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0057 WHIDAH WAY
Wh . %' OD Sf 2'I 3 Town of Barnstable *Permit# Expires 6 months from issue e °� Regulatory Services Feel ,�xtvsrnsr.E, _ ` MASS. Thomas F.Geiler,Director AT 1659. 6�m ED N10` Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcelN-umbe 3��2Dtj �..C7 3�1 , �vH f t�/q tf G��l �B�u''a/L r�0��e Property Address Residential Value of Work./- � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number X- Home Improvement Contractor License#(if applicable) PRESS PERMIT Construction Supervisor's License#(if applicable) MAR 2 5 2013 ❑Workman's Compensation Insurance Check one: TOWN OF BARNSTABLE ❑ I am a sole proprietor C---!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 Req—ue(check bo`x) ®Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to )14A,1 f 7-e . ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [ "Re-side #of doors [Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows j 3 ❑ 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 Im rovement Contractors License&Construction Supervisors.License is r uired. ..SIGNATURE: n,UrocrrFizlcnp -g\l",;ld;evnermitforms\E3PRESS.doc t �o*'THE ram, Town of Barnstable PST Regulatory Services BARNWABLE, ' Thomas F.Geiler,Director 1659. .�� ArEo5+a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m.a.us Office:. 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print SKATE-- J�OB OCAT—IONS number // street/ ` �/ village `HOMEOWNER". 17f4— S2 name /� home phone# work phone# CURREN-T-MA NGNG-ADDRESS: Y p& CottIJW4 19- ) '7 (/// $ /lT!('IfTYLZ+C/flr"7©/L� •('r o?67 city/town f 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 procedu and,require en and that he/she will comply with said procedures and requirements. GS ignature-of-Homeowner Approval of Building Official Note: Three-family dwellings containing 15,000 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. . Opp 1HE BARNSTABM �9 ,�� Town of Barnstable prEp MA't� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry, CBO_ Building Commissioner 200 Main-Street,' Hyannis,M' 02601 www.town.barnsta.ble.ma'.us r` I Office: 508-862-4038 °� Fax: 508-790-6230 o rty Owner Must - Co plete _d Sign This Section If Us g A Builder , h __;as er of the su }eet-property hereby authorize to act on my behalf, in all matters relative to work aut'zorized by this g permit a lication for: (Address Job) Signature of Owner Date Z Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on;the �___r-eyerseeyerse side-� . - _ • Q:\WPFILES\FORMS\building permit foimslE kESS..doc _ r Town of Barnstable �pE THE - o Regulatory Services Thomas F.Geiler,Director ELAMMBM 9� MAW. �0�' Building Division iOrFn 39. ° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 PERMIT# K,� 7 Cn L _ FEE: $ 02) SHED REGISTRATION 120 square feet or less i lt�16:,;)e Location of shed(address) Village Property owner's name Telephone number -c;L30 mo o r � - Size of Shed Map/Parcel# Signature Date Y Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? w Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 r !y if V �kh5 4 A� 9A: 4�t wgw � Y T g ' 00 LL 1 r �z 9 ; Z 132 I z S'Iry 7r T"lYV 7 6� � E CERTIFIED PLOT PLAN 07 7 VIZ: IN St �m AAAM iL1EgT,____,__� I CERTIFY THAT THE `twnr� f.v.R/ . } „ REo1TEtEQ SHOWN" ON THIS PLAN 19 LOCATED J4A Np. 3o.9 LAND HE GROUND AS INDICATED ��EItIGINEER =�'� �-�--- ON T ANli ' SURVEYOR CONFORMS TO THE ZONIy@ l,A1MS OR! Y, '°�' �'%' Of BAR NSTAaL Tt� MA1 $NEET, ,,.QF D TE REG. LAND SURVEYOR r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �OS Permit# (9c 2 4 Health Division`, ; �'� -1�� Date Issued Conservation Division �(p I Fee ® g Tax Collector /. Dd511N Application Fee UMITEDTO'"" ' "< OF BEDROOMS Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Z -- Project Street Address Village L�-����i�� - 40�2 Owner �� YAP .�!��.G//�-S Address Telephone 5—C98 - —/Ne Permit Request /�4d/Tl�7v' ��1 71 Square feet: 1 st floor: existing /,076 proposed 2nd floor: existing 66W proposed Totah`new y g Valuation ZoningDistrict Flood Plain Ground'ater Overlay' Construction Type 410,0V t� • � 3.` r Lot Size 0 5 a Grandfathered: ❑Yes 0 No If yes, attach supporting doc mentation. Dwelling Type: Single Family 0( Two Family 0 Multi-Family(#units) Age of Existing Structure oZ® Historic House: O Yes & o On Old King's Highway: ❑Yes UK Basement Type: eull ❑Crawl R alkout ❑Other Al Basement Finished Area(sq.ft.) ® Basement Unfinished Area(sq.ft) t¢a Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing - new Z First Floor Room Count �- Heat Type and Fuel: VGas ❑Oil ❑ Electric Cl Other Central Air:' ❑Yes R o Fireplaces: Existing New Existing wood/coal stove: ❑Yes UKo Detached garage:O existing ❑new size Pool:El lexisting ❑new size Barn: O existing ❑new size Attached garage:0 existing ❑ u new size Shed: existing ❑new size F oX Go Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded O Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _2;0e��k Fe SIGNATURE DATE / FOR OFFICIAL USE ONLY • " "1y PIiRMIT NO. - DATE ISSUED MAP/PARCEL NO. ADDRESS - ' VILLAGE OWNER DATE OF INSPECTION FOUND TION FRAME INSULATION /2-Z-Ff U S FIREPLACE 0 ELECTRICAL: PO&H FINAL tn m PLUMBING: OH FINAL' GAS: ROITGH FINAL } �e FINAL BUILDING ��\ �' c -- Z U© C� i DATE CLOSED OUT - ASSOCIATION PLAN NO. �l Bk 20251 P020 6 0-63602 09-13-200 5 10 m 20u Town of Barnstable CF tHE 1p� Regulatory Services BAMSTABLE Thomas F.Geiler,Director y HAss., Q,A 039• Building Division rEn �A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I(We), the undersigned, being the owner(s) of property situated at 57 Whidah Way in Centerville, MA, holding title under a deed recorded with the Barnstable County Registry of Deeds or Barnstable County District Registry of the Land Court in 13ook/ , Page J/ or as Document No. , being shown on Assessors' Map 230 as Parcel 205,hereby agree, certify,warrant and represent to the Town of Barnstable that the accessory attached apartment, which contains living quarters, is intended for use as a family apartment, for year-round occupancy. The intended and authorized use is for Erik E. Erickson Brother/Brother-in-law to owners Jayne & Peter Robbins associated with the residential use on the same premises. This unit shall be used for a"Family Apartment" (as defined in Zoning Ordinances) which would require compliance with the Family Apartment Rules and Regulations. This unit shall not be rented as an apartment or as a single room, or in any fashion,which rental would be a violation of the Town of Barnstable's rules,regulations,.and zoning ordinances. Prior to occupancy.of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. _. This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land Court for the purpose of alerting future owners of the property, of this binding Agreement concerning the use of the property as herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. /� WITNESS our hands and seals this t.3 day of,�V6 xy 2005 TOWN OF BARNSTABLE OWNER By: wilding Commissioner THE COMMONWEALTH OF MASS CHUSETT BARNSTABLE COUNTY, SS Date Then personally appeared the above-named (owner), /) Q j mx"and made oath as to the truth of the foregoing instrument,before me. n, ,q U_._.� Notary Pub My Commi sion xpires: &/JD/A U!! AN JOYCE E.MARGRAF Notary Public Commonwealth of Massachusetts 1WMy Commission Expires June 30,2011 Q:word/accessoryagreement �t Town of Barnstable Building Department - 200 Main Street 9BARNSTABLE, Hyannis, MA 02601 MASS �p 019. a�� (508) 862-4038 r�o nnp� Certificate of Occupancy Application Number: 86824 CO Number: 20060109 Parcel ID: 230205 CO Issue Date: 09101106 Location: 57 WHIDAH WAY Zoning Classification: RESIDENCE D-1 DISTRICT Owner: ROBBINS; PETER S SR & JAYNE F Proposed Use: RESIDENTIAL PO BOX 584 BARNSTABLE, MA 02630 Village: CENTERVILLE Gen Contractor: PROPERTY OWNER Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: )c L j Buildin D partment Signature Date Signed TOWN► OF BARNSTABLE . • ; tUf LDING PERMIT PARCEL ID 230 205 ,GEOBASE' ID 35664 DRESS 57 Vm,ftDAH WAY PHONE CE'gTERV ILLE Z I P 10T 33 BLACK LOT SIZE DMA DEVELOPMENT DISTRICT C 1Y fir_ P"E;k'.TT 86824 DESCRIPTION 528SF FAM APT/GAR UNDER/BREEZ AYlD :CI{ '. ". ZI&IIT TYPE BFAM TITLES FAMILY..APARTMEgT !'OXTRACTORS: PROPERTY OWNER • Department of � �,✓, c AxcH ITECTS" ? 44 y ery Regulatory Sices TOTAL FEES: $382.28 0�Nn $.00 CONSTRUCTION COSTS $73,728 4t „r''`�,l^*«.�'``"'•* FAMILY APARTMENT AFF_ tBAMSTasIS, • 1639. 1 l • BUnDINffDIVISION y BY 005 EXPIRATION DATE } =r .' „ TO .OF .BAR14STAksE . . W�LDING PERMIT PARCEL;_- ID-.230 206_ sOEOSASE ID 35634 ADDRESS.., :, 57,.WHID M WADI PRUE CENTR 'IfiLE - SIP SLOT 33 ' G ,JOT file ,DB • `� - DEVELOPMENT ;DISTRICT L$Af) -. ' "DESCRIPTION 62tla ...FAX APT/GAR lUND9R/BRPE� ,A�' P RMI� � St F� i4_ TITI EAMI IW AP�i�ENT ,r � o(ZQ T eTORs;: ,QW!�4R Department o J Regulatory Services} , s r � 3'''Cgy�A'_I1 ,332.'2 01. Ap 4 1 � * ELAMSTABLE; j r F a BUILD•INGrDI�IISION BY : 11 CO pF ` - t AT x_ISSUED 00/1:.3/2005 EX,PIRATION DATE �.r ���� •7••fg+'�--rv3:^*'r+tr ..��� :$` r „�� :: . ' . .. ...:,.+' .,,. r A1'� v,h j �r,. IA - '.. '. STHIS PERMIT CONVEYS,NO'RIGHT;TO OCCUPY ANY STREET, ALLEY OR SIDEWA-LK ORMANY'PAFT THEREOF'EIT R'TEMPORARILY,OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER'THE BUILD1.HJGCODE :MUST BE'APPROVED BY THE{JURISDICTION.STREET ORt r. %ti ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT`OFP,UBLIC WORKS T%Hi�SSUANCE OFTHIS 4! r'PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.'', �eu ''. r �J�a ,':MINIMUM OF FOUR,CALL INSPECTIONS REQUIRED/ =� p'q a 'FOR-ALL CONSTRUCTION WORK: ,;. APPROVED PLANS MUST BE RETAINED ON-JOB"AND;r� t I fir' �1A!HERE APPLICABLE SEPARATE• s x 1.FOUNQATIONS'OR FQOTINGS THIS CARD KEPT POSTED UNTIL•FINAL INSPECTIONz r r .. r PERMITS ARE ,REQUIRED; ` .2s PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE,A CERTIFICATE OF OCCU PANCY IS-.REQUIRED' SUCH BUILDING SHALL NOT BED ELECTRICALS PLUMBING AND MECH-, (READY TO LATH): ° ANICAL INSTALLATIONS 3.INSULATION. ''' OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE4= > .r FINAL INSPECTION BEFORE OCCUPANCY. 11F. ` 4 tty; �. ® ® Ai. BUILDING INSPECTION APPROVALS„ M, `PLUMBING INSPECTION APPROVALS', r, ELECTRICAL INSPECTION APPROVALS Ic41. � ,"� � � w s ,5's„pX�� Its r,r..��•�- � s.r .{_' m��r [ J �- l� - � , 2_ ot- i 3 1 HEATING INSPECTION APPROVALS,, ENGINEERING DEPARTMENT'` rt� I �. A BOA' D OF H�TI� _ �(_1 �" OTHER: SITE PLAN REVIEW APPROVAL FA WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. �"fu. R � • lit t ILDING T . A ti 6.w+ t ±$.rat 1 d ' F 1+'. } a�.'Y r ` "i1 t "_ F!° 4Tf�"tg i+�'I,,''it, K.d a•�y4 1 `'� -,• 4 a •iy,33i.'N,,.ih'-•Ga'�cytf E IVI IT ;k ;7 4 � •' i r,,.• 1 . v4 i t+ �.y�,f-':: } t, i it t r"`' � * ` �s ,� 't...l,w. _ 4 �4 r;.F .:�i3 a •L'-Y; 111 x, { „�y i Y� ' $'"fy r 3'4 4'+•* 11 w 7wi�a w r wr Y i� `a°r. ytdi� e iT "7 a 7 '. yt�a•+�` '�CI'ti5` �f y-R �i� .�``r s` Cs� :'�t "..� rtil"9+�✓. r. ''S'++'y,. C iay J e: ..J i li •fi .t. tyr. _ it1; r, .. i a S +ram .a r# S�- 6.+SJ°t'• r 750 CUR AppwAk J Table JS216(continued) pmcriptive Packages for One and Two-Family Residential Buildings Hated with Fosait Fuel MAXIMUM MIN1141UM �g Weis Floor Basement 31ab Heating/Cooling Glazing Perimeter Equipment Arran(%) U-value= R-value' R-value' R-Valuef` R-values' �ete EtFiciea Package 5701 to 6500 Heating Degree Days' Normal 38 13 19 10 IZ/• 0.40 6 ° Normal Q 6 R 12% 0.52 30 19 19 _ 10 ti •45 AEUE g 12% 0.50 38 13 19 10 WA Normal -38 13 ZS NIA —— ..- 19 10 .6 --— — --- -- - U I S% 0.46.. . 38 .. 19 ~ V 15% 0.44 85 AFUE 38-.. 13 25 N/A r N/A 85 AM . 19 19 10 W 13% 0.52 30 - 6 ..,':, .. NIA Normal x 18% 032 38 13 25 NIA N/A Normal y 18% 0.42 38 ... 19 25 NIA ti 90 AFUE Z 18%. 0.42 38 19 19 10 ti 90 AFUE pA 18% O.50 30 19 19 10 1. ADDRESS OF PROPERTY: .7 &ia e �elA-kZ4-// ARE FOOTAGE OF ALL EXTERIOR WALLS:. 2. SQUARE 22 y. 3. SQUARE FOOTAGE OF ALL GLAZING: MS. a, %GLAZING AREA(#3 DIVIDED BY#2): n b� 5. SELECT PACKAGE(Q AA-see chart above): • -- -- r NOTE: OTHER MORE INVOLVED METHODS OF.DETERMINING ENERGY REQUMEMETITS LE. ASK US FOR THIS INFORMATION. ARE AVAILAB , r BUILDING INSPECTOR APPROVAL: ^ YES: NO:' _ q-forms-f980303a 780 CMR Appendix J Footnotes to Table J5.2.1b: 4 Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 W of decorative glass may be excluded from a building design with 300 S of glazing area 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U=values cannot be used. 3 The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R 38 insuyation-may be substituted#or R-49-insulation: Ceiling R-values-represent-the-sum-ol`cavaty—...--... __. insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include. exterior siding, structural sheathing, and interior drywall.For example,an R 19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions;but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. "The R-value requirements are for unheated slabs.Add an additional R-2 for heated,slabs. ' If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5.• If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment,the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see.Table J5.2.1a NOTES: Glazing areas and.U-values are maximum acceptable levels. Insulation R-values are minimum acceptable-levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE , New Buildings $100.00 _ Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET a• NEW LIVING SPACE /Q�3 Z a 2 j 5'� 2 _square feet x$96/sq.foot= x.0041= plus from below(if applicable) ' n ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) - GARAGES(attached&detached) // q 6' 2 9a square feet x$32/sq.ft.= l9 �(A x.004 1= ( n ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS . Open Porch x$30.00= (number) Deck f x$30.00 (number) Fireplace/Chimney ' x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00. Relocation/Moving $150.00 (plus above if applicable) Permit Fee 3<2 a Z projcost Rev:063004 Town of Barnstable Regulatory Services • Thomas F.Geiler,Director a y►RN6TABLE, � MAM 3 Building Division pTfO�'�p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 4 www.town.barnstable.ma.us 'fice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: _ 2 JOB IACAn number street village "HOMEOWNER': 71 ���/�—P 1,6o�Ixt S C5,5-'7F' name �,///, om phone# work phone# CURRENT MAM NG ADDRESS: -� //"� �/ / G- -P /��z 4� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellin¢s 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 su ep rvisor. 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 ' ection procedures and requirements and that he/she will comply with said procedures and require z�Wakture o Home er 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 hates 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 am unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board-cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 186.67' EXIST. LEACH PIT fU O EXIST. SEPTIC , 0) pop TANK Lo PROP. 8'x 22' �� n DECK -i EXIST. 35.1, o m _ I-ae.�1-a:---�4 2 DWELL. 47.25 � .03 F-3�7 39s3 DIRT a �� TOP FNDN m DRIVE. Q 4 4 4.82 ELEV. 48.6' �9 u r,I 7 I .s moo. -1 z +40.32 40. *41.3 t 2.65 , 47.60 6 PROP. 47.39 �� /+46.96 36. 22'x 24' + 6. D Co ADD'N. . 4`.00 r I 40.98 \ +46.35 3. 7 146.43 O +4 \� i 128 9 '1�46.60 3' GRAVEL N \42.04 i 3.88 \ DRIVEWAY v 40.99 2 a) 0 43.0 / 128 94, / cti +43.33 / v 147.55' Tp WHID +43.11 qH WAY SEPTIC SYSTEM SHOWN AS PER AS—BUILT CARD ON FILE AT HEALTH DEPT. (NOT CONFIRMED IN FIELD) 04-076 PL 0 T PLAN BUILDING NG PER THE MSE OF ONLY OBTAINING A LOCATION : 57 WHIDAH WAY PREPARED FOR: (CENTERVILLE) BARNSTABLE PETER ROBBINS SCALE : 1" = 30' DATE : JULY 29, 2005 REFERENCE : DB. 12497 PC 114 PB 395 PC 91 ASSESS. MAP 230 PCL 205 I HEREBY CERTIFY THAT THE STRUCTURE y A OF 4fq SHOWN ON THIS:PLAN IS LOCATED ON THE ARNE cti� GROUND AS SHOWN HEREON. H. OJALA Fax No. 3 I Fo.soe-3sz-eeeo � down cape engineering, mc. CIVIL ENGINEERS N ` LAND SURVEYORS _-- — ---- ------ — -` ' v' ` ---_-- 989 main st. yarmcuth, ma 02675 DATE REG. LAND SURVEYOR BOISE BC CALC® 2003 DESIGN REPORT - US Thursday,August 25,2005 15:55 Double 1 3/4" x 9 1/2" VERSA-LAM® 3100 SP File Name: BC CALC Project: F1301 Job Name: PETER ROBBINS Description: BASEMENT BEAM Address: 57 WHIDAH WAY Specifier: City,State,Zip:CENTERVILLE, MA Designer: Joe Madera Customer: Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: Standard Load-40 psf 1 15 psf Tributary 11-00-00 W i Q W ' i 12-00-00 12-00-00 BO B1 B2 2310 Ibs LL 6600 Ibs LL 2310 Ibs LL 785 Ibs DL 2615 Ibs DL 785 Ibs DL Total Horizontal Length-24-00-00 General Data Load Summary Version: US Imperial ID Description Load Type ,Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 24-00-00 Live 40 psf 11-00-00 100% Member Type: Floor Beam Dead 15 psf 11-00-00 90% Number of Spans: 2 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 11058 ft-Ibs 79.2% 100% 2 2-Left Slope: 0/12 Neg. Moment -11058 ft-Ibs 79.2% 100% 2 1 -Right Tributary: 11-00-00 End Shear 2608 Ibs 40.6% 100% 4 1 -Left Cont. Shear 4121 Ibs 64.1% 100% 2 1 -Right Total Load Defl. U405(0.355") 59.2% 5 2 Live Load Defl. U501 (0.288") 71.9% 5 2 Live Load: 40 psf Total Neg. Defl. -0.078" 15.6% 4 2 Dead Load: 15 psf Max Defl. 0.355" 35.5% 5 2 Partition Load: 0 psf Duration: 100 Notes Disclosure Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(L/360)Live load deflection criteria. The completeness and accuracy of Design meets arbitrary(1")Maximum load deflection criteria. the input must be verified by anyone Minimum bearing length for BO is 1-1/2". who would rely on the output as Minimum bearing length for B1 is 3-1/8". evidence of suitability for a Minimum bearing length for B2 is 1-1/2". particular application. The output Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing above is based upon building code-accepted design properties Connection Diagram and analysis methods. Installation Consult project design professional of record or BOISE technical representative for connection design of BOISE engineered wood Member has no side loads. products must be in accordance with the current Installation Guide Connectors are: 16d Sinker Nails and the applicable building codes. To obtain an Installation Guide or if a_2„ d you have any questions,please call b=3„ b (800)232-0788 before beginning c=2-3/4" a product installation. d=12" — — • • j BC CALC®, BC FRAMER®, BCI®, BC RIM BOARD TM, BC OSB RIM C BOARD TM BOISE GLULAMTM VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, • • VERSA-STRAND TM VERSA-STUD®,ALLJOISTO and AJSTm are trademarks of Boise Cascade Corporation. Page 1 of 1 BOISE, BC CALCO 2003 DESIGN REPORT - US Thursday,August 25,2005 15:55 Triple 1 3/4" x 18" VERSA-LAM@ 3100 SP File Name: BC CALC Project: RB01 Job Name: PETER ROBBINS Description: RIDGE Address: 57 WHIDAH WAY Specifier: City,State,Zip:CENTERVILLE, MA Designer: Joe Madera Customer: Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: �0 12 Standard Load-30 psf 1 15 psf Tributary 12-00-00 1 1 1 _ BO B1 3960 Ibs LIL 3960 Ibs LL 2272 Ibs DL 2272 Ibs DL Total Horizontal Length-22-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 22-00-00 Live 30 psf 12-00-00 115% Member Type: Roof Beam Dead 15 psf 12-00-00 90% Number of Spans: 1 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 34278 ft-Ibs 42.6% 115% 2 1 -Internal Slope: 0/12 Neg. Moment 0 ft-Ibs n/a 100% Tributary: 12-00-00 End Shear 5382 Ibs 25.6% 115% 2 1 -Left Total Load Defl. L/451 (0.585") 39.9% 2 1 Live Load Defl. L/710(0.372") 33.8% 2 1 Live Load: 30 psf Max Defl. 0.585" 58.5% 2 1 Dead Load: 15 psf Notes Partition Load: 0 psf Design meets Code minimum(L/180)Total load deflection criteria. Duration: 115 Design meets Code minimum(L/240)Live load deflection criteria. Disclosure Design meets arbitrary(1")Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". The completeness and accuracy of Minimum bearing length for B1 is 1-1/2". the input must be verified by anyone Member Slope=0,consider drainage. who would rely on the output as Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing evidence of suitability for a particular application. The output Connection Diagram above is based upon building Consult project design professional of record or BOISE technical representative for connection design code-accepted design properties Nailing schedule applies to both sides of the member. and analysis methods. Installation of BOISE engineered wood Member has no side loads. products must be in accordance Connectors are: 16d Sinker Nails with the current Installation Guide and the applicable building codes. a=2" d 1 To obtain an Installation Guide or if b-3" you have any questions,please call c-4-5/8" a (800)232-0788 before beginning d- 12" product installation. e=3„ c I_ BC CALCO, BC FRAMERO, BCIO, %7/ BC RIM BOARDTM BC OSB RIM /\j BOARDTM, BOISE GLULAMTM VERSA-LAMA,VERSA-RIMO, �_ /7777 VERSA-RIM PLUSO, VERSA-STRANDTM' _�b VERSA-STUDO,ALLJOISTO and AJSTM,are'trademarks of Boise Cascade Corporation. Page 1 of 1 i 3 601SE, BC CALC® 2003 DESIGN REPORT - US Thursday,August 25,2005 15:55 Double 1 3/4" x 9 1/2" VERSA-LAM® 3100 SP File Name: BC CALC Project: FB02 Job Name: PETER ROBBINS Description: BEAM SUPPORTING SECOND FLOOR Address: 57 WHIDAH WAY Specifier: City,State,Zip:CENTERVILLE, MA Designer: Joe Madera Customer: Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: Standard Load-40 psf 110 psf Tributary 12-00-00 w AL 11-00-00 Ak AL 11-00-00 BO B1 B2 2310 Ibs LL 6600 Ibs LL 2310 Ibs LL 534 Ibs DL 1779 Ibs DL 534 Ibs DL Total Horizontal Length-22-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 22-00-00 Live 40 psf 12-00-00 100% Member Type: Floor Beam Dead 10 psf 12-00-00 90% Number of Spans: 2 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 9216 ft-Ibs 66.0% 100% 2 2-Left Slope: 0/12 Neg. Moment -9216 ft-Ibs 66.0% 100% 2 1 -Right Tributary: 12-00-00 End Shear 2361 Ibs 36.7% 100% 4 1 -Left Cont.Shear 3707 Ibs 57.7% 100% 2 1 -Right Total Load Defl. L/513(0.257") 46.8% 5 2 Live Load Defl. L/595(0.222") 60.5% 5 2 Live Load: 40 psf Total Neg. Defl. -0.07" 14.0% 5 1 Dead Load: 10 psf Max Defl. 0.257" 25.7% 5 2 Partition Load: 0 psf Duration: 100 Notes Disclosure Design meets Code minimum(L/240)Total load deflection criteria. Design meets Code minimum(L/360)Live load deflection criteria. The completeness and accuracy of Design meets arbitrary(1")Maximum load deflection criteria. the input must be verified by anyone Minimum bearing length for BO is 1-1/2". who would rely on the output as Minimum bearing length for B1 is 3". evidence of suitability for a Minimum bearing length for B2 is 1-1/2". particular application. The output Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing above is based upon building code-accepted design properties Connection Diagram and analysis methods. Installation Consult project design professional of record or BOISE technical representative for connection design of BOISE engineered wood products must be in accordance Member has no side loads. with the current Installation Guide Connectors are: 16d Sinker Nails and the applicable building codes. To obtain an Installation Guide or if a=2„ d you have any questions, please call b=3" _ b (800)232-0788 before beginning c=2-3/4" a product installation. d= 12" -+--♦ T BC CALC®, BC FRAMER®, BCIO, BC RIM BOARD TM, BC OSB RIM C / BOARD TM BOISE GLULAMTM VERSA-LAM®,VERSA-RIME), VERSA-RIM PLUS®, VERSA-STRAND TM VERSA-STUD®,ALLJOISTO and AJSTm are trademarks of Boise Cascade Corporation. Page 1 of 1 F ` r The Town ®f Barnstable BARWA81.B. of Health Safety and Environmental Services Department Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 PLAT REVIEW Owner: Map/Parcel:n Project Address: �t d 4 r L Builder The following items were voted on reviewing: Q Y r �f- SegoflO Reviewed by: Date: COMMONWEALTH OF MASSACHUSETTS Z EXE6UTIVE OFFICE OF ENVIRONMENTAL AFFAIRS w DEPARTMENT OF ENVIRONMENTAL PROTECTION i 1 s y TITLE 5 . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS , SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 57 WHIDDAH WAY CENTERVILLE Owners Name: PETER ROBBINS Owner's Address: - Date of Inspection:6/27/05 Name of Inspector: (please print) Douglas A.Brown Company Name: Douglas A.Brown Septic Inspections Mailing Address:P.O Box 145 Centerville,MA 02632 'Telephone Number: 508-420-4534 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature• Date: 6/27/05 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving, authority. Notes and Comments LIQUID DEPTH IN PIT IS ABOUT 2'FROM TOP OF PIT AT THIS TIME ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different Conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 �p Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 57 WIDDAH WAY CENTERVH,LE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection: 6/27/05 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: one or more system components as described in the"Conditional Pase'section need to be replaced or repaired. The system,upon completion of the,replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board.of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed r Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 57 WIDDAH WAY CENTERVILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection: 6/27/05 C.Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(t)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2.System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ the system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a , private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: I Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 57 WIDDAH WAY CENTERUILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection:6/27/05 D. System Failure Criteria applicable to all systems: You must indicate "yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool I X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure, E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water,supply _ _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered yes'm Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR I Page 5 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 57 WIDDAH WAY CENTERVIL,LE Owner: PETER ROBBINS Date of Inspection: 6/27/05 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks ? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X Were all system components,excluding,the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3 ))(b)] r 5 i Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. Property Address: 57 WIDDAH WAY CENTERVILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection. 6/27/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x# of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NA Seasonal use: (yes or no): NO 03.. % Cc� Water meter readings,if available(last 2 years usage(gpd)): D " ' c.A Sump pump(yes or no): NO Last date of occupancy: cumENT COMMERCIAL/INDUSTRIAL: Type of establishment: - Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): — Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: PUMPED TANK6-3-05 Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: r000 gat gallons--How was quantity pumped determined? OFF BILL Reason for pumping: MAINTENANCE. TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: system installed 1985 JJ DRISCOLL Were sewage odors detected when arriving at the site (yes or no)? NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 WIDDAH WAY CENTERVILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection: 6/27/05 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): r SEPTIC TANK:_ (locate on site plan) Depth below,grade: 12" Material of construction: X concrete_metal_fiberglass _polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: 1000 gal Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: TANK PUMPED 6-3-05 Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)- GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass—polyethylene other (explairi): T Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:' Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 WIDDAH WAY CENTERVILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection: 6/27/05 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):ap PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps.and appurtenances,etc.): A Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 WIDDAH WAY CENTERVILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection: 6/27/05 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type X -leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 WIDDAH WAY CENTERVILLE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection: 6/27/05 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 3 3Q 3 0 IL f ! Page 11 of I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 WIDDAH WAY CENTERVII,LE Owner's Name: PETER ROBBINS Owner's Address: Date of Inspection:6/27/05 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to groundwater 10 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: PLAN DATED 9-16-85 ELDREDGE ENGINEERING i l } t i• f Town of,Barnstable Regulatory Services �t toy, Thomas F. Geiler,Director Building Division �nssBM ` Thomas Perry, CBO,Building Commissioner _ k = 2 09 Ar 1639. �� 200 Main Street, Hyannis, MA 02601 Ep Mp`l www.town.barnstable.maxs Office: 508-862-4038 � a�ac 5 -79042-30 W. Town of Barnstable Family Apartment Affidavit _W 1, being on oath, depose and state as follows: M name.is b6 I am-the owner/tasi� of the y , . property located at: dzUV The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: . , Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the:event that the listed relatives vacate said apartment,I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family'Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building ' Commissioner listing the names and relationship of occupants in said Family.Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the.Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree` to notes the Building Commissioner immediately in the event of the sale of this property.. If there is`no longer a FamilyApartment at this location,please explain The apartment has been dismantled. o - The apartment has been transferred to the Amnesty Program (Appeal No. = ) Other Sworn to under the pains d penalties of perjury this �. day o 2013. Signature . , ., _ ,; Phone Number Print Name q:forms/f imaffid.doc rev l l/0.8/T1 Town of Barnstable Reguiatory Services Thomas F. Geiler,Director . Building Division TOY - OF '"x'''„' ' Thomas Perry,CBO,Building ComTM Wri# n gg 0 9.ATFn a 200 Main Street, Hyannis, MA 02601'" www.town.ba rnstable.ma.us Office: 508-862-4038 Na Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit,,,, I, being on oath, depose and state as follows: My name is 6� �1 P14 F �i`' I am the owner/resident of the property located at: J�7. W th _PAJJ W QA The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: fQ Name &relationship to owner: The Family Apartment will,be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in,writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program:(Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 11 ULYYJ 2012. Signature y Phone Number,:.. x Print Name v ,- q:forms/famaffi d.do c rev 11/08/11 Town of Barnstable Regulatory Services oft Thomas F. Geiler,Director TOVVINR'_ Building Division ELAPNSUISLE, ' Thomas Perry, CBO, Building Commissioner ; 1 # 't 1!1: e10 AT 1639. s`�� 200 Main Street, Hyannis, MA 02601 f0 MA'S www.town.ba rnsta ble.ma.us Office: 508-862-4038 W'` r `Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is L 1 am the owner/resident of the property located at: lx.�'[�Gl• Vv The following members of my family will be the sole'occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: rl ,&(J n Name & relationship to owner: . The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.l Family Apartments. I agree to notes the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of J.quaw 2011. Signature Phone Number Print Name �` n e abbrli'q 5' f -- - -- - - Town of Barnstable Regulatory Services FZHe loq, Thomas F.Geiler,Director Building Division 10'1 r� OF PA l4,.. • sAiuvsTAs�, Tom Perry, Building Commissioner "i " �t= 9 MASS. 039. �0 lBo 200 Main Street,Hyannis,MA 02601 ;�d ? t ,yA� s www.town.barnstable.ma.us ' $' 2- - - D1v� � - Office: 508 862 4038 .1J,.QA1 J Fax. 508-7.90 6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is d I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: / Name & relationship to owner: �e �i'�le �it�o -/ti►•Gr� Name & relationship to owner: - The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building'Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of 2010. O Signature Phone Number Print Name Q/bldg/forms/famaffid Rev:12/08 Town of Barnstable Regulatory Services Ftt tp� Thomas F.Geiler,Director- tio�, 10 I1 Ul: BARNS TABLE ,Building Division * BMMSTABLE, ' Tom Perry, Building Commissioner v� MASS.9• ��� 200 Main Street,Hyannis, MA 02601 209 JAN 2 ATEp �a www.town.barnstable.ma.us DIVISION Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable. Family Apartment Affidavit I, being on oath,depose and state as follows: Warne is I'` he owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Z eeG; �_5 Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, 1 will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment.is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of'this property., If there is no longer a Family Apartment at this location, please explain: The apartment has.been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the ins and penalties of perjury this day of (/ 2009. SignatuKe Phone Number Print Name �: .� ,S'�ivs Q/bldg/fortm/famaffid Rev:12/08 - Town of Barnstable Regulatory Services °F1He r°k, Thomas F.Geiler,Director.-. E<< r. Building Division BARNSTABLE, f MASS. Tom Perry,.Building Commissi6ieij �i Z f 9�A i639. 200 Main Street,Hyannis,MA 02601 rFGMpvs www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is / �� -S— A o I am the owner/resident of the property located at: -577. . The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name & relationship to owner: Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately . notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that 1 am required to file an Affidavit annually with the'Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. Other i,. Sworn to under e pains and penalties of perjury this // day of 2008. SdL S ature Phone.Number Print Named S �d.�/�/�S Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable o�� Regulatory Services 1� °FINE l° Thomas F.Geiler,Director Building Division i OkIE ;,i fault�' ',13L SARNSTABLE, Tom Perry, Building Commissioner MASS. 9�ArE0 MA'I A10� 200 Main Street,Hyannis,MA 02601 , + www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is � �"0��� S I am the owner/resident of the property located at: The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address:- Name &..relationship to owner: �� � �/C� � 4exiW,l' Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. 1 understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location, please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this p%� day o 2007. . Signature __ _ _ --. ._ .._ Phone Number-'.. . Print Name ._ ._ /W, Q/bldg/forms/famaffid Rev:1/03 Town of Barnstable OK Regulatory Services pFTNE tok, Thomas F.Geiler,Director Building Division snataFrns[E Tom Perry, Building Commissioner (} 9� 1 `0� 200 Main Street,Hyannis,MA 02601 ? ,u�FB 23 8" www.town.barnstable.ma.us 16 Office: 508-862-4038 F 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: t My name is _j K�e ����5 I am the owner/resident of the property located at: 67 Map and Parcel Number The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: �� ���L �N �Pff �k--;,P, Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that 1 am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other I Sworn to under the pains and penalties of perjury this_L(Q day of 2006. ba 77� q3Ll 3 - Signatur Phone Number Print Name Q/bldg/forms/famaffid Rev:1/03 Bk 20251 P-s206 -wor63602 09_13--20 05 a Ila _ 20ct -THE r Town of Barnstable Regulatory Services swxxsTABM : Thomas F.Geiler,.Director 9 6.9 .0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I(We), the undersigned, being the owner(s) of property situated at 57 Whidah Way in Centerville, MA, holding title under a deed recorded with the Barnstable County Registry of Deeds or Barnstable County District Registry of the Land Court in BoolVj j , Page // or as Document No. ,being shown on Assessors'Map 230 as Parcel 205,hereby agree, certify,warrant and represent to the Town of Barnstable that the accessory attached apartment, which contains living quarters, is intended for use as a family apartment, for year-round occupancy. The intended and authorized use is for Erik E. Erickson Brother/Brother-in-law to owners Jayne &Peter Robbins associated with the residential use on the same premises. This unit shall be used for a"Family Apartment" (as defined in Zoning Ordinances) which would require compliance with the Family Apartment Rules and Regulations. This unit shall not be rented as an apartment or as a single room,or in any fashion,which rental would be a violation of the Town of Barnstable's rules,regulations,.and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. n WITNESS our hands and seals this t.3 day ofI�i�. 2005. TOWN OF BARNSTABLE OWNER By: wilding Commissioner THE COMMONWEALTH OF MASSESETT BARNSTABLE COUNTY,SS Date Then'personally appeared the above-named (owner), �d j // toand made oath as to the truth of the foregoing instrument,before me. Notary Pub My Commi sion xpires: &1,o/a 0!/ JOYCE E.MARGRAF Notary Public Commonwealth of Massachusetts My Commission Expires June 30,2011 Q:word/accessoryagreement ._ _ � � � �, � } <,. � .,�. ..�..... . _ . . r.'. � ' k e �. f 1/16/2014 08:54 FAX 1j001 Town of Harnstanle Building Department Services 1 Brian Florence, CBO KAM Building Commissioner 200 Main Street,Hyannis,MA 02601 WWWAown.barnstable.ma.as Office: 508-862-4038 fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: J / Y- f � 0_1A4&the owner/resident of they My name is property located at: 'n members of my family will be the sole occupants of the Family Apartmen at the The following co aforementioned address; Name&relationship to owner: Name&relationship to owner; The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing.I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments- I agree to not Jy the Building Commissioner immediately in the event of the sale of this-property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. (Appeal No. The apartment has been transferred to the Amnesty Program Other penalties of a 'ur this day of—/, 2019. ' Sworn to under a pains and p P rJ y !— r7—.� ZVO Phone Number Signature l J Print Name q:forrns/famaffid-doc rev 11/08/13 Town of Barnstable Building Department Brian Florence,CBO MAMg" Building CommissionTOWN OF BARNSTABLE 1°rF16 9. 200 Main Street,Hyannis, MA 02601 www.town.barnstable.=7448 JAN 18 PM , 1: 56 Office: 508-862-4038 Fax: 508-790-6230 DIVISION Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: Qr My name is d6wne, '`� ( S I am the owner/resident of the property located at: 52 W i, 1,•AVI' W J T The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: p Name &relationship to owner: Name & relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notify the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit andlor the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to notify the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program (Appeal No. ) Other Sworn to under the pains and penalties of perjury this day of j61K,LJajr-y/ 2018. Signature Phone Number �f 1 Print Name q:forms/famaffid.doc rev 11/22/2017 Town of Barnstable Regulatory Services . oFtHE Richard V. Scali,Director Building Division ,,,ASS. Paul':Roma,Building Commissioner {` '° 16 9.o "� 200 Main Street, Hyannis, MA-02601�' www.town.barnstable.ma:us ry Office: 508-862-4038 ,Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I,being on oath, depose and state as follows: My name is O�rJ I I am the ownerk of the - property located at, 4 v 676 3 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to'owner:E �� r Name&relationship to owner: -The Family Apartmenttwill be the primary year-round residence for the abov e aidentif ed family members: In the event that the listed relatives vacate said apartment, I wili'°iinnmedaatelfj - . note the Building Commissioner in writing. I understand that`no subletting or stub easing ofsaid ' Family Apartment is permitted. ,, '° • . ,� I understand that I am required to file'an Affidavit`annually with the Bulling Commissioner listing the names and relationship of occupants in.said Family Ap rtment. I also` understand that I am required to comply with all conditions imposed by;the.ZBA Special emit and/or the Town of Barnstable Zoning Ordinances Section'240-47.I Family Apt tments.;�agreg4 to noti `the Buildin Commissioner immediate) in the o the sale o this, ro er .f' g Y f f p P tytzp --=�-If there i�.n�°?arber a-Family t�apartr. ent= *�h:s lc,ation;-please explain.. - - The apartment has been dismantled.. The apartment has been transferred to,the Amnesty Program(Appeal No. ) Other Sworn to er the pal s:and`penalties of per uryIhis day of f 2017 uJ `> a Signatures Phone Number, Print Name V O' � `J✓ 5 q:forms/famaffid.doc rev 11/08/12 Town of Barnstable Regulatory Services oFINE rwrti Richard V. Scali,Director °^ Building Division ' MM& ' Thomas Perry, CBO,Building Commissioner En ''°r r•`�� 200 Main Street, Hyannis, MA 02601 T -14* wwwaown.barnstable.ma.us O Office: 508-862-4038 Fax: '%§ 790-6230 STge lF Town of Barnstable Family Apartment Affidavit r I, being on oath, depose and state as follows: My name is SffiyNi yzr�*/f-� 5 I am the owner/res C�Ye t of the property located at: aJli� ! The following members of my family will be the sole occupants of the Family_Apartment at the aforementioned address: Name &relationship to owner: L � Name &relationship to owner: _ The.Family Apartment_will,be the primary year-round residence for.. the above-identifi ed family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said, Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in-the event of the sale of this property. - If there is no longer a Family Apartment at this location,please explain: The apartment has been disiriantied. - I The apartment has been transferred to the Amnesty Program(Appeal No. ) Other 4 Sworn to under the pains.and penalties of perjury this �`� day ofian t) 016. Signature _ Phone Number Print Name 4W y , I� q:forms/famaffid.doc _ ,rev 11/08/12 Town of Barnstable oFTHE Tp�, Regulatory Services Richard V. Scali,DirectorOWN OF BARNSTABLE BARNSTABLE, + Building Division � MASS. $ iify`) dial —8 P1` 7 3 i 039. A.0 Thomas Perry,CBO,Building Commissioner FD MA'S 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs , DIVISION Office: 508-862-4038 Fax: 508-790-6230 Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is S� I am the owner/w ideAt of the property located at: d-a ),► uV The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: nn Name &relationship to owner: P� / Name &relationship to owner: The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately notes the Building Commissioner in writing. I understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names,and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the p 'ns and penalties of perjury this day of 2015. Signature Phone Number Print-Name q:forms/famaffi d.do c rev 11/68/11 Town of Barnstable Regulatory Services a. toy, Richard V. Scali,Interim Director Building Division TO N; :0F 614 STf * ssB Thomas Perry, CBO,Building Commis 'Qner , �At i639' p�m 200 Main Street, Hyannis, MA 0260 .�, ` "'"' 17 f j EO MA'S www.town.barnstable.maxs Office: 508-862-4038 —g—"- —,�£Fax508_-790-6230 DIVIsTof4Town of Barnstable Family Apartment Affidavit I, being on oath, depose and state as follows: My name is S I am the owner/resiTe t of the property'located at: -7 The following members of my family will be the sole occupants of the Family Apartment at the aforementioned address: Name &relationship to owner: Name &relationship to owner: �— The Family Apartment will be the primary year-round residence for the above-identified family members. In the event that the listed relatives vacate said apartment, I will immediately note the Building Commissioner in writing. 1 understand that no subletting or subleasing of said Family Apartment is permitted. I understand that I am required to file an Affidavit annually with the Building Commissioner listing the names and relationship of occupants in said Family Apartment. I also understand that I am required to comply with all conditions imposed by the ZBA Special Permit and/or the Town of Barnstable Zoning Ordinances Section 240-47.1 Family Apartments. I agree to note the Building Commissioner immediately in the event of the sale of this property. If there is no longer a Family.Apartment at this location,please explain: The apartment has been dismantled. The apartment has been transferred to the Amnesty Program(Appeal No. ) Other Sworn to under the pains and penalties of perjury this 14 day of JO/k_ 2014. �4 3 Signature Phone Number Print Name V I ' ► 6 ? �S q:forms/farnaffid.doc rev 11/08/11 er ..�� Assefsor's map and lot numb � 57-... A SEPTIC SYSTEM MUST BE r 4 . d K n C INSTALLED IN COMPLIA Q THE Toy♦ Sewage Permit number ........g......... ...... ................... WITH TITLE 5 + ENVIRONMENTAL CODESTABLE, e0 House number ......................� ................. ...... . . TOWN REGULATION M6a39. MAI ••' • TOWN OFAARNSTABLE BUILDING INSPECTOR APPLICATION-FOR PERMIT TO ........................................ TYPE OF CONSTRUCTION .........�..,l.jXd... G. ......................................... ........... ................../... .... ....19. �� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a) permit according' too the following information: Location ..... .... .J�!lK.. ..... t/G)r .. ..... ./...*vL/f11.... ....................................... /Ij Proposed Use ......... (. . ..! � ..................... .. ..................................:.................... Zoning District .... ... .... ............................... .......Fire District ...... .....� l r— r� Name of Owner �� .� r. .�� ..!...Address*...... .. �C,l '�'�4���` ............�.j;... r ................... ........ ....... ... Nameof Builder ......... .......................................Address .................................................................................... Nameof Architect ..................................................................Address ...................................................I.. .......................p... Number of Rooms ......1...................... ............Foundation �l i / Exterior .....e...c. s .......1 ` `S' ...Roofing ��l ................. Floors ... ./........... �.�f�J�. .....................Interior ........5!?, .....s Q ................................. Heating /...... . :... . ..... ..................... Plumbing. ....... ...�G'(/' 17 � ......... .............................................. Fireplace C.l............................................................Approximate Cost ...........C.. e.7&P�>...................:......... . Definitive Plan Approved by Planning Board ----------- ___ _____19__ � Area .......................................... - 60 L5 ©O Diagram of Lot and Building with Dimensions 704 74� x C/ Y6 Fee / SUBJECT TO APPROVAL OF BOARD OF HEALTH 3©$ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... .... . . .... ...... Construction Supervisor's License .. �� 3/... .... GREENBRIER CORP. 'W .2853.7..... Permit for .... -2 1'..Stor.y.............. to, - . .......Siagle...Family..DwP-1 I is ....................... Location .......lot.-a3,5-7•..Wh-i-dah--W-ay.......... j Centerville . ................................................................................. Greenbrier Corp. Owner .................................................................. Frame Type of Construction .......................................... ................................................................................ Plot ............................. Lot ................................ Permit Granted ......October. . ..I.I.,.........L19 85 . Date.of Inspection .)....................................19 Date Completed 1 ; of M A I Ilk, r ir n4 3 < i UK AMID q r 4 t �, � �' * -� f•`� � g A t' i .r� k a as s ." 1 dp �o ► 0 rl r g � !Al � � x €jt.&p'�ykr.ek"'4rs^�'"F; a� 7.. 1 s-i• \ �- ✓ r e }�1 f J4ap'pim r. '� ,� n ♦`fig' -�''$a �' e�' t 1 ,a r� _ I,.327 /.2.r M11'4)7t( 1 e av r U'Q,' � � 110 ' f � , ; � � J ��'c.7; T ,G. ', r��,�r� y�•a !ems'' CERTIFIED PLOT PLAN k pBERT 9�ys 1, T �3 ►n/�ii0,,�f ✓�/ k s 'F v.LDRE'DGE 'Ad. IM67 0 � IN ®'. .: EaF ST SCALE,/°'z7'40 DATE� , B.S` r` I CERTIFY THAT THEdv�u��' '!l w CLIENT SHOWN' ON THIS PLAN 19 LOCATED Sid?EFt a 0Ef9TERE. 0 ON THE AROUND A9 INDICATED AIMk CLVII. LAND J00 NO, _ °9�.. EN®INFER Ww SURVEYOR DIt,0Y� CONFORIMS TO THE ZONING LAWS i F OF lIARNSTAOL .� MAB$ 12'M A I_N STREET -�---- ems- lSMASS.'' HEETLOF 'DATE RES. LAND SURVEEYOR r� ts afi( E t Co777 1 ...'F��nlllxx1111 + ti fKy!l r( y bf t / 3 ly , � �T 3 3 .' v � t ✓. 9. i V , �:_ #� ;,r�,r' -VY+9 A( a � 1 �� Y #. � , �,a� 1.1r:gb 'ate' ��,�n° � MC'RSE G �;(.� y v i (!MG B l ,�l , NU 10951 4.Q... ���� i43?�fiF`:i1�-Y< Q5 '�ay.YL}'S• :'y# � tl/,` 't " f ��y.`{y��1� �i�"•' � li' f�, ,� P..G l//�qGJ 4L Z t1'` h3.figr N ,3 y''�£,q• `d s Ji( �e ���qf ' Q Z'i. �'P `{. Of. RO�tOF{T .16� G,. �f 44- b aLt .Yh C.i. •�V Nam•:. P 'sv; .� \, ELDF DUE N y. A aT/�/. jU ® yD,",'IV s1 sa?a PA Lv e_�crion/ _d�Cf2 kT, !11 SEcT�l11 G.+� r al 70 W S 43 GE XIiTIN® ,$POT, ELE I '-'0�0 yEXI$TIN®.-:GOWTOUR CERTIFIED PLOT PLAN pf { tN,l:#MED t>$PO:T,: ELE.YATI =:( j/i, �1 fl G7/�4 y 1—o r 33 ofx �ny�„exispn underQ:ound sewerage, IN r1 ;5;or pthex utilities shown';oni teas' 1;an is ,approx- Ge .,pniy determined frpm r,acoxds` and/or verbal'° wEcatxpn,'.af'the ` � A �� � � e or theto Th i eXistng locfons .an thefield: D O ATE m v , g icy IN£DGE rENGINEERINGi .G IN CL,IXNT I CERTIFY THAT THE PROPOSED r � � QI$.TEpR ; REti,1�TBREO ,�OQ,,;NO, 8-3 9UILDING SHOWN ON THIS PLAN �iy ;t'ti C1Yll. .LAND ; CONFORMS TO THE ZONING LAWS NOINEER R � : ICH.;: ��uR. Y/' T-�j--{�--.G_.: OF ®A R/N'S TA®L E , MASS • n �Sn ,g f t itxp ,ayr ,81 ?-12 M. CHCI N'ST..REET, 9 /b { , ::M YA N N I S M A 9 9.`:45 , E.T.LOF DATE REG. LAND SURVEYOR � ;,, 9 N'E Z" r 1 ', ..;:w..c.��ci��?:a_'t�.a,z,'._-,�-=.-y ,_.,�-........• �... ;..a.,..•.y-, rti n:_ 'F;-=•'' -� ..�".c v..-a _ ri'rz�,,v' '1�:.3?✓. .�a.'s.tCi..t,.:*« -"'�.. . _ _ �`� aft... •:� ::'� - • o TOWN OF BAIip STABLE permit .No- --- 28537 ------- BwlA Ins ector snseraa i Cash .°79. ,. < r ADL OCCUPANCY PERMIT Bond ________ Issued to Greenbrier Corp. Address . lot .#33 „ 57 Wl idah tray,. Eenterville ;firing Inspector Inspection datef. e`-- L ✓ Plumbing.Inspector^� W Inspection date Gas4Inspector C ®tft�i'ft9 Cl�'1C6�i�re� Inspection date F3,57f f Engineering De artment '` d` _ Inspection date Board of Health . � ,, (_(G L1 COY+ � 'Inspection, date THIS PERMIT WILL NOT BEVALID, AND THE BUILDING.SHALL NOT BE. OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR. UPON SATISFACTORY', COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION.119A OF THE MASSACHUSETTS STATE BUILDING CODE. -" y g Building Inspector, E 48'-0" f1C G3 5250 2032 2032 2032 0032 �/ I ON BATH I a.-0. KITCHEN T DINING z I� ' ]e88 < O _ 1 FAMILY ROOM 2m 12288 IMPORTANT - UPGRADE REQUIRED tr1 STATE BUILDING CODE REQUIRES THE UPGRADING OF Ln SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN OLLJ FLIVING a00M ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. —I t A�p NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE p INSTALLATION OF SN40KE DETECTORS—THE ELECTRICAL �— PERMIT DOES NOT SATISFY THIS REQUIREMENT. I esae . 260 2048 30GZ 2040 4040 2040 - ,40 37Cr SMOKE ETECTORS EVIEWED AS BUILT FIRST FLOOR PLAN R DATE r - s BUILDING PT. DATE � m FIRE DEPARTMENT DATE Q i suo 202lo e+4o BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Y BATH . I � I m HALL ® m I Q —ATTIC- — .. Ld V1 � - - - - - - - - - - - - I > I I m � z Cz � v AS BUILT SECOND FLOOR PLAN � � O W lb Z coHIM 111111 HIM fill IIIII 1 Hi O ® FMI If If 111111 11 11 111 1111111 1111 ®� �t Ln o J I Milli Q O %V Ill fill 111111111111111 FRONT ELEVATION REAR ELEVATION Z m w Qw AITTrTFFTTimillillilifillillililililI 1111111111 HIM 111111111111111111 Ill ATrTTTiTFMIIIIIIIIIIIIIIIIIIIililI V Z >- uj Q Ll w Q Z � oG .� w go = F- Ill a� Z O � w Ln V SIDE ELEVATION SIDE ELEVATION 241-001 14'-0„ 13'-0" 14'-4" 0 4X4 POST e-- 2'4 0'DH 2'4•X4'O'DH X� xx �..� REF SINK ( V'Ell FIr EXISTING PRE-MADE BATH WC DOOR SHOWER I a Z 12'-01' -KITCHEN _ /811 i� DECK o X i FRAME LU J � P. FOR � � t- 8 (2)13/4"x 91/2" c MBo s C, S VERSALAM 3100 i 5P GIRTAW \,� i 3'O'X 6'S' a GLASS DOOR 0 ' a 12'-011 4x4 Po sr � M EXISTING ~ a 4 } 4 ? OPENING ED ENTRY o O Q o FAMILY ROOM �._ Z - 10'-101, O Q�-�� o a max,LU p oc a0 LIVING ROOM o BEDROOM Q O 2 4 CZ. LL N LLJ e N < DECK 4 V v 2'--4'X4'-0e 9'0°X6'6' 2' 4°X4'-O° 2'-4'X4'-0' Z DOVBLE HVNG RAISED PANEL DOOR I DOUBLE HVNG DOUBLEHUNG W .... W ui t/1 J N-4x4 PosT DN C4 Q J m � Z 3'-811 5'-001 50 3'-8„ I^ V W EXISTING PROPOSED FIRST FLOOR PLAN W O z - - - - - - - - - - - - - - - - - - - - - - , r - - - <NXXY I o 0 UJ I I I � II Q u - a. - 6'-S"HIGH KNEEWALLS - - - ATTIC 5TORAGE- - - - - - t- - - rtI Z w I I Q I i v PECK BELOW I w � 3 L i I w = J > - - Zzw c a aLU in V ATTIC PLAN V '-6 9'-011co 7 i O f— — W�� I I I 94 - 4— — — — 7v 'O"X T O"OH DOOR — — I — — — - — --— — O °� I I I � oo I I I I I o ti I o wl 2X6 STUD WALL I I I I Q \ J Q , o 2X10 � I I PROVIDE BEAM I CID � - Q Z ct I I I r 1 I I POCKET GIRT I I Q ° ou �' j I I — _� - — I I — c I I VER5ALAM 3100 CO CO 5P GIPTABV vn VV nl_pl21 PROVIDE BEAM POCKET +C4) PC FILLED- s \ I I I I10 p I I I I I I - - - - - - - - - — - -I LINE OF BEAM ABOVE- - ON SPREAD 04 N FOOTINGS @- C, I I ( _ _ p FOOTI Lu O PROVIDE BEAM POCK I 1 —0 V� 4- 0 4"PC FILLED LALLY COLUMN I I I I BELOW O ON 2'X 2'X 12"DEEP PC I I I GRAD FOOTING I0- n ( I I I O w 12t-0o 12 I a. W I a,t----------_- I I PROVIDE BEAM I I o �4'�RC FLOOR #10 WEL"DED� I POCKET �3j PT •- W RI E M ON POLY VAPOR I 3) I I BARRIER,OVER-COMPACTED I I .�GIR'T I S"PC-FOVNDATION WALL ON -GONTINVOVS FOOTING I i I I w Q W Lu - - - - - - - - - - - - - - - - - - - - - - - - - - I _ - - aQ > ccl 24'-0" - Z w� m 0 W t,n V PROPOSED FOUNDATION PLAN ri� w Z ..... 00 Li � o I I WL-j I w , N T u CID O ;c} T i Z ^u C) Q I� o [A I a, w MATCH ALL EXTERIOR F'INI5HE5AND COLORS TO W EXI5TI NG V HOUSE MTTTTT } W Q -^ LLI LLJ CAL .J VN PROPOSED STRUCTURE i EXISTING STRUCTURE _ cc cca Z c4 � v PROPOSED FRONT ELEVATION `Q t- O� O O CZ a o Ll M J � Qa � o � a I Hill Q ® uj cz Ca z wo CL > TFT-T= Hill Ow Q. w w LLL wQ � LLi Z _ W z m � z PROPOSED REAR ELEVATION PT2X105.C�9b- co W � HHO I v� I � SEE ATTACHED CALC SHEEtS Q u p co O � I I I uj IL L I I EEH I I I I I I I I I WY�YMIIIIIIIIIIO � z � O I m t'p � LU Q V�j Z QUA M I W Ljj Z }' N W Q LLS \ Q I I VLU p PROPOSED LEFT 51 DE ELEVATION C4 L FIRST FLOOR FRAMING PLAN cz LJ 1 L 0 0 O O N It� u O w m v _a M 2 Q o z c LL. a 1 X M P- N W v U wQ n ?: ci W LU CAL Q J � p z -- w m z SECOND FLOOR FRAMING PLAN Cz Ln STRUCTURAL RIDGE •� VENTED (3) 13/4 x 18 VERSALAM e— ���5� 3100 5P RIDGE ONr e-- 12 � SEE ATTACHED CALC SHEETS 127 0 ��OS R�3016NSULATION W/ , CHANNELSNT KNEEWALLS Ln O 2X1OsO 16"OC co Ln J _ W --VENTEED-50EE ITS , 2X105 O 16"OC 2x1O5016"OC —` v o I � Z � , Z v R-16 WALLS < W (3) 1 3/4"x 18"VERSALAM 3100 5P RIDGE �INSU�,ATI'ON < v 11 II I1 1 z SEE ATTACHED CALC SHEETS L Q m 2X105 @ 16"OC UUUUUUUU�� 2X10sL�16"OC UUUt'II�UUuul —GRADE W L—r,e.P,--30 IN�SOLATION V Z W Q Q S"PC WALL W/CONTINUOUS W = W FOOTING 0 MIN 4' O"BELOW J GRADE � Q _Z W 4"PC FLOOR Z T7 O w ROOF FRAMING PLAN Cz to V BUILDING SECTION Mi°ry