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I,,�v,�i,,,,,�X , - ," ,,;,,j,�-T,,�;lIi­?;��:i. - , , ,,, ;�,:, � IST �!iV !!!! il:'l ,, 11 ;1t, f"j, MMM, .if " - '', xwlxv� .1 j.i I ­,''e" W �,',',,I�,,I� I � ,vl�i4l:P..I I ,F,I"� 55, ;;, ;, r j,, ,4i 9 4': :" ,,-',,, ,�...I� " , , 'II l,tiUlf­I Al�;, . 11.1i iiii %, ,1"iiiiii , � , a 11 1 112""k f A Q�j , 91 -P n.,,, - `�` �` Pnnted On 7t1512019 Complain Call Relpo,rt MAE& 31 LOUISS?REST FIkYi4NNIS � r "» �n , � Case# C 19-572, fD MA .� Case#: C-19-572 Address: 51 LOUIS STREET, HYANNIS Date: 7/15/2019 Owner Info: Property Info: LIMARINO, ANDRE MBL: 48 WARWICK WAY 309-202 CENTERVILLE MA 02632 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Zoning Medium Priority Phone Complaint Summary: Woman cooking commercially in her home (rice & beans)and selling thru Whatsapp and on facebook. Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: mckechnr Filed by: andersor Comments: Comment Date Commenter Comment 7/15/2019 andersor Referred from Health Dept. Will make Officer Gallant aware as well. Date 7I1�512019 : t Town of,Barnstable Citizen Web Request Page 1 of 1 C- lq-57� °� yd Citizen Request Management Request ID: 70117 Created: 7/11/2019 12:22:07 PM g Status: Closed Assigned To: McKenzie, Marybeth Health Office 4 Article X- Food : Illegal Anonymous: Yes Category: g Operations E.C. Date: 7/25/2019 Created By: Soto, Kathryn Citations: Health.Office 9 02 Time Worked: 0.75 Response Time: 1.00 i Request Location: 51 LOUIS STREET Hyannis, Ma 02601 Parcel Number: Map: 309 Block: 202 Lot: 00l) Request: Caller reports tenant in unit B/right side is making rice, beans, etc in kitchen and selling to the public through whatsapp messenger Request Work History: Entered on 7/11/2019 3:34:53 PM The health department can not investigate a complaint like this due to so little information.To use the app you need a name and it is not an advertisement type of app. https:Hitsgldb.town.bamstable.ma.us/CitizeriRequest/WRequestPrintPub.aspx?ID=70117 7/15/2019 J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel `� o A lication 15 I11UZ Pp Health Division Date Issued G us Conservation Division Application Fe G Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project:Str_eet:Add ess `1 Village G �2v C.li Owner ( 0 6 Lk Address Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Pr eojecct Valuatiorr--' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach': portingtdocur.r. ntation. Dwelling Type: Single Family, ❑ Two Family ❑ Multi-Family (# units) _ Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Highway,`:= ❑KaL ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other --a Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. ) 0 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 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) O=Telephone Number 13 e) �1 Address t�" r'Lk� A' CA-0- stir t--- �L-icensez# CC" w`v r Home Improvement Contractor,# Email Worker's-Compensation# ALL CONSTRUCTION DE IS R ULTING FROM THIS PROJECT WILL BETAKEN TO --DATE 'O �� r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ` MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME qlls- INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING � d> DATE CLOSED OUT ASSOCIATION PLAN NO. The Camwmvealth of-fassachusetis Department aflndusfrialAcc!Am& Office of Investigations ` 600 Washbigfon Street Boston;MA 02111 www.mass gov1&a Workers' Compensation fmsurance Affidavit:-BOders/Contractors/Elecfricians/Plmnbers Applicant Information Please Print Legibly Name(BusinCSs/organiz2.tlmrrnrimduan: _ Address:_ 491 'c,oA--u�lCL& «J✓ � City/State/Zip: cc---k-p,✓�Lte tM W%bne#:' 7Z E Are you an employer?Check the appropriate box: Type of ro ect re _ eral contractor and I 3'P P ] ( qB a e�: -l.❑ I am a employer with 4 ❑I am a i� . employees(fall and/or part-time)_* have hired the sub-coniractars ❑6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling. ship and have no employees These salrcomiractors have 8. ❑Demolition working for me io,any capacity employees and have workers' com insurance-1 9- ❑Building addition [No workers'comp.incrtrance p• ' regniruil 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.X�fys(-,lf am a homeowner doing all work officers have exercised their I L[I Plumbing repairs or additions [No workers'comp. right of exemption per MGL 12 gDof r insurance required-]t c.152, §I(4),and we have no ❑ ��s employees_[No workers' I3.[]Other comp.msuranceregnuell *Any applicantthat chocks box Wl mast also fill oaf the scction bclow shouting thcirworkcrs'compcnsation policy fi fnrmaiion_ t Homcowncrs who submit this affidavit indicating they arc doing all wD&and thin hire outsidc contactms nnist submit anew affidavit indicafing such. #Cunt-dd=tint chock this box must altach`cd an additional shot showing the na*nc of the sub-contactors and statc whcthcr or not those czdfies have cmploy=s• Zf the sub-contactors havc cmployccs,they mast providc thcir wmkcrs'comer.policy ma]bcr. I arrz an employer that is pravid&g workers'compensation insurance for my employees. Below is fhe poUcy and job site in"formation, Insurance Company Name: Policy#or Self-ins.Lic.# Exp>ration.Date: Job Site Address: City/Sta&zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage render Section25A of MGL c.152 can leadto the imposition of crnniaal penalties of a fine up to$1,5W.00 and/or e ear imprisonment,as well as civil penalties in the fowl of a STOP WORK ORDER and a fine of rip to$250.00 a violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the for ce coverage'verification_ I do hereby certify andpena&Les ofpm jury that the informaion provided above is and correct Sr Date: Phone# \ ��p Official use only. Do not write in this areg to be completed by city or town ouzciaL City or Town: PermiilLiceuse# Len m.g Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Mst uefions Massachusetts Geaaral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Purl m 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 vnPfqJ'er u�is defined as individual,partnership,association,corporation or other Legal entity,or any two or more en gaged in.a joint ente e and including the le re esentatives of a deceased employer,or the of the foregoing ) , udmg Pr g � ngag � receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho 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 ofpublic work until acceptable evidence of compliance with the in uranCC-- requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checlang the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers)along with their certificates)of. - immn ance. 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 in trance. 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 ici ce 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 Iaw or if you are required to obtain a workers' compensation policy,please call the Department at the number lisiad below. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town OfaiciaLs 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 permitilicense number which wr11 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"t-e 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 burn 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. Thu Com mnwealtb,of Massachusetts Department of I idustdak Aor-ideut% Office of kvestuntio.As 6GO Wasb-iVm S =t Boston,MA 02111 Td.9 617-727-4900 cxt 406 Qr 1--977-MASSAFE Fax#617-727-7749 Revised 4-24-07 W ,mass_gov/dia Town of Barnstable Regulatory Services 0kTHE roiyy Richard V_ScaIi,Director ° Building Division ! E E 4 �LE. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 D www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: OS JOB LOCATION: n ber street village "HOMEOWNER: Its N OU �i rA W� scla}3°151�4 name home phone# work phone it CURRENT MA L NG ADDRFSS: fj gQ�l cityhown 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,oa 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`lio eowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws44ements ations. w The uneowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced and that he/she will comply with said procedures and requirements. Signature o Ho co r Approval of Building cial 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,RuIes &ReguIations for Licensing Construction Supervisors,Section 2JS) 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/certificatioa for use in your community. Q:\WPFU_ES\FORMS\building permit fbnns\EXPRESS.doc Revised 061313 THE T � Town of Barnstable 0"1 Regulatory Services �RA"RNST"I'E'$`/ Richard V.Scali,Director �A i639. ♦� _. . .-_.. T 6yq.c& Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property 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 a thorized bythis building p t application for. (Addre of Job) "Pool fences and alarms are the r p ibilityof the applicant. Pools are not to be filled or utilized efore fe e is installed and all final inspections are performed d accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FOF.MS:O WNERPERMISSIONPOOLS 1 \ i e {tft r SS4 Y r E ZZx= (n f t l ? i . u `xl��t;• 6 I t ' 4 _ 4 a i y f , • k • a { 8 E ���� 4 5 �. k..._ ..,........._ '...�_... ..�� �..�G ``J ( `�`,� V" i1! ;, _} i Y r i �`�t �, �� ' — �, � �} � � � � CXi�1 � L���2� ��. ���� 611t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-, Parcel lication #q Pp .Health Division Date Issued ?. fL Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address `i ' a C Z- v.j Village C"Ate Owner o � b ryn-fliil o Address S `^F Telephone 5-O -3qt) I-GLi Permit Request toF�`czE; Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type o o ®_ .Lot Size Grandfathered: ❑Yes ❑ No If yes, attach si�orting d�um ration. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) - Age of Existing Structure Historic House: ❑Yes Z No On Old King's Highway: 0 Ye8"2 No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement.Finished Area(sq.ft.) "� ate® Basement Unfinished Area (sq.ft) it zc rn Number of Baths: Full: existing 2- new 3 Half: existing o new o Number of Bedrooms: existing S new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Od Gas ❑ Oil ❑ Electric ❑ Other Central Air:~ 2'S'es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes -3/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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name b 2c= i rvvn "^� - _ y Telephone Number C, Address . G� W A-Q—L X C%L VJ A`/ License # 17IC)I-67 06,A c--1-2, LJ iUvcHome Improvement Contractor# Email Worker's Compensation # , s ALL CONSTRUCTION DEBRIS ESULTING FROM THIS PROJECT WILL BE TAKEN TO /V SIGNATURE t c. DATE FOR OFFICIAL USE ONLY s APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t* DATE OF INSPECTION: FOUNDATION j FRAME �� y ►� INSULATION i FIREPLACE C ELECTRICAL: ROUGH FINAL 't PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING S 0 ��i I� ,. DATE CLOSED,OUT ASSOCIATION PLAN NO. Town of.Barnstable oFtME r�,,, Regulatory Services, c Richard V. Scali, Director &MWgrABLE. ; Building Division BARNSTABLE BF.cN$'aBLE•.TMFPM1IE•NTIfI•HYAYti15 MAS& 4:F�S'5 M1_S.u51EfM19L'£.' 4"T S a?Si BaY o a0tf 9cb 1639, ,0� Thomas Perry, CBO 634_20 ATFD1A0�A Building CommissionerD� 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 May 5, 2014 Andre Limarino 48 Warwick Way Centerville, MA. 02632 RE: 48 Warwick Way, Centerville, Map: 148 Parcel: 070 Dear Mr. Limarino, This letter is in response to application number 201401191 submitted to finish the basement at the above referenced property. Unfortunately, the application is not approved because the property is the subject of open permit application number 201301136. The open building permit must successfully complete all required inspections before another building permit is issued. Please do not hesitate to contact this office with any questions. Respectfully, J ` J r �n ocal.Inspector Jeffrey.lauzon(atown.barnstable.ma.us (508) 862-4034 The Ctm lrmr pm dA ofHassachram"& AL' t ofInr mftidAcciderdr e-Of hmleSi�'�tl.Orr5 Boston,MA 02 wnnv.i�aaax.gmlrlrrz • _ ' Warke& Ca'mpennsafiunInsurance davit Bmffders/CnntractorsMedncmnMambers t Information Please hint Leeihlv Name(Basineasloigmiz�rvidn : C. L��✓�r��1� �-t� dress 2� u,)(Y2- UL- G V- CN nM GityfStatrJZip: Z 2 CC-^ tsLv ram- Phone� Are you an employer?Check the appropriate bos: Type of o ect r 4. I am a contractor and I 3'Pe �' 3 �mod}= ❑ I am a employer witTi i% ❑New canabruclim emvloyees(full an&orpmt-ime�* havehxiredthe sub-eontracibm 2❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑RtAdelzrng ship and have no employees Theze sob-contractors have S- ❑Demolitioa woz6ng forme in airy capacity employees and have wogs' 9_ El Buihdsng addition [90 wmkers'conlp. ar iuMna=e comp_incamy If 5. ❑ We are a corpotatioaand its 10-0 Electrical repairs or additions 3 I am-a homeowner doing all wor- officers have emardsed fheir 11-Q Plumbing repairs or additions (( �_ myself[No workers'cDnT_ riggld ofes=pfion per MGL 12.❑Roof repairs instaanee; d]F c_152. §l(4),andweFtMT na employees-[No WOA=' -❑Other comp-insurance reIquired.1 *Amy sppficmat itched sboxK=stalso ffi out the sectionbetowshmia5 0uawodcen' infi=xdtm- T T Homeowners vrho subntrt this af&vh in they am daing wnuade sad.&m b$e outride coat La rs om soils_ rCant ctaa that check this boot most stta<hed au additiansl sheet auncmg thanme of Hte md stst a uhather ornmtthase Save tmpIcr3—. Ifthe sohto ct—have employees,they must Fide their markers'comp-policy a»b- 1 am art employer that is prr»�Wag it�orkers'comperisr&n insurance for my eagAayear. Be£otr is file pa£icy aed job sits Inv fOfYfttntiC<rL - Insarmce CompanyName: Policy 9 cr.Self strfi_L1c-& FXpimflonDate: Job Site A dd=t r City staW2l p: Attach a wpy of the workers'compensation_policf declaration page(show.fiig the policy number and ezpaation date). Failure to Sectifln 25A o€MGL c 152 can lead to the imposition ofciiminal pies of a fine up to S I-500.00 and, ML y4i*ris tt,as well as civil penalties in the form of a STOP WORK ORDER,and a fine of up to$250.00 a day a �the viola r_ Be advised that a copy of this staatement maybe fibrwarded to the Office of Iuve*gations of the DIA florin tri ,r ovr;zrage 4 c�kion I do ftereby cerh;fp cinder " s dpenatties ofpetjrwy thatihafo irrmabFnprati�dedaham is Jwd-correct tore: Date: �Z Qjkioz use oven. M\uAl trrihs in this area,for be campieted by do or town ofJiciaL. City or Town: PermitUcense# Fcsmng Am-thority(circle one}: L Board of Health. 2.BuHding Department I Ci.crown Clerk 4.Electrical lnspector 5.Plumbing Iuspector 6.Other Contact Person. Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers compensation for their employees. Pursuamttn this statute,an employee is defined as"._-every person m the service of another under any contract ofhire, 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 budding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states thst"every state or Iocal 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-contractors)name(s),address(es)and phone number(s)along with their cerificatc{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 au 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 ingurana6 t;overage.- 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. SeIf-insured companies should enter their self-insurance license number on true appropriate lime. City or Town Offiici ils 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 pmmitllicense applications in any given year,need only submif one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or gown)."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 fur future permits or licenses. A new affidavit must be,rifled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial ventage (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of l avestigations would lice 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;telephohe and fax number. The ComMMWedffi of Massachusetts Department of Indtstdal Accidents Office of kV1EeStjg2ttFans 6QG'�asbz>,.gtan Stt�el: Bas w4 MA G21 I 1 Tel#617'27-49W W 4€16 or 1.4 CA,'. E Revised 4-24-07 Fax#617-727-7749 _ w . gov/dia f , Town of Barnstable - Regulatory Services - of To�� Richard V.ScA Interim Director °-� Building.Division - f R�R*rcrAR_T,�F i - Tom Perry,Building Commissioner - •- 9 3 ���� ' 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6290 HOMEOWNER LICENSE EXEMPTION . - Please Print DATE: 9_ JOB.IACAnQk �i W'/n' J 1 r� V-� ��'� n er 0 f street I Yfflage . 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 strictures. 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=onsi-ble 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,rul andreguT ions. The undersigns "hoic caner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures d r ents and that he/she will comply with said procedures and requirements. Signat ne of Homed Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do.such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities"of a supervisor - (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,.particularly when the homeowner hires unlicensed persons. In this case;our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. r EVE Town of Barnstable o� Regulatory Services • R�ANRPARi.A- • Mnss �, Richard V.Scab,Interim Director 16.1 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner.Must Complete.and Sign This Section If Using A Builder as Ownet of the subject ptoperty heteby authorize to act on my behal. in all mattets telative to work authorized by this building permit (Addtess of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections e' erformed and accepted. S' tote o Signatute of Applicant Print Name Print Name Date '20 . '7G -f ............ Vj i 11 ltt�t..t l f 1 1 CM i, I r " -01 " f DATE II_D 1 ,LI BUIN(.,DEPl. 1 ` x SFIED DECK y hPJE C T' 3.SEASON ROOM / / LANDSCAPED / m Ln 101 �Z�o S. 4° IAl MA 0 32 IGVENYV9 A0 U01 FT. C�P1t�Pali ��9 I 16,228 •SCE t — I 0.3.7 ACRES 10 14 A SE'►ED ( DECK ,V; / 3 SEASON _ ROOM / LANDSCAPED / a . N vrn cr G . Andre Lima in® " LOT 41 48 WarwiC a 16 228 SQ.. .FT. Centerville, IN ACRES 0.37 AC -' �, Cy- --_----= 1 t 1 r r1,,..._ - ------. _.•_---'--sue-.- �-----._--- ........... r I /, ` JI S z -.S-c p-,y &-d , - 4 .. .... ._.... I\)�G.) In �a: �✓ 1>� s90 �' II J 1 -, OF&f4lv _...........,..__.............. ..._.. j_._.......... .. MICHELE fl. g CUDILO f o STRUCTURAL y I' No 34774• <, -9 1 • -)�) '••�t...1 (\(�.��;)i r'.��� „�J/�:^..) _._ C..c.L,l�y:':e_.t1i l.�l.i: °`, �� 9v�FFcesYEP�c\��� I;'; _ � _ �N oaacrj (A o CCC7 0 i0 wA�gm r cr`,9 v C7, p m � • F pp 7-77 Wj •�� `' ,i �e iif � �r 1. r ' qik- f l ►' i S. T 1 y ----- -- - At > } i ou TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel (naApplication # Health Division Date Issued i Conservation Divisionly Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 31J�3 Historic - OKH _ Preservation/Hyannis Project Street Address Village` LLE Q Owner ID Addresses Telephone Permit Request w -bp�rt�s " "S �- e.�. ��� �!2Lo Clow+ can . Square feet: 1 st floor: existing �wproposed 312 2nd floor: existing =W= proposed Total new 312 Zoning District Flood Plain-- Groundwater Overlay Project Valuation Construction Type 141' Lot Size I& US Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family N( Two Family ❑ Multi-Family (# units) Age of Existing Structure I 03b9 Historic House: ❑Yes NrNo On Old King's Highway: ❑Yes Flo Basement Type: YFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 'L, new Half: existing new -i Number of Bedrooms: 3 existing O new Total Room Count (not including bathe): existing new O First Floor Room Count Heat Type and Fuel: b(Gas . '❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing , New 'O Existing wood/coal stove: ❑Yes YNo v Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: L e isting ❑new size_ Attached garage: 6fexisting ❑ new size _Shed: (existing Ll new size _ Other-,,,, . .: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# t Current Use Proposed Use .f` APPLICANT INFORMATION - -- --  .---(BUILDER-OR HOMEOWNER).- Name Telephone Number `Address 49, WAtyi '.0 Z W&� j License # Home Improvement Contractor# Worker's Compensation # A^A,, _- ALL CONSTRUCTION DEBRIS RESUL I FROM THIS PROJECT WILL BETAKEN TO 1•''I 40XI> WIAM v%3 M SIGNATURE DATE OL �3 F � c FOR OFFICIAL USE ONLY APPLICATION# r DATEISSUED MAP/PARCELNO. t 6 ADDRESS VILLAGE k OWNER � a . t 4 ' I' DATE OF INSPECTION: FOUNDATION R• • 0 FRAME 12-0 o 3 his f INSULATION hi 2S FIREPLACE el ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT t ASSOCIATION PLAN NO.,y . rt t r i Ftf7 .. 14/ �l . Ati SM® x= p�TECTORS REVIEWED A = C —- —'----DEP DATE. R �LI'.BUILDING / SHED ` DECK y sPART=- DATE_ i T� FIREb 1! f�TN sIGNATUR:S A R u` I FOR PERMITTING / 005 3,SEASON % tl / s . o .•/ ROOM / LANDSCAPEDLn i i foe— ko a' N Y` a . T a .N S U i�C-� ' - -TON \ Ll An re Imarino S48 ick iNa �} c,� t ZT 41 a 0 32.. ► SQ. FT. . _ Centervo fie, MA _ � : 16,228 , 0.37 ACRES Zen . ,.. ,.... ,.,my,.-• �. ..... _::-. .. . '< . .. i�kw.t Uaa;.�txaa3..,d5',iY..:`ac'x .................... AM 0° f SHED t DECK IA v110 mac + 4 3 SEASON / N'�r1. � ROOMLn LANDSCAPEL pLnrn At / 30 (\j TON'' r \\ G Y .. Andre Lima in® LOT 4 '48 WarwiC �ay .16 228 SC .'i FT. Centerville, M p.37 ACRES IN, i, '\. .,:_ ._:' . .,. ., . , ,.. .4Jd.W««nip 7.3w•„!ak�.:iiiuC�,"��r"'' k " 7' -1 F--L-f i It k ............ .... . .. 1 � y,I� :_.....T.. :_� _:�e_..._..._.._.....�_...._ __..._ r - --.... . --__.._ . ; ; , .. /;} � � Ems-/rl"'I�--� �%► ; � j s LA if w ` WAIL, -_-- l �HOFA4gs CU IL STRUCTURAL No 34774 �.) 'l)....1 ( @-V;J►r _ 4::,1(..,.l �.L-r.l "C�'.a/I �.1. t � tyT£�NG���� f I3 s • L OF Mgss9Cy MICHELE COP ILO TURAL m o gTRUC No 774 � o e °9p 9FGI StEQ`�� evY - g •-1 �t C c 2 Y 10 Ft. CsI� P' ( cry i -�J w bL i I e' r ({C n .. r r {{ • f r I - - i �_ _._,.,_, r._..__..., ._r .-a._....... v. ...r-....n_.r.._ .. .� ,r .._._. .•.a v. ..r. r..,, ,... ... - � - - Ii 4 _ i I 1 . 4 .......•.tom... JJJ Q 3 ---0 jH OF Mgss90 �02 MICHELE g CUDIlO , STRUCTURAL y No 34774 1. FSSlONAL�G ` ��� _• MICR N _ . • � ( � � CUDIlO a _ S No 34774 L' Q9p GISTEP��Q. SSIONA ' `•� ,� - ..� V �l �_.,r 1 F%• ��' 1�.1 /"1 t�{�•vlii.._�._.e.� J r:�k i•' , ! c r,t(,:,;V ..aJ �-"A :i(Y,ltl�;�;• 1 1rJ6 ----�-i -----._.___.,_.._,. �hfl1� 6�t��..4 f��f41 }•� cPf, +r"ltu_:__S4°�.,}�.1.�.�..1...,f...._._._.. �:lt,i _ x r f r ! �r•-• .,� i ` t L. \+��te'{ •�.�, �� �C.µl� h� 4.r��' G'ly L.t Y}�.c; 1P-g, - �-• f��. • I ` Ut t ,I`1 ._l` f t l�/..t.,�� I'��.-�ib..l("�Y..' V�+.f�l��� (�t t,l i^.C��,�C"� t�+ (f, t, 1"tC•i��S-,'>�., �� `I's1•!.{'i�'i CJ'►1'tvl,:.�,1�: I � � y i x- L t i ra6,E: ,�,.4� .iyl ?�.`.` � �, 1..0 \Tltrts � -, .. ., .._ '1'2. J..1`� C),J r f lGi:• ..1`� '?•�i�.,'�a�.,}I - ._..._ .,. .._.f..__. ......__ri --1 �`"_T'_'..��y `)''i V'.�i �'l)1c i�' ;iZ r�!::: W�_ � �. •l�r.t' ''f��••�.._.__ �_ _ j`'y(jIrY1 c7 4 =`rJl•ji________ :yi r1J DVGkL+K4 �Y.OF MASS o STRUCT Rtqo �L ai �� ijQa?t '� y'JGi'`.t�.� tr ./..,(I !j ? �• ,� `i r�l', ( { C�FFSSION � �, w� O d 04z -A RS REVIEWED • --- --"" tE DETEClO _ _ t DATE 4 B aR Tait 2 BLc BUILDIN DEPT. 1 SHED ( DECK z :IRE DEPARTME J DATE . BOTH SIG yATURES ARE RI t�UIRED FOR PERMITTING CA # / " 3 SEASON / 9tP. i ROOM / ,LANDSCAPED' / Ln p . W 1Y_1tC.� r3, o Cu `J 1 Zr S. . rs C -TON \ L�J �r / cM - Andre imarino LOT 41 48 M idk Way ' Centenril MA 32 }I ��-�fi � 228 SQ. FT. �� 16, • I 0.37 ACRES _- LIJ .. - �J jec LL- 00 Jin �i 0 of M �EWA is V. Y T. ,. . 155.54' STOCKADE FENCE w vi z` �q Q �� ' The Commonwealth of Massachusetts t Department of lndustrial Accidersts Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dipc Workers' Compensation.lusurance Affidavit: ByRders/Contractors/Electricians/Plumbers ' Applicant Inforlaiation ^ Please Print Le bl ' Name(Business(Organization/Individual): ' �J -Address: awl 1C4 V\1" City/State/Zip:Are you an employer?Check the appropriate box: -Type of roct re e • 4. I am a neraitt contractor and I P_ J ( 4 1.❑ I am a employer with 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 These sub-contractors have ship and have uio employees "8. ❑Demolifion working for iri an capacity. employees and have workers' rking Y aP t3' $• 9. ❑Building addition. [No workers'comp.insurance comp.insrrance. required.] 5. 0 We are a corporation"and its 10.0 Electrical�epai s or additions 3. I am a homeowner doing all•worlc officers have exercised their ` 11.0 Phumbmg repairs or additions•.- right of exemption per MGL myself [No workers comp. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no. employees.[No workers' . 13.0 Other comp.msnrance required.] *Any applicant that checks box#1 must also fill out the section belowshowi g their workers'compensation policy information. t Homeowners who submit this affidavit indicating trey are doing all work and then him outside contractors must submit anew affidavit indicating such. tContract ors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub•coatractors have employees,they must providt:their worioas'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: ExpirationDate: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A-of MGL e.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or o ear 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 violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the D r' ce coverage verification I do-hereby certify under ' s-and penalties.of perjury that the information provided abov,is true correct Si tire: Date: �Z .2�- . Phone# Official use only. D of wr in this.area,to be completed by city or town official' City or Town: PermitUcense# r Issuing Authority(circle one): e .'1,+-Board of Health 2,Building Department 3:City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone.#: . 'THETown of Barnstable fi P�p Regulatory Services rsrnsr Thomas F.Geiler,Director rsass. 16 u►. °•�� Building Division . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m-a.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 02J 22 JOB LOCATION: 49)WQLW IC4 umb I street. village "HOMEOWNER": L�•v�,t,(`/�J name home phone# work phone# CURRENT MAILING ADDRESS: C' iL�k I+VA 02632 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to . be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. app4em es,byl s,rules and regulations. Thee "ho co er"certifies that he/she understands the Town of Barn table Building Department minects p c dares and requirements and that he/she will comply with said procedures and req SignownerAppring O sal 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 fonn/certification for use in your community. Q:forms:homeexempt �'E rti Town of Barnstable °« Regulatory Services TMSMARLMThomas F.Geiler,Director jOrF16 9. � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www:town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 r } Property Owner Must Complete ands* - �This' S�ectiori''� If Using A Builder. L , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 ��� �`D �'bP+ �► � — � Wry- ��►� � A WC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)' Check Compliance 1.1 SCOPE Wind Speed(3-sec. gust). ...110 mph WindExposure Category.................................................................. .............................................................B 1.2 APPLICABILITY 11 Number of Stories ..............................................................(Fig 2)............................ I ' stories s 2 stories RoofPitch ..........................................................................(Fig 2) ..,:.......................................3 : 1 Z 5 12:12 MeanRoof Height ..............................................................(Fig 2).................................................,,_IS ft 5 33' BuildingWidth,W ...............................................................(Fig 3)................................................ OE ft 5 80' BuildingLength, L ..........................................:...................(Fig 3).................................................23ft 5 80' Building Aspect Ratio(L/W) ......... .....................................(Fig 4)....:........................................... ' ' ll/s 3:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)................................................ �D n s 6,8" 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2).......................:........................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................:................................................ ConcreteMasonry ..............................:...................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION'3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general ..........................................(Table . ......f tom_in. Bolt Spacing from end/joint of plate ....................'.........(Fig 5)..................... ............... — in. :56"—12" Bolt Embedment:--concrete.........................................(Fig 5).................... ............................ in. 2!7" Bolt Embedment—masonry..........................................(Fig 5);.................. ..................... in. >_ 15 PlateWasher...............................................................(Fig 5)...............................................>3"x 3"x%" 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension.............:.....................(Fig 6)..........................4/1L ft<_ 12'or U2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall (Fig 6).........�... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or She_arvvall................(Fig 7).................................................... — ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)........:........................................... — ft 5 d Floor Bracing at Endwalls..............:............:.:.....................(Fig 9)............................ Floor Sheathing Type ........................................................(per 780 CMR Chapter 55).......................... ......... Floor Sheathing Thickness ..................................................(per 780 CMR Chapter 55)...................� in. Floor Sheathing Fastening..................................................(Table 2)..g_d nails at in edge/ -2 in field 4.1 WALLS Wall Height Loadbearing walls.. ......:...............:.........:.:.:.................(Fig 10 and Table 5).........:.:....:.......... ft :5 10, Non-Loadbearing walls................................................(Fig 10 and Table 5).................:....`:. . ft 5 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)................... .Ua in.:5 24"o.c. Wall Story Offsets ....................................:.:......:...:....:.(Figs 7&8)............................................ ft <_d 4.2 EXTERIOR,WALLS', Wood Studs Loadbearing walls........................................................(Table 5)..............................2x ft in. Non-Loadbearing walls................................................(Table 5)..............................2x - ft in. Gable End Wall Bracing' Full Height Endwall Studs...............:.............................(Fig 10).................................................................. WSP Attic Floor Length................................................(Fig 11 . / ft 20/3 Gypsum Ceiling Length(if WSP not used)....................(Fig 11)...........................................�ft_0.9W ' �SrsOFMq 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. ..(Fig 11).............................. .............................. a� le Top Plate MICHELE ti lice Length .............. . .. . ..................(Fig13 and Table 6� Q.....Ca .n CUDILO lice Connection (no.of 16d common.nails)......:.......(Table 6).......................:...................... Cif ft STRUCTURAL -- No 34774 SS10NA� r F � A WC Guide to Wood Construction in High Wind Areas: 110 mph &Md Zone Massachusetts Checklist for Compliance (7s0 CMR 5301.2.1.1)' Loadbearing Wall Connections Lateral(no. of endnailed 16d common nails)..............(Table 7)....:...........0. 5..`....�... .... ............. - Non-Loadbearing Wall Connections Lateral(no. of endnailed 16d common nails)...............(Table 8)................................. ..:....:............. ✓ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9).................................. Zft f in. 5 11' Sill Plate Spans .....................................:..................(Table 9).................................. ..T ft f in. 5 11' Full Height Studs (no.of studs)...................................(Table 9)......................................................'.. Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table Q HeaderSpans.............................................................(Table 9)..:............................... - ft - in.<_ 12' Sill Plate Spans..........................................................:(Table 9).................................. —ft=in. s 12" Full Height Studs(no. of studs)....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously" Minimum Building Dimension,W 1 i p Nominal Height of Tallest Opening. .......................:...................................................... 6 8° Sheathing Type............................................ (note 4)...................................................... W� Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................--I--in. Field Nail Spacing.............'.,..............:...........(Table 10)...................................................I Shear Connection(no.of 16d common nails)(Table 10)........................................................ Percent Full-Height Sheathing.......................(Table 10)...................................................:�%x 14-�=¢, -5- 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)............,..: ...... Maximum Building Dimension, L = Z 3' u Nominal Height of Tallest Opening2...................................................................... 5 6'8" Sheathing Type..............................................(note 4)...................................................... Iff Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................3�in. Field Nail Spacing.........................................(Table 11).................................................min. Shear Connection(no.of 16d common nails)(Table 11)........................................................ , Percent Full-Height Sheathing.......................(Table 11)......:.............. .............................. V x?3= 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)...................3;'z ( - Wall Cladding Ratedfor Wind Speed?..................................`........................... .................... .......................................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) Roof Overhang ...............................................I... (Figure 19)...........r��_L ft<_smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls //� Proprietary Connectors �fIn �� S . ..... ................. C9< Uplift..................:.. . . ; _ J Lateral.............................................(Tablet12).....::..........::.......:..'...............L-4_,�2 plf Shear................................:...............(Table 12)............................................S=_12 plf Ridge Strap Connections, if collar ties not used per page 21..... (Table 13)..........................:...T= - plf Gable Rake Outlooker......................................... (Figure 20)........1V� ft<_smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift:...............................................(Table 14)................. . .......................U= lb. Lateral(no. of 16d common nails)...(Table 14)................. ........':...'.........L= - lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59)`................. Roof Sheathing Thickness........................:........:.......... . ............................... in.>_7/16"WSP kD .... .Roof Sheathing Fastening..................:...........:............(Table 2)...�d...q. .. ..Y.4..... . - Notes: 1. This checklist must be met in its entirety, excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1-. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11. c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a 2. Exception: Opening heights of up to 8 ft. shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. -- The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness. pressure treated#2-grade. V\OF MASS9cy ?� MICNcool ELE vgTRUCTR4 L rn No � 0 9FCISS�e`�Ga4. 9�FFSSIONA&� f s. . dF E ' _ � - • �� ����y j j 31 (� 0 f" I e �ztr o.� IN'S�Rt��D1it�E ' DG j ���it�tTlCtiD,N11t3Ca 1 d1�N����TAP• tll6,Mtati:�,GYP. �� r�►L P,prrt��u �/g ( , INI ►AI WSP AT'°TAC H M E N T To% `VER-T• 040 AORiZ. hTTACAMBIMT NOTES: { Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii.- All horizontal joints'shall occur over and be nailed to framing. iii. On single story construction.panels shall be attached to bottom plates and top member of the double top place. iv. On two story constructions,upper panels shall be attached to the top member of lice upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment nude to lowest plate at fist floor framing. v. Horizontal nail spacing at double top plates.band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment Wit Kti �DG� �ST� 6f i — IT — ` , 1 — — -�-j ; R l- .i 1 i 1.1 IJi :I. wo s WOOD -5TR,OGTOP-AcL AMEL NJ WS P ATTACHMENT No7 To SGAI.L i c L +-lC?R IZWT°A-L !T G _ 1 Commonwealth of Massachusetts O U Sheet•Metal. Permit Map Parcel Date: �'d Permit#Aw / Estimated Job Cost: $ t o� �� Permit Fee: $ Plans Submitted: YES NO Plans'Reviewed YES .: NO h Business License# -7 1—7 Applicant License# Business Information: Property Owner/Job Location'Information: Name: B-sq 6 s05 • t'I 4i Name: A-Y1 d S C L `M Q s.i—n O Street: 05or r7C v c7i Street r Uj Q s uV i CIS l i(J Ll r . City/Town: Q�m ✓� Q� City/Town! Telephone: C-7 7 f q, P—$05 I Telephone: J U I �p t Photo I.D. required/Copy of Photo I.D. attached: YES O staff Initial J-1/M-1-unrestricted license o.. %AJ J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 1.0,000 sq.ft.rr :stories or.lest Residential: 1-2 family Multi-family Condo./Townhouses 0 er Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney Vents Air Balancing Provide detailed description of work to be done: r-Y, a�� a ' e w U C, S 5 eyh 14-�l h P ��5(-`rn C�L e. • � r NSURANCE COVERAGE: ti have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No ❑ ter fi you have checked , indicate the type of coverage by checking the appropriate box below: k liability insurance policy ❑ Other type of indemnity ❑ Bond-❑ i )WNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 112.of the Massachusetts General Laws,and that my signature on this permit application waives this requirement $ Check One"Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 3y checking this box[],I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and iccurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be , n compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments . Type of License: ; y ❑ Master' Ale . ❑ Master-Restricted ityrTown ❑Joumeyperson ` Signature of Licensee ermit# - ❑Joumeyperson-Restricted License Number. ee$ 4. ❑ Check at www.mass.gov/dal ispector Signature of Permit Approval ' The Commonwealth of Massachusetts Department oflndusMd Accidents Office of Investigations 600 Washington Sfreef _ Boston,MA 02111 www.mass.gav/dia ' Workers' Compensation IusurAnce Affidavit Builders/Contractors/FIectricians/Plumbers ApPlicant Information ` Please Print Legly Name(Business/Organizet maudividnal): B-Yqclq 133-05. / f� Address: City/State✓Zip: 7q'h'?1 i5 MA O (COI Phone . �7�7�(� 9Y7- 705/ Are you an employer?Cheek the appropriate bay -Type of >-o ect re e L I am.a to with . �4. � I am a general ca�actor and I 6. e 1• ( � � employer * have hired$ie sob:-contractors 6. ❑New crrr;ahnrt;�,7, . employees(fall and/or pit time). _ _ 2._❑ I am a•sole proprietor orpmt=- listed on fhe-attarhwi sheet. 7. ❑Remodeling ship and have no employees These sub-coutractois have 8. []Demolition working for use in any capacity, employees-Mud hale waI3=' [No workers' comp.iner=e, 9. []$m7dmg addition required,] 5. '.We are a corporation and-its IQ.0-Electrical repairs or addifmns '3.❑ I am a homeowner doing aIl•tivork officers have emerriced their 11.�PImnbing repairs or additions -. niyseli: [No wor]=' rain. tig�t of exemption per MGL ]2,[]Roof repairs rasa-ance req=d.]t c. 152, §1(4), and we have no employees. [No work=' 13.KO33er comp,insurance required] *Any appHcaat that checks box#1 mmst also fill out ffie sectiou below showing thea•vodo&campeasatioa policy information. t H®eowncrs who submit fbis afndavit mdicating f=7 arc doing all work and they late mtm&ooatractom mast submit a new a5ndavit mdicamg such. $Contractors Lot rhrrlr this box most attached sa addifiral sheet showing the name of ffib sub-contractors and state whew•arnot those eatifies have employees. If ffie sub-=t ac-ta s havo au:3Plo3oes,ffiey mnsI provide their wa i mrs'camp,pacymmmba. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and jab site information. Tin za rn Company Name: f e -f (� i cl I' Policy#or Self-ins.Lic.#: WC a r 315 ®376V 6.)""O(0 B Date '' !Al_I Job Site Address: -(,Z7 U)Ct Jr UA fit\ (ill aD Attach a copy of the workers' compensation policy declara$on pag %(showin.g the policy m—ber and expiration date). Fa:a='to.secure coverage as requi Und er der Section 25A of MGI,c. 152 can lead to the imposition of crmmzat penalties af'a , fine up to$1,5oo.b0.and/or one-year imprisammertt, as well as civil penalties in the foffi of a STOP WORK ORDER and a fine of up to$250.00 a day against the violamr Be advised fat a copy of this sbLtmi P ±may be mrwarded to the Office of Investiaaiions of the!)IA far;-nrmanr:e coverage vexification. 16 hereby certify e airs-and penalties o.f perjury That the information providerdab a is and correct . .7.7 ionainre Date Phone P- C 7M. "G 11 7� / ® �1 Offcciat use only. Do not write in this area,tb be completed by city or.town ojfzriaL ' City or To*= I Pet-133R MMe# Issuing Airthority(circle one): 1.Board of Health 2.Building Department 3.CltrTowu Clerk 4.Electrical Inspector 5.Plumbing hspednr 6.Other Contact Person: ; Phone#:. i l IHF Tow n 4 of Ba rnstable Regulatory Services + A�R1V�'ARf�yY f MASS Thomas F.Geiler,Director 1639. BuBding iviSiOII Tom Perry,Building Commissioner 200 Man Street,Hyannis,MA 02601 www.town.barnstable.ma.ns 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 '1QAC-- °tP1O2 ' to act on mp behalf in all matters relative to-Work authorized by this bolding permit (Address of Job) I 4ab larms are the responsibility-of the applicant. Pools P efore fence is installed and pools are not to be inspectiotis are performed and accepted. Signature of Applicant 0 Oa Iex Print Name Print Name x cc 11sl 13 Date QFORMS•OWIERPERMISSIONPOOIS e + r j THE Town of Barnstable F Regulatory Services z3narasrwBts, Thomas F.Geiler,Director Hues. � 1639. h 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 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 cuirent 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. - DEFINTTION 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 perf'omZed under the buil ;nc 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 m;n;mum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 1 t 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 msponsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisor;,Section 2.15).This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board carmot 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 requi ,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 earn t amend and adopt such a form/certification for use in your cammunity. ' Q:forms homeexempt 04/29/2013 10:41 5087710663 SCHLEGEL_INSURANCE PAGE 02/02 CERTIFICATE OF LIABILITY INSURANC E , DATE(MwoaAry ) F04/26/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS IIPON THE CERTIFICATE HOLDER; THIS CERTIFICATE DOES NOT AFFIRMAVO LY Oit NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED E3Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE, A CONTRACT BETWEEN TIE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE-CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pWICy{Ies) must be endofsed. 11 SUBROGATION IS WAIVED, Su0ject to� the terms and conditions Of the pollcy, certain policies may require an endorsement. A statement on this Ce►tlflute doss not eonfar rights to the certificate holder in lieu of such endorsement($). PRODUCER r—sahl®gal r;i Schlegel xii9urarl,oe B PAUL SCM EL(;ELgrokexs Ina NAME: 4ON exli_^508-771-8381 _ 508�771�0663 34 MFATfI gET (aK,No4 AbOREea; 8CHLEGZLjN8URAN(Z@VERTZOX.N,ET CUSTOMER ID 0! ?lest Yarmouth,_x4A02673 INSURED --_ INSURtHIS)AFFORDII ID CO%itma J Nam.d Ales Bi"04a Dba Braga sxos Plumbing Heating IN9uRERANGM INSQRAIgCE�COk�'RNY 14788 2 Mountwood Rd INBuRRRaPktOGRIISSxVE. � w INSURER C i - (NSURER D; - D7d,C9ton6 Mi11B, HA 02648 IrMURERRI . -- INSURER F — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW I•iAvE BEEN ISSUED Ta THE INSURED NAMED ABOVE FOR THE OLic—PERIOD INDICATED, Nonni STANDINQ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DO(UMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE k-f6kDPD By THF. POLICIES DESCRIEIRD H.REIN 1s SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI-I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE OF INSURANCE •-INSR WVD POLICY NUMaRR GENERAL IJABILITY (MMlDDNYYYI (MMIDI)NYYY) LIMITS A t4k03439T COMMFRCIALOENERAJ,LIAOILItY 02/17/2013 02/17/2014�CH O ENCE S2,000,000 Xr.+ PFEMISEe(fROEEunanao CLAIMS-MADE. �Dc� $500,000IR - r ' —Y M(D G(P(Arty ana paroen9 $10,00 0 PF iSONAL&ADV INJURY s2,000,000 GNMALA(;CREOA% s4,000,000 OEML AOOREGATF L(M(T APPUF,S PM: — --V J O, LPR MUCTS-COMPIOP AGG %4,000,0TY04974 7a - CCMeINFDSINOLELIMIT 02/2a/2013 02/24/201a- (FA Reelddm) TOS (90 ALY INJURY(Pv pomon) g 100,000 X SCHFOULWAUTO$ h0]II,Y NARY(For aceldgrll) 300,000 HIREDAUTOB - PR)PFRTY DAMAGE $ ],OO OOO (Pa—IdArA) , NON•OWNEgAU705 — - _—=-- S ' g uMRRELLa UaS OCCUR --- -- FAItp- C=E :::ERCESB LUUI —_ -1REGADEDUcTIDLERETF.NTIONWORKER'6OMPEhfBATIONAND RMPLOYERS°LIABILITY • mC2L31 S-3764ti2-010 - 03/04/201303/04/2014 X WeANY PROPRIETORIPARTmFke('ECUriVE Y!N1� OFFIMMMEMPER EXCLUDEDf 17t I N ra s r F,L,EAtH ACCID9NT g 100,000 IMnndnlmy In NW R 9»I{"((�Qtrtao E.L.YSEASE-FA EMPLOYEE g 100,000 DESCRIPTION OF OPERATIONS Enlmro _ — _ FJ.ASEASE-POLIOYUMIT $$00,000 DESCRIPTION OF OPERATIONS!LdCAv6kNq t VEHICLE/S�, (Attach ACORO 101,AddlRnrMI marks Sehart4lto.It mom apgro m mpulrod - THE WORKERS COMPENSATION pOLICY DOTS NOT T' 11DA COVERAGE FOR Attk BRP, j CERTIFICATE HOLDER CANCELLATION TOWN OF SAR1ISTA81,~no MATIq STP=T SHOULD ANY OF THE ABOVE DESI AIRED ,POLICIES BE CANCELt Ep B@FORE THE EXPIRATION DATE THEERESDI, NOTI$IE NRLL BE DELIVERED IN BYANNT$, MA 02501 ' ACCORDANCE WITH THE POLICY PROM91i)NS: AUTHoR17BD REPREBE FAX 0 1- 08-790-6230 V)198M&2*0S ACORD CORPORATION: All rights.taeervCd. ACORD Rti(Z009/0SI) The ACORD ame and logo are registered mark of ORD COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS • WE •• • :e••• • • • • •• • :e••• • SHEET METAL WORKERS PLUMBERS AND GASFITTERS AS A MASTER-UNRESTRICTED' LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: 1' ISSUES THE ABOVE LICENSE TO: t t ALEX B BRAGA - �� _ .r,LEX "B BRAGAm 2 MOUNTWOOD RD �' R 2• MOUNTWOOD RD N MARSTONS MILLS MA 02648-2111 MARSTONS MILLS MA 02648-2111 6717 08/28/14 227270 # 15668 05/01/14 159310 III COMMONWEALTH OF MASSACHUSETTS SLUMBERS AND GASFITTERS Gas LICII.V.S.ED Al"" A-.I.OURNEYMAN_P_LU.MBER,4 The System Is t5olutlon ISSUES THE ABOVE LICENSE TO: t The rollowng person has successfully completed the Gastite CertiOcation Training Program and is hereby recognized as a ALEX .1 BRAGA �. Qualified Gastite Installer Alex Braga B_ I Van Norman 2 M O U N -;`I O O D RD t 0 Name �I•structor L`o . Braga"Bica°!g 8 Htg� --- . 0h.7/20_0.9__- G MA R S T O N i' MILL.', MA 0 2 6 4 8-2111 ccr�G-y 08G438610 ,ate Ce: ficate No. 169525 31524 0�i '01/14 159311 �- ' r Authorized to purchase anal;nsw:Gss::ce;=!exib'e Gas Piping �� - 1-800c82-C208 envv+.Gas:ite.ccm • z� azti, iea•t' o e0tn f t!0)i The person named below has completed the Tracfte ceffiedby' training program and is hereby awarded the Alex B B"raga VGrrraining ku:4" as a EPA Approved CERTIFICATE OF TRAINING. ^, September 30,1993 z. •3 A I e X e)ra Per• _ .rMr. Technician TYPE;UNIVERSAL qQ QQa -� 1 *,/ installer's Name Company a& d,Gay Rio e RY 82 s pa t 17. - �Ce �atd 2302994 '- -•3/29/2011 . ccertlncate Number — Daie '- varT tiw o. � 9-6 8 3 _� (� O 3._ Day 800.621.9419 e SAFETY CERTIFICATE r' Name: Alex Braga _ ,,�-� Alex B.Bra 9a -•,. Has completed Excellence In Safety's Ad.Qered Registration Number: 169165 Industrial Truck kOperator Training at Boteflo Home,-Center,Mashpee,MA.a Date: 12/10/2009 4 it Richard Hughes,C.E.C.M. January 9,2008 Rinnai Tankless Water Heater Trainer Training Date Installation Training Course TOWN OF..BARNSTABLE BUILDING PER,MITAPPLICATION, `Z Map v Pa -Application # 7 Pare I;V7q Health Division Date Issued - Conservation Division ' Appl icat& Fee Planning Dept. -Perm 6Q it Fee. 1v Date Definitive.Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Address vi N-9—\Jj Village.J:%A)v Owner �1 oc_ LX ry^ Address wa&4 Telephone Lt Permit Request bt cj�L�k • Square feet: 1 st floor: existing—proposed °2ncl floor: existing—proposed Total new Z6ning District, Flood Plain Groundwater Overlay Project Valuation -S 0 0 0,r-0: Construction Type Lot Size Grandfathered: 0 Yes J No If yes, attach supp orting documentation. Dwelling Type: Single Family Two Family L1 Multi-Family (# units) Age of Existing Structure Historic House: Q Yes I No On Old King's HiahwaV-_,L3 Yes LJ No Basement Type: Ll Full LJ Crawl L3 Walkout 0 Other 2 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.DI > Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new iv Total Room Count (not including baths): existing new First Floor Room CounG m� r 9 Heat Type and Fuel: Q Gas LJ Oil Q Electric Ll Other Central Air: LJ Yes LJ No Fireplaces: Existing New Existing wood/coal stove: LJ Yes LJ No Detached garage: LJ existing LJ new size—Pool: LJ existing U new size Barn: LJ existing LJ new size Attached garage: Ll existing L3 new size —Shed: U existing LJ new size Other: Zoning Board of Appeals Autho rization 0 Appeal # Recorded Ll Commercial L3 Yes L3 No If yes, site plan review# Current US6-- Proposed-Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address V\j�', License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION \VESULTING FROM THIS PROJECT WILL BE TAKEN TO A' SIGNATURE ( A\ DATE i FOR OFFICIAL USE ONLY lk x APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: FOUNDATION FRAME (- ? o? INSULATION `2,7 o f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL s FINAL BUILDING( s DATE CLOSED OUT ASSOCIATION PLAN NO. Ow' The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Ou Address: oL Vj ' G :AJ City/State/Zip: Q.,AC✓LU% Lt- yvla z. Phone-#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction employees (full and/or part-titne).* have hired the sub-contractors 2.0 I am a soleproprietor or'partner-' listed on the attached sheet. T. EI Remodeling ship and have no employees These sub-contractors have g, -0 Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'-comp.-insurance comp. insurance.# required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.L I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.j *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy,and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimirial penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day ag ' e violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the IA urance covera e verification. Ida hereby certify un t ains and penalties of perjury that the information provided abov is tr•e and correct. . Si mature: Date: -1 Phone#: }�g }(D . 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: u 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 stee of an individual,partnership, association or other legal entity, employing employees. However the tiu owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance;construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not 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),-address(es)andphone 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 then 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 permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense 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 io 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 Imvestigatians. 600 Washington Streot Boston, MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia r Town of Barnstable�I� o Regulatory Services BAxxMee Thomas F.Geiler,Director MASS. 9�A 0.19. A��� Building Division lf0r Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 `T HOMEOWNER LICENSE EXEMPTION Please Print DATE: 0 I v ) n / JOB LOCATION: 4 �'` number street village "HOMEOWNER": f�Q �= � J'_'> s:zz �3��-� Co� g gZOZ%(�s 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. DEFIMTION 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 undersi*nhomeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inocedures and requirements and that he/she will comply with said procedures and requirementSignatur'ofH Approval o B ding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORM S\homeex empt.DOC �IRE 1bk't' Town of Barnstable Regulatory Services, snaxAM e, Thomas F. Geiler,Director 039. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 -Property 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. (Address of Job) signature of Owner Date Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMIS SION L ' i I r 6-O (oa I,I Gs i 1 . i ov R a n x ov � off' s� � I i I I i U � I I I � c� 1`1 O Z C. i t IKE ---ToWn-of Barnstable---- - .---_-`Permit O d -7( ¢;,� Expires 6 nron//�s jrou�issue date X. IT Regulatory Services Fee��� Thomas F. Geiler, Director J•la 2009 Building Division TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab l e.ma,us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / g G-70 Property Address t? W Ny.fin-) C/-- C - .I,F KrA Q"Z(, . 2 Residential Value of Work­'It Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �6 0 L1 Y�i�lLl✓� �{ �"c�li. i I� �^ Contractor's Name Telephone Number Home'\Prove.ment Contractor License#(if applicable) Constrpervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insur ce Company Name Workman's omp. Policy.# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value (maximum .44) Ce-70—) *Where'required: Issuance of this pe mit do s not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property O ne �t sign Property Owner Letter of Permission. Home Irti Contractors License& Construct Supervisors License is required, SIGNATURE: �/ Q:\WPFILES\FORMS\Express\EXPRESSP RMl 0 Revise06O4O9 i- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information . Please Print Legibly Name(Business/Organization/Individual): Address: 8 VJ 1,-1LeW 1 Gam- _J r-N^9 City/State/Zip: �Ck62��t,� MG37 Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction .2.0 I am a sole proprietor or partner- listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp. insurance comp. insurance.$ equired.] 5. ❑ We are a corporation and its �� 10.❑Electrical repairs or additions 3.N a am homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑Other comp.insurance required.] *My 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. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. J am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site \Insance n. Company Name: Self-ins.Lie.#: Expiration Date: Job Site Ad ss: 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$1,500.0 or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250. Ka inst the violator. Be advised that a copy of this statement may be forwarded to the Office of 71d ations e for insurance coverage verification. eby cerliapains andpenalties of perjury that tl:e information provided a ve is rue and correcte: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one):- 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: n 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 who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or ` renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not 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),-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 f 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 permitllicense 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. Anew 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 brim 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 11-22-06 . www.mass.gov/dia s Teti Town of Barn-stable ` Regulatory Services r � 9au�xes[s$ 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 �Y ProP e 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 a orized by this building permit application for: (Address of Jo Signature of Owner Date • F Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. T Town. of Barnstable n4'P�O4 THE Regulatory Services Thomas F. Geiler,Director • atixxsrxsre, • tFtwss . 163�. �•� Building Division p�FD Tom Perry,Building Commissioner -200 Marti -Hyannis-MA 02601 vt-wv.town.b arnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOl%1EOF4rNER LICENSE EXEMPTION aO Please Print CDA* E: 2 OJ LOCATION: W A,Ujl C number street village MEOWNER : I I�nr1AP1i(� I®GW �name home phone# work phone# RENT MAILING ADDRESS: �� v`� �.1 "Cue- yJ W-( cityhown 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 tinder the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes y ws,Hiles and regulations. "I The and 1 6 ."ho owner"certifies that.'hdshe understands the Town of Barnstable,Buildiug Department ign um e n gcedures and requirements and that he/she will comply with said procedures and r quiremen Signa ' of No Appro al of Buil ing Official 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 pcmrit is required shall be exempt from the provisions of this section(Section 1 D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homcowna shall act as supervisor." . Many homeowners who use this exemption arc unaware that they are assuming the responsrbrlidcs 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. Tc ensure that the homeowner is fully aware of his/her responsrbilitics,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 can t amend and adopt sucb a formicertification.for use in your community. Q:fomrs:homccxempt i 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel p Application# Health Division Conservation Division � —� Permit# Tax Collector Date Issued Treasurer Application Fee 5 01 Planning Dept. Permit Fee O,o Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address y Village Owner ryy.NeAr�_o Address Telephone �30<? Permit Request F' Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District ,-A Flood Plain Groundwater Overlay f � -4Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: 00 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 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: CVGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes XNo Fireplaces: Existing 3 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 ®( �1 nogoeA f vo Telephone Number g R64 Address uArew s ct V Pq License# V ik U Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS SLING FROM THIS PROJECT WILL BE TAKEN TO Y SIGNATURE DATE � Uy — FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED t . MAP/PARCEL NO.,' i ADDRESS �' VILLAGE OWNER DATE OF INSPECTION: �SsA.G FOUNDATION FRAME 0 10 01®(- L- INSULATION $ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING 1S(GZfo 6+9 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts 02 Department of Industrial Accidents Office of Investigations 600 Washington Street , Boston, MA 02111 www-mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A_pplicant Information Please Print Legibly Name (Busiaess/organizationaavidual):_ 0a Li No Address: vi I CK City/State/Zip: - CL-1 i i�, � Phone Are you an employer? Check the appropriate bog: Type of project(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees(fall and/or part-time).* have hired the sub-contractors, 2.❑ I am a sole proprietor or partner- i listed on the attached sheet t 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' ConIp.insurance 5• ❑ We area corporation and its 10.❑ Electrical repairs or additions required.'] officers have exercised their 3X I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions TN myself.[No workers' comp. c. 152, §1(4),and we have no 12:[3 Roof repairs insurance required.] t 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 policyinfm=tion: t Homeowners wbo submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such tContractm that check this box must attached an additional sheet showing the name ofthe 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: Job Site Address: City/Statdzip: 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. 1152 can lead to the imposition of criminal penalties of a fine up to$1,500.90 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine, of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' ance coverage verification. I I do hereby certify under th a ns a penalties of perjury that the information provided above is true and correct Y , Si atire: Date: Phone#: so Official use only. Do not write in this area,to be completed by city or fawn official City or Town: Permit/Licease# Issuing Authority (circle one): 1.Board of Health 3.Building Department. 3.Cityrfown Clerk 4.Electrical Inspector S.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 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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate it 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 ofpublic 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),address(es)and phone ni mber(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. Se advised that this affidavit may be submitted to the Department of Industrial Accidents for confrrmation 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 shonTd eater 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 permft/license number which will be used as a reference number. In addition,an applicant that roust 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. Anew 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 burn 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. t 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-2b-o5 Fax#617-727-7749 W-ww.mass.gov/dia I� Town of Barnstable Regulatory Services ' Thomas F.Geiler,Director Ec n �A`��9. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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 registeied contractors,with certain exceptions,along with other requirements. Type of Work: kP t�•� �_ ,UL AEG 1�. Estimated Cost QOO o Address of Work: `l N Owner's Name: V0 Date of Application: K_) I hereby certify that: Registration is not required for the following reason(s): ' FWork excluded by law ❑Job Under$1,000 Building not owner-occupied (Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PZUURY I hereby apply for a permit as the agent of the owner: Date Contract Registration No. �Q� OR rVY3 el fv Date er' Q:fb=:homeaffidav f F r 1 �oFIHE, � Town of Barnstable o� Regulatory Services sAxtvsTAate, g Thomas F.Geiler,Director 9 MASS. 039r ak Building Division A�ED MP'1 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: Q5j0q -jQo+ JOB LOCATION: a oict 4w icl::� number , street c village a "HOMEOWNER,,: name /gyp home phone# work phone# i'CURRENT MAILING ADDRESS: `i 0 wo w a_ w pa, - Cie"4-C-leati I I PA O2Co3Z city/town state zip code The current exemption.for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or,detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) - The undersigned"homeowner"assumes responsibility for compliance with the-State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned" o eowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspec r ced es and requirements and that he/she will comply with said procedures and requirements. Signature of H\a e>t Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt r r r fj O o � � z la N � g - c> s � o r I sf S �J J Jj ull (31 �r G 1 S 1 1. �� C116 MAY-08-06 10:28 FROWGill4evine 1 White 506-957-6033 T-636 P-002/002 F-019 -MORTGAGE INSPECTION PLAN JOEM . 'GISTERED LANDFILE NO.: 15641AODRE55: 48 WARWtCM. 1�AYBARNSTABLE, MA m0987 PAGE:040 ATTORNEY: GILL, DEVINIE do WHITE •IGK: 350 PAGE:55 LOT(S):41 LENDER: - •rMBER: OF OWNER:IRENE CRIASIA APPLICANT:AND RE L ,RNO RE STFRED LAND DATE: 08/11/2005 — SCALE: 1"=30' REGIS I IiTION BOOK: PAGE: CERTI1 CATE OF TITLE: FLOOD HAZARD INFORMATION PLANI rMBElh LDT(S): FLOOD MAP COMMUNITY NO,: 250001 ZONE: C AS ISORSt MAP PANEL: 0015 C _ DATED: 08/19f 1985 MAP. 1 8 BLOCK; PARCEL' 70 LOT 46 LOT 47 LOT 45 77 105.00' c e. LOT 41 16,227 S.F f DECK Ln LOT 42 LOT 40 OIL t s D Y 1�,5. i6 t �D e I DRAIN I EASEMENT 104,98' c.e. MORTGAGE LENDER WARWICK WAY USE ONLY THIS ISF THE' RESULT 01' TAPE MEASUREMENT, NOT THE RESULTOF-AN DINSFIED TO THE TITLE ES��� NSURANCETCOMPANY RUMENT AND ABOVE SRVEY AND (LISTED TIATTORNEY AND LENDER. ��•• aa c�.cc����ii s�i�cc tX.&J4U T69 INC 101 CONSTITUTION BLVD, SUITE D, FRANKLIN, MA 02036 THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED TEL'.(800)287-8800 FAX.:(508)528-4011 DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON-THIS LOT EXCEPT AS SHOWN. ZH OF THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN �RAYMOND A SPECIAL FLOOD HAZI,RO ZONE. E. BEALE, JR. rn THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER N0. 6973 WAS IN COMPLIANCE WITH THE LOCAL ZONING BY-SLAWS IN f+ISTER�o � EFFECT WHEN CONSTRI;CTEO WITH RESPECT TO STRUCTURAL A r Apq Sg SETBACK REQUIREMENT!, ONLY, OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII. CHAPTER 40A, SECTION 7. GENEApI NOTES: (1) The decmrotlons mode above are an the battle of my knowledge, Informa on, and b flef as the reeuil of o fnerigoge Inspecuon tape surtby mope to the normol standard of core of ragletered land ourveyore practicing In Massachusetts, (2)Or orations.ate made to the above named Clint only et of thle dole. fll Thir nrnn lino nnl mfk&Inv raMrdlM n"mness lnr see In rmitinrinn Aoetl AesMIntlMa if fnr 1'rrinittriff4frin (A) VMIRPnIlms M nrmnl,r lhm nlmenafnno Nilldinn vl� Town of Barnstable *Permit# DOCvG�3, g Expires 6 montlu from issue date Regulatory Services Fee ©d Thomas F.Geiler,Director Building Division ` �U, P Torn Perry,CBO, Building Commissioner MAY U 8 � �� 200 Main Street,Hyannis,MA 02601 oON www.town.barnstable.ma.us eq/1�N`,SSrr Office: 508-862-4038 Fax: 50S 74kzn EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number c. Property Address V� C F-� rP rJ' , ❑Residential Value of Wor 3.000.0D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Vj W�— 1 Y yo-&ram, y L d)4gLAJ I"C 02-G-3 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) [� Re-side ❑ Replacement Windows U-Value (maximum.44) *Where required: Issuance of thi ermit d s not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property r t sign Property Owner Letter of Permission. Ho ent ontractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 Y The Commonwealth ofMmsachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 y ' www.masagov/dia- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applf cant Information Please Print Legibly Name (Bushess/OrganizationdudividuP �j repyA n,a Address: Ll 4 W I C,11 W� City/State74: • ate➢Tir&U LU -0—U12 Phone M 7931z ,�3s V_) H Are you an employer? Check the•approprlate box: Type of project'(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New,construction employees(fall and/or part time).* have hired the sub-contractors 2.El am a sale proprietor or partner. listed on the attached sheet $ 7. Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp,insurance, g, ❑ g addition [No workers' wrap.insurance ' 5. El We are a corporation and its required.] officers have exercised their 10,❑ Electrical repairs or additions 3. I am a hauieowaer doing all work right of exemption per MGL 11.❑ Plambmg repairs ax additions myself.[No workers' comp, c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t . employees.[No workers' 13,❑ Other insurance camp. required.] *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation polieyinformatioa: ` t Ammown=who submit this affidavit indicating they=doing an work aadthen hire outside contractors must submit anew affidavit$idicating�such �Conb actass that check ibis box must attached an additional aheat showing the name of the suhrcontraotom sad their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for.my employees. Below Is the pol4 andjob site information Insurance Company Name: ¢` policy,#or Bei".Lic, : Ida : Job Site Address: 0ty/State*.- Attach a copy of the workers' compensation policy declaration page(showing the policy number and W.1ration date). Failure to secarg-coverage as required under Section 25A of MGL c. 152 can Lead to the imposition of eriminalpenalties of a fine up to$1,300,.00 and/or one-year b4aismmen%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 f e coverage verification. I do hereby cetl fy under th a d penalties of pedury that the information provided above is true and correct; Si tore: Date: Phone Iiiai K3E Do ne,M*E it:Ift amz,to U c-swXeed 4-c or mm oJijcid 1 � City or Town: Permit/License# Issues Authority (circle one): 11.Board of Deal.h 2.Building Department, 3.0tyriCown.Clerk 4.Electrical Inspector 5.Plumbii?a Iusp_-c--etor 16. Other Cou.act Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide wbrkers' compensationfor-their employees. 1 arsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,aial 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 apm-thents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair workmn such dw-cUing house or on the grounds Or building appurtenant thereto shall not because of such employment be deemed tote an employer." MGL chapter 152, 125C(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,§25 C(7)states'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfom=ct ofpublic work until acceptable evidence of comliance 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-hat apply to your situation and, if necessary,supply sub-contractor(s)uame(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited LiablW 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 retained to the city or town that lhe 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 hould cuter their self-insurance license number on-the appropriate line. City or Town 0111cials . Please be sure that the affidavit is complete and printed legibly: The Department has provided a space at the.bottam. cffti affidavit for you to fill=in the evart the Office of Invesdiations has to contact you regarding the applicant. - Please be sine to fiIl in the permitRieease number which wi"Zi. be used as a reference number. Tn addition,as ape Iic-ant indicating current " one affidavit ludic curr that Est submit multiple permitllicense applications in any green year,nett only submit S policy information if necessary)and under"Job,Site Address"the applicant should write all locations in _(city or P cY ( 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. Anew affidavit mast be filled out each year.Where a Home owner or citizen is Obtaining a license or permit ngtrelated to any business or commercial venture (i.e.a dog license or permit to burn 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 amber: The Commonwealth of MMsachUCEU Depu mt of Industrial Accidents Ofm of in 600 Washington Street Boston,IAA 02111 Tel.#617-727-4900 ext 406 or, 1-1077-MA.SSAFE ' Fes.#617-727-7749 Revised 5-26-05 w wT,t.m2 Ss.��v/dla r Assessor's Office(1st fl � Parcel of 7 a4ermit# Conservation Office(4th floor)(8-30-9:30/ 1:00 2:00) 17MA KUF-6 Date Issue Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) .01 V ee A0_7r, Engineeriiig�Dept. (3rd floor) House# PTryC VIKE ' lSTALLED 1 BE 19 ��J�•9 ; ns�v TOWN OF BARNSTABLE .. Building Permit Applicati/on, Project street ress G !N o� ei Village ! l P ti°)-L//�L�P /�' I�� lC�1 6 7 Owner ' 4 �'�. / ca S'jt t k Address ,_ • GU �`k.0. Telephone - Permit Request / / / 1 dJ lsc �4 First Floor square feet Second Floor square feet Estimated Project Cost $ Z � � Zoning District Flood Plain Water Protection Lot Size Grandfathered ? 'Zoning Board of Appeals Authorization, Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure �� P�L-'` Basement Type: Finished Historic House Unfinished 4— Old King's Highway Number of Baths _�_11 No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air 4�Q Fireplaces Garage: Detached Other Detached Structures: Pool /rO Attached C.2 Barn 0 None Sheds Other Builder Information Name pA4 ( Telephone Number Address �3 s a14 &O-C 1, License# y19 j]-16 - Home Improvement Contractor# © Q D Worker's Compensation# C T: l Z S / f NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO )=h SIGNATURE DATEAgel 171,94 BUILDING ERMIT DEN D FOR THE FOLLOWING REASON(S) J, f. FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED f' " MAP/PARCEL NO. t RESS VILLAGE ` w OW NER r r DATE OF INSPECTION: FOUNDATION r y FRAME' t J VA� 90b INSULATION = FIREPLACE • ELECTRICAL: ROUGH FINAL PLUMBING: r-'ROUGH FINAL GAS: �- (ROUGH FINAL FINAL BUILDING DATE CLOSED OUT + ASSOCIATION PLAN NO. '} , y TheCunrnrun>+•calllr uf?Itassackusctts •ri j -�� Department of IndustrialAccidena ;# •r?` 6 N1 If aship.-gim Street x�;�•; " ap ton.Afa= 02111 Workers, Compensation lnsumnee Affidavit Aitntican nformatin`n�. Please 1'R(NT Te,h © qe Alla 1 a i sit s• •P 1. V' !/ [ t, ,C L,T1 �l T. 1�`1 l� / Rhone t+ ��^/S/ Z �� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. ct+�nany name• address! tih,r_ Ithnne#t • insurance ce polio•# 1 am a sole proprieto •general contractor r homeowner(circle one)and have hired the contractors listed below who the following worke mpensation polices: cemnanv name: address: cit,•, phone#r incur•nee co notice!! Waco additionafsheei tftieee�a �+ w�, -+y�^�'r•� '"�-."•: :MIW-4 �: Failure to secure coverage as required under Section 3A of A1GL 153 can lead to the imposition of criminal penalties of a tine op to SIS00.00 and. une years'imprisonment as welt as civil penalties in the form of a STOP NVORK ORDER and a fine ofS100 00 a day against me. I undersmod the copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage veriQaalon. i do hereht•cerrif•an rite pains and penaidl ' rr that the in fibmavion prvrided above is tare and correct Sianmure— Oate , 7 Print name O one# Z2 r otticial•use only do not write in this area to be completed by city or town official city or town: permits cruse# r•t8uitdiug Department Oucensing Board cheek if immediate response is required aSeleetmen's Office (311aitb Department contact person: phone#t n0'ther�� information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for t. employees. As quoted from the "law", an employee is defined as every person in the service of another under an% contract of hire, express or implied. oral or written. An etnph rcr is defined as an individual• partnership, association. corporation or other legal entity, or any two or m the foregoing engaged in a joint enterprise, and including the legal representath-cs of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However owner of a dweiling house having not more cc than three apartments and who resides therein, or the oupant of the dwelling house of another who employs persons to do maintenance, construction or repair wort: on such dwelling l or on'the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empio, MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or reneival 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. dditionaily 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 been presented to the contracting authority. . .. .. - '�. .. •f.�t�f.[i • .��' ". ''... •,.�°i�`FSK::' t(�.•.w:,�V ar••9..... !_'iy::.'.iw�YcrM�g1."•,�li�...`i .'J.�..7;77�' Applicants Please `,H in the workers' compensation affidavit completely, by checking the boa that applies to your situation anc supplying company names. address and phone numbers as ail 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 requir( to obtain a workers' compensation policy, please call the Department at the number listed below. Gn• or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P1 be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be returnee 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 questiL please do not hesitate to `ive us a call. •.I- r: - . .fM!' '!Jr �!.•• yam,_ ..,! - The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents r. Office of Investigations 600 «'ashington Street - - Boston,Ma. 02111 fax#: (617) 727-7749 The Town of Barnstable MM& 1� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA OMM Ralph Cross= Office: sob 790-6u7 BnadiagCommi F= 308775 3344. For office use only . Permit no. Date AFFIDAVIT HOME IMROVEMENTCONTRACI'ORLAW SUPPLEMENT TO PERwr APPLICATION MGL c I47A requires that the"reconstruction.aitemtious renovation,repak moderntzadon,convemon, impmverne:tt,.removal, demolition. or eonsuucd= of an addition to any P owner 00cpic bniIcnt ding containing at least one but not more than four dwelling traits or to which are h to such residence or building be done by registered contractors,with certain c=ptions, along with other tequireme-um Type of Work: r=L Cost ` / Address of Work: Ov6mcr.Name: ;�' .►� 1^ c� S Date ofPermit Application: -S 7 J I herd)•certify that: Registration is not required for the following rtiason(s): Work coduded by law Job wader SI,000 Building not ow-er-o=cp cd Ow=P°ning own Notice is hereby gh=that: OWNERS PULLING THER OWN P DEALING W NUNIiE a �OT HAVE .ACCESS TO , FOR APPLICABLE KOUE 2"ROVEIAENT WORK ARBITRATION PROGRAM OR GUARANTY FM UNDER MGL c. I42A SIGYED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. ate Coa name Registration Z.zz Na OR ' ..- �� �� � �„I � � ��� /) � F y, � + .t t� • ' e . � '�� � 1 �� I� ,� � �`1 � � ''� r .� t �� a� �. � � • - LEI' � Y, . . �� � �� / t� !ram � � � ---- �` f � « � � � / .ram rr �..�o��� ♦_ �► ����� ► j j �� /� y: Assessors map and lot number / ......... F .....,o..............w� Py�f IN E T0� Sewage Permit number ..., . .. " ..../ /.: ...?...)4- Z 31AUSTAJIBLE i House number MMIL ........... /...................... BOO i639 9� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 1............... ' !� `�. �. :�....... �J/::. .. ........ TYPE OF CONSTRUCTION .......... © ... .ece NYIe.. ........................... .......................v..... ............................................19........ TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information: Location ( " ����/ C � �� � �� �`V/ v t s 1 (,� Proposed Use .......�/A j ..... .G. .�. ....... �` .� .�`.............................................. ./. ....,......................... Zoning District ��Ile . r �!.. ...............................Fire District .... ...... ..1 ��i?.....�.. ....... 1y SAS / �� �^ ',ter Name of Owner .....................��� ...1.�?. .: ...........Address ..�...!............U/ 7 .. ... C...............................:.�. I .. .. Nameof Builder ....................Address ........................... ..,..................i................................ Name of Architect ........... ...........................................` ! .........Address .............................. 1..`.................t....l.........Number of Rooms !........................... ......Foundation ...... u h Exterior ..4....... .........(.t..� / �f:.�..`�..... !...Roofing 4� //� Floorr"s 1/ Interior / C `... C ....................... ..1... .................................................................. �+ Heating `ti`/�. ` �... ............ .......Plumbing ....Z?.`.::`r J .. cQ,.?l.>yL ......................... Fireplace r" ` ................Approximate. Cost .,r�......................,..........., :............ /-71q 5.1 . Definitive Plan Approved by Planning Board _______----_____-----------19_______. Area P] Diagram of Lot and Building with Dimensions Fee .......r ......J ? ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of the Town/of Barnstable regarding the above construction. � / vlI Name ........ w ...... .... ... t / o 0 Construction Supeirvisor's License ................................ r COOI,ZDGE HOMES A=148-70 � 25784 One Story No ................. Permit for ------------ ' . , Single Family Dwelling -----.-----------.----.-..--.. . - ..` . � Lot 41 48 Warwick Way Location ................................................................ . - �� . . Centerville ---..---.--.---.--..----------. . ' Cc»olid Homes [�vnar ---��.���!�.�-..------.,---.. � ' ` Type of Construction IrzaConstruction -----me--------_ --------^-----------------'' ' ' Plot ............................. Lot - ---------- , - . � . November 10, 83 Permit Granted ---'--.....'�-----.lq � . . ' Date at Inspection -..----------.lQ _ � Date Completed 19 . ..��---,------ ' . � ~ g� ` � - ' - - � ' ' ' - ' � - � | I _ i %kin a v' IAFT - \ f l _ ' I f I ro 0 I _ i T i Assessor's map and lot number ........�.7..6...�..7 0.... ...�� /� / THE � oa to Sewage Permit number ... ........... .. 0d!/�. ........ d`' o" p D6DdSTADLL i House number ............................�............%�.�'...................... Mu6 �`•0 YPY a' TOWN OF BARNSTABLE BUILD NG� INSPECTOR APPLICATION FOR PERMIT TO .. . .. ,l�. 1� 4/l�/ / . l�{t „••.... TYPE OF CONSTRUCTION ..........41/�Cl.. . ....`...F..u.lne............................................................................... 11. .. ................19-99 TO THE INSPECTOR OF BUILDINGS: The undersigned ereby ap li/es for /a,�/pe[]rmitt according toy the following information: Location ............. �.( .........." .lj W.�.SI.' ..w. �� �UV�E�I//LL El .................... ......................... .... ............................ ProposedUse .......�,aA.1..y/, ........ .....................(...�p.......'.................. .... ............ . Zoning District ......1�,../!f/G/..t1l t..�. .........................Fire(/District .....0/../.�. V.l./�... ..� Name of Owner ....CQO..! !.6Q....bo' .Ae5...........Address .. .1./.... /..!!�..L... .�°.� / ....... Y......L:. Name of Builder .....4.Lv...jj.... .OVe Ql.....................Address ..........I, I.......................................................................... Name of Architect 1 \ 1 I .........................................1 \ \ ` \ t I........................................................ .........Address .. . Number of Rooms ......... .................. ............. ..........Foundation ..... L' [` d... ... ei.C/E Tf� Exterior .. A.�. 1 .... ...Q./~...... /!/Il 9 /,,. ...Roofing ....//. �•. ��f,u/...�..... �1.1.h ... ,1 ............ UU (,t �J G(/!��...Interior .... �...................... "�'..G /e:. .. ....................... Floors .......... T .......... ............... . ..... .. Heating �.f.( .../ ...........................Plumbing l g .......... oo ............ .... ..Q... . . / .... .......G.................. . .............................. Fireplace ...... .f-:. 1'/... . . ./1...�!'tC( •� ....................Approximate Cost ........... �1.0.(J.Ur.. ................ .......... Definitive Plan Approved by Planning Boar _______--------__—-----------19_______. Area r �.1.....1.: . Diagram of Lot and Building with Dimensions Fee . .. ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 \ �� � \a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town o Barnstable regarding the above construction. Name ......... ..�... ..... . ........................................... Construction Supervisor's License �! .. n�Q. .......... �COOLIDGE HOMES �No ..2. 764 Permit for ..... ne,,,Story,....... Single„Famil y,,,Dw,�a r}g,,,,,,,,,,,,, Location .Lot,,,4.1A.......4.8...W.arxick...way. .. ................Centel:yid .a.................................. Owner ...COOldg. ... ].P.IItG'S.......................... Frame Type of Construction .......................................... ................................................................................ ' Plot ............................ Lot ................................ Permit Granted November 10, 1 q 8 3 ..................... ....... Date of Inspection ....................................19 Date Completed .. Q ......6..............19'/ C,P. l S f p„m• . TOWN OF BARNSTABLE 25764 Permit No. ------------------------------ .` 1 DAU3TAU Building_ Inspector cash WY6 A•Oyp. x OCCUPANCY PERMIT Bond `� ---- Issued to Coolidge Homes _ Address,. Lot 41, 48 WarWvirck ,Wafy, 4Qentervi11e. . Wiring Inspector u� ,�/ Inspection date Plumbing Inspector, .4•,/ ' \ Inspection date i �v /� l Gas Inspector R f ✓rf' -t�rsaaL Inspection date f3Q Engineering Department Inspection date f /io L? s ' j���- r f Board of Health +-,-� eC Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. �f EGG -��- e7 19 !... . . . .............................. t`/' Building Inspector f FROM .. TOWN OF BARNSTA13LE Mr. Francis Laht i •' _ BUILDING DEPARTMENT Town. Clerk r , «, .,9 '� » w « 367 MAIN STREET HYANNlS, MA 026 Phone: 775-11 ZO SUBJECT: ' FOLD HERE DATE zanuary 17 198V AA E'S S A G E - H Work has ,been completed nde�j . : ►kt � 2.5,7gf,4.,(,Caal�.dge, o ,mes ) Please lrelfetdgel"�R=d' S r DATE v F .. V REPLY r SIGNED Y Ne7-RM1 RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY i PRINTED IN,U.S.A. SENDER:.SNAP OUT YELLOW COPY.ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. GOT` 4? q 4.1 GAT 4 l V i of 4m 6Ore 7- c77- 1 r Nt�C�dlr CE+,E'T/.GY TNi4T 7-AV asCc%c/� i43 --rA*V*VA.' NG'tBq�I AUvD TNAgT /T C©AA-40G/-'1'. 7 770 W, 7bsvv oF' YRie/v?O UTN , 1*'?A S S ,�,,;qre► Y GEM31AL NOTES SEPTIC SWIM COIII t11UCilON NOTES: 1) THE NTi NT OF THIS PLAN 61D DMA SEPi1C SYSTEM REPAIRAT LOCUS THIS PUN iS NOT To BE W P i' 1. ALL SYSTEM COMPONENTS SHALL. BE INSTALLED N ACCORDANCE WITH TITLE V OF THE STATE SANITARY CONSTRUED AS A PROPERTY LINE OR EXISTING CONDITIONS SURVEY. CODE DATED 4/21/06. AS AMENDED THROUGH THE DATE OF THIS PLAN, & ANY LOCAL RULES A: / OR COMP A LOCUS REA 5RISED REGtAATiONS APPLICABLE 2) � CA" oT � � 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED Mr WRITING BY THE ENGINEER. ELEVATION INFORMATIONZONE RC WITH GP OVERUY MUST NOT BE CHANGED WITHOUT WRITTEN PRIOR APPROVAL BY THE ENGINEER. A�OR'S MAP 148 PARCEL 070 3. WHEN EXCAVATION FOR SAS iS COMPLETE; PRIOR TO INSTALLATION, NOTIFY OEM ENGINEER FOR THE PROPERTY LINE WMM710N 6AS SHOWN PER THE DEED RECORDED AT THE BW67ABLE aX NiY REGISTRY T INSPECTION. ' Mnr _ OF DEEDS IN PLAN BOOK 350 PAGE 55, DATED .MMIARY A1981. ti e lxr�? l J • 3) OWNER AMW LAMM 4. WHEN CONSTRUCTION !S COMPLETED. PRIOR TO BACNffNJ.NrG. NOTIFY THE BOARD OF HEALTH AGENT' 48 WARM WAY T AND DESIGN ENMNEER FAR INSPECTION. cl / J AN Om 4. ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4' SCHED 40 PVL:. UNLESS OTHERWISE NOTED HERON.LA �tr 4) PROJECT BENCHMARK S. EXCAVATE UANSLNTABLE MATERIAL AS NOTED, TO THE •C HORIZON' , FOR A HORIZ. DISTANCE OF 5' CONCRETE BOUND HOLE FOUND SOUTH EAST CORNER OF PROPERTY 5URR�OUNDNVG THE LFl�NMG FIELD, AND REPLACE WiTH CLEAN SAND PER 310 CMR 15.255 TO THE LOP E1EY � ��, �L ELEVATION OF THE SAS. 1� PERFORMED BY BOXIER-M'E NVSUTATE ALL PIPES AGNNST FREEZING AS REQUIRED WHEN LESS THAN 3' OF COVER. 5� �qr wRgN 19 2009�AND FROM GIS IrFORMA710N OBTMED FROM THE TOWN OF BARNSTABLE GIS DEPARTMENT. THE GIS N MOWN IS APPROXOTE IF ANY E7OW WORT RMATiON SI�ION�N iS DEiEIWO TO BE 7. THE SEPTIC SYSTEM DESIGN ] INCLUDE GARBAGE GRINDER I�IAOCLJRMIE OR N CONFLICT WITH THE THE CONTRACTOR SHALL CONTACT fit �F� G / CIY� IRRIGATION CONTROL BOX DESIGN, ACT THE E1r(INI:TR N6EDMTELY FOR 0 & MMON: THE CONTRACTOR SHALL CONTACT DiG SAFE AT 1-888-W- MID UTILITY COMPANIES TO IF"MD PEE REDESIGNL 5 LF - 4" SCH. 40 --/ 31 _ J , _ � � _ -- N. LOCATE..ALL E>aSTpMG U1>rJTESr AT LEAST 72 HOURS BEFORE THE START of 00NSTRUCTTONI. THE /\ PVC O S-1.0R / / ��` ` \s6 - CONTRACTOR SWILL DETERMINE THE EXACT LOCATION, BOTH HORIZONTALLY AND VERTICALLY, OF ALL 6) CO1IMWTY PANEL MJM� 250001 W15 C OF THE FLOOD INSlAWM RATE MAP DE WES THIS AREA AS LOCUS MAP NOT TO SCALE TP ExrsrlNc urnmFs BEFORE THE START of ANY WORK. THE LOCATION of txNssTING UNDERGROUI S / ARE SHOWN IN AN APPROXMMTE WAY ONLY, MAY-Nor BE-L m-m THOSE SHOWN HEREON � UTILITIES ZONE u:, AREA OF MMIOML FLooDIrG ( 5 lF ^� 4 SCH. 40 X APPROXIMATE LOCATION NOT BEEN INDEPENDEMLY VERIFIED BY THE OWNER OR ITS RIPRt;MAP& Tim CONTIR�TL?I� TO � DIVIRONMENIAL INFORMATION: y% OF SEPTIC COMPONENTS PVC O S�-t.O�C i BE FULLY RESPONSOLE FOR ANY AND ALL DAMAGES WHICH WWII BE OCCASIONED BY THE CO TRACTOR'S • SITE IS NOT WITHIN AN AGEC. (AREA OF CRMTiCAL ENVIRONMENTAL CONCERN). FAILLIRE TO LOCATE THE UTILITIES EXACTLY. F ELEVATION INFORMATION DFFERS FROM PLAN INFORMATION./ DOSTiNG SEPTIC SYSTEM TO BE _ i / \ THE CONTRACTOR SHALL NOW THE ENGINEER IMMEDIATELY FOR-POSSIBLE REDEW AT UTILITY PUMPED. ABANDONED. REMOVED AND WILDLIff PER [PROPERLY DISPOSED of OFF CROSSINGS, VERIFY IN FIELD THE LOCATION / INVERTS OF ELECiiRIG, GAS, TELEPHONE & oNTADATA/COWAND NMESP MAP OCTOBERR 1, 20M 'ESIMATED HANTATS OF RATE WiLDLFr RELOCATE AP�RE�ERVECONFLICTING WITH PROUND SEDI UTILITIES REQUIRED.TAD. ENGINEERS DIRECTION. THE CONTRACTOR FOR USE WITH THE w WETLANDS PROTECTION ACT' REDl1LATIONS (310 CMR 10).- SHALL,� #2 /,�r -SCH- 40 �� 9. THE PROPOSED UTILITY CONNECTIONS SHOWN HEREON ARE SCHEMATIC. FINK. LAYOUT SHALL BE AS •'�CEs7EED NOT PEA ( RTiFiED VERNAL POOL PER NIESP MAP OCiDBER 1. 2006 12 O s 410% 0 - 4" SCH. 40 c DETERMINED BY THE APPROPRIATE UTILITY COMPANY.PROPOSED O S-5.65X \o •S SiTE IS NOT WIFOI A PRIORITY HMBTDiT PER N4E5P MAP OCTOBER 1, 2006 "Off 1500 GAL OON CT PROPOSE) PIPE �$i �ti HMBRATS OF RARE SPECIES FOR SPECIES UNDER THE wSSACIIUSEITS ENDANGERED SEPTIC TANK `\TO G OUTLET s� vo a�F SP�y SPECIES ACT, REgXAT10NS (321 CURIO). \ / �� /`' o� j. o�'coa • SITE IS NOT W ININ A ZONE I (WIELL)IEAD ZONE OF CON 1WITiON) . EXI W SEPTIC SYSTEM IMRWTION OBTAINED FROM THE TOWN OF BARNSIABLE AS-BUN.r CARD J83-969, DATED 11/28/A RECEIM ON MARCH 11, 2009. • BMW ELECTRIC L /SMILE SHOWN ON THIS PLAN WAS LOCATED BY DNGSAFE ON 31311M. So oo� i . COW WMI R SERVICE SHOWN ON THIS PUN WAS PRMED BY C-O-W WATER \ / DEPARTMENT. FAX DATED iNARCH 25, 2009, SKETCH DATED 11/8/$3. . OEM GAS SERVICE SHOWN ON THIS PUN WAS PROVIDED BY NATIONAL GRD RECIINED APRI. 1, 2009. dD i"S FINISHED GRADE 36"MAX.-9"MIN./y �COMPAC� LL.\ TOP OF CHAMBER 2" LAYER DOUBLE WASHED STONE 1/8" TO 1/2" PIPE INVERT � / \ 80L LOOS - DATE a/BM L90L LOAL3 - DATE SAMDO OR GEOTEXTILE FABRIC PER 310 CMR 15.247 o� c� \� / BON EFFECTIVE MRNSTABLE CLEAN SAND y \ I // cF DON DESMARAZIS, RS . PER 310 CMR SOIL EVAL 15.255 . . � -;^ Y � / BENCHMARK' STEPHEN MUSON, PE / EL 5&4g TEST PIT 1 TEST PIT 2 SECTION / G.S.E = 56.0 � G.S.E. = 56.0 NOT TO SCALE `o iF o / P� � \ �'"�' / Ap ; 1 OYR 2/1 ; SANDY LOAM Ap ; 10YR 2/1 ; SANDY LRAM \ �P / 81 ; IOYR 5/4 B ; 1OYR 5/6 ADS-BIODIFFUSER 160OBD (OR EQUAL) / FiLL (SAND LJ AM f) � LAY-UP LENGTH 76" PER UNIT \� _ o VEL SANDY LOAM 8- 55.33 20• �V .54.33 48 Warwick Way, Centerville Ma B2 ; IOYR 3/4 C ; 1OYR 5/4 PREPARED FOR FiLL (SAND LOAM W/ COURSE SAND 40• (ELE„ 52,67) °RNA) CAPEWIDE ENTERPRISES RESERVE AM ,�. (�,, °) 2.L3'RESERVE AREA 7 1 ��� �P C ; IOYR I6 4 P.O. BOX 7639 CENTERYILLE, MA 02632 2.8 DIST. LINE IN DIET. UNE IN .,o s » BIODIFFUSER 1 sooeo (OR 5 » BtoaFFusER i 60oe0 (OR �� �y COURSE �OF LT 308.42!8"4028 LOAM) / 128' (10" 45.33) TITLE EGLAUD BOX LEACHING CHAMBERS LEACHING CHAMBERS / \ \ No WATER oesExvED �0 4s°�° TO°j20 REPAIR PLAN FOR / \�� ' TO 128 , ELEV 45.33 31.67 r - 31.67 RATE 2 MTN/IN � ON-SITE SEWAGE DISPOSAL SYSTEM / iCLASS;:T-.SOIL PLAN VIEW // \ I CERTIFY THAT ON 7/1%7. 1 HAVE PASSED THE SOIL EVALUATOR L7UIMINATiON \ � BA►X'TER NYE ENGINEERING & SURVEYINGNOT TO SCALE \ \ APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL: PROTECTION AND THAT THE TYPICAL EWSTEM PROFILE ys°� �1 'I \ \ ABOVE ANALYSIS WAS PERFORMED BY ME CONSISTENT WITH THE REQUIRED NOT TO SGALE c �\ TRAINING, EX AND D(PERIENCE DESCRIBED IN 310 CMR 15.017 Registered Professional Engineers and Land Surveyors NOTEs: _ LOADING IF PLACED / �. (r 78 North Street- 3rd Floor, Hyannis, Massachusetts 02601 1. ALL MATERWS SHALL. MEET H 20 SIGNATURE DATE �t �I WITHIN 10 FT OF it ROADWAY OR DRIVEWAY. / Phone- (508) 771-7502 Fax - (508) 771-7622 LEACFNN(� AREA QW-Ekaffs SH OF 41,1' \ NITROGEN LOADING UMiTA77ON: NA S TOP OF FPM FLOOR SET FRMAES & COVERS TO wRMN FLOOR ELEV - 59.3 C OF FINISH GRADE. RISERS t RESIDENTIAL- 3 10 0 10 20 o M D. N ` EXiST. GRADE = 57.0 COVERS SHALL BE WATER 1GHt / x 110 SCALE IN FEET o.46345 C GPDf FNIISHn GRADE OVER TAW - SQS TOTAL DESIGN FLOW - 330 GPD 1"=10' ' SE FI � a• 000 OW On � - � GARBAGE GRINDER (NOT INCLUDED) = N/A �ss G"�0 N A L 'G\� 4• SCH 40 PVC 3• MK COVERS SMALL BE EATERTi ff RL I, 26' S.&85% (1.0x MN Mom) 2 LF»4•SCH 40 PVC �t.oac F01M GId DE D. WK - S&O sY ®caw 94STAlL ONE 9YSPDCTIWIITIHON PORT ~ LTAR RATE _ <5 MIN. ,Ll�y (CLASS 1) �, INN. 3r(„ O>�.► LIAR = 0.74 GPD/S.F p ASSUMED EXIST. INv OUT - 55.97 INV W- 54.5 1O' 1f1. W OUT- 4MM Y 1AYER DOLIeLF WASHED STONE �� MIN. iNG AREA OF S.A.S. REQUIRED: CONTRACTOR To VEFi1FY PVC 1 T3• m 1 OR GEOrTEXTLE s » 81oDIFFtlgER /e008o (OR CONTRACCTION - ERF SEE � � BAFFLERau 330 GPD/ 0.74 GPD/S.F. a 44s S.F. MIN. / DATE: 04/02/09 IN FlELD PFtlCR TO � 5 �.� � � �1� � FABRIC 310 CMR ts.247 � PROPOSED SYSML GENERAL NOTE /5. 14• �: 12' RAST r (ro BE 4•SCH 40 PIC LEACHING CWiMBERS/ M CONFKK�t11RATi0N, 5 GiAMBERS PER TRENCH RSWORCm CONCRETE 6•0BASE r �' 4•Sal 40 PVC CWMNR W W- 53.92 54,14 ;,I SAS: 2 TRENCHES 0 31.67' L x 2.8' W x 0.942' o cm , - SuriP our WmBOr. EFFECTIVE AREA: 1 s7(2.83' + (2 x 0.942)) x 63.3 = 498 SF No. BY DATE REMARKS TAWTOTAL EFFECTIVE LEACHING AREA = 498 SF DRAWING IVUMiBER We o N000 e� UMRWABLE SOILS IF EwOOUIRT m NEW 4' MIN SYSTEM DESIGN WACiTY - 498 SF x 0.74 GPD/SF = 368.5 GPD To SWW TANK m BE NoarED & aFN+m NIAKLY THE m 7 ELEV )' SHALL SEPTIC TANK SIZING: 330 GPD x 200X = 660 GAL 0:\2009\2009-011\CAL\PL0112009-011-SEP.DWG RHE PEA To TIE 'C IIORIzoN' As RSgA L NO GROUNDWATER TO ELEV 45.33 DIT3I MU I ION BOX - SEE CONSTRUCTION WM /s FIEIlEAN. TO BE 96TA2 M ON A STWE RASE USE 1500 GALLON TANK MIN. - - JOB �2009-011