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ARWROWN�Nw W" 'U'Un MIT, M"A TU A V�y ag �7�jy �g , c 0 saw RX, jaw ."Y" i I ji Isle, Y�j 1% 'W 'g 2N" ,ni'� - MUMMY �,�kili 7�v F z ;i�,,g, 111) _12 UUAT;a Q MW quoit AVANX-f-W Ult I r,� A N iw� %Ng'f gaw �k3 �1;-.44 'VAN1'U',G',z WOO WAMMUep My M NK ...... , "M "N 'AV "WRA"I M W W"y-a-1 1�3 lli�;�RnM El"�Nv* M� �14 _21 MOM 4 auk k�, gj �p_ _�tp- ,-KN ,qm f, gj 5 wpmm gqg 4 �4Mxl-'k."i"64 t�, _',,A Q. _"P"A 'W"t__, WWWA31"Y" NO X alum 5 W -Mull 2 'pq WE A P., WRM W Q,J,A A A M-W NY MR a Mel it W11 if,I. ...... '14? W-11-1, 49 11 jIlly ARKayst"wq�� Jlk IOM "p;p,1 V WW, Nis I M1 wj f'. wA FTC Amobegin OVA too. OR.,- - Z i S 01 Ab OVA' A 'rS coo gvnm to 01 hi f f MIN ie'�`TA plp MR, 4,§Rx RAW XWOW"NQ V. low W PIMA?, , , 'q' -011. MOM= ?L W Mom nom 1 KIM= mss"Unaung SAO, ANN 'w" WV-""AliM1V 'fg "Way" f kywy-owl ARNO WON MANNU A TAK, N I M, Mmey -WA T.- 0,W MOM& v AA 311'114� V 41"�i� fM 4. MOM moo 'M -z""M a , iz;70 � � I, - I � a 4' 1, 4, W", N6 6y j"W2 W v Egg OW0001 4 4"F am" t 1 _WWW" W_ MW QvQ0=q:Q ANA W, noun no I W"Ah F and"n- PA I MAIN! Pam IZ j,Q___0"ggM"g vy RqAq qy"_�W- W 0011. amp MIJOWAQW-P M, �Y�16 I p n 4,now, WIN � i �u�� i � �� cv , '�� I i � ,� ,� o ' � i y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel t. App icl ation #�® Z Health Division Date Issued C Conservation Division Application Fee Planning Dept. Permit Fee Ag;`i Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 5 M0-A l�l Village ���� Owner K11M U IU, Address 4412 Telephone 1 �J 1 55D (el Permit Request -e WW_ rjjUM 6 Square feet: 1 st floor: existing Mproposed 2nd floor: existing proposed Total new Zoning District UVO CRJS�> Flood Plain Groundwater Overlay Project Valuation -, 001) Construction Type LQQ Lot Size 1 0 3- I Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family d Two Family ❑ Multi-Family(# units) Age of Existing Structure IM Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) ZUo Basement Unfinished Area (sq.ft) »� Number of Baths: Full: existing_ new Half: existing I new_ Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: YGas ❑ Oil ❑ Electric ❑ Other Central Air: L% 'es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 'fYlLP- :� Detached garage: ❑existing 6Ynew size_Pool: ❑ existing ❑ new size _ Barn: ❑ a ting ❑rew ss+ e_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 4� _T7 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use , "APPLICANT INFORMATION (BUILDER OR HOMEOWNER) t Name r"irin Telephone Number t5 QS-`Y-7 1 `W7 Address tv,(� ��.G(.� �� • License # CS JUo 1 Z� 3 Home Improvement Contractor# Worker's Compensation # 9 �- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �- --� DATE �2 ��(� 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER '- DATE OF INSPECTION:FOUNDATION C& qj/q 5 FRAME INSULATION 3 FIREPLACE .i ELECTRICAL: ROUGH FINAL 'Y ti PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING ,f DATE CLOSED.OUT ASSOCIATION PLAN NO. Town of Barnstable Regulatory Service Th om as F. Geil er,.Directer �$p} Building Divisiob Th omas p erry, CB 0,13 uil din g C 0-Minissi o n Er 200 Main Street, Hy.a=is,MA 02 60 1 " . . wwzv.tawn�harnstahlama=us _ . Ol�icz: 508-862-4038 Fax: 508-790-6230 ' -PLA-N R.E�4�LE� � Owner: . MaplParcel: Z��o �. Project Address S4S S M4t ST- Builder: r The following items -mere noted on reviewing: 0 rA[' ELAOD Z-P,04: 2�4uZ �M� S 'P1°L`� FPrFc.-T.LyE DP 1 - 0F_ MAPS IYU�9 O�, Z0/� L�fi� "Cll3? RMew-ea by. 1 ,per The Commonwealth of Massachusetts ; �\ Department of Industrial Accidents .Oice of Investigations 600 Washington Street Boston,MA 02111 www-Tass.gov/dia orkers' Com etisation Insurance Affidavit:Builders/Contractors/Enpctrile sePs/'P lumbers Pr Print Le bl A `licant Information at Name(Business/organization/individual): Address: Phone M City/State/Zip: 1 i�Qi 4%y�►��� � 'L°` ro mate box Type of project(required): Are ou an employer?Check the app P.4 I am a general contractor and I 6. [v/New construction 1: I am a employer with * El have hired the sub-contractors Remodeling employees(full and/or part-time). listed on'the attached sheet.,t 2.❑ I am a.sole proprietor or partner- g, []Demolition These sub-contractors have addition ship and have no employees insurance. g. Building working for me in any capacity. workers'.comp. ❑ [No workers' comp. insurance S� � We are a corporation and its 10�Electrical repairs or additions officers,have exercised their 11 ❑Plumbing repairs or additions required.] right of exemption per MGL 3.❑ I am a homeowner.doing all work c. 152 §1(4),'and we have no . 12.[]Roof repairs l myself. [No workers' comp. employees.[No workers' 431y Other insurance required.]t comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers•compensation policy information. information. t Homeowners who submit this affidavit indicating they n�al doing all work and then him sheet showing the name of sub-contractorstheu and their workerstside contractors must submit a `com�policydicating such. =Contractors that check this box must attached an adds 'compensation insurance for my employees Below Is the policy and job site I ant an employer that is providing workers information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lie.#: City/State/Zip:I/Qlf11U'V' lK, Job Site Address: number and expiration date). Attach a copy of the workers'compensation policy declaration page(showing th�po ostt on of criminal penalties of a Failure to secure coverage as required under Section 25A of MGL c. 152'can lead to p fine up to$1,500.00 and/or oneies in the form of a S -year imprisonment,as well asvtlof this statement ay be forwa dedTOP o th Offic of d a fine of up to$250.00 a day against the violator. Be advised that copy Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the Information provided above Is true and eorreet, D to• Si nature' Phone# Official:use only. Do not write In this area,to be completed by eliy or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G, Other s Phone#: Contact Person: i AC� CERTIFICATE OF LIABILITY INSURANCE14122/2014DATE �' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER MAME: Rogers&Gray Ins.-Kingston Branch ENE a No - 63 Smith Lane E-MAIL Kingston MA 02364 140D INSURE S AFFORDING COVERAGE NAIC N INSURERA;Arbella Indemnity Insurance INSURED CAPEENT-01 INSURER B: Capewide Enterprises LLC INSURERC: J.P.Macomber&Sons INSURERD: 153 Commercial Street Mashpee MA 02649 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER:1865828735 1 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. ILTR TYPE OF INSURANCE POLICY NUMBER POLICY n POLICY Y EXP LIMITS A GENERAL LIABILITY 8500050813 0/2014 U3012015 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTE X COMMERCIAL GENERAL LIABILITY PgrzmisFs a om ce $250,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE. $2,000,000 I GEN7.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 POLICY X PRO- LOC $ JECT OMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY W20017539 012014 0/2015 a accident 10D0 D00 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED r7_1 SCHEDULED AUTOS AUTOS BODILY INJURY(Per aodden0 $ X X NON-OWNED PPR�OP�ERd�DAMAGE $ HIRED AUTOS AUTOS A X UMBRELLA LIAB OCCUR 4600050814 /30/2014 4130120115 EACH OCCURRENCE $5,000,000 EXCESS LIAR HCLAIMS-MADE AGGREGATE $5,000,000 DED X I RETENTION$10 000 $ A WORKERS COMPENSATION D120510414 14/2014 /14/2015 X WC STATU- I JOTH- AND EMPLOYERS'LIABILITY PR ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.LEACHACCIDENT $1000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) EL DISEASE-EA EMPLOYEE $1 000 000 0 es IPT10N be under EL DISEASE-POLICY LIMIT $1,000,000 DEescri SCRIPTION OF OPERATIONS below Leased Rented Equip LR LImB $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Sci'edule,8 more space Is regrdred) i i CERTIFICATE HOLDER CANCELLATION t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I. , CTtieomnwruueall�z C-/�lcraaacluca License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration: 143358 Type: 10 Park Plaza-Suite 5170 xpiration:u—719[ 1 16.,. Ltd Liability Corpor' Boston,MA 02116 low CAPEWIDE ENTERP�21S9t L L C. RICHARD CAPEN 4507 R RTE 28 COTUIT,MA 02635 Undersecretary of valid witho ignature Massachpsetts -Department of Public Safety. _ Board of Building Regulations and Standards which. .Unrestricted-Buildings of any use group ConstrUction Supervisor cormn less than 35,000 cubic feet(991m3)of License: CSi-OB9273 enclosed space. n, RICHARDD CAP ITM" ,•� Cotui�MA 0263 A. Failure to possess a wrrertt edition of the Massachusetts ' „-IiA Expiration J 11/2712015 State Building Code is cause for revocation of this license• Commissioner For DPS Uce°nina information visit: www.htass.Gov/DPS .. r k 0�1► Town of Barnstable.;. u Rogulatory Services ' '"a''W"$bLm Thomas F.Geflu,Director Buzid 49 Division Tom Ferry, Building-Comtriissioner 200 Main Street, Hyannis,MA 026.01 w�tryvaown.barnstablema:os - ' Office: 508-8624038 Fax: 508790-6230 Proppity Owner Must Complete.and Sign This Section If Using ABulder I, is ,as Owner- - of the subjecrproperty hereby authorize to act on my behalf, in al matters relative to.work authorized bytU l 4ding pemut application for SCE 5 S. '�► S�., CP,, �;/le (Address of Job) /7-4 4 Signatuxe of.'Qwne Date �M /3 �1ts .:.:.:. . .... .... .... .... .. . ........ Print Nam-e , Q-=ORMS:0VNBJ PMAISSION U.S.'DEPARTMENTOF HOMELAND SECURITY ELEVATION CERTIFICATE 'r FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION 3C)R INSURANCCOIVIPAN'I USE Al. Building Owner's Name Kim B&Bonnie K Wells Pollcy Number �. A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAI&Number 545 South Main St.(Detached Garage with living above only) � �ON w . ... , .., .. . _ . City Centerville State MA ZIP Code 02632 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Town Assessors Lot 206 Parcel 071 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Single Family Residential A5. Latitude/Longitude:Lat.41.6407 Long.-70.3505 Horizontal Datum: ® NAD 1927 ❑ NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1B A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 394 sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 2 within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 400 sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ® Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community Name&Community Number B2.County Name B3.State Town of Barnstable Barnstable County MA B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 250001/0563 J July 16,2014 Effective/Revised Date Zone(s) AO,use base flood depth) July 16,2014 AE AE 12',AE 13' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Date: ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:RTK BM Vertical Datum: NAVD'88 Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 ®NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 8.4 ®feet ❑meters b)Top of the next higher floor 18.4 ®feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N.A ❑feet ❑meters d)Attached garage(top of slab) 8.4 ®feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 8.7 ®feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 5.3 ®feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 7.9 ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 5.3 ®feet ❑meters SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. OF Iyq ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �F ❑ Check here if attachments. licensed land surveyor? ❑ Yes ® No o� JOHNS"-n OIDE Certifier's Name John C.O'Dea PE License Number 48168 CIVIL E t 1 Title Civil Engineer Company Name Sullivan Engineering&Consulting No.48168 Address 7 Parker Road(PO Box 659) City Osterville State MA ZIP Code 02655 � ®�� FGISTER``�\`y�`Q Signature Date 10/6/2015 Telephone 508-428-3344 NAL FEMA Form 086-0-33(7/1.2) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces,copy the corresponding information from Section A. FORINSl3RANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. PolicyNumber K ` 545 South Main Street City Centerville State MA ZIP Code 02632 Corripany NAfC Number SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments This flood certificate is for the Garage and room above only.The garage is located in an AE elev. 12'flood zone,but there is an AE elev. 13'on the property.The mechanicals at the site are septic ejector pump(top)at el.8.65',electric pannel el. 12.7',water hater el 13.0%ac unit on back of building el. 13.1'.The two flood vents area smart vents(model#1540-510)and certified to cover a 200 sf area each,see attached photo. Signature Date 10/6/2015 SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name John C O'Dea Address 7 Parker Road City Osterville State MA ZIP Code 02655 Signature f11 Date 10/6/2015 Telephone 508-428-3344 Comments ❑Check here if attachments. SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G10.In Puerto Rico only,enter meters. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces,copy the corresponding information from Section A. FORINSURANCECOMPANYSE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Pol icy,Numlier 545 South Main Street City Centeville State MA ZIP Code 02632 Company'NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and 'Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page,use the Continuation Page. R ( I k £ F i 4w Y s , o r Front View Photo Taken 10-2-2015 Left Side of Building & Flood Vents Photo Taken 10-2-2015 � 4• j a r i � F i � n �n � ,s f� • Rear View of Building Photo Electric Panel Taken 10-2-2015 Photo Taken 10-2-2015 FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR<INSURSNCE COMPANY USE SURANC s Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Pol€cyNumtier 545 South Main Street , City Centerville State MA ZIP Code 02632 CompanyNAIC Number .r If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. P �✓a� yr �, r, a i rw�,-,=..: 3 a -xA't /%fir. r•�«;.; 1 Flood vents (1 of 2)on garage slab Water heater&sewer ejector pump Photo Taken 10-2-2015 Photo Taken 10-2-2015 i z �H y n Smart Vent Photo Taken 10-7-2015 FEMA Form 086-0-33(7/12) Replaces all previous editions. d i r 1 OFF BARNSTABLE I I 1 14116 ASSE ORS REF.: Map 206, Parcel 071 °\P° � P Jb��c6o 20 ,1) OVERLAY DISTRICT: PE��' AP — Aquifer Protection District a���dR 9�21 h New Concrete FLOOD ZONE: e� 0 Foundation 0(k� , TOF E1=9.0'(NAVD'ss) Zone X, AE(el. 12) & AE(el. 13) Map j 25001CO563J 14' July 16, 2014 Ot�e��in9t` �O 2 ZONE. / o RD-1 (RPOD) °° �<cF�Ei `co Area (min.) 87,120 SF Fronts e (min) 20' Width min) 125' Setbacks: Front 30' Side 10' Rear 10' o O W ootL vsT• �°�ca° \\ ,Q Q a n� o-11 60,110±SF woo�s. c, Total Area 0 1% V .L aU ca Cq certify that the foundation how hereon :onforms to ►�+ he setback r�Q}jirements of N . e Zoning Bylaws of the o down of Barnstable. Vr _ RICHARD R. L'HEUREUX NO.:'34312 c PLOT PLAN At 545 South Main Street ��e'(J {Io 06 BARNSTABLE �e ebb (Centerville) MASS, NOTES: DATE:03/APR/15 SCALE: 1"=60' 0 15 30 45 60 90 120FEET 1.) The structures shown were located on the ground by conventional survey methods on (or between) PREPARED FOR: 10/APR/06' and 13/APR/15. Kim B & Bonnie K Wells 2.) The property line information shown hereon was compiled from available record information. PREPARED BY: CaeSury 3.) This plan is not for recording and is not to be p used for construction layout or deed description 23 West Bay Rd, Suite G purposes. Osterville MA 02655 (508) 420-3994 / 420-3995fax DWG #. C517_2g2 cppl FIELD BY. WHK/KAR teed ASSESSORS REF.: O, E PParcel ?�°, "�� �12 OVERLAY DISTRICT: 0 ti� P� 6� l l - P AP — Aquifer Protection District a�0 9� h, New Concrete FLOOD ZONE: e� o Foundation i `lJo(�o11� 618 TOF EI=9.0'(NAVD'es) Zone X, AE(el. 12) & AE(el. 13) 0-t10 Map # 25001CO563J rr.4' July 16, 2014 5k P °?. � �Stye���n9 � Z ZONE. RD-1 (RPOD) w°° o ` F��Fi. Area (min.) 87,120 SF �Fo? Frontage (min) 20' Width (min) 125' Setbacks: Front 30' Side 10' Rear 10' CIO qj h i T \ C0 Vj Q a 0. 0-1 60,11O±SF Total Area 0 I certify that the foundation v shown hereon conforms to the setback requirements of N . the Zoning Bylaws of the 0 _ town of Barnstable. <s a `f RI CHARD R L'HEUREUX p 0 4312 a o >° Fs rsTEa`` P�`` o AL G�gew `Jet a PLOT PLAN �.��' vool - \e�ooa At 545 South Main Street e BARNSTABLE Ge��' ebb (Centerville) MASS, NOTES: DATE: 031APRI15 SCALE. 1 —60 0 15 30 45 60 90 120 FEET 1.) The structures shown were located on the ground by conventional survey methods on (or between) PREPARED FOR: 10/APR/06 and 13/APR/15. Kim BA Bonnie K Wells 2.) The property line information shown hereon was compiled from available record information. PREPARED BY: CaeSury 3.) This plan is not for recording and is not to be p used for construction layout or deed description 23 West Bay Rd, Suite G purposes. Osterville MA 02655 (508) 420-3994 / 420-3995fax DWG #:C517_2g2 cppl FIELD BY: WHK/KAR 1HE i Town of Barnstable BARNSTARLE.q Regulatory Services, MASS 0 `be tB39' �• Building Division �f0 MPS� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 i Inspection Correction Notice i Type of Inspection � � 7Y2"--1AJ& Location soli��/ �t� L,6W Permit Number T® �- Owner � L�l Builder 's -�.� l t One notice to remain on job site,one notice on file in Building Department. The following items need correcting: C c- JJa T /j64 IJ gR d CcJ loxZ,G S/6E f hz) Vg J G/Avis ioc-�e L66 E Hop ji r%-7- QTd( C&C P- Y i Ova 4J4t/t- l y6 (�)r sue.�Ff�-.v� O� sE Pr -3 (C- 7a Of L o- J� i51 lk Please call: 508-862-4 -for re-inspection. Inspected by L lAtc Town of Barnstable Regulatory Services oFIME Thomas F.Geiler,Director Building Division w JIMMSTneIX # Tom Perry,Building Commissioner v '6i 9. 200 Main Street,Hyannis,MA 02601 m ��FD MA'S a Office: 508-862-4038 Fax: 508-790-6230 October 18, 2012 Irene Cook 5 Crystal Lane N. Easton, Ma. 02356 RE: 545 South Main St. Centerville Map: 206 Parcel: 071 o p Dear Property Owner: This letter is to notify you that a final inspection was conducted at the above referenced address for permit application number 200902978 and the following was found to be not in compliance with 780 CMR(State Building Code): ' 1) Handrail not installed continuous for the full length of the stairway. 2) Guard installed below the minimum height requirement of 34 inches on stairway. Please contact this office immediately with any questions or once corrections are made. Respectfully, WeLa&uo—n Local Inspector jeffrey.lauzon@town.bamstable.ma.us (508) 862-4034 Q:zoning5 :► -�, "K�, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.. Map Parcel f� ,Application # 7 Health Division 'Date Issued Conservation Division Application Fee Planning Dept: Permit Fee, Date Definitive"Plan Approved by Planning Board Historic = OKH _ Preservation / Hyannis / Project Street Address ,r�f J� S�o oAkA MAtA SN-QX,\— C Village Owner CLc1, f 3:" C.00 Address 5 eldsN-r-k Lt4 �. C4S6. M4 Telephone_Ce. `5oa-.155�-6553 \1 1017-19'63- 31606 Coll !�►7�9�3-96ZZ�Z�S�o Permit Request GnA - 0UV&\ b,(- ACC.k, tP\ocL ,Q,I�rgS cr,4 d -CAk anLs .``?unayl4. Ro ilkb ?. ►rt \Itc- C�oo SSian' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Flood Plain Groundwater Overlay Zonirigbistrict Project Valuation (i1G� ' Construction Type Lot-Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Oa Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. new Half: existing v new Number of Bedrooms: J — existing —new Total Room Count (not including baths): existing to new First Floor Room Count Heat Type and Fuel: 9'Gas ❑Oil ❑ Electric ❑ Other Central Air: 0Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: 0 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes U/o If yes, site plan review# c+� 0 Current Use Proposed Use -zs 63 N APPLICANT INFORMATION ch (BUILDER OR HOMEOWNER) Name Berl- r nr �' �d�L Telephone NumberQ - _T Address 47 qy S" ry) Pd o T License # AN rtw 4� 1 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE X (� c � s FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE I<• - OWNER DATE OF INSPECTION: FOUNDATION - FRAME INSULATION FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH I FINAL FINAL BUILDING /6/�`� d 19�IL DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofmassachuse&s! Department of lndustrial Accidenfv Office of Investigations 600 Washington Street Boston, MA 02111 wlww.mass.gov/dia Workers' Compensation Insnrance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le�iblY Name (Business/Organisation/Individuai): 'Ln 1e e oo l c— Address• City/State/Zip: ��v� Z� hone-#: �o `��•� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4• ❑ 1 am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a•sole proprietor or partner- ship listed on the attached sheet 7• ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition rmployees and have workers' 9. Building addition working for me in any capacity. [No workers' comp•insurance comp.insurance.$ equired] 5. ❑ We are a corporation and its 1D.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL self. [No workers comp. l2.❑Roof repairs in.c,,,ance required]t c. 152, §1(4), and we have no employees. [No workers' I3.0 Other . comp,insurance required_] *Any applicant that chocks box#1 must also fill out the 9ec6on below showing their workers'compcnsation policy information. t Homeowners who submit this affidavit indicating they arc doing all workand then hire outside contractors must submit anew affidavit in di citing such. 4--on-actors that check this box must attached an additional sheet showing the name of the subcontractors and state whether err not those entities have employers. Lf the sub-contractors have employees,they must pravidt their workers'comp.policy number. lam an employer ilsai is providing workers'compertsation insurance far my employees. Below is the policy and jab site information. Insurance Company Name: Policy 4 or Self-ins. Lic.#: Expiration Date: Job Site Address: CitylStatc/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to-the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the bL4 for insurance coverage verification. Ido hereby certify un r the pains•art naLdes of perjury that the infarmadon provided aboue is true and correct. • Si afore: — Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Pere- Licenm 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact person: Phone#: Information and. Inst °actiO s Massaohusetts Genezal Laws chapter 152 requires all employers to provide workers' compensation for their.cmployees: Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association; corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the.legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter,152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produred•acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ohapter 152, §25C(7) states 'Neither the commonwealth nor any of its political subdivisions shall n enter into any contract for.the performance of public work until acceptable cvi deuce of cornpliznce with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if along with their certificates) necessary, supply sub-contractors)name(s), address(cs) and phone numbers) insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships (LLP)with no employees other er than they members or partners, arc not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affadavlt. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self insured companies should enter their sclf-insuranGo license number on the appropriate line. City or Towle Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to:fill out in the event the Of iicc of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/liccasc number which will be used m a reference number. In addition, an applicant that must submit multiple permit/liccnsc applications in any given year, need only submit onp affidavit indicating currciat policy information(if Accessary) and under"Job Site Address the applicant should write"all locations in-(city l? . the town)."A cbpy of the affidavit that has been officially stamped or marked by the city or town may be provided to applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or p.erzait not related to any business or commercial venture (Le. a dog license or-permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call " The Department's address,tclephone•and fax number: T(,, Commollwt,Wth of MmsaGhi=tts Dt,-putmont of Industxial Arcictonts Office of luvestigativas 600 Washington Street $oston, IAA 02111 Tel. # 617--727-49-00 ext 406 w 1-V7-MA.SSAFE Fax# 617-727-7749 Revised 11-22-06 jig www.mass gpy/ Town of Barnstable ��of-rHe r�o Regulatory Services Thomas F. Geiler, Director BARNSTABLE, MAC' 1679• Building Division �� �PJFD Mtn Tom Perry,Building Commissioner 200 Main Street, Hyannis., MA 02601 ,Arwjv.town.barnstable.ma•us Fax: 508-790-6M Office: 508-862-4038 UOAfEOWNER LICENSE EXEMPTION Please Print DATE: S4 JOB LOCATION: j 7J6 50(J'C`� "'tG.td1 "L;T" L en\, ,, `L Mot - t5,3 number , street village v d �+ ��} Qe �I sob 6 "HOMEOWNER": �2.%tom y -,Te—f �K CG�` �q1 493� I �t name `' home phone N work phone# CURRENT MAILING ADDRESS: OZS S city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEI'INITION OF HOMEOWNER Person(s) who owns a parcel of land on'which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a fvio-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) sibility for compliance with the State Building Code and other The undersigned"homeowner" assumes respon applicable codes, bylaws,rules.and regulations. The u ed"homeowner"certifies that he/she understands the Town of Barnstable Building Department mum inspe tion paoce es and r uirements and that he/she will comply with said procedures and equirements j Signa omeowner Approval of Building Official Note: Three-family dwellings'containing 35.,000 cubic feet or larger will be required to comply with the State Building Code Section 127,0 Construction Control. HOAEEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section lom,l-Licensing of construction Supervisors);.provided that if the homeowner engages a person(s)for-hire to do such ' Work, that such Homeowner shall act as supervisor," Many homeowners who use this exemption aTe unaware that they are assuming the responsibilities or supervisor(see Appendix Q, Rules&'Rcgulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems,particularly ` when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would Aith a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsiblc. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hc/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. you may care t amend and adopt such a formhertificalion for use in your community. . may:• .. w �0 SHEtp 2 Town. of Barnstable Regulatory Services r + RA"STAB Thomas F. Geiler, Director �prFo �a`s, wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.toivn.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ff using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th'e reverse side. - I r Y To 4-4 112T111GT W1 ` 1 77 'ram'•/ ,� � y = ,'�- � 1 t t :.. � 7 4L'"` ss , v i xrh f .. is `,��3 ���I"��" �°`{`.Jr- y;z -'3..-�� yt �.r•�. t j � :. i MA I KI N1AI�f -.LiU-1HAt14rt=V NOT ivy VV Wk - ,yr - ' .T A� Y I t ix, fx1 +�'��t�'�•w�'4- s+ .�amygi r�Ci.: ':� r. t >Ht�tttar^ i t > . 4tNAT NOW A 4 4•l � 41t �� .5iyrt"{�i,Y4y - VOW off . tY� ;YW - .. :jq� �' TY � ,:`b �C .��r�b!Y'•x. tf.,��U.N��`�,IO,'1 � r• Y _ �I i>tf 4+b' ,#�s F L.!., ' a L MO gp c g' ��-aa'flsgxr r ' 4 ,u, iN k i � K cro-1%1f r 'rxrnz--�20-11t4\ INV r r �A �.......wrvn ho.eee•-a�xs� 1 05 . 9 ys Uj ti y � I z $. r�..•�.��.e k�s ..i�: < ,- .; pa}!._ �.. e :: �a�t*.Nw"J�tF°s�,r�'' `y�-' ia"^�p dk��.� �"`���- ,,// .s x n � � � :. ._ .ry ,$. #..' _.;_. 3 i�,o*x- '�'$. _ vt +e � h� d J# '`�.',y � ,t•,._, rn5.. .> ,+ �u,: ia.. ,r'a P,...;9'^ -.tx:.< 2F. ..., a .. `'�' ,1::;' ,...:�+ _.�` .:.# •� � rws-. .,�^�ix,S s kk.� ''9ra,.. '�me :`•r: �„ .. � •iY� P'S. � A ,�� f.'e,SPY �3 �' 7t[�#�.� �1Cf�V�� �iS»'� V i r l ,,2 _A I � 4•.7.� JO V ,r y � 1 ,f)T'i � c Ell W'�� �k�(' %i �Nit S 4 ✓� 1 v�-s .•Sr 1 1 s -y t / I I � - >, AV _ ► rrI Any GROW Am"4, MLa OWN f � S S�♦O,. r�c c1 t �.rv"" �T..� r S'�'x�';1( y"a-4'`b ,ry S r.. .{y`�Q�f1 k tscC, �' +9• -t,a i � �SA \ i 1j COG�t ��V r1.�l� OG'1"it-1Gf Q i - - SCALE: �- I if APPROVED SV DRAWN 8V. ' DATE: a DRAWING NUMBEi ..,... . 1 .. l Gay I Er � Town of Barnstable *Permit#s 402�C v Qi. Expires 6 nronths front issue date { , STAB Regulatory Services Feel MA9& Thomas F.Geiler, Director �ArfD�AP'�b Building Division Tom Perry,CBO, Building Commissioner MI200 Main Street, Hyannis, MA 02601 JUN 5, 2009 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF EPTt IT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number L Property Address S jc CA-) IV► 17 �Lii �&n11�nVi Ind Residential Value of Work 000 •'� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name N��C hffy— Owner Telephone Number Gl11.f3'911LZ' co sD8'.,M-72, 73 Home Improvement Contractor License#(if applicable) ` l/ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Pq I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner Ie must sign Property Owner Letter of Permission. o rov I ement Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS x` e s\EXPRESSPERMIT.DOC Revise06O4O9 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations" 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� to Please Print LedblY Name (Business/Organization/Individual): 6} J cola C` Address: 5 C C 2 3 6(o City/State/Zip: IV, (; CS} =(Y1►�} 6 2-3 6(o Phone,.#:.508 7.7 73 W7'-5, -63 Are you an employer? Check the appropriate box: Type of proj&ct(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors ..2:❑ 1 am a sole prpprietor or parttler-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have g.'❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'••comp.•insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comip. right of exemption per MGL 12.K Roof repairs S1i ao insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required_] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy infom-ation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must pmvidt their workers'conT.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimuial penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb ce ��der the pains•and penalties of perjury that the infarrnation provided above is true and correct. Si mature: L Date: Phone ,j'Of� ,01.���ZL7.7 • Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information an�( InstruCt101C�S Massachusetts General Laws chapter 1S2 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more 7.�_ " of the foregomg-engag in alomEen rpnsee,i—h m&lu3_m_g_ ie leg representatives-6f- deczaseti=empivyer�rthc:=- -.- 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 maintenknce,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not,becausc.of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that".every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not•produced•acceptible evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-Conti-actors)name(s),-address(es)md.phone number(s) along with their cer6Lcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required- Be advised that this affidavit may be submitted to the Department of Industrial -Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp Officials .Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit onp affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is on file for future permits or licenses. A neyv affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to-thank you in advance for your cooperation and should you Lave any questions, please do not hesitate tc give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts ti . Department of Industrial Accidents O fice of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext-406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass_gov/dia I THME ti Town of Barnstable ` Regulatory Services p �$, Thomas F. Geiler,Director E 16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town-barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-623C , ,Property Owner Must . Complete and Sign This Section If Using.A Builder { I, � �`4 , as Owner of the subject property , hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: .(Address of Job) , Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.' Town of Barnstable . a, N�'��Of THE tp�y� Regulatory Services Thomas F. Geller,Director Building Division Tom Perry,Building Commissioner . .200 Rfairi=Strcet--Hyanais,Nbk--026-01 www.town.barnstable-ma us Office: 508-862-4039 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / g Please Print DATE—T(o1 S 19 JOB LOCATION: �T S S 6aA auA SkL.f" xo/ r 16WV e AW `'4_44 &f- number street village a "HOMEOWNER': Tc� •Coo k S68-XV-7?73 (0/7S63-311U_ name 11 home phone# work phone# CURRENT MAILING ADDRFSS:�rq 1a Lc __t_ eityhown state zip code The current exemption far"homeowners"was extended to include owner-occupied dwellings of sic units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINIITON OF HOMBAWT'ER < Person(s)who owns a parcel of land on which he%she resides or intends`to"reside;odwhich-thefe is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) -rlae undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable.codes,bylaws,rules and regulations. The un ad."homeowner"certifies that.he/she understands the Tpwn of Barpstable,Building Deparhnent um' action procedures and requirements and that he/she will comply with said procedures and CZ[= me • Si omcawner Approval of Budding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The code states that Any bome %%mcr parfvnnbg work for which a building permit is required shall be exempt from the provisions of this section(Section 1 D9.1.1 -Licernsing of construction Supervisors);provided that if the hamcowner engages a penon(s)for biro to do such work,that such Homcowmer shall ad as supervisor." Many homcowmers who use this exemption are unm=that they an assuming the rrsponmbtlities of a supervisor(see Appendix Q, Rules&RcguladOns'for Licensing Construction Supervison,Section 2.15) This lack of awatrncss often results in serious problems,particularly when the homcown cr hirrs unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ubirnately responsble. To ensure that the homeowner is fully aware ofMs/her responnNlitics,many communities require,as part of the permit application, that the homeowner certify that Wshe understands the responsibilities of a Supervisor. On the last page of this issue is a form curdy used by several towns_ You may care t amend and adopt such a ferrr/ceatification.for use in your community. Q:forrrra:h omocxcmp t 1012 .: jug .� �}r `Rle Edit Taals #fle _ . 4- ti F. De eecied m' lr =Ga ectrrt requisite Ad�an t?t. dry.. Pappiraved B3 St�ttvs. sp rri jmr e N 1 5 M�F'Sfat , H A. r c � r y Vt+ORKCOMP SUBMISSION 6300 €G 15oND-9 DB.AR APPR a4jdk Hista t ° T. 41. 775 4 -BA -HISTOR x.SR Ne ed ... type P�PP.Rfii�141 J'ETS '- ETST Act�ar� g V l S W :L z Finectaera"'; , a -Ha _e �21 BRAB ER15T0 `IG ` i I = t,. Ke s __ eferenee. ._ , 4.x' - < Statuses AFPRR'RUED , :' K .. _,-�� .- _<x^ ,_ , � � �. , _ x,.:v , ., - 3 -.date 5,213. u ` :.. _ < $' ,,r3 „ :, aru�merat=code ., „ .< *.,°; (�rattedl €lBt 1 y oi {m�ta a tined ,,: � �.�• ,� N �: ram'� ,,M_, �-•� '°� 5 � � y 4 . ;N E � A: :Rte�a�sf.�r�h�t�cedar s}�In es l.rE lacek4v�irdau�s-rtrF. .s .: Y � ffi . .: :-- -, L ., :. .r Tfad. _ - - z' x 4 s p 1 of 2' } f _ m a "s k ,f x MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 5/20/2011 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: JEFFREY&IRENE COOK Property Address: 545 S.MAIN ST.,CENTERVILLE,MA 02632 Policy Number: 0797221 Type Loss: Lightning(not resulting in Fire) Date of Loss: 05/10/2011 Claim Number: 288822 Claim has been made involving loss,damage or destruction of the above captioned propert,which may either pCD exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any z.� notice under Massachusetts General Laws,Chapter 139 Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. - -'' MPIUA Claims Divisions 4 CMA00021 - _ ° eel- _ 5Jfing ho mane c niq rest, deuce - 31 (e(s Town of Barnstable 9 0 fD C h U) t S' Approved Regulatory Services Nmes Fee 5, O® Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner G 200 Main Street, Hyannis,MA 02601 � o � N }� Office: 508-862-4038 x: 50 90-6 0 --i r. 03 Home Occupation Registration N ca Date: r o N - 7 Name: \)�.f1�Yl l c _�JV f�}1 S Phone#: 156� 7 53 / rrrr � Env Address: ,'DW � S lfl _ aI t'l� `1 Village: Name of Business: �- Type of Business: u �� �i �Map/Lot: b Zoning District Zoning Districts RF and RC-1 require Special Perriut from Zoning Boar Appeals. INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. J After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located r within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there rz) is no outside evidence of such use. C• No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I, the undersigned,have_rea nd agree wit the above restrictions for my home occupation I am registering. Applicant: Date: -6 2 ,0 Homeoc.doc TO ALL,NEW BUSINESS OWNERS �� ���� ►'� DATE: -/-- 2 - 3 ni y — Fill in please: APPLICANT'S �' ;` YOUR NAME: I / //-, S S>✓��rS BUSINESS 3 YO R HOME ADDRESS: S /lit . - y . G TELEPHONE Telephone Number. Home 9& - ? - cn A- ..�..,.....(�...._,,E �..,.�S,!..., I P � , 0, �� ,. ,,,...,,._ ........ .::.:.....:...... ....... ......: �AP,ARcEL NuMt��i� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make.sure you have all the required permits and licenses.. GO TO 200 Main St. -(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISS NER'S FICE This individual a b i ormed f y permit requirements that pertain to this type of business. u on d Signature" COMMENTS: %Z� — 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost$20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. TOWN OF BARNSTABLE, MASSACHUSE77S BUILDING PERMIT RMIT DATE February 27 95 No 37459 APPLICANT Alan Nagle 19 ox PERMIT Nj� Repair foundation, replace Windows, ADDRESS � entervll e, (N0.) (STREET) _ !• PERMIT TO Build deck, basement GGlab ` (CONTR*S LICENSE) T_) STORYA Single Family Dwelling NUMBER OF y (TYPE OF IMPROVEMENT) RO. (PROPOSE ,USE) DWELLING UNITS - - d AT (LOCATION) 545 South Main Street, Centerville, MA zoNING f(N0.) (STREET) DISTR ICT— �_�� ' BETWEEN (CROSS STREET) AND - � ' - (CROSS STREET) SUBDIVISION LOT BLOCK LOT SIZE BUILDING IS TO BE�_FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION _ REMARKS: Spwncyp 4694-635 (TYPE) AA AREA OR ? VOLUME Nn 7YPA (•}ian on M (CUBIC/SQUARE FEETI PER OWNER Alan Nagle ESTIMATED COST iB4O00.00 FEE MIT $ 135.00 - P.O. Box ADDRESS entervl e, BUIVGZET. BY I 5 it a Assessor's Office Ist floor MaD f `0 Lot L �-2— Permit# 1 3 z7 Conservation Office Oth floors Date Issued Z Z 5"- Board of Health Ord floor g wx, n ineermg Dent. Ord floor) HousePlanning Dept. (1st floor/School Admin.Bldg.): �$ MUST MPLIANCE Definitive Plan Approved by Planning Board 19 '= E 5 �,• (Applications processed 8:30-9:30 a.m.'& 1:00-2:00p.m.) �- EN Q;®®E AND 'TOWN OF BARNSTABLE y Building Permit Application, Pro'ect Street Address 5Y5 , .57. A4 • Villa e : LIClI Fire District I- Owner fhJ CVV* .J f}7�L[C/ AM4 G-Address e4041 dl L-LE- Tele hone 7 �` Permit Request: �iJ� J Zoning District /— `�"� / Flood Plain Water Protection Lot Size / - 3 *ZA=5 Grandfathered Zoning Board of Anneals Authorization Recorded •'1 Current Use ��a ���n/C � Proposed Use Construction Tvne W-08 e ` Existing Information Dwelling T e: Sin le Fami1v Two family .Multi-family Age of structure 's Basement h/ 4-vfG _ / Historic House 0 Finished Old Kin, s Highway �,j 0 Unfinished Number of Baths No.of Bedrooms Total Room Count not including baths First Floor Heat Type and Fuel r w4-7 —loll Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None r Sheds Other 1 Builder Information Name Lam' Telephone number Address /3> P 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 Pro'ect Cost Fee g _ SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T ma's 2/2 7/9 5 37459 9� 1.�` -FOR OFFICE USE ONLY y �06.071 ,f 545 South Main Street Centerville ADDRESS VILLAGE Alan Nagle ` OWNER DATE OF Il JSPEC-HON: /a2cS�/�6 �G�i• .o/C¢�C `��� i 1 FOUNDATION ! J •. 1 P s . - f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO." R �lZ-�a •fix-yia � � ` � - - - d �^ � l�ornrfw�zcueaCth o f Wa�jjacluuleth _ e1Je�arfrnenf o��rutu9trial ._/Hccidenfs '• 600 I/Vailtincgfon Street James J.Campbell 12oifon, aJiachcc9efb 02111 Commissioner - Workers' Compensation Insurance Affidavit (lice=Wpecmiccee) with a principal place of business at: - ���� c-/P14/ 1�/Ll.� Get/ �iD • ��NTE�c'd/GAL r��i¢. /�63� `� (Gey/sace P) do hereby certify under the pains and penalties of perjury, that: O I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number O 1 am a sole proprietor and have no one working for me in any capacity. I am a sole proprietor, general contractor o homeowner circle one and have hired the contractors listed below who have the following workers' compensation policies: . 1 v A ti/S q&OA; Co IA' Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O 1 am a homeowner performing all the work myself. 1 understand that a copy of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure coverage as required under Section 25 f MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or one years'imprisonment as well a civil pe It in the form a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this day of // 3 — 19 Licensee/Permittee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 577i-> 4 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE 9 S/ JOB LOCATION s . Number Street address Section of:-town "HOMEOWNER" ameRome phone Work phone--.- PRESENT MAILING ADDRESS `D ,9 City town State Zip co e The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to aiiow such homeowners dividual for hire who does not possess a license providdto engage an in acts as supervisor provided that the owner DEFINITION OF HOMEO WNER: Person s ( ) 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 res onsible for all such work Derformed under the buildinq permit. p (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 inspec ion procedures and requirements and that he/she will comply with d proce res 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 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 a Home Owner engages a person(s) for hire to do such work, that such Home -Owner shall act as supervisor. " t .: 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 SupervE�,ors,%Section 2. 15) ` This -lack of awarenes often7results'�i'n serious problems, particularly when the Home_ Owner hires unlicensed persons. In this case our Board cannot proceed, against-:--the= inlicensed person as it wouldi with licensed-Su ervisor: �;The. Home Owner'actin •as.-supervisoz, is ultimately. responsible. To ensure that the Home Owner is fully 4aware�of his/her. responsibilities,`'man communities requirre,�Aas,part, of;t66 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-'W"amend and adopt such a form/certification for use in your community. n 3ui Mzin JL�lid:tin»1,IA 02<i01 Oboe: 508-790-6227 Fa�c 508 775 3344 RaIphcrossea For office use only B�'�aommi=oncr Permit no. D2te AFMAVIT HO ME DOROVEMI WTOONIPACMRL&W SDPPLEMENM pERWrAPPUC&UC)N : MQ,c I42A mquirrs that ihe'Yaooze aioq aItcrsi<orts, i tmocatro4s�modcmi t _ �P��, tc:xrtoc�dcmolitioci,a oousiivaioa cf an acWifioa to . ZY prat-C)dS ag<mytr btu-idin g containing at lcm one but not more than four dwd iqg units ar to sttucRttrs�srhich ad_Poeat to such nsidcncc or building be donc by TtZis red contractors,azth amain txoeptioas.aivng Vft o 3i%peofWork: l cC'r� ✓�✓D/� on/ �i¢ Est.Cost Address of Work:_ Ovycs Tame: Gf¢i�/ /VGA Datc ofpermit Application: I hcrz~n-ccrtifvthat: Rcgistrztion is not rquircd for ttrc folloKin-r rras nw: Fork<zcludcd b.,-1aa- Job under S1 O00 Ecileing not-(mmcr-oaa:pic:� ;K �•Mcr pulling Dawn pc nux hoticc is hcrcbySivcn thzt. 0XVINIEPS pULLT;;G T lR 0v:^,:i-,1,0 DSl,1T�G 1:'TTii L:�'REGiSTERED CO�'ER�CTOi� FOn7 TASPTLICABLE FON,:E- P..T,T' tt�� T:OT♦,Tv- ACCESS i0 Try r• �`I✓ IfLLi114� �'l'14C`..Ll�i OL��FCL*�'� ��—D !;GL C. 1<2A - SlCNF-D L?�D1✓R pLl;/,LTICS Of PrF.tl!�1' r . ;1, Qp . Dzic I � �f�lam: �vC /� t�1�5 � �➢�G� ���, ` r 4 2 �. SK lov ,i t z\1 s ze cA/ -ba�- ��- - � - i f f 1 1{I ( II j I I I . I • 1 . r 11- 1) Ir I� I r i it k � • r �1 Town' of Barnstable - Regulatory Services - �'THE�q Thomas F.Geiler,Director Building Division MUMSTPABLE, : Tom Perry,Building Commissioner � 1"g q: � 200 Main Street,Hyannis,MA 02601 �ED MA'S A Office: 508-862-4038 Fax: 508-790-6230 October 18, 2012 Irene Cook -5 Crystal Lane — N. Easton, Ma. 02356 RE: 545 South Main St., Centerville Map: 206 Parcel: 071 Dear Property Owner: This letter is to notify you that a final inspection was conducted at the above referenced address for permit application number 200902978 and the following was found to be not in compliance with 780 CMR(State Building Code): 1) Handrail not installed continuous for the full length of the stairway. 2)' Guard installed below the minimum height requirement of 34 inches on stairway. Please contact this office immediately with any questions or once corrections are made. Respectfully, e Lain . Local Inspector j effrey.lauzongtown.barnstable.ma:us (508) 862-4034 Qzoning5 Bldg. Dept. 200 Main St. U.S.POSTAGE>>PITNEYBOWES Hyannis, Ma. 02601 awe ZIP 02601 $Z .5000.4 02 1 YV 0001.3614.75 OCT. 18. 2012, Irene Cook 5 Crystal Lane N. Easton, Ma. 02356 ,r�• rrr}LDS J _ 'S 3.i�s t= � i` � �_y !:f 1' ��_�'=� _.. I Y F�Y . r � _ 16'-0" 13'A• Ili B P.T.6 x 6 POSTS B A5 ____ A5 ® 00UTU_-NEOFNEWDECKABOVE 4 EXPANDED DECK ,65 4 S.F. OUTLINE OF NEW DECK ABOVE _r 16•-p- I 1 UP II ANDERSEN ASERIES I I p IMPACT GLAZING G 6068APLR FRENCH DOOR I I Y Lu 4 O c r o Iw STONE m I3 2'-0" ANDERSEN ASERIES NOERSEN - m STEPS I� IMPACTGLA23NG SERIES - O ANDERSEN AAN2614 IMPACT GLA21N ASERIES N2620 I IMPACT GLAZING STORAGE INSTALL SMARTVENT - FLOOD VENTS UNDER AAN2614 UNDER EACH WINDOW __—_—_—_—__— Lc o m ASERIESN NEW RETAINING IMPACT GLAZING WALL AAN2614 GAMEROOM ANDERSEN NEW m 280 S.F. q LALG ASERIES (VAULTED CEILING) EXIST. IMPACT G q GARAGE AAN2614 ENTRY A A A5 384 S.F. A5 A5 A5 o ANDERSEN ASERIES 2'-0" ANDERSEN IMPACT GLAZING STORAGE SERIES 4--7" AAN2614 UNDER IMPACT GLAZIN p INSTALL FIRE RESISTANCE HARDIPLANK CLAPBOARD SIDING&HARDITRIM ON THE WEST SIDE OF BUILDING DUE 60 O ro TO THE PROXIMITY OF THE NEW ACCESSORY STRUCTURE HVAC INSTALL FIRE RESISTANCE NEW fO PER IRC2009 SECTION 302.1 .....,� m 2Q HARDIPLANK CLAPBOARD O -' 4 SIDING&HARDITRIM ON THE AT H ,^ , - +sd. WEST SIDE OF BUILDING DUE TO THE PROXIMITY OF THE 9'0"x TO"O.H.DOOR NEW ACCESSORY STRUCTURE PER IRC2009 SECTION 302.1 w .u _ —3 ANDERSEN ANDERSEN CO NC. ASERIES ASERIES APRON IMPACT GL qING - ADH2644 EXIST. _ - - ADH78 EXIST.40 IMPACT GLAZING z _-. HOUSE HOUSE + - Y - '2,3 Z,S, 4•.0• - / vJ L!L T r" -- SECOND FLOOR PLAN v .i—_I. - .. .._.�.... _-:...:..�w._:__..:._.--_.. y..__.P....,_....�:�-.-_.emu..-....--.- . i IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS FIRST FLOOR PLAN CLIM,0,TE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION TABLE 402.1.1 (MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) FENESTRATION SKYLIGHT CEILING WOOD F FLOOR BASEMENT WALL BASEMENT SLAB CRAWL SPACE WALL U-FACTOR, U-FACTOR R-VALUE R-VALUERAMED WALL R-VALUE R-VALUE R-VALUE R-VALUE LEGEND: 0.35 ! 0.60 49 26 30 10/13 10(2FT.DEEP) 10H3 NOTES: Q EXISTING WALLS 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. CONSTRUCTION TO BE REMOVED 2.10/13 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR OF;THE HOME OR R=13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL ® NEW CONSTRUCTION 3,REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS THE DESIGNER SMALL ME FOUND ERRORS R SCALE : DRAWING NO.: COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR: ERROR CONSTRUCTION. THE BUILDING ADING CODON OMISSIONS THESE DRAWNGS PRIOR TO START OF ®EK - WILL BE RESPONSIBLE FOR THE CONTT EN TOR 1/4"- 1'-OIL IN DESIGNER OFAN E RORSOROMISSI Al 43 BREWSTER ROAD COMMENCESWITHOUTNOTIFYINGTHE c (1 DESIGNER OF ANY ERRORS OR OMISSIONS. MASHPEE MA. 02649 THESE DRAWNGS ARE SOLELY FOR THE USE WELLS RESIDENCE OF THE OWNER NOTED.ANY OTHER USE OF DATE THESE DRAWINGS REQUIRES THE WRITTEN 9/22/2014 FAX((508) 2 39-94 6 545 SOUTH MAIN STREET C;ENTERVILLE, MA ACONSENT OF THE RCH RECTURALCOPYRGPTPROTECTION FAX (508) 539-9402 ACTOFIM. 13'-8" P.T.6 It 6 POSTS _ B B A5 x A5 ® �JUTLINEOFNEWDECKABOVE 4 EXPANDED I DECK 165 S.F. " • OUTLINE OF NEW DECK ABOVE 16'-0" UPANDERSEN II OIMPACT GLAZING A-SERIES I I a 6068APLR FRENCH DOOR I I Y IW T0"X 6'8" I y I� LL 4 Iw ANDERSEN 4 i STONE 19- 2'-0" ASERIES DERSEN m STEPS -. IP! S' IMPACT GLAZING A-SERIES ,. O ua ANDERSEN _ AAN2614 IMPACTGLAZIN - I o. ASERIES N2620 - I - IMPACTGLAZING INSTALL SMARTVENT ST E ORAG FLOOD VENTS UNDER AAN2614 UNDER EACH WINDOW ————- -—————— ANDERSEN - RETAINING - _ ASERIES N E . IMPA yj m WALL AAN2614 LAZING GAM -NEW I ANDERSEN (VA S.F. o ' o ASERIES (VAULTED CEILING) b A GARAGE A EXIST. N ,�"614"� G ENTRY A A A5 384 S.F. A5 A5 A5 c ANDERSEN ASERIES ANDERSEN IMPACT GLAZING STORAGE A-SERIES 4'-7" AAN2614 UNDER IMPACT GLAZIN 0 INSTALL FIRE RESISTANCE HARDIPLANK CLAPBOARD -- SIDING&HARDITRIM ON THE WEST I DE OF m m TO THE PROXIMITY O'F THE NG E NEW ACCESSORY STRUCTURE do HVAC INSTALL FIRE RESISTANCE I O A I E1IL 1 ! XF�-, PER IRC2009 SECTION 3021 HARDIPLANK CLAPBOARD _ IY V V SIDING&HARDITRIM ON THE ATH / \ WEST SIDE OF BUILDING DUE _ o TO THE PROXIMITY OF THE 9'0"x TO"O.H.DOOR NEW ACCESSORY STRUCTURE PER IRC2009 SECTION 302.1 CONC. ANDERSEN ? - ANDERSEN ! - APRON A-SERIES ASERIES $ .. I :••� IMPACT GL aING ADH2644 { _ ADH1840 EXIST. ) IMPACT GLAZING EXIST. - - HOUSE B'-0" 6'-0". HOUSE f 14,L� •.2t0 _ - 9:^0. 2 3 2•-9" 4'-0" y iJ z��s l�EL- SI-iLDHNC yir_ Em SECOND FLOOR PLANrn i . IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS CLIMA E ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION FIRST FLOOR PLAN TABI-Ej402.1.1 (MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) FENESTRATION I SKYLIGHT CEIUNG WOOD FRAMED WALL FLOOR BASEMENT WALL BASEMENT SLAB CRAWL SPACE WALL U-FACTOR' U-FACTOR R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE LEGEND: 0.35 1 49 20 30 10/13 10(2 FT.DEEP) 10/13 EXISTING WALLS NOTES_ O • 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. r--, CONSTRUCTION TO BE REMOVED 2.10I,13;aEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR --J OF THE HOME OR R=13 CAVITY INSULATION AT,THE INTERIOR OF THE BASEMENT WALL . ® NEW CONSTRUCTION 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS TH ERRORS RO SHALL BENOTIFIEDFOUND IF ANY SCALE : DRAWING NO.: COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR: ERRORSORON.THENSAREFOUNNTR f ®� THESE DRESPONS PRIOR TO START T CONSTRUCTION.THE SUILDINGCONTAACTOR 1/4,1 _ 11_011 WILL BE RESPONSIBLE FOR THE CONTENT IN THESE DRAWINGS IF CONSTRUCTION 43 BREWSTER ROAD COMMENCES WITHOUT NOTIFYING THE DESIGN ER OF ANY ERRORS OR OMISSIONS. MASHPEE MA. 02649 + THIES E DRAWINGS ERRORS OR FOR THE USE WELLS RESIDENCE I D E N C E THESE ORAVNNGS REQUIRES THE WRITTEN DATE : p I ;� OF SEOW NGSREQUIRES THERUSEOF 9/22/2014 PH. (50H 274-1166 CONSENT OF THE DESIGNER UNDER THE Al FAX (50 ) 539-9402 545 SOUTH MAIN STREET i�,ENTERVILLE, MA ARDHREGTUR LLCOP RIGHT PROTECTON ACT OF 1990. I ,j • ., . ASSESSORS REF.: e Top 0f SQlJF•• ' �JP ` 1tig / Map 206, Parcel 071 EI = 17.84' �9. / saptk �1t N Move Driveway > ` 1 q Around Proposed Garage & Widen \, Drive To End of I \,7'•.,� N q�♦ . q`' O��e / ,�\\0. arage Door 0 ,\l w is c^w uth.. s, �/ g ......... . d,c° aK' ` ./ \ lg\ ^l; c.�eimxBeaep.•�,.✓ �¢�'1"� 7 z,., V ... /P` e•f�.. 1 \ Z LOCATION MAP P \� ,, '' / _ _ sow /• \ ''••.� *13 2 OVERLAY DISTRICT: /A y �i —--'-\ oPy m� \\ \ '0 y AP - Aquifer Protection District �~ As Shown on Plan Entitled a o Revised Groundwater Protection —� 6 Overlay Districts' — April, 1993 \ _ 5ed \ PoDec \ \ . VMFt `\ 2 0 1 K \ ....... ........ �•� . ......... •� \ ° o , .� " \ FLOOD ZONE: Zone B, &A10(e111) \\ \ \ \ Community Panel No. ° \ J250001 0016 D \\ \ \ / Snell Ww"Y \ July 2, 1992 Proposed Silt o ZONE: Fence Work Limit � \ Area to Frontsgeln�min3)),�� SF Width (min) 115' Setbacks: Front 30' Side 10' `\,\ j \ _4 , /. \ `•\ \ ` \ S Rear 10' 1 elm - _ __— / , \•\ ! i � \ 270 SF of Mitigation #• ' Remove Driveway& / \ `\ DIRECTIONS: �5 i >" '\ Plant with Native d>t' \ \ From Hyannis: Take West Main St o •\ Ntknd Fl°ye B„�°d N,n J Vegitation/ and take a left onto Pine Street. �� \ 1 zot \ \'\ \ Take a slight left onto South Main " `\ 00 Street and the property is on the \ �• left #545. y \\� / �e� Lot Area 59.665 S.F. (Total) 17,880 S.F. (Upland) Existing Building Coverage = 7,603 S.F. \`\ wo \ \ (Includes Rear Deck &Stairs) \ '0_ Proposed Garage 541 S.F \\ c c `\ (Includes Deck) \ n �\ Proposed Building Coverage = 2,144 S.F. `•\ ; m� \\ Allowable Building Coverage = Z172 S.F. \ to \ Existing Lot Coverage = 1,726 S.F. �`•\ �' \•\ Includes Front Deck, Stairs, Walls &Steps) \ Proposed Garage &Deck 541 S.F. `\ `, Proposed Lot Coverage = Z267 S.F. \ �•� Allowable Lot Coverage = 3,400 S.F. VNF s `\ LEGEND: Mitigation Area Existing Hardscape 0-50,Buffer \ a Deciduous Tree 2151.1 SF \ 50-100'Buffer 2895.1 SF Coniferous Tree Proposed Hardscapeope 0-50'Buffer 0 GUY 1890.7 SF <>- Utility Pole 50-100'Buffer Light Post 3323.7 SF SS �N OF MA Wetland Flag �1 � q� NOTE: ® Water Gate (round) Required Mitigation © Gas Gate (round) 0-50, O� JOHN C. a, a 1.) The property line information shown was ® Catch Basin 2151.1-1890.7=260.4 SF 'DEA compiled from available record information. O Vent Pipe Net Decrease of 260.4 SFCD IL O CBAH 26o.4x4=1041.E Mitigation Credit 50-100' CD 48168 2.) The topographic information was obtained rn O SB/MHB 3323.7-2895..8 SF 6 ig Increase o9 p rii$TE�O orom an on the between 10/APR/O6 andround v14%APR/O6d on ■ MHB 428.6x3=1285.8 SF Mitigation F Q. k, —OHW— Overhead Wires 1285.8-1041.E=244.2 SF of Mitigation Required OI tC\ updated 14/MAY/14 25—— Elevation Contour 270 SF of Mitigation Provided 3.) The datum used is NGVD '29 Co w c (a fixed mean sea level datum) r^ TITLE PREPARED FOR. PREPARED BY.• Site Plan SullivanEngineering,an n ineerin Ca eSUry Kim B & Bonnie K Wells g 1 Inc. p m PO Box 659 7 Parker Road Plan of Land at 4412 Nicklaus�+Drive Osterville, MA 02655 Osferville MA 02655 �L 545 South Main Street Lawrence, KS 66047 (508)428-3344(508)428-3115 fox (508) 420—J994(508)420--3995 fax _ PSullPEBnol.com ca esurvdka ecod.net 71 Barnstable (Centerville) Mass. � 20 0 10 20 40 so Comp./Draft: Field. WHK/JPM DATE: SCALE: Review: Comp./Draft: RLH/JPM September 4, 2014 1"=20f Proi. # Drawing # C517-1gl New F2r4rarNta To SLOPE .® 1:12 FOR 8' MIN.-� M/v-re-H e;rirSTIrjy 2.C., - —J LOAM & SEED ALL DISTURBED AREAS N FLbG1 R 10" MIN. GE�c-A- , FINISH GR ADE \ •' / s.. • NEWLY GRADED AREA OVER a d . FOUNDATION SEPTIC SYSTEM TO BE SEEDED WALL Z rj . . . . . i� t� w 8" MIN. G.�O 71NG LEACH/NG � r,,,•,_ 4" MIN. , O0 R " ' °` FFE r e �" FOOTING . .� O 8 MIN. 00 2 0 - 1 W Z cr U I 0 '1 FROM J L � n � Ex/SANc .. 16 MIN. -N00 GA LON S S PT/C TA �• -o ... . . . . : . � FOUNDATION DETAIL ._ a, SCALE: 1 •=2 p .M. WER /GHT STEP• EL�V N 1 35 N.G. V.D. o�5e FOUNDATION/FOOTING NOTES 9 \ sting n tev" PROPOSED FOOTING 5 0 1. THIS DESIGN IS FOR EXISTING CONDITIONS ,ONLY NO CHANGES TO ,EXISTING # flo ;FOUNDATION TO BE CONSTRUCTED a... 5 c fir N x FOUNDATION LOADS OR DISTRIBUTION ARE PROPOSED. sPRucE t4 t ELOW EXISTING WALLS - A N 2. FOOTING IS DESIGNED TO BE SET:ON NATURAL OCCURIN G SAND BEARING '=•4'• • STRATA. IF THE CONTRACTOR ENCOUNTERS SOILS CONSISTING OF PEAT, - - TOP FN T.. . . �. . =;ORGANIC SILT 'ORGANIC CLAY -MEDIUM TO `SOFT CLAY OR IF BEARING T' -7. . . MATERIAL IS N DOUBT, SOIL BORINGS, TEST PITS, SOIL, BEARING 6 ESTS OR F#7 jti _ 2 o OTHER SOIL INVESTIGATIONS SHALL BE PERFORMED AND THE DESIGN 5 - MODIFIED BY A STRUCTURAL ENGINEER. N YAPLE • 3. IF WATER IS ENCOUNTERED DURING .THE EXCAVATION THE CONTRATOR, - . . . . SHALL PLACE A` MIN. OF 6 OF COMPACTED CRUSHED STONE BELOW FOOTING 6 AND MAINTAIN DRY CONDITIONS FOR PLACING AND CURRING CONCRETE. PUMPED LAWN i WATER SHALL NOT BE ALLOWED TO DISCHARGE DIRECTLY TOWARD WETLAND AREAS PROPOSED . OAK SUMPS, STONE CHECKDAMS, HAYBALES -0R OTHER MEANS SHALL BE INCORPORATED -54 1 K DECK & LAW SA- �z BY THE THE SITE CONTRACTOR. STAIRS o -< 4. CONCRETE SHALL HAVE A MINIMUM STRENGTH OF 2500 PSI @ ,28 DAYS. O _ , N a.�� r"= �r�rniT� _rt.,r�_,_ MASS. 3erL 3 n CnOr5, ALL r aST i tCT,r SH� BE IN CONFrOn. v v c PAN BY Q =R o� AND LOCAL REGULATIONS. WLF 5 CEDAR F, 1 GENERAL NOTES: LOT 71 1. LOCUS IS RECORDED IN DEED BOOK 9392, PAGE 249 MAP 20E wLF, 2'rh 2.' PROPERTY LINES ARE DERIVED FROM DEED DESCRIPTION, PROPERTY o 1.37 ACRESf - LINES ARE .APPROXIMATE .ONLY. ,� F 4 OF BORDERING VEGETA T EDGE ; 3. LOCUS LIES WITHIN FLOOD ZONE A10 (ELEVATION 11) SHOWN ON PANEL # 25001 0016 D, SHEET 16 Of 25 F.I.R.M. MAP. f- . ED 4. BENCH MARK ON SITE"DERIVED FROM COMMONWEALTH OF MASSACHUSETTS WETLAND FLAGGED. BY.• SAGA TIA, • TRAVERSE STATION `M28QQ, ELEVATION 38.548 N.G.V.D ® MAIN STREET, RaBERT M. - GRA Y WETLAND B/OLOG/ST •'O / .p 'yrl AND SOUTH COUNTY ROAD. ` KF JJ _ 5. SEPTIC SYSTEM LOCATION TAKEN FROM "AS-BUILT" SKETCH PLAN ON G ON , RECORD AT THE BOARD OF HEALTH AS PERMIT # 94-635, INSTALLED 10-27-94. LOCATION SHOWN ON THIS PLAN IS APPROXIMATE ONLY. Q SAL T MARSH/ TIDAL STREAM SYSTEM S/TE PLAN 'OF LAND LOCUS MAP 1 -2083 ,. 1N ✓^-� ,;, Q CENTER VILLE MA. S/TE /'LAN Bay — Y;fF �; ,: d' PREPARED FOR -oAL � _. ,. �, �•. . . ,� , ,� , SCALE .z LOT. 71 MAP 206 SOUTH MAIN STREET N&rt es -. N�+' ! ' ✓✓ .. :._T�raf vllle os� �1.4L REP ED BY DQ � F. r KEN, JR. �, FLAHERTY STEFAN/ & R N INC. Craigvil C ,Q f�// r' o2erarcn.\b �. Lsnblic d n Beach{ /e Q^e.. Y' BRA E h . k 1 e $c , rvrt y 170 COURT STREET PL YMO UTH, MA. 9..�! F, ,°;' REGISTERED ENG/NEERS & LAND SURVEYORS � r1`Q OD * Rork j fi a1°y� Spindle G c CENTER wILLE .HAR.61OR � //������ SCALE.• AS NOTED DA TE,' 111281,94 e� e I . I i I f _ ----4 -� _ - ! it � ---__ _,____ � /�- k ►-� --4 V.A M I; ►I 1 i - - - 1 --- _ - _i Isk _ i 2 X ' fps: -15 r - I �� � ��'t��� � Ili �•�=. f ( r\ � � �� �. 1�r'T�l •:-,�Lfy� � � j�`I �4 /�� �j'�,-��C r� r 4' L.,:;},:I � ' SCALE: / E APPROVED BY DATE: n