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0 00 a r as' achusetts Department of Environmental Protection Bur u of Resource Protection - Waterways Regulation Program x267750 Transmittal No. Chi ter 91 Waterways License Application -310 CMR 9.00 ate i Dependent, Nonwater-Dependent,Amendment . Junicipal Planning Board Notification Notice to Matthew G. &Sarah K. Fair Applicant: Name of Applicant Section H should 1001 West Main Street Long Pond Centerville be completed and Project street address Waterway City/Town submitted along with the original Description of use or change in use: application material. To permit and maintain a seasonal pier. To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans have been submitted by the applicant to the municipal planning board." Ap i A,:0,:) p Printed Name of Municipal Official Date f c)C,2 ature otWunicipal Offici I Title City/Town Note: Any comments, including but not limited to written comments, by the general public, applicant, municipality, and/or an interested party submitted after the close of the public comment period pertaining to this Application shall not be considered, and shall not constitute a basis for standing in any further appeal pursuant to 310 CMR 9.13(4)and/or 310 CMR 9.17. C CH91A .doc•Rev.08/13 pp Page 7 of 13. ATI Evaluation Service A Division of Architectural Testing —Certification Services Code Compliance Research Report CCRR-0187 Subject to Renewal: 11/29/2015 Issued: 10123/2013 Visit www.ati-es.com for current status Page 1 of 12 CertainTeed Corporation 3:3.1 Top rails are T-Rail profiles 3 inch wide 750 E. Swedesford Road at the top, 1-3/4 inch wide at the bottom and t Valley Forge, PA 19482 approximately'3.5 inch tall. 800-233-8990 3.3.2 Bottom rails in all systems are.a 1-3/4 www.certainteed.com inch wide by 3.5 inch tall rectangular profile. 1. Subject 3.3.3 Balusters supplied in the three styles Oxford Vinyl Railing System identified below. Rails are routed to the shape of the baluster profile to receive balusters. See 2. Research Scope Table 2 and Table 3 for uses. 2.1 Building Codes: 3.3.3.1 Spindle = thermoformed PVC, 1-1/4 2012 International Building Code(IBC) inch square cross-section and thermoformed to a turned spindle through the middle of its length 2012 International Residential Code (IRC) with a nominal wall thickness of 0.105 inch.. 2010 Florida Building Code(FBC), 3.3.3.2 Picket — co-extruded PVC, 1-1/4 inch ' excluding High Velocity Hurricane Zone(HVHZ) square along the entire length with a nominal wall thickness of 0.105 inch. 2.2 Properties: Structural Performance 3.3.3.3 Glass balustrades—4-1/8 inch wide by 38-1/4 inch long by 0.32 inch thick tempered Durability glass with two angled corners. Surface Burning 3.3.4 An extruded 6005-T5 aluminum insert 3. Description - provides reinforcement in the top and bottom rails. The 'Light U" aluminum insert is used in 3.1 General The Oxford Vinyl Railing the bottom rail for rail lengths as specified in Systems are guardrails (guards) under the Table 2 and Table 3. The "Heavy U" aluminum definitions of the referenced codes and are insert is used,in top rails for all rail lengths and intended for use on elevated walking areas in bottom rails.for rail lengths as specified in Table buildings and walkways, including stairs and 2 and Table 3. See Figure 5 for aluminum insert ramps, as required by the referenced codes. profiles. 3.2 Guard systems are provided as level . 3.3.5 Top and bottom rails are connected to guards for level walking areas such as decks, posts using external or internal metal brackets, balconies and porches, and sloped guards for as defined in Table 1—Fastening Schedule. open sides of stairways. 3.3.6 The Oxford Vinyl Railing Systems are 3.2.1 Level guards are provided,in lengths up attached to conventional wood supports, the EZ- to 115-1/2 inch between supports and overall Set post mount, or The Mount (also known as heights up to 42 inches. See Table 2 .and the LMT Blu-Mount). A 4 inch square PVC post Table 3. sleeve is used as non-structural cover for 3.2.2 Stair guards are provided in lengths up to conventional 44 wood posts which are outside the scope of this report or, as a structural 114-1/2 inch between supports projected along the stair slope and 42 inch high projected support post when installed over the EZ-Set post Vertically. See Table 2 and Table 3. `. Lnount or The Mount. See Figure 7 through o-017ig.are�, Q 3.3 Materials and Processes Oxford Vinyl Railing- Systems, are an, assemblage of co-extruded and molded components utilizing almond, clay and white Poly. Vinyl blor;ide (PVC) material with aluminum reinfofc`eimlr�t I � v and metal mounting Systems.stems consist Y - of the following components: � 0 i Architectural Testing 130 Derry Court® York; PA 17406 717-764-7700 www.archtest.com f /REV .. - Code Compliance Research Report CCRR-0187 Page 2 of 12 3.3.7 The EZ-Set post mount may be utilized 4.4 Materials used in the Oxford guardrail for installation to concrete or structural framing system have a flame spread index not greater of a wood deck. EZ-Set post mount nylon inserts than 200 when tested in accordance with ASTM serve as spacer blocks located at the top and E 84, as required by the reference criteria, bottom rail attachments. Alternatively, the EZ AC174. Set metal bracket and railing lock plate may 5. Installation serve as a spacer. See Installation outlined in Section 5.0 and Conditions of Use outlined in Installation shall be in accordance with the Section 7.0: manufacturer's .installation instructions and this report. Where differences occur between this 3.3.7.1 The EZ-Set post mount for.concrete installation consists of a 1.68 inch diameter report, and . the .manufacturer's installation instructions,this.report shall govern. galvanized steel pipe permanently welded to a 3.5 inch square by 5/16 inch thick galvanized 5.1 Railing. assemblies consist of top and steel base plate. See Table 1 fastening bottom rails with pre-routed holes to receive schedule. balusters. Aluminum railing reinforcements are 3.3.7.2 The EZ-Set post mount for installation inserted in the rails during assembly as specified in structural framing of a wood deck consists of for the type and length of railing (see Tables 3,& a 1.68 inch galvanized steel pipe permanently 4). Aluminum insert lengths must be the same welded to a 4.5 inch high by 3.5 inch by 3.5 inch length as the PVC railings to assure bracket (1/4 inch thick) °L" shaped galvanized .steel screws penetrate the aluminum inserts. plate. 5.2 Railings are secured to sleeved 4x4 wood 3.3.8 The Mount is utilized for installation to posts,the EZ-Set post mount, or The Mount with concrete. PVC guide blocks serve as spacer metal brackets and stainless steel screws. The blocks located at the to and bottom rail wood in the supporting structure shall have a p- — - specific gravity of 0.50 or greater-(Southern attachments (see Figure 9). See Installation Yellow Pine or better) and a minimum thickness outlined in Section 5.0 and Conditions of Use to allow full penetration of the bracket mounting . outlined in Section 7.0. screws. Rail attachment shall be in accordance 3.3.8.1 The Mount installation for concrete with Table 1. installation consists of a 2 inch square 10 gage 5.2.1 The EZ-Set post mount uses two types of steel tube post permanently welded to a 3.5 inch - square by 5/8 inch thick galvanized steel base rail attachments. plate. See Table 1 for fastening schedule. 5.2.1.1.Two nylon blocks are held in place by a -20 x 2.75 inch hex bolt and nut through 4. Performance Characteristics 1/4 predrilled holes in both the blocks.and the steel 4.1 The Oxford Vinyl Railing System described center posts. There are two block. assemblies in this report has demonstrated the capacity to. per each EZ-Set post mount. Once the blocks resist the design loads specified in Chapter 16 of are installed, the PVC sleeve is assembled over the IBC and FBC, as well as SectionR3.01 of the the EZ-Setpost mount.• IRC when tested in accordance with ICC-ES 5.2.1.2Two EZ-Set aluminum brackets. are AC174 for uses limited to One- and Two-Family clamped to the center post with two 1/4 inch x 2- Dwellings. 3/4 inch steel hex bolts and nuts. There are two 4.2 Structural performance has been - of these assemblies per each EZ-Set post demonstrated for a temperature range from mount. Once the bracket assemblies are -20OF to 125°F. installed, a PVC sleeve (routed to fit the top and 4.3 Materials used are deemed equivalent to bottom rails)is assembled over the EZ-Set post preservative treated or naturally durable wood mount. The stainless steel railing lock plate is for resistance to weathering effects, decay, and: inserted over the steel center post, for attack from termites. attachment to the top rail. 5.2.2 The Mount utilizes a PVC guide, held in place by a #10-16 x 3/4 inch self-starting, pan- head sheet metal screw. There are two PVC guides per each.mount. Once the guides are Architectural Testing 130 Derry Court. York, PA 17406 71.7-764-7700 www.archtest.com A TPES Code Compliance Research Report CCRR-0187 Page 3 of 12 installed, the PVC sleeve is assembled over The 1.Conditions of Use Mount. The guardrail assemblies identified in this report 5.3 The EZ-Set post mounts shown in Figure 7 are deemed to comply with the intent of the and 8 are anchored to suitable structural support provisions of the referenced building codes framing within a wood deck system or anchored subject to the following conditions: to concrete with approved anchors. 7.1 Guards recognized in Table 3 regulated by 5.3.1 The wood deck installation for the EZ-Set the IBC or FBC are limited to exterior use in all post mount utilizes four 1/2 inch diameter construction types where wood is permitted in galvanized carriage bolts to attach the structural accordance with Section 1406.3 of the IBC and wood framing and the"L"shaped anchor plate. FBC and in One- and Two-Family Dwellings 5.3.2 The EZ-Set post mount concrete surface regulated by the IRC. Guards recognized in mount installation utilizes four 1/2 inch anchor Table 2 are further limited to use in One- and bolts. The type and length of the anchor bolts is Two-Family Dwellings(IRC). dependent upon the material and condition of 7.2 Conventional wood guardrail supports the supporting structure and is not within the` including 4x4 posts, and framing are not within scope of this report. See Section 7 Conditions of the scope of this report and are subject to Use for additional requirements. evaluation and approval by the building official. 5.4 The Mount shown in Figure 9 is anchored Supports must satisfy the design load to concrete with approved anchors. Concrete requirements specified in Chapter 16 of the IBC surface mount installation utilizes four 3/8 inch and FBC. Supports and framing must provide anchor bolts. The type and length of the anchor suitable material for anchorage of the rail bolts is dependent upon the material and brackets and post mount, respectively. Where condition of the supporting structure and. is not required by the building official, .engineering within the scope of this report. See Section 1 calculations and details shall be provided. Conditions of Use for additional requirements. 7.3 Concrete anchors and anchoring systems 6. Supporting Evidence for use with the EZ-Set post mount and The Mount are not within the scope of this report and 6.1 Manufacturer's drawings and installation are subject to evaluation and approval by the . instructions. building official, Anchors must satisfy the design 6.2 Reports of testing demonstrating load requirements specified in Chapter 16 of the compliance with ICC-ES AC174, Acceptance building code and must. meet the following Criteria for Deck Board Span Ratings and minimum requirements: Guardrail Systems (Guards and Handrails), 7.3.1 A minimum of four anchor bolts must be approved January, 2012 with additional testing used and located in the four pre-drilled holes in including increased test loads to address IBC the post base plate. and FBC Section 2407.1.1 for assemblies that 7.3.2 The anchors must be stainless steel, utilize glass balusters.. galvanized steel or other approved material 6.3 Reports of testing and engineering analysis compatible with the steel post mount system. demonstrating compliance with the performance 7,3.3 The anchor bolts must have a minimum requirements of ASTM D 7032-08, Standard diameter of 1/2 inch, for the EZ-Set post.mount, Specification .for Establishing � Performance or. 3/8 inch, for: The Mount,. and utilize flat . .Ratings .for Wood-Plastic Composite Deck washers. The type and ,length of the anchor •Boards and Guardrail. Systems (Guards . or bolts is dependent upon the material and Handrails): condition of the supporting structure and is not 6.4 Quality control manual demonstrating within the,scope of this report. compliance with ICC-ES AC10, Acceptance 7.3.4 When the supporting structure is a wood ' Criteria for Quality Documentation, effective framed deck, installation must include January 2012. anchorage ' to suitable structural framing. Decking is not considered structural framing, and anchorage to decking alone is not an approved installation method. Architectural Testing 130 Derry Court o York, PA 17406 717-764-7700 www.archtest.com A TI-ES Code Compliance Research Report CCRR-0187 Page 4 of 12 7.3.5 Where required by the building official, 7:9 The Oxford Vinyl Railing System is engineering calculations and details shall be manufactured in Buffalo, NY in accordance with provided. The calculations shall verify that the the manufacturer's approved quality control anchorage and supporting structure complies . system with inspections by Architectural Testing with the building code for the type and condition (IAS AA-676). of the supporting construction. 8. Identification 7.4 Any component or configuration not The Oxford Vinyl Railing System is produced in identified in this report has not been evaluated accordance with .this report shall be identified for performance and/or compliance to the �referenced codes. Identification of such with labeling on the individual components or the components with the CCRR program mark or packaging that includes the following information: number is prohibited. 7.5 Only those types of fasteners and 8.1 The.following statement: "See CCRR-0187 fastening methods described in this report have at www.ati-es.com for uses and performance been evaluated for the installation of the Oxford levels." Railing System; other methods of attachment 8.2 The phrase: "For Use in One- and Two- are outside the scope of this report. Family Dwellings Only" for the applicable 7.6 Compatibility of fasteners and other guardrail systems. See Table 4. t installation hardware with the supporting 8.3 The Architectural Testing Code construction including treated wood is not within Compliance Research Report mark and number the scope of this report. (CCRR-0187) 7.7 The glass balustrade of guards is 9. Code Compliance Research Report Use considered a hazardous location as defined by 9.1 Approval of building products and/or Sections 2406.4 of the IBC and 2406.3 of the materials can: only be granted by a building FBC. Glass must be identified by permanent etching as required by Sections 2406.3 of the official having legal authority in the specific . IBC and 2406.2 of the FBC. Each section of jurisdiction where approval is sought. glass must bear the manufacturer's name or 9.2 Code Compliance Research Reports shall mark and the acceptable test standard. (Class A: not be used in any manner that implies an of ANSI Z97.1-2009 or Category II of 16 CFR endorsement of the product :by Architectural 1201) Testing. 7.8 Guards utilizing glass balustrade are not 9.3 Reference to the Architectural Testing approved for use in wind-borne debris regions internet web site address at www.ati-es.com is as defined by the IBC in accordance with recommended to ascertain the current version Section 2407.1.4. and status of this report. Architectural Testing 130 Deny Court e York, PA 17406 717-764-7700 www.archtest.com CertainTeed [91 Technical Documentation Commodity Code: See Table ' QUALITY MADE CERTAIN, satisfaction gusrentood. I - Description and Part Name: Double Angle Glass Baluster CertainTeed Corporation . Document Title: Glass Balusters Revision:A Pipe and Plastics Group `Document Type: Purchasing Specification Drawn Date: 09/15/2006 750 East Swedesford Road ; Control Number: Valley Forge, PA 19482 I Effective Date: 09/15/2006 610-341-7000 Section: .Glass Balusters Drawn By: Rick Magargal 1 . 000+0 . 063 4 . 125 ±0 . 025 Round Sharp Corners 1/16" 6 places _ A Bevel Edges 3/32 @45° 12 places 32° +1° 3 . 25 max. T ANSI mark (White Lettering) "ANSI Z97 . 1-2004" o 0 +f 0 In IN - OD M DETAIL A 8mm Tempered Glass SCALE 1 1 . 2 BPCS Description Catalog # 607911026046 RLG OX/CAM GLASS 38 .25 CL FE71370 607911026053 RLG OX/CAM GLASS FILL 38 . 25 CL FE71370F 607911026060 RLG OX/CAM GLASS 38 . 25 G FE71370G 607911026077 RLG OX/CAM GLASS FILL 38125 G . FE71370FG ©CertainTeed Corporation Confidential Document Do not distribute to unauthorized personnel Fwd: safety glass. Page 1 of 1 From: Boilard, Chris A. <Chris.A.Boilard@saint-gobain.com> To: massbuilding<massbuilding@aoI.com> Subject: Fwd: safety glass Date: Wed,Aug 6,2014 12:36 pm Sent from Divide managed by MobileIron ---------- Forwarded Message -------- From: "blucher, Doug L" <Doug.L.Mucher@saint-gobain.com> Date: Aug 6, 2014 12:19:47 PM Subject: safety glass To: 'Boilard, Chris A." <Chris.A.Boilard@saint-gobain.com> TEMPERED GLASS meeting the requirements of CPSC 16 CFR 1201 Cat l & II and ANSI Z97.1.72009 is defined as a SAFETY GLASS PRODUCT suitable for category l & II architectural safety glazing in the United States of America. Only glass fabricated by Precision Glass Bending, and issued with an individual permanent logo or certificate stating it has been tempered to meet the aforementioned requirements, is certified to be tempered with the Category I & II safety glass deSignation. Doug Mucher Marketing Manager CertainTeed Fence,Railing,Deck,&PVC Trim Products 231 Ship Canal Parkway Buffalo,NY 14218 1.800.333.0569 Ext 227 Doug.L.Mucher@saint-gobain.com Cev tainTeed 5ANT H ilk http://mail.aol.com/38683-216/aol-6/en-us/mail/PrintMessage.aspx 8/6/2014 I MEMBER REPORT Level,2 Ply 16"SLIDER:Header ®� Y PASSED 2 piece(s) 13/4"x 16" 1.9E Microllam® LVL Overall Length:16'9" 0 0 i 0 All locations are measured from the outside face of left support(or left cantilever end).All dimensions are horizontal.;Drawing is Conceptual Design Results Ach I @ Location Allowed Result LDF Load:combination(pattern) System:Wall Member Reaction(Ibs) 8860 @ 3" 11419(4.50") Passed(78%) -- 1.0 D+0.75 L+0.75 Lr(All Spans) Member Type:Header Shear(Ibs) 7053 @ 1'8 1/2" 13300 Passed(53%) 1.25 1.0 D+0.75 L+0.75 Lr(All Spans) Building Use:Residential Moment(Ft-Ibs) 34921 @ 8'4 1/2" 38893 Passed(90%) 1.25 1.0 D+0.75 L+0.75 Lr(All Spans) Building Code:IBC Live Load Defl.(in) 0.475 @ 8'4 1/2" 0.542 Passed(L/411) 1.0 D+0.75 L+0.75 Lr(All Spans) Design Methodology:Aso Total Load Defl.(in) 0.807 @ 8'4 1/2" 0.813 Passed(L/242) 1.0 D+0.75 L+0.75 Lr(All Spans) Deflection criteria:LL(L/360)and TL(L/240). Bracing(Lu):All compression edges(top and bottom)must be braced at 2'3 7/8"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Bearing Loads to Supports(Ibs) Supports Total Available Required Dead Floor Roof Total Accessories Live Live 1-Trimmer-SPF 4.50" 4.50" 3.49" 3647 2680 4271 10598 None 2-Trimmer-SPF 4.50" 4.50" 3.49" 3647 2680 4271 10598 None Tributary Dead Floor live li Roof Live Loads Location Width (0.90) (1.00) (nows.1.25) comments 1-Uniform(PLF) 0 to 16 9" N/A 340.0 - 510.0 Roof Load 30/20 IT 2-Uniform(PLF) 0 to 16 9" N/A 80.0 320.0 Second Floor Load 40110 8'0 Weyerhaeuser Notes S SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. Y Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Bloddng Panels and Squash Blodcs)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. The product application,input design loads,dimensions and support information have been provided by No Drawings Provided Forte Software operator Job Notes 7/15/2014 3:32:14 PM JIAndrew Shakliks Steve Bobola - Forte v4.1,Design Engine:V5.7.0.245 Mid-Cape Home Center 1001 West Main St Bobola 1001 West Main HDRAte (508)39MO71 Centerville MA ashakliks@midcape.net Page 3 of 5 L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �'� Parcel S $ Application el Health Division Date Issued 1 1 I`( Conservation Division OIL App licatIT41 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board CA�c� `c_ Historic - OKH _ Preservation/ Hyannis "�rj L Project Street Address 7T nA Vn Village C . n Lif vA i Owner + F ml ► r Address 0s �z r p®e Telephone "L O "1 - T S 4 9 A-1 pp�� n J ) Permit Request &,s-ern to L yt I ��°�` ///t 9,,4L Re m o dl.c�/ e X tS4?.n 3 �he s n &Vlemt,i V F1 ri Flo=Y Rempild Pt PS V Fl ` o k j ,Z� 14 /✓e,,..) /'C i�4GhCr, Square feet: 1 st floor: existing /L7�roposed 2nd floor: existing gS7 proposed samA-Total new r) Zoning District Flood Plain Groundwater Overlay Project Valuation 7 S 110 0®O Construction Type Lot Size r 'L- 4 Grandfathered: ❑Yes YNo If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family # units) Age of Existing Structure s istoric House: ❑Yes No On Old Kin 's Hi hwa =0 Yes [l'No 9 9 Y Basement Type: ElFull ❑ Crawl Walkout ❑ Other cn Basement Finished Area•(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z^ new Half: existing new Number of Bedrooms: existinqZnew Total Room Count (no7Gas luding baths): existing %,3 new��First Floor Room Count J Heat Type and uel: ❑ Oil ❑ Electric ❑ Other Central Air: ZeS ❑ No Fireplaces: eplaces: Existing New Existing wood/coal stove: ❑Yes /No Detache arage: ❑ existing 0 new size_P L3 existing ❑ new size ❑ existing ❑ new size_ Attac garage: ❑ existing ❑ new size _/ d: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Adthorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ZN io If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _-3 55_3 -' Co eO�� Name �iQ.r, i�,��� Telephone Number s0 F "` ?7 - 3,qi 71 Address 2 5w 5-6 C. "_1 Cl iC7e. License# ,S$% $-7 �^� Y h el 1't Vic. Q2. (6 I Home Improvement Contractor# S Email ^ ik 5 s .�L, f'�,n 9 MO Worker's Compensation # 1y)C Z 3 l S 3 17 _L> > o 43 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 61,'es Y SIGNATURE DATE �"' Z It / ' FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED MAP/PARCEL NO. '9 ADDRESS VILLAGE OWNER R r DATE OF INSPECTION: FOUNDATION r FRAME INSULATION PO�� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t r DATE CLOSED OUT ASSOCIATION PLAN NO. 6 .r, to C'ramwonYswd li of Massachusda joelmrfinmt o,f fidmstnd Accidents OjTwe o,ffinvestgafions 600 Washington,?eet Boston,MA 02-HI wmv mass_goWdira Workus' Compensation Insurance Affidavit.Builders/Contractors/Electricians/Plumbers Applicant Infarmation �J _1 Please Print Legibly Name(ksmew/6rganizalionaffiidnai)_ �k`,4 �/✓�U' ?"'� , 5-I/ Ad&ess: ?--r`8 �'� c,t.a C 1 r C,Imo. g ylStat&Zip: 01-6 Q Phone 47 4`6--7~7 1 '5 11 —Are n_an_employer?Checkft appr�priatebo -J-- ------ —Type of :o ect-r 4. I am s contractor and I - pa ] (eq��=-___—___._—___-- L I am a employer with ❑ i 6. P �employees(full andlorpart-lime)* ha°ehi the� c2.ElI am a sole proprietor or partner- listed on the attached sheet; 7- Remodeling ship and have no employees These sub-oonttactots have 8. ❑Demolition w for me in an capacity employees and have workers' working y � tY- 9_ ❑Building addition U9 _0,workers, Comp-insurance comp_insurance-I req�ed-] 5_ ❑ '%Te area corporation and its 10..❑Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their 11-.❑Plumbing repairs or additions myself [No workers'comp right of'ex-ernptionper MGL 12_1-1 Roof repairs insurance required.]$ c.152,§l(4),and we have no employees_[No workers' 13_❑Other comp-insurance required-] *Arty WUcmt flat checks boa*1 vast also fM out the section below showing ihel woafters'compensation police udbrimtion- *Homeowners who submit this affidavit M&WAtkg they are doing all v ak sad then hire outside contractors=si suluat a new affidnit indicating such- tC=tmctors that chea this bore mat wwudted ai addtttnno sheet showh3g-the name of the pub-ems and stste whettwr ornot those ontibes have amplayges. If the suit-contmdurshate empIcytes,they must provide their worke€e comp.policy number. I am an employer that is prmid&zg tt orkers'comTensation irLsirrarcce for iTty*amply em B.eIoty is the policy and job sits in,jormalion_ / Istsumnce CompanyName: rn PDk-y#or Self-ins-Luc-#: `L✓(Z 3 l S 3 011) Q Y 3 Expiration Date: 13 Job site Address: /6 0 i 1✓-ct;� Citylstate/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A o€MGL c. 152 can lead to the imposition of'criminal penalties of a fine up to$1,500.0D andlor one pear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator- Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance,coverage verification I do hereby certify u.. the `ns and ponattiss ofptdtrry that the inforrization prosided abm a is tnw and correct Signature: Bate: L 9 /' Phone#- �a 8 - 7-2 7 !3,f j`ictal use only. Da not rungs to this area,to be completed by city or town officiaL City or Town:. PermiVUcense At Esuing Authority{circle one).: - 1.Board of Health. 2.Building Department 3.Cit ytTown Clerk 4.EIectrlcal inspector S.Plumbing Inspector 6.Other Contact Person: Phone ff: 6 Information xn ton and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 IocaI licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealt'a,`.or 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 situadon and,if necessary,supply sub-contractor(s)name(s),address(es)and phone aumber(s)along with their cer-aficate(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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance Coverage. Also be sure to sign and date the affidavit 'Ilhe affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Deparment of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be.provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner 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 Offim of kvestigations 600 Wasbington Street Boston,MA G2111 Tel.A 617-727-4900 ext 406 or 1-977-I ASWE Revised 4-24-07 Fax## 617-727-7 749 www.ma.ss�-govjdia ® - DATE(MM/DD/YYYY) �® CERTIFICATE OF LIABILITY INSURANCE 6/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES.NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . CT PRODUCER BRYDEN & SULLIVAN INS NAME: - 88 FALMOUTH RD PHONE FAx A/C No Exl: A/C No: HYANNIS, MA02601 ADDREE-MAIL " SS: INSURER(S)AFFORDING COVERAGE - NAIC it INSURERA: Liberty Mutual Fire Insurance 23035 INSURED INSURERB: MASS BUILDING SYSTEMS LLC 24 ST FRANCIS CIRCLE INsuRERc: HYANNIS MA 02601 INSURERD: INSURER E INSURERF: COVERAGES CERTIFICATE NUMBER: 20737496 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO'ALL.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF P OLICY EXP INSR LTR ADM SUBR TYPE OF INSURANCE INSD-WVD - POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS- COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ ME EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: AUTOMOBILE LIABILITY - COMBINEDc ideI)SINGLE LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOSNON-O PROPERTY DAMAGE HIRED AUTOS AUTOS (Per Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEC RETENTION - ER OT $ A WORKERS COMPENSATION WC2-31 S-317211-044 6/7/2014 6/7/2015 S PT I I ERH AND EMPLOYERS'LIABILITY YIN - E 500000 ANY PROPRIETOR/PARTNER/EXECUTNE - _ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ® N/A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED tN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE � i6 . Liberty Mutual Fire Insurance _4 ©1988-2014 ACORD CORPORATION. All rights`reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: '20737496 CLIENT CODE: 1611184 ❑idi Dangas 6/30/2014 2:49:17 PH (EDT) Pagel Of 1 e Massachusetts -Department_of;Public Safety, Board of Building Regulations and Staridards Construction Supervisor License: CS-053987 3 " VTS STEPIIEN E BOBQLA. 24 ST FRANCIS C7R. '. " IiYANNIS M 0 601 Expiration. 02/0412016 Commissioner ejorrUnaaiacueczlc�z o�Ocaaaac/ccoeC License or registration valid for individul use only. Office of Consumer Affairs&Bush ess Regulation ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egisttation: 158588 Type: Office of Consumer Affairs and.Business Regulation 10 Park Plaza-Suite 5170 xpiration: ,,.2/11/2016 Partnership Boston,MA 02116 MASS UILDING SYSTEMS STEPHEN BOBOLA 24 ST. FARNCIS CIRCLE HYANNIS,MA 02601 Undersecretary Not valid without signature ,� �TME Teti Town of Barnstable Regulatory Services 9 ' r E g Richard V.Scali,Director Qjo i639' ♦0 TEn Mai'' 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 I, ld� Ili t ,� , as Owner of the subject property hereby authorize 5-b-e'I AI, R- ,b a, (1 to act on my behalf, in all matters relative to work authoorrized by this building permit application for: k).,, A (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 ' re natu of Applicant Print Name Print Name 7-7 Date QIORMS:O WNERPERMISSIONPOOLS Town of Barnstable . Regulatory Services i �oFe rorzy Richard V.Scali,Director Building Division =nxxsrnsr Tom Perry,Building Commissioner hr ass v$ 1639. ��� 200.Main Street, Hyannis,MA 02601 ATFo rMt a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRFSS: 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"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official 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 Iast 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\FORMS\building permit fOnTls\EXPRESS.doc Revised 061313 /do / m Pr ffi o I 1 1 / / k OE ff i 1 � ✓ i 4A /74>a� — m t -L --� AA i 30, . 1 } Y {y[F jj _.__�-,m,..v..r..�.es..w«:a•....a.w-n•+..+-�..Ravi.:.wK...:a�..i�ay...r�...o--.�....-..a.-_ma...+a.d....�.-w...�.:.--w.,�a+...:-.x.�-Z :...-..- �.,..:.m-....�.-........-..+r�ro-..............�..:v._:w.:�:..:»S�bw.:.wm........:...�.+....,�.. -.,-i._�..- - .. ... .a+Tj 30/ lu f � _ a v1� t"� f P P • I • .dceu.xmre.c...rrnw+ar+. �nouw.-+avnr4dCUK.-a•su�W',-o Y.r�---�---•gin�� ra �� w.aesemm All .. �0 ! ...A �'�'F�4i C Ai�� l�4• ���� Rf � ` ` i fi�f'n..i.: I..a;m.� .: i.�••� c � n = j ILk ' s, LAM DET,EC TORS�f Ii� VED BARNSTABLE BUILDING DEPT DATE FIRE DEPARTMENT -DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Town of Barnstable BIKE r Regulatory Services Richard V. Scali,Director g Buildin Division BAMSTABLE MASS snaxsres�. � A IIiRSl�VS M,IIt505iFfM�1i•MtNSTISffiE 1639, ♦0 Thomas Perry, CBO 1639-2014 Building CommissionerD� a 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 March 23, 2015 Stephen Bobola ` 24 St. Francis Circle Hyannis, Ma. 02601 RE: 1001 West Main St., Centerville, Map: 229 Parcel: 058 Dear Mr. Bobola, This letter shall serve as notice that a building inspection was conducted at the above referenced address and the following deficiencies were found: 1) The guards spacing greater than allowed by 780 CMR R312.3 (should not allow the passage of a four inch sphere). 4 2) Lack of lateral load connection as per 780 CMR R502.2.2 provided. 3;) Ledger attachment not as per 780 CMR 502.2.2.1.1. 4) Guards are not adequately secured. You must correct the above deficiencies and contact this office to arrange for an additional inspection.Thank you for your anticipated cooperation in this matter.. Respectfully, J L. Lauzon ocal Inspector j effrey.lauzongtown.barnstable.ma.us (508) 862-4034 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Z21 Parcel S ;ppIiQai, L#i C) LP Health Division Date Issued 1 f y Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4 0 d s 2. ) '7-� Village Owner / � f6 -a ��cp,�� �a• ► r Address �d �Tve.��, el or, Telephone �C# 3 5 6 19-1 �L p�.A t , cr �G8$c� Permit Request 1 l /�- ^ 6 �� 1 Q G Square feet: 1 st floor: existing,, proposed/ 2nd floor: existing 37 0 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6 o et a Construction Type Lot Size Grandfathered: ❑Yes ZNoIf yes, attach supporting documentation. Dwelling Type: Single Family •Z Two Family ❑ Multi-FaZo units) Age of Existing Structure -storic House: ❑Yes On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other Basement Finished Area (sq.ft.) 9 90 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z^ new Half: existing new, Number of Bedrooms: existing�w Total Room Count (not in #ding baths): existing new First Floor Room Count Heat Type and F el: Gas ❑ Oil ❑ Electric ❑ Other Central Air: es ❑ No Fireplaces: Existing New Existing wood' al`stove ❑Y /No r Detache age: ❑ existing ❑ new size_P : ❑ existing ❑ new size _ B O:existing q=new size_ =' Atta( e: ❑ existin ❑ new siz Shed: ❑ existing ❑ new size g g _ e s g e s e _ Other: � Zoning Board of Appeal/No rization ❑ Appeal # Recorded ❑ Cn Commercial ❑Yes If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION )(BUILDER OR HOMEOWNER) Name sy-�-.eo&+, ./�eil� Telephone Number Address yam.In r. +s C, License # .S $9 F-7 1"t Y /Zee 0- Z60I Home Improvement Contractor# s �� 2N Email /%7 0,s S 0:j�,T(�) G.o I cc�*'� Worker's Compensation # VG Z3/s 3 1-7 © 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sr SIGNATURE DATE 6 Z 6J v FOR OFFICIAL USE ONLY APPLICATION# t # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE f OWNER F DATE OF INSPECTION: c FOUNDATION SeNas Cotes 7��3�1y k FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL F - GAS: ROUGH FINAL FINAL BUILDING 3�13115 Zl�`1�� �{s o 2. r DATE CLOSED OUT i ASSOCIATION PLAN NO: v,. . r TTw CamarxoressteuM of Uassachuse M Depairftnent offardusftid Accidents - EjTWe of Invesagafions 600 Wasldnglon Street Boston,,MA 02HI wmv.Ynasmgmld a Workers' Compensaf on Insurance Affidavit:Builders/ContractorsMectriciansMumbers Applicant Information �i y� Please Print Legibly me Na eP,sm Organizationl7 &&dual): / lP:5s Z5,, GityfS t�efZip: ��Y nn �s rn OZ.6G1 Phone#r —Dire. n-an.employcr?Check f sppapriate bad -----�. _ _ _- --Type of o'ect. r 4_ I star a contractor and I �' J ����=_.__�_-- _-- I_ I am a employer with 1 ❑ 1 6_ ❑New corfion employees(full and/or part-time)* have hired.the sub-contracfars strm 2__❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees Thew -contractors have 8. ❑Demolition w for me m an c ci �- employees and have workers' or�.ng y apt. � 1 9_ ❑Building addition a Ego workzrs'comp.iusmnre comp.insurance required_] 5_.❑ We are a corporation and its 10-0 Electrical repairs or additions 3111 am a homeowner doing all work officers hum exercised their 11_❑Plumbing repairs or additions myself [No warkm'comp_ right of exemption per MGL 12_0 Itnofrepairs insurance required.]T c.152,§1(4),and we have no employees-[No workers' 13_❑Odrer comp-insurance required.] *Pityappllcantthatcbecksboa-91MustalsoMI Out the secfimbelow showing theirwa�ceis'rnmgevsatioaipolieySn rmatiorri Hnmerrwners vrho sabarit this sf�davit iadi rating they tie dying s1I tto�an3 @ten hag outside coatracton mmsi submit a new afdsvit indicating snrh_ tractors that rhxk this boa must attached at[additional sheet showing the name of the Wb-conffXWa and btste whethw ornot tlta5a ecaines hsve mplayees. If the sub-contmctars hace employees,tlley tnzst pmvUe their workers'comp.policy number. I am an emplojvr that is protfidurg workers'congmus rtion inszzrarzce for azy Rnrpinycres. Belot`is thepoTicy and job site informatLgn. Insurance Company Name: G,► c i D� / to '6 Zs. / Policy�or Self ins_Lim 4- WC Z 3 IS 3 17 111 U 3 Expiration Date: Job Site Address: is / G1 z n CitV State/zip: CC,7 .u e I �.Pn ®Z (-3-Z- Attach a mpy of the workers'compensation policy declaration page(shaving the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c 152 can lead to the imposition ofrrirninal penalties of a fine up to$1,500.00 and/or one year imprisoitment,as well as mil penalties in the farm of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of hn-restigations of the DIA for instra ce coverage verification- I do hereby certzfy itnder the pains and pena Was o•f`pedwy titatthe information pratdded a biwe is hue and correct SiEmatare: Date- CA ZY Phone# Offsz,al use only. Da not write in tfzis area,to be completed by city or town official City or Town:. PerudtUcense# Issuing Autharity(circle one): 1.Board of Health 2.Building Department I CitylFown Clerk 4.Electrical Inspector S.Plumbing LLTector 6.Other Contact Person: Phone#_ • i 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 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 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. AIso be sure to sign and date the affidavit 'I1ie affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below..Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that:the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations mi (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 tilled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture G.a.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hke 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 Degaxt<ntnt of Industdal Accidents Office of kvcstigatians 600 Washington Suet Boston,IAA 02111 Tel#f I7-727-4900 W 406 or 1-9 MASSAFE Revised 4-24-07 Fax# f 17-` 27-7749 w.iaass govjdia f THE lq�, Town of Barnstable Regulatory Services 9swxr' Le� Richard V.Scali,Director rfo,% 16. 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 e �P ,., e,z' e� to act on my behalf, in all matters relative to work authorized by this building permit application for: Zoo (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 Ignature of Applicant Print Name Print Name Date Q TORM&O WNERPERMIS SIONPOOLS Town of Barnstable Regulatory Services �opTtiE T�cyy Richard V.ScaIi,Director Building Division * �� Tom Perry,Building Commissioner 9Q� k.s 1 ��� 200 Main Street, Hyannis,MA 02601 ATED �a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityltown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures 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 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\FORMS\building permit forms\EXPRESS.doc Revised 061313 l Massachusetts -Department,of.Public Safety Board of Building Regulations and Staridacds:; Construction Supervisor .I License: CS-058987t STEPHEN E BOBOLA 24 ST FRANCIS C`R HyA11�TIS:MA 02601 c Expiration 02/04/2016 Commissioner ��� ai,�,aai,c�eccCC1 0l C�/U6aJatcc/ccaeC License or registration valid for individul use only Office of Consumer Affairs&Busi�fess Regulation ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation egist�ation: 158588 10 Park Plaza-Suite 5170 xpiration 2L1112016„ Partnership Boston,MA 02116 MASS UILDING SYSTEMS STEPHEN BOBOLA ' 24 ST. FARNCIS CIRCLE'" f,F i out signature HYANNIS,MA 02601 Undersecretary Not valid with A CC?R D® CERTIFICATE OF LIABILITY INSURANCE 6/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES ,NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to quire an endorsement. A statement on this certificate does not confer rights to.the the terms and conditions of the policy,certain policies may re certificate holder in lieu of such endorsements . CONTACT PRODUCER BRYDEN & SULLIVAN INS NAME: FAX 88 FALMOUTH RD PHONE AIC No: A/C No Ext: HYANNIS, MA 02601 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE • NAIC it L INsuRERa: Liberty Mutual Fire Insurance 23035 E INSURED - INSURER B MASS BUILDING SYSTEMS LLC INSURERC: 24 ST FRANCIS CIRCLE HYANNIS MA 02601. INsuRERD: INSURER E: INSURERF: - COVERAGES CERTIFICATE NUMBER: 20737496 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MM/DDIYYYY LTR - - COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ I MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PR PRODUCTS-COMP/OP AGG $ POLICY❑JECT ElCOC $ OTHER: COMBINED SINGLE LIMIT $. . - AUTOMOBILE LIABILITY Ea accident - .BODILY INJURY(Per person) $ I dDED AUTO OWNED SCHEDULED BODILY INJURY(Per accident) $ OS. AUTOS • ' _ PROPERTY DAMAGE $. _ NON-OWNED - Per accident D AUTOS AUTOS -. - $ RELLA LIAR OCCUR _ - EACH OCCURRENCE $ i AGGREGATE $ EXCESS CLAIMS-MADE - - - - - RETENTION - A WORKERS COMPENSATION 7C2-31S-3 1 721 1-044 sm2014 sm2015 ,/ STATUTE ER ' AND EMPLOYERS'LIABILITY Y 1 N - E.L.EACH ACCIDENT $ SOOOOOI ANY PROPRIETORIPARTNEWEXECUTIVE N/A - - 500000 OFFICER/MEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYEE $ (Mandatory in NH) 500000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ l DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of M,A. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. I CERTIFICATE HOLDER CANCELLATION 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF B ARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED" IN . e .ZOO MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. i HYANNIS MA 02601 - - - AUTHORIZED REPRESENTATIVE _ E Liberty Mutual Fire Insurance -, ©1988-2014 ACORD CORPORATION. All.rights resert,ea'. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 20737496 CLIENT CODE: 16111S4 Didi Dangas 6/30/2014 2:49:17 PM (EDT) Page,L of 1 - r Oxford Vinyl Railing with Glass Balusters System-Railing - Fence,Decking and Railing... Page 1 of 1 Oxford Vinyl Railing with Glass Balusters Need an Estimate? System Find a Pro 1*, .. - The images on our website can be used to assist in your decision,but should not be relied on as the sole reference point. Due to variation in computer monitors and printers,the images shown may not exactly replicate the corresponding color,texture or appearance. To verify actual product color,texture or appearance,ask to see the actual product,available through a CertainTeed contractor or distributor. Read More n Overview I Technical Information I Installation Warranty Green Information Decorative glass balusters provide more options for design flexibility 3-1/2'height offers a clearer view with less obstructions Easy to order—no need for custom sizing Easy to install—routed rails eliminate the need to fasten and screw balusters without extra brackets Same baluster works for both flat and stair applications 4"x 3/8"tempered glass Vinyl rails are designed to meet IBC Standards for building safety Glass balusters meet safety performance specifications for glazing materials(ANSI-Z97.1) Two options:Clear&Smoked Lifetime limited warranty with SureStartTm parts and labor protection See our complete offering of vinyl hand rail accessories as well as finishing accessories. Hand Rail Accessories Finishing Accessories , h4://www.certainteed.com/products/fence-railing-deck/railing/313624 7/18/2014 /Olt 11 7 e- .f �> 4 nor ... 8 r s G711 Co GAI " .< y"K. f�.. a� ft �^ 1 R�.�� ho '0' e 44%O$ A7, �. 7 ?? c clZ �iao`��rug.t TyL.. � t6g ow 2 SMOKE DETECTORS REVIEWED eoxrs• P�•x.:� Labadie Family Trust, 1001 West Main St, S�f1013_ BUIL—A*Ci CDEPT. DATE a Centerville b Sunroom a 1st Floor Plan FIRE DEPARTMENT DATE N 1/8°= 12"Scale BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 34W a 4'-9' pi 10'6" 8,gx 3'3" 3'-3• 4=0" t+e•xea oo zax�a +a•x a rcx,+o• +N•xrc a� ,. UPGRADE RE®UI d•xea• O Ir-3'•11^-►�+-3- ^ STATE,BUILQlNL3 REtiIIWS T ?; Dining !� GRADING OF Kitchen i (E DETECTORS FOR E DIMrrLi1NB VMiEN ONE OR MORE SLEEPINGG S DED OR CREATED. Living Room NOTE: A SE E PER7JRT,IS REQUIRE OR THE INST OF SMOKE DETECTORS-THE EL TRICAL PE az NOT'SARSFY"t !iS REQUIREMENT. N M"OExI"BS ------- ieMo4S/9�1 -•----- Jpsl. C�/JS• r.,�.�s•6/J or IOW Do Chimney Bedroom Bedroom CD •--••- p. S Q 42"w g R x 10.00"T ��p� { 4.7 2.9" 9,-7� .I. 6 9" 2-9" b i7 ii C� 0 !1$# i 34 0 �� M 01 r, Labadie Family Trust, 1001 West Main Street, Centerville 2nd Floor Dormer 118"= 1.2"Scale \ 34'-0` so-=a Tatr M• - JO'=eA• _ ,. Open Area e clos rno•,ea•to Kitchenette Bedroom �ra•=ea• ''ai'_�' Y - -- — LEIY chim. closet Bathroom Bedroom I J 20'-0• 5'-61 9'-0" 5'-6" Labadie Family Trust, 1601 West Main Street, Centerville a e Basement L 118 = 12"Scale -0" M 7,.5 o 17'-0" Recreation Ro om 4 i i _3,,g• Y )p a r 42'W 13R x 10.007 6 h 34 i JO N, O.i i f 20�-0" 3.e" 6-7" 6._5" 3 aa•,"u• ea•xra• ea•xw• Labadie Family Trust, 1001 West Main St, a Centerville Sunroom 1st Floor Plan 11811= 12"Scale 34'-0• b4'-3"—►�---101-8" 9.9 3�• 94. ' :p }N•ved'OD t'a'=P-0• ta•x!-0• ew'xtu• tb•xro' . L-3.11"-•1•-3- Dining Kitchen Living Room co N M"OEx'IxB9 ------- iem04S/9�l ------- i'i ra-=ea•eRn i y y -rhimne v r'-0•xea. y �re•xcs. Bedroom Bedroom - CO _____ N 42"W Q _ r j ��'a� Rx 10.007 ra=ea 2-9.. 9-7" 8-9" 2 9" 34--0' -IV Zd 081 C� 7u11 : J0 NIA01 Labadie Family Trust, 1001 West Main Street, Centerville 2nd Floor Dormer 1/8"= 12"Scale \ 34'-0+ ' rPxlP J'Oxlb' ra•xro• clos �. Bedroom . •. xs•xer b aea• x . ' I ra•xea• w b g O � C chim. closet Bathroom 6Ir :8 14' uvlstd VO J® NMOI i 20'-0" 5'-s• s'. . s'-s" Labadie Family Trust, 1001 West Main Street, a b Centerville � 4 b e Basement b 118"= 12"Scale ' 34'-0' 9�• A 17..5. 7-4" 7.5" o 17'-0" g..2. Recreation e;; Room 4 NI SIAIG 42'W 13R x 10.00"T 6 h :8 8Z .kV 001 [r i • J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel QATS Application J Health Division loi Date Issued o Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board cEc Historic - OKH Preservation / Hyannis v Project Street Address G'nJ a) lvaia S-/ Village U Owner S Address Telephone L�8 Sella �eT�eisf�e Permit Request RQ+2 ) 6WcLi je)!I--�&,Si�e.-FC'imiiq sia4uS.14pve 2,,7I&Ab2eX-'1 0hW Square feet: 1 st floor: existing LaE,74oposed _ 2nd floor: existing , •cj proposed Total new Zoning District TJg1� ° Flood Plain eGroundwater Overlay Project Valuation Construction Type A&iAAynV,,Q o Lot Size o Grandfathered: ❑Yes V No If yes, attach s7pagporting d curr tation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) t k '' 0 Age of Existing Structure Historic House: ❑Yes [B No On Old King's Highway:w ]Yes; Flo Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other g'' Basement Finished Area(sq.ft.) `2 3 8' Basement Unfinished Area (sq.ft) JD & Number of Baths: Full: existing new at' Half: existing Ag�' new Number of Bedrooms: 4 existing Onew Total Room Count (not i cluding baths): existing new 'E') first Floor Room Count Heat Type and Fuel:(not ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 6/No Fireplaces: Existing _New Existing wood/coal stove: ❑Yes Ur/No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: S existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes VNo If,yes, site plan review# Current Use Proposed Use - "AkA2 Q LUnQ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RLII141, L � , hQhQCW,-&7tt Telephone Number 508y1�8'�1�7 j of t Address P. Q : 80X 12 ��!1 q5 kleU f/l e License # Home Improvement Contractor# Worker's Compensation # 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�(�r _Z4n 0_0 SIGNATURE CAWDATE 51a ak�?Olz FOR OFFICIAL USE ONLY r. APPLICATION# y i DATE ISSUED MAP/PARCEL NO. r I ADDRESS VILLAGE L. OWNER DATE OF INSPECTION: '`} .• FOUNDATION . FRAME INSULATION 'A FIREPLACE jpe _ k, t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL G GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. i x t a 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): La h /r y 1,?_a 6i /Z ,60 Address: / l Zlaw 61' City/State/Zip: �(-�A01?1)1do Phone#:6M 0k Are you an employer?Check the appropriate box: Type of project(required): 1.El 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.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp: insurance. # 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.F Electrical repairs or additions 3.URII'am a homeowner doing all work officers have exercised their 11.❑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.] *Any applicant that checks box#I 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 criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may ay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: '17G,1C 4 Date: ci V— Phone#: U�S`'4Q�*67o� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# ` Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and 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-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license.number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.govfdia Town of Barnstable \ Regi latory Services « MST"Biz, « Thomas F. Geiler,Director nsnss. p� sb39• ��� Building Division ArfD MA'1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 509-862-403 8 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print' ' DATE:_ JOB LOCATION: Wes T l[t 17 �J P.n � f� L/e, number street village "HOMEOWNER" U eS��ya7 d'T�CS'Y name T =phone# work phone# / CURRENT MAILING ADDRESS: J�p�C:/!Q� 149 n6 L�fP11i�i.�Zy�ll¢7 NA ©tea. 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"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she,will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official 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 I 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 hims 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 foml/cerlification:for use in your community. Q:forms:homeexempt oFE ram, Town of Barnstable 0 ' ]regulatory Services * SAMSPAE A Mass. Thomas F.Geiler,Director 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 ' Y 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 QFORMS:0WNERPERMISSI0NP00L•S 6/2012 q ' SYSTEM 0, w �>. Assessors map and lot number ........ ..... ... �.. .... ......_. I INSTALLED IN COM"OLI i Toy T E Sewage Permit ".....:....:... � �VI`��1 T6�'e.E ......... WITH CEDE '�� House number O O f REGULATIONS "' t639 STAL :�....r.......... T WN � ib Y TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..1t.4h►.. !1.5`......Gl h.....C�h.G�.A.S. 41.......... .... .. �..........I.......... TYPE OF CONSTRUCTION .. . ..S4_-1;1t4: �1�.!'!'ll.,................................ .................... ................. ... 21 .i 9.z z- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ........... A ........... TCnJ�t� ..�..� ' ......Location ....... . b ............. ................................. ProposedUse ............J..QIG.✓..!.vkm........................................................................................ ........ Zoning District ...........G`�r..................... ................................Fire District .. Pra�?.!.�it.�.�........... �!.�.� ..... /� rr L Name of Owner /I�r.!.. Y.;.....47x'te.J 4.a S9i�.eAddress f� .......s1.e. ............................. ehT�.. �,....................... Name of Builder-� 0. �,!\......1. ....... �-h ? .........Address ......................7..�.�f`' ...:.....kh.. .y.-.4Cn:F' tJ ie Nameof Architect i ...Address. ............................................................... .............:....................................................................... Number of Rooms .............0-11A............................................Foundation X.�.. ........... �� ;Alr........................... a Exterior ....C.C.S-R-X.........s ..`. ►.�j� �.................................: Roofin a r�ha�f Floors b.n a i ...Interior ....... _�f.... Heating. 1'4.��........................................................Plumbing ..........`'�.....................................:........................ Fireplace. .......... ... ..................................................Approximate Cost .3 Jr .'. ........................................... Definitive Plan Approved by Planning Board -----------___-___-----------19_______. Area ............A�. ....:........... Diagram of Lot and Building .with Dimensions--, Fee ..... ................................. SUBJECT TO APPROVAL OF BOARD OF �EAL - G Viv� 13 Sol I2, 5 OCCUPANCY PERMI S REQUIRED FOR NEW DWELLINGS I hereby agree tdonform to all the Rules and Regulations of the Town of Barnstable.regarding the above construction. Name . .....:................. .. ............. .................................... LaBADIE, ERNEST 24425 ADDITION No ................. Permit fpr ..................................... Single Family Dwelling . ...................... . ................................ ................. 1001 West Main Street....... Location ................................................................ Centerville ............................................................................... Ernest LaBadie Owner ................................................................... Type of Construction ......................Frame..................... ............................................................................... Plot ........................ Lot ................................. Permit.Granted ......... ......19 82 Date of (nspection- ........ gk-z-- Date Compieted ... RAII? .............19 -Assessor's map and lot number ....... :... FTHET Pao o�y Sewage Permit number- ?z, t4,n .. ,k.�W............... ! d`` Z B88ISTULL i House number ............�.�.� ................................ ISM 039. up'l a� } t" TOWN OF BARNSTABLE BUILDING . INSPECTOR r APPLICATION .FOR PERMIT TO ...... ..........19�.iz-k......... ......... TYPE OF CONSTRUCTION ........S: i.f ........ V a.!'Y'..!........................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies foorr a permit according•.to the following information: - Location .......<•Q.d/........... .clj .S.!.......... �... ?............>,, ......... .!°I.I ....................................... ProposedUse .............>.. .�.G. .:.s�.Yt'....................................................................................................................................... Zoning District .......... .t- Fire District .. f't1.*1.:�ti.l°e - o S"l�vi 1 ..z. Name of Owner fr !....'}../..tXj..... r.+ .3 ......4.Q..lr>JdPAddress !'.✓1.......W eA.......�`�........... -°...... ......... ..� 1 r Name of-Builder" .�Y°•�. itl� ...... .,..... v�. :t``✓.........Address T3 ........!�k .�1e✓ 1 ........!�. !....y.... r ,.w; ;,f Nameof Architect ..................'.... ..................................Address ............ .................................................................... Number of Rooms .............�'—h.R............................................Foundation ..........�!.�.�:��........................... Exterior` ......Ce G Y........ `?..1. .��.5:................................... .Roofing .........a J Nu.l. ...................................................... Floors (•! a i�r,.t Interior .... t�°voGct ...........................::............................... ............ ................................... �+neanngwR ........ . +--................................. 4.. .....:...Plumbing :` Y-� .. ... ... .. Fireplace ....................,............................................................Approximate Cost C3U:. 2 Definitive Plan Approved by Planning Board _________________`_--____-_-__19:_______. Area 2 _ ' .........����'................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF �, uakql f OCCUPANCY PERM[ S REQUIRED FOR NEW DWELLINGS I hereby agree t onform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ................................... ..... ................................... " tr'• tic � Oc�lSS4� a LaBADIE, ERNEST A=229-58 i 24425 ADDI1ION No ................. Permit for ................ Single Family Dwelli Location „1001 West Main Centerville Ernest LaBadie Owner .................................................................. ' Type of Con ruction Frame • ................... i............. . . ................... ............. Plot ............ ............... Lot ............... ................ IOct ber 1, 19 82Permit Gra ed ............ ................. .... ` Date of Ins ction ........ .................... ......19 Date Compl ted .......... ................... ......19 i r . 4 r pot 1 cci Town of Barnstable *Permit# tF1E Expires 6 months from issue date Regulatory Services Fee BARNSTASLE. 1 ,0g Thomas F.Geiler,Director 'A 0.9. X PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner APR s 200 Main Street,Hyannis,MA 02601 2013 www.town.bamstable.ma us Office: 508-862-4038 TOW a6.006XQS21T/gBt_E EXPRESS PERAUT APPLICATION - RESIDENTIAL ONE Map/parcel Number aaa kba Not Valid without Red X--Press Imprint J Property Address � o l / 1Q t?t'l S T [04esidential Value of Work Oq 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �lt_-AJI���^ ��1 G �Chc�. �r Telephone Numbe69 41 S-L Contractor's Name o� 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 accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ' #of doors [Replacement Windows/doors/sliders.U-Value 33 (maximum.35)#of windows Z ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: PrkC�= l n:ki:roisr Fckri-)D Tc\hnildinn nrrtnit fmms=RE$$.doC The CtrmmonWealih a,f Massachusetts Deparhnent of Indrrsbgal Accidents Office o,j'Investigadons 660 Washington Street Boston,K4 0111 . Wn".Mas&gVV1dia Workers' Compensatfan Insurance Affidavit:BmltierslContractoi JElectriciansfPhimbers' ApptiCant Information Please.Print L . illy Name VVL_ r rn Address: C �if1 CityfStatef�sp: �4 (1VZ U`1 L� 1� phone#: � Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a genera contractor and 1 6- ❑New constructions employees(full and/or part-time)-* have hired the sub-conhwf ors . 2.❑ I am a sole praoprietoi or partner- listed on the attached sheet. 7. ❑Remodeling sbip.and have no employees These sub-caatractors have g_ ❑Demolition Q forme in a employees and have workers' Building addition worktnz, ny capa'city- i„sura�.1 ❑ g INo worlmrs'comp.insurance C° 10. Electrical sirs or additions required] I ❑ We are a corporation and its ❑ � 3. I am a homeowner doing all work officers have exercised flieSr I L0 Plumbing repairs or additions right i rg of exemption per H1GI myself[No workers'camp. 12.0 Rflofrepairs insurance required.] C.152,§1(4),and we have no E ] •T t o o wcxleers' 13.[other c QW) employees- comp.insurance required.] *Any apphcwn that checks box#1 tmtist also fill oat the section below showing then workeW r,,,,pens Lion policy informatim I Homeowiiers who submit this affidavit m&cadng they are doing ail wat and/thea hire outside contracturs'mnst submit a new affidavit indicating such tContractors that ched this box mvtst attached ur sdditianal sheet showing the name of the sat-cmatrKIoa and state whether or not those entities have employees. If the snb-cautsaaors have etnpl Teen-,they m.R provide their workere comp.policy number_ I win all empjoJ,er that isproviding workers'comperrsatian insurance for nzy evTla3'eas. Beaty is f�h�po e��and job site inforatadom Insurance Company Name: Policy-or.Self-ins-Lic-# Expiration Date: Job Site Address: City/State/zip: Attach a copy of the walkers'compensation policy declaration page(showing the policy mmnber 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-aa andlor one-yeas imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$254.00 a day against the violator. Be advised that a copy of this statement may be.forwarded to the Office of im-estigalions of the DIA for -ance coverage veriffcaticn- I do hereby cerh;y under th.apaiks and pens afFedmy that the iRfnnraanrnrr provided a;€m is true and correct. --� Date Phi � UZ rs�_U/SAC/ oyrial mm only: Do not write in this are a,to be completed by city or totter offwiQL . CW or Town: PermiiVIAcense# Issuing Authority(tarcie one):L.Board.of Health 2.Budding I?epartment 3.C tyffav u Clerk Electrical inspector 5.Plumbing.Fnslrect©c ..6.Other.. d. Notice to Removed Trustee Written notice. of removal under our Trust Agreement shall be effective immediately when signed by the person or persons authorized to make the removal and delivered to our Trustee personally or three business days after mailing by certified mail, return receipt requested. The written notice removing a Trustee shall identify the Successor Trustee appointed pursuant to the other provisions of this Article. e. Transfer of Trust Property The Trustee so removed shall promptly transfer and deliver to the Successor Trustee all property of our Trust under the removed Trustee's possession and control. Section 4. Designated Successor Trustees Subject to the provisions of Section 3 of this Article,whenever a Trustee is removed, dies, resigns,becomes incapacitated, or is otherwise unable or unwilling to serve, the vacant Trustee position shall be filled as follows: a. Vacancy in Position of'Trustee While We Are Both Alive and Competent We may serve as the only Trustees, or we may name any number of Trustees to serve with us. If any of these other Trustees subsequently fails or ceases to serve as a Trustee for any reason, we may or may not appoint another to fill the vacancy as we both agree. b. Vacancy in Position of Trustee While One of Us Is Alive and Competent If only one of us is living and competent and a Trustee position becomes vacant, or such Trustor desires to appoint a Co-Trustee, then that one of us may or may not appoint.another Trustee. c. Incapacity Trustees o ERNK�Z T A R If ERNEST C.. LABADIE becomes incapacitated while serving as an Initial Trustee, he shall be replaced by the following Incapacity Trustee(s): A—A-+� E If, for any reason, any Incapacity Trustee named above is unable or unwilling to serve, the following Successor Incapacity Trustee(s) shall serve in the priority listed until the list has been exhausted. Unless otherwise specified, if Co-Incapacity Trustees are serving, the next following named Successor Page 7 of 68 �67� i Article Three Appointment of Trustees Section 1. Definition of Trustee All uses of the word "Trustee" in our Trust Agreement shall be deemed a reference to the person or entity then serving as Trustee and shall include alternate or Successor Trustees or Co-Trustees (if multiple trustees are serving), unless the context requires otherwise: Section 2. Resignation of a Trustee Any Trustee may resign at any time without court approval by giving written notice to each then living and competent Trustor. If neither of us is then living and competent, written notice shall be given to our next Successor Trustee; or if there is no next Successor Trustee, to the beneficiaries then entitled to receive income or principal distributions under our Trust Agreement or their respective Personal Representatives, or if any of such beneficiaries then be a minor, to the persons having the care or custody of any such minor. Such resignation shall be effective upon the appointment of a Successor Trustee. Section 3. Removal of a Trustee Any Trustee may be removed under our Trust Agreement as follows: a. While We Are Both Alive and Competent While we are both alive and competent, and if we both agree, we shall have the right to remove or replace any other Trustee appointed under our Trust Agreement at any time without cause. b. While One of Us Is Alive and Competent After the death or incapacity of one of us, unless directed otherwise by other provisions of our Trust Agreement (if any),the surviving, competent Trustor may add a Trustee or remove or replace any other Trustee appointed under our Trust Agreement at any time without cause. c. Removal by Others After the death or incapacity of both of us, any Trustee may be removed at any time for cause by a majority vote of the beneficiaries then entitled to receive income or principal distributions under our Trust Agreement, or their respective Personal Representatives. i i Page 6 of 68 C � I Incapacity Trustee(s) shall serve only after all of the Co-Incapacity Trustees initially fail or thereafter cease to act as Trustees: PAULINE SCHAFER If, for any reason, any Incapacity Trustee named above is unable or unwilling to serve, the following Successor Incapacity Trustee(s) shall serve in the priority listed until the list has been. exhausted. Unless otherwise specified, if Co-Incapacity Trustees are serving, the next following named Successor Incapacity Trustee(s) shall serve only after all of the Co-Incapacity Trustees initially fail or thereafter cease to act as Trustees: ANN CASSIM d. Incapacity Trustees of ANITA A. LABADIE If ANITA A. LABADIE becomes incapacitated while serving as an Initial Trustee, she shall be replaced by the following Incapacity Trustee(s): ERNEST C. LABADIE If, for any reason, any Incapacity Trustee named above is unable or unwilling to serve, the following Successor Incapacity Trustee(s) shall serve in the priority listed until the list has been exhausted. Unless otherwise specified, if Co-Incapacity Trustees are serving, the next following named Successor Incapacity Trustee(s) shall serve only after. all of the Co-Incapacity Trustees initially fail or thereafter cease to act as Trustees: If, for any reason, any Incapacity Trustee named above is unable or unwilling to serve, the following Successor Incapacity Trustee(s) shall serve in the priority listed until the list has been exhausted. Unless otherwise specified, if Co-Incapacity Trustees are serving, the next following named Successor Incapacity Trustee(s) shall serve only after all of the Co-Incapacity Trustees initially fail or thereafter cease to act as Trustees: ANN CASSIM e. Death Trustees of ERNEST C. LABADIE Upon the death of ERNEST C. LABADIE, he or his Incapacity Trustee, if either is then serving as Trustee, shall be replaced by the following Death Trustee(s): ANITA A. LABADIE Page 8 of 68 residue of my estate to the Trustee(s) named in the Trust instrument, to be held, managed and-distributed in the manner described in the Trust instrument for the period beginning with the date of my death, giving effect to all then existing amendments of the Trust that shall be valid, and in any event giving effect to all terms of the Trust now in effect; and for those purposes I incorporate by reference the Trust instrument as it now exists into this Will. SECOND: I nominate and appoint my spouse, ANITA A. LABADIE, as Executrix and Temporary Executrix of this will. If, for any reason, she shall fail to qualify or cease to act as executrix, then I nominate, constitute and appoint my daughter, PAULINE SCHAFER, as Executrix and Temporary Executrix of this will to serve without bond. I direct my Executrix and Temporary Executrix to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. My executor, temporary executor, or person who shall execute my will or administer my estate shall be exempt from furnishing surety on their fiduciary bonds. THIRD: My Executor or Temporary Executor shall have Statutory Optional Fiduciary Powers (G.L. ch. 184B, sec. 2) which, with any other powers accorded by law, may be exercised without order or license of any court. In addition, my Executor may make any election or allocation afforded by applicable tax laws whenever in my Executor's sole discretion my Executor determines that it is advisable to do so, including without limitation (i) the election to have any qualifying property passing under this will or otherwise treated as "qualified terminable interest property" for state and federal transfer tax purposes, and (ii) the allocation of my exemption for state and federal generation-skipping transfer tax purposes. The determination of my Executor with respect to any such election or allocation shall be final and binding on all concerned. My Executor or Temporary Executor shall not be liable to any person for decisions made in good faith.under this Section. FOURTH: All expenses and claims and all estate, inheritance, and death taxes, excluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or,through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. Page,2 of 4 i �. Town of Barnstable ato 1 Services Regulatory, g rY " twertAM Thomas F.Geiler,Director e►`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION F IAO r� Please Print DATE: I r ` JOB LOCATION: 100 ` U-) Can �� ��1��c►��t number �-s-ttrre�e(t� village a "HOMEOWNER_ name home phone# work phone# CURRENT MAILING ADDRESS: 0) ��� 12GS city/town state up code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures: A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,, bylaws,rules and regulations- The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection edures 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 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContenLOadook\QWZUBN\EXPRESS.doc Re ice d 05-0)12 Town of Barnstable *Permit# Expires 6 months from issue date ,X-PRESS PERMIT Regulatory Services Fee Thomas F.Geiler,Director Buildmg.Divisiola 0 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 w-ww.town.barnstable,ma.us Fax: 508-790-6230 Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint CA CAY( Map/parcel Number Property Address ' o I v�-�� wo-n �fi ok `r 60 00.00 [''fResidential Value of Work ���� ' � M nimum fee of$25.00 for work,unde $ . Lri � Owner's Name&Address N-v i Mdu Telephone Number Contractor's Name `J 1911 Home Improvement Contractor License#(if applicable) -I q Construction Supervisor's License#(if apPlicable) RWorkman's Compensation Insurance [hT I none: 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) n to [�Re-roof(stripping old shingles) All construction debris will be take Going over existing layers of roof) Re-roof(not stripe g. g - Re-side [] Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Own t sign P Owner Letter of Permission. A copy of e Horn lmpro men ontractors License is required. SIGNATURE: - Q:Fm=:expmtrg Rcyisc061306 1HFI " N. o 'Town of Barnstable. " . Regulatory Services. nAaNSTABLE, y rsnss. �* Thomas F. Geller,Director Building Division Tom Perry, Building Commissioner .200 Main Street, Hyannis,Na 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 50B--790-6230 Property Owner Must Complete aril .Sign This Section If Using A Builder � as Owner of the subject ro e P P riY herebyauthorize to act on my behalf, . in all matters relative to work authorized b wildin�p �D6�� ation for; IU-o� � . I�h �-, ���-erg �I I�, • (Address off ob) Signature of Owner Date Print Name Q TOPUM S:O W NERPERMIS S ION - The Comrnanweafth of 1{Massachusetts M -Deparfinent of)-ndustrialAecidents Office of Investigations 600 Washington Street B0st971,1{MA 02111 TPjVl N.M ass.go v/die Workers' Compensation lasurancAff e AUcant Information davit: Builders/Contractors/Eleefrician m s/Plubers Please Print Le 'bl Name (Business/Organization/Individual):. ------------- ------------- Address: City/State/Zip: (��11n(S �A • �2�O Phone.#: 19 O - . [Ax- 1_ e you an employer? Check the appropriate box: ❑ I ama employer with 4. ❑ I am a general contractor and IType of project(required):Afnployees (full and/or part.time).* have hired the sub-contractors 6• New construction"�T am a'sole proprietor or partner- listed on the•attac hed sheef 7. Remodeling ship and have no employees These sub--contractors have working for me in any capacity. employees and have workers' 8' ❑Demolition [No workers' comp.insurance comp.insurance.$' 9• ❑Building addition 3.❑ required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their m self 11.❑Plumbing repairs or additions y [No workers' comp. right of exemption per MGL insurance required_] t Q. 152, V(4),and we have no 12.&�R6°frepairs employees. [No workers' ..13.0 Other comp.insurance required.] . °Any applicant that checks box#1 must also fill out the section below sbowing their workers'compensation policy information. t Homeowners who submit this aIIidavii indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating •such. tCdntractors that ehecic this box must attached an additional sheet showing tho nirrne of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have eo�ployccs,they must providh their Workers'co mp.policy number. Xam an employer that is providing.workers'com information. pensation inmrance for my employees Below lsfhe policy and job site 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 uttmber and expiration Failure_to secure coverage as required under Section 25A of MGL,c. 152 can lead to the ' osition of c ' perial date), fine tip to$1,SOp.00 and/o'r one-year � criminal penalties of a y imprisontnent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up esti ations ofthe WA for to$250.00 a day against the violator. Be advised ves In that a copy of this statement may be forwarded to the Office of ' cb c e verification. ' Ido hereb��cpr}� ;ruder e_patn •an en ties ofperjury that the information provide aho a is true and correC4 Sienature: _ I t . �q • Date: Phone #: 9 -- Official use only. Do not write in this area,'fo be completed by city or town official City or Town: Permit/License#. Issuing Authority(circle one); I.Board of Health 2.Building Department 3. City/Tovvn Clerk 4.Electrical Inspector 5.PlumhinQ 6. Other o Inspector Contact Person: Phone# Bbaoinge�u a ions an an ar s License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 124310 Board of Building Regulations and Standards Expiration: 6/1/2011 Tr# 284683 One Ashburton Place Rm 1301 Type: Individual Boston,Ma.02108 James Curley James Curley 287 Fuller Rd. Centerville,MA 02632 Administrator �" blot valid without signature L- Nlassachusetts- Department of Public SafetN Board of Building Regulations and Standards Construction Supervisor Specialty License License: CS SL 99133 Restricted.to: .RF,WS JAMES CURLEY 287 FULLER ROAD. CENTERVILLE, MA 02632 Expiration: 1/28/2012 ('ummissiuner Tr#: 99138 ,I e p , �ze;'taanvrrNy� � tzc�ic�eG� i` r - Boa d of Builc Lna gulalians.an.d.st�ndards-=-.— - license ar gisfiation�alit}tfor indJrduI use only HO E IMPROVEM;NT CONTRACTOR before the a iration date. found ttleturn to: Re 'stcation-1-24 0 m Board of Bui diFib Regul tirj' sand S an.dards E 'iration 6l}hq g° Tr# 1 0873 One Ashburta Place Rm 13 �ndd•al Boston,Ma.0 108 James urley — James urley. — \ 287 Full r.Rd. --•..:" _ .�,.� ....,,�,..�� _ _._.._nry_ ..�. r,"® ---Cn e, A 02632 Administrator �Vot yali w]thout re_ M W i i °F� r Town of Barnstable *Perrru_trc Expires 6\n o the fro "ssue da e Regulatory Services Fee anxNszest.E, Thomas F. Geiler,Director 1 ,�� Building Division CDk y1,109 TFD MA't Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 aacl /(M-b Property Address (�(� (�� � CeR " 3 L (residential Value of Work � 06 • � Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address pill -tCL (e oo G Oi YiU w((L 1 Y (A V r-pa-5z Contractor's Name C - T Telephone Number5Z M Y-(- Home mprovement Contractor License#(if applicable) Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I am a sole proprietor BAR ZOOM •am the Homeowner have Worker's Compensation Insurance Tr)1CVR1 0F BARNSTABLE /�� Insurance Company Name 11'1�(M ('YICIt UCAJ r41_`)(_)Z0rCC dYj (. q Workman's Comp.Policy# �()U Ll0( 5C(q j 9. 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/doors/sliders.U-Value Q `1 (maximum.44) 7 w41/lG(0,iJ'5 *Where required: Issuance of this permit does t exempt compliance wit then town department regulations,i.e.Historic,Conse anon,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q MPFILESTORMS\building permit forms\EXPRESS.doc Revise020108 i 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 LeLribly Name(Business/Organization/Individual): Address: Lcl cl Uu>n pk 12�rl, City/State/Zip: 5VK4k Phone.#: 5:0g-715 111& Are yo n 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. Q New construction employees(full and/or part-time).* have hired the sub-contractors 2:n I am a sole proprietor or partner-' listed on the attached sheet. 7. .E1 Remodeling ship and have no employees These sub-contractors have g;'0 Demolition workingfor me in an capacity. employees and have workers' Y P t5'• $ 9. ❑Building addition •[No workers comp.-insurance comp.insurance. required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am ahomeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13:4 Other comp.insurance required.] J DUX5SQ�UI� "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors liave_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: Paw �, Policy#or Self=ins.Lic.#: QUQ `p 61-34q Expiration Date: Job Site-AddresS: .�O U I 1 � Y T ��-�1 City/State/zip: rL ,bL - Attach a copy of the workers' compensation policy declaration page(showing the.policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of crimiriail penalties of a fintt tip to$1,500.00'and/or one-year imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the•Office of Investigations of the bIA for insgQ=verage verification: I do hereby certi er t &andpenalties of perjury that the information provided above is true and correct.• _ e: - q ' afor Date: �rL(�' . Phone#: —77S-- tT Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# m 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#: .. .E �- �dil:�'3�i[:�E�►�:TiH�Ti�►��7::I:u�:ulul�:ul�:i:► T , �,• 12/31/2008 14:18 Bryden & Sullivan Insurance Donna Seviour-►Margo 1/2 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DSFOATE(MNVOO YYYY) SPRIN-112/31/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins.Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Associated Industzies of HA INSURER 9: - - S rinkle Home,Improvement Inc. INSURERC: 1�9 Barnstable Rd INSURER0 Hyannis MA 02601 INSURER E: - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE IMD0/YY DATE(MWOD/YY LIMITS M/ GENERAL LIABILITY - - - EACH OCCURRENCE- S COMMERCIAL GENERAL LIABILITY PREMISES Ea accurence S CLAIMS MADE OCCUR nIEO EXP(Arry one person) S• PERSONAL E AOV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ - POLICY ECa LOC AUTOMOBILE LIABIUTY - COMBINED SINGLE LIMIT S ANY AUTO (EA accident) ALL OWNED AUTOS BOOILYIWURY 3 SCHEDULEDAUTOS - (Per person) HIRED AUTOS BODILY INJURY S NON-OWNEDAUTOS - - (Pef accident) - PROPERTYDAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY•EAACCIOENT S ANY AUTO - OTHER THAN EAACC S AUTOONLY: AGO S EXCESSNMSRELLA LIABILITY EACH OCCURRENCE $ "f OCCUR CLAIMS MADE AGGREGATE S S DEOUCTIBLE Y RETENTION S S WC STATU•. OTH- WORKERS COMPENSATION AND TORY UMYTS q R EMPLOYERS'LIABILITYA ANY PROPRIETOR/PARTNER/EXECUTIVE AWC7OO4943O1Z OO9 01/01/09 Ol/Ol/lO E.L.EACH ACCIDENT 4 SOOOOO OFFICERnAEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE S 500000- .a yes,describe Under SPECIAL PROVISIONS below - E.L.DISEASE,POLICY UMIT S 500000. OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPEC WL PROVISI095 CERTIFICATE HOLDER CANCELLATION SPRNKFIO SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 NAYS WRITTEN Sprinkle Home Improvement, Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL Fax #508-775-1350 Margo Mack IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER,RE AGENTS OR . 199 'Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE Kelle A.Sullivan ACORD 25(2001l08) O ACORD CORPORATION 1988 :•! [io r d bBliflldmg Regul iticilss anJ Sl_ nclai^its Construct ion Supervisor;Licens:e License CS:, 6643 Ex.pa.ratron. 10/8/2009 Try 04`7 Rest"ricticn: .00 BRAD+K aPR_NKL'E 1 gO. O>HOPS LANE i W BARNSTABLE Mk02668 Citrnnutieio`ict 0.0 35;:900 cf enclosedspac:e,' i 1•A M'asbnry on.�y `. j 1G 1 .2Farnil 44-0 "es . a ailur to:e possess a curreid Qdltion-At l the 1vlassach'usetts Sib`ate Bnildtng Code i z is cause for revocakion ofahts hcens,e: I. ,i • .................. ......... . ...... - - ,�%ir., ! r�t pre n(!!�/•t: � X1'�.,f r�rrOcr1.}er,`r:ii BoM7d of Biiiidi`ng Regulations antStan.dai-6 Il tx �a HOME IMPROVEMENT CONTRACTOR ` F i .f�'N Registration: 10375-7,., Expiratio.n 7/g/201`0 Tr# 271;033 I Type;.: Private Corpo.rAtion SPRINKLE HOME I OVEMENT,:INC, Brad Sprinkle r. 199>Bamstatile Rd: Hyannis,MA'02601 AJministrato'i License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,.Ma.02168 Not valid wit out sig ture J t VEr, Town of Barnstable ' Regulatory Services • BAaxsMr.E v• � � Thomas F.Geller,Director a�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230, Property Owner Must Complete.,and Sign This Section, If Using ABuilder T, aUfa �� ,as Owner of the subject property r• hereby authorize O �AL T-VkA QUO to act on mybehalf, m all mattes relative to-work-authorized by this building permit application for: (Address of Job) CCV+eru� e VV x 6---403 Signature of Owner � Date L251-V-� 1 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse.side. _ !1•FlIRMR•f1WNFRPFR1uTT.CC1(lU HYANN15, TOP OF 51AB 24'diameterconcrete covers MA EL=43.3 raised to wrthm 6'of hmsh grade (or as noted) Inspection Port and cap with magnetic S mar*mg tape to within 3'of grade PC S� o� n ^ o EL=42.0(mm) EL=4/.6(mrn) EL=4/.0-42.7(max) eet R,2 LOCUS dq 4/ 2+ m 3,3 28 tie,2� West Main Street rw I 40.9+ 3 c0'i� 39.7+ X cn 4t� _,U 42.3 4o.or� Parcel A 39.75 39.57 39.40 39.30 1 Existing v} N �: Area= 18,750 5.F.± \ n 0 Lon Gas Baffle 36.40 � � � 0 g I Pond � - - - - - 50 m Longest Run TWENTY F/L/E(25)ADS ARC361-IC (36/6002)LEACH CHAMBERS IN BED 87 DB 6 COA06LIP4T/ON W/TH FIVE(5)ROW5 / / PROPOSED l500 GALLON (H-20 Rated) OF FIVE(5)CHAMBERS O y,y , .y ; i S I T� ..LQC U� „ 1,1L=31.&t Bbtt°rn of Test Ho% 48- � 1 � � , � � i �:SBPTIC TANK D-BOX LEACH CHAMBEie.� NOT TO SCALE Map 229 FLOW PROFILE Parcel 59 , 3 NOT TO SCALE 1 .) Assessor's Map 229 Parcel 58 CONSTRUCTION NOTES - _ _ - -4,q 2.) Deed Book I G750 Page 135 ErT trn9 4 3.) Plan Book 80 Page 33 1 .)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR 1 5.000): _ - STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE. AND BENCHMARK 45- - - ��fg/dear 4.) Th1s property Is in a Zone II of a Public ply EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT FTEOL� of Bottom Corner Step 4. n b FLg e/fn Map 229 , WatZonet C AND DISPOSAL OF 5EPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. Bdrm Bth 44.0(Assumed Datum) 4 3� Parcel 57 5.) Flobd Zone: C 44. E 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 a.z LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. 44- '- - J at'�� / O - G / -46 25 LEGEND 3.)TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL BE INSTALLED ON A STAB Bdrm LE k V MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. G 5.0' 5.0 5.0 5.0' 5.0 Open Area EXISTING SPOT GRADE 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX, AND /2) Planter 24x5 PROPOSED SPOT GRADE THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING FIELDS, /O"�rn 42x) 3z.o pF\`L "� m EXISTING CONTOUR Second Floor �` ti��. `�/ %Ce5s ool a TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL HAVE AT p 4?. AST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED VERTICALLY TO of W - PROPOSED CONTOUR F THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, TIED WITH MAGNETIC MARKING TAPE, N WATER SERVICE LINE ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. Bdrm Bdrm J 2G"Oak -BOX N 0 OVERHEAD UTILITY EWES 42- .- UNDERGROUND UTILITY LINE5 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A 4.1 MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE SEPTIC TANK, / ♦ \ N G GAS SERVICE LINE AND NOT LESS THAN I%OTHERWISE. Bth o p 0 ` ♦ 4i� 40.8 Q? -��- LIMIT OF WORK ti ti� 0%, ♦ N FENCE 6.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE 40 Living ti� euf{er�♦ Inspection Port(5ee Note,f`4) TEST HOLE LOCATION PVC (OR EQUIVALENT) LAID AT 0.00-V FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED D�nmg Kitchen 4 - 2 - .- - - ���- - _ _40.0 h 5T 5FPTIC TANK 40 mi/HDPE Leer(SrG Note,f'22) AT END OR AS NOTED. �'o,,E - _ E,hang Gesspen/s '�•w,�., -� DB D15TKIBUTION BOX 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIR5T TWO (2) FEET BEFORE Frst Floor of41 Cesspool - _ to be 46a"d°ned �� /� N \ /I r,A/ SPS 501L ABSORPTION 5Y5TEM PITCHING TO THE 501L A55ORPTION.5Y5TEM. DISTRIBUTION BOX SHALL BE WATER TFSTED TO 5uhroorn F i`i (ze Note T2/) L/� VIEW V`/ ASSURE EVEN DISTRIBUTION. 38.E SCALE: I" = 10' - - - - - - - - 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES - - - 38 IN ORDER TO PROVIDE A WATERTIGHT SEAL, FLOOR PLAN h� 6 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE h_F b� oti0 DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. 3G ♦ g - -- - - - - - - - - h_3� NOT TO5CALE - - - - - - - - - 3, SYSTEM DESIGN CALCULATIONS 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 1. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING TAPE. SO e♦ I'�IN OF M,�SS � 3 �fer ♦ _ SfWAGf DES/GN PLOW RfOU/RED.•4 BEDROOM DWELL/NG� yam' 9C I 1.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. - - - 20n - //O GPD/BEDROOM=440 GPD REQUIRED LINDA J. y OF THE 501E ABSORPTION SYSTEM UNTIL RECEIPT OF ♦ F PINTO 12.) FROM THE DATE OF THE INSTALLATION _ SEWAGEDES/GN fLOW PROVIDED: TWENTY,IV,-(25)ADS UN/T5/N BED THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT - - - - 33.'�' L - - - �� CONF/GURAT/ON/At FIVE(5)ROWS OF FIVE(5)UNITS EACH. USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. - _ - - -_ -=•.`- - - -32 6 • Vt=((440/O.74)/(4.B P7z/PT)/5.0 LPJ = 24.7 ADS UNITS ��0��F 1 3.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNI�SS - C'ISTEP a CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE 3!s REQUIRED(25 PROI//DED) 8 G� _ S�ONAI E� DESIGNER. _ 444 GPD PROVIDED> 440 GPD REQUIRED 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE \ 5EPRC TANK G4PACLTYREOU/RED: 440 6ALL0N =BBO(K REOU/RED SEPTIC TANK CAPACITY PROWDED: /SOrJ GALLON SEP77C TANK SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED. ��\ A 6ARBAGE0/5PI95AL /5 NOT PERMITTED WITH TH/5 Df5/6N FLOW 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR �Fa \ SITE PLAN. - Survey i�orx b� DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO \\LyA & M Land Services COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO DIG5AFE, ,S /a _ _`8 ejCALE: 1" = 20' 818 Route 28, S&te 3 ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. O Xest Yarmouth, J1A OZ673 SHALL VERIFY THAT All WASTELINES ARE CONNECTED BY WATER TESTING WITHIN Lo,L I CERTIFY THAT I AM CURRENTLY APPROVED BY THE Pb. (5W) M-1777 Aaatl.• anm9and0comcast.net 16.)CONTRACTOR, THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 9 Pp \ DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO '/q' 31 O CMR 15.017 TO CONDUCT SOIL EVALUATIONS AND THAT 17.)CONTRACTOR SHALL VERIFY IXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY ? THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CON515TENT � Prepared for: WITH THE REQUIRED TRAINING. EXPERTI5E, AND EXPERIENCE SEPTIC SYSTEM COMPONENTS. DnCRIBED•-IN 3d 0'CMR,15.0 17: 'I'FLJRTI1ER CERTIFY THAT THE Erne5t Anita Labadle, TrS. 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY, SITE PLAN SHALL NOT BE RESULTS OF SOIL EVALUATION AS INDICATED ON THE USED FOR STAKING, OR ANY OTHER PURPOSES. ATTACHED SOI1LL EVALUATION FORM, ARE ACCURATE AND IN 100 I West Main St., Centerville, MA ACCORDANCE WITH 310 CMR 15.100 THROUGH 1 5.107 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR Test Hole#I (EL=42.5 Proposed Sewage DISpo5al System ZONING BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT RESTRICTIONS. OWNER IS RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE Depth Layer Soil Class Soil Color Comments TEST HOLE LOGS I I West Main St., Centerville, MA APPROPRIATE AUTHORITY. Linda J. Pinto, Certified Soil Evaluator A Medium Sandy Loam I OYR 3/3 Prepared by: 20.) IF 50115 DIFFER FROM THOSE SHOWN IN THE SOILS LOGS, DE51GN ENGINEER 15 TO INSPECT 8"-2 1" B Medium Sandy Loam I OYR 4/6 THE 50115 PRIOR TO PROCEEDING WITH INSTALLATION. _ 2 I"-122" C I Medium Sand I OYR 5/6 Perc @ 36" Test Hole#2 (EL=42.0±) Ernest E Anita Labadie,Trs 100 2 1.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND CSN �, ent West Main Street ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. Depth Layer Soil Class Soil Color Comments Centerville, MA 02632 I 22.) INSTALL A 40 and HDPE LINER FROM EL 39.7 TO EL 35.7 AS SHOWN ON PLAN (SEE PLAN VIEW). DATE OF TESTING: 04122113 Paf 0"-G" A Medium Saner Engineering 13927 6"-27" 15 Medium San Loam I OYR 3/3 Loam I OYR 4/6 ��, SOIL EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING -2I CI Medium Sand I OYR 5/6 2� 4® 60 INSPECTION NOTE: BOARD OF HEALTH AGENT: DON DESMARAIS, BARNSTABLE HEALTH DEPT PERCOLATION RATE: LESS THAN 2 MIWINCH IN"C'LAYER P.O.Bar2030 Phone.(508)299-3250 Teadeket,MA 02536 Far.(508)548-5478 PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM SCALE 1"=20' NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. NO GROUNDWATER ENCOUNTERED C:\C5N\RR-West MainWP-West Main-5D5 Plan.dwg Date:04/22/13 1 5calc:As Shown I By: LJP Check:MTA I Project No.C5NO341