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HomeMy WebLinkAbout0066 TERN LANE e \\awl• ® s.4 '� �i' � �'.. �`�, �.h.��",�� �- >3°'j 'y� �� �+'b e4. zz ik �a �.rt - i iwl tp y , ` n .�• J. a ..v�r ., _,,� �,; •:.� ,Tx .� W d. gi-:M1y _`� aft .3. v'e n s a b n a � y's" � u { }.u� •V��. � � amp" c f - .a c .{.• ,.. . u v.. i q Iry y w d Iv. y * v iR it — of O n Y y �x ... i NII - Nu' tter Patrick M. Butler Direct Line: 508-790-5407 Fax: 508-771-8079 E-mail: pbutler@nutter.com MEMORANDUM March 26, 2007 #107763-1. TO: Tom Perry FROM: Patrick M. Butler RE:—6�6=Tern-Lane,=Center ll l Tom, In accordance with our prior discussions, I have prepared and have had executed the attached deed restriction. As you will recall, the purpose for the deed restriction is to provide that the detached garage will serve as an accessory structure and that it will not be used, in any I fashion, for residential use. Would you kindly acknowledge your receipt of this copy of the deed restriction and confirm that I may proceed to record same with the Barnstable County Registry of Deeds. It is my understanding that based upon the recording of this deed restriction there shall be no limitation on doorways, windows or other fenestration associated with the building. Thank you for your assistance on this r. PMB:cam \ Enclosure Receipt acknowledged and agreed: omas Perry, Building Commissioner 1616861.1 NUTTER McCLENNEN & FISH LLP •ATTORNEYS AT LAW 1513 Iyannough Road • P.O. Box 1630 • Hyannis, Massachusetts 02601-1630 • 508-790-5400 • Fax: 508-771-8079 www.nutter.com r DEED RESTRICTION WHEREAS, Glenn E. Tobin("Tobin") is the owner of the property known and numbered as 66 Tern Lane, Centerville, (Barnstable County), Massachusetts, which property is shown as Lot 43, by plan recorded in the Barnstable County Registry of Deeds in Plan Book 88, Page 13 (the "Property"); and WHEREAS, Tobin purchased the property via Quitclaim Deed dated October 30, 2006 and recorded with the Barnstable County Registry of Deeds in Book 21487, Page 302; WHEREAS, Tobin has constructed upon the Property accessory structure containing, inter alia, a garage, storage area, work space and fitness room(the "Accessory Structure");and WHEREAS, the owner has agreed to place a restriction on the above referenced land associated with use of the accessory structure. NOW, THEREFORE, the following restrictions are hereby placed upon the property governing the accessory structure, which restriction shall run with the land and be binding upon all successors in title. 1. The accessory structure shall be incidental and subordinate to the primary dwelling house located on the Property in accordance with Section 240-43 of the Barnstable Zoning Ordinances. 2. The aaccessory structure shall not have a stove or other kitchen�equipment as to allow , for year round occupation or use. 3. The ar ccessory structure shall not bedr have a m s defined under 310 CMR 15.000 State Environmental Code, Title V, minimum requirements for the sub-surface disposal of sanitary sewerage. This shall be a permanent deed restriction affecting the property. Executed as a sealed instrument this a g day of February, 2007. ALEXANDER T.SENATORI Notary Public lenn E. Tobin Commonwealth of Massachusetts My Commission Expires August 30,2013: u ' ti COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this S day of r-s5p-,ex" , 2007, before me, the undersigned notary public, personally appeared Glenn E. Tobin, proved to me through satisfactory evidence of identification, which were D VA✓1*+S �►�-wgs , to be the person whose name is signed on the preceding or attached document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best`of his knowledge and belief. ALEXANDER T,SENAT081 Notary Public Notary Commonwealth of Massachusetts My Commission expires: My Commission Expires August 30,2013 1607945.1 a r• x . Nutte , Patrick M. Butler Direct Line: 508-790-5407 Fax: 508-771-8079 E-mail: pbutler@nutter.com MEMORANDUM May 15, 2007 #107763-1 Via Email TO: Tom Perry CC: Mr. and Mrs. Glenn Tobin (via'email) FROM: Patrick M. Butler RE: 66 Tern Lane, Centerville Tom, r As you may recall, I prepared a deed restriction for the owner of this property relating to the use of the garage. In the interim, the owner has initiated discussions with the Board of Health, which we believe will lead t the issuance of a permit for an increased septic system capacity to.5.bcdrooms, ccordingl , the deed restriction will�nolonyerrTbe necessary, s ou dthat_s s_ be put into place The use of t e garage wl cont be an accessory use i.e., no kitchen acl rtles or permanent use) I anticipate having_final permits and construction take place in the next thirty days and I will keep you advised. Accordingly, I am holding the deed restriction in my file. Please feel free to contact me should you have any questions. PMB:cam 1630512.1 Nutter McClennen &Fish LLP ■ Attorneys at Law 1513 lyannough Road, P.O. Box 1630 ■ Hyannis,MA 02601-1630 ■ 508-790-5400 ■ Fax:508-771-8679 ■ www.nutter.com From: Cynthia McGrath town.barnstable:ma.us To: tom.perry@ town.barnstable-ma.us ~. Subject: Memorandum from Pat Butler re: 66 Tern Lane Please see the attached memo from Pat regarding the 66 Tern Lane property. Thanks, Cindy i n QUITCLAIM DEED I, RAMSAY E.CRAIN,surviving tenant by the entirety and single man,with an address of 5536. Isleworth Country Club Drive,Windermere, FL 34786 For consideration paid in the full amount of One Million Three Hundred Fifty Thousand and no/100 Dollars($1,350,000.00) Grant to JAMES JOHNSON and NANCY JOHNSON, husband and wife as tenants by the entirety with an address of 85 East India Row 14-C, Boston,MA 02110 With QUITCLAIM COVENANTS The land together with the buildings and other improvements located thereon situated at 66 Tern Lane,Barnstable(Centerville),Barnstable County,Massachusetts bounded and described as follows: NORTHEASTERLY by the waters of Wequaquet Lake,as shown on a plan hereinafter mentioned,75 feet, more or less; SOUTHEASTERLY by LOT 44,as shown on said plan,235 feet, more or less; SOUTHWESTERLY by a drainage area,as shown on said plan,45 feet; SOUTHEASTERLY by a drainage area,as shown on said plan,45 feet SOUTHWESTERLY by a private way,as shown on said plan,85 feet;and NORTHWESTERLY by LOT 42,as shown on said plan,280 feet,more or less. Being shown as L01-43 on a plan of land entitled"Subdivision of Land in Centerville, Barnstable, Mass. Property Wequaquet Trust,Scale 1"-60',July 1949",which said plan is duly filed in the Barnstable County Registry of Deeds in Plan Book 88, Page 13. Said premises are conveyed subject to and with the benefit of the restrictions contained in the deed recorded in Book 17595,Page 1,drainage easement shown on the plan filed in Plan Book 88, Page 13,taking of Tern Lane as a public way by the Town of Barnstable by instrument recored in Book 1035, Page 569, Order of Conditions recorded in Book 17119, Page 37,as affected by a certificate of compliance with ongoing conditions recorded in Book 17594, Page 350 and a license to construct and maintain a seasonal pier recorded in Book 17981, Page 213. he, se'of tl a coed floor rspace in th garage is restricted to its.uusse�as'storage'and/or=prr vat, offices se as accessorry to the main`dwelling and;may hot used, a residential'apartment�- except pursuant to-appropriate relief under the Barnstable Zoning ByLaw �Et is intended tliatthis restnct�o _6 enforci6le bythe�Town-of Barnstable by and through.its Build ng`Cominissioner. For title see deed from Aristedes Haseotes et al to Ramsay E.Crain and Merrilee Crain dated November 7,2011 and recorded in Book 25859, Page 40. See death certificate of the said Merrilee Crain and M792 recorded herewith. Executed as a sealed instrument this day of February,2014. RAMSAY E. RAIN STATE OF FLORIDA County of O R-AN GF- On this : Tit day of February, 2014,before me, the undersigned notary public, personally appeared RAMSAY E. CRAIN, as aforesaid, and proved to me through satisfactory evidence of identification, which was a[ ) driver's license, ( ) passport, or X personally known to me, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. Notary Public My commission expires: S.&HOFMANN Nosy PuDGc.Stele of Plaids 1dp CWM EVIMG duly 14.2015 Mo.EE 111160 � , ��� f � � � � �� � ��� �� ���`�( . Page 22 of 37 under Chapter 24o,Zoning, iapter 76,Fees,Article II... zoning.............................1. use located in a nonresidential nforming business use along ._d as single-or two-family I zoning............................1 i by a special permit from the must find that the proposed j I i 66 Tern Ln, Centerville, MA 02632 - Zillow Page 2 of 5 r i Contact a loca l agent 66 Tern Ln, Centerville, MA 02632 Leo Doyle p ...._ . _� _ ! r Sold on 11122I11:$1s00,000 IT Photos ` Ma Bird's Eye Street View s Regent sales (508)534-8306 ' Zestimate°:$1,533,021 - - Est.Mortgage:$6,279/mo Thinking remodel? ; Nile Morin Get ideas and estimates on Zillow Digs. r cas) See current rates on Zillow - ! i 20 Recent sales (508)534-8782 ! View your 2014 Credit Score Instantly for$1 i Marie Souza Team Bedrooms: 4 beds ! (s> 177 S j Recent sales Bathrooms:7 baths (508)534-8115 ..... 9 q . .._....... _. ..-. Single 2,369 s ft Family: Your Name See more ideas Phone Lot: 0.61 acres -------.--- ---- Year Built: 1960 View larger ' Email Address --— — _ . Last Sold: Nov 2011 for I would like advice about selling a home i similar to 66 Tern Ln,Centerville,MA 02632. $1,600,000 i Heating Contact for details. contact Agent Type. I C,I want to get pre-approved. - - --- ----; -- Learn how to appear as the agent Correct home facts ? Save this home Get updates Email I more- above -._......_-._ .�� _ ...... _.._ _ . - ---..... Description • • This Quintessential Cape, located directly on Waquaquet Lake, offers state of the art amenities with old world charm. Open concept floor plan features gourmet eat-in $' kitchen, granite counters and high-end appliances, opening to dining and fireplaced living areas with enticing views of the lush landscaping and waterfront. French '. , doors give access to large mahogany deck.Two en-suite bedrooms complete first ail uei s nr w New Vermont level. Second floor, accessed by charming central staircase includes two bedrooms HomeAuctlonsfr plus master suite with separate fire laced sitting room, large bath with walk-in P p p 9 9 closet. Open staircase leads to lower level media room complete with wet bar and ©penhoseswtllbeheldaxtion *com• refrigerator. Screened-in porch opens to fieldstone patio, stone walls and summer kitchen. Sandy beach area, dock and storage shed. Three car garage with full guest f�. Irk suite. Brokered And Advertised By: Oyster Real Estate Listing Agent: Herbert S t , Pheeney . 8.� 4 a m Less Cooling Parking Basement Type Unknown Unknown Unknown Fireplace Floor Covering Attic Unknown Unknown Unknown gg qq a j -More See data sources s _ t--�!!IE Zestimates Value Range 36-day change$Isgft Last updated Zestimate $1,533,021 $1.26M-$1.73M -$118,791 $647 01119/2014 Nearby Similar Sales 57 Swift Ave Osterville MA 02... Rent Zestim ate $2,000/mo $1.4K-$4.OK/mo - $0.84 01/20/2014 _ Sold on 6/2812013: $1,210,000 Owner tools `` Pdsf your own estimate -- - __ : 6ghomes fifer-saW3map ,V�w hots*_Pare to k I wl o m ared to a 0.8/o increase for Barnstable as a whole. Among L'63 http://www.zillow.com/homedetails/66-Tern-Ln-Centerville-MA-02632/55839664_zpid/ 1/21/2014 66 Tern Ln, Centerville, MA 02632 -Zillow Page 3 of 5 Value Range 30-day change$Isgft Last updated more Zestimate`Listing price;Rent Zestimate more- 1 year.5 years 10 years This home -- 02632 -- i i 1 L i i i i i I I View Your 2014 Credit Score Instantly for$1 i Neighborhood View-larger map _ r.Home Values t Listings t E °y i i i r I Is . I E i I 5 homes for sale nearby. View photo�st of nearby homes _ ..... http://www.zillow.com/homedetails/66-Tern-Ln-Centerville-MA-02632/55839664_zpid/ 1/21/2014 66 Tern Ln, Centerville, MA 02632 - Zillow Page 4 of 5 Nearby Schools in Barnstable Data by GreatSchools.org 4 i Grades Distance 8 Centerville Elementary (assigned) K-3&ungraded 1.7 mi out of 10 NR Barnstable Intermediate School (assigned) 6-7&ungraded 2.1 mi Barnstable High(assigned) 8-12&ungraded 2.2 mi out of 10 More schools in Barnstable i Contact a local agent Leo Doyle r r a i 6 'Recent sales I Your Name j _! (508)534-8306 ....... ... ....)` i Phone .. Nile Morin s (39) i Email Address Recent sales -- - - - .......... i (soe)534-6762 I would like advice about selling a home similar to 66 Tern Ln,Centerville,MA 02632. Marie Souza Team (9) 5'Recent sales ...._........ — ._- .. ........... (508)534-8115 Contact Agent `E G I want to get pre-approved. i Learn how to appear as the agent s above Browse more 02632 listing agents .. .......... Beds: 3 Sgft: 3328 Lot: 0.63 Baths: 5.0 ac 255 Green Dunes Dr,Centervill... Sold on 7/11/2013: $1,400,000 Beds:4 Sgft: 2940 Lot: 1.19 Baths:4.0 ac ) i j 295 Green Dunes Dr,Centervill... Sold on 11/13/2013: $1,185,000 ` 4 Beds: 3 Sgft: 3252 Lot: 1.29 i Baths: 7.0 ac APe , 5ahomepvcWTs(ale nearby. View photos > htt :/ - - p /www.zillow.com/homedetails/66 Tern-Ln-Centerville MA-02632/55839664_zpid/ 1/21/2014 66 Tern Ln, Centerville, MA 02632 -Zillow Page 5 of 5 Featured Partners Wells Fargo Home Mortgage www.wellsfargo.com/mortgage Get Prequalified with Wells Fargo i Your Credit Report&Score Online Experian.com Check your Credit Score in 2 easy steps for$1 ------ Don't Delay -- —� Start the VA Loan Process Today - CALLUS AMMME AT et1l-Veterans United. 800 258-0052 Homa Laans. LEGAL t f�amFs s" Proud s,rr,�r of A1,— { AdChocesf' Nearby Cities Nearby Zip Codes Other Centerville Topics Real Estate in East Falmouth Real Estate in 02601 Apartments for Rent in 02632 Real Estate in Harwich Real Estate in 02632 Houses for Sale in 02632 Real Estate in Mashpee Real Estate in 02635 Houses for Rent in 02632 Real Estate in South Dennis Real Estate in 02648 02632 Real Estate Real Estate in South Yarmouth Real Estate in 02668 Condos Real Estate in Town of Bourne Houses for Sale in Real Estate in Town of Newest Listings in Brewster Home Values Real Estate in Town of Real Estate Agents Falmouth Refinance Real Estate in Town of Orleans Mortgage Rates Real Estate in Town of Sandwich Real Estate in Centerville Real Estate in Cotuit Real Estate in Cummaquid Real Estate in Hardwich Real Estate in Hyannis Real Estate in Marstons Mills Real Estate in Monomoscoy Island Real Estate in Otis ANGB Real Estate in Teaticket Real Estate in West Barnstable 66 Tern Ln;Centerville,MA,02632 is a single family home of 2,369 sgft on a lot of 26,571 sgft(or 0.61 acres).Zillow's Zestimate(g)for 66 Tern Ln is$1,533,021 and the Rent Zestimate@ is$2,0001mo. This single family home has 4 bedrooms,7 baths,and was built in 1960.Leo Doyle and Nile Morin provide real estate services in 02632.The closest ZIP codes are 02668 and 02648.West Barnstable, Teaticket,and Otis ANGB are the nearest cities. About Zestimates Jobs Help Advertise Terms of Use&Privacy Policy Ad Choice Blog Mobile Yahoo!-Zillow Real Estate Network ©2006-2014 Zillow Follow us 0 f g+ 5 homes for sale nearby. View photos > http://www.zillow.com/homedetails/66-Tern-Ln-Centerville-MA-02632/55839664_zpid/ 1/21/2014 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ Parcel 1 . 61V Application lication # (DI Z � � �. Health Division _ Date Issued t(-0 12-- Conservation Division Application Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Z1lb�i2 Historic - OKH _ Preservation / Hyannis Project Street Address Village Vie Owner , Address Telephone !1 - G _ 07- Permit .eguest o n r /�Zow e r S re eet: 1st floor: exi g proposed 2nd floor: existing proposed _ Total new Zoning District Flood Plain Groundwater Overlay I Project Valuation) c2ffd 6OO 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 YNo On Old King's Highway: ❑Yes ❑ No Basement Type: kull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) _ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: _ existing new Total Room Count (not including baths): existing new First Floor°Room Countat Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other a r Central Air: 9Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stove: 0(es ❑ No Detached garage: existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: existing=❑ now size Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: CO Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name phone Number Address` License # c ,P/)✓r� ,____% f� 4201�_ Home Improvement Contractor# ��� 71 Y Worker's Compensation # ov ALL CONSTRUCTI N DEf3RIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE i ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED f MAP/PARCEL NO. ADDRESS VILLAGE OWNER . DATE OF INSPECTION: r'FOUNDATION' FRAME INSULATION! > •a " �� FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL Y iGAS: F ROUGH t,.. n. . FINAL i FINAL BUILDING f DATE CLOSED OUT � ASSOCIATION PLAN NO. y s r 9 The C�tnmonwealtFt of H=sachmseft Department offndus&id Acciderfx ,tic D e of�veskgahons ; 600 yT'ashingtori 3 -eet ' i Workers' Compensation Affidavit.- Build C A ACant Information antracfors/IIectricians/Plmabers Please Print Le Name Cosiness/Orga�aficanlFnciivid�; Address: - C stg P: ��tG��Pholle# Ar you an employer? Check the approp ' - A 1• I mn a employer with am a general contwtor and I Type'of proj eat(required): IaYees (fall and/or part-three):* bave hired the sub-contractm 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ship and have no euployees These mb-c s have ❑Remodeling s g, working for me.in any capacity, employee&and have.wor)mis' ❑Demoli$on [No workers'comp• iagu=e coup,insurance•$ ,9• ❑Building addition 3,❑ re4ui�d.] 5• ❑ We are a corporation and its.. . 10 El Electrical ores or -1 am a homeowner doing an work officers have exercised them � ' additions myself [No workers' comp, right of exemption per 1�GL 11'❑Phmmbing rePaIM or additions MSUrame required,]t c. 152,§1(4_), and we have no: 12•❑Roof repair " :amployees• [No workers' 13' Dther comp,in�e requited.] k'-Y epPlicaat that cherlm box#1 must also fIl ont the section below showing their a ork , t Homeowners who sabaut thisaffidmvit indicating they srz compematioa policy arformatLm #Canhactors that eh=k this box mast atachod an additional sh�sIl wort and then hir"md's'a coatrar-t=must smbmit a new am davit indicating such ntactnn have to showia�g 63e name of the�layees If flee snh-co y �,Est tars end stale whether or not these entities have Pravide thds wow comp.policy Mmber. I run an employer that is providing workers'catrcpensm�on insurance far my amp! p urfonrratio2 ayees Belv�y is the a&cy andjob site` Iusarance Company Name: f . Policy#or Self ins•Lic: Expiration Date Job Site Address: / Attach a copy of the workers' compensation o T � F Fad to secure cov Policy page(showing the policy number and expiration d:ste}.. e as required under Section 25A of Ie GL c. 152 can lead to the Q fine up to$1,500.00 and/or one-year anpriso cut, well as civil � s�nn of�mal Penalties of a of up to$250.00 a clay P �in the form of a STOP WORK ORDER and a fine Y t violsfnr. Be advised that a copy of this statement maY be hrf'estigatians of the DIA for iaer, j-coverage vmj cation, Rrwaided to the Office of Ida hereby certify e parrrs and fPT3'that the information provided aboN is fr and cnrrec4 Sienatztre; � I?ates Phone# a}zcial use only. Do not Write in this area to be canrpleted by rzty or town otciaL City or Town: PermitUcense# Issuing Authority(circle one) L Board of Health I BmMing Department 3. City/Tuwn Clef$ .4.R:I G. Otherectcicai Fu pspector S.Plumb' Ins e etor 'Contact Person: Phone'#: s.. 4 Client#: 10798 2RILEYCJ DD/YYY1� ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/TE(MMIz011 TtIIS 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 AM&PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ORTANT: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 NAME: Dowling&O'Neil Insurance PHONE 508 775-1620. FAX A/C No Ext: A/C,No): 5087781218 Agency E-MAIL ADDRESS: 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIL# National ational Grange Mutual Insuranc INSURED INSURER B: C.J.Riley Builder,Inc. INSURER C P.0.Box 382 Osterville, MA 02655 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE iADD't Sian POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YY A GENERAL LIABILITY MP059664 5/02/2011 05/02/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PRESE a MIS occurrence) $500 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JET LOC $ U- MOBILE LIABILITY M9059664 5/02/2011 05/02/201 EO accident) SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ A WORKERS COMPENSATION WC059664 5/05/2011 05/OS/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • 230 South Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE G r ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S80520/M80519 LS1 t i 71. ° `��dC`�u`QP� License or registration valid for individul use only Office of Consumer Affairs&B siness Regulatlon g y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: -,11.25799 Type: Office of Consumer Affairs and Business Regulation Expiration: 4/30/2014 Private Corporation 10 Park Plaza-Suite 5170 - _- Boston,MA 02116 C. . ILEY BUILDER ANC'' + CRAIG RILEY 10 B WIANNO AV OSTERVILLE,MA 0 Undersecretary �thout signat Massachusetts- Department of Public Safety Board of Building; Regulations and Standards Construction Supervisor License License: CS 66147 k ` CRAIG'J RILEY ; = S PO BOX 382` �. OSTERVILLE, MA 02655` Expiration: 2/5/2013 ('ummissioner Tr#: 11061 • �IK Town of Barnstable Regulatory,Services swxrtsr,�e�. • nines Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r; as Owner of the subject property hereby authorize J 1 I �'V C41 L"� to act on my behalf, • in all matters relative to work authorized by this building permit. (Address of Joby **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. 4 Signature of Owner 4Stur� e of App i 4 KAMSAS i^d Print Name P Name o�Z • Date , Q:FORMS:OWNERPERMISSIONPOOLS THE 1r,. Town of Barnstable Regulatory Services BARNSTABLE, Thomas F.Geller,Director 9 MASS. 03 Building Division rF0 NAA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form.acceptable to he Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner , Approval of Building Official � r Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed_ Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt i F 17+a`P n of Barnstable negulutory Swvlces Thomas F.Geller,Dlrec(or `t'boutas Porry,COO Suitding Comntlsslpngr 2Ol1 lvtatn Street, 1 I}annis.MA 02601 »•++ht.tawn,barnslnit)e,tna•ug OMwe• $08-862-4038 Fax 508-790-6230 :t,'ropcxty � �t aVJ.ti:�et Cow-plctc and Sign TW9 Section IfU shig A Bu-11cier • i, ,, �R sR. .. ,—cP-'O'`-t ,os sjf the:sub)+sct prctpotty ]saki>> aunc(+rl/c 7B 2NAO-Q -T. tit act an my terhaff, in all matterQ r0ag%v to\N ttrk audtor&d by this building permit appkatton fur• (o(o TE2ti! 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(t M E1�OfC, 2'b'XS'8` '8'Xb'E' 2'8LI aea • 1�8Q 11E1 rdmo q i2'xb'8' 2'10`xa'6° 2b'x6'8• 2'10'x8'8' 12'x6'e 12x68 12'x8'8' 14'xb'B' 31a'Xa'b' 3'0'xe'8' 3tJ'X6'8' 30'x6'8' 14'x6'8` 14'Xa'a' 14'48T (S6o961•N3.� ROW Mrs MAY Ye7 tram M 40101 appYatlon due td twtva"Ons in 410 my or the F105-4 Foci"at Ihb calm". TOWN OF BARNSTABLE Building INE 201200371 a BARNSTABLE, * Issue Date: 02/16/12 Pefffift MASS qj 1639• Applicant: RILEY,CRAIG J. Permit Number: B 20120319 ArfD��a Proposed Use:, SINGLE FAMILY HOME Expiration Date: 08/15/12 Location 66 TERN LANE Zoning District RD-1 Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 192027 Permit Fee$ 35.00 Contractor RILEY,CRAIG J. Village CENTERVILLE App Fee$ 50.00 License Num 066147 Est Construction Cost$ 1,200 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TO ADD AN EGRESS DOOR AT BOTTOM OF EXISTING STAIRWAY HFWs CARD MUST BE KEPT POSTED UNTIL FINAL THERE IS AN EXISTING WINDOW FOR RIGHT SIDE OF GARAGE INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: HASEOTES,ARISTEDES&ASHLEY BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: PO BOX 600157 INSPECTION HAS BEEN MADE. NEWTON,MA 02460 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT.TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART.THEREOF,EITHER T ORARII Y0 N °ENCROACHMENTS ONPUBLIC„PROPERTY,NO k SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE.APPROVED'BY THE JMSDICTION...STREET OR ALLEY-GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED.FROM THE-DEPARTMENT OF,PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF;.kNY APPLICABLE SUBDIVISION.. RESTRICTIONS", MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5. INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL o,142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 Xl-*';'�&A ildi� 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health y _ ml m A a v Y f d n �w M 4 I d _ gym.. .... V X f _ yr ' 1 w 42 MMI ti� Rle� ti i i �+ w rk. 7 i o .µ N' %L A ' t .r f Le, C "t,• .t'4`.» ; !�,al"1S�q�1�+�7�,��'4� �q1y� `��,�. �D'�1�.��i�'� ,� � "..tom i4S�'�'If, 'r '�.'W1�� A�• _,�+ „� �� ' �° :�1. R1�''� +M ������` `�ti '*iM�^Aj" � �'� ,;o 'F+. � � �� �>-•`r.r+��!�cw,�* ti:r"� 'wl �L' ;b'.. �i s; i ,l S 1 Y � e. �c es `, 47' i �'- a qf:K ✓.r v R I l I Y i 1 p j 5 11 t � I 1 $Sr CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28-Centerville, MA 02632-3117 1926 508-790-2375 x1 - FAX: 508-790-2385 John M.Farrington,Chief Martin O'L.MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer August 6, 2007 Mr. Thomas Perry- Building Commissioner Town of Barnstable 200 Main Street Hyannis,MA 02601 Dear Commissioner Perry: Pursuant to MGL Chapter 148 Section 28A, I am making you aware and request your interpretation of an accessory use apartment without adequate egress at: 66 Tern Lane 'Centerville, MA . While on afire alarm inspection at this address, I observed a finished area over a new two- vehicle detached garage. Our plans show the second floor as "storage". The owner of the property stated that the area is an "office". When I arrived for the fire alarm test, I found a bed and associated furnishings present, full-bath; and kitchen with sink, microwave, and mini refrigerator. The area did not resemble an "office"use.. In addition, one of the exits leads to a second floor balcony without a stairway to grade and the second exit is via an interior enclosed stairwell leading into the garage not to the - exterior as indicated on the plans. Please contact me with any questions you have relative to this situation at 508- 790-2375 Ext.l. Thank you for your attention to this issue. Sincerely, Q , c-i 'Y co Francis M. PulsiferCD crs� Fire Prevention Officer . rn Cc: Robin Giagregorio' ` "Commitment to Our Community" ' I ' 'own of Barnstable a1HE, Regulatory Services LQ. m\,e ,� r Thomas F.Geiler,Director l` 2 anaxsTAai,E. MAS& Building Division 039. ♦� ArfD Mp`l Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 �p COMPLAI10 T INO UIRY REPORT Date: J/7 _ Rec'd by: Complaint Name:,A�n/'o G. �� Map/Parcel Location Address: Originator Name: /�/Lfe'xt 4 M&ems Street: Village: State: Zip: Telephone: �`��Q Of O 5 Complaint Description: r— FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: 0-A r I Additional Info.Attached Q:forms:complaint I 4 t - : l .ey L � 1 e� f ' t it 66 Ter1,,, Lane , Centerville - 1 /16/ 11 AQ0vr- GhR-A-r-15 f n a. { x , ; r . i 00+ ' f � t , a � i F� 1 r, , el $ ALI. 4 � i .. t C 5 i rx 4 3 ! 3 .� � � nti y;�. Aye 'z+J'- a L ; r � r� +, aF by �� _ � y �R J [y �i ���� Vh rh a !7 oF��ram, Town of Barnstable BARNSTABLE. II Regulatory Services 1639. ��� Thomas F. Geiler�Director Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 January 7, 2008 Mr. Glenn Tobin 66 Tern Lane Centerville MA 02632 Illegal Apartment: 66 Tern Lane Centerville, MA 02632 Map: 192 Parcel: 027 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. inda Edson Amnesty Apartment Investigator Building Department gf6rms:zoning3 NutterrZJ Patrick M. Butler Direct Line: 508-790-5407 Fax: .508-771-8079 E-mail: pbutler@nutter.coin December 9, 2008 #107763-1 B_y Facsimile - 508-790-2385 Fire Chief John Farrington Centerville-Osterville=Marstons Mills Fire Department 1875 Falmouth Road Centerville, MA 02632 Re: 66 Tern Lane, Centerville, MA 02632 Dear Chief Farrington: Please be advised that I have previously represented Mr. and Mrs. Glenn Tobin with reference to certain zoning issues associated with the 66 Tern Lane property. In particular, I have previously met with the Building Commissioner, Thomas.Perry, to discuss the status of the space located above the garage at the subject property. Based on my discussions with the Building Commissioner, I made clear that the proposed use of the area above the garage is intended as a home office and use as an accessory structure in accordance with the applicable provisions of the Barnstable Zoning Ordinance. -I also confirmed with him that the area above the garage would not be utilized as an apartment or separate single family dwelling: Certainly,.should you have any questions regarding the foregoing, please do not hesitate to contact me. Ve ly yours, atric Butler PMB:cam cc: SarahmTurano}Flores; Esq Mr. and Mrs. Glenn Tobin 17901.17.1 NUTTER MCCLENNEN & FISH LLP • ATTORNEYS AT LAW 1513 Iyannough Road a P.O. Box 1630 Hyannis, Massachusetts 02601-1630 • 508-790-5400 • Fax: 508-771-8079 www.nutter.com DEC-10-2008 08:25 MetLife Home Loansdp4510 P-.01✓01 The Co-11111jonwealtlz of M4ssachusetts u,p Department o f Fire Services- Office of the State lire Marshal P.O.Box 1025, State Road, Stow,Mass. 01775 'P-7 (rev. 1/06) CERTIFICATE .'OF COMPLIANCE' M.G.L. CHAPTER 148 SECTIONS 26E,26F, & 26F1/2 (-_,ty or Town COMM Fire District Date: 12/04/2008 UnitlP,pt Thin Cer'lzfie, that the property Loc�)ted at 66TERN LN ICENTERVELLE, MA 02632 has been equipped, with approved sfaoke 'detector.^. and carbon ntouoxide alarms and was �oi�nd Yto bc_ . in compliance with MassachusettS Prne..r.al. Law, C.h=+peer 148 Sections 26E, 26F, & 26F1/2 and Chit-, G 31, et seq. Ynsr,ecCi.on/T�es`t].ng Gampleted on: Mors Dec'8, 206B P• permit PLO 001.581 Check Number ].128 Fee Paid:$25. 00 Head of Fire Department: John M. Farri.ngton, Chief SFW ER'S. COPY TOTAL F.01 Sarah Turano,Flores FW Copy of Certificate of Compliance from Fire Marshall Page 1 From: "Glenn E. Tobin" <Gtobin@metlifehomeloans.com> To: Patrick Butler<pbutler@nutter.com>, Sarah Turano-Flores <sturano_ fores@n utter.com> Date: 12/10/2008 9:11:53 AM Subject: FW,: Copy of Certificate of Compliance from Fire Marshall Anna; Attached you will find certificate of compliance from Fire Marshall for 66 Tern Lane. �. This certificate includes inspection of area over garage. Could you also forward me a copy of letter sent to the Chief John Farrington regarding same: Also; I would like to discuss next step to finalize the sign off of the building permit. We have a closing scheduled for 12/15/2008. Cell# is 508-776-2525 thank you Glenn Tobin Glenn Tobin Regional President 29 Bassett Lane Hyannis, MA 02601 . Phone: 508-862-2303 Fax: 508-771-9216 Email: gtobin@metlifehomeloans.com -----Original Message------ From: mbx_247p01 Sent: Wednesday;-December 10, 2008 8:25 AM To: Tobin, Glenn'E Subject: An internet fax from MetLife Home Loans An image data in TIFF-F format has been attached to this email. You can download the TIFF-F Image Viewer from the following URL addresses. http://pbneisonic.co.jp/pcc/en/ Confidentiality notice: This e-mail message, including any attachments, may contain legally privileged and/or confidential information. If you are not the intended recipient(s), or the employee or agent responsible for delivery of this message to the intended recipient(s), you are hereby notified that any dissemination, distribution, or copying of this e-mail messageis strictly prohibited. If you have received this message in error, please immediately notify the sender and delete this e-mail message from your computer. C yST. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 d926 508-790-2375 x1 • FAX: 508-790-2385 John M.Farrington,Chief Martin O'L..MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer August 6, 2007 s Mr. Thomas Perry- Building Commissioner Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear-Commissioner Perry: Pursuant to MGL Chapter 148 Section 28A, I am making you aware and request your interpretation of an accessory use apartment without adequate egress at: 66 Tern Lane Centerville, MA While on a fire alarm inspection at this address, I observed.a finished area over a new two- vehicle detached garage. Our plans show the second floor as "storage". The owner of the property stated that the area Is an-"office". .When I arrived for the fire alarm test, I found a bed and associated furnishings present;full bath, and kitchen with sink, microwave, and mini refrigerator. The area did not resemble an "office"use. In addition, one of the exits leads to a second floor balcony without a stairway to grade and the second exit is via an interior.enclosed stairwell leading into the garage not to the exterior as indicated on the plans. Please contact me with any questions you have relative to this situation at 508- 790-2375 Ext.l. Thank you for your attention to this issue. Sincerely, Francis M.�Pulsifer Fire Prevent4oi Officer 10 0 Hd 8- Ofl LQOI LCc.�Robin_Giagregorio7 m t "Commitment to Our Community" yam,_ J Vs 2� 4Y Zw ' z b 1 44 Lie IMG--242 iMG 428";` ;.- - IMC24 7. - h y. 4�.x M ... M _ ._ .: i G=242� . P x - IM .243 - . .. : iM 2: :•: MJ -Nutter O Patrick M. Butler Direct Line: 508-790-5407 Fax: 508-771-8079 E-mail: pbutler@nutter.com MEMORANDUM' March 26, 2007 y #107763-1 TO: Tom Perry FROM: Patrick M. Butler RE: 66 Tern Lane, Centerville Tom, In accordance with our prior discussions, I have prepared and have had executed the attached deed restriction. As you will recall, the purpose for the deed restriction is to provide that the detached garage will serve as an accessory structure and that it will not be used, in any fashion, for residential use. Would you kindly acknowledge your receipt of this copy of the deed restriction and confirm that I may proceed to record same with the Barnstable County Registry of Deeds. It is my understanding that based upon the recording of this deed restriction there sha11 be no limitation on doorways, windows or other fenestration associated with the building. ' Thank you for your assistance on this matter. PMB:cam _ Enclosure Receipt acknowledged and agreed: Thomas Perry, Building Commissioner 1616861 1 NUTTER MCCLENNEN & FISH LLP ATTORNEYS AT,LAW 1513 Iyannough Road = P.O. Box 1630 v Hyannis, Massachusetts 02601-1630 A 508-790-5400 Fax: 508-771-8079 www.nutter.com. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /7 Z Parcel � ` G 3 7erirO ' Health Division (t-' %19 l3 pate Issued Conservation Division i/Zc�o2 Application F �!U Tax Collector OZ Permit Fee &2 Treasurer_ GEPTIO SYSTEM MUST DE Planning Dept. S'aSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITIX 5 ENVIRONMENTAL CODE ANL Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address Village Owner 4 %foyP j2�affy';9 4 Address � ) � buJ � V Telephone 50927/ 706 Permit Request ��,h�e�/!� ;Cis lr✓� e✓S Qya /Y/6r T��✓ a e!Zk•vim Lf ln'l h s �—z c� 40 ►v e—< 0,- �o l"1��ZP Square feet: 1 st floor: existing �i proposed 16-6 2nd floor: existing C168 proposed 0 Total new /60 Zoning Di trict d Plain �, Groundwater Overlay /Vd V1 r3 Project Va uation — _._Construction Type�I., e Lot Size . ? Z s or Grandfathered: Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure <0 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: X(Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 7 Z fig Basement Unfinished Area(sq.ft) JC[ZZ S%� Number of Baths: Full: existing new Half: existing ® ' new, 6 Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Cog nt Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other co Central Air: XYes ❑No Fireplaces: Existing New Existing wood/coal s ove: ❑Yes r1b No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ko If yes, site plan review# Current Use V.0G� tv Proposed Use Re �JnL BUILDER INVORMATION Name Telephone Number S�� 0 7-7 7 4-1 d Address Yam® License# 6 � �74a iv. i/ aMa,,_rh A4* Home Improvement Contractor# Worker's Compensation# '�j�0 07S W7.3.��A-��- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE '���� r FOR OFFICIAL USE ONLY PER MIT,�tNO. r f � r DATE ISSUED MAP/PARCEL NO. try f _ L r ADDRESS ' , �� .• VILLAGE Ohm R f' DATE OF INSPECTION: _ j , —• FOUNDATION �.�� ✓ Z�''� Z—. * r FRAME 6 2-- Ziu 03 J INSULATION 0tr\ D r" r FIREPLACE _ ELECTRICAL: ROUGH FINAL w•, PLUMBING: ROUGH ' • #^ _ '- FINAL GAS? ROUGH t FINAL � FINAL BUILDING «.,� �'� i .� fir• '' C`� cii DATE CLOSED OUT . ASSOCIATI.ON PLAN'NO. ' , f -_ The Commonwealth of Massachusetts Department of Industrial Accidents -- 0111ee 01111FOSMOOMOOS J 600 Washington Street ti Boston,Mass. 02111 `3 Workers' Com ensation Insurance Affidavit name CI 5 G+ R Ry 9 C 171% �tgdl 5 j' /A�55 0 K140 Ce &,Vs/• Cv. location J (� till/rij 1 ' city F t9 yk j!� hone I ❑ I am a homeowner performing all wok myself. ❑ I am a sole r netor and have no one workin in capacity 1 r rovidin workers' compensation for my employees working.on this job.: :: :: ::::: ::: :: :::: ::::::::: I am an a oye P g............................ . :::::::::.: :.;;:;. :... ..::::::::::::.::.::.::::::.::::::..;.:..:::.:.::::::.:....::::::::::.::::::::.:::.::::.;:.;:;;::;:;: mP ::::::.:.:........::...::::::.:...........::::::::::::::::::.......... COmQ env n Qr .; :::... �car�ss " ........:.:.:... ..:. X. X. n Boe ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired°the contractors listed below who have workers compensation Po lices: 51. the following ..........mP....:..:.:.::::.:::::..:::::::.:::::,.;:.;:;:::..:::.:.::::::.::.;:.::.:::::.::::::::::.;;':;.;:.::::::::.:::::.:::::..::::.:.:::::.:::::.........:.:::::::::::::.;'.;:<;.;;::;;<:.;:.;:;.;:.:;:.:.::::»::F::F: .................. .........:.:::.... .::.:::::::::.::.::::.:.:...:.:... coin an...name. . . . :: >} r ?i ;>`p ;i'?'.<,F".... i2:?Si ii i;;>;y i!i i:i i;i ;•'';i; i :2 i%.'i2;;%i`;2;i`"F'F%Y;: i 7iisi;:;:i; ;$;:i;r..z::;;::::;::;i;:F::F:;:;;FkJ.:�::.:: .......... ate4iY' ..... .................. ...................::.:..:................... n..... ` ':2G:% :#<F:%'r ;' ' F:':::::;.•;y::;': is:S;isF:::<22::i::;y':::;:;: ::n•:.....•:::..':::..,.. -. i;3i:¢C�eQ�;<?[`iEEiE:?i:'`> iijiE':?:`>< ::'i:iYY�i:Ei' i iiy�i"`:?;''�'i::'%i` •::S`::;�:��:>; :,'`:p:>C:>.:i:i i%i`'">`.. ti c as.n X. address, ....... X. ::...:::::.... xxxh en.......:.......... ::... ::::::::...........:: ::.:........................... ::::.:.,y. x. .;:0 ;: --------------- j/ Fafime to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.0o and/or one years'imprisonment as weft as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify ralties of perjury that the information provided above is true and correct Si tore Date ._L�`e�"Z Print name � S1 y�U +` Phone# ��L �� / omdai use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑chedcif immediate response is required ❑Sdectmews Office OHeslth Department contact person: - phone#; ❑Other (revised 9/95 PJA) Information and Instruction's Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. .k ( - An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal construct buildingsin the commonwealth for any appl icant who has of a license or permit to operate a business or to co not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`9aw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pe i�rmitllicense riumbei which will be used as a reference number. The affidavits maybe red�med in - be Department by mail or. FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents office of InveStlgauens 600 Washington Street Boston, Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 1 Town of Barnstable Regulatory Services IARNMBLE. ' Thomas F.Geiler,Director MASS. 9�plE1639.D MA'S Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: y��C r%�� e � '" Estimated Cost /. ��4GG• Address of Work: '0 Zf/Z/� z/ Cf0`?�Pr�Ls Owner's Name: Date of Application: Aa ti I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Jwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENTWORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. 4 SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date OwTer's Name 4 Q:forrmhomeaffidav RESIDE BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE ` V/ r g square feet x$96/sq.foot= lY('d Zo `' x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$641sq.foot= �3 — x.0031= Z ` plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 ' >150 sf- 1000 sf 75.00 >1000 sf- 1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) 3� — Deck _.L__,_x$30.00= - (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving S150.00 (plus above if applicable) 2 0 , w Permit Fee The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: C, /Q✓h �iti ( e/2T�Fyc��� number street G village "HOMEOWNER': C- ����"r—G/C_j p G 77�T TI G S name home phone# work phone# CURRENT MAILING ADDRESS:_ Atyltown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply.with said procedures P quir e Si lure of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the pemrit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXBMPTN WORKERS COMPENSATION ` I 1Tan•rFan, _ AND EMPLOYERS LIABILITY POLICY CHANGE INFORMATION PAGE WC 99 00 06 ( -A) POLICY NUMBER. (GS60UB-737X947-A-02) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGE EFFECTIVE DATE: 04-06-02 NCCI CO CODE: 80411 INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED'S NAME: ASSURANCE CONSTRUCTION INC This change is issued by the Company or Companies that issued the policy and forms apart of the policy. It is agreed that the policy is amended as follows: . An absence of an entry in the premium spaces below means that the premium adjustment, if any, will be made at time of audit. ` ADDITIONAL PREMIUM $ NIL' RETURN PREMIUM ' $ 101 ADDITIONAL NON-PREMIUM $ NIL RETURN NON-PREMIUM $ 6 THIS POLICY CHANGE WAS PROCESSED, PER A REQUEST RECEIVED FROM YOU OR YOUR PRODUCER . THE FOLLOWING ENDORSEMENT(S) IS ADDED: WC89041500-01. _..__. POLICY_INFO_PAGE__E.NDT_ WC89061400-01 POLICY INFORMATION PAGE ENDORSEMENT WC990006 A-01 CHANGE DOCUMENT THE FOLLOWING ENDORSEMENT(S) IS DELETED: WC00040200-01 ANNIVERSARY RATING DATE ENDORSEMENT , THE FINANCE COMPANY IS ADDED.- AM GRO 100 N PARKWAY WORCESTER MA016150089 CONTRACT NUMBER 635225 EMPL MINIMUM DIFFERENCE IS AMENDED AS FOLLOWS: 15 FOR STATE : MASSACHUSETTS EXPENSE CONSTANT IS AMENDED AS FOLLOWS : 244 FOR STATE : MASSACHUSETTS r t DATE OF ISSUE:•04-1 7-02 NR CHANGE NO:001 PAGE 001 f'OF LAST POL. EFF..DATE: 04-06-02 POL. EXP. DATE: 04-OG-03 OFFICE: ORLANDO DA HTFD 05G PRODUCER: HORGAN INS AGCY 28XBF 012065 Co XN'TERSGNED AGEN 1. ACORD CERTIFICATE OF LIABILITY INSURANCE "A,L'' / 002- "� 05/03J 2002 �''1 EI` (508)775-5830 FAX (508)775-6688 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Horgan Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 44 Barnstable Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 250 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURERS AFFORDING COVERAGE IIJS'UR@D - �- oJSURr_RA: -Commercial Union Insurance Co Assurance Construction Inc nJSURLRft 550 Willow St INSURER C: West Yarmouth MA 02673 wsuRr_RI: INSURER E:• COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEIJ ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.IgOTVVITHSTANDING ANY REOUIREIUAENT,TERIN OR CONDITION OF AIJY 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 A14D CONDITIONS OF SUCH i POLICIES.AGGREGATE LIMITS SHOWN 10AY HAVE BEEN REDUCED BY PAID CLAIMS. IIJSk POLICY EFCIICY EXIRATIO14 LTR TYPE OF INSURANCE POLICY NUMBERDATE MMID FED/T VE POL YY DATE P I,,,z /YY LIMITS GEIJERAL LIABILITY CBLW28940 01/01/2002 01/01/2003 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GEIJERAL LIABILITY FIRE DAIAAGL(Any one fire) 9 300,00 CLAIMS MADE a OCCUR MED EXP(Any one person) $ S.00 ,00 A PERSONAL&ADV 114JURY $ 1,000,w) GEIJERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COI nP/OP AGG $ 2.000.0() 000,00 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY CBXB14146 04/28/2002 04/28/2003 GOIABI14ED S114GLE LIMIT AIJY AUTO (Ea accident) $ ALL OWNED AUTOS ° BODILY INJURY $ A X SCHEDULED AUTOS (Per person) 500,00 HIRED AUTOS w BODILY INJURY $ NON-OWNED AUTOS (Per accident) 500,000 ' PROPERTY DAMAGE S (Per accident) 250,000 'GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE $ S,000,00( X OCCUR CLAIMS MADE CBDV10177 01/01/2002 01/01/2003 AGGREGATE $ 5,000,00 A $' DEDUCTIBLE $ RETENTION STH- $ WORKERS COMPENSATION AND I ORY L MTS ER EMPLOYERS'LIABILITY O — R E.L.EACH ACCIDENT S E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE ALL IMPOSE NO OBLIGATION OR LIABILITY < OF.ANY KIND UPON THE COMPANY TS AGENTS 9D P�R REESe ATIVES. AUTHORIZED REPRESENTATIVE Frank Hor an ACORD 25-S(7/97) F ©ACORD"CORPORATION 1988 (3 ? ACORD. CERTIFICATE OF LIABILITY INSURANCE (.,08)775-5830 FAX' (,08)77.,-6688 T 11l�Ci=RTIf ICAT£ IS ISSUED AS A MAIJER O IN OHMA1101� Horgan Insurance Agency, Inc, 0141 YAND COMERS NO RIGHTS UPON T111- CER11FIClaf1: 44 Barnstable Rd. HOI_DCR. 1HIS CERIO ICA'11' DOES NO1 AIVII-ND,EXI1-ND OR AI_i£it 7H1: COVERAGE AVFORDEI:)13Y1HE POLIC1CS BELOW. 110 Box 250 ---- — --------- Hyannis, MA 0260) INSURERS Al-FORDING COVERAGE III;;L71<!:U aJo-au;I:RA: ConirLrcial Union Insurance Co Assurance Construction Inc IIJ::tlltl:lt11: 550 Willow St IN:'UNFIgr,---- -------- --------- - West Yarmouth MA 02673 INSUki-11, r. INSURE R I COVERAGES 7 HE POLICIES OF INSURANCE 1_IBTED BELO141 HAVE BEEN 1SSIJED TO THE INSURED NAME DAB OVE.-:FOR"THE POI-ICY PERIOD INDICATED.NOT1V71 HS'IANDING ANY REOUIREIOE_N1,TERI+A OR CONDITION OF AIJY CONTRACT OR OTHER DOCUMENT V01 H RESPECT 10 WHICH 7 HIS CERTIFICATE_MAY BE ISSUED OR MAY PERTAIN.PERTA IN,THE INSURANCE AFFORDED L''Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OP SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA110.1. V_j POLICYEFFECTIVE POLICYEXPIRATIO4SURAIJCF POLICY NUMBER DATE fNh41DD/YY DATE 10101DD/YY 1_IMITS BLW28940 01/01/2002 01/01/2003 EACH OCCURRENCE S 1,OUO,OOENEAUALLIABILITY FIREDAMAGE(Anyonefire) S 300,00DE aOCCUR MED EXP(Any one person) 5,170 PE-RS014AL&ADV 114JURY S; 1,000,00 GE14ERAL AGGREGATE S 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S; 2,000,06N POLICY PRO- LOC JECT AUTOMOBILE LIABILITY CBXB14146 04/28/2002 04/28/2003 COIABI14ED S114GLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY 114JURY A X SCHEDULED AUTOS - (Per person) $ 500,00 HIRED AUTOS BODILY INJURY $ IJ014-OW 1JED AUTOS (Per accident) S 00,D O PROPERTY DAMAGE S (Per accident) 2 SO,00 'GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO EA ACC $ OTHER7HAN AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE $ S,000,000 X OCCUR CLAIMSMADE CBDVID177 01/01/2002 01/01/2003 AGGREGATE $ 5,000,00 A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY L MATS I I ER EMPLOYERS,LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE•POLICY LIMIT $ OTHER a DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS { CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE ALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COtVP NY TS AGENTS RR REPRESf ATIVES. AUTHORIZED REPRESENTATIVE � �f Frank Horgan '- �' '✓'�'` '7 ACORD 25-5(7197) F ©ACORN CORPORATION 1988 v MASch(�ck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: DATE OF PLANS: 02_ TITLE: PROJECT INFORMATION: . .X 26 CAPE COMPANY INFORMATION: ASSURANCE CONSTRUCTION 550 W14L O W S'TP - HYANNIS, MA 02601 COMPLIANCE: PASSES Required UA = 335 Your Home = 270 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 952 30 .0 0 .0 34 WALLS: Wood Frame, 16" O.C. 1984 11.0 3 .0 152 GLAZING: Windows or Doors 64 0 .400 26 DOORS 36 0 .350 13 FLOORS : Over Unconditioned Space 952 19 .0 45 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date h C f racheck INSPECTION CHECKLIST .,iassachusetts Energy Code MAScheck Software Version 2 .0 DATE: 8-2E-2002 Bldg. Dept . Use CEILINGS: [ ] 1 - R-30 Comments/Location WALLS : [ ] 1. Wood Frame, 16" O_C. , R-11 + R-3 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1. U-value: 0 .40 For windows without labeled U-values, describe features: . # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1 . U-value: 0 .35 Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location AIR. LEAKAGE: [ l Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ l Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be. insulated to R-8 _0 . - DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. Il _ i / /"JFEMPERATURE CONTROLS : " 'j "" Thermostats are required for each separate HVAC system. A manual o.; automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor ..,shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : 7 Refer to 780 CMR, Appendix J for requirements relating to swimming Pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) -------------------------- I F r , ��i`€ '�" __ ✓fie �i o7n�rearuueca�i ^p..�i _ f y�`� . BOARD OF BUILDING REGULATIONS License CONSTRUGTIOKSUPERVISOR '! j Number CS O46420 WOO ` i � . I e Expires:_11/14/2002 Tr:no: 621.2' ? Restricted To`1 00 4 ' f EDWARD T STAFFORD` 46 550 WILLOW ST HYANNIS, MA 02601 Administrator TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 192 027 GEOBASE ID 11648 ADDRESS 66 TERN LANE PHONE CENTERVILLE ZIP — LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT TYPE Z6003 ffTLEIPTION CERTIFYRTS 8PTOWN8Y3768 CONTRACTORS: Department of yt ARCHITECTS: Regulatory Services TOTAL FEES:BOND i X ' .00 CONSTRUCTION COSTS $.00 756 •CERTIFICATE OF OCCUPANCY 1 PRIVATE 0 * r BLE, Mass. FO Mpl A f BUI N Is ON BY DATE ISSUED 08/28/2003 EXPIRATION DATE (. �� ' . f �.=a::� • -C TOWN OF ARNS' " ', :. BUILDING PEM°IT , PARCEL ID 192 627 '' �' r GEOBASE Ib i184$ F ADDRESS 66 TERN LANE PHONE CENTERVILLE ZIP _ , - LOT BLOCK LOT SIZE DBA 4^ DEVELORMENT DISTRICT CO PERMIT 63768 DESCRIPTION REMODEL EXISTING HOME ?ERMIT TYPE BREMOD TI'BL4, _RESIDENTIAL ALA'/CONY ` Department of CONTRACTORS: STAFFORD, ED � P ARCHITECTiS: Regulatory Services TOTAL FEES: $678.61 BOND " $.00 CONSTBUP,,TION COSTS $183,424.00 434 / RESID ADD/ALT/CONV 1 PRIVATE I R. LE, Mass. 1639. 1 RFD MP'�A BUILDING D SION DATE ISSUED 09/13/2002 EXPIRATION DATE _ o . 1 r If j+�i!rv1•s-�"� kTOWN J' ,7"ij+ •n`-c r 'f: Q 1 r s PARCEL. I .,:192.'027 �' = ' G�'OI3ASB .I k' 8 r4 ` ADDRESS .,. Ci6�TERN LANE• CENTRV I L ,E F f. w. 1P BLOCK •L®T �SIZF f LOT ly r I3BA J t ,- D ELfl ENT DISTRIff Cfl r M. PERMIT 637i8 D . t'' IPT�(}N REMODEL EXISTIC kOME PERMIT ;TAPE BREMOD: ," T `-XSIDENTIAL ALT/CONY CC}NTRACflRS STAF 'QRD, ED ""4 Department of. , ARcxzTECT << Regulatory Services -- r TOTAL .FM:, ., `f $87.8.,G 1 `1 BOND co 'j'� 7�7 (-�('� ryY(� A f�q$.00 " - y y - a-v ;�,A ,Fa.k+OU 9J '�� .. • i s a t � 434 I2ESID..ADD/ALTLflN�T k.r °sr °P ° Vt' +, A �B>[.�:," 1639i 1 } - " BUDING�DIVI ION .� Bin. ._ DATE I SUE 09/1�/ EXPIRATION DAAT THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR, ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS'OF-ANY...APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK..: APPROVED,'PLANS MOST'BE,RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 'THIS CARD KEPT.POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING'STRUCTURAL MEMBERS -HAS BEEN MADE.WHERE'A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). r s PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE gNICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFARE`OCCUPANCY. POST ® ® ITIS VISIBLE 'FROM s BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS APPROVALS l�,,�e(.sC. t)l\l U2,21)--u3 94 7-c> 2�e�e CLer� 5 ;� .- r S$v� 2 i dvok 19P 2 A /'� 3 1 PAT G INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 ® B A OF HEALTH OTHER: SITE PLAN REV APPROVAL ILLa.��3 WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. r . i 1 t i � r 4 � t rr �'C SULLIVAN ENGINEERING INC. 7 PARKER ROAD/P O BOX 659 - OSTERVILLE, MA 02655 Peter Sullivan P. E. Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 June 25, 2003 Building Commissioner Town of Barnstable 200 Main Street Hyannis, MA 02601 RE:' Waterways License Permit Application CSC Group/66 Tern Lane, Centerville Dear Building Commissioner, Please find enclosed a Municipal Zoning Certificate along with the Department of Environmental Protection Waterways License application and plan. We have received an Order of Conditions from the Conservation Commission, file number SE3-4125. Would you please review these and sign the Municipal Zoning Certificate and return it to me in the enclosed self addressed, stamped envelope. Thank you for your assistance in this matter. If you-have any questions, please contact the office. Very truly yours, Peter Sullivan, P. E. Sullivan Engineering Inc. Enclosures Members of American Society of Civil Engineers, Boston Society of Civil Engineers r ,Deparimeit of Adushial Accidents Office of Investigaztaons 6011 Washington Street, Boston,MA 02111 w.wv.mass,9ov1dia Workers' Com'pensatim l sux"ce Affidavit: BiWders/Coy.tr ctors/El,�e iciauslPlL7-mbers Appliegat information Please P6g Le '�lv Dame(tbusmess/CT_2:mizano�dividual). �J.C ,.zE / oar Address: � r / ate/Zip: 94u_L s Cell 09 7 7 City/St Phone:#:�4'�83 ------------- ze yo em.loyer?Check the'appropriate box: -Type* ofiproject(required)__ 1.+ I am a ,*Oyer with �57 4. I am a general contractor and I employees(fall and/or pa t_p e). have hived nt the sy�b-coactors 6. ❑New Construction . 2.Lj_,_1 I az•a sole pzoprietoi or partner- listed oxt the'attache,d sheet. 7. ❑Remodeling ship amd.have no employees Tiaese sub-contractors have S, (�I?emol:tiorx worldus for me in any capacity. employees and have workers' 9._.®Building addition [No workers'comp.ins 'Mce comp.M rarance t' required.] 5. ❑ We are a coipozztion and its I O.Q g ectrical repairs or additions 3.ElI ant a home oVinci doind.a- work offacers have exercised,fneir ll.®plumbing repairs or adciitiozs myself[,No workers' comp. right 01 exemption per IvICrL 12.0 Roafrepa zs insurance required.]t c. 152, §1(4),and we have no employees, [No workers' 13 Other comp.insurance requ hed.] *Ary applica>,•t"mat checks box mI Must also fill out the section below showing fncir workers'corr;Dirsation policy t Honnow,erswho submt this ztEda�t hidic-�rg they err doing all work and then hire a;.+tside cmi-Iactars must' zMe'w aiMzvit in d;"ting such. tcortractors that check this box must attached as additional shdet showing the name of the'sub-contractors and state whe::2ar ornct those entities have employees: If One sub contactors bl-ve crnployl;es,they must provide their workers'eomp:polidynumber. lam an employer that is providing workers'cornpensathm inzurance for my employees. Below s:the policy and job site information. Durance Company Name: tJLSC, cet Policy'or Self ins.Lic. ( Expiration Date: Q 7ori Site Address_ L�i city/state/zip: C' L�TGGv�� Attach a copy of theworkers! compensation policy declaration page'(showirg the policy number and expiration sate), a 11=1e secure ooverage as recalrCd m er Sect on- 25A of MGL c. 152 caa lead to the position of criminal pcnal�ses oif a fine IT, to S 1,500.00 and/or o y ar mxp,'sonmeat, as well as civil penalties in the form of a ST02 WOE ORD-17 ,a.ud a fine of up to$250.00 a day t the violat Be advised that a copy of this statement may be forwarded to thu Office of Investi ztioas of 1A-for insw e covega e verification. X ao hereby ce under th sins and p.enaIties of perjury that the information provided above is true and,correct 11 Phone=r: A)16 I Official use only. Do not write in taus area, to be completed by city or town offircial City or Town. i Iermuit111IC2Ilse Issuing Authority(circle one): ;t 1,.Eoard of Health 2.Euildb g Depzrtment 3. City/Town Clerk 4.Electrical—Spector 5,Plat ling InsoecL � 1 6. Other A �o. I� Co ntactFersoa; Phone '. t !}�413/LUU7 11:28 FAA 508 790 1677 FAIR INS 003 .,mom DAM MWMMM fa CERTIFICATE OF LIABILITY INSURANCE 1 04n3LOO7 PRODIF S (S08)775-3131 PAX (S09)790-1677 7M CERTIMATE 6 MED AS A MATTER OF IWOMMMI The Fail r Insurance Agency, Inc � .ONLY AND CONFERS NO RIGHTS UPON THE°C►ERMIIGA I E 14OLDER.THIS CgRWICATE DOES Will IDCTEND OR P.O. Box 430 ALTER THE COVERAGE AFFORDED Ov'T IE SOY €w_ 619 Main St. CenteT*ville. KA 02632 94SURERS AFFORDING COVERAGE NAIC4 INSURED GZJ WIIDERS INS lw-R p-, National Grange P3 BOX 509 INSURERS. SaVerS Narstons Mills, MA 02649 MMUMC: INR E: i GOVER�GES THE PM(QIES OF INSURANCE LISTED BELOW HAN,%BEEN I$SUE)TO THE INSURED NAWD ABOVE FOR THE PQLW PERIOD 1I,010ATED-NOWATHSTAN AN:'REQUIREA91ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DMMEAT WITH RESPECT TO WHICH THIS CERT)fRAATE MAY BE ISSUED OR Aaxr P&.11AIN.THE INSURANCE AFFORDED BY TIC PC7WES DESCRIBED HEREIN IS$OBJECT TO ALL THE TERMS.@XCLUSIRId:u AND CONDITIONS OF SUC4 POLICIES.AGGREGATE LIWS SHOWIN MAY i- VE BEEN REDUCED BY PAID CLAIMS. � I> TYPE OF WSWE4N E pi3.atY. r'O�1i"i>�I VC ATE E°dDlt�dAS'�i � ORMPAL LMOUN 14P143701 OS/28/20 OS/28/2007 EACH OCCURR±IiE IS 1.0 X GO RCIAL aWEI A&LABILITY Oros `f�g f M.CE&wtummca) dud CLnaaS MWEE ®OCCUR � � eED EIT VVW.c A PcR$QA1A4 Efatt.'INPJRT S Low. _ haENKRAI,AGG 7: ATE ,S Low, ��. ` GEM nGGRI;CgA7EL> T APPLIES QER PftODdICT.- E 4RtkGG $ Low. f VVCY P L� AWAM AI i.QWNW AUTOS BWILY a iUr 1' SOMMULED AVr O$ KRED A rOS BODILY iN.1uF1'... (Per-6daftt) DfifPS�GE $ rMRAGrz LIABILITY j AUTO ONLY-E4 ACOMENT $ ANY AUY4 OTWSR TWIN EA ACC $ ONLY: AOG $ r�sC"�^aSfLlid3�l.LdLTY :AGHT?4;�sCc` OCCUR D CLAM MAp> OWUCnIKE RETENTION $ +1"AERS CONW AYM AW WCM23741 05/28/2 0512$12007 [ iLovssTY EL, ta nrr 1 8 Vr.Pt�ARTtCUrNE %OFF+ - EQXUDriTn EL.DMEASC-I;,E $ 100. f D I° 1-� i*rQ Ws bear E1,D�aSr-cf:JCY LINAT 1 5 : ;�u. C I E FL�A1`E 05/29/2I j 05/29/2 7 .� TELERANDLER SEWL4!39664 VALUE 47745 DEMMBLE D'c issmo A Or-OP TWO M t LOCATIOM!V I MLUV"i5 ALDER BY OUXW. I4 t$K— e T LIATION 5} IUI.DAWY OF WE A MCPAW PCILI L?S b' GAS 7tlia EXpIFATOW IbATG TM F.Tm ISSUM w—AUR i ALL ENWAVOk TO M" 15 OAYS WMrr P N0=TO ne GERTLHCA,:Ii itAM TO TEE LEFT, $Itei 1 Glen T in M"FAILURE TO rkAa sucH NnT�SK4LL O I iD OBUC-.4TION OR �141.0 W i anno Avenue CUFF Aw UPON TK WSURK TY3 AGENTS OR F c IT1IE3. Osterville, MA 02655 ATY�E ACORD 25(20M/M J�ItCORD CORPORAr-ON 9 Q4+43/2007 11:28 FAX $08 790 1677 FAIR INS wJ uUz t IMPORTANT tf the certiific a holder is an ADDITIONAL INSURED,the policy(es)must be endorsm.A stag€ent on this certificate do"not confer rights to the cefficate troider in lieu of soch endorsements) If SUBROGATION IS WAIVED,subject to the teMr.and conditions of the policY,certain poficie y require an endorsement.A statement on this ceffmate does not confer rights to the cerfificate holier in Lieu of such endorsee s)_ DIS MER The Ces9l'icate of Insurance on the reverse side of this form does not cons#tute a contract betw,a m the issuing insurer(s),authored represwtative or producer,and the ceocate holder,nor doe=It affirmatively or negatively amend,extend or after the coverage afforded by the policies lisp thfneon. f t j t AC RD:ES(2 11/08) Town-of Barnstable hP °� regulatory Services t 33AMS1rastE, II Thomas F.Geller,Director 9 Mnss. $ q, i639. Bulldincr Division MP'�a b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date -s / 0 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: jr_�/1�✓�TG�L�l/ Estimated Cost Address of Work: ( -TELV 0Ji (`e&,�Vl el, P4 4 Owner's Name: 62 �f1,1✓ ®��� Date of Application: ,c / 0 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR OMI UYIPROVEMENT WORK DO NOT FLUE ACCESS TO THE ITRATION PRO OR GUARANTY FUND UNDER MGL c.142A. SIG UNDER PENALTIES.OF PERTURY I hereby ly for a permit as agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:fo=.homeaffidzv ,NF Town of Barnstable Regulatory Services a a Bn ME& � Thomas F.Geiler,Director 26 9 �:;9. Building Division Tom Perry; Building Commissioner 200 Main Street Hyznni.s,MA 02601 www-town.b arnstable.ma.us Office: 508-862-403 8 Fax: 5 0.8-790-62.3 0 Property Owner Dust CorriPlete and Sign This Section If Using A Builder I,- GnZi/I� / C���� ��!,/ a5 Owner of the subject property hereby authorize (�7(.- .Z 13(// lo� /,(j e, to act on rn behalf Y , in L matters relative to work authorized bythis wilding permit application for; , (Address of Job) SignatLLre Qwner D L6e Print Name 0-YORW!S:0i rNE ✓P V-ISS101 - �of�u �ge' auos�da ��3rse1,� w - }� tE=1�11�'RUNEI ENf'CO 1TRACT6.R Regstratrbn 1,62263 EXp atrts v t1 t12008 Type=Pssvate Co poeation Gr-I BUILDERS N PAUL iMAZZOLA, 644 RIVER ROAD MARSTONS MILT-S,i+sA(3 645 bieputy AdaiiniStmtor mom' �raens '� 5 IGTK3S> loR�15L? � � ,° tf � jgeS6F1�L0J7� Tz �]U T- N r ResYsaed� -1-- - i� �otk � ' f = i MORTGAGE INSPECTION PLAN DES LAmERS INC. ADDRESS: 66 TERN LANE, BARNSTABLE. MA &ASSOCIATES, . LENDER: FIRST HORIZON I OME LOANS , 101 CONSTITUTION BLVD, SUITE D, FRANKUN, MA 02038 • TEL:(800)287-8800 FAX.:(508)528-4011 ATTORNEY: GILL. DEVINE a: WHITE. P.C. 06-2154 'UNREGI3TERED LAND FILE No.: 161370 OWNER: LINDA K..MARINO APPLICANT: GLENN E. TOWN DEED BOOK: 17595 PACE: 001 DATE: 10117f 2008 SCALE" 1"=60r ' PLAN BOCK:88 PAGE: 13 LOT(S), 43 PLAN NUMBER; OF ' ..FLOOD ,HAZARD INFORMATION' COMMUNITY NO.: 250001 ZONE C PANEL:_DO15C ". DATED: 8/1911985 REGISTERED LAND CERTIFICATE OF TITLE: --REGISTRATION BOOK: -PAGE: ASSESSORS MAP;_192 O27 BLOCK: LOT; PLAN NUMBER: LOT(S): _WEQ UAQ UET r J:AKE • , . LOT":4 3 y ti \ N PORCH . +I 1 N LOT 44 LOT 42 . STAKE 10' WIDE EASEMENT FOR POWER LINE o DRAINAGE Lo AREA .85.Do y STAKE s - TERN;, :LANE : NOTE: DWELLING APPEARS TO ENCROACH`-ONTO ` r MORTGAGE LENDER -POWER LINE EASEMENT AS.SHOWN BY*TAPE MEASURENENTS. r USE ONLY . THIS 1S A COMPILED PLAN MADE BY TAPE www.plotplone.com `• ,� ` MEASUREMENT, NOT THE RESULT OF AN ry INSTRUMENT SURVEY AND IS, AS SUCH, CERTIFIED :� • �' TO THE TITLE INSURANCE COMPANY.AND.ABOVE , _; .: LISTED ATTORNEY AND LENDER. ih OF`�AS i THERE ARE NO DEEDED EASEMENTS IN THE ' ABOVE REFERENCED DEED OR ENCROACHMENTS o� RAYMOND , , WITH RESPECT TO DWELLING SITUATED ON THIS E. LOT EXCEPT AS STATED ON THE DEED OF RECORD BEALE. JR. N SHOWN, NO. 8973 THE LOCATION,OF THE DWELi_ING SHOWN o4 DOES NOT FALL.WITHIN A SPECIAL FLOOD HAZARD.:. , . 'PFC/STE��� ZONE, EXCEPT AS MAY BE INDICATED. THE LOCATION OF THE DWEL_ING AS SHOWNCNAC AND HEREON EITHER WAS IN COMPLIANCE WITH THE LOCAL ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY), OR IS EXEMPT " FROM VIOLATION ENFORCEMENT ACTION UNDER ' MASS. G.L. TITLE VII. CHAPTER 40A, SECTION 7, •ENERAL NOTES (1) The declarations made above are on the basis of my knowledge, Information, and belief as the result of a mortgage inspection-tape survey made 3 the normal standard of care cf registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date, t. f) This plan was,not mode for recording purposes, for use,In preparing deed descriptions or for construction. '(4) Verifications of property line dimensions, building y, ffsets, fences,,or lot configuroticn may be accomplished by an accurate instrument survey. (5) No responsibility Is assumed herein to the land owner or occupant. f •. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �`1 Parcel 097 s ^Application# ®�CYO Health Division Conservation Division Permit# Tax Collector Date Issued 5 Treasurer Application Fee Via Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address &(o L/U Village OeNT•e2 Vr/16 Owner �. �, .�— ,1, i} -TblbiN Address rhle Telephone _5Q 8 778 // ?7 Permit Request E iPr SW o FE ExIgTIOCo LAP.A vC eo APD o Fic-e A 7:�:Nsa-4AI - Tle INTO Ex-f4nv5- ci k-tl/L oLLQ U Ns47e L10e,5 -y Square feet: 1st floor:existing propose 2nd floor:existing 5�_ proposed F>(f54f abtal new Zoning District Re-5,bpr4A:'- L Flood Plain C Groundwater Overlay Project Valuation Q 67 b60 ' Construction Type �-)DU D Lot Size N Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure /6 Historic House: ❑Yes La, On Old King's Highway: ❑Yes 2'No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /V Basement Unfinished Area(sq.ft) A/ Number of Baths: Full:existing _ new / Half:existing O" 4 new Number of Bedrooms: existing " new ''—© ' Total Room Count(not including baths):existing 0- new First Floor Room Count Heat Type and F ❑Gas ❑Oil Electric ❑Other Central Air: Yes No Fireplaces: Existing 'D New �� Existing wood/coal stove: ❑Yes ❑No Detached garage:O existin ❑new size Pool:❑existing ❑new size Barn:❑ x'g g g � g e_� a e istmg��Y'new._,size . c� Attached garage:❑existing ❑new size _ Shed:❑existing ❑new size Other: Zoning-Board-brAppeals Authorization ❑, Appeal# Recorded❑` Commercial ❑Yes ago---if yes, site plan review# Current Use 5 T6k Proposed Use /c It-�e BUILDER INFORMATION PKIL Cet( S08 -776­4 Name u C 1 u',08k T�iL Telephone Number Address .-t�o x 0 q License# C �J 05 79<�A ( 1 e Home Improvement Contractor# FF}I L (Y)422.0 L9 Worker's Compensation# �, ALL CONSTRUCTIO EBRIS RESULTI FROM THIS PROJECT WILL BETAKEN TO t-A J D F i I 5BY �U C(L �i N R �U►'1>l See SIGNATURE DATE I—e;?'l A N : a FOR OFFICIAL USE ONLY PERMIT NO. �Ik - DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME C®R 6 r INSULATION CSI Lz `®a FIREPLACE - F' ELECTRICAL: ROUGH FINAL r t PLUMBING: ROUGH FINAL GAS: ROUGH - NAL &'olr FINAL BUILDING !— 0 .y DATE CLOSED OUT ASSOCIATION PLAN NO. -No. Fee /L THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS ;Yes Zi ppli cation for Mi5pogat &pftem Construction Permit Application for a Permit to Construct( ) Repair( ). Upgrade(� Abandon( ) Complete System U Individual Components Location Address or Lot No. 6 6 Owner's Name,Address,and Tel..No. Assessor's Map/Parcel ' �'? V o `^ Ajv_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ae� y3.-5-700 77S-0735 Type of Building: Dwelling No.of Bedrooms CC � _ g J Lot Size '�,9Q(� sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) i l O gpd 'Design flow provided gpd Plan Date 5 116 0 7 Number of sheets I Revision Date Title Size of Septic Tank SQb Type of S.A.S. Description of Soil . -ex,, 122aw. Nature of Repairs or Alterations Yl(Answer when applicable) �.Qp� 1�OQP1�.. ( o, Z_ rOp Date last inspected: , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the'Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date �j k i t7 Application Approved Date 511216 7 Application Disapproved by: Date for the following reasons Permit No. Date Issued 11 P THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed.( ) Repaired (. ) Upgraded ((/) Abandoned�by 1V�C at b N'W�, .' L g Rnl^ cat.` has been constructed inn accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 _/c dated5//) 67. Installer_ • Q / +n.1 t ,v�c _ Designer #bedrooms �j Approved design.11flow 0 5�6 • gpd The issuance of thi permit shall not be gonstrued as a guarantee that the system w.'1. furlct�on as de igned , '' � J �j Date "�� ,�}- �)5)7, // _ Inspector 0 ��� ;/ ;`t%' t/ /t% l�!`�1 t .- �•:--) Parcel Detail Page 1 of 4 I' I sAns Any Mats. Logged In As: Parcel Detail Monday, Janu Parcel Lookup Parcellnfo Parcel ID;192-027 Developeo� LOT 43 Location `66 TERN LANE Pri Frontage 185 Sec Road Sec _ -- ----- -- -------------- --- Frontage -- ------ village[CENTERVILLE ) Fire District[C-O-MM Sewer Acct Road Index 1698 Asbuilt Septic Scan: ~;` _- 192027 1 Interactive Map 192027_2 - Owner Info owner'TOBIN, GLENN E &SHEILA LP Co-owner Streetl ;66 TERN LANE Street2 city,CENTERVILLE I State MA zip 02632 Country - Land Info Acres 10.61^� I Use Single Fam MDL-01 zoning IRD� 1 Nghbd�PF07 Topography;Level Road Paved -- -- -- - -----. - - -------- - Utilities(Public Water,Gas,Septic Location Lake/Pond Front,Excel View - Construction Info Building 1 of 1 Year Roo f(1960 Gable/Hip Ext T� Wood Shingle Built -- --- ---- Struct Wall Effect -` Roof AC I Wood Shin-9 le Central 12758 _ II Area - Cover - --' Type — - -- -------' In Style Cape Cod Wald I-Plastered- Rooms 3 Bedrooms II -� Int Bath i Model;Residential _ Floor r Rooms 1 H I s -- Grade Luxury Plus J Heat[Hot Water Total Rooms^ Type - --- Rooms — _ http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13575 1/7/2008 Parcel Detail Page 2 of 4 DK[2561 WDK5B' _-K 8 16. 16= ; 62 3 `—"— Heat Found- t ]AS i AS stories r1 1/2 Stories Fuel Gas ation Typical �7 o GMT "1'.8 ?5, TQS.. . IQ'B� r ' Permit History Issue Date Purpose Permit# Amount Insp Date Comme 12/12/2006 Addition 20064634 $35,000 11/15/2007 12:00:00 AM ADD TC 4/8/2003 Out Building 67999 $40,000 2/6/2004 12:00:00 AM 9/13/2002 Addn+Renovate 63768 $183,424 4/28/2003 12:00:00 AM -visit,History Date Who Purpose 11/15/2007 12:00:00 AM Paul Talbot Cyclical Inspection 6/8/2007 12:00:00 AM Sheila Fowler In Office Review . 5/3/2007 12:00:00 AM Tony Podlesney New Construction 9/6/2006 12:00:00 AM Paul Talbot Cyclical Inspection 2/6/2004 12:00:00 AM Martin Flynn Meas/Listed 7/23/2003 12:00:00 AM Martin Flynn Mea./List Bldg Permit Only 4/28/2003 12:00:00 AM Martin Flynn Bldg Permit N/C 11/28/2000 12:00:00 AM Paul Talbot Meas/Listed Sales History_ _.._._ _._ Line Sale Date Owner Book/Page Sale P 1 10/31/2006 TOBIN, GLENN E & SHEILA LP 21487/302 $1 2 9/5/2003 MARINO, LINDA K 17595/001 $1 3 7/25/2002 CARLETON, ROBERT T TR& 15402/210 4 6/27/2002 NAILOR, DAVID 15304/164 5 9/15/1996 BROADBENT, MADELINE P & NAILOR, D 10380/294 6 BROADBENT, HARVARD H 944/065 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $344,000 $18,100 $21,500 $634,000 $1 2 2006 $340,800 $18,100 $22,000 $593,600 3 2005 $306,100 $17,800 $22,400 $646,900 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13575 1/7/2008 Parcel Detail Page 4 of 4 _A V MIS{{ ' A `_ :tr i { 33� http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13575 1/7/2008 Parcel Detail Page 3 of 4 4 2004 $143,100 $15,400 $500 $494,700 5 2003 $119,400 $15,400 $500 $201,200 6 2002 $119,400 $15,400 $500 $201,200 7 2001 $119,400 $15,400 $500 $201,200 8 2000 $88,800 $14,700 $1,200 $121,700 9 1999 $88,800 $14,700 $1,200 $121,700 10 1998 $88,800 $14,700 $1,200 $121,700 11 1997 $148,400 $0 $0 $101,400 12 1996 $148,400 $0 $0 $101,400 13 1995 $148,400 $0 $0 $101,400 14 1994 $136,200 $0 $0 $109,500 15 1993 $136,200 $0 $0 $109,500 16 1992 $154,900 $0 $0 $121,700 17 1991 $156,100 $0 $0 $178,500 18 1990 $156,100 $0 $0 $178,500 ; 19 1989 $156,100 $0 $0 $81,100 20 1988 $96,200 $0 $0 $39,000 21 1987 $96,200 $0 $0 $39,000 22 1986 $96,200 $0 $0 $39,000 Photos 7 An `+ ,, i' -; .. - - .'�' cf-. ,..::t •�'�'",.tin �°, http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=13575 1/7/2008 66 Tern Lane, Centerville Page 1 of 1 Giangregorio, Robin From: Pulsifer, Francis [FPulsifer@commfiredistrict.com] Sent: Monday, August 06, 2007 4:08 PM To: Perry, Tom Cc: Giangregorio, Robin; Pulsifer, Francis Subject: 66 Tern Lane, Centerville Tom: During a fire alarm inspection today at 66 Tern Lane, Centerville, I found what appears to be an accessory use apartment. The inspection was for a new two vehicle detached garage with a finished "storage" area above. I arrived to find the second floor with a finished space with a bed and associated furnishings, full bath, kitchen including sink, microwave and mini fridge. The owner stated that the area is an 'office" but admitted that her son sleeps there. There was no resemblence of an "office" use. In addition to use group, the egress for the space does not appear to be adequate. One egress leads to a second floor balcony without a stairway to grade. The second egress leads to an interior stairwell which discharges into the garage not the exterior of the building. Let me know what you think. Frank Pulsifer \ `l ua 8/7/2007 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t. Map ��°�Q•o1� Parcel Application# Health Division -2da2 d/` Conservation Division Permit# Tax Collector Date Issued 3 Treasurer Application Fee o r D Planning Dept. Permit Fee z a , bD Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 66(o Tee w C LIJ, Village �tuTe?v Owner MR.,MR6 Cam' f.&W ►a1iNiQ Address _ G& 7-ckW LIJ Telephone S08 Permit Request -� �41& wt, ) -aec.1. (%q 'Re" 6r- HnyS-P 9.e,2 14c_e . 6P ReTnlq(-t Vx1�Ti►.�Sr ��ciNn wju CXI<71�_(6A-14 Square feet: 1 st floor:existing proposed 2nd floor:existing proposes, Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00,tote, Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 141 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yew Zo Basement Type: ❑ Full ❑Crawl Walkout ❑OtherCD __ ) Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) N Number of Baths: Full:existing new Half:existing ` new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Cou t � r- co Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑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:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# _—`Current Use Proposed Use BUILDER INFORMATION Name t9.C .T 7&;#IseR!5 XV C Telephone Number SO -4 a 0. 9 S 3`I- Address w-44 RkyeA 13D . License# C5 DS"7934 MAa5TOP eh#85 Home Improvement Contractor# I5;LA 53 Worker's Compensation# W G O Od Q3 74 ALL CONSTRUCTION DE TING FROM THIS PROJECT WILL BE TAKEN TO 17uM Py 4 -T SIGNATURE DATE L FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED y MAP/PARCEL NO. ADDRESS VILLAGE j OWNER • DATE OF INSPECTION: 'F FOUNDATION FRAME INSULATION 2 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. a 1 he commonwealth o,j massachusetts Department of Industrial Accidents • Office.of Investigations 600 Washington Street Boston,MA 02111 M s�•J www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Org nization/Individual): (�j.C, i�ctC�QS 2NL Address: 644 give& &b 1b ?::&2x SD°( City/State/Zip: sT6i� M,1) S OA 6o)G�� Phone #: Sbe -r�?g - �i8 34 1►iA_ Are you an employer? Check the appropriate box:. Type of project(required) 1. 1 am a employer with S• 4. ❑.I.am a general contractor and I 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling• ship and have no employees ._ These sub-contractors have 8. ❑ Demolition working for me in any capacity. ` workers' comp. insurance.:- 9. ❑ Building addition [No workers.' comp. insurance 5. ❑ We are a corporation and its required.} = officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work-t " right of exemption per MGL. 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t5. _; employees..[No workers' -_- _ 13.❑.Other comp: insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such-, that check this box must attached an additional sheet"showing the name of the sub-contractors and their workers'comp.policy information. I"am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. - Insurance Company Name: q 1 SSA LY-e C- A009 - Policy#or Self-ins.Lie. #: no Q 3 74 _Expiration Date: S Ia $ 0 7 Job Site Address: ?'EizLj 41J. City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under'Section 25A-of MGL c.-152 can lead to the imposition of criminal penalties-of a fine up to$1,500.00 and/or one-year imprisonment, as well as`civil penalties in the form of a STOP WORK ORDER and a fine -. of up to$250.00 a day against the violator. Be advised that a copy-of this"statement may be forwarded to the Office of Investigations of the DIA fo ce coverage verification. I do hereby certi under the pa* and penalties of perjury that the information provided above is true and correct -- Signature: - Dater / 0 Phone#: Official use only. Do not write in this area,to be completed by city or town official-+ City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector _ 6. Other Contact Person: Phone#: Information and Instructions f Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair woik-on such dwelling house to shall not because of such employment be deemed to be an employer." or on the grounds or building appurtenant there MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license o pe rmit ermit to*operate a business or construct buildings in the commonwealth for.any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.„ Additionally,MGL chapter 152, §25C(7)states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance �... requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), addresses)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the.permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their, self-insurance license number on the appropriate line.= City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ._ of the affidavit for you to fill out in the event the Office of Investigations has to contact you.regarding the applicant Please be sure to fillin the permit/license number which will be used as a reference number. In addition; an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations m. (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts . Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111., Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia �11/01/2006 10:19 FAX 508 790 1677 FAIR INS [I001 A CERTIFICATE OF LIABILITY INSURANCE 11/01/20° Q�L�,, 006 PROmmm (S08)77S-3131 FAX (508)790-1677 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Fair Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 430 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW: 619 Main St. Centerville, MA 02632 INSURERS AFFORDING COVERAGE NAIC# msuRED GCI BUILDERS INC INSURER A National Grange PO BOX 509 INSURERS: Savers Marstons Mills, MIA 02648 INSURER C; INSURER D: INSURER E; COVERAGES 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL UABILM MIP143707 OS/28/2006 05/28/2007 EACH OCCURRENCE $ 19000,000 X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED & 50,000c CLAIMS MADE XJ OCCUR - - t MED ExP(Any ens person) $ S.0001 A9:: PERSONAL&ADv INJURY $ 1100010 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY JECT LOC AUTOMOBILE LL41MUTY COMBINED SINGLE LIMB ANY AUTO (Ee sockw t) $ ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Por person) HIRED AUTOS BODILY INJURY NON-OWNED AUTO$ (Pa 2G*ent) $ PROPERTY DAMAGE $ (Per pmWo a) GARAGELIABILRY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC s AUTO ONLY. AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE & RETENTION 5 $ WORKERS COMPENSATION AND MIC0002374 OS/28/2006 05/28/2007 1,W STATIY oTH EMPLOYERS'UABIUTY B ANY PROPRIETORIPARTNERIEXECV".% E.L.EACH ACCIDENT $ 100, OFFICERIMEMBER EXCLUDED? EL.DISEASE-EA EMPLOYE $ IOO OO NreedouNbe under 6�E6LAL PROVISIONS below E.L.DISEASE-POLICY LIMB I$ 500,00 rj1IMENT FLOATER 05/28/2006 OS/28/2007 TEREX LIFT TELEHANDLER A SERIAL#09664 VALUE 47745 1,000 DEDUCTIBLE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I OMUSIONS ADDED HY ENDORSEMENT I SPECIAL PROVISIONS CANCELLATIQN SHOULD ANY OF M ABOVE OMMSED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILJ-ENDEAVOR TO MAIL 1S DAYS WRITTEN NOTICE TO THE CERMFICATE HOLDER NAMED TO THE LEFT, Glenn a Sheila TW n BUT FAILURE TO OWL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY I 66 Tern Lane - OF ANY KIND UPON THE INSURER,ITS A09M OR REPRESENTATIVES, Centerville, MA 02632 AUTHORM ReFRESENTATIVE lKathySilvia FAIOSI ACORD 26(2001/08) PAX: (508)428-9834 OACORD CORPORATION 1988 � � �T�:�0���3yG0�y1�!/E�� ��;�xA{•g�CIfiSR•G _ N B0AR€ 9F B 'Bt G REGN m r0 3 - LecenseONSTR�ICTK}NStiPERtr"FSO�i Numiser' CSC 0579$4 .' = Expt� 06f19[2t 7 Tr_no. "I -46 1.c Y PAUL J 1 AZZO.LA ✓ i. NIA£ZSONS MII,I:S., 07-7 Me Yi• l, BoardoBui;tAngReg�u�ataansandards HOME IMPROVEMENT CONTRACTOR Registration: .152263 may' Exprratica._$/1't/2008 H " T, .gate Corporation GCI BUILDERS INC PAUL MAZZOLA 644 RIVER ROAD MARSTONS MILLS MA-0-2o4a Deputy Administrator ¢,A�E p� Town of Barnstable Regulatory Services MASS $ Thomas P. Geiler,Director �$ 039. Building Division Tone Perm, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If 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: rz)71 � �Z (Address of Job) . - Signature Owner D to Pri:at Name a:F0RMs:0wxEPPMv sioN i } MORTGAGE INSPECTION PLAN v&DEsLAuRims ADDRESS: 66 TERN LANE, BARNSTABLE, MA &ASSOCIATES,INC, LENDER: FIRST HORIZON IOME LOANS 101 CONSTITUTION BLVD, SUITE D, FRANKLIN, MA 02038 TEL,:(800)287-8800 FAX.;(508)528-4011 ATTORNEY: GILL, DEVINE A WHITE, P.C. 06-2154 UNREGISTERED LAND FILE No.: 161370 OWNER: ONDA K. MARINO APPLICANT: GLENN E. TOEeIN DEED BOOK:` 17595 PAGE: 001 PLAN BOCK:88 PAGE: 13 LOT(S); 43 DATE: 10/17L2006 _ SCALE: . 1"=60' PLAN NUMBER: OF. FLOOD ' HAZARD',INFORMATION COMMUNITY No.: 290001 ZONE: C ' PANEL:'•0015C DATED: 8/19/1985 REGISTERED LAND CERTIFICATE OF TITLE: REGISTRATION BOOK: PAGE: ` ASSESSORS MAP, 192 027 BLOCK: LOT: PLAN NUMBER: LOTS) WE UA UET Q Q LAKE 51 7. A3,. .. � N • '� ' ' PORCH • � � � li►s•w -H i M N LOT 44 LOT 42 r STAKE •� 10' WIDE EASEMENT FOR POWER LINE o DRAINAGE Ui AREA • 85'00' STAKE TERN -LANE NOTE: DWELLING APPEARS TO ENCROACH ONTO MORTGAGE LENDER POWER LIME EASEMENT AS SHOWN BY TAPE USE ONLY MEASUREN-ENTS. THIS IS A COMPILED PLAN MADE BY TAPE www.plotplang.com �..,�•-Ara. MEASUREMENT, NOT THE RESULT OF AN p INSTRUMENT SURVEY AND IS, AS SUCH, CERTIFIED TO THE TITLE INSURANCE COMPANY AND ABOVE + LISTED ATTORNEY AND LENDER. I�,t� OF NASS ' e THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED DEED OR ENCROACHMENTS RAYMOND WITH RESPECT TO DWELLING SITUATED ON THIS �� E LOT EXCEPT AS STATED ON THE DEED OF-RECORD i; BEALE, JR. A SHOWN. N THE LOCATION OF THE DWEL1,ING SHOWN �t DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARDj, o fcf$To ZONE, EXCEPT AS MAY BE INDICATED. THE LOCATION OF THE DWEL_ING AS SHOWN NAC AND HEREON EITHER WAS IN COMPLfANZE WITH THE LOCAL ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY), OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS, G.L. TITLE VII, CHAPTER 40A, SECTION 7. 1a.�..•�.mv+re�wY'�• 1ny,rtlmrsh ENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, Information, and belief as the result of a mortgage inspection tape survey made 3 the normal standard of care of registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date, S) This plan was not made for recording purposes, for use In preparing deed descriptions or for construction. (4) Verifications of property line dimensions, building ffsets, fences, or lot configuration may be accomplished by an accurate instrument survey. (5) No responsibility Is assumed herein to the land owner or occupant, MORTGAGE INSPECTION PLAN DFs LAuRims ADDRESS: 66 TERN LANE, BARNSTABLE, MA &ASSOCIATES,INC. 101 CONSTITUTION BLVD, SUITE 0, FRANKLIN, MA 02038 LENDER: FIRST HORIZON HOME LOANS TEL.:(800)287-8800 FAX,:(508)528-4011 ATTORNEY: GILL, DEVINE d: WHITE. P.C. 06-2154 UNREGISTERED LAND FILE No.: 161370 OWNER:- LINDA K. MARINO APPLICANT: GLENN E. TONN DEED BOOK: 17595 PAGE: OOI DATE. -I0/1712006 SCALE: I"=60' ' PLAN BOC1c:86 PACE: 13 LOT(S): �43 PLAN NUMBER: of FLOOD .HAZARD INFORMATION coMMUNi'rr No,: 250001' ` ._ ZONE: C PANEL: OOISC f DATED: 8/1911985 _ REGISTERED LAND CERTIFICATE OF TITLE: ' REGISTRA"ION BOOK: PAGE: ASSESSORS MAP92 O27 BLOCK: LOT; ` PLAN NUMBER: ; Y LOT(S); WEQUAQUET LAKE LOT."':4:3 co\ PORCH \ \ i -H IN i-) N LOT 42 \ LOT 44 STAKE 1, 10' WIDE EASEMENT FOR POWER LINE o -DRAINAGE Ui ,. of 4 ,'AREA ' •8500 , STAKE TERN LANE NOTE: DWELLING APPEARS TO ENCROACH ONTO MORTGAGE LENDER POWER LINE EASEMENT AS'SHOWN BY TAPE USE ONLY MEASUREN•ENTS. THIS IS A COMPILED PLAN MADE BY TAPE WWW.plotplans:com 1., ,• �. MEASUREMENT, NOT THE RESULT OF AN N INSTRUMENT SURVEY AND IS, AS SUCH, CERTIFIED TO THE TITLE INSURANCE COMPANY,AND ABOVE LISTED ATTORNEY AND LENDER. OF MASS THERE ARE NO DEEDED EASEMENTS IN THE 9 " ABOVE REFERENCED DEED OR ENCROACHMENTS o' RAYMOND , WITH RESPECT TO DWELLING SITUATED ON THIS E. LOT EXCEPT AS STATED ON THE DEED OF RECORD L3 BEALE, JR. N SHOWN. NO. 8973 THE LOCATION OF THE DWELIING SHOWN 4 DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD f �FGISTE�E� �� ZONE, EXCEPT AS MAY BE INDICATED. THE LOCATION OF THE DWELLING AS SHOWN �NA( ANO HEREON EITHER WAS IN COMPLIANZE WITH THE LOCAL ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY), OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII. CHAPTER 40A, SECTION 7. ENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, information, and belief as the result of a mortgage inspection tape survey made i the normal standard of care of reglstered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date. f) This plan was not made for recording purposes, for use in preparing deed descriptions or for construction.`'(4) Verifications of property line dimensions, building ffsets, fences, or lot configuration may be accomplished by an accurate instrument survey. (5) No responsibility is assumed herein to the land owner or occupant. MAp *10A 7 IA I&I IL{ a .- .. Pt ��' } � )_... a .. �. Alf•. �. ' 141 �'._...•.�'�" �°`£' �y�s° �" ^� ate-; ,, r � 7 , I r t i. a =r 11�.4.� Cl IL _ ... s4 � a l v �C rT 1 41 ' J ch f i Ilk s �Izzl 1 1 } �D 4-1 OD if r ti r The Commonwealth-of Massachusetts 1 Department of Industrial Accidents Office of Investigations M1 , a 600 Washington Street �+ l Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: B.uilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ••�. �y i 1�e�� 2u c Address: &4A 'RiVm ?0 1 b . f o x so ry City/State/Zip: �'Ag,Q-JO 11�,I�1 �� 0Q618 Phone#: SbA^qaa^5B 34- Are y�an employer? Check the appropriate box: Type of project(required): I. am a employer with 4= 4. ❑ I am'a general contractor and I 6. New construction employees(full and/or part-time)..*. have hiredthe•sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling , ship and have no employees These sub-contractors have 8. ❑Demolition wtirking for mein any capacity. workers' comp:insurance. g, 0 Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself. [No workers' comp. c. 152, §1(4),and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ ATbN4 ci G12w se Policy#or Self-ins.Lic.#: W 00 a3 74 Expiration Date: S ,Q9 J47 Job Site Address: (06 City/State/Zip:�QcITCRVi�rC � 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 im risonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day ag ' e violator. B$ dvised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance cover e verification. I do hereby cer fy under the pat nd penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: SC)S - 4a8 -96 39 C'e[- . S68 - 77b-4459 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f /f E '1V TY JA V1 LKJL iLOL-94 71V , Regulatory Services �xxsTest�. *' Thomas F.Geiler,Director WASS. 0,19. � Building Division TED MP . Tom-Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ice: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROYEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c, 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which'are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. n Type of Work: l�l ?G Q_ !�► l wig/ Estimated Cost 00 . Address of Work: GG l eRw LU, n 907d V►l e Owner's Name: i►1 Q . d/11�1 hA.� Ob 1 N Date of Application 1 J_/ -7 Z O I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law M'Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME WROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTYFUND UNDER MGL c.142A. SiG ER PE TIES OF PERJURY I hereby apply for a permit as the a nt of the own It 7 D G Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpf nes.fm=:homeaffi day Rev: 060606 i Town of Barnstable Regulatory Services Thomas F.Gener,Director 16 +°1� Building]Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 0260I Office: 508-862-4038 Fax: 508-790-6230 �Y Prop e Owner Must Complete and Sign This Section If Using.A. Builder 1, kk , la )n _,as Owner of the subject property hereby authorize-- (5;C-7 Sula16L to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signs of Owner Date . Punt Name Q--F0RMS:0WNM1? R=SION -- - ircease .G:dNS 1 t 7C`ijON St1PERV ISOR., _ Number CS 057934 ' Tr.no, 74346 y Y Resiraclied PAUL J iVVA4&Uf^ PO-BQX.509 C VfARSTONS MILLS, �1AA (32648 _Commissioner ✓!� f /1/ • <� Board ot`Bui dingy cgu ations nd Stau ards HOME IMPROVEMENT CONTRACTOR Registration: atio ;.--..,BII V2008 YPe Privet Corpo n GCI BUILDERS = - PAUL MAZZOLA -- 644 RIVER ROADa-�^� MARSTONS MILLS,MA-02648 Deputy Administrator IvrTll VA JJa111134L L1AV Regulatory Services s�xivsTt . ' Thomas F.Geller,Director 16 i d9- Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,b arnstabl e.ma.us Rce: 508-862-4038 Fax: 508-790-6230 Permit no. Date ) D 0 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL•c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adj scent to such residence or building be done by registered contractors,with certain exceptions,along Rzth Other requirements. Type of Work: N'eW Dec 1L . col- fue,*,t o�, Estimated Cost oZV DO u . Address of Work:. --FeAp Owner's Name: ,A,R,.M A'S - L l � u 11-� Date of Application: 11A2 l 66 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑IJob Under$1,000 CIBuilding 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 PERMRY I hereby ply for a t as the agent of the owner: Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpMesi br=homeaffiday Rev: 060606 ` i 10:31/2 r/20K, 12: 2S 5684283115 SULLIVAH DIG 1h4C PAGE 02 Y 1Pi{rt^ c V a xsrre 4Yidth (min) 125' e 5ide 10' r f„ Peor 10' 1 • _FLOOD ZONE } zone 8 & C (se5 pion) N,/F Lo ` L�Qn �_ COMMUnity PCfl&f N. eorol Hi 1"mz.00a }250001 0015 C ,fury 2, 1992 N2801 _ 1 rs,e• - _- ------ •------ - grovel Drive GB 1 , - --- �� Exist9p5 9y We 1 _ wood Wtl•KO 1 e,ent tea 8dse g j t► e' a� i 1 e; 1 l q PL // 1 SCai A{otl � o �¢2 Existing 40, ro PREPARED BY. q 4 f L r\ V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel d- Permit# /o Health Division $ Q 4 2—J 6 Date Issued Conservation Division b i D 3 le.. Application Fee Taz Collector 'i pe mi Fee l i SEPTIC V TEllilMUST BE L� TreasurerOf INSTALLED IN COMPLIANCE L Planning Dept. " VM TITLE 5 ENVIRONMENTAL CODE ANO Date Definitive Plan Approved by Planning Board TOWN REGIIJURTIONS Historic-OKH Preservation/Hyannis welt, m Project Street Address r!o�o /Cili1/ //✓� Village e��Lll/lC Owner C S-C. 6- oU P R6A IZ4 / !Tvj%, Address STo W 10ct, r Telephone 7,7/ 7 4/ Permit Requests r✓/ / Square feet: 1st floor: existing proposed j 7(0 2nd floor: existing -5441 proposed S—? Total new / S Zoning District Flood Plain (�. Groundwater Overlay UfV Project Valuation 4:�,DdG Construction Type Lot Size a(,,I (,Z 5T—_. Grandfathered: 0 Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family P/ Two Family 0 Multi-Family(#units) Age of Existing Structure AZerdJ Historic House: ❑Yes t$dNo On Old King's Highway: 0 Yes No Basement Type: ❑Full ❑Crawl ❑Walkout Other .5� �„ Basement Finished Area(sq.ft.) 4V Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing '1/ new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Ot er Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:Cl existing N(new sized-W-4 Pool:O existing ❑new size Barn:0 existing ❑new size Attached garage:O existing ❑new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization l] Appeal# - Recorded❑ r1 Commercial ❑Yes 4No If yes,site plan review# Current Use Rgst A2g*, -e- Proposed Use y BUILDER INFORMATION Name /1 f /4` Telephone Number :iz,8 -22 70) Address We # _ l Home Improvement Contractor# n Worker's Compensation# ILL CONSTRUCTION DEBRIS RESULTING fROM THIS PROJECT WILL BE TAKEN TO- .01 of SIGNATURE DATE =/0 FOR OFFICIAL USE ONLY v PERMIT NO. DATE ISSUED ` ti MAP/PftCEL NO. ADDRESS VILLAGE i OWNER ' DATE OF INSPECT/IOON: FOUNDATION --29-03 FRAME r N-1 �iCJ INSULATION FIREPLACE ELECTRICAL: ROUGH _ FINAL PLUMBING: ROUGH FINAL GAS: ROUGH t-,. ► FINAL y! ' ti •rv, FINAL BUILDING o • j ; ' f.it DATE CLOSED OUT,, ASSOCI"ATION PLAN NO. A _ The Commonwealth of Massachusetts Department of Industrial Accidents office 0//0yesti9atims ' 600 Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit name �v�/1/`�C f? s Cc- location: hone# o city n I am a home caner performing all work myself. ' I am a sole proprietor and have no one working in any capacity Emig I am an employer providing workers' compensation for my employees workmg on this job -r-- ti �- � r z�r -x x;. 4 Cyi--ti<y'`'^y,,ay r 2 •�--�'tt ''. •' �' s k2Y-.;w 4.,F t'o [� ,1,�' '1'r L ..*'t'sFsi.,.x. {..Y-`J:'Z°'"yyyj'i x£Y,.4: ) z ,�P z S t i r2fii 's X a Ja r r 3 i{ xa Nom arL 'name5 R § ,� � ? � i -. Y .. s r 7 '.. ws •K�� �hx {4-r } `r'"t az�FS4J���N�""�P� ���1'�?, ryry,t Sa`�ryr w §ir ..,.y g ter- . +air ' _.."'' 'f7...;s�" S 7y.ss t t yr"' F�rk,.•t , � ,r''�'�xy 'ti } �i+��•'3.'. : .-:. +y]`9 M Y. 2 J. �q t$ddre�a�1`-r n ca r x fit. d§.x .':* YtT-+y+ ,p, x. 3 ..X t➢ J w._.�s 7 �? t 7'rr a s�-i c � h1'�iw'S�" ti• r t l.x s-'"i -•, t n t � l: o11ne# . Yq i S'"• �'��'=� t`".•,r`?, '.. r~ Msucaace.c :.. ..,. .... ol SC #,.,:,t?:� ,: _ .. _ •4, �,� �,:. ';�::rat dt,.>_.._,±a; [] I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices &rT:7a'^*':t .. r ""'e�r 'R � 5 .'i# � �..t- :C"s t y c r"^.�"... ++ 9 {'�CS.,,�J'i�`` w4?' :x: k< # t zcj*c }r'�•tsk,°k,I�v m�Y+i`.� ,." 4 4 i .tS Y, r •r'ir r. 4 u •ictXr�'t A '� > r•`S's�' ' 1r*+' 'r R v i c zj +' rt 3�*zefS,'",;,iax.'i""srz.�'n ry,Tlr,s 1 a' rrx7j2s..�'".'±,we�` i -r Y' com an dame r �� R r 7 '�"{' ,� Se,+ yYFy �-•�j s a^' '�5»""�- vy f ',( F f,., i r >r �3 a y"zc.r 1eii..v��y'R.�gy i.f T J ¢ tl �L r11 J} i s s raidres t n 9 k t X�nY 7 t e k S z 4 a fr3�'� fi tJr:3v�K 'u •k- wE i x93. �" rr l''rt'7's ...t• ,..� -:u I' s � -�r P .a T P ,r•E S �• 2w'�t�....i.uu S'c>:' ��1'!!'''3r�f'��i}7�5��1'L�� ��2 � yr � � Z i J ,rtti� 4a.�' �.f>)�r�'s n'"�,-.kh x) a+ �. k'�"�'.r5 �4s�s,.r� t.�i�r� �'.,xi. 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Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify w d r�t�te Pen ties of perjury that the information provided above is true and correct. Signature Date Print name_ ; '(� 1Z,G J���1 Phone# d official use only do not write in this area to be completed by city or town official city or town: permit/license# F- Building Department ❑Licensing Board []check if immediate response is required []Selectmen's Office ❑Health Department contact person: phone#; (-10ther (revised 9/95 PIA) Information and Instructions • Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. IN Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. ago 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. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, Please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 r �OFZHE TO�ti Town of Barnstable Regulatory Services i f ' ST''SLE, ' Thomas F.Geiler,Director MASS 1639..E A � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: Estimated Cost Address of Work: �P Owner's Name: Date of Application: (J. I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 _Upuilding not owner-occupied (NdOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit the gent of the. owner: Date Contractor Name Registration No. OR Date Owner's Name f ti RESIDENTIAL BUILDING PERMIT FEES • f APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft. x.0031= l�0 ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) / // Permit Fee /� C3! l� projcost , °tE7 The Town of Barnstable BARNSTABM ' Department of Health Safety and Environmental Services MASS. a plEOMp�� Building Division 367 Main Street,Hyannis,MA 02601 :e: 508-862-4038 508-790-6230 PLAN REVIEW Owner: v — Map/Parcel:Tq� 11) 9-7 Project Address: �D(n-2Yr, n Builder: The following items were noted on reviewing: !, Y Q_ i Y ,Q V"_ Q, -14 e — o rL_ o Reviewed by: Date: 1 O BOARD OF.BUILDING REGULATIONS .z License: CONSTRUCTION SUPERVISOR Number CS O46420 Exptres14- 4/2004 Tr.no: 5625 � Restricted 00 : j EDWARD T STAFFORD r, 550 WILLOW ST HYANNIS, 'MA 02601 Administrator j r r 00-35;000 cf,enclosed.space (MGL CA 12:S:601-) 1A-Masonry only 1G-1&2 family.Homes Failure to possess a.current edition of the Massachusetts-State Building Code j is cause for,revocation of this license. i i i v DIG SAFE CALL 6ENTER: (888)344-7233 i � s I1 f Ht�V/TL, t..,�li-C i i�ll�H 1 L Llfi LlHl�iLl I � IIUJUt�HIV1l.,C `� t�,/�3/Z00! t I,r,l�ucl (S(j2{)77a-5S30 FAX THIS C:S:.RIII1C/Ail iS ISSULD AS A MA•T-lf.-,k Of 110ON1✓iP.71ON — Norgan Insurance Agency, 3_nc, ONN-Y AND CON1 LR NO f;1GHIS UPON 7H1 Cf RIIJ ICA-II 44 13arnstab-!e Rd. HOLDI—k:. l fiiS CE.R Ill ICA.I' IJO)_S W01 AM1.14ll,f XI E ND OP 1;'1H! C)Vff2AG1: A.11OI:l�f: )' llif 1'ULIC)1.;�131:1-Ol+i+. PO Box 2 50 Al 'If- _.—__ C _— I7I�_ -------.--- ljyann"is, MA 02601 Iw uRl:rs AFFORDING COVI--RAGI nasulzLt' Iw:,ula1.J.A: Comn>rrr�a'I Union j-nsuranre Co Assurance Construction Inc u•,<;ul<rltl.: 550 Willow St West Yarmouth MA 02673 II>rsuRLlrl�: --- IlasuraFR r: COVERAGES J '11dE I�U1_IC1ES Of 1N5U1tP,IJCE 1_L'-;7LU fjU_UUd HA;+/ii GEEIJ 155UEI�7OTHE IIJ.SURI=U 1JA,I14EU A.GOVI: FGk 71-I1:I'UI_IC1'PC1�dOU JIJDIGA.TL-U.NUTV✓1TH8"IAiJUIidL AN1'REC1UIr{CttnCiJ1,7'Lft1+4 f�ft GOWG1TI01'J Gf AIJ'+'CG1J7ft/aCl Ur-c OlHEFt llUCUIVjEIJT VrNTiI r;L- -PF-CT iU V✓HICfi TH15 Cf_rt71f1C/-,7f I✓Al'L'f ISL'UI=1J Ol; MA:Y PERIAHJ,]HE INSURANCE-AFFORDED BY 7HE POLICIES fJESGfd&EU HEREIN 1S:=U1 JECT TO A.LI.THf-TERIAL,EY.GLUSIOWN AND GUNDJTIUNS Of SUCJ-i AGGREGATE LIIV175 SHOirI+IJ l✓AY HP.VE BEEN REDUCED BY PAID C'LA.IMS. IIJ.`iR - POLICY L-Ff-f_C71VE PULiCY EY.PIRAT10KLIMfUT I T R TYPE OF iIJSURA.idCE POLICY NUMBErt DA7E 1✓IIJ�/DUlYY f,ATE yv%,A D/YYlLII✓�ITS GENERAL LIABILITY BLW28940 01/01/2002 •01/01/2003ccuRraNcr. s, 3,000,00 X COMMERCIAL GENERAL LIABILITY MAGE(Any onelue) 9; 300,00 CU+.IIJS 1J,AUE OCCUR (Any one person) 9• 5,00 A AL 5 ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,0GE14-L AGGREGATE LIMIT APPLIES PE-R: TS-COMP/OP AGG 9 2,poo,0OPOLICY PRO•JECTLOC AUTOMOBILE LIABILITY BXB14146 04/28/2002 04/28/2003D S114GLE-L1MfTA14Y AUTO nt) AL'L•OVVNED AUTOS BODILY 114JURY A X SCHEDULED AUTOS (Per person) $ 500,00 HIRED AUTOS BODILY INJURY S lJO1J-OVVIJED AUTOS (Peraccidenf) 500 a 00 PROPERTY DAMAGE S (Peraccidenf) 250,001) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5 ANYAUTO OTHER THAN EAACC S AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE S S,000,00 X OCCUR a CLAIMS MADE BDV10177 01/01/2002 01/01/2003 AGGREGATE s 5 e 000,00 A J; S DEDUCTIBLE $ RETENTION 1 S S WORKERS COMPENSATION AND TORY LIMITS ER _ EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S E.L.DISEASE-EA EMPLOYEE S E.L.DISEASE-POLICY LIMIT S OTHER )ESCRIPTION OF C+PERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDDRSEMENTISPECIAL PROVISIONS :ERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NDTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE ALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMP ANY dTS AGENTS pR Rl I?RESEA'`TATIVES. _ AUTHORIZED REPRESENTATIVE �/ f/,, Frank Horgan ��"✓r� ""-r' � ''7 .CORD 25-S(7/97) e, ©ACORR,ly GuRPORATION 1988 DATE CERTIFICATE OF INSUR�'NCE - -F. 01 02 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUBBARD & PRESTON SINS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 400 W CUMMINGS PK ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. STE 1725-25G 1. WOBURN MA 01801 COMPANIES AFFORDING COVERAGE COMPANY 7367W A ST.PAUL FIRE AND MARINE INSURANCE COMPANY INSURED COMPANY RESOURCE MANAGEMENT INC B SUITE 5 COMPANY 281 MAIN STREET FITCHBURG MA 01420 C COMPANY D COVERAGES. .:> 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMODWYY) DATE(MMIDD,YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&ADV.INJURY S OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE $ GARAGE LIABILITY. AUTO ONLY-EA ACCIDENT $ ANY AUTO i, OTHER THAN AUTO ONLY: -r EACH ACCIDENT $ IC AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ • r OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYER'S LIABILITY (UB-979X457-9-02) 1 1-20-02 1 1-20-03 EACH ACCIDENT $ 100,000 THE PROPRIETOR/ X INCL DISEASE-POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS COVERS EMPLOYEES- LEASED FROM RESOURCE MANAGEMENT INC. R. k THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CFiTIf I GATE:.HQLDER AR JCELLATl01 ......... ...................................... ... . . ..... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ASSURANCE CONSTRUCTION INC LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 550 WILLOW STREET LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. W YARMOUTH MA 02673 AUTHORIZED REPRESENTATIVE ...................... ............. .......... ........... .. AC R ::25 S`3 93. ..:.:... .. :..':::> '::;'.::: :: .:..:.... 1.:. ). .... ::.:.::.:...:::..:.. :.:......: -< S f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . Map f 9 cZ O Parcel 497 �r ,,ij,=1 Application# D� %ay tj Health Division ' $ Conservation Division -- �_ � Permit# 62o u G 196 3 Tax Collector "ST� Date Issue (L11. o Treasurer Application Fee Planning Dept. A+ Permit Fee 41 y3,D Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address G(D TER 0 LN Village 04 I tRV AP fnt� -Owner MQ O fZS G k*_ i 0 iN Address Telephone SOG - c a 7 B SDI Permit Request GARA� At;&-n6to -m txiS-r cn no q;;i?�.A+,c w VA F1 q.T 12nag Q b r,_ d1NjFrr 1,1%�4 ?JJD F)Ova- G r&YS A-S s Square feet: 1st floor:existing �7!o proposed a40 2nd floor:existing S7 G proposed Total new a"I Zoning District b- 1 Flood Plain Ib• L Groundwater Overlay Project Valuation 24,o00 ,W Construction Type O q-T b/4r '!~ Co1j STRjjCTtOAV Lot Size !/.2 4, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure % 'YR 5 Historic House: ❑Yes 3 No On Old King's Highway: ❑Yes Zo Basement Type: ❑Full ❑Crawl ❑Walkout VOther SLk s Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Iletached garage: existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use r1 BUILDER INFORMATION Name �.C •Z &0Oters XAJ C. Telephone Number 508 -4A 8 . 5 B 3 Address (641 Rh;tg P • MAR SZ u CA M S License# 'C S 0 5c f 34 tw• 3o x Soq Oa 6A$ Home Improvement Contractor# So?a S 3 Worker's Compensation# 141 L o oo A A74 ALL CONSTRUCTION PEOR RESULTING F M THIS PROJECT WILL BE TAKEN TO 'Dg MD By 1�r1�p Ste e SIGNATURE DATE 1( J 7 �� (o A. FOR OFFICIAL USE ONLY' = �` i L PERMIT NO. p. DATE ISSUED MAP/PARCEL NO. } ADDRESS VILLAGE ' OWNER t mDATE OF INSPECTION: ' t FOUNDATION I 1 66 FRAME 2,47 INSULATION h16 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT 5 ASSOCIATION PLAN NO. { S , Pl\ The Commonwealth ofMassachusetts Department of Industrial Accidents l Office of Investigations �t In j a 600 Washington Street Boston, MA 02111 Mc s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): i o•.C. . Dci,1 t�e C. Address: Cy41 'Rt/e!1 R� . 1� . —eo x SO City/State/Zip: N.Q51 1011/5 IVA 0P61 O Phone#: Are y an employer?Check the appropriate box: Type of project(required): 2 1. I am a employer with 4 _ 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors ❑ 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me 'many capacity. workers' comp;insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 'required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work. right of exemption per MGL 11.0 Plumbing repairs 6r additions . myself. [No workers' comp. c. 152, §l(4), and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' ' equired.] comp.insurance r 13.❑ Other *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of'the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: S o?$ V Job Site Address: sue& T« r City/State/Zip:(,_WTCRU� (,_ AV 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 im risonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day aga' e violator. Be dvised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance cover e verification. I do'hereby cer fy under the pat nd penalties ofperjury that the information provided above is true and correct. Si ature: Phone#: Me - 4a8 -96 39 C!e[.L Sbg - 77b-4499 �vC /yJ.f4&L4 Official use only. Do not write in this area,,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual;partnership, association or other legal entity,employing employees.-However the owner of a dwelling house having not more than three apartments and whd 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" r MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or, . renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s).of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance, If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to,obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: T. Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TeL #617-727-4900 ext 406 or 1-8.77-MASWE Fax 617-727-7749 Revised 5-26-05 www,mass.govfdia / E t v rr ll. VA ""I JLLO L"LYA1, Regulatory Services 3ARNSTAMM Thomas T.Geiler,Director 9 'MASS. s639• .•� Building Division pTFD MAGI� g Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Face: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142Arequires that the"reconstruction,alterations,renovatiori,repair,inodernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adjacent to \ such residence or building be done by registered contractors,wife certain exceptions,alon€w ith other requirements. Type of Work: 1�1�QAG,Q 1�J► '� �cS�cJ Estimated Cost OU , Address of Work: GG (eeeo VI Owner's Name: i!`1 Q . dl l l� l 2 Date of Application: 1 If Z 7 / O I hereby certify that Registration is not required for-the following reason(s): []Work excluded by law ❑Job Under$1,000 Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNS ER PE TIES OF PBRRMY I hereby apply for a permit as the a t of the own 11 7 D 6 Date - Contractor Signature Registration No. OR Date Owner's Signature QvpMes.for=:homeaffidav Rev: 060606 -i YI Tay Town of Barnstable Regulatory Services Thomas P. Geiler,Director ap 1639• Building Division Tom Perry, Building Commissioner. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property owner Must ' Complete and Sign T11L his Section If Using A elder i, gelk !OhI4 , as Owner of the subject pro ert7 p . hereby authorize_ (�� �(iLGOG?�YS y� to act on rzy behalf, in all matters relative to work authorized by this building pernait application. for: (Address of Job) ^� Asa of Owner Date Print Name p:F0RMS:0 aPEFJYiz S10N OAR t} B'( LDfNG RE LAT-JiV.dS license-, LT CJNSTRJCTtON SUP,Ef2 _rSOR _ =5` Number s' 057934 _ x `~ Expares uta�492007.. Tr.no: r4346 Restrrcted aC3 - a PAUL J PO!OX.509 MA STONS MIL,S MA 02648:' -Gtxmmission8r � - ,l�Lr• i.�,?irn cll fX�[.� Board of BuNin; gu�ationsand Standards HOME IMPROVEMENT CONTRACTOR Reg^strabo prratiott 8/11J200$ Tyke r Private_Corpo n GCI BUILDERS. _ - PAUL MAZZOLA 644 RIVER ROAD � C7 a MARSTONS MILLS,MA 0�648 Deputy Administrator A�L-L-OLA C Nutter Patrick M. Butler Direct Line: 508-790-5407 Fax: 508-771-8079 E-mail: pbutier@nutter.com. MEMORANDUM March 26, 2007 #107763-1 R TO: Tom Perry FROM: Patrick M. Butler - RE: 66 Tern bane, Centerville Tom, In accordance with our prior discussions, I have prepared and have had executed the attached deed restriction. As you will recall, the purpose for the deed restriction is to provide that the detached garage will serve as an accessory structure and that it will not be used, in any fashion, for residential use. Would you kindly acknowledge your receipt of this copy of the deed restriction and confirm that I may proceed to record same with the Barnstable County Registry of Deeds. It is my understanding that based upon the recording of this deed restriction the garage may be completed in accordance with plans attached herewith (G,C.I. Builders dated 11/7/06). ` Thank you for your assistance on this matter PMB:cam Enclosure Receipt acknowledg a d agreed: Thomas Perry, Building C issioner 1616861.1 1 ` NUTTER McCLENNEN &. FISH LLP ATTORNEYS AT LAW 1513 Iyannough Road P.O. Box 1630 H Hyannis, Massachusetts 02601-1630 508-790-5400•c Fax: 508-771-8079 www.nutter.com NnI Nutter Patrick M. Butler Direct Line: 508-790-5407 Fax: 508-771-8079 E-mail: pbutler@nutter.com MEMORANDUM April 2, 2007 #107763-1 TO: Tom Perry FROM: Patrick M. Butler RE: 66 Tern Lane, Centerville Attached please find revised memorandum dated March 26, 2007 in which I have changed the last line in conformance with your suggestions. Could you kindly countersign and return the enclosed by telecopy. Thank you in advance. PMB:cam Enclosure 1618405.1 NUTTER McCLENNEN & FISH LLP •ATTORNEYS AT LAW 1513 Iyannough Road • P.O. Box 1630 • Hyannis, Massachusetts 02601-1630 • 508-790-5400 • Fax: 508-771-8079 www.nutter.com MassachusettsDepartment of Environmental Protection ,___ � tsureau of Resource Protection - Waterways Regulation Program W040212Transmittal No. Chapter 91 Waterways License Application -310 CMR 9.00 t Simplified,Water-Dependent,Nonwater-Dependent,Amendment B. Applicant Information Proposed Project/Use Information 1. Applicant: CSC Group Nominee Trust Name E-mail Address 550 Willow Street.. Mailing Address Note:Please refer WesfYarmoutH MA 02673 to the"Instructions' Citylrown State Zip Code v 50847127410 508-771-8923 Telephone Number Fax Number 2. Authorized Agent(if any): Sullivan Engineering Inc./Peter Sullivan', P. E. pstillpe@aol.com Name E-mail Address P O Box 659/7 Parker Road Mailing Address Osterville MA 02655 City/Town State Zip Code 508-428-3344 508-428-3115 Telephone Number Fax Number C. Proposed Project/Use Information 1. Property Information (all information must be provided): .same Owner Name(if different from applicant) Map 192 Parcel 027 N 41 40'25" W 70 20' 59" Tax Assessor's Map and Parcel Numbers Latitude. 66 Tem Lane, Centerville MA 02632 Street Address and City/Town State Zip Code 2. Registered Land 0 Yes ® No 3. Name of the water body where the project site is located: Weguaguet Lake ' 4. Description of the water body'in which the project site is located (check all that apply): Type Nature Designation Nontidal river/stream ® Natural El Area of Critical.Environmental Concern Flowed tidelands ❑ Enlarged/dammed ❑ Designated Port Area ❑.Filled tidelands Uncertain E1 Ocean Sanctuary ® Great Pond ❑ Uncertain ❑ Uncertain CH91App.doc-Rev. 10/02 Page 2 of 17. t-- `Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program W040212 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent,Nonwater-Dependent,Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type Table 5. Proposed Use/Activity,description on pg.2 of the Recreational boating and docking. "Instructions" 9 9• ' 6. Is the project a pre-1984 existing structure AND less than 600 square feet? ❑ Yes., ®'No _ 7. Is the project a post-1984 existing or new structure, less than 300 square feet AND water dependent? E Yes >: ❑ No 8. What is the estimated total cost of proposed work(including materials&labor)?• $10,000.00 9. List the name&complete mailing address of each abutter(attach additional sheets,if necessary).An abutter is defined as the owner of land that shares a common boundary with the project site, as well as the owner of land that lies within 50',across a waterbody from the project. Priscilla N Sherman, Tr. 82 Tern lane, Centerville, MA 02632 Name Carol N Hirsh 30 Branch Ave., Rochester, NY 14618: Name Address Dana W&Claire M 73 Tern Lane, Centerville, MA 02632 Wingren. -3-apnes r,,spvll,,lr. 9-".4C /K,��� T. br,. €za .�lxr�,['s F• v md-rcrcir� 6'/ TCrh ,�CLrLe �er�/Erv�Y/e m!� Cb�G D. Project Plans 1. 1 have attached plans for my project in accordance with the instructions contained in (check one): ® Appendix A(License plan) ❑ Appendix B(Simplified License plan) ❑ Appendix C(Permit plan) 2. Other State and Local Approvals/Certifications ❑ 401 Water Quality Certificate Date of Issuance ®Wetlands SE3-4125 File Number ❑ Jurisdictional Determination JD ' File Number ❑ MEPA File Number ❑ EOEA Secretary Certificate Date ❑ 21 E Waste Site Cleanup RTN Number CH91App.doc•Rev. 10/02 Page 3 of 17 Massachusetts Department of Environmental Protection -Bureau of Resource Protection Waterways Regulation Program ' W040212 G, Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent,Nonwater-Dependent,Amendment F. Waterways Dredging Addendum 1. Provide a description of the dredging project . ❑ Maintenance Dredging (include last dredge date&`permit no.) ❑ Improvement Dredging Purpose of Dredging 2. What is the volume(cubic yards)of material to be dredged? 3. What method will be used to dredge? ❑ Hydraulic ❑ ,Mechanical ❑ Other' F 4. Describe disposal method and provide disposal location (include separate disposal site location map) 5. Provide copy of grain size analysis. If grain size is compatible for beach nourishment purposes, the Department recommends that the dredged material be used as beach nourishment for public beaches. Note: In the event beach nourishment is proposed for private property, pursuant to 310 CMR 9.40(4)(a)1, public access easements below the existing high water mark shall be secured by applicant and submitted to the Department. CH91App.doc•Rev. 10/02 Page 5 of 17 Massachusetts Department of Environmental Protection - - Bureau of Resource Protection - Waterways Regulation Program T W040212No. Chapter 91 Waterways License Application -310 CMR 9.00 nsmittal Simplified,Water-Dependent,Nonwater-Dependent,Amendment E. Certification All applicants, property owners and authorized agents must sign this page. All future application correspondence may be signed by the authorized agent alone: "I hereby make application for a permit or license to authorize the activities I have described herein. Upon my signature, I agree to allow the duly authorized representatives of the Massachusetts Department of Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the F, premises of the project site at reasonable times for the purpose`of inspection." "I hereby certify that the information submitted in this application is true and accurate to the best of my kno�wlei�d.� e L��_\L �_� -, t ,�i (, �� � r ter. Applicant's signature Date Pro ie y Owner's signature(if different than applicant),' Date Agent's signature(if applicable) Date APPLICANTS FILING A SIMPLIFIED APPLICATION STOP HERE C: s CH91App.doc•Rev.10/02 Page 4 of 17 oFI►�� Town of Barnstable Regulatory Services • Y 9B"W 'E'MASS. �` Thomas F.Geiler,Director Fo;. 1% Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4024 Fax: 508-790-6230 March 12, 2008 Mr. Glenn Tobin 66 Tern Lane Centerville MA 02632 RE: Illegal Apartment: 66 Tern Lane Centerville MA 02632 Map: 192 Parcel: 027 Dear Property Owner, This letter is to inform you that you currently are in violation of Barnstable Zoning Ordinance 240-11. You must contact this office by March 31, 2008 to arrange to bring the above address into compliance or be subject to fines of no more than $300.00 per day of non-compliance. Thank you for your attention in this matter This property must be restored to a single family home.. By Order, coda Edson Amnesty Zoning Enforcement Officer Building Department Q:zoning$ O to VAL vt.6 t . .... .... . x. �S O'NV '.244t—w:(4� `ef 4,4 > I { I — r I. LL xnt;�otu5 aas2wr i� — --- 11 J`- .. ..F%(G•,41 h�"1'.. EL. .'JE,,'f'I.CtfJ - fLIfZT. L Lev 1DE asp , • II { r A 1 : ry : 1 r\ .1d 52W 11Gi��MU4'liA lJ�2) _— LE 08-428-6191 - evl i n a J A-: @Ustom C%%V . designs --------- --_-- copyright,m 2002 All Rights_ - - , L:E�"C' I Reserved h e t , p ,t cal s A e 4 C Pi el iminar Tans and layouts b DC.D.are for [he use of Ineir customers onl y p y y Y Any other use is sinc[ly Prohib to 4 r NEw 2'.>:io acoGisr I; 44. 44 �. 15, : Fcci,ai,a . ;.:a... I m �'- � bb r•Jdq'•428'6191 _.-- I meviin h•SM @.usto.m w, o esigns . copyright 02002 All Rights 1 ed Sre r Resery 1 ir.YxiL I F. , H P a°n+K.wALw^ON t•a•x a: t rfI.K.K[YED F",G. - I. . TTT •' ) E A - .... . .. la n•s n ' ' st�z[fY Prohitl + t theuse-o Cb Y oth r e � � .. .. r r { - ,l j i. 1 r. F : - TIT - t sm 152, firJ!kur�-GN.ia�;ly [Al"I : ,08.428.6191 ecsx, .. } �i 'a eviln Iesegns pyright Cs 200Is Rightsserved 1111 T11 11': I l : Pieliminzry plans and layouts by Wz.D.are for the'use of their customers only....WA y orK6,r use is st rk fly Prdhi'bi to id l*� 1 k � n J ; S y i N N, I i � ry D f m � (R n� 1 y 43 g I° e;ao,m s a 0 o tr 7-7 o y 4.'6 _.}. I'a !(A 0, 7 . 4. —77 ri tj N p U -L -41 ° D o :A LP aIA o N � { NOTES: FOR PROPERTY LINE INFORMATION SEE BOOK 15402 PAGE 210 AT THE BARNSTABLE COUNTY REGISTRY OF DEEDS. o W£OUAOUET SOUNDINGS BASED ON WEQUAQUET LAKE CONTROLLED WATER DATUM 1• LAKE (CHAPTER 91 LICENSE NO.4294). `' LOCUS FOR PROPOSED PIER SEE SE3-4125. _ c� 2 0 Zcn \ LOCUS PLAN SCALE•1:25 000 HYAhNIS QUAD. N/F C•4R0 30 N.y/RS Z R�yE Eq4E Q GRAV ,,,NY v w EL DR/V $ N 61°57' � E PARKING 40 E 2808+ m ° o N ti: n n1 EXISTING DWELLING r 4 N 5102740°E C 45.0 4 °$ EXISTING 9, N GARAGE tA C. r w _ N � iT ; C �.,,�'� 00 >1 o N 51027'40° E 235t t ry N/FPR/SC/LLA N. SHERMAN,TR. m 82 TERNLANE CENMRV/L L E,MASS. OVERALL SITE PLAN SCALE: I 50' 0 50 I OO f t. 36'OVERALL ALUMINUM SEASONAL PIER 5' 311 FROM LAKE CONTROL DATUM RAMP ELEV. 35.0 . , ELEV. 33.5 GRADE I - — . SECTION A-A SCALE: 1/8 �=1�-0 � 0 4 8 16ft. SHEET I of 2 PLAN ACCOMPANYING PETITION OF THE CSC GROUP 66 TERN LANE CENTERVILLE , MASS. FOR CONSTRUCTING 81 MAINTAINING A SEASONAL PIER IN WEQU AQUET LAKE JUNE 18,2003 SULLIVAN ENGINEERING INC. OSTERVILLE, MASS. I i j EXISTING SHED rn BEACH � Q j PROPOSED —35 RAMP _Lo - - - - -34 DATUM ELEV. 33.5 j LA ! PROPOSED ALUMINUM p s SEASONAL PIER _ ►- 26.5 - - - -31 � � Q Orr LAKE - -30 PLAN VIEW -29 SCALE: 1 �= 20' 0 10 20 40 ft. ' r SHEET 2 of 2 THE CSC GROUP CENTERVILLE,MASS. SULLIVAN ENGINEERING INC. OSTERVILLE,MASS. JUKE 18,2003 i . ! m m o J o a o R J t , AL Ito 44 ($ { r'L ! 10F -�- ; 1 i • 1 I i 1 I r I i 1 a.- S 0 o. 0 x• 3 a 3 d 1 t 4j i Z { a+y { M o s - 1 r � L # L � i J a m z 0 z s 2_ yrrm Mint res:►sht� r . l '' � a r Qs < i tjl to ! 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Y rt ��U{+ i ti4 :,y�f�r�f� ly P� yi1`'F�C y�f 4��.+'��+.' �,� H. i y ➢, r �, elv _ � i 1 �.;.r t wF vr;£�# �� skofiT6' �is.y � i ;Y v r t'4 - ',J '1 1 "e -p"� •I .f ; !P L47,p?�r, r Y'.� .,;a,`f. „�. .-.n� }S k you � R1 .' 4 °.°?aa.. __ a3�. ,;;,f s l�z 'Y x,'»at��h,�ti � ti�I�ti�f +}i}t�f��«�. '•t° P's.`t�°d �,' ,lbw,. r,., ' i ? e .C: `i },Mjw 4•i � 5'.. YS l�'�Y :- .], 5 [Yzv ?` _ M' y,=-�•:. � F•.. t�� i f ( r� �^.�er z� fj�"aS.; �'��a���1�}?��}.f �. r .f, Y`�� Ftk _.:'f?�` 4 �1 1 - �� _ I.-L ul ia• ;I'! t � 1 a f O^ I� 1 '_" - - •- �1 -=tee. .,- •I.. _ I,��� � �S! - .. +Uf.� ' t.kt 7 �. i e i O o - ts • F , , N _'L4' C C _a eL N r . 3 n NEW ENGLAND REPROGRAPHSCS t SUPPLY CO. 1D5362 - 1 ®r" NK '71 r L ill 1�4 1 1 �r t < r j 'I < i 14 i r �• i ., � � � C ]ER fjG:.._. �r. � ' 1 '• � i l i l � ;I 1 i � 1 j � j i `. � � l . , . l l ._ .. . � � . . � .«w..v.�.,.�,..r...radu�rww..si�ar.....r�r.w�s'r•.n+.�..+ws...e.r _ �.,�1. _ F �� . ' � w i i �� ` p i `,` ��� _ __ n .. l 1 1 flVWe. �� .. } ' ` r � '� � ' i � i. ' .�. r _ -- - - - -- y 1 i ' � � S ' S _ __ 1 � a , _s n F _ a - _ k , v \ R J 1 n n y t , s �ci, 5.5' 0 CB WITH dh SET :�. 3.r CV -vim riq 4 FEaG ,o �'�• �Z COpsi 011 qe -P O T CB WITH dh SET C1 Ff� � yOG o LOT 43 �0 279 400f S. F. ,, A � p POF o ' �C 00 , , 0 � CB WITH dh SET , '" o �10• O�0 po ; SURVEY ROD & CAP SET '0. CB WITH dh SET r'04 •,�� SURVEY ROD & CAP SET , NO CB WITH dh SET � � � CB WITH dh SET roG� /AI C) / LOCATED R NF FLOOD TPLAIN THE PIER ZONE SB AND '�•9 I CERTIFY THAT THE BUILDINGS ARE LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON of FLOOD INSURANCE RATE MAP COMMUNITY J PANEL NO. 250001 015 C AND THAT FLOOD PLAIN ZONES B AND C ARE NOT SPECIAL FLOOD HAZARD AREAS. O NOTICE DATE R STERED PROFESSIONAL Unless and until such time as the original (red) stamp of the LAND SURVE';OR responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, including any municipal or other public officials, may rely upon the information contained herein; and (B) this plan remains the property of Holmes & McGrath, Inc. DATE DESCRIPTION Drawn hecked REVISIONS I CERTIFY THAT THE STRUCTURES ARE LOCATED ON THE LOT AS SHOWN. AS BUILT PLAN OF PIER PREPARED FOR DATE REGISTERED PROFESSIONAL WILLIAM KERN AND SURVEYOR LOT 43, #66 TERN LANE IN CENTERVILLE BARNSTABLE MA holmes and merath inc SCALE: 1 "=20' DATE: OCT. 6 2005 ' H �F-4 NOTES GRAPHIC SCALE t ,FP . 20 10 0 20 60 civil engineers and land surveyors J STAETTEf� 1. HOUSE NUMBER: 66 362 gifford street R08 08 548-3564(PHONE `' �' No.2923' ` 2. ASSESSOR'S NUMBER: 192 027 falmouth, ma. 02540 548-9672 FAX 3. ZONING DISTRICT: RF 1 ( IN FEET ) 4.FLOOD PLAIN ZONES: B, C 1 inch = zo rt~ DRAWN: RLR, SGL CHECKED: Z� I - V\VALERIO 98260WS TAP KERN ASBUILT JOB NO: 205248 DWG. NO.: 70-1 -17A EkET 1 OF 1 OVERLAY DISTRICT: ASSESSORS REF.: AP — Aquifer Protection District q Map 192, Parcels ?7 `' v a 4,� As Shown on Plan Entitled y �j ' "Revised Groundwater Protection Overlay Districts" - April, 1993 c+ • F` ZONE:ga- - • -'• •y. ' yV b rr . S E,. n \ to • , M ,• t, t Area (min.) 87,120 SF (RPOD) o \ Fron to e (min) 20 : r Width min) 125 �Li„ • •: 7 ° �l{'h� z`'`�j '�,,, Setbacks: rt Fron t 20 G� ,ti �*. • :Y,^ ,,, Side 10 �y L •. \ \ \ • '� Rear 10' \ • :'r't,.: • ,� �!•.,: 2 Y .p � to '\ L :.o FLOOD ZONE: i' ,' i >\ \ .X01. II II a _ Zone B & C (ses plan) N N Io \ II \ �% oLocat►on Map: l Hirsh i, �y Panel No. L, 1"=2,000±' #250001 0015 C ro Juiy 2, 1992 01 '57.40 a 61 ,,wA ------------------ AA 1 \ • \;, \ \ � I Grovel Drive __---------- 11� 2 Story �l \ I \ `�d \ �� 1 I \ ___- --- d I, 1 I \ \ \ \ ``\` � EWOO ld9Wdlkiou9 n- I t�Ra \\2� \ ` \ with ent \ 1 I I 01, \ \ \ \ t 1 \ � Area Basem \ I I %r, \ \ \ O �\ I P°rkin9 ; R \ I I �4'l1\ GrOve I �.� 1 1 \ ree Une Y. 1 1 G \ \ \ \ 1 I \ \ f \ ` V40use oQL E ii \ );, re° sb• OVCRAI_L- ALUMINUM .TW"0hX%_ o �.21 40 , 1 I 235 ,40 E PIER N 5 06 t N 517� 5-' a1: FROM LAKE coN-rRot_ PATUM ate v. 33.s sherrnon RAw�p CD I esX\6T1NG • . 1, N , PLAN VIEW GR�oa Sclle : 1 = 20' Area SECTION A—A o 82 Scale: I"= 10' >esv®wwnro�aera,e�r o o / Existing e�.y 12S CSc GrouP Nse , KryHym NOMINme TRuST d�� GG N L..ANE AS PeR 1. to/oa CONS¢iZVAT10%1 GEn�teYzvi L���A StNpF �H OF prq� RCv15►oN b�I1�03 CoMMI•1910N MtCT1NG G � a�t1AAfl ��coall � r�I .. , lfbprojetlr�Qrpe�JmdQdrKCae�far ❑ o v � o .00 at .tor /j c� 45 A9 #343f 2' Diroctlons to Site: From Barnstable Town Hail o�Kcb.e�..oacrrs� � � - take Route 28 towards Centerville; Take a right • 0 onto Old Stage Road and then a right onto Shoot Flying Hill Road; Take a right onto Tern Lane and the house is on the left#66 Title: PREPARED BY: PREPARED FOR: Notes/Revision: Sullivan Engineering Inca CapeSury 1.) The property line information shown was The CSC Grou compiled from available record information. PO Box 659 ,7, ,.Parker Road p rn PROPOSED SEASONAL PIER Osterville, MA 02655 Osterville MA 02655 550 Willow Street 2.) The topographic information was obtained 66 TERN LANE (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fax W Yarmouth MA 02673 from on on the ground survey performed on V CENTERV 1 L L E , MASS. or between 281OCT12002 and 11/MAR/03. 3.) The datum used is based on water elevation Draft: MJD Field: WHK MDH 20 0 10 20 40 80 4 4 ( Pan/ of Lake We ua uet see plan). Date: Scale- Review: PS Comp/Draft: WHK/RRL March 17 , 2003 As Shown Proj. # 23011 Drawing # C424_1G1 1 "Ni �,J U 0 t O r O ,�r,�� to /a �,�� � <y.4�s�•.,�-��N?— �,/ to X-44, U^� a ! � 00, 2 2 s �C co 0 Ile ' ah us G��t •oo BU I LD ! NIG LOCATION PLAID Fop I GG TERN LANE CENTERVILLE, MA PREPARED FOR 4 i GLENN 5111EILA TOBIN of A, SCULL: u/LTf: L)kAWN bY: OF 1 " = 2.0' 1 2-04-2000 TMW � WGW STrVFf� '. JOB NUMBtK: f;LVIJION: 9fTt1- NUMl3tf;: w. 'TEVE N ". OG-097 I cP�- I y ,� �a t RUM 35 WELLEK A50CIATE5 I G45 I ALIVOUTf1 RD., SUf?"F 4C -- P.O. �3UX 4 17 CENTERVILLE, MA 02632 ' 2 WINDY WAY, #232 NANTUCKET, MA 02554 LL.: (506) 775-0735 --- FAX: (506) 775-075/1 I. EMAIL: trlt.wellcrLcomco5t.net k ice:,OFESSIONAL ENGINEERS * LAND SURVEYORS a is .n�,.e..a..-�..��...,...� .T�v'dH:'�w.�e�em. t'a..c�::.*«t,st...-.:�2uc:..,..evv2�._Jxt!Y.a+�.—'mm�..—...:..xsY'a��sC189Lc+.:^Nr."—•fSY��"t!.'�:a�na��FMa#VYTst^•rtl[it^b:..1!'Il..._e :._.:y4.:wtt.:.a:s-....� s..-_.....w , mM•M......:�........_..+�....._ ...--.��..m�ay�l.,.w� . .,........ T..xYYYYeraea _.••e.:+sWCsfiv:_a:-...at _. .. N Ia 1LJ J °- Q 0 p -- \ \ m Q k p ,. Q \ Y� \ Y 5 i\ r4 ,LSO \. b � S � . t bc• 2 E'L 4 ,f if OD 5 U I L D ING OCAS O FOR GG TERN LANE CENTERVILLE, MA PREPARED FOR GLENN t- 5HEiLA T0511N, 5CALE: UAT(_: URAWN BY: — TrVf-.N 1 = 20' 1 2-04-20:�G TUfb't/ WGW' ! _` ! JOD NUMDER: REV15ION: �St1EE1 NUMf'; C?P- 1 { i 4 WELLED A550C1ATE5 I G45 FALMOUTH RD., SUITE 4C --- P.O. BOX 4 1 7 CENTERVILLE, MA 02G32 2- 5 2 WINDY WAY, #232 NANTUCKET, MA 02554 TEL.: (508) 775-0735 --- FAX: (508) 775-0754 E-MAIL: tri5wellerScomca5t.net PROFE5510NAL ENGINEER5 *- LAND 5UeVf-Y0K5 a wuj a J d 0 O w v� Z � CL 0-/ 0 Uj o a r Q \ I \ O Sim S c o � R A �p /awc>oo S e--.O I Op t EI IvC LOCATION I L FOR I� GG TERN LANE CENTERVILLE, MA i� PREPARED FOR LENN � 5HEILA TOBIN SCALE: DATE: UKAWN BY: �'Tr-Vf_-N I " = 20' 12-04-2000 TMW WGV\l ;t; "'' -1 JOD NUMDEK; KEV1510N: 5HL-E7 NUMBER: ;1 sv OG-037 CPP— f ..:.._�; WELLER ASSOCIATES I G45 FALMOUTH RD., 5UITE 4C P.O. BOX 4 17 CENTERVILLE MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 i TEL.: (508) 775-0735 --- FAX: (508) 775-0754 i EMAIL: tri5wellerecomca5t.net Y PROFESSIONAL ENGINEERS *- LAND 5URVEYOR5 Cl MANHOLE H-20 SCREEN ED VENT 1.00' MIN, 3.00 MAX AT GRADE LEVEL 2' MIN US 6 BENCHMARK: DRIP EDGE 0.17 2� SLOPE RD OF SHINGLES 9" MIN, 36" MAX 54.83 MIN _ 093 -, 2" PEASTONE FLYING HILL ELEV 57.02 56.83 MAX -� 5.00 40 MIL VINYL SHOOT 1.25 77 ° -- 53.83 BARRIER BETWEEN --� 54.50 CA ®®® ® "IC33C3 ELEVATIONS V-3 1.17 z.y`, : ®® ®® p 50.00 AND 54.00 53.50 ®® ®® ®o 3%4" TO 1-1 254.00 0.25 53.75 53.33 -- / AT LOCATION s: : ;,y ®® ® ®®o DOUBLE WASHED STONE 0.83 4.00 50 90 ON SITE PLAN. T RN LANE 52.9( � � 16.50' x 4 �b�" LAKE WEQUAQUET DISTRIBUTION BOX 4.00 -4-- 5.00 1500 GALLON SEPTIC TANK DB-3 OR DB5 H-20 2-500 GAL H-LO LEACH ING CHAMBERS1 ST-1500-H-20 PROVE EQUAL WATER TEST OFLOW BOTTOM OF TEST HOLE 45.90 �� GREAT MARSH 6" GRAVEL ON NATIVE SOIL OR 24.5' x 12.83' x LOCATION MAP MECHANICALLY COMPACTED BASE Q� 72± 9Q� / EL 34: CONTROL ELEVATION OF LAKE WEQUAQUET 2gOx� GENERAL NOTES KIT DR SHORE LINE 1) ALL WORKMANSHIP AND MATERIALS SHALL Pl MP AND FILL GIS TOPO CONFORM TO 310CMR15.00 THE STATE CE SSPOOL AND EDGE OF WATER ENVIRONMENTAL CODE TITLE V: MINIMUM 10.00 10' EASEMEN AN IY OVERFLOW FAM FOUND 05-10-02 REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF 20.00 FOR POWER LI E CC 'NNECTED TO EL 31.8 SANITARY SEWAGE, AVAILABLE FROM STATE HOUSE 3.00 EL RESTORE TURF. UNF. BASEMENT BOOKSTORE 1-617-727-2834, AND TOWN OF 10.00 40.5± BARNSTABLE RULES AND REGULATIONS FOR THE 60 i 7 / SUBSURFACE DISPOSAL OF SANITARY SEWAGE. PROPOSED WATER SERVICE Gy 2) CONTRACTOR SHALL VERIFY LOCATION OF / BA EXISTING UTILITIES. CONTACT DIG-SAFE AND LOCAL WATER DEPARTMENT 3 BUSINESS DAYS BEFORE 56 P,b�" BR BEGINNING CONSTRUCTION. EXISTING WATER SERVICE / o =� c gR LR 3) CONTRACTOR RESPONSIBLE FOR OBTAINING ADEQUATE HORIZONTAL AND VERTICAL CONTROL. PATIO 4) CONTRACTOR SHALL VERIFY ALL PLUMBING FLOWS TO PROPOSED SEPTIC TANK, AND SHALL LOCATE ALL OTHER EXISTING SANITARY FACILITIES ON PREMISES FLOOR PLA NTS) NO LONGER, USED AND PUMP, AND FILL OR REMOVE SAME IN ACCORDANCE LOCAL REQUIREMENTS. 5) AL COVERS OF SANITARY UNITSSHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. ALL Off% �ry .12 100' MASONRY UNITS TO BE MORTARED IN PLACE. ALL BUFFER PVC PIPE TO BE SOLVENT WELDED. 55#10 / I �NAL GRADES TSHAL/LSREMAINI EISSENTIIALLYG AND 2s1.56� � I ' v 5 x LEGEND: UNCHANGED. 4.00 / �Gj� 7) NO DETERMINATION HAS BEEN MADE AS TO EXISTING SPOT ELEVATION Ox00 COMPLIANCE WITH DEEDED OR ZONING RESTRICTIONS j D`��..� E 4.0 � XISTING CONTOUR -- 00� AND/OR REGULATIONS. OWNER/APPLICANT MUST j 20.00 FINAL SPOT ELEVATION MOO] OBTAIN SUCH DETERMINATION ' FROM APPROPRIATE LIMITS OF 64 12.83 FINAL CONTOUR ELEVATION 00 AUTHORITY. 5' REMOVAL SOIL TEST LOCATION AND ELEVATION OxOO OF UNSUITABLE � 8) EXCAVATE AND REMOVE UNSUITABLE MATERIAL MATERIAL UTLILITY POLE -0- BELOW THE LEACHING INVERT ELEVATION FOR 5' 26,962 DOWN TO LIMITS OF 40 UNDERGROUND GAS, WATER, ELECTRIC, AROUND LEACHING SYSTEM AND REPLACE WITH CLEAN 6,2 / / SF ± CLEAN SAND VIN L BAR R TELEPHONE, CABLE -G,W,E,T,C SAND. \ Q� (SE E ATION) CATCH BASIN ® 9) IF ANY DETAIL OF THIS PLAN IS NOT / UNDERSTOOD, CONTACT DESIGN ENGINEER AT 394-1960. \ % / BOTTOM OF KETTLE 10 48 HOUR NOTICE IS REQUIRED FOR ANY r� 58 5654 52 / ELEV. 42.1 ) 60 5 u`S` � ��z3/ INSPECTION OR CERTIFICATION REQUIRED. 11)��OO G� p0 S L TE ,1 MAPS2500ITE1Efl5--&e-e8--E DAS WITHIN TED D 0-7=03=86.D ZONE C AS SHOWN ON �P\P DATE OF SOIL TEST 06- 1?_0,) APPROVED BY BOARD OF HEALTH z;���, ��,� 09-19 Ss a--y WITNESSED BY D. STTRJ /y SOIL EVALUATOR B.J. YC LNG DATE: AGENT: PERCOLATION RATE G2 v11N./INCH. ASSESSORS MAP: 192 PARCEL: 27 OBSERVATI )N HOLE PLAN BK 88 PG 13 DESIGN CALCULATIONS ELEV.= 55.9 DEED BK 944 PG 65 ELEV. IDEPTH HORIZ SOIL TEXTURE COLOR MOTTLING OTHER NUMBER OF BEDROOMS 3 - - GARBAGE DISPOSAL UNIT NOT ALLOWED 54.23 0-20 FILL N DESIGN FLOW PROPOSED SITE PLAN OF LAND IN BARNSTABLE 3 BEDROOMS x '110 GAL/(BR-DA)=330 GPD. 53.81 20-25 A LOAMY SAND 10YR 4/ 0 MASSIVE VERY FRIABLE REQUIRED SEPTIC TANK CAPACITY '1500 GAL """` 66 TERN LANE, CENTERVILLE 52.57 25-40 Bw LOAMY SAND 10YR 5/6 N MASSIVE VERY FRIABLE �ZN�F41� ACTUAL SEPTIC TANK CAPACITY 1500 GAL � F s� LEACHING AREA REQUIREMENTS EERNARD �`>. AS PREPARED FOR: 45.90 40-12C C MED. SAND 10YR 6 E SINGLE ( o c SCALE DATE: JULY 1, 2002 RAIN. LOOSE �c"NvouNc DAVID NAILOR EST. MADELINE 1 -20 --BOTTOM 0.74 GAL/(SF-DA) TRACE C � No.3oU78 -+ - REV.: JARSE GRAVEL o BROADBENT --SIDE 0.74 GAL/(SF-DA) & COBBI AF'c"" co LEACHING CAPACITY S 9��! � BERNARD J. YOUNG, P.E. ((24.5'x'l 2.83') + 2x(24.5'+12.83')x2') F's A, `d BOX 1539, DENNISPORT, MASS 02639 (508) 394-1960 x0.74 GAL/(SF-DAl'}- 343 GPD PERCOLATION TEST DONE AT A DEPTH OF 56 -68 - ✓ NO WATER ENCOUNTERED FILE NO. PROBABLE HIGH GROUND WATER EL.= 34.0 �I 0000-00 SHEET 1 OF 1