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HomeMy WebLinkAbout0055 DOGWOOD LANE ,► Town of Barnstable *Permit Er ' month issue date - pffit7 Regulatory Services • t�xst'nB� Thomas F.Geiler,-Director ; . �p1E0 J9, ♦� n 0 Building Division -,.�,"Wsorn Perry,CBO, 'Building Commissioner, 200 Main Street,Hyannis,MA 0260,1 www:town.barnstable.maus Office: 50�tt2job8105 Fax:508-790-6230 EXPR-S 1 M APPLICATION - RESIDENTIAL ONLY �i (��j lr IT Not Valid►vlt/ront Red X--Press Imprint R Map/paj VKke) Property Address: Residential Value of Wort NIinimum fee of$35.00 for work under$6000.00 Owner'sName'&.Address Contractor's Name V i�c�.. h'lar;n� v Telephone Number.,(sn`d> Home Improvement Contractor License#(if applicable) k io 0 9 q-1 Construction Supervisor's License#(if applicable) C s Q.0 ly Workman's Cotripensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner Y� I have Worker's—C—oontp�ensation Insurance Insurance Company Name 1(o�ylkle K .:�-v� Arcj,,-�Le i 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) El Re-side #of doors, o (maimm.35) owindowwcemntWRepla f 0 Smoke/Carbon Monoxide detectors 4 floor plans marked`with red S and inspections required. Separate Electrical&Fire Permits required: t; *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: d!O C:\Users\decollik\AppDala\Local\A icrosoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 MARVIN DESIGN GALLERY a complete window and door showroom by MHG Permit Authorization . Le���� , as Owner of the sukie t property understand that Marvin Design Gallery by MHC is a department of Marine Lumber Operator located at 134 Orange St., Nantucket, MA and hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ��ture of Owne• Date C�nef- 1 Print Name �7 ~J M.'ruih Road Flyannis.JIIA02601 (508)771-6278 (5ub...s 771-6L/1(=ax) �vwg.marvindesianaailerybyrniic.c otii i The Connnonw alth of Massachusetts i Department oflndustrialAccidents d Off ce of Investigations a ' ' a 1 Congress Street, Suite 100 v4� Boston,MA 02114-2017 jvwjv mass.gov1Wa Workers' Compensatiori Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiorAndividual): Marine Lumber Operator Address: 134 Orange Street Nantucket, MA 02554 508-228-0900 City/State/Zip: Phone#: Are you an employer?.Check the appropriate box: Type of project(required):: 1.X I am a employer with 1310 4, ❑ I am a general contractor and I 6. New construction employees(fi ll and/or part time):* have hired the sub-contractors . 2.'❑ I am a sole proprietor or partner= : listed on the attached sheet. 7. ❑.Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working 'for me in any capacity. employees and have workers' 0. Buildin addition [No workers' comp. insurance comp. insurance.t g required.] 5. ❑ We are a corporation And its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' comp. right of exemption per MGL Y p 12 ❑Roofrepairs _ 52;§1(4) insurance.required.] t c 1 ,and we no have employees. [No workers' J ❑ Other comp. insurance required.] *Any applicant that checks box#l;must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit*indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or riot those entities have employees. If the sub-contractors have employees,they-must provide their workers'comp.policy number. I ani di:employer tl:at is providing fvorkers'conepeniatioi hisur m:ce foi airy employees. Below.is the policy and job site information. Insurance.Compan I Name:Travelers Insurance Policy#or Self-ins Lic.# 6KU:B0167N03512 Expiration,Date: 12/1$/15 Job Site Address: �sr 1>0gLA64 Lw"Ll City/State/Zip:_ �� KJA 6X?,5' —A-ttach-a-copy-of-thCNYorke`rs'-compens at oii-policy-declaratd&o page(sho yingthf*blicy number.and ezpirafion dam): fine up to$1,500.00 and/or one year—Fdi re to secure coverage as rdimprisonment,l ss well asc ivil penalties in the form of a STOP WORK ORDER and a fine. o ti. to_S2_SU U0 a day agates, the yiolatoL_Be_adyised thaLammop___Q this-stateme Lmay-belonwa de.d-to�tih&Offtce=of- -- - v _. Investigations of the DIA for insurance coverage verification. I do hereby certify tin er th pains arrd penalties of perjury that the informationprovided aboye:is trite and correct. Sim,ature: - - _ -_ r Date. . rb. T _ .Phone#: Official tise only. Do not write in this areit,to be completed by city or towrr 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#: Act CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDYM `..� 112112015 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER Risk Strategies Company CONTACT ME: Judi March 15 Pacella hark Drive, Suite 240 PNONE 781-961.6325 ac o: 781-336.4420 Randolph,MA 02366 EMAIL march risk-strata ias.com INSURE S AFFORDING COVERAGE NAIC 9 www.risk-strategles.com INSURERA: Travelers INSURED INSURER B• Marine Lumber Operator, Inc. DBA Marine Lumber Co., Inca INSURERC: 134 Orange Street INSURERD: Nantuckef MA 02554 wsuRertE: INSURER F COVERAGES CERTIFICATE NUMBER: 23138628 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUBR POLICY EF POLICY EXP LTR . TYPE OF INSURANCE POLICYNUMBER M MMID LIMITS COMMERCIALGEHERALLIABILITY EACH OCCURRENCE S CLAIMS-MADE 'OCCUR DAMAGE TO RENTED PREMISES s occurrence] E - MED EXP(Any one n) S PERSONAL&ADV INJURY S GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY PRO- FLOC PROWCTS•COMPlOPAGO E OTHER: E II AUTOMOBILE LIABILITY I E COMBINED I LIMIT a • ANY AUTO 1 BODILY INJURY(Per person) .E t AUTOS OWNED SCHEDULED BODILY INJURY(Per eodderd) $ AUTOSNON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS low a UMBRELLA LUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLA1MS-MADE - AGGREGATE DEO. RETENTION S S A WORKERS COMPENSATION 6KUB0167NO3512 12/18=14 1211&2015 ;P AND EMPLOYERS'LIABILITY Y.1.N STERTUTE ETM ANY PROPRIETORIPARTNERIEXECUTIVE - E.L.EACH ACCIDENT S 500,000 OFFICERIMEMBER EXCLUDED? a NIA (Mandatory In NH) El,DISEASE•EA EMPLOYE $ -500,000 11 yye6 tlesalDe under DMRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT i 500.000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be atlactrotl if more spece Is required) CERTIFICATE HOLDER - CANCELLATION Marvin n Desi Galle SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 ry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 73 Falmouth Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE 1 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.t 21138620 CLIENT CODE: MRIH-2 Judi Hatch 1/21/2015 3:52:32 PH ItSTI Page 1 or 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Consti-uctioh Supervisor -- License:.CS-091884 VINCENT J MAR*O II 58 LIBERTY LANE MARSTONSNI II..S MIA�)�[ 8 01 Ji10 Expiration Commissioner 01/24/2017 tJ/ce ntiuoucueall�o`P/7�l�a.....1,uaem _,___,"-120ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR I: before the expiration date. If found return to: z Office of Consumer Affairs and Business Regulation Registrations 160991.r Type 10 Park Plaza-Suite 5170 Expiration: 9/17/2016',r SupplemensF and Boston,MA 02116 MARINE LUMBER,OPERATOR:INC }} �1 VIN MARINO _ l r 134 LOWER ORANGEST NANTUCKET,MA 02554 Undersecretary i Not v lid without signature _ ..® f . 4 s, Town of Barnstable C)t�7t✓-Zq� z Permit# 1FxPires iont/is from issue dale PERMITReg.ulatoi y Services Fee it rFn ,�a Thomas F.Geiler,Director AY 15 2007 wilding Division Tom ferry, Building Commissioner �E,����� � ��a��i�T��L� Zoo Main street, Hyannis,MA02601 Office: 508-862-4038 Fax: 508-790-6230 E�'ItESS PEI2MI'r APPLIC _ATION RESYDENTTAL ONLY Not Falid without ged X--Press li.pr,t Map/parcel Number ( Property AddressC�l.:�oC�� XRPsideitial Value of Work �V nimum fee of$25.00 for work under$6000.00 Dwner's Name&Address Mi =ontractor's Name r- Telephone Number tome Improvement Contractor License#(if'applicable) n�y :onstruction Supervisor's License#(if applicable) a { y CJ ]Workman's Compensation Insurance Check one: ❑ I an'a sole proprietor ❑ I am the homeowner 1 have Worker's.Compensation Insurance surance Company Name �- orkman's Comp.Policy# Opy of Insuranee Compliance Certificate must be on file, anit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken t;LL ❑Re-roof(not stripping, Going over existing layers of roo fl ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) "'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. home Improvement Contractors License is required. atur ms:expmtr :063004 _ E 1 . APIZ G , � 21 Home Improvement In °1. 'I, Gary Gustafson 'Product ion.inana er Of Ca izzi Home Im rovement hereb autliorize g P P, . Y Lisa Haworth, to sign on my lielialf for perriiit'applications'filed.through the town" y r e , _r +.. .. y .2 Signed. Gary G stafso.. Date: h 1645 Newtown Road Cotuit, MA 02.635 (508) 428-9518 . (800).262-5060 FAX (508) 428-1547 Client#:47293 CAPIHo n ACORDM CERTIFICATE 4F LIABILITY INSURANCE DATE(,M,=,IYYYY) FRODUCE!t 0 N'09107 THIS CERTIFICATE IS ISSUED AS A MATTER OF[NFORMATIGN Rogers&Gray Ins. Agency,inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 1601 ALTER THE COVERAGE AFFORDED SYTHE POLICIES BELOW. South L}ennis,MA 02660-16G1 INSURERS AFFORDING COVERAGE NAIC INSURED rOVa Ca Lui Home Im ItJSUREP.k National Grange Mutual Ins, Co. CapPi p zi E,��rprises, Inc.ment,Inc. INStJRER3: American in emational Gr ts 1W Newtown Road INSURERG: COtuit, MA 02635 INSURERD: INSURER c COVERAGES THE POLICIES OF INSURANCE LIS I'cD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOlr--A E:) NOTWITHSTANDING ANY REQUIRa,4ENT,TERNI OR OONDITION OP ANY CONTRACT OR OTHER DOCUVENT AriTH RESPECT TO WHICH THIS CFR IF!CATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI THE TERMS,EXCLUSIONS AND CONOITIGNS OF SUCH POLICIES.AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR tJ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ATI=tM / i Y E f ATMM! IYY I 'LIMITS A I GENERAL LIABILITY MP010707 06108106 i 06108/07 EACH OCCURRENCE 0,000,000 X w MMERCIAL GENERAL LIABILITY CAM l:GE TO REPJTED I i PR uS' i� r $500 GGO ' I ...EMITS RACE OCCUR KED ECF(Anv one pers znl $10000 I I PERSONAL d AOV INJURY $1,000 000 GFt!'L AGGREGATE U)rllT APPLIES FER GENErR.ALAGGREGA:TE $2,000 000 PRO• PRODUCTS-CON PICA AGO $2,000 000 II POLICY lECT LOS i AUTOMOBILE LIABILITY ANY AUTO 'CMBINED SINGLE LIMIT $ iEz accident) ALL OWNED ALTOS" SCHEDULED AUTOS BODILY INJURY $ (Poe person) I HIRED AL(rCS BODILY INJURY t NON-OWNED AUTOS (Per 3md2r4) $ I PROPERTY DAMAC,E $ (P-r rc dertt) GARAGE LABILITY AU,r0 ONLY.EA ACCIDENT $ I .ANIY AUTO OTHER THAN EA ACC $ I AUTO ONLY: AGG $ I EXCESSMIABRELLA LIABILITY ' EACH OCCURRENCE $ OCCUR ❑ E ^LALMS MADE AGGREGATE $ I OF.DUCTi6LE :RETENTION $ I $ B WORKERS COMPENSATION AND- 1764953 2/26f06 12`25/O7 1!v STAT'U GTH- , EMPLOYERS'LIABILITY - TORY INIIT' FR Ally PROPRIETORrPARTNEFRIEXECUTtVE E.L.EACH ACCICENT $500,000 CFFICMS/ tEm SER EXCLUDED? If yes,deccrbe under E.L.DISEASE•.HA EMPLOYEE $500,000 . L PROVISIONS ce OTHER cn - E.L.DISE-,SE.•POUCYU1,117- $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEI;}ENTJ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C.ANCELLED BEFORE THE EXPRA nam D.ATETHEREOF,THE ISSUING INSURER WILL ENDEAVORTOMAL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER,NAM ED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE N0 OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAT iVE ACORD 25(2001 Q8) 1 0{2 #26435 DRAW ~ O ACORD CORPORATION 1983 \ 1 ne t ommonweatln of massacnusetts Department ofIndustrial Accidents O{�{i�ce o Investigations, L JJ f b 600 Washington Street t Boston;M4 02111 y WWW.Massgov/dia Workers' Compensation Insurance Affidavit: Buis:ders/Conti-actors/Electricians/Plunabers Applicant Information Please Print Legibly Name (BusinesJorganization%Individual): Address:. I645 Newtown Road ,,ttjit, VA,-825315 City/Mate/Zip: Tel. 428.9518 #800-262-5060 lloze- e ou an employer?Check the-appropriate box: Type of project(required): I am a employer with 4. El I am a general contractor and I 6. .New consfi cliosa employees (fill and/or part tense).* hs we hired fare sub-contractors 2_❑ I ari a sole proprietor or partner- fisted on the attached sheet7. El'Remodeling ship and hatiz no.employees These sub-,contractors have 8. D.Demolition wo g for ne in any capacity. workers' con1p.msitrance. ding 9. 0 Buis addition .[No workers comp.insurance 5. 0 W.e 4e a,corporation and its regmreci l officers have exercised tiieiz 1a-0 Eltetribal repairs or additions 3. I.am a;honieowner doing all work rig3it of exe gptson pet 1V1GL . 11.0 PIiitnbing repairs oz additions ruyself'jl�7o workers' comp- c i 52,:§l(4),and we fisve no 12;�R6ofiepairs ins�Tance requsred 7'fi •.employees .{No workers° co ,��rrancer 13.E Other *Any applicant that oIiecks box m l must also fill:butte section below showing their woiiceis'compensation policy mfonnanon' t figmeowriers who subna#ffiis affidavit m3icating they axe doing sIi work and they hire oafside contractors must suit a new affidavit m'dicating-—ch. tcoretractors 8 thrs bog must wtFarhed_an addifional sheet showing the name oftne sabcontzactors and thea.wozkers co o7ic niforrnstion P.. Y I errs an employer that is providing workers',compensation,insurance f or my Employees. elofv is the policy m zd tQ information 1 �rl°-`9"Ti ^ir � _. � X Policy#orSelf--ins. Lic. / -7( 1/4q Exp lion Date V C Job Site Address;. City7State/4ip: 4ttach a c he vokeis o p nopy mp o page(showing the.0olicy nuimber and expiration date). lailiire to secure coverage as required under Section 25A of MGL c_ 152 can lead to the nnposition'of criminal penalties of me.up to$1,500 OO and/or one-year imprisonment, as well as civil:penalties in the form of a STOP WORK ER,a id,a_fwe ifizp#�)$2 0 00 a:tzay agaihst the. ioiator. B,e:advise. thAt`a ,—*-'of statement may be forwarded to the Office of nvestigations of the DIA fbi in:�, ce coverage vei fication do hereby.ce under the_iains and penalties ofpe ry fhatthe in_formation pr©vided above is true unit correct ,i afore: Date: 'hone#: — 0•Yacial 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 Z.Building.Department 3. City/Towu Clerk 4.Electrical Inspector 5.Plumbing Inspector b. Other - -. 'hone r,-. _.._.. �� � �✓t Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 100740 One Ashburton Place Rm 1301 Expiration: `6/23/2008 • Boston,Ma.02108 Type::Supplement Card CAPI=I HOME IMPROVEMENT,I bi RY GUSTAFSON 1645 Newton Rd. � Cotuit, MA 02635 Administrator N t valid with t sig ture Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108, Home Improvement,Contractor Registration Registration: 100740 Type: Supplement Card _ Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT, INC GARY GUSTAFSON 1645 Newton Rd. COtUIt, MA 02635 Update Address and return card.Mark reason for change. ❑ Address. Renewal Employment ❑ Lost Card ✓fze 'C�omvmoaru�eal� a���i'aaaacic�etla Board of Building Regulations and Standards Construction Supervisor License . License: CS 74640 B i rthdate: 11/29/1975 Expiration: 11/2k008 Tr# 6430 Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I r" A S. J OWN THE PROPERTY LOCATED AT .S S 120 0- t&,oc IN % T MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: S �O& '� OWNER'S TELEPHONE: Ty LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: J/ APPLICANT'S ADDRESS: 1 5 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: oFtNE� TOWN OF BARNSTABLE Permit No.. .....28572.... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ................ HYANNIS,MASS.02601 Bond ................ i CERTIFICATE OF USE AND OCCUPANCY Issued to RUTH RUDOWSKI Address lot #9 55 Dogwood Lane, Cotuit USE GROUP FIRE GRADING OCCUPANCY LOAD THIS-PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING. INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. May 12 87 /� 19................. ....1(\..././Jv ........... Building'Inspector `- w TOWN OF BARNSTABLE BUILDING DEPARTMENT t asaaSrAU : TOWN OFFICE BUILDING rda �9► +679• �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk ,FROM: Building Department ' DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #. ?. » %? ` �... . ........ .7.............. !.. ...................... .................... issuedto ............ .. .., .... ..........................»........... ......j... ...»r...»........ ..�.». Please release the performance bond. �� BUILDING '?' - r ml TOWN OF BARNSTABLE, PER A=125-58 JOB WEATHJ�o CA-R-D- <:Ic t o ba r 21 85 Fd8 5 f fti DATE 19 ,p ERMIT.NO, - APPLICANT - Polcaro Ccnstruc4 L ADDRESS " 011i .,IA 1LDZLOK t u. , UU j_)U_ (NO.) (STREET) (CONTR'S LICENSE) Build dL"el.li't7U I i >?;")�;7.e1 �.3:Ttl.�}' dwelling NUMBER OF I. PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) iot (19 D5 iltia}W17«i.i L:i3. LE: , l;C?':LS (. ZONING 15," AT (LOCATION) DISTRICT(NOJ (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI -� TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: BOND AREA-OR 3Cj. 1C. .l..U(1,Uc./U PERMIT s 116.UU VOLUME ESTIMATED COST . FEE ' •� (CUBIC/SQUARE FEET) !ut11 !�tlt10W:1:: OWNER BUILDING DEPT.,- ADDRESS BY .THIS PERMIT CONVEYS. NO RIGHT: TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY PERMANENTLY.'ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE / PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN ( FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT. RELEASE THE APPLICANT FROM THE CONDITIC .� OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE .INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT -IS VISIBLE FROM STREET I I I G INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION ,APPROVALS VL .2 1;,, 3 HEAT:NG INSPECTING APPROVALS RF' ROVAL: 744-. j 2 2 oll WORK S"SAL_ N PROCEED UNTIL tHE PERMIT WILL BECOME.NULL AND VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS C, NSPECTOR =!AS.APPROVED-TL+E VARICUS WORK IS NOT STARTED WITHIN,SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPW STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. L r� \ h 0 \ ., 172.00' L0 - c- Q s N � 0 c�Q 6 N_0 r (D X 13- O \ N , \ N� 6 1. 6 0 co LOT 9 ,,fi r co o ti R=52.50' io EASEMENT 10 I75.00 - 7.0. 821 { LOT 8 I cer.-t;i*f.y t;h-at t-he f-.0-undation I CERTIFY THAT THE" HOUSE is loca.te.d on the lot as shown . IS LOCATED IN FLOOD PLAIN and that its location conforms ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP to the minimum setback requirements COMMUNITY PANEL NO.250001- of the Barnstable Zoning Bylaw . 0015BAND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL i FLOOD HAZARD AREA. � Date Registered 66hd,6urveyor r Registered Professional Land Surveyor PLOT PLAN IP olmas and n, cgra9h inc. civil engineers and land surveyors POLCARO CONSTRUCTION CO, INC. LOT9 DOGWOOD LANE 200main street COTUIT BARNSTABLE , MASS Falmouth, ma. 02540 Scale : 1= 50 Date: SEPT/j1985 Dra.,jn: B. Y. Ch ck JOB N° 85467 DWG N2A1516 ox Assessor's. map and lot n ..... 4 umbee ftre..... ........... O 1 0 K SEPTIC SYSTEM MUS 7HE Sewage Permit- number ........ ........................ INSTALLED IN COMPL WITH TITLE 5 1 33ARNSTAILE, House number ...........:i.; .. ....... ................................ ENVIRONMENTAL CO D 199. '"WN RFOULATI N Ar. TOWN OF BARNSTABLE BUILDING - INSPECTOR APPLICATION FOR PERMIT TO .......&11.a............................................................................................... TYPE, OF CONSTRUCTION ... ............................................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ........64-S.0t .........4.06,W004......kz.f... Vt...................COIT-4?�-T.................. Proposed Use ...... )P: K 1.4...) ......... .....Zoning District A_1f#­***k..)Pr...........................................Fire District .............................................................................. Name 0 wner ..........R.1VA0..W..SXj......................Address ........CHArA�.Ai.... ... ............. Name of Builder .....r,,0.447- A -ro . . ... ...... .....Address ... .....4..... .... /V........!�e.......... Nameof Architect ................A114.................................Address ............................. ...................................................... Number of Rooms .....................6 .............................................Fapdation .......&....... ...... Exterior .......... Roofing6 .........T)..M.40, Floors .............O.&K..........................................................Interior .......... ......................................... �E Name o*wWner .. Heating ....01.�..7... 0.T...Wit .............Plumbing .... ......Al rlA...... ............. 0A...L C, Fireplace ............. ......<.......................................Approximate Cost ............... tm...................... . .... - ? Definitive Plan Approved by Planning Board _L4, ----- 19 Area ....4_4 .......I.......... Diagram of Lot and Building with Dimensions Fee ......... ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree,to conform to all the Rules and Regulations of he Town at Barnstable regarding.the above construction. 4P'0 OL Name .. ... ......... ................ .. .. .. . .. ........... Construction Supervisor's License RUDOWSK.I, RUTH N ..285....... .... Permit for ...11...Story............... Sin le ......................Dwellin .. . .. ...... .... . . Location ........... Cotuit ................................................................. ............. Owner .......I-Ruth........Ru d..o.......w s k.i............................. ........ . Type of Construction .....F.KaMP........................... ............................................................... Plot ........................... Lot ................................ October !21, 85 Permit Granted ........................................Tq Date of, Inspection ....................................19 Date Completed ........ 19 r 'V n > M (V >. 0 MC' IM C) 4 t:; - n r e-0 Assessor's map and lot number ..... '- .............. I E TO Sewage Permit number ....... ....4,f,.... ... ... .. ... .... .. .. ....... BARNSTAMLE. House number ......... MASIL t639- TOWN OF. BARNSTABLE • BUILDING INSPECTOR . APPLICATION FOR PERMIT TO ...... ............................................................................................... TYPE OF CONSTRUCTION ... .......................................................................... .W. ......... 711 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .../,4U.-Of....... .........4.06,WOOW......1-AViK ...................... .7a/T.................. Proposed Use ... .........ka." JAJ511c.&....................................................... Zoning District .... .R..jPr...........................................Fire District ................................................................?.............. '0 Name of ,District .......... ......................Address ........ A,0 ........... ..... A............. Name of Builder .... ........Address ......... ...... ...... Nameof Architect ................ .................................Address ..................................................................................... Number of Rooms .....................& 1 0:0.............................................Foundation &....... ...0.... xiei-ior ......... 00 1 a.....N. Rk... -,Af*Roofing ......... Floors ............0A.K..........................................................Interior .......... ................................. 4 A.Ti�, .............Plumbing ....i�.. 401 " Heating ....0.14.�... .... ... ..7A4...... ................... Fireplace .............16A,L C +51�'........................................Approximate Cost ............................. Definitive Plan Approved by Planning Board s ------19? Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS, I hereby agree to conform to all the Rules and Regulations of the Town 84',,13arnstable regarding the above construction. Pot e-,,4AO Cio Name .. ... ......... .............. ..... .... . . .. . ........ Construction Supervisor's License j RUDOWSKI, RUTH No ..28572.... Permit for ...1.z...StorY................ Single...F.amil Dwellin..... . ......... .... ..........5................... Location .,Lotd &q&vQq4..Lane,..._...... Cotuit ............................................................................... Owner ....Ruth Rudowski Type of Construction ... rame F.ram.e............................. ................................................................................ Plot ............................ Lot ............................... October 21, Permit Granted 19 85 Date of Inspection ....................................19 Date Completed ......................................19 30 l 2- 27 1 r r p Finish grade above and adjacent shall slope a min.of 2%oway from system t L 0 T 8 \ 4"diom. cost iron or Schedule 40PVC pipe (tight joints). LOT I PL. BK. 282 PG 27 Stoke. 20 min.distance ( building to edge of leaching system ) 269.19- Stoke R6 IO'min.dist. / e 4 4 L O T 9 0 ' Access ,of finish grade. set 54, 328 t /IS. IF N First Floor Elev.=50.50 hin 12 �.. Fin i s h r o d e �� - - \ 'LOT. / a 7 o° � 12��mox. - 0 S=0.02 - - Removable covers b -o`'• - RemovoV i S=O. 2' ~ 130'± O topose cP- 5 02 cover I+ Clean back N level •,•p Li uid level 2"loyerof I/8"to I/2'. � I` � %0 �p 50' x_ a o°000•• washed stone. — ►- Got A- 2 i1 n o ; o,Od . o a 0 0 0 0 0 s u oao/ N Z Test ND , rn: \Q , /'S \O OOp�iC SANK N — DIST. Q c t 0 0 0 0 0 0 0 0' o•J N W Hole oY C1 ,- Ep' � tL N BOX N c�! • o 0 0 0 0 0 •c o Y W OtweW 2 \\ $ 'aul aeeQ SEPTIC TANK : '� N ct° V ` _ — Effective °° '.o m to 62 Q `�� d�00. P�� / 1000 GAL. — q -q IT dam' 0 6 Depth a° L a � w _ 9 N ° a _ W SERVE" .i \ Zfi:o� s take a9- C/ y y p— ° 00 cb Precost concrete tao x )2 yd. f Foundation c' ' > a S.o° LEACHING PIT �u ° 20 Elev. F- I Design - - - O I By others 2ft.- -6ft.diameter —+ 2ft,� J 4 Wo>jer I \5`��� �{�►`v�" PROF I LE 21 vave DESIGN . CRITERIA 2 ft.of3/Alto II/2"woshedstone 4.6' Not to scale all around precast pit providing an - �'t8 el i I - • N P effective diameter of 10 ft. t EL- 33 4 00 NUMBER OF BEDROOMS 3 (equivalent to 330 gals/day). Bottom of test hole O GARBAGE DISPOSAL UNIT N0 N E ►- / O OD /` . BENCH MAR K LEACHING AREA-CAPACITY REQUIRED 330 galls/day- GENERAL NOTES Stake G Hydrant spindle SIDE AREA PROPOSED 188 Sq. Ft. I )NOCHANGE TO THIS SYSTEM SHALL BE MADE UNLESS Elev.=5Q100(assigned) BOTTOM AREA -PROPOSED 78 Sq. Ft. APPROVED IN WRITING BY.HOLMES and McGRATH, INC. s 2-)SUBJECT TO INSPECTION DURING CONSTRUCTION BY TOTAL, AREA PROPOSED 266 Sq. Ft. x; . THE BOARD OF HEALTH AND HOLMES and McGRATH,INC. PROPOSED LEACHING CAPACITY 548 gals/day r 31 HEAVY CONSTRUCTION EQUIPMENT SHALL NOT TRAVEL OVER DISPOSAL SYSTEWDUR1;NG OR:/ FTER CONSTRUCTION. WATER SUPPLY TOWN SYSTEM 4) DISPOSAL SYSTEM TO'BE-COIF RUCTED IN WITH TITLE 5 OF THE s>A�E ivvIRONMENTAL CODE. PRECAST CONCRETE UNITS H-10 LOADING DESIGN. 5)A COPY OF THESE PLANSMU-ST BEKEPT ON THE SITE BENCHMARK: HYDRANT SPINDLE EL=50.00(Assigned) . DURING THE TIME OF CONSTRUCTION . 6)A COPY OF THESE PLANS MUST BE FURNISHED TO THE -'� CONTRACTOR CONSTRUCTING THE DISPOSAL SYSTEM. SOIL LOG 7) BEFORE BACKFI LLI NG,TH E CONTRACTOR SHALL NOTIFY HOLMES and McGRATH ,INC OR THE BOARD OF HEALTH N° I Ns 2 AGENT TO INSPECT THE SYSTEM AS CONSTRUCTOR. s Depth So ils • Elev. Depth Soils Elev. 8) FLOOD PLAIN HAZARD ZONE C n b Checked b 45.4 9) ZONING DISTRICT R F DATE DESCRIPTION Draw y Y LOA M, 10) THE NORTH ARROW IS DERIVED FROM RECORDED FLANS REVISIONS SUBSOIL • OR DEEDS. THE NORTH ARROW SHALL NOT BE USED FOR ORIENTATION FOR SOLAR HEATING PURPOSES. HOUSE PLOT PLANsi 9 ) 43.9 11) SOIL TEST APPLICATION # P 3341 ' i N° OF PROPOSED SEWAGE DISPOSAL SYSTEM �� �•-- --� ,a,°4` < I. 5 5 FOR POLCARO CONSTRUCTION CO. INC. f cS' P.00ERT ~t% Clean SOIL TEST TITLE REFERENCE; LOT 9 DOGWOOD LANE " 1� :` rnedfurfi COTUIT B�IRNSTABLE , MASS >#r'0 ' ,k~' ' Sad DATE OF SOIL TEST_-- MAY 16. _1984. ��. avel . L.C. Pet. Plan 3 66 B SCALE: I 50 DATE: DULY 9, 1985il�\ Gr !� b TEST TAKEN BY D. THU L I N holmes and mcgrath, inc. RESULTS WITNESSED BY G I F FO R D ` civil engineers and land surveyors f nr��; � NCH. 200 main street Checked Cl vl Ectnrf,E PERCOLATION RATE_2_ MIN./I J folmouth, ma. 02540 0 0 GROUND WATER NOT ENCOUNTERED- ASSESSORS MAPe 25-55- t�" ' 548- 3564 Drawn by R.S.J. JOB N- 85335 DWG N- A I5 6 SHEET I OF 2 All outlet pipes from the distribution box �- shall be set Level for at least 2'from the box. OUTLET KNOCKOUTS ALTERNATE ALTERNATE N`LET OUTLET INLET+ OUTLET ; p 2-6" { ! _ OUTLET II KNOCKOUTS INLET ; OUTLET PLAN \ 5 -3 'CIE i I 4 -10„ -- - _ 2,-6., Conc. Cover PLAN I I All access manhole covers for septic tank, I distribution box and/or leochinp system a- �-� shall have covers set within 12'of finish Mo �' A LTE RNATE ";INLET .ALTERNATEgrade or as directed by the inspect inq23 OUTLET authority. NLET -►•- OOO STEEL REINFORCED PRECAST CONCRETE Metal from &cover or �2"min. OUTLET - precast concrete cover. a.` 6"min. ��. 4 OUTLET KNOCKOUTS o ,a 9 -0 -{- Precast concrete riser, 6" 8 -6" 6" concrete block or SECTION ELEVATION brick masonry. 3" 3.' {�= = TYPICAL PRECAST CONCRETE DISTRIBUTION BOX Removable covers �6 _ o , SCALE . l/2" I'-O" 3��min.clearance required ..'� T INLET INLET -... 8 2 min.inlet fo outlet. 6 min. 13 Tee - --� OUTLET Liquid level- -14" 10 min. _ - - - min.. 6r O„ rt - 5-7 - _ DATE DESCRIPT10 N Drawn by Checked by i 4=0 4-0 min: min. REV I S ION S PLOT PLAN - DETAIL SHEET ' OF PROPOSED SEWAGE DISPOSAL SYSTEM" j� of .�3„ FOR POLCAROCONSTRUCTION CO.INC. o�� ROBER -IF LOT 9 WOOD 00 D LANE ELEVATION SECTION CROSS SECTION COTU.IT BARNSTABLE, MASS. 5UR N TYPICAL 1000 GALLON 'SEPTIC .TANK/" H-10 LOADING ' SCALE: as shown DATE: JULY 9, 1985 IL55 holmes and mcgrat h,inc. _ c�sTE��`' SCALE: 3/8" = 1'-d' civil engineers and land surveyors - FssiON 200 main street NOTE : DENOTES DIMENSION OF H -20 LOADING DESIGN falmouth,ma.02540 Checked b �___ . I1 548-3564 IDrown by R.S.J. JOB 42 5 DWU.N° SHEET 2 OF 2