µ 'E .
.. � �H' :•: • , r,• � Y..J' !� :2+L: rn . +..,.Y--- S',., +„c ,i�3 .,,. Ft . u�. �. TJ�n'�;r4 '�,.r ! L.a. 9L U U.. ,ti 'Y,�t i�. r91. ,•'F
n 4 �k �, '•�,�`.� .73ro� ,�, x x"':�f� ;_�r .$ .7 •�.,,,r� :+tt'+�`a' 3,F 9! tC_,t ilc .ra. Y4;,
C + ., .iy'� ♦ I '' �,. s.- �#. .yam. ,t ! f.t. "� :, i � � !3' �..3 ,r,k �! '.'s,zs,� �.
r •6=8r �,f. .ia..�j � .3 '+,dz<.'-^c.. .+ ,.,� k.w:� „4v. ".b- ,a SS�:q .tsa.
.} �,,x• 5 t!. s `- ,:r, �, a. „.e g.,'�„yf ,.'Sa<�+'.,. ,Q#`, p.:•;;.,. �fi, �•.� ;t� -a:; u'ttsrt�• t,,''a, a
1 ;� R ,,jj->sf ¢ I�a �..:r„ x,K, )ro.a� d3Fx,,;..�'+f: •{.a. �y a X!. n,. .yr.,G
i r .X,. :#. k$'-. ld�:��, `7,'.,: w`-;Fq ,.,%Sk �v f a:.x=�.. ,Y}✓r"d {, �•, 3'. y��F
. � '.t a'.,: ,. .. •,.; � :- ., ...Y rb`•': � o-.t-+w.= t"t..i1:F;` �P$r.• ;8. .+ .. �t ;.t ��:. /. ,r�+ '+�
s., ,.! r 7,...$, ,y. .�x d ii�,:.,r .`�.n.,,,.y,,. � ,:k� 1k i�r.��x: �.� }�n .f,,r ...,. 4f'`. •'��.
t: "� .I s#. �� � �rr a+y g.T r t> .,, t:t.. c rs+• , ur �7.,!L Y. rs his .�"�: �^',4.
., G�ty�<: ', �,. . . i[> �n., . '� 2-it,.,< ;� �- .z inn � �k Y+r .:��' cam,. .t c � „�a•.,!t r €
t. �„ .� t .:Y.t .�1'r :,F.r,t}9.. 1: 6 t,:�": ,�^,"r"3..'�'.ta;,�t" „�•,'� `S�z..a i �'S�- ,�*':?3ri�1.5C.v... i, �:H,
' � �'.. : -.> ..�f-., ....,tr ?'t., t F'!`, .� . ..„fi t� s ."' x. >, d. S-..t, �S- <�.�,, i t G,' x t�, v, Y t 3: -�•.
- �' �a rt s-,-z��'': a�:, 1:, ,�, . r�4s:,t€i•t�. �,..� ..��� GG bu s ,,,�'r��:<r t a. �� ,at,a�M. �*+ f' �. . :,� .N•...�..,F,fa§, .:a.i y1..r..:a ,. ,f+� a^.,r a>f`r � F-...,e ,..4.,r:;.f5 .'5.+ ',t .�+,,,a`;y,:
,
:,,ks � e. �M t.,. .t �=F;S '2 �'t,€��X7-,r �t,, ..a F r$. „,�y3,'�s, ,54?t c,a•� :*5�'a„'Ftu.wf ,,�1ero_.4 r, v....a.l�'.n�� •�#'ara,G r,� s,e.::k'�.attYUi.t.,¢,.`lCi. s:.s t^,',/t>,o. �.q lix a��,, .ea+.'>fF� �;y, �'rr.,.�'.s ,,S �'r ���.:;F x'':",
s s: � a ro + '�'a.F-s._.t.��3r � '!d�s.�x• :��# sa #� ,f r n, a i� „x~we. t
-.±k....f, .:{ - 'A`•._2.�".. ask... as-'3 ..x,., >x ;�.
•. ,. .. ` '' ;�'. �'; s � 4. - :� ,4 �.&-r. ,...::fir L,r .:'.��'s .. '�-»{�-: ,4x, z4 xy-A��y4..,3, ryt_ti:i' se,: fp -"rs � -'l�C -3�.;;�s n'6rxs s rp�' ,.st%":.
z ."�"_..,a '�iRt�i� •°t �s iz�gf�t.'�, �3s ?' � �' Jt��f���£ '.,; ia?�a{ y t..�n}, ,rr-b�,�,'``��+"x,.��,"�iit�, a�€ f # ;� 3r
.:f �Y .%€ � it t, � E",,!'''iS'� ',Pi 7A �• 2 P�, �.,33tt�� �'.F��9 b, Fr 5y�,'k,ifY,iM 4}!./;a� r,S`L "t,A ti .,I
£ : - �_v ���£„ i tz•:�r i,$. �* v�t s dtS��Y,�`-rr�`-.' �:s,c :,,G .tt':,.I.r �,. ,f 4k,... '��
- � '�,& ,k, �#� a cs �'^„1'Fr,']-� .� ,..s '� L;.y �t r?-�,. fr,#' "` :t�..�a •4
S
r
' e r, r
+
' s
¢ �7,�`i �tac. r1 �� � $J1 �,t ''&". t ,!t : ��'�r Y3�{�Aia.!�`kJ,��{I��'j"•+�!^a'ax�a'S< Sy�,
_ � x � � K � �t �'ksd. p ��•a y'.. `"R r.•-.r7f + �t�.t..4'r4.�Tf �q7 '�S4 zd kfy Ilrf'�'t•• t#„ '3! y.� -�Yt � j%X#�t"4F(, r `�;J.�S',:{A Y
a v
���� tap"„ t,fii � a�r � ��� A ��• � y fin;-; aA� mr:a� �l�ut§T!f fK�r,n, i,
',�' .' � d.� �[[yyw,y�� -��te1�.4, !,'r� ACp, .t 3 e" .��G, 1•;M � 4���fr '� 3'ck J�t t� �t �4U�,x�A��;�:
,
+ A„+�� ?, s... .:t...'. t 4 0. �,s,;g���;tr:�,It�Ra����i±�L A i€�.�3��`��;�4'�t r a{c •�..f'�'�h�frfx 3dtJ;a� '"��ii�� J K�.:� +'"_;t
n;
�C a,,
pp 3
�.it 4
at > } 1,;�,:fk F €hr4�1���' '� :�tq�'4t'` :r£ �_ � t•:;d ��`L'��� �?�A'�^,S'�r I� f r'q�,ro` ,�s%' ;q'�;:'tl
a,
1
h. .,l, t: k�� { r�� p�:.:{. f ats �'�° `g:dr>5 $.r � •:.�to-x /.'�,F�.`'c'r`
k2;rU(i ts,1 a ,E- .i .1 n:.'i..r. :� rAkY' t'"d r..�t.. L.c �" -`f 7 '' i•..3,:, ( .:.fie...w t we*` 't.. •N: �' ,:.3. s.i 5_.i �.h<< 'l+<551 -.2°'^ a. a ,r s:.
e i$ •d "J �r"' } 'F, .fix •:o*. x.a � �zt?'.k, '1"' t,� n, Y
, r
+
,'�' � �` +A77�t�•. to P� '�r-. .fir*': s�,•�,,rs y�`,k ��r ' +� P�$�',�'�+��'$ 5�s I
,J� S. <- ,. L '.tl el:-b t A-�, .V >t,. L#�. ,.1 i }t�, 2 _r_� "{ �3+t� s��+,'•,�'.
' ,. 3: ! •+i,.�k .(;5,§i qq +.M A'�:` `X. 6A .t. r�= l,,.P :"i '..lr,r!g � } Mn
r.xr
': ', ..: . :.' y� > Nt r<,} •.St,:.. q,,.+L ,,ent .1 P .A� ,..� ",�rat Y:v'»r �?' >• r 3 :' �. c °Yd'` at'} 4"r�e'gS n>x` 3H ''tydG
.. ,... :� � ..aw K. ..:,, ,.. c'Y ... .-. f,. g€� rt. .a:? F.�.:r....� • ,r-,`, h .,,. r , r,,.. 715 a;m# .Atli,,.;' ,4
X n ' _ , .,{?:a, .. 1«:_.,y t, i ,����. ?itc k.'. 7 ,. .1i ,.ttA+�"t�...arF•rt'f .p .1,,t%L3�. P�,},.I{> r ,.,„ tA���.
- � � - � � ..3YF`., .,,.� ` .,�^.., ��r'�i v .•p:`�.! .. ir.:.. .� :�,1^,,, ':-., ,_ �� i_ d� s� 1 rt�iaz�',t�. .t tip t 2.�,.
+ ..� f t . ,5,�,.US�x -0',`A'S 4r�€ r• a 4'�t}�:,.�rdt.�,a �� ,re. � �r'w o ,.•t
• ,. .,,- .. { _.q,� '. .�, ,' 3• 4 r �..'rY;:ta°,� §, {;+k2si� -.�?'' .¢,F:v. aA t�z:: �i�': �y:`sd ��':��"Brr34 4�7r,?�-�ay
a' '%'a`' s a14$�`,. -�, P? ,�t .�ty s�,cA. .e •1} , >;rF.. s..�a `�., } l..�'� !�...:..T ; a.., ,'t a,:,,,,a .
x ,. 1 ,a,: , ��� .� a "1.,. ..- �„ �,�. -.,: � e ,� �!f' ;•.a ;..,i:ao-.,. i4.bs
,- ,.,�.. Y.,. � ,.., L„,:- . ,.,;'..t. � ,r-�a� , � ,,•, � ,, ,-' r n at .��E, ,,tar. .t k ,f.s.+... �!t ,.:rJ.rtw..�' ( :% •^u
` � •s nn -. ,ff# a.'. .., :Er ,, `+ �� t�:,�a x. ,..fr,4. n�S-,- r1:N' ��'�3.:.q.�w a..,.. zaS., �Ct s,�^c s,:,.:.
. - It 7f q' sw+,--:..x .. # ,. �, ,2 i � �r ,.). t fG-.4, .,•,k ufafx...�.
--... -I -. .< .. .. . _.,:a: :.'.:<�{: :r t,� ,€'.- 'ii rb,a. � �.t.wd.:a f .., Y '+ '-•F � wr' t r'.yc.rx;ar
:.. � �N� _ ,c �•• #t^,tngesw€s"�rc'a .'?"„x.. _. . - .1�''• �. i. °. c..=r`-. :,. ....._ �,F
Town of Barnstable *Permit#
Expires 6 months fror issue date
Regulatory Services Fee
Richard V.Scali,Director
Building Division 1 0'.
Tom Perry,CBO,Building Commissioner OCT 12 2016
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us TOWN OF BA R N STA B L E
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERAHT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X- ess Imprint
Map/parcel Number � '�
Property Address�� C -- � Cjj 6 C zry. �I e - IPA!Al �d,& 3 aZ
❑Residential Value of Work$ �p?D0o Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address�o7 t C C aec iA {y
Contractor's Name_ L,M4=Z A. 6-C�-- !•L/LOL4G Telephone Number-go�ei'rt g 3 4-
Home Improvement Contractor License#(if applicable) �Jro�.��?j Email:�9G 1�jvt�t. tS[A��MG4ST.NL
;Zrkman's
ction Supervisor's License#(if applicable)Com ensation Insurance
Check o
Va sole proprietor
the Homeowner
e Worker's Compensation Insurance
Insurance Company Name 'y TK1St144�1xQ_
Workman's Comp.Policy# JJe Q 00@ 1174
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to hk^p C kQ4 1C,
❑xe-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
[� Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
❑ Smoke/Carbon Monoxide.detector�s -� ked with red S and inspections required.
Separate Electrical&Fir remits required.
.*Where required: Issuance of th' emut does not exempt complian th other town department regulations,i.e.Historic,Conservation,etc.
***Note: operty Owner must sign Pro rty Owner Letter of Permission.
A copy of the Home Im ement Contractors License&Construction Supervisors License is
quired.
SIGNATURE:
Q:\WPFILES\FO i ding permit forms\.U9RESS.doc
Revised 040215
The Comnronweakh of?faswad7, s
Department of trial Accidents
Ofb"Iestigadons
600 Washfitpon Street
Boston,M54#2.111
> Ynv mazLgov1dia
Workers' Campensatian InsuranceAffidavit:Buildex—dConft=lur&MecfricianslP"hambers
App Please Print s
Na>ne �T vt OBVC
Addresss:
CityfSta l 0 X4t,Phone i'- SOB -4-29-9834-
Aree an employer?Check the appropriate box: Type of project(required):
1-L� I am a employer vri& 4. ❑I am a general contractor and I 6. ❑New consbmcEjon
employees(full andfor part-time)-* 'rave hired&e sulr-=twtors
2.❑ I am a sale proprietor or partuer- listed on the attached sheet. 7- ❑i"-+deligg
ship and have no employees These sub-contractors have ll_ E]Demolition
wading for me is any capacity- employees aad have worms'
[No workras'comp_insurance comp_ils uranm# 9. El Building addition.
required-] 5. ❑ We are a c mpomfim and its 10❑Electrical repairs or additions
3. I am homeowner doing all wow offcess have esereiise'd their 1L0 Flumbingrepairs or additions
myself o workers' F- right of a tiou 12 per MGL �Roof repairs
imnz=e ewe&]t c.152, §1{4h andwehaveno
employees,[No worms• 13.El Other Slat 6
comp-insurance required.]
'fray applicat H�atcbetksbax R amst alsa fiIlaathe secfi=belawshovvtg ehekvjulCets'campensati npa&eyini mnordan-
fi l€nmeoarnerswho submit dtis sffidzvt iasfic-f- they axe doin-an wa*and then hire autsl&contzaetaes—st submit a new 2Mdzzest indicating sacii
rCAnZzacsn6 thzt check thin bao:x4=rftrhe3 as sddieinnal sheet sbawh g the name of ft sdb-cuWxx=m snd state whether or not those ewes hzve
employees.If tbpsohtantntct=bace employs,t5e}'moistpnr; a their wwkeW-Mp.paliCY aumbm
I am an eluplay�r fleazt is prQuidirrg ye�urk¢rs'eoerrperasafiar[iresraratuce or empla �eR Setaw is flea paucy and jab site
irtformadviL
IrtsvranceCompanyName: 5AM 3�"U2A&Xe. C.:U.
Policy#or ins.Lic_# a�2c 7 F-Vigation Date:
Job Site Address ,2A� eul., 904JO Cityl5tawZip: l;Q�.R�Jl:al /•t�
Attach a copy of the workers'coaeepensationpolicy declaration page(showing the polity,number r and expiration date).
Failure to secure coverage as r�equir Section 25A of MGL c_152 can lead to the imposition of criminal penalties of a
fine up to I,54Q0"aadlar yearimpfis nmcut:a s well as civd penalties in the farm of a STOP y�(}}Zg ORDER and a time
of up tax$25U_�a day th,e violator a adtdsed that a copy of this statement may be forded to the Office of
Investigations of TA for fr sum overage verificat m
I do hffe-iy c �eMd et and,psrr a z>2 arma€mprmidW abmv is true and awrect
Siomitt2re: A Date: /D
Phase 9-7
0,0cid use anlJ: Da net write€n dais area,ter be cvrnpieted by edip ortonn ojok-rat
City or Town: Perrmtllieense it
'suing Anthaatty(circle one):
L.Board of Heap i ::.Builifing Department 3.Myffown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone<#-
6
formation and Instructions
M�ecar-7 mse#ts Ge=aal Laws chapfYZ 152 rMpn-M all euhPloyess to provide worl=s'compensation fair flies employees.
Purso2Mt-to this sfatuie,an.Crrpla5 PW is deed as"_.every person in the service of anofher under any coaixact ofhire,
express or implied,oral or7ziftmf
Air enrpToyn-is defined as ran individnal,pmtaersbip,as=i&001,caiporaf=or other legal eatf5r.or any two or mare
of the foregoing engaged in a Joint eofxpase,and inolnding file legal representatives of a deceased Moyer,or the
receiver or trustee,of an individual,per,association or other legal mfifL employing employees. However the
owner of a dwelling house having not more than three apartments and-Who resides thsein,or the 0=40nt ofthe -
dwelling house of anoffim'tvho employs persons to do maidmance,consf•ract on or repair work on such dwelling house
or on tim grounds or bmldmg appm�fliermto shall not because of such eurployment be deemed to be an employer."
MOL chapter 152,§25C(t7 also states fbaf"every state or local liicenskg agency shall wi&hold$he issuance or
renewal of a license or permit to operate a business or to consiract buffdh3gs za the commonwealth for,any
a_pplicantwho has not produced acceptable-evidence of compHance wiitt the insurance.coverage required."
A.ddi ionaIly,M(ff chapter 152, §25C(7)states¢Neither the commonwealth nor my of its political subdivisions shall
enter tutu any confrad for the performance ofpnblic work mmT aucepfable evidence of compliance with ffie iusm=ce.
regL==eEts of this Chapter have Been presented m file
':.
Applicatrts :...
Please fill obt fhe workers'compensation affidavit completely,by checking the boxes f$at apply to yom-sifnafion and,if
. necessaLYa�PPIY sub-contractors)name(s), addresses)and phone numbers)along with their ccate(s) of •
„mince. Limited Liability Companies(LLC)or Limited Liability Partnerships(LIP)with no employees other than the
members or pas ft s,are not required to carry workers'compensaf<on insurance. If an LLC ar LLP does have
employees,a policy is regone�L Be advised that this affidavit may be submitted to the Department of Industrial
Accidmfs for confrrmatinn of insurance coverage. Also he sure to sign and date the affidapit: The affidavit should
be returned to the city or town fly the application for the.pemait or license is being mqutsted,not the Depa dment of
hn-dustnal Acddm s..Should you bare any questions regarding the law or if you.are recp3red to obtam a workers'
co eosat on olicy,please call the Departmeat at fee number listed below. Self-insr companies should entz t heir
� P
self-insurance,license nIDnber on fhe appropriate lime.
City or Town Officials .
Please be so a that the affidavit is complete and priofed.leghRly. she Department has provided a space at ffie bottom
of the affidavitfor youto fM our en iathe evt the Office ofInvestigations has to cojtactyouregm Engtbe applicant
Please be sure to fM is fee pen:t/ cease mmnbes which will be used as a reference number. In addition,an applicant
that must subm-i'L multiPIe penIWlicense applicadms in any given year,need only submit one affidavit indlcafing r-rn-r•mt
poHay fi Lfonnafion(if necessary)and under"Job Sit e.Fern the applicant should Ovate-alI locations in (city or
town)"A copy'of t$e•affidavit that has beat officially stamped or marked by the,city or town maybe provided to the
applicant as proofthat a valid affidavit is on file for future permits or licenses A new affi.davrt must be filled out each
year.Whew a home owner or citizen is obtaining a li==or permit not related to any business or commercial vent=
(ie. a dog license or permit to bran leaves etc.)said pm-son is NOT required to r.'vmplete this affidavit ' +
The Office of Invesligaiions would like to thank you in advance for your cooperation and should you have any quasfiom,
please do not hesifatr to give us a caIL
The DepartmeuYs addi ess,telephone and fax rmmbea:
nke CGMnionwUath of M .,Sachem 5 '
paga f ment of Xrr�a}Aocidenta
BaStan�MA Q111
•., •`I`�L:�Cl�' -�-9��t 4€��car I-� h�A��� ; F
Revised4-24-07 . rriassv gidi&
AC 40RLX® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°D/YYYY)
`.,,/ 10/12/2016
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 CONTACT Kathy Silvia
NAME: y
The Fair Insurance Agency Inc. PHCN o (508)775-3131 (FAX,
No:(508)790-1677
619 Main Street AIL
ADDRESS:kathy@thefairagency.com
Suite 1 INSURERS AFFORDING COVERAGE NAIC#
Centerville MA 02632 INSURERAESSex Insurance Cc
INSURED INSURERB:Safety Insurance Co. 39454
The Waquoit Group LLC, DBA: GCI Builders DBA'Paul INSURERC:Savers Property & Cas.-ARWC 31771
PO BOX 509 INSURER D:
INSURER E:
Marstons Mills MA 02648 INSURERF:
COVERAGES CERTIFICATE NUMBER:16-17 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM/DDIYYYY MMIDDIYYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS MADE ❑X OCCUR DAMAGE TO RENTED 500,000
PREMISES Ea occurrence $
2CW6103 5/28/2016 5/28/2017 MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: 4 r GENERAL AGGREGATE $ 2,000,000
X POLICY❑PRO ❑ LOC PRODUCTS COMPIOPAGG $ 2,000,000
JECT
OTHER: Individual Risk Mod Prem $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident _
B ANY AUTO ' BODILY INJURY(Per person) $
ALL OWNED X SCHEDULED 5052134 6/3/2016 6/3/2017 BODILY INJURY(Per accident) $
AUTOS AUTOS
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Per accident
Medical payments $ 10,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-WADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE I ER
ANY PROPRIETORIPARTNER/EXECUTIVE E-L EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? ❑ NIA
C (Mandatory in NH) WC0002374 5/28/2016 5/28/2017 E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,060
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
CERTIFICATE HOLDER + CANCELLATION
gcibuilders@comcast.net
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Bobby Grossman THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
264 Longbeach Road ACCORDANCE WITH THE POLICY PROVISIONS.
Centerville, MA 02632
AUTHORIZED REPRESENTATIVE
Jackie Stewart/FAIMT1
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025 f2ounn
Town of Barnstable
Rlegulatoq Services
` '" ' ` Richard V.Scali,Director
Building Division .
Paul Roma,Building Commissioner
200 Main Sheet,Hyannis,MA 02601
wwWA6*n.b9rnstable.ma.us
Office: '508-862-40.38 Fax: 508490-6230
Property Owner.Must,
Conplete and Sign.This Section.
If Using A Builder
I as Ownes.of the subject property
hereby authorize To I AQ-1/ s Zn C to'act on my behalf
in all matters relative to work authorized by this;building pemait application for:.
(Address of Job) r
**Pool fences and:alaams are the responsibility of the applicant.Pools
are not to be filled or utilized before fence is installed and all final'
inspections are performed and accepted:
gnatute of, wner Lure of Applicant
Print NTM Print Name
Date
Q:FORMS OWNERPERMISSIONPOOLS
1
7
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
iion uPetvvior i uc 2 Panirl"v'
I. License: CSFA-057934
PADL J MAZZOI
PO BOX 509 r Q IF ;.
Marston Mills Mh
Expiration
Commissioner 06/19/2017
j 1 ,
. ✓Vlee tp�irrnrecvrrcu�al�a.�llcwac�ccae/t
0 Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration C152253 Type: 1 Office of Consumer Affairs and Business Regulation
N Expiration 811 1%2018 Private Corporation 10 Park Plaza-Suite 5170
ss -- 3 =—`� '
± Boston MA 02116
GCI BUILDERS INCi
PAUL MAZZOLA
644 RIVER ROAD +wL '
MARSTONS MILLS, MA 02648' Undersecretary --
ot valid without signature
Town of Barnstable
FINE Tp��O Regulatory Services
Thomas F.Geiler,Director
BARNHABM
��$ Building Division
�ptED MP'�A Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
PERMIT#1rs�� (o 21 FEE: $ �S-6 y rn'
SHED REGISTRATION
120 square feet or less
dn 3,ec:Gh p . 0 <
Location of shed(addr ss) Village.
sy P Il/crr ry� 73 ca.��w� 6r a ssm An i'f'�U s ��I-7�J
Property owner's name Telephone number
Size of Shed Map/Parcel#
F�
C)
"T
Signature Date � -..�•;
Hyannis Main Street Waterfront Historic District? 00
Old King's Highway Historic District Commission jurisdiction? Ill C)
ry.� co
Conservation Commission(signature required) �� `�c�b O 5--e .2i L.c-
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
Q-forms-shedreg
REV:121901
I
�r�4rl+vr c�E
hr ¢r%is
S `
F�°0,7 .� wAuTUcrcr:f
r{ I•otvs S0 U r.10
lt
L-C C-ATIOU tj,&P LIle 000
/FW .k
-011
I,rc L1sr wo.
/ lit
/v�� ✓ qB 6 . C. rJsE cIo �19y.2
� e �
p� � � fsazbrt�-i1 J G2vgsM pklr i Z
ti 5uE-OAK[
'(jzrls�
t q9 AP PIE VALA,E1( (2(?'4E
L S►�l�Qol.l,M A
L ASSESSOR`S MAP I SS, 'Aj?CEt. 2,7
\/Oa 4!,Ij
i�. /�ul. FASfrrd S To (�E C,At,\/APr1Er� �o�� ARNE\�,
5 EXlsfr►JC, Pr��IZ 9AN P [ FI.aA'(S AP?f2cvt i7 o H.
A
�Y GoNsEQJ r . � o�A�A
r od C 0ro1 M r5S1 ok(U►J r>Ep yG No.26848
5E 3 1458 ,o
`ass cf n
4t Z 16101.
2?4j F- N OJAt A,?L1s pA-rE
down Cape- ec-Smeer-ir, inL
Q$q rVO4t GA
r t�°.(- 0u+t dC-i I rv,o. oLG�S
_f�l.f''►.t I�GGoM P,41.!`(IrJC� T�� �cii i etJr1 pr
DAe5AR/a GR_osSMAr�J
I�IGE IJSt No . S gip
To AP 0 A"0 r•�rAr► j-A i d A r"t,o�T
I FJ AN D 0 JET' I e �/A-rG 12-5 0r"
Engineering`Dept.(3rd floor) Map Parcel eZ 7 �ermit#
House# 4 le Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Z3- •3 2 Fee AV
Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) 'q
��
Planning Dept.(1st floor/School Admin. Bldg.) P � ' �� �/� �Q
®dy P
Definitive Plan Approved by Planning Board 19 ���Q�,�' • ® !9LE'
TOWN OF BARNSTABLE
Building Permit Application //AA
Project Street Address [�/ �L�� LDT- 14 Ise
Village
Owner RWvQJ,® Address
Telephone
Permit Request
First Floor . square feet Se co d Floor square feet
Construction Type
Estimated Project Cost $
Zoning,District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No'garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review# -
Current Use Proposed Use
Builder Information
Name /U Telephone Number
Address ,o. License#
14e 5� Home Improvement Contractor#
Worker's Compensation#401VY 010-Z aj qqq a
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
SIGNATUR � DATE
IL kF(BUDING I L 0 IN REASON(S)
FOR OFFICIAL USE ONLY
TiERMIT NO. ,. a
DATE ISSUED
MAP/PARCEL NO. " r
ADDRESS VILLAGE ,
OWNER
DATE OF INSPECTION:
r
r f
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL .
PLUMBIN'( - ''ROUGH FINAL ,
GAS: "9? ROUGH FINAL
FINAL BUILDfNb` s
DATE CLOSED OUT:`'..'
ASSOCIATION PLAN NO.
t
Restricted To: 00
00 - None 89095
14 Masonry only
& 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revoca 'tion of this license,
cast+.
., DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Number:` Expires:
Restricted To: 00
GEORGE R GILLMORE
PO Box 940
COIUIT, NA 02635
° HOME IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston , Massachusetts 02108
HOME IMPROVEMENT CONTRACTOR
Registration 123494 Expiration 02/26/99
Type - PRIVATE CORPORATION
Gillmore Marine Contracting , Inc .
George R . Gillmore
37 Bowdoin Rd
Mashpee MA 02649
The Town of Barnstable
• au►Br�sr�. •
1119�06- tee$ Department of Health Safety and Environmental Services
16 Building Division
367 Main Street,Hyannis MA 02601
Office: 508 790-6227 Ralph Grossen
Fax: 508 775-3344 Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME E"ROVEMENT 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 owner opted
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: M a) Est Cost C
Address of Work: 6-V 4 Lt e� 2 0--
Owner.Name:—
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000
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 hcrcby apply for a permit as the agent of the owner:
Date Contractor name Registration No.
OR
Date Owner's name
• +'''� The ConlmonN'calth ojAtassacbusctts
""` '� •''' ' Department of Industrial Accidents
100 A//Ceof/A7=09dl/Ods
61111 Caltington Street
Bos7on.Ma s. 02111
Workers' Compensation Insuranee.Afridavit
An;+lienn nfortnation i'le�se PRi1V`i'Te ,► J ,,�, --
location-
ci1y nhone it
1 am a homeowner performing all work:myself.
I am a sole proprietor and have no one working in any capacity
L= ...
1 am an emplover providing workers' compensation for my employees working on
this job.
address• / t. ��'l / ►�-� '
city �y � nhnnc 1 �
#� � `
1 am a sole proprietor, general contractor, or homeowner(ddrt:de one)and have hired the contractors listed below who ha
the following workers' compensation polices:
comriany n
address:
tits nhone/1•
insurnnc co noiicv ll
�. -fir: «--:--:.�•- - .. 4cn o••c:..-a�"+•'�""'T�•'"��"�'�'= -.s - - TJ9FiQ��°�l�r�t='""f.�S�?,�r�,'�'•-'.� -
m �• c•
address:
city phone#s
Insurance co _
nolicy a
.Atiach additionai'sheet if tiecessa /t i s-'M �:s""�'"�•'�r�yy'r .�t`['.� v. .`w '�`�"
K-aure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a rise up to SI.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a tine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. '
!do hereAr certify under the itt cnaltdes of pedurf that the information provided above is trae and correct:
Signature au
Print name
Phone
otlicial use oniv do not write in this area to be completed by city or town otlicial
permit/lieense# riBuilding Department
cit,or town: I Uccusing Board
C3 check if immediate response is required 13seleetmes95
Once
(3lialth Department
- contact person:
phone#; M01her_�
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 emplm�ee is defined as every person in the service of another under any
contract of hire,express or implied, oral or written.
An emplm)er is defined as an individual, partnership,association. corporation or other .;-,-gal entity, or any two or more
the fore=oink 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 hou
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter i'S2 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
table evidence of compliance with the insurannce coverage required.
applicant who has not produced acceptable p
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 lip
been presented to the contracting authority.
.� w•......++.ww yy i.ra. .�•;.: .y... 1- +,� v.."A y�.:�:S::ix.:� �:}:�.. _..i-.;T. •1'i. .t.
I:.�w..�'�•f�� - /,)�.1�•:�::'t. ,. •./IM�f`7•/..•.�:�. '�lh _ ....��. �`���..1.• .M.w.1!`.�1iLI l��A
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 coy coverage.
Also be sure to sibs and date the affida�•it. 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 list
ed below.
!Q-R.{-w.'.O�.lw - • ..ti�v. J 7FM'- ...) .��.L.,t_ �'n7 jY' • ._. ...
i ._•� �...r •.... •. .: �1�7 � �:+•7 �•1IY �1'+.� ,^•T: IQ�/I'. ...i�•.:..•�. �ii�..
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. Plez
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned t
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 question
please do not hesitate to give us a call.
ws.... w _ _ • �„ _ _� ..;...-• air: :::•�:'•
` - -w.T..Y+l1�!!!�t�. ... ..� �I _ _• �•w "'f�V�.:.w�:r.M�l•..PI_ I:i�•.M�•.�..��• wr � ..
•.�tr . .r.Z i;..r•.._�.'. .... .1 n12Yt r.'\..::m..' a-..',...ier..:
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts *,t.
Department of Industrial Accidents ,...
Office of investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749 -.
phone#: (617) 7274900 ext. 406, 409 or 375
cIZA(6VI4LLE
VAC to
r
G�,S hj Qlve
V o '4 '` c/ /
o , /
// / / Locus 5ou&.10
tsuo`(� l�vc./ST10u
Lil riv A
I=1-oAf/ 12441-} FI.,OAI'i
1,Ic�Et lsk/IJo/ . .�• LIc-j;NsE tlo q4y,2
nn °,ate
J / %r.r
` s
�c f•�S� o
(yaz�A -T U-05SM AID,;Z
� SUE-►JA�I'(►�i1Si
y s►��aot 1, MA .�S E o�n
ILI
I. ASSF_SSoR`S MAP 1 8S, 'AI?GEI. L'7
2. FI.ovV2at,1E At9,E1,.11` �(7 .
3. M�Q PA-rilr4,le1,.o.0 VO P"tH or
�t dlgJ
��. /�'-i• r gSfE:rd s To at C+AL-VAPi'XED �o� ARNE\;y
5• �XJlstrlJC, Pig=IZ I�AIy P � FI.oA'(S Af't'12oJf:t7 o H.
�l G01-JSEQ�I ' OJALq
t od C OM M 15S1 OLl U►J I>E12 9G No.26;W8 V
C/ n ,o
0i A I A.?,,5 pi� I?AT E
dow11 cape- emgineericl. inL
fQ3Q rvvlG GA J
qa.f-re,ou4-%l- oc-{,rv�o. os.G2S
(50ST L- 44 Sy!
f�l�p.,.l /��GoMPA.►J`t!t►,1C, '1`�!� 1'cili:Tj�l pr
DAe5ARA C,R.bSSMArJ �
`16 A IVt(:-Q IG6 ti5E No . s of C)
To a f?0 /1 0 t--rP 10--A I Ll /-\ 1=L 0/,J-
10 AN 0 o JE?- f H E \,/ATr_zs o r i
_CCI�t'ft�.Jll�trE f,Zlyr
Town of Barnstable
Department of Health, Safety, and Environmental Services
230 Soutli Street, P.O; Box 2430
Ilyaiiiiis, MA 02601
Tel: 508-790-6250
B"RNBI"BL& '
Muss. Fax: 508.778-2412
Thomas F. Geiler, Director
TO: Rob Gatewood, Conservation
Dan Horn, Harbormaster
Ralph Crossen, Building Commissioner
FROM: Thomas F. Geiler, Directorof Health, Safety, and Environmental Services
SUBJECT Bornstein Property - Long Beach Road
DATE April 26, 1995
Regarding the above, please forward your comments to me by
.May 10 ._
Thank you.
I U v`I N OF MiliNSTABLE
BUILDING DEPT.
D .APR 211996'
• �FINE Tp�
The Town of Barnstable
BARNSrABLE,
MASS. Office of Town Manager
t6gq• ��
ATFOn�'i°' 367 Main Street, Hyannis MA 02601
Office: 508-790-6205 H�W E9 V E D Warren J. Rutherford
Fax: 508-790-6226 Town Manager
APR, 2 6 1995
TOWN OF BARNSTABLE
WEIGHTS ANC) MEASURES
UCENSIK!(--'/pARKiNG
TO: Thomas Geiler, Director, Department of Health, Safety and Enviromental
Services
cc Tom Mullen, Supt., DPW
FROM: Warren J. Rutherford, Town Manager >� }
DATE: April 25, 1995
RE: Bornstein Property - Long Beach Road
In reference to the enclosed, please consult with Mr. Mullen relative to Mr, Bornstein's
suggestion and then be in contact with Mr, Bornstein for resolution.
FROM TEL: APR. 14. 1995 '3:25 PM P 1
the
bornstein compo►nles
T :4.
1 .
297 north street, h9 annis, M0 02601 a le h e 5
,yt CSoa) 775-6526 1b
April 14 , 1995
Warren Rutherford, Town Manager VIA �ACSIM LF No, 7PC 6226
Town of Barnar.a )l F
367 Main ,StrAAr.
Hyannis, MA 02601
Dear Warren,
I am enclosing a elan of a house whi, h I own on speculation for
reeala on Longbear-h ir. Ccntcx•V:ille .
One of the problems wo havo been having has to do with li�ei:sin�•
the dock under the "grandfathered" licensing letwe which, the State
hao made availabic. In the course of doing this, we find LhaL
thorc is approximately two feet, of, concietc aL-uLmai-;L J.i) d
Tow,i way. There y no way to Ll':e waLut i,i Lhlizi Tuwn wdy; this was
done originally in 194-1 , Pudrslbly, Ulir, cl.>ck way there and an
easement- was yzaia.r:a 1:.) Uik- ;own which was, inadvertently,
incorpure<Led _:1L� a uuitier of our docX.. Tor all practical
purpoeee, we� du ijvL use it and I do not think anybody else will
aver uee iL UwL aL is solid concrete and almost impossible to
remove - ahurL of clyiibtaiiting it
The W6L rxway,a R(,,qulation Program requires approval from my easterly
ak�ulL�z , which is the ':own cf Barnstable, so that 1 can go aheaa
aiid license this dock.
I an beginning with you because I do not know where else to go with
it , 1f. you could please direct me where to go to get this
approval, 1 would appreciai.e it . We have been playing with this
thing now for over two and a half years.
Anything you cou.:la do would be greatly appreciated
Kindly yours,
SAa : jk
Enclosures (2)
"ROM TEL: APR. 14. 1995 3:26 FM P 3
naR_1 n--gs FR i,, L O;26 Dow14 CHPE ENi.t NkF-R i NG 508 362 9000 P. 02
1
Lautly, the WRp gannot bogin roview of thl.a application for lxaenba
issuance until Che following information has been oubmikted to the tile :
X Proof of Publication of the public notice
9 Expiration of the statutory 45 day comment period
21 Revise Mylar/Application Plane as followst
1. The mylar plansheet has been returned to your consultant for the
following revisions:
Add the historic Mean High water Shoreline (Hmxw) to the plan.
Pursuant to Waterways Regulations 31Q. CMR 9, 35, provide a lateral
aooessway upland of tho pier, concrot , �a and seawall ,
2 , Qbtain the aasant of yuux c�a9tarl mutt ex for the following :
The existinc conorare pad which extendu over r.he property line, and
The placement and use of the ramp and floats within twenty-five
(�51 ) feet of the property line.
.9hould you have any question with regard to the foregoing, please contact
me at (617) 55C-1.111.
Sincerely.
` 6 J�Qr4v�
Ja y leonard
Li ai Engineer
Water.wa a Reaulation Program
cc: aStuart Bornstein
Town of Barnstable Town Manager
'town of Barnstable Conservation commission
Daniel Horn, Harbormaster
0£five, of Cvaet al Zone Management
DRM, Ooeatt sanctuaries
DMP, Randall Fairbanks
DiviaiQn of Fiph & Wildlife
Massachusetts Niat:orical Commission
Capa God Cpmmission
WRP Application File (2)
`ROM TEL: APR. 14, 1995 3:26 PM F 2
1
APR-14,61`1 OCT 10,20 DO'", CI+I`l n,Gi112CRnvG b+otl •Oz ve8p p,Ba
'*-napwr�r'rwkM+t ewd
2A 7 "IDOO rN oqur
-•'••••• I•�.�nw.ln•1 Vi, -�h C�Gor.91
lM,'lCe4.6Rrr
49 6.4 Ac.rv*-)
\������ .•'" .w • M,N.W.AT e.",a P'
• / •GSNEsr�+akA� �'� r' M r1,4+. aT P�.•OB'
r•r „+,.,'� � r, ti�'C•,''YiKNin MIFgM't
N� — r��♦ / �� ��
// ..r.1�L� �,[v.Nr r�la,�aT>e.�.f►•iJ46 wOOtw lt+Mv
� f/'� • Iv --.�+ 1,.1�ca,�OfY �-JF..a��•C�C�hYiM1F�'a
•�. barb ••iGrJ,:-iAGlp-4 6 M1GifA
ROOK RM�r' !A('li/r'. P1sA+n'4 41•Ga,4i�'��t 60' '(.��,Q,tNhR1Vi� pJ 'T1 w.l h1b1C.
•r r r wwor OP er417 ove PtL7rr9
r/ D Y1.l�G+wi n+t:. .�.,1� e.-W I t) xpr.t,1p :"A w4 OC W+.+vtA
b r ' A YAWN v*v 4i&ww4
prrT ►.Vy N 6Y, Wn►+wb,M1► wlaKar
Ir 15'r;
(4•' x In'1
P1,rs>,ro Ccf►vw'�
i
is
cog OY'•G7w4a6•
djvv..�(1 C".ol�d/'aifl�M:f1l(l�, If'1C
�IVit,P.�Rl60�G*Yk
cum Gay,4�s.trr�aun�cr, M*
4�L.A.1J Ac`»C-p►�Pq+�i`Y n�Gr r- Ml CIF ,._._,�,:•_.J..:1��.._ .1 y
. The Town of Barnstable
NAM Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
July 18, 1995
Mr. Jeffrey Leonard
Department of Environmental Protection
1 Winter Street
Eighth Floor
Boston, MA 02108
Re: . 264 Long Beach Road, Centerville;MA"-_,
Dear Mr. Leonard:
The Town of Barnstable has no objections to the location of the pier and floats within 25
feet of its common boundary with the above referenced property.
Sincerely,
Ralph M. Crossen
Building Commissioner
RMC/km
i
• .�►arrsreaz�, •
The Town of Barnstable
Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
July 11, 1995
Mr. Jeffrey Leonard
Department of Environmental Protection
1 Winter Street
Eighth Floor
Boston, MA 02108
Re: t264 Long Beach Road,Centerville;MA-
Dear Mr. Leonard:
We have reviewed the site plan for the above referenced property. Although the bulkhead
infringes (to the east approximately 1.5 feet)on Town of Barnstable property, the Town
has no interest or objections to its current location.
If we can be of any further assistance, please let us know.
Sincerely,
Ralph M. Crossen
Building Commissioner
RMC/km
cc: Stuart Bornstein
-r .
. FPPM TEL: TUL. 17. 19a5 10:11 AM P 1
e r
HOLLY MANAGEMENT & SUPPLY CORPORATION
297 North Strept
Hyannis, Massachusetts 02601
(508) 775.9316
FAX (508) 775-6526
DATES July 17, 1995 VIA FACSIMILE No'. ' (50S) 790-6230
TOs Ralph M. Crossen
Building Commissioner, Town of Barnstable
Attention: Kathy
PROM; Stuart Bornstein
REs 264 Long Beach Road
Centerville
Thank you for your letter of July lath regarding the referenced
property (copy enclosed) .
Mr. Leonard of the Department. of Environmental Protection is now
requesting a second letter from, you stating that the Town of
Barnstable has no problem with the pier and floats being within 25
Feet of the common boundary.
Thank you!
(3} pages TtowN OF DA NSTABLE
BUILDING DER
Lj
Fr. CE �U
w FP M !Y TEL: JUL. 17. 1995 10:11 RIM P 2
The 'own of Barest able
Departtmeat of Healtb Safety and Ettvironmentat Services
Building Division
367 ti?aln Sheet,HyUWI MA 02601
Ofts, $03-7904227 ��Crossen
Fax: ",08.79Q•b230 13uildtng Comrdfuloner
July 11, 1995
Mr.Jamey Leonard .
.Department of Environmental protection
1 Winter Street
Eighth Floor
Boston,MA 02108
Re: 264 Long Beach!toad,Contorvidle,MA
Dear Mr.Leonard:
We have reviewed the site plan for tho above referenced property. Although the bulkhead
Infringes(to the east approximately 1.5 feet)on Town of Barnstable properly,tlic'town
has no interest or objections to its current location.
If we can be of any further assistance,please lot us know.
Sincerely,
Ralph M, Crossen
Building Conurdssioner
Rmc/lrnn
cc: Stuart Bometein '
p
TEL: JUL..17. 1995 10:12 AM P 3
JU'L-14•-9g FRS 14 :4 1 DOWN CA.EC ENGINLCRXNG 508 362 9883 p ®g
- a
L1kstly, the WRP cannot begin review of this application for license
issuance until the following information has been submitttad to the file:
A Proof of publication of the public notice
X Expiration of the statutory 45 day comment period
X Reviae Mylar/Application Plana as follows:
1. The mylar plansheet has been returned to your consultant for the
foll.owi revisions;
- V Add the historic Mean High Water shoreline (KM11W) to the plan.
pursuant to Waterways Regulations 310. CMR 9.35, provide a lateral
accessway upland of the pier, concrete pad, and seawall .
2. Obtain the assent of your east Orly abutter for the following:
-� The existing concrete pad which extends over the property line, and
he placement and use of the ramp and floats within twenty-five
(25� et of the property line.
Should you have any question with regard to the foregoing, please coaitact
me at (617) 556-1111.
Sir�G ely
Je y vi
le�onard
Li .Engineer
Waterwa a Regulation Program
cc: Stuart Bornstein
Town of Barnstable Town Manager
Town of Barnstable Conservation Commission'
Daniel Morn, Harbormaster
Office of Coastal Zone Management
OEM, Ocean Sanctuaries
DMF, Randall. pairbanks
Division of Fish & Wildlife
Massachusetts Historical Commission
Cape Cod Commission
W Application File (2)
4
snsxSTABX
PEAS&
bss
N
r
Office:.1�5Q0
Fax: 51"
6
r
f
t
' TOWN OF BARNSTABLE w
CERTIFICATE OF OCCUPANCY
e.
PARCEL ID 185 027 GEOBASE ID 10617
ADDRESS 264 LONG BEACH ROAD PHONE.
Centerville ZIP
LOT A BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT CO
'PERMIT TYPE BCOUB TETCIIPTION CERTFICA?E Q OCCUCY
TRACTORS: Department of Health, Safety
]�CHITECTS: and Environmental Services
TOTAL FEES i
BOND $.00 Ok1ME
CONSTRUCTION COSTS $.00
i
753 MISC_ NOT CODED ELSEWHERE * ;
* BARNSTABLF., •
MASS'
`OWNER GROSSMAN, BARBARA i6g9.
EA
ADDRESS 264 LONG BEACH ROAD �
CENTERVILLE, MA BUIL DI S N
BY
DATE ISSUED 07/18/1996 EXPIRATION DATE
c
' Q s n
t Assessor's Office(1st floor) Map O S Parcel a r/dXPermit# / Y-�
conservation Office(4th floor)(8:30- 9:30/ 1:00- 2:0 ) Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) e (�
J Engineering Dept.(3rd floor) House# At4c S ;UST BE
INST C�
R
y amm�g r GO- LOP, EUVCR RAW
TOWN OF BARNSTABLE Town R or��
r
Building Permit Application
Pro t Str t Address / Lau &-f�-/4- &Z
Village v G
Owner Address
Telephone — :zE4— I IS
Permit Request L2 kza�4 &/_ =:Z� _
First Floor square feet lro? /
Second Floor square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size 3l� A- _ Grandfathered ?
Zoning Board of Appeals Authorization ��� �i�C i iC D Recorded
Current Use Proposed Use
Construction Type
Commercial ec esidential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure, 19. Basement Type: Finished y�
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 •Vp
None Sheds
Other
Builder Information
Name /IItIg Telephone Number/,
Address icense#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE✓� , GTE a,S1 f a ,1, 6 DATE-�C— yt�
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
vs
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO.;
i
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME m V" W —
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: -WUdH FINAL
GAS: i I UQU : FINAL
FINAL BUILDING --� � .�' •�..Cj�
DATE CLOSED'A
ASSOCIATION !.
"� m
i
310 CMR 10.99
Form S DEOE File No. SE3-2988
�.• C�THE�0` (To be prortletl by DEOEI
v�P` #, Barnstable
Commonwealth City.Town
Grossman
SEff ? of Massachusetts i BAR13TLU : Applicant
%639
�•. `= f0 YAY M.
Order of Conditions
Massachusetts Wetlands Protection Act
G.L. c. 131, §40
TOWN OF BARNSTABLE ORDINANCES, ARTICLE XXVII
From Barnstable Conservation Commission
TO Ronald Grossman same
(Name of Applicant) (Name of property owner)
49 Apple Valley Rd.
Sharon, MA 02067
Address Address
Map Number 185 Parcel Number 27
This Order is issued and delivered as follows:
❑ by hand delivery to applicant or representative on (date)
® by certified mail. return receipt requested on March 21, 1996 (date)
This project is located at 264 Loner Beach Rd. . Centervil l P
The property is recorded at the Registry of Deeds in Barnstable
Book Page
118395
Certificate (if registered)
The Notice of Intent for this project was filed on Jan. 30, 1996 (date)
The public hearing was closed on Feb. 27, 1996 (date)
Findings
The Barnstable Conservation o mi Gci nn has reviewed the above-referenced Notice of
Intent and plans and has held a public hearing on the project. Based on the information available to the
Commission at this time.the Commission has determined that
the area on which the proposed work is to be done is significant to the following interests in accordance with
the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the
Act(check as appropriate):
❑ Public water supply Flood control Land containing shellfish
❑ Private water supply Storm damage prevention �isheries
❑ Ground water supply Prevention of pollution C ' Protection of wildlife habitat
Total Filing Fee Submitted $2.29.00 State Share $102.00
City/Town Share ('/-,fee in excess of S25)
Total Refund Due S City/Town Portion S State Portion S
ARTICLE 27 only: (1/2 total) (,h total)
/Public Trust Rights ❑ Agriculture ['Erosion Control
❑ Aquaculture [Recreational
Q�Aesthetic
Effective 11/10/89 ❑ Historic
5t
MICHELE C . TUDOR , P . E .
Consulting Structural Engineer
123 Cottonwood Lane •Centerville,Massachusetts 02632 • Fax/Voice(508)771-7601
July 12, 1996
Mr. Ralph Crossen
Building Commissioner
Town of Barnstable
367 Main St.
Hyannis, MA 02601.
RE: Grossman Residence
-264 Long Beach Road ti
Centerville, MA ,
Proposed Flood Resistant Foundation
Dear Mr: Crossen,'
Please be advised that as of this date the structural requirements for the above captioned project,
as shown on the structural drawings, SK-1 through SK-3 inclusive, as provided by this office,
have been completed.
You will note that this structure is flood resistant to the Base Flood Elevation of Elevation.11.0,
at minimum. The building walls are substantially impermeable to the passage of water,which will
not permit the accumulation of more than 4 inches of water during a 24 hour period.
The 6'-0"wide glass sliding door openings are protected by flood shields, manufactured locally.
The flood shields are stored along the building exterior, and shall be installed over the openings
prior to flooding. Periodic inspection of the flood shields is required to ensure that they fit
properly and that the gaskets and seals are in good working order.
Upon your approval of all items in addition to those covered herein, this office recommends that
an Occupancy Certificate be issued on this project.
Sincerely,
Michele C. Tudor,`P.E. 0-�1i OF.�„gs��c .
MICHELE
Account ID: GrossmanOccpy �uooR4 -
s
cc: R. Grossman, File STRUCTURAL
�fSSIONAt E��\
tel.(508)362-4541
939 main street rt 6a fax(508)362-9880
yarmouth port
mass 02675 down cope eneifteerifg '
civil engineers& land surveyors
structural design July 1 7 1996
� Arne H.Ojala P.E.,P.L.S.
Timothy H.Covell,P.L.S.
land court David C.Thulin,P.E.
surveys Mr. Ralph Crossen
Town of Barnstable Building Inspector
P. 0. Box 534
site planning Hyannis, MA 02601
Re: 264 Long Beach. Road, Centerville
sewage system
designs
Dear Mr. Crossen:
This is to certify that the elevation of the top of the aluminum
inspections structure, which I understand is to provide storm damage protection
for the residence at the above address, is at elevation 11.2 NGVD.
The base flood elevation for this area is 11.0 NGVD. No
permits certification is made as to the adequacy of this structure to its
intended purpose.
Very truly yours,
Arne H. Ojala, P'.L.S. ,P.E. tHOf ,
ARNEs
Cc: Michelle Tudor P.E. M.
B. Grossman Oi,1ALA y
N W 26348
it
A[ LANO SO
O
`y
` The Commonwealth of Massachusetts
-- �—.�;:.• Department of Industrial Accidents
,x - iF 0111ceofi mest/yatloos
60011'ashimegon Street
Boston.Alas. 02111
Workers' Compensation insurance.AMdavit
_.__. .. __.__.. --,.._.�... ..__.. .. »,.-.cam••-. --.,--
,Annlican nformaiion: Please PRiWT«
citti• /y phone# 61 7 7e 51-11 7
am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
comnanv name:
address:
m�'• tthone#•
a le pro or,general contractor,o _ eo t ii o and have hired the contractors listed below who have
e fo ng workers' compensation pol' ----
comeatn-name:
address! :..
city phone s!
insurance co. policy#
�.�x-t.. ��--:,,T.: �:_ �rnt:rr..�,a��?y 7..:�.iR;�;'i?.4F.:'xr3=S - - --- -T.RF�a01E?�R:!!'t�'1.7�RS�� •9!.�R4'3�4�sT!".":':7S
comnanv name:
address:
i v: phone#•
insurance co. policy Al
;Attach sdditiiinai'sheet if tiice ie i.. '-yasrAY;'t;'h1J"rr�exp;= :•ram. .a a..
' .ice a.a:•.as.n:.
Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of it STOP WORK ORDER and a tine of SI00.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. '
!do ltereht•cc Jj-under the pains and penalties of eoYmy float the information provided above is tosoe and come
Signatu ate /
Print name' Phone# LIW-7 —
official use only do not write in this area to be completed by city or town official
city or town: permit/license# Building Department
[3l.icensing Board `
p check if immediate response is required Selectmen's Office
Dllcaltb Department
contact person: phone#;. nOthcr
(revised J-'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 empinree is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An emplityer is defined as an individual, partnership,association, corporation or other ;opal entity, or anv two or more of
the fore::=oing 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
dwc1lin-, 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 1'52 section 25 also states that even,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.
.•r w*-77 7.P�-7 7777i.•• i•";.: • �.n l i.. ay:w ii"::,',a ..V:I"• may•=C t-..i.tAr .y:
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.
.. :..............,.... _ i fir. 6Cu% ...L .3'si-�>. ,'i • ._. _.
�.. .� �.; t- �J +.r'-.+ pit+•}i.. tl,t. �%'...
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
!
r t I r
The Office of]nvesti=ations would Like to thank you'in advance for cooperation and should you have any questions,
please do not hesitate to give us a call.
.- ..,Y... :,....rv .--�e!..!sv:`er._ - .-yew'':.,. .• Se�:e;...::�':.' ."'a :.•:iur_,;.`►=.:r-'. :: ,;e- :�:,j•�•.:r•:.:.
777. .. - : � Syr ate.,.:. . _ ••„-...,,...yy... ..
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) 7274900 ext. 406, 409 or 375
L
• TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION G�-
_ Number St et address Section of town
"HOMEOWNER" -
L
Name Home phone Work phone
PRESENT MAILING ADDRESS
of
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 such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Person(sj who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six 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 Stat
Building Code and other applicable codes, by-laws, 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 requirements.
HOMEOWNER'S SIGNATURE_
i
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
i
HOME OWNER'S EXEMPTION
The code state that: "Any Home Owner 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
Home Owner engages a person(s) for hire to do such work, that such Home Owner
shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for licensing Construction Supervisors, Section 2. 15) . This lack of awarenes
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it would with licensed Supervisor. The Home It0-wner- actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities, man
communities require, as part of the permit application, that the Home Owner
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 to amend and adopt such a form/certification for use in your community.
° The Town of Barnstable
1�P Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
O&ce: 508 790-6227 Ralph Crosse►
Fax 508 775-3344 Htz C.ommz_
g
For office use only
Permit no.
AFFMAVIT
ROME MO'ROVEMENTCONTRAGTORLAW
SUPPLEMENT TO PERKM APPLICATION
MGL c 142A requires that the"reconstruction,alterations;renovation,.rcpM4 Mkmi=d t,aonversiost►
improvement,.removal, demolition. or construction of an addition to nay PMI ee Omer 000F
building containing at le one but not mom than four dandling units or to some asz
ast adjacent
to such residence or building be done by registered aontrac tOM with eatain C=Ptions, along with other
requirements. '
Type of Work: &IAL
-Cost
Address of Work:
Owner.Name:
Date of Permit Application:
I hereb<•certify that:
Registration is not required for the following reason(s):
Work ccduded by law
Job under S1,000
_
�— wilding not owneroccupied
Owner pulling am permit
Notice is hereby gh n that:
OWNERS PULLING TMR OWN PERMIT OR DEALING VVTrHUNREGIS1' D CONTRACTORS
FOR APPLICABLE HOME IMPROVEivtENT WORK DO NOT HAVE .ACCESS TO ME
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A
SIGNED UNDER PENALTIES OF PERtURY
I hcrcby apply for a permit as the agent of the owner.
�r Registran
Date Contractor frame tio No.
OR
e�cac nfF;^o ` __-) Map Parcel G �, Permit#
Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) 5 %ate Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45 Fee `.2S,G c)
Engineering Dept. (3rd floor) House#
• ' BARNSTABLE, `
MASS.
F.proveaTy-FTEN..goRewd 19
TOWN OF BARNSTABLE
Building Permit Application
P ject S Address (Q y LOnG1 5
Village C en4cy6 l ` e '
Owner'—Bd/ ay-n J <c/ SS(Y1Ctr1 Address c2�q LOAQ --Leca pR ,
Telephone
Permit Request p is c f-1
First Floor 3O square feet ,
Second Floor �- square feet
Estimated Project Cost $ S'c3y
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ?
Zoning Board of Appeals Authorization n Recorded
Current Use Proposed Use
Construction Type
Commercial - Residential
Dwelling Type: Single Family J Two Family Multi-Family
Age of Existing Structure Basement Type: Finished /
Historic House Unfinished V/
Old King's Highway
Number of Baths �-�- No.of Bedrooms 4
Total Room Count(not including baths) First Floor
Heat Type and Fuel CA Central Air Fireplaces_
Garage: Detached Other Detached Structures: Pool
Attached U Ad e/' Barn �
None Sheds 0.
Other
Builder Information
Name k o 4 Y' Telephone Number
Address License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
IGNATURE C [.�,J �►,E-d�J J DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO. '
DAFT, E ISSUED
M P/PARCEL NO.
ADDRESS VILLAGE I r
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME;
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH - FINAL
GAS: ROUGH FINAL
FINAL BUILDING ;
,
DATE CLOSED OUT
ASSOCIATION PLAN NO.
tER-v���E R lvE
Gti� --�
DECK�
occk S'*bRY Wopp ZNs STY +1
}� FhAME 14*(XF .
Zlop
cF* E,&v. wqs• _� W
!; 59.oY
4
iLot
1LA,-1GLit
�o.3tiiAc� 3�� r
I
0
LONG SEAIIC -% RoA�
Z t�
3 a -
F°- d
0
�s ice f 89-235
CEPTII IED PLOT PLAN
LOCATION. - LOT A LONG BEACH RD CENTERVI PP
EPARED FOR:
SCALE: 111=40 - DATE: 08/30/89
REFERENCE: SKAIWMUT BANK IV.A.
L . C . C . #16409
I HEREBY CERTIFY THAT THE STRUCTURE N IGKU L^S SORNS-T"EIN -MUST
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS .SHOWN HEREON.
STRUCTURE CONFORMS TO SETBACK REQUIREMENTS
OF THE TOWN WHEN CONSTRUCTED
STRUCTURE FALLS IN FLOOD HAZARD
ZONE A-13 ��N OF
own cape engineering, inc . ��� JOHN
CIVIL ENGINEERS CELVVM
LAND SURVEYORS
444f&r "9
ROUTE 6A YARMOUTH MA DATE R
d
Form 5 DEOEFa 7
File SE3-302
.► ��THE T� (To be provioed by DECEI
Q�.
W a fq City Town Barn+ab�P
Commonwealth Grossman
of Massachusetts a ss���sr> Applicant
9�p 1t
Order of Conditions
Massachusetts Wetlands Protection Act
G.L. c.131, §40
TOWN OF BARNSTABLE ORDINANCES, ARTICLE XXVII
From Barnstable Conservation Commi5aien — - —
To Ronald Grossman same __—•_ —__—_ --
(Name of Applicant) (Name of property owner)
49 Apple Valley Rd.
Address Sharon, MA 02067 — _ Address—
-----
Map Number 185 Parcel Number 27
This Order is issued and delivered as follows:
(date)
O by hand delivery to applicant or representative on
r A r.i1 25. 996 (date)
E) by certified mail. return receipt requested on
This project ls;l'oea'�ted attl'` 264 Loncr Beach Road Centerville
.-.� �. .'F' .•?,;57.�'"• i•.ti Ee .� .. a"t�`J,1.;1�+
1,
C.1" 1': ' '+ ?Deeds in Barnstable — -
The property is recorded at the Registry of _.. _ , ,; . .. ;
P -
Book age
Certificate (if registered)
118395 —
The Notice of Intent for this project was filed on march 25 1996 (date)
April. 9, 1996 _(date)
'(h.e piJbiic hearing was cioscc.'u_vi..__�.�.—_------- --- -
Findings
TI?e B�rrstabl.e onserY. i:rri__C=�cii-ss;=�:�— _has reviewed the above referenced Notice c!
Intent am plar?s and has held a public.hearing car;the project. !?2sed on tt;e information,available to the
commission at this fir-re,tna C<�rmiss_ion has detenrined that
the area c i which the proposed work.is tc be do r significant to'.he following interests in accordance with
the Presumptions Qt Significance sell forth il?the r .gulatlot?s for each AI•ea Subject to Protection Under the..
Act( eck as a,propriale)`
i Public water;;apply L� ,.FI oc CD`trCt l� Land containing.snellfis11
;Private watp�`:;.,tep'�. C Stomm d ma prevention r Fisheries
water s6p'p'ly P r,=ve,:t�.,-.°.f pollution t J Protection of tvl=dfife t abjsai
51.00 --
- Total Filing Fee Submi?ed_� __— State Share �_ _ 5 15.00 -
cl _ _ (1�:.fee tri a LSa.04.�25).
7=1 Refund lown Share
SUE� _ �.It���y?tt'i POf I^•'r2 �_�_� Stavc i�-Tion s_.
R°�'ICTFs 2% Cnly:� (',`$tvt21) ('/a to
Q. . t,.r._iculture � Ero:--i-
. �aa Control
Public TraSt Rigbts � � 3_ecxeational
® .Aafpjacu,l.tu e
�j $;'tS�QXiC C AesthetIc
Bffeciive i ih gr69
5 �
Issued By Conservation Commission
I
' atur 1 rder must be signed by a majority of the Conservation Commission.
On this day of tsxy,,A 19 9 before me
personally appeared • �.' ' s1 to me known to be the
person described in-and who ezecuted"the foregoing iistr lment and acknowiedged*that'he/she executed the same
as his/her free act and deed.
Notary Public My commission expires
The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed
work is to be.done or any ten residents of the city,or town in which such land is located are.hereby notified of their right
to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is
made by certified mail or hand delivery to the Department within ten days from the date of issuance of this Order. A copy
of the request shall at the same time be sent by certified mail or hand delivery to the Conservation"Commission and the applicant.
Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work.
To Barnstable Conservation Commission(Issuing Authority)
PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT ' 264 Long Beach Rd. ,
Centerville . FILE NUMBER SE3-3027 HAS BEEN RECORDED AT THE
REGISTRY OF
ON (DATE)
If recorded land, the instrument number which identifies this transaction is- `
If registered land. the document number which identifies this transaction is
Signed —�
Applicant
I
1
SE3-3027---Grossman
Approved Plan=March 23,1996 Site Plan,Arne Ojala,PE
...1. --, _General-Conditions-l_a12_on;the preceding page are bin ding,_and demand both•your attention and,
complianc 'e rw '
2. Within one month of receipt of this Order of Conditions and prior to-the commencement of.any, .
work approved herein,General Condition number 8(preceding page)shall be complied with.
3. The applicant shall pay for their legal advertisement as invoiced.
4. The deck shall be supported by sono-tubes.
5. No creosote material shall be used.
6: F'This approval is contingent upon the approval by the Board of Heal th«of the subsurface sewage
disposal system.
7. All areas disturbed during construction shall be revegetated immediately following completion of
work at the site. No areas shall be left unvegetated or unmulched for more than 30 days.
8. It is the responsibility of the applicant, owner and/or successor(s) to ensure that all conditions of
this Order are'complied with. The project engineer and contractors are to be provided with a copy
of this.Order and referenced documents before the commencement of construction. The foregoing
condition shall 'not be construed to exempt project'contractors from'responsibility,for any`work ' «
performed m deviation with provisions of the'Order of Condition's or with the detail of the plans
of record., ax..
9. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect
for compliance with the provisions of this Order of Conditions.
10. At the completion of work,or by the expiration of the present permit,the applicant shall request in
writing a Certificate of Compliance for the work herein permitted. Where a project has been
completed in accordance with plans stamped by a registered professional engineer, architect,
landscape architect or land surveyor, a written statement by such a professional person certifying
substantial compliance with the plans and setting forth what deviation, if any, exists with the
record plans approved in the Order shall accompany the request for a Certificate of Compliance.
.. a i4
A
0 x
Therefore, the Barnstable Conservation Commission hereby finds that the
following conditions are necessary, in accordance with the Performance
Standards set forth in the regulations, to protect these interests
checked above. The Commission orders that all work -shall be performed in
accordance with said conditions and with the Noticetof Intent referenced
K
abov,'e: To the extent that the -following conditions;modify. or differ from
the plans, specifications-or other proposals submitted-with ahe� Notice
of Intent, the conditions shall control. r.
General Conditions: _
1. Failure to comply with all conditions stated herein, and with all
related statutes and other regulatory measures,. shall be deemed
cause to revoke or modify this Order.
2. This order does not grant any property rights. or any exclusive
` privileges; it doEs -not_authorize any injury_to. private property
or invasion of private rights. 3 .
3. This order does not relieve the permittee or any other person of
the necessity of complying with all other applicable federal,
state or local statutes, ordinances, by-laws or regulations.
4. The work authorized hereunder shall be completed within three
years from the date of this Order unless either-of the following
apply:
a) The .work is a maintenance dredging project as provided for
in the Act; or
b) The time for completion has been extended to a specified
date more than three years, but less than five years, from
the date of issuance and both that date and the special
circumstances warranting the extended time period are set
forth in-this order.
5. This .order may be extended by the issuing authority for one or
more periods of up to three years each upon application to the
issuiriq- atit ority-a' 'least : 0 cages prior to the expiration date '4l
the. order
6. Any fill used in connection with this project shall be clean fill,
containing no trash, refuse rubbish or debris, including but not
limited to lumber, bricks, plaster, wire, lath, paper,. cardboard,
pipe, tires, ashes, refrigerators, motor vehicles or parts of any
of" the foregoing:
7. No work shall be undertaken until all administrative appeal e
periods. :frcm this order have elapsed or, if such an .appeal has
been filed, until all proceedings before the Department have been
completed.'
8.1 No work,ahall be undertaken until the Final order has been
recorded'`in the Registry of Deeds or the Land Court for the
district in which the land is located, within the chain of title
of the affected property. In the case of recorded land, the Final
order :shalL also .be noted .in the Re,gistry•s Grantor index under
-the name of the' owner of the land upon.which the proposed work is
''t" be done: The- recording information shall be ,submitted to.athe. ,
K coidriis9ion,-.on then form,at the end of-this. prior to
commencement of the work.
9. A sign shall be displayed at the site not less. than two square
feet or more than three square feet in size bearing the words,
"Massachusetts Department of Environmental Protection, File Number
SE3-3027 ."
10. Where the Department of Environmental Protection is requested to
make a determination and to issue a superseding order, the
Conservation commission- shall be ,.a.party, to .all agency proceedings
and hearings bnf i6 the Department. .� • -
11. Upon completion of the work described herein, the applicant shall
forthwith request in writing that a Certificate of Compliance be
issued stating that the work has been satisfactorily completed.
12. The work shall conform to the following plans -and special
conditions. i.
ZAa Ir.
_ a ,....-; f ..a.,-... --. • me ...l. .. ._. ,:. _`, ter'. .:X`' _ ,..
_ f
.'.ti,.t aaRwae:3 .i. �..r,.i"�..:.,`.�y�'�i ., L � • S `.�':: _ :'-'ttX"aiY,'. r •..,... C.`4.E is C. }
v
d
L
The Town of Barnstable
HAM' S De artment of Health Safety and Environmental Services
Buff-4-in g Division
367 Main Strut,HYaaais MA 02601
aalph C==
Off= 509-790-6227 Building
Far- 508-775-33"
For office use Only
Permit no.
Dau AFFMAVIT
HOME BUROVEMENT CONTRACrORLAW
SUPPLEMENT TO PERMIT APPLICATION
anon,aitetat GM rtaovat=repair,modcrni trou,conversion,
MGL c 142A requires that the"rzcotsstnn ction of an addition to 2W P Bch ==pied
remo%ml, demolition. or aonsuu
>nsiIding containing at least one but not more than four dwelling units on among with to such residence or building be done by registered contractors.with
rcquircaeats
Type of Wark: G�
Est, Cos '4zu -
Address of Work-. .21.,`-:
n e-t N rA✓t. r.�sm an
O rtter.Name:
Date of permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work c chided by law
job under SI,000
uilding not mvnw-00cupted
aw=pulling own Pit
Notice is hereby gh=that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING DSO NOT HAG LESS TO THE
FOR APPLICABLE HOU E RAFROVov'ENT
ARBITRATION PROGRAM OR GUARANTY FUND UN MGL c I42A
DER
SIGNED UNDER PENALTIES OF PERMRY
I hereby apply for a permit as the agent of the owner.
No.
Conuz
Dat ,1�
OR '
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE 5
JOB LOCATIONLoo
I
Number reet address Section of town
"HOMEOWNER" QL 61-7. y r-(n
Name Home phone Work phone
PRESENT MAILING ADDRESS C4( 4�7JC UQI1,nA -b((Je
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 such homeowners to engage an in-
dividual-for hire who does not possess a license, provided that the owner
acts as supervisor.
DEFINITION OF HOMEOWNER:
Persons) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six 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 Stat
Building Code and other applicable codes, by-laws, 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 requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35, 000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
HOME OWNER' S EXEMPTION
The code state that: "Any li ome Owner performing work for which- a building
permit is required shall bd.",exempt from the provisions of this section
(Section 109. 1 . 1 ,- Licensi" of Construction Supervisors) ; provided that if
Home Owner engages, a perso
s�u ns) for hire to do such work, that such Home Ownez
shall act as perV sor. " ,
Many Home Owne�s who u,se {this exemption are unaware that they are assuming
the respons ' ice ies bf., as supe� visor (see Appendix Q.� t , Rules and Regulations
for licensing Cons uctdn Sup rvisors, Section 2. 15) . This lack of awarenes
often results in se 'ousprobl s, particularly when the Home Owner hires
unlicensed persons. th\' s ca a our Board cannot proceed against the
inlicensed person as i wou d w th licensed Supervisor.- The Home `bwner actin
as supervisor is ultima { ly es onsible.
To ensure that the Home ,IOw �r ' s fully aware of his/her res onsibilities
communities require, asipa 'of he permit application, that the Home Owneran
certify that he/she underst ds he responsibilities of a supervisor. On the
last page of this issueis a r currently used by several towns. You may
care to amend and adoptiIsuch m/certification for use in your community.
i
r -
aft
• TheComnrunx'tultb of!ltassacl Iusctts
+ ...1� 1 j'..ii� ♦ +
... �'.��•� Department of Industrial Accidents
6fJ 1 11 i -U)n Street
'1* Bum7on.M ass. 02111
Workers' Compensation Insurance Atridavit
Please PRI1V'i'T�tbl_y�
nh •gym tmormation
ttams� �f�xn/� �• cs(.��
C1I1 r all nhone#
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
rl 1 am an empiover providing workers' compensation for my employees working on this fob.
address!
city. phone#•
insurance co poitcv# .M_..--.-
C.... •..
I am a sole proprietor,general contractor, or homeowner circle one)and have hired the contractors listed below who
the following workers' compensation polices:
somnIt» nImc U S i1 ^�r✓
address*
rih•! 'j'
_c — cam.
sun P G�' (C)-1 /� # J
nm inv name*
iddress:
city phone#t
insurnnee co-
'' neiicv# . .. .
:Attach sddltional'shtiet If rieeeiar , ^- �"'� �"' `^"•r'•`' - - - ---- �*owl
fu'ilure to secure coverage as required under Section:SA of 111GL 152 an lad to the imposition of criminal penalties of a tine up to S1.500.00 sat
une vears,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a floe of S100.00 a day against ma 1 undtxstand tbv
copy of this statement mad be forwarded to the OM
of investigations of the DIA for coverage veriQation.
1 do herehr renrif y under the pains and penalties ojperjurr that the injornmtion pro►ided above is true and convxL
- ate
Signature
Primname —Ra/60VrA — -Ph 1one# -7 6i 6 r Ian
LIE
r
otlicial use oniv do not write in this area to be completed by city or town otliciai
cin or to'
do rm=itAlcense# rntiuilding Department
(3Liceasing Huard
check if immediate response is required (]selectmen's Otlice
O11aith Department
contact person•
phone#• mother_,__
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensat.;09 for
employees. As quoted from.the "law-, an enrplgree is defined as every person in the service ofanother udder any
contract of hire, express or implied. oral or%witten.
An etnphti- r is defined as an individual. partnership, association, corporation or other legal entity, or any two or n
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or tite
rccciver or trustee of an ind, ividual , partnership. association or other legal entity, employing employees. However
owner of a'dweiling house flaying not more than three apartments and who resides therein. or the occupant of the
dwcilin`, house of another wli 1employs persons to do maintenance , construction or repair work on such dwelling
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empic
l E
j.
MGL chapter 152 section '15"alsostates that even• state or local licensing agency shall withhold the issuance or
i
rencival of a license or pe n to�pernte a business or to construct buildings in the Common��calth foram
applicant who fins not produced acceptable e�,i ence of compliance with the insurance coverage required.
Additionalh•. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
�• ' J s compliance with the insurance re uirements of this chaps:
evid nce of
.tcee able q
performance of public work until �p� � � P
been presented to the contracting i th-;ri I
• - . . . ...-....�.+.�w .�1... .. .:�..b••. .�•i'�.:: , _.,... .e�10 `4a;..'r,�a7M:..•?:��:.��:. :..::.u ',.,r�a�.^�.::7 '�'i�•ey•�.
Applicants
Please `;11 in the workers' compensation a vi c m pletely, by checking the box that applies to your situation an
as all affidavits may be submitted to the Department of
supplying company names, address and phone'numbe
Industrial Accidents for confirmation of insurance.,9%ie nee. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that t1 I app 'cation 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 requi
to obtain a workers' compensation policy, pleaseEcall thq =nt at the number listed below.
P �
... .. .. - _ •'S_s :>.: .�'_. . . .-�:• '.w�i�.r.�. ���..►. :'~ice.r..+3'r:.•t c''ua'i..' _
Clry or Towns �
Please be sure that the affidavit is complete and printed legibly. T'he Dep'a ment has provided a space at the bottotr
the affidavit for you to fill out in the event the Office of Investigations has t;contact you regarding the applicant. F
be sure to fill in the permit/license number which wili;be�sed as a reference number. T1te affidavits may be retttrne
the Department by mail or FAX unless other arranged enIs have been made. \ \
► would like to thank you �;ii advance for you cooperation and s ould you have any quest
The Office of In estigations -
please do not hesitate to ;,give us a call.
17he Department's address. telephone and fax number
The Comtnolmvealt� Of Massachusetts:
Department of Industrial Accidents y'
Office ofInuestigations
600 «'aslii Teton Street -
Boston,Ma. 02111
fax #: (617) 727-7749
nhnnn #- (617) 727--1900 ext. 406, 409 or 375
r
MICHELE C . TUDOR , Q.P. E .
Consulting- Structural Engineer
123 Cottonwood Lone •Centerville,Massachusetts 02632 • (508)771';��
DATE January 24, 1996
Building Department
Town of Barnstable
367 Main St .
Hyannis , MA 02601
A.TTN: Ralph M. Crossen
Building Commissioner
RE:
(ossman Reside e
64 Long Beach R Centerville , MA
Dear Mr. Crossen
This office is forwarding herewith:
Addendum #1 to Engineering Sketches SK-1 , SK-2 , and SK-3
Remarks ,
Also , returning your copy of "Flood-Proofing Regulations" ,
US Army Corps of Engineers .
ACTION KEY:
Generally conforms with ( ) ' As requested.
. design, subject to notes . ( ) For your use .
(. ) Rejected, ( ) For your information & file .
( ) Revise and/or complete as ( X ) For inclusion in the project
noted. plans and specifications .
( ) Resubmit. ( ) For your review & comments .
By s ,�✓
Michele C . Tudor, P.E.
cc : File
I
Opt1iE iq�,_
. "�. The Town of Barnstable
IIAMUrnBM •
16A388� `0�' Department of Health Safety and Environmental Services
"rFc Meg" Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
May 27, 1997
TO WHOM IT MAY CONCERN:
Please be advised that side rails are required on structures if the distance to the ground is over 30".
Further, intermediate balusters,either horizontal or vertical,9"on center,are also required. Other side
balusters that achieve the same purpose may be allowed by the building official on a case by case basis.
Sincerely,
Ralph M.Crossen
Building Commissioner
RMC/km
,*TWE TOWN OF BARNSTABLE Permit No. ..33611 ,
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
7 M�
i679•
q''�owr► HYANNIS,MASS.02601 Bond X
CERTIFICATE OF USE AND OCCUPANCY
Issued to Larry Nickula5
Address 264 Long Beach Road
Centerville, Mass.
USE GROUP- FIRE GRADING OCC:UPANCY.LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON:;SATISFACTORY COMPLIANCE.WITH TOWN
REQUIREMENTS.AND.IN ACCORDANCE WITH SECTION 119;0.OF THE"MASSACHUSETTS•STATE
BUILDING CODE:, .
January 4, 19:.94 ?i. .
............... ... . . .. � ildng.Inspe5to.
'! Assessor's office(1st Floor): SEPTIC BAST
Assessor's map and lot number�i�5/l �� �G AF �NST EIS MIDST BE QyoF YNa toy`
Board of Health(3rd floor): / \ `� N�PUANCE
Sewage Permit number �—` , D /', �} �q �� E 5 • •
�r Z DADQ9TADLL i
Engineering Department(3rd floor): MMRON'� N fAL CODE AND NAM
2C c/ PL — TOWN REGULATIONS �, 39
House number, °o .639•
Definitive Plan Approved by Planning Board /J�/i/�9
APPLICATION P Pff W3VJ800-9:30 A.M.and 1:00-2:00 P.M.only
xx _
Are'L
Is CAserfsAt�®A a�® N OF BARNSTAB`LE'
�-1 - � LDING INSPECTORDatePICATION FOR PERMIT TO /(/. /
TYPE OF CONSTRUCTION C-1p
�� 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following informatio
Location
Proposed Use
Zoning District �� `! Fire District
Name of Owner i � Address A(k ?2,,C_ 6A, Axlxe��I
Name of Builder / Address
Name of Architect ! 'C1 Ao7z Address
Number of Rooms Foundation ®
Exterior 66 Roofing f /
Floors / � f Interior �T
Heating Plumbing e �
Fireplace Ve Approximate Cost ZATOe 0
�/Area !Z
Diagram of Lot and Building with Dimensions Fee
�q®
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding a above constr
Name
Construction Supervisor's License �� z
NIJ'ZULAS, LARRY
s No 33611 Permit`For wo Story
-
Single Family) Jellincr
-
Location 264 1Long Be ch Road
too
CentervilleTlt
rl
Owner Larry Nickulas
1 } '
-Type of Construction fS Pr P
Plot Lot
Permit Granted March 2 6-, ^ 19 90
Date of Inspection �"" � 19 �' s
1� l �
� �r
M P
Zj
i4 ���Z193 1,ri S v L / ..`
CO
WE
MO
° 2, r f
Ji
°.'e 7 /fir..
SIS5 027. A F F R A J. S A L 0 A T A KEY i06174
BORNSTEIN, STUART A
LASO OLDIPEATURES BUILDINGS NUNSER upwo
315nW lol ,soo 1. A-COST 416,SOO
OWT 415,50ci
BY oo/ or me 3/9.1 &INCOME
PCA=1011 FCS=00 SIZE= 3336 JUST-VAL 416fSOO
LEV=500 CONST-C 0
----COOPARISON TO CONTROL AREA 35UA -- TREND EXCEEDS STANDARD
NEIGHBORHOOD 35UA OSTERVILLSICENTERVILLE
PARCEL CONTROL AREA TREND STANDARD
i 15 Is , LAND-TYPE.,
31500�) LAND--hEAN +0%
416800 576800 !NPROVED-HEAN -82% 25%
FRONT-FT
100 OEFTOIACRES TABLE 02
100% LOCATION-AW APPLY-VAL-STAT I
LNR LAND LFTIIMP ADWISSIFEAT SIR STRUCTURS ARR AREA-NEASUREMENTS NOR NOTES
COE MARKET INC INCOME PER PERMITS GRR GRAPHIC
FUNCTfom- STRUCTURE-CARD NO- 000 QATA- XMT
� t t
,,/I LLE
%No 5Tr
„i DfGK)?
1 occk 1 2 S�P-Y Woop I %No S-rY }j
+r FLAME sco&F
F Env. r4 gV 1� ..�.!!
ro � W
fr S9.o I t
dri
• IH,iGyt � v
(o.3tiiAc� s°
0 .
LONG BEAGF�► ROAD
Z ul
V1
0 .0
d
v
i
::
j�
CEPT: F I D PLOT PLAN
Locarrow "OT A LONG BEACH RO CENTERVI P�EP�RED FOR:
SCALE. 1 "=40 ' DATE. 08/30/89 '
REFERENCE, —% AWMUT BA-4 y4 N.A o
L . C . C . #16409
I HEREBY CERTIFY THAT THE STRUCTURE N IGKU LAS gORNS—mit4 "mj s-r
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON,
STRUCTURE CONFORMS TO SETBACK REQUIREMENTS +I
OF THE TOWN WHEN CONSTRUCTED
STRUCTURE FALLS IN FLOOD HAZARD
ZONE A-13 d� OF
Own cape engineering, inc .
JOHN ..
CIVIL ENGINEERS CELWm
LAND SURVEYORS �
ROUTE 6A YARMOUTH MA DATE •
R J'r YOR
COMMONWEALTH OF MASSACHUSETTS da�a M�
� ti
4 W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT �s
°M Veyo 100 CAMBRIDGE ST.,BOSTON,MA 02202 617-727-3180 FAX 727-9402 AL MAt '
December 10, 1993
William F.Weld
GOVERNOR
Joseph D. DaLuz, Building Commissioner
Argeo Paul Cellucci 367 Main Street
LT.GOVERNOR Hyannis, MA 02601
Trudy Coxe Re: 264 Long Beach Road, Centerville
SECRETARY
D
Peter C.Webber ear Mr. DaLuz:
COMMISSIONER This letter is in response to your recent conversation
with Eric Carlson, and your letter regarding the
structure located at 264 Long Beach Road in
Centerville. Based on the information you provided, it
is our understanding that the structure is located in
an A zone with a "walkout basement" (at or above grade
on at least one side) ; the next floor is above the base
flood elevation (bfe) . A gas heater and water heater
are located in the walkout basement. You stated that,
in your judgement, the recent renovation to the
structure constituted a substantial improvement.
Structures that are substantially improved must be
brought into compliance with regulations for
construction in the 100-year floodplain. In A zones,
enclosures below the base flood elevation are permitted
provided that they meet the following three conditions:
1. the space is used for parking of vehicles,
building access or storage,
2 . , the space is not a basement or cellar,
f 3 . the enclosure be designed to automatically
equalize hydrostatic flood forces on exterior
walls by allowing for the entry and exit of flood
waters.
As you described it, the walkout basement would not
constitute a basement or cellar and therefore condition
#2 above would be met. The room with the fireplace
sounds as though it is used as a living area which is
not allowable under condition #1. You mentioned that
the house is designed to allow the flow of water in
case of flooding. Under the State Building Code
Section 2102 . 3 , 7, designs to meet condition #3
printed on recycled paper
Joseph D. DaLuz
December 10,. 1993
Page 2
"
. . .must either be so certified by a registered professional
engineer or architect or must meet or exceed the following
criteria: A minimum of two openings having a total net area of not
less than one square inch for every square foot of enclosed area
subject to flooding shall be provided. " Glass sliders, in general,
do not meet condition #3 because they impede the flow of water into
and out of the structure.
Your suggestion is that a block wall be built around the gas heater
and water heater. to protect them from flooding. . Furnaces, hot
water 6.i Q\.C.%1 J, -and Other cr J\.1 V 1C\... L at-4 1 i ias are Considered o be
part of the structure; they do not constitute a "use" of the
enclosed space below the bfe. They must, however, meet certain
requirements. The State Building Code, Section 2102 . 3 , 4, requires
that "Electrical, heating, ventilation, plumbing and air
conditioning equipment and other service facilities are designed
and/or located so as to prevent water from entering or 'accumulating
within the components during conditions of flooding. :' As Tong as
they are floodproofed (with walls substantially impermeable to the
passage of water) to at least the bfe or, preferably, elevated
above the bfe, the gas furnace and water heater are allowed in the
enclosed space below the bfe.
If you have any questions regarding this matter please contact Eric
Carlson at (617) 727-3267 x513 .
'n e y,
Mike Gil saame. Chief Planner
Office o Water. Resources
TWY LU FF ARCHITECT
December 21,1993
Joseph D. Daluz
Building'Commissioner
367.Main St:
Hyannis Ma 02601
Re: "Lower level"
264 Long Beach Rd.
Centerville Ma.
Dear Mr. Daluz:
This letter is to inform you that a floddproof wall complete with a watertight door has been-built
around the existing heating furnace, h6f water heater and-electrical panel and complies with the
State Building Code Section 2102,12,.3,
Also 2-2'x3' openings have been provided to comply-with the State Building Code Section
2102,3,7. ;Any questions please call
'Y ours truly,
Terry Luff R.A.
832 Main Street • Suite D • Osterville, MA 02655 Tele & Fax (508)428-9119
Joseph D. UaLuz Telephoner 790-6227
Building Commissioner-
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
TOWN OFFICE BUILDING
HYANNIS, MASS . 02601
DATE: August 18, 1993.
TO: Larry Nickulas
P.O. Box 507
West Barnstable, .MAss.
Occupancy
'.The inspection at
264 Long Beach Road, Centerville does not comply With MA Building
Code No. listed below
Please contact. this office for reinspection.
Thank you ,
1-!IBU iding Inspector
AEMzkm
Figure 3401 -1
4 3401.9.1 Openings
3401 9,4 Floor Level
3401,9;2 Fire Protection
707.1
3 Section M 1604.1 BOCA
National Mechanical Code
R185 027.
LOC 0264 LONG BEACH ROAD CT 10 TDS 300 CO KEY 106174
----MAILING ADDRESS------- PCA 1011 PCs 00 YR 00 PARENT 0
BORNSTEIN, STUART A TRS MAP AREA 35WA jV MTO 0000
ONCE UPON A TIME TRUST spi SF'. SP3
297 NORTH ST UTI. UT2 . 40 SO FT 3336
HYANNIS MA 02&01 AYB 1990 EYB 1990 -OBS 40 CONST
0000 LAND 315000 IMP 101800 OTHER
----LEGAL DESCRIPTION---- TRUE MKT 44800 REA CLASSIFIED
-XPLA11,411"i 1 315, 000 ASO LND 315000 ASD IMP 101800 ASE OTH
#BLDG(S) -CARD-1 1 101 , 800 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE
#DL LOT A TAX EXEMPT
OPL LONG BEACH RD CENT RESIDENT"L. 416800 416800 416000
#RR 0912 015o OPEN SPACE
COMMERCIAL
INDUSTRIAL-
EXEMPTIONS
SALE 01/?l PRICE: I ORB C122580 AFD I B
LAST ACTIVITY 03/14/91 PCR Y
.................. ...... ------------
� Assessor's office(1st Floor):Assessor's map and lot numb r WITH MTLE 5 of THE rod
Board a Health(3rd REGULATIONSfloor): 4 � TO�JW���� ��®��
Sewage Permit number
Engineering Department(3rd floor). •,, nn ;s�aasrsntt39 J
J o��` 0
House number '7� 7 °o �6�q.
Definitive Plan Approved by Planning Board ` �J _ 19 ��UP 6\
.c.
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only'
A P P A 0 V E 'OWN :.. OF -BARNSTABLE
Ba st a Con ervatioa C is;
U I L D I N G INSPECTOR
Si ION Fd"E a'
TYPE OF CONSTRUCTION
/.� 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fora permit according to the following information: or
Location 3 c-a
Proposed Use 'L '
Zoning District T Fire District
Name of Owner / Address o
Name of Builder Address
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior.
Heating Plumbing
Fireplace Approximate Cost
Area_
Diagram of Lot and Building with Dimensions Fee
U
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
Q
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the bove constr coon.
Name
Construction Supervisor's License ® �
NICKULAS, LARRY
Y:.
r•
No 33621 ..Permit For b emo lei s h .4 ;
w Frame' Dwellbing I A
Location 264 LonQwBd;ach Road
Centerville
'!4 h
e Owner Larry Nckula r
ai
Type of Construction. Fram"e }.
Plot ' Lot ;� 1
� March 26, �0
`Permit Granted 19
Date of Inspection = 19
} Date Completed fb 0f 19
Yf
�`�� � g � F ra�w '� � J � .�• •
t"Q
Ell
11 t
f -
PROJECT
NAME:
ADDRESS:
PERMIT#
PERMIT DATE: -16
M/P•
LARGE ROLLED PLANS ARE IN:
Bob
SLOT
Data entered in MAPS program on.-
BY:
11�
l
�r
a/wnfi les/archive
_ ..
ee
Ni
tom_-F X�:"S,l4A,T_ MAs
o
p
14-
�"C,Mw 1 a ,. -- • j2"LoilU
_ c�C f '��1tk 3 - n
C-{AFA-C�re. /1 :=
FRAM llmft
011
3
• r -
_' -
_CCU ������c• --I�k.Q`D::�T _a�.4�1%L -
-
_
6,1M.POF-7.�_.
_
\AIA OF
I
/off MICHELE yG
C.
TUDOR
o _.... -
�' No. 34774 `n --
STRUCTURAL -
L:ao-D-PP-C�FI N OFH0H- EA
FSSlO11UAAL
(-# 4U f P.oAD
tVIICHELE. C. TU®®R, P. E.;:. -- - ..
Consulting Structural Engineer� �� t� S
123 Cottonwood Lane o Centerville.Massachusetts 02632 m(508)771-7601 - - , - - - -
_K -
C •
-- ,—t��8knf�ItP�C� VI NUOW
�o j ----_--:_-
--
.MF4F.�:-..
F.
AtA
�i
- - _-
-- tST_ 34 '(L�D. Wr4Ll�.
q c
S
i
- Yi�� -Wtr Tir�t�T :: Ai:Af�1T,
t -c�ui
i �t1
ram; m 0#- 3
v. ,
A .
,i ,
OF at -
MICHELE y
-_
C.
can
TUDOR
No. 34774 r^r
STRUCTURAL
M I C H E L E. C. T U D O R,
_ o-
Consulting Structural Engineer; FSto l � s • 2(�. i�N� � A�l-� �p _
123,Cottonwood Lone•Centerville,Massachusetts U2632•(508)771-7601
o
_ _
'-GENERAL; NOTES AND MATERIAL SPECIFICATIONS ry
1 . .The, existing structure is located - in a stillwater flood
. .zone , A13 , with Base Flood Elevation, B. F.E. , to
Elevation 11 . 0 , as determined by the Site Plan Engineer ,
Down Cape Engineering .
2..; Prism'.strength of concrete masonry, f'm = 3000 psi . `
3 . Reinforcing steel : :New billet steel, ASTM A615, Grade 60 .
4 . Concrete : 28 day compressive strength, f' c=3000 psi minimum.
5 . Mortar joints that lie within the flood shield should be
struck flush with the masonry units so there will be a better
seal .
6 . Between two sliders : 2" rr
e 1 C .M.U. w/#10 @ 8 o . c . required.
7 . Floodshields may be either `
y premanufactured , based on the -
flood levels anticipated, or fabricated per the following
shop drawing(s) . Manufacturer shall submit shop drawings '
to the Engineer of Record for approval .
8 . Type A waterproofing construction shown herein, are completely z
impermeable to the passage of external water . Type A water-
proofing construction shall consist of either a continuous
membrane , integrally ,waterproofed concrete , or a continuous.
interior lining . Block walls 'to be protected against
water penetration by coating with a material that is thick
and durable, a waterproofing compound or impermeable
sheeting, that are commercially available , and shall be
approved by the Engineer of Record .
9 • Move electrical wiring, ' switches , fixtures , as required to
install all work.
10 . Connectors and Fasteners : Hilti C-100 System bolting into
existing concrete using standard embedment lengths per Hilo9.
and with the size rebar to match size and spacing of rebar
shown for block-in. ACI standard rebar lap lengths are required .
w
d
i
OF
M{CHELE cy�
C.
1 TUDOR N
v No. 34774
STRUCTURAL
Ado RFGISTER��
SSIONAI ��G\
MICHELE C. TUDOR, P•E.
Consulting Structural Engin`eer
,r 123 Cottonwood Lone•Centerville,Massachusetts 02632•(508)711 7601: :5 O�
i i'-
°T 514t�
i
t
�p
0,0
�� 7
IN Co-.Go
WkLL Tp
2_GQ
NOT UD0P.PPWF.._
3
0r-F1G
_.
"py'_ OTHEPl, _
L�_`4
g='�': ::
.yA oF ��9�ti
= MICHELE ,
C. c 4 _ ...
o TUDOR IOU'lT-ID P�.�N .._..... -S. C?V�I
C.D No. 34774 M
STRUCTURALD �"
a w �
f�.si D
A� 9E61STER��.�`q q. "Z(o - LOI`{ 4 r_14 ROA
D....,
-
�FFSStONAI
MICHELE C. TUDOR, P E. _
0 Consulting Structural Engineec
123 Cottonwood Lone=Centerville.Mossoch-efts 02632=(508)771-7601, ✓ _.._ ___ _.__
.....:d..s......�..,... ._.o..�-..v......�-.�.�.,.�-wkc,�.................-...�........:...-^—.-'�--.-�.-.,....o..:........,..e....m..-.o..�.�....r....�.....e.�-...e..-.............v.....��.,....,..�--•-.-^0^--•-.a.........:.........--....s�r.,...A..�..-.......�..�...�........-.. --•--•"" -
I" -
1
{
Arlon Arl�ty4 WtN>aow : 281�==
TO -'tA-T-
• - i
t =-EXt5T: 2 h D:::.WALI,
Xe - i
) YIP Wkt -�'ICIt�T -%ALAST,
_ .
�a� a -rb =PyENT
OF
o� MICHELE
C. f
TUDO R 1a
No. 34774
STRUCTURAL
eyPUs D- F� DPPoo��D GLc)sURe
IV11CF-iELE C. TU®®R, P. E. 2� �A�
9 9FGISTE��O PoQAP
Consulting Structural Engineer S
:
FFS AL
123 Cottonwood Lane o Centerville,Massachusetts 02632.(508)771-7601 r
GENERAL ROTES AND MATERIAL SPECIFICATIONS
1
1 . The existing .structure is located in a stillwater flood
zone , A13 , with Base Flood Elevation, B. F.E. , to
Elevation 11 . 0 , as determined by the Site Plan Engineer ,
Down Cape Engineering .
2 . Prism strength of concrete masonry, f'm = 3000 psi .
3 . Reinforcing steel : New billet steel, ASTM A615, Grade 60 ."
4. Concrete : 28 day compressive strength, f' c=3000 psi minimum.
5. Mortar joints that lie within the flood shield should be
struck flush with the masonry units so there will be a better
seal .
6 . Between two sliders : 12" C .M. U. w/#10 @ 8" o . c . required .
7 . Floodshields may be either premanufactured , based on the
flood levels anticipated, or fabricated per the following
shop drawing( s) . Manufacturer shall submit shop drawings
to the Engineer of Record for approval .
8 . Type A waterproofing construction shown herein, are completely
impermeable to the passage of external water . Type A water-
proofing construction shall consist of either a continuous
membrane , integrally waterproofed concrete , or a continuous , t
interior lining . Block walls• to be protected against
water penetration by coating with a material that is thick
and durable , a waterproofing compound or impermeable
sheeting, that are commercially available , and shall be
approved by the Engineer of Record .
9 . Move electrical wiring, switches , fixtures , as required to
..install all work.
OF
d a
MICHELE
cy 8
C.
TUDOR -i
o I No. 34774
' STRUCTURAL
IST
b
MICHELE C. TUD® , E.
Consulting Structural Engineer'
123 Cottonwood Lone•Centerville,Massachusetts 02632•(508)771-7601
In
- �. -•- La:HLOY LO
NCw t-its ` w co
�' I C�-u:pGo /.:.Ir�r- - -:NIt•'L'CY 1
CID
U �
ry
CN
✓-r�rz•r
_
0 V
, I
5.
Ln
-� —--
I
1
�t
I
--
__ II' I 1' '—��' _ � i• t- CC - ��_�,� '_ � I ' I I I I ' I I I � I � c
_vs.ryxrX,5.
_- _ -- ,....:_ - f � I �.zr✓.a-r_vs2z� II t-- I__ ;, I :1!I�� :';� 1 I 1 I � f' vl
_,
__ ..
I I i
---R-O f-J T V 4-T 10.}:1
z -t=0 --'-- - - -------- - u_
— -\
iH—
F-
-- --- .'L__.1.1 G..,N,Y4.LC, �✓ � � _ � .o� II � I I' in �� I R
I r ------ --- 1 = U =
c
__j
! -YJY III-tY4 LY.5 ` 1 � I I
I I• i !,` I `i�- ! j L filt�`I •L�.l II i /'Pt�Tf-T't.2.- _
UT1 -v-u4 r,!53
1
~ nAn ' ,
_ I
!
SHEET .#
tn s
s :�, �� �r'l_II r! ,I:, ry I;T Vc-cK �rn..•� — —� + Luco
A)
ry
�Jfh11L
r e2j-i. �•L ING ti h' CE:M7Ve Gxls7,7.41. I - N I
O
—
r� ( Ln
LA
I I txIST, G�r.4Ge ¢pvl7ev _, �Y1oT.G.i rt64e Rrvl7en r d �l C
j I I I J .nYnT e+— - I=xnrverL- -7a 4e•W �T�rzt.. fLM,� tl i
/ + // q pruse — ' I = I
�L
Fr-
0�
• ; - I� �, prre me . . .n
WrH !-{ 12Y hTL 6r4dM arVNG•- {I { {
co
L
I ;ienx�d --- I ;
- - I —'F'nN tJ/{=xTlWq - •-- UPt�F {. .. - Iz,-Ll ru x
vrok 0
L)6T101N
I I
1.1Fr+-If,",r„1uosr vll.l 1 I
I Be`G rriv pruo - - .
g'-p• IG' O' 7-O". 10'-0' -7 O" ' .__ Iv,.p' �, _
- . ..-- ---- — — 111
>
r
t
LU w i
41
DATE i-',!il l
CIEpIN
REV.
SHEET #
- 9
O '
f}I
IJ
' U N
W c
_ co
LL
1
M..P�ED lJOM �C ♦;1 !tpjkDfLOO beGlc; I ��DIZOONI
i
• ,I� I i pvrNs I W
N
_II.F: II I I. - I 1�W-IWZF-UUFItNkX- I - .
I6
7 -
-11AI5
G4ILb I,IeW PW-�p
r+' � i!• Yl Gla ftT_ki. _ i i,• .. � � .. —_T-__'_ _—_ ._ _..__.-- I I�
FX I?-rr I.I G. - ' =pscichfiG011
--- ---
, .UP,Z�C (_� f�. .-LMUM4 •._� �" I _ I �I��. ate,. I ... � I
Fi
O'
- - - �_ -- --- Ploy r-K --- --— -- - =- -- ----
It
LU
I�
i I
I i
l o
i
a �
orAlrr
CHECrb:
REV.-
0
....-._�+...,..n.. -mwn'.«re.+r.w.«....»w.,.++rw�.-.�a.,%ser.. ....,,vie.....•�eY,.4,zTsv�".x+a+e.ti»..,.w!+��d erne ..�...e.._.�...w....... ... - .-. _ _ .,M _*.,. ^.w^,�s..sww+wgfr"'.e"+Y4p"so"4"�'e„'^....! _ ... ._. -
r <
4�
t '
t GaA�M✓L�ryE 1
9aeGM ;,I
J LA +a
�J
2 � '�r1./��VP^ GO t-��✓1-1 fL►..��`- Arm w '(O �i i �. .:•�-- r/r'vf�-�J3..t k..Lr - �� .
'? - ��- s.TE(✓ A w PASTE L-1 is�'� 'ro 6E C9Le.V✓O.t.t l L�v .
I �— Aw �tV1nJ� Afz 'TU f. tr1 ; S'ia�tit ��Ti EO Fok �. r1M�r:''
�, �r .t ti,.o r' � '���L.,,� 1-}A r✓1 r1 G K-- „•iZ t�/`�P•1 'T-o iC t-�..9,�i, C ti s' M ►.1 (��•.l E
ir
T �'---- � �• J Lis!`J
Lw r`�' •7 ?.' ;I
1 I i
r^
i CLAM PT
O�f
' ►.I
21 ' /f Si t t►-L. C I:ar>�_ v,li_ _ j e.,J t c k' 1 j iGit -Jh j L
T J �E it 2 Ems J t Q-1�D ¢f G'►'�
. � / � � /� � � -- -- -� ';,..t.►-t � Ni�-�.:�v.,icQ.� Tc ..ic J€_ �j r�-ri�r� V� P� ~j rc t.'j;a L.� i -
',/
.4� i2-
' '�� � �. .,.,_-_1 - � ��i� � -'� �"t, �* � z.1 r✓;Av/�T� T� (��c_ t-r-lc..�!v r��.t% Tv ��+C%'
_ � �. . .-- 'n', a ;; k1 �d J v �J,.�t= i 5�-L r .::�..-i o E .�S S t-��i..►►-� `
• 111
-4,14 Z+ t t z"
1 � to aT5
42
1 � 1
t - " ✓�;1H C� is►-, r--✓
Z Ara,
o 5' VAL
_
�✓ �� xe s' I 'GE a�z�.r� F00-. 01.AA.►..r'O
OIL
a
_^ .�a.�.�A ZZ, Alit.
45
1 1 .
O �
7
_ U _
j_: T
�LOL1 SILL �►� N�.�a O
!.••1IN GOL-1S �
`t' tiles Tc�1 I_�•
ex
I i
i
- Pw•OP'v�-t=c> i i �T��-. +-�w•-� Ws�.L�°, I � � � _J.
`lk ti r4l W-4f-+ , L-�Ot- CGS- _:!•-I F.,1�' I _��% //i _.
I
I-rE PLAIN
LL
�N
iC
-
t
I
X
w
d ,
F- C
o ZML
U u Q 4.1
I - Q' OU
u u v o OU
•! -.,.._' .--.°m..., ..s:-..ray.....- .+w - _ ._,.a.•.:.,-.:..tea• c am.-mr_se-:>..,_- -.-.-...+.n--.. .:-.. .-,.+.w.-..•ww*1-. ..a..» .•a..x..m.-...w,._,... w._.
57
.++•...n.. .•.. _. ., .:-...,.ex�rn#'+rt...ecr_ar,.wr++.:.<..•..<•,r... +-.w-.......-<.=.w++....•.w..-..m...w•.+•: e<+<^+�...++ *+w.+.+e�r•:;,„y-..gy,syr.<....x-.::...ww+ .. •. -� �•mA.r, _ .r-a., nmr.._ _ -g..a.r+ -s..-.wss. -.+ .zra vws+..v...c.. -__.._
......r m.....-ate.....-_..-..
_ -__.-..____ ..-_ __.-._.-T__._._._.__- �•::'+v^'.'^'�®.,-"_+'fie_.^!"-'-_
{{
1 � --- - -
I
1
7 :SH Ih,:aL�
F
FfA" Gh/F- F-
1 llJ � V
A
T i y -
r✓ -
t
I '
I ,
FF[
_ Liob no,
"TE A� l
-- -
--
_ f
Imr�
� � f
1 I
• I
J
,
;opyright 199
., I